The Sports Physical Therapy Podcast
The Sports Physical Therapy Podcast
Integrating Performance Training and Physical Therapy with Dan Lorenz - Episode 27
Full show notes: https://mikereinold.com/integrating-performance-training-and-physical-therapy-with-dan-lorenz
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On this episode of the sports physical therapy podcast, I'm joined by Dan Lorens. Dan's the director of sports medicine at Lawrence Memorial hospital in ortho, Kansas in Lawrence, Kansas, and also teaches for his con ed company. Ortho athletic education does an expert at many things but one area that he's really passionate about is strength and conditioning and how that relates to late stage rehab and return to play we talk about that and an update on how we're using bfr in our practice all in this episode
Mike:Hey, Dan, welcome to the podcast. Thanks so much for joining us today,
Dan:Mr. President, great to be here, man.
Mike:Wow. that still, that still felt weird,
Dan:Yeah. Good to see you, Mike. How are you man?
Mike:I'm doing great. You know, and appreciate you taking time doing this. Um, you know, for those listening that don't understand, I mean, this is like six 30 in the morning right now for Dan before work. Um, but this is, you know, the, the type of character that Dan is that, you know, is always willing to share and all that great stuff that he does online. So, um, really appreciate you taking time outta your, your personal day to, to join us this morning.
Dan:Mike, thank you for asking me. I really appreciate it. You got a lot of great people that have been on here already, and I know you have a lot of other people you could have asked, so.
Mike:No, no, this is, I, I've been waiting for this one for a while. I wanted to make sure we had some time to do this. Um, there's, there's so many things that we can talk about. So Dan and I are friends, we've known each other for, for a bunch of years now. Um, and, you know, we geek out about some things online and, and through text messages and stuff when we see each other in person. But, um, I what I think what I wanted to focus on for the, the, the sake of the podcast for now is this background that you have in this area that I know you're super passionate about and you've been building out on the later stages of rehab and even performance training to an extent too. Right? Um, you, uh, you're, you know, the past, uh, sig leader, um, in the sports academy of the a pta, the American, uh, Academy of Sports Physical Therapy. You were the sig leader for the sports performance sig. Um, did you start that sig by the.
Dan:I did. Yeah.
Mike:Nice. So you were the, the founder, right? We'll call that, We'll call you the, the, the, the originator of that sig. So, you know, I know you've always been interested in this sort of thing. Um, for me, this is an area that I see so many PTs struggle and I know that so many of the students that we have coming through our place at Champion. Have so many questions about why do you think we're at a point right now in physical therapy where the later stages of rehab in, in training in general just seems so daunting to so many people?
Dan:Uh, I would say that I think the biggest problem there is that in school we, we just don't get it. They. As generalists, you know, you have to, you have to treat everything when they're trying to prepare you for being an acute therapist or work peds or general ortho. And, and I do believe that part of the later stage, uh, stuff is, uh, is something I have to acquire either on your own or through continuing ed. Uh, you know, I think part of it is that we don't, um, it's so highly specialized, uh, at, at that later, those terminal phases, and so we just don't get it. I think in.
Mike:Yeah. And I, I think that makes sense, right? And I don't think that's necessarily a slight towards school. I know you're not saying that. I know we don't think that way. There's just so much that a PT student needs to learn. Um, so I don't, I mean, so what, what do you recommend then? So when you have people asking for advice, maybe they're already. In PT school right now, and they're saying, Wow, my curriculum just doesn't have enough of strength and conditioning principles or, or, or high level late orthopedic sports type type rehab things. Where do you tell people to get started? Like what do you, what do you recommend they do?
Dan:I think studying for the CSCs exam, you don't necessarily have to take it, but I mean, studying for it isn't a bad idea cuz you'll get at least some foundational knowledge, uh, about those concepts and principles. I think. Even being an NSCA member, I mean, they have a couple different articles, or excuse me, a couple different journals. We get a lot of, they have some really good information in those. There's tons of strength conditioning courses out there. I think, uh, you know, even hanging out in a local weight room, like a uni, like maybe a community college or, you know, if you have access to a university where you could just volunteer and, uh, put, put some time in here and they're like, I. Uh, you know, to loading weights or wiping chalk off bars or whatever, just to, just to pick up some things. I think those are probably some of the better ways to do it. There's a lot of good con, I mean, heck, the, the Academy has the sports performance enhancement sig, so you get some good information there, especially with the mobilized platform and things. So just through engagement of people that are already doing it.
Mike:I like that. So, so let's do this. Walk me through your history then, because I think you started to elude it a little bit, but you know what, You're in PT school, right? Obviously you have a, um, almost like a personal, uh, uh, area that you want to pursue here with strength and conditioning. You know, you enjoy that sort of stuff yourself, you train yourself. Um, what did you do to put yourself here to, to really grasp this, this concept?
Dan:You know, how many people do you know in sports pt, uh, went into this because they played sports and they got an injury themselves, right? So that, that happened with me. You know, I, um, I broke my leg in high school playing football and wanted be a PT from, from there on. Well, same thing with the strength editioning piece. Uh, I started power lifting in seventh grade, um, and uh, really just kind of became a gym rat from. And in early, like undergrad and things like that, I was going to a lot of strength conditioning courses. Uh, I spent a lot of time just, uh, uh, again, like just kind of volunteering and, and shadowing and in some different weight rooms at the collegiate setting. So I, I learned a lot there. And, uh, like I said, it's just always been an interest area of mine and, and, uh, the fact that you can kind of merge PT and strengthen dishing in those later phases, it's just, it's served me well, cuz I, I really did understand those concepts of loading and progressing exercises and, and, uh, regressing and lateralizing exercises, those kinds of things. So it, I think that's probably what got me to this point.
Mike:And I like the way you, you said you put yourself out there a little bit, right? And it's really, really hard. You, you, you mentioned two things and um, I really like these two points. One was, you know, the CSCs was essentially in, in, even if you don't take the test, but you might as well take the test, but, um, is understanding the concepts of strength and condit. Right. So that's almost, that's the textbook, that's the classroom style, right? That's that's learning the principles and the physiology of strength and conditioning. I think that's a great start, and what I like about that is you could do that very asynchronously, right? You can wake up early in school and read a chapter a day. Right. If you really wanted to or you know, do that in between classes, right? You can, You can take time to asynchronously, asynchronously, start learning the concept of drinking conditioning. But then what you did though is you did the practical application too. And I think that's the hard part that sometimes students don't realize right now is that it's not just about reading, it's and understanding thing and even watching. You know, social media, YouTube, reading people's blogs. It's also about applying it. So I like how you went out there and you volunteered. Um, where did you go? Did you say, Was it college high school? Like what, what, how'd that go about? Like how did you know people? Like how'd you get your, your feet in the door there?
Dan:Uh, asking questions, like, Hey, I'm really interested in this. Like, I may went to a guy's course. Um, or some somebody's course and just said, Hey, uh, you know, I really like this aspect of things. You know, sometime in the summer when I'm back, can I come up like an hour, uh, an hour or two on a certain day of the week and just make it throughout the summer and, and hang out a little bit and just observe. And like I said, I, I can be a runner for some things. I just, I just wanna learn, you know, and, and showing that passion. So there was a few universities back home in Illinois. Spend some time with. And um, again, you just do a few hours here and there over the course of a couple years during the summer, you accumulate a lot of knowledge, you know, So I think that helped me out a lot. No question.
Mike:Yeah, and I wonder too, if I was in your shoes back then and I wanted to get specialized in one specific area, I think what you could do now is you could reach out to some local universities that are near you and maybe let's say for example, my case, just reach out to the strength coach that's in charge of baseball and say, Hey, I want to come help. I wanna come volunteer, be your assistant, um, you know, just be an extra set of hands in the weight room. Um, and then, like you said, it's only a few hours a week, right? Because that's all that, you know, baseball gets access to the weight room at a lot of universities, right? But you can really be nice and, and and strict with that and also develop a relationship with. The train coach, the team, probably everybody else over time, like I, I, I think that's, that's one area that I think people don't understand is you can, you can get very specific with who you want to try to volunteer with as well.
Dan:You can, and, and like, you know, it's all about relationships, Mike, you know, they gotta know you. They gotta like, and they gotta trust you, right? And you just, those things take time to build. And, um, I. I always, I get this question a lot. I spoke in a meeting not too long ago. I had a couple students ask me, and I'm like, you know, I, I always encourage students, or if you're trying to get into this, a lot of times, you know, PT students or early, early professional PTs always like going into those environments and kind of showing off what they know. And it's like, remember you're going in their turf. You know, uh uh, you gotta, you know, can kinda keep your mouth shut and your ears open. You know, like, uh, you're there to learn. You're there to absorb, and you're the one that has to be there. They didn't ask you necessarily. Right. So, I think it's important that you have some humility when you go to those environments that you don't know everything. You might learn a thing or two, you might see some things you don't like, but you kind of put those in the catalog just, well, I wouldn't do that. Right. Um, you know, but also, again, I think athletic trainers too. That helped me out a lot. I was an undergrad athletic trainer. I learned a. From our athletic training colleagues and I got'em dual credentialed. And um, I know there's always been a turf war, unfortunately, between those two professions, you know, for a long time now. Uh, there's, there's definitely a responsibility on both sides to be shared there, but, uh, I learned a lot, you know, in the late stage stuff. Cause again, they, they just do, do it better I think in some capacities,
Mike:That's actually a really good point too is, is is volunteering a little bit with athletic training staff too. Cuz you're right cuz they do a lot of that in-house, late stage rehab themselves too. Um, it's not just the strength and conditioning room. I like that.
Dan:And they're, and then they're twice understaffed. Like, show me an athletic training staff that's fully staffed where they're not overburdened with, uh, having to cover multiple sports or, you know, uh, or, or just too many athletes for the amount of hands they have. I mean, they, they love to help, you know, So, uh, I, I think that's a, that's an excellent way, uh, to kind of work yourself into.
Mike:Yeah, I'm, I'm really glad you brought up that concept too, about going in there and not trying to impress people. Um, Right. And I, I think sometimes, you know, it depends on your personality, right? But sometimes people go in there and their way of impressing people is to try to get you to think that they know a lot, right? When that's not. Really the path to impressing like a strength coach that's been doing it for 20 years, and you're in PT school right now, you're gonna impress us by putting your head down and grinding, right?
Dan:Exactly.
Mike:get you, get dirt, get your hands dirty, get on the floor, get out there and coach, and get out there and be a good member of the team, right? It's not about what you. Not about showing everybody, you know, that's not how you're gonna get a job, you know, if it's two people there and, and one's the, the one's always trying to show everyone how smart they are and the other one's that just puts their head down and works. Um, that's probably the person that's gonna get that, that job when there's an opening in the future. Right.
Dan:No question.
Mike:Yeah. So, alright. So here's what I was thinking while you were telling me this story a little bit. So walk me through, you've been power lifting since middle school, you said, right? So, which is, which is awesome. What's your, what's your deadlift pr by the way, We'll get off topic for a second.
Dan:Oh man. Oh gosh. Uh, that's a long time ago, Mike. I, I don't, gosh, I don't even remember. I, I haven't done it. I, I mean, I still, I still deadlift heavy. Um, but oh my gosh. Uh, this is probably early college. I was around, I wanna say 4 85, 500, I think,
Mike:Adam boy, and what, what's heavy now? Cause now you're, you're old, right? You're an old guy, but, Right.
Dan:Yeah. Old with old, with wearing an unloader brace on one knee, cuz like, I've had four operations and yeah. Uh, no, I usually, uh, I still do sets of four to five, you know, just
Mike:good for you.
Dan:think it's, I think it's good for us to pick up heavy things every now and then just for.
Mike:Yeah.
Dan:you're gonna have to do it eventually, at some point in your day to day life, picking up a heavy box of Christmas lights or something here pretty soon. So it's good that you've, It's good that you've been there before, right?
Mike:What kind of Christmas lights do you guys have at the Loren's house? That's so heavy. No, I I I love that. So here's what I was thinking when you were telling me about that. So how, what was going through your head when you were an ortho class in school, like sophomore year at college and you're doing like, There had been exercises with people like, what, what, what was going through your head as somebody that was comfortable in the weight room that knows how to load people and just, just sees like the complete lack of loading that sometimes happens in pt. What, what was going through your head?
Dan:I tell you what, I had some sympathy for my colleagues in class that were just feverishly writing notes on some of this stuff. And having been a student athletic trainer, I had already been exposed to a lot of it. That really, really helped. I mean, I, I really, that part of PT school I sailed through because I really understood those concepts very, very well. Um, I think. I think some of it with the why, why so many therapists struggle is just, there's just, I think they, they put this fear in the back of your head that if you put another plate on the bar or another couple stacks in the leg press that the ACL's just gonna explode or something. Or you know that, you know that that total knee that you just had, I mean, you're just gonna ruin it if you go, If you go a little too heavy, like I'm not certainly advocating to be reckless, but on the flip side, I think they just put this fear like, you know, protect the healing, protect the healing. And you know, uh, all those, all those things they say, you know, don't do, don't do squats with the knee over the toes because of compression. Don't open chain knee extension cuz of compressive forces of patella for oral joint. They're so high and people freak out and they never do those things. You know what I mean? Like I, there's just this irrational fear that I, I think that I was noticing that people had. So having, uh, that, that strength editioning background, uh, You, you just learn. You, you, you know it. The easy stuff, the early phase stuff is easy, and I think most people just hit a roadblock and having the later stage stuff just made my programs, uh, more comprehensive and, and well round.
Mike:That's awesome. And, and I I what we try to teach our students here when we have these discussions, cuz they'll come in with the same thing and be like, well, you know, everybody on Instagram now they're, they're, you know, they're debating knees over toes or open connection knee extension. And I'm like, You have to understand this knees over, toes open, connection ne all these things, they do increase stress. You have to just, you have to understand it increases stress, but that increase in stress isn't always bad. It isn't always disadvantageous. Sometimes it's actually advantageous, right? So it's, you try to like tell people, don't get caught up in, you know, these false conflicts online that are, you know, just attention draws and just understand it's the same thing. Do. Throw weight a ball as a baseball player. Okay, go nuts. It's more stressful, but we just have to talk about how to apply that stress as as best as we can. Right? And and you're right. The PT world was just full of fear and it was just like, if you do this, your knee's gonna explode. If that knee goes over your toe just one centimeter, the surgery's gonna fail. Right? you're just
Dan:there is man,
Mike:you
Dan:there is.
Mike:It's crazy, but you just draw a graph like, look, here's stress over range emotion. You see like, sure. When your knee goes over your toe, does the stress go up a little bit. Sure. But you know the world's not gonna end. Right. And, And that's a good way of doing it. But do you think you were comfortable because you yourself had a training age at that time, you were comfortable in the gym, you've moved weights, right? You've had loads on your own body. Do you think that was a big part of why you, you felt that you were more comfortable doing these sorts of.
Dan:That's a good question. Um, I think I maybe, uh, I think I just had a, a good idea of periodization and progression. I grew up, you know, I start, when I got started, you know, we would, you know, this is an early high school or, or as I was beginning my training, like we, we, the workout would be on the board and, you know, we'd have a set of 10, a set of eight, two sets of six, and maybe a set of four. And you went up a little bit each time. And it was all based on technique and form and, uh, Gosh, Mike, that's a, that's a good thought. Probably. Probably, yeah. I'd say yeah, probably just a comfort level with, again, I've watched people lift and I, I could, I could pick up technique or if you were unloading one side or shifting your weight or those kind of things. Like I just had a, a keen eye for it, I think, and that helped out a lot.
Mike:And you had experience. So not only did you do that yourself and felt it, but you also did it with all your teammates and your friends probably in high school, and none of them blew out their knees by adding a plate or by going a centimeter past their toes. Right. You know, like, so I think, I think you saw, like when you, when you get to um, you know, maybe being a little bit too conservative at times you're like, Well wait a minute, I've been doing this for years and you know, my knee's fine. Right? Like, you know, like that's gotta be part.
Dan:I think this circles back to the original or the first question you asked today about, you know, PT school stuff. Cuz remember sometimes load for our patients is sitting up in bed and they teach you that stuff. You know, again, they're trying to teach, teach you in school to take care of traumatic brain injury, acute care where people have been, you know, bedridden for weeks. And like I said, sitting up and going to the, uh, going to the bathroom, walking 10 feet is like a maximal attempt for them. So I think they're more worried. That you'll get that late stage ACL stuff down the road. We gotta worry about getting people home and you know, living independently again. And I, I think a lot of time is spent on that stuff and not so much on the, you know, the later stage.
Mike:Right. Yeah. And, and I, I, I, I didn't mean to come across earlier as pooping on yellow theand, by the
Dan:No, no, no, no, no. I didn't take it that way at all. And nobody else should either. Nobody else should either. No, no. I don't think that's it at all. But it's, But what it is, is, is not, um, the yellow TheraBand is that, you know, don't, when you write down, you know, external rotation and you just write a check mark in all your treatment logs, like, did you change the reps? Did you change the load? Did you change rest, period. That's the piece. I think that where a lot of therapists struggle, um, it, yeah, that's the part for.
Mike:I, All right, so I, I'm gonna try to summarize what we talked about so far, because I actually think this has turned out to be a really cool, uh, episode for people looking to get into this. So let's, let's go through it. Step one, I think you're a PT student or even a, an early career professional that's just starting to think about these things. I think step one is get book smart. Right. I like that. It's easy to do. You can do it in your own time. Grab the CSCs book, start studying for the test. You might as well write and become book smart, but all of that is useless if you don't apply it. So you gotta get your foot in the door somewhere. Either volunteer, uh, go to a local university. Now there are so many private facilities like mine that are out there that you can, you can come. We have strength and conditioning internship. At Champion where we designed it for future strength coaches, right? And exercise FS students to come. And I will say half of our people tend to be PT students or new grads that are just wanna learn and immerse themselves for three months a semester as a coach on the floor. So you learn somebody's system, but then you're also out there performing and you're doing it. So you gotta get, so get book. Get in the weight room somehow where you can do this. And then I do think you gotta, you gotta go through these programs yourself a little bit. And I don't think that's mandatory. Not everybody can, right? Some people don't have the physical abilities to do that, but do as much as you can so that way you can experience it a little bit. If, if you have the ability, I think that will do wonders for your understanding of some of those things. Right. Um, what do you think was, was that a, was that a, was that a cool summary?
Dan:great summary. A hundred.
Mike:I, I thought that, I thought, I think, I just think that is a, that's a really good roadmap for, for somebody to follow and, and, and, and I think you're gonna be a much, much better PT because of it.
Dan:And you have to train somebody. You know, I, I, I talk a lot of times with students about, Oh, should I take this CSCs? Like, well, You'll study for it and probably pass it. I think you have a lot more knowledge than, uh, from PT school and stuff to, to study for a little and take that test. I mean, there are probably some gym based thing, like, you know, gym design stuff that you might struggle with, but I, I would say you might have the css, but can you really train anybody? Can you, You know, So that's why I said, take your 14 year old kid that you're seeing for Tendonopathy and get him on a, you know, good like total body strengthening. Teach'em how to hinge, teach'em how to squat. You know, can, can you coach the hinge, Can you coach the squat? You know, like those are fundamental. Foundational concepts that we should know how to do. And the bottom line is, it's kind of our job because somebody in a few years, when that kid gets to high school, somebody's gonna put a bar in that kid's back or put'em underneath a bench and they're, they're not gonna have any foundation. And we have a tremendous opportunity to do that. Like I said, you can almost use, in a sense, you can kind of use your, you use your patience as, as lab rats in a way to kind of tinker with progressions and loading and, and actually training someone.
Mike:Right. Right. I love that. And I, I would still say at this point in this person's career, right, you're, I think you're still technically a technician with all this sort of things where you're still just bringing people through the paces with, with what you understand. You haven't evolved yet to be a coach until you have some experience underneath your belt working with people where you can say, Oh, if this happens, I'm gonna pivot this way. Uh, I'm gonna regress this, I'm gonna lateralize this, I'm gonna progress this. Um, to me that's coaching and. Coachings also the ability to connect with the person, right? When we get into some soft skills, now that's a, that's a whole nother podcast conversation, right?
Dan:yeah, it is for sure. It.
Mike:there's, there's, there's so much that goes into it. It's more than just just knowing. So you get book smarts, you got technical smarts, and then to me, I think you get those, you know, to be a great coach, you have to be able to connect with people in and understand when to pivot. I think that's, that's, that's important too.
Dan:No question. Yeah. And, and that the soft skills piece, I mean, you can work on it, but sometimes as they say, it's hard to make a zebra change its stripes. So, know, uh, you know that Mike, Mike, you know that there's people that, you know, you went to PT school with that, you know, maybe they were, you know, had the. Had a 7.0 gpa, but you know, they couldn't talk to a doorknob, so it's like, but, but there's, and there's other people. Let's face it, there's other people that may not have been the, the, the bookish type or the real book smart types, but man, they could, they could work a room and they knew people. And I would take, again, having been a private practice owner, I would take the, the ladder any day, uh, the people skill piece because I can teach you how to progress and load. But if, if people don't like you, if you're just not a warm, engaging person, good.
Mike:I like it. So. Alright. How does a sports pt or even, you know, northo pt, I guess too, um, how do they apply these concepts to the later stages of rehab and returning somebody to sport? Right. Cause I think this is an area we, we, um, we need to get better at in physical therapy. Again, don't get me wrong, I think sometimes we blame ourselves a little bit, but you just talked about you get an 18 year old kid that just toured their ACL playing football that's never lifted a weight before in his life. I'm pretty sure at six months he's gonna be weak because he was weak at zero months or he was weak at negative one months. Right. Like I, I, I think that's part of it too, but like, how do you take these concepts and how do you apply'em to the later stages of.
Dan:Well, first off, I think it's, it's screening for appropriateness like is. Done. And whenever I teach, anybody that's heard me speak before, one of the concepts I I always start with, uh, when I teach is, is rehab done? Um, because obviously when we got people going back with 65% quad strength or. Or what have you that rehab's not done. So I think starting there, I think you, they have to have requisite the requisite mobility and exercise technique to do what you want'em to do. Like you might want'em to do a back squat, you know, or a front squat. But do they even have the technique? Like, that's why I said the co familiarizing yourself with these basic concepts. Uh, cuz again, my, my programs are, are painfully boring. We, we push, we pull.
Mike:right, right.
Dan:and can you, can you, can you teach a front squat? Do you know what a good front squat looks like? Do you know why? If it does, does, If it doesn't look right, why does it not look right? So I, I think starting there and then, um, Uh, from the progression standpoint, it, it's like anything else. I mean, I, I think this is where that the whole periodization idea comes in a little bit. You know, you gotta get a foundation first, and then you continue to build, build strength, and then eventually you start to, um, move, move lighter things fast, right? Appropriate. And then, then you work on speed towards the end. So, um, I, That's where you gotta start. I can start with the basics. Do they, Is rehab done and then. Whatever, basically, whatever. As I've said this before too, like whatever factor is contributing to their lack of power, that's what you have to focus on. And it might be an ankle doors of flexion restriction. They can't squat because of it, so if they can't squat, they can't get their legs strong and then they therefore can't work on explosiveness. So that's your job is to pick up the impairment that's limiting their ability to be powerful.
Mike:Right. And when in doubt, just start getting them strong. And I think things will, will start to click over time is you, you have to be able to load, You have to be able to increase that, that over time. And then, then I think things will appear right. I think, you know, if this is your first ACL that you're working with, past six months, you're working on their strength, you're trying to get'em going, I, I think you're gonna notice. Oh wow. They're agility, they're running mechanics, those sorts of things. They're all gonna improve as strength improves. Right? It's almost a limiting factor.
Dan:I'll give you an example real quick. This literally happened Friday, so I have a, uh, we have a, we have a residency program now, sports BT residency, and I was, uh, kind of mentoring with my resident and we had a patient, she's a college basketball player and really no training history coming in. And we, we started trap bar deadlift the other day. She's, uh, kind of a later stage acl and, um, you know, I, I had her, uh, I think she had like probably one 15 on the. And I said, because we were still trying to establish a load for her, and she did six, like six reps, and I said, zero to 10 on difficulty scale, like 10. And she saw it was about an eight and it didn't look like our heart rate got past resting. And I'm, and I said, Yeah. I said, We're gonna go, we're gonna go up, we're gonna go up 20 pounds. Uh, so we went up, we went up 20 pounds, so roughly 20% for where she was at. And we did it again and still didn't look so good. So I, I went up another 20%. And then I felt like I kind of saw that last rep where there was a little bit of strain and I'm like, Okay, we got a good, we got a good, a good weight here. So I, I think part of it too is just, is it's okay to tinker. You might go through five or six sets of dumbbells, or you may have to change weights six or seven times before you find that sweet spot. That truly is where they should be today. Cause I, You don't wanna waste reps. I mean, why would you lift in three weeks, which you can lift.
Mike:And, and I hope everybody noticed right there. So that was, that was Dan being a coach, right? So remember the, what I talked about earlier about technician versus coach, right? So the technician would show somebody how to deadlift, show them, show them the technique, tell'em how to, how to cue it through it and perform the task. The coach within Dan determined that that was not the appropriate load. There wasn't enough intent from the athlete that's next level stuff. And you can't do that without experience, right? You can't do that without reps doing that. So, you know, that's, that's that coaching muscle that you have.
Dan:And that circles back to our discussion earlier about my comfort level, the lifting. Give me a comfort level with this and Yeah, it did. Because you saw when somebody, you know, we used to always say like, Oh man, that was a toy. You gotta put some weight on the bar. You know, like, And then, so for her that weight was a toy. We gotta put some weight on the bar where you see that effort. Or maybe you see that there's, they struggle with that last rep or two, you know, like that. That's a good spot to be. And I think the challenge for us, like I said, is, It's hard to base a lot of our progressions on one RM because those are unhealthy people. Right. So it's effort, scale. I mean, you, I mean, there's a lot of different ways to kind of measure that. You know, when you have somebody with no training history, you gotta kind of read your patient, which is really hard to do, you know? Uh, that that's a, that's a challenge for us. That's why I said, I think with the recovering patient, that first time he put somebody in the leg press, M pfl reconstruction, you know, uh, what, what weight is okay to start with. And, um, I probably, I would say many, many, many therapists, both, uh, uh, new ones and seasoned ones, struggle with this.
Mike:And I think you actually did an amazing job actually teaching that athlete as well. Right? So that was part of that process there is you taught her intent a little bit and what really is an eight outta 10. And you know, I, I, I don't, I, I, I don't, I don't, that doesn't get lost with me is that sometimes with these people, we have to teach them intent. And that's a big component of our strength and conditioning principles that we do at Champion here. Is that a lot of. Kids, right? We do sports performance with kids. Um, one of the things we have to teach them is intent and how that isn't always, um, you know, your, your eight outta 10 effort isn't always what you think it is. So, um, awesome stuff. So, um, alright. So one other question related to this for me in my mind is you have experience with this both as a private practice owner as well as working in big like mega corporations and hospital systems, right? Um, how do you, how do you do these later stages of rehab in this insurance based.
Dan:Oh, good question. Cause that's affecting all of us. Uh, well, a, a couple things. So one, um, I think you have to kind of reverse engineering on how many visits you have and how many you're projecting that you probably are gonna. So typically if I'm running outta visits, uh, I start to space'em out a little bit more. Uh, I provide, I provide a lot of programming, like I write stuff out and give them something to do. And that comes back to coaching again, like when you teach them how to, you know, I write out like, here here's five or six, you know, quad based exercises, and I make sure that they're pro tech, uh, uh, proficient in their technique. So writing out a program is, is definitely one way for. To, but keep it simple. You know, pick, pick four, five exercises that you know they can execute. You gotta find out what resource they have access to. So that's one way. The other one is, is that it's always helpful to have some sort of a step down program. And we had at our, at our, uh, where I'm at now, called Final Hurdle, where rehab was kind of done or the money ran out, but rehab wasn't done. You know, so we, we had a. Uh, we worked with our, our strength coach would, we'd kind of give him a summary and, and he would address, uh, whatever remaining deficits there were. So that'll help for sure, uh, having something like that. Um, but it's one of those things too. Talking to your physicians, talking to the family, letting people know ahead of time, like, you know, day one postop, you might start trying to plan for this. Now we're gonna have to do something late stage. And you might work with people just to just say, Hey look, I got, here's what our, here's what our rates are. I, I can do 30 minutes so that you can do 30 minutes of the one on one time. And then they can work out on their own. You know, they're within your eyesight. You can still supervise, but uh, you know, you can help work with their financial situation. Cause we obviously now in our current state like that, that's a big.
Mike:Right. Yeah, no, I, I think that makes sense. And, um, collaborating. I think sometimes too with, with a nice solid gym that's near you, maybe that have a strength coach
Dan:Forgot to, forgot to mention that.
Mike:Yeah, I mean, just like go out there and spend some time there. Maybe, like, maybe you need to actually go there and spend time there. I think that's important. Like, and actually, you know, talk to those people, um, you know, and, and not just refer people there, but let them become part of your network. Like that would be amazing.
Dan:it is. That, that, that was really one of the main ways I, I built my practices is that there was a, a local gym. He actually got started when I. And I really kind of cold called him, just stop by, said hello, and I'm down the street. And it just evolved into a great relationship. In fact, my son trains there now. So, um, you know, I mean, no, it's, it's, it's great. And, and, but again, bouncing ideas off each other, building a collaborative model, you know, uh, if they don't need to be in therapy and they don't need to be with you, then call that strength coach and say, Look, just don't do these things for the next two, three weeks. Do these things instead. I mean, that, that's how it's.
Mike:Awesome. I love it. That's awesome. All right, one other topic I wanted to hit about real quick with us here. You and I, uh, we put together an online course on blood flow restriction training, which I think is kind of related to this conversation, Right. Um, you know, and how we do that. Um, you know, as a PT that's working in this environment, um, how are you currently using BFR in your. Because I do think a lot of people are thinking this. A lot of people want to go through this and you know how we use bfr, but like what are, what are some of the main reasons why you start whipping out BFR for people?
Dan:I still say for me, the over overwhelming majority, probably 95% or greater, is just quad strengthen atrophy at postop knee. I, I think it's really, really great for that. I particularly like it for, you know, I got a lot of folks right now with car restoration procedures, some that had a, some that had a car restoration procedure and a fulkerson that's like dropping a nuke on the quad. So, I mean, yeah, I mean, it's way worse than any ACL I've ever had. I mean, those, those people, I mean, they're often restricted for 12 weeks from, you know, closed chain loading. So, uh, those are the, are are the folks that are, are still very active but have terrible knees. Like this guy
Mike:right.
Dan:I do it myself. Like it's not shameless self-promotion, but you know, my, I have one knee. It's just trash. It's just trash. So I mean, it really helps those folks out. I do, I don't use it. We've talked about this. I don't use it much in the upper body except for my big athletes that have pec tend and tears, uh, to get that atrophy back or like, you know, I had a, and actually I've been publishing this case study very soon in I js b t about a strong man competitor I had that had a distal biceps rupture. So, uh, I did it with him. Um, you know, I, I can't say, you know, as you know, Mike, there's no studies that really say don't do it, or that it's, you know, uh, I, I'm just. Other than those cases that I suggested, like we've talked before, I don't have a problem getting folks strong or getting strong in the upper body. I think the legs are a little different because of that quad atrophy after surgery. So that, that's the, that's the main reason I'm using it. I'm not using it yet for tendinopathy. We might, down the road, there's been a couple studies to show that it helps with healthy tendons. But you know, I've even talked to the, the tendon experts, you know, at different times. You know, Chris Segger and Jill Cook and asked him about, This and, and they're like, Yeah, I'm not really on board yet with the whole tendinopathy thing and bf r maybe down the road it will be. Um, I think right, right now those are the probably the main ones for me.
Mike:I, I, I feel like I completely agree by the way, it's, it's, it's a no brainer to perform in all these lower extremity things where we struggle to get strength. Um, I just, I, you know, I definitely, I don't, I don't do it much in the upper body. I don't think anybody at Champion does maybe Dan Pope a little bit, um, with some of his athletes, cuz he has different, like, weightlifting type, you know, backgrounds, fitness athletes. Uh, but I think we agree. We, one, I'm not seeing overwhelming benefit, but two, like, I don't know. I don't, I have no problem getting the cuff strong. I don. You know, having to do that is, is hard. I mean, I, you know, we make a living off that. Um, you know, to the Tendonopathy concept. I just wonder if, um, you know, it allows us to load the tendon more, or is it really just that you did an exercise for 75 reps? Right. Which we wouldn't normally do. You know, say you're working on lateral epicondylitis and you're doing some risk extens, Real basic, right? We normally do two to three sets of 10, right? But with bfr we're doing 30, 15. 15, 15 a lot of times, right? That's the standard protocol out there nowadays. Um, is it helpful just because we did 75 reps
Dan:I don't know, man. I, I, I do, I wrestled it because as you know, the two main things that tendons like are tension and load,
Mike:load,
Dan:not doing, you're not doing, you're not doing a whole lot of. And the 10, the tensions there a little, I suppose. Cause it's, you know, the amount of reps you're doing. It's just not my, it's just not my first go-to. I'm not sure what to say. Like it's certainly an option. You know, take Patel pain like there, you know, hip and quad strengthening first. I mean, do you go down the road of, of taping? Well, maybe, but that's like, you know, five, six down the road on my list. That's kind of how I feel right now about tendinopathies and, and again, maybe, maybe I'll be proven wrong here in, in, in, in, in the near future. But on the flip side, I'm also getting really good results with isometrics to get the pain down and then going either heavy, slow, or eccentrically based. To get'em better. And I got 20 years of a huge end. Uh, where, where that, that's helped.
Mike:Yeah, that's actually a good point. Like you, that's not an area where you think you even need it, which is, which is pretty helpful in there. Uh, that, that was the first thing we talked about at Champion as a staff when we were talking about starting using BFR a little bit more, uh, you know, several years ago now at this point. And I think we all said, Well, well wait a minute. If we're not loading the tendon, maybe this is good for strength, but what's the long term ramifications of doing all these exercises with less load on the tendon? Um, and it was definitely something we, you know, we were, we. We thought about. I'll leave it at that.
Dan:I've always said, uh, and I even wrote a, a clinical viewpoint piece in I G S P T on this like, definite room for optimism. And you should be looking at this, no question, you know, but pump the brakes like you should not replace. Traditional loading methods. You, you know, it's an adjunct, it's a supplement, it's a whatever word you want to use, but it should not be, it should not be a replacement. Um, you know, and just remember a lot of the stuff that they talk about with bfr, all these amazing benefits with hormones and things like that. We get that with normal training too,
Mike:Right.
Dan:Like there's not just this, uh, it doesn't stop when you, you, you deflate the cuff, so to speak.
Mike:Ex. Exactly.
Dan:think it's important. Remember that too. A lot of those benefits happen with our traditional training methods,
Mike:right. But for the right person at the right time, that has an inability to load, but wants to get some of the benefit, it's a no brainer. It just, it just seems obvious.
Dan:right? For sure.
Mike:I love it. Right? And so this is why you need to check out Dan and I's Course, by the way, uh, because you know, it's our personal experience. It's how we use it and you know, we teach you that, right? We teach you how we use it and why we use it, right? Not just some, some, you know, random stuff. It, it's more of a, you know, clinical application concept as well as all the signs. So, um, yeah, check that out. Dan and I, you know, put a lot of work into that. Dans the mastermind behind that. So I'm, I'm super appreciative of all that. But, um, you know, if you wanna check that out, that's just mike round.com/bfr. You can head to that course, but, um, Dan, before I let you go, we'd like to end with a high five. Still calling it that, even though everybody makes fun of it. But, uh, the high five, five quick questions, five quick answers at the end, um, just to kinda learn a little bit more about you. But number one, what are you, what is Dan Lorenz currently doing right now for your own ConEd or professional develop?
Dan:This has never really stopped for me, but I, I read incessantly. I think that's the first thing. I think, you know, that I do a staff journal club. Um, I'm constantly posting articles on, on social media, uh, or at least on Twitter. I don't do much else other than that. But, uh, it all starts with reading. Um, uh, I think preparation for all my teaching. Uh, you know, cuz if you're teaching something, you really gotta be on your game and you gotta know, you gotta know the material. So I think that indirectly through teaching, uh, I, I, I get a lot of, uh, stuff there. Um, I'm signing up here very, very soon. Actually, this week I'm gonna take, uh, uh, Derek Hanson speed course.
Mike:Oh, nice. Yeah,
Dan:Yeah, I wanna take that. Uh, again, that's just some later stage stuff that you really gotta kind of spend some time with and, and he's probably one of the best in the field at it. So, uh, he has a, a speed course. I'm, I'm gonna, I think I'm gonna delve into that. And I think for me too, I think part of it is, you know, I have all this new technology I never had before. So like we have force plates now, a ice connect device. Like we've had these things for about a year and for 20 years I never got those things. I didn't have the band. What was the point of, of, uh, knowing what the, the latest on force plate technology is when you don't get to use it, so, Right. Why would, why would you fill your brain with that stuff when you have access season? So again, I'm, I'm a, I admit, I'm, I feel like a new grad in a way. Excuse me. Learning, learning how to use the ice kinetic device with speeds, you know, um, what we're looking at in the force plate and stuff. So, uh, that, that's been kind of fun, um, because again, it's new, it's, it's cool technology and it's really, um, changed how, frankly changed how I practice. So,
Mike:Awesome. Always growing. I like it. Well, I know you're a little stubborn, but I'm just kidding. But, uh, what's one thing that, that you've recently changed your mind about?
Dan:I would say evolved last couple years. I think more the open chain knee extension stuff. I mean, I think you and I came up about the same time in PT school and I mean, if, if you, uh, you know, if, if you did open chain knee extensions after an acl, I mean, man, that that was, that was grounds for, uh, Being arrested. Being arrested and thrown in, thrown in the go log, right? So, uh, I think that's changed a bit. I've certainly gone been more progressive there. Uh, I've also, um, also slowed down my cuffs considerably rotator cuff repairs. I say that all the time. Uh, and I think too, it's been kind of good on uh, uh, helping out tens a lot is the isometrics. You know, I, I've been using those a ton for pain. You know, I have a, a high school, uh, wide receiver. I mean, who was, he came to see me constant proximal hamstring tendinopathy, like pain. It hurt all the time. Sitting in class doing nothing. He was on isometrics for two days and his pain went away to only when he ran at practice. I mean, there, there's definitely something there. I mean, we weren't really talking about this 20 years ago. It was kind of go right. Right. To eccentric or something like that. So I would say that those are probably three off the top of my head that, um, have, I've evolved on a bit.
Mike:Yeah. That's awesome. And, and I agree. Follow Dan on Twitter, by the way, because you, you do share what you're reading, um, quite a bit. Like one of the, one of the most, you know, um, Twitter accounts that I follow, like, like you, you do share all these articles you're reading with a little comment. So it's always cool to see that. So, um, you know, definitely follow Dan for that. Um, what's your favorite piece of advice that you give your students or your new resident now?
Dan:Be an expert at the basics, Uh, no question. Uh, the careful with the social media fads and those kind of things. Uh, know what you're measuring, you know, uh, get an algorithm base for progression for everything. Uh, test, test people. Uh, you know, again, my resident, you know, he had a patient not too long ago and, um, I was like, you know, he mentioned about strength. I'm like, Well, did you test it? You
Mike:Right.
Dan:the Dino's right there, man. You know what I mean? Not to, but again, we, I literally say it with him every mentoring session, like there's an opportunity to say being expert at the. And like I said, you don't have to have this crazy exercise that nobody's ever seen before that the main guy in Instagram is doing. Like, can they squat, can they hinge? You know, push, pull, hinge, uh, carry. Like it really is that simple. It really is. You don't have to, but people wanna do the like, well there's gotta be a different exercise other than sideline external rotation. There's a reason why we've been doing it since it's don a time because it works.
Mike:Right, exactly.
Dan:so yeah,
Mike:and,
Dan:I, No question. That's the biggest advice I give.
Mike:And, and I hate to break it to everybody, but you know that person on Instagram that's doing all those crazy things, even for them, that's 1% of what they're probably doing. But that's just what they choose to show you, right? They're not showing you the mini squat that they're doing. That progresses to a, a partial squat, which progresses to a deep squat, which progresses to the load that, cuz that's really boring on Instagram. right? like you know? So, uh, good point.
Dan:I think the other thing too is just, you know, find the experts in whatever, whatever area it is, and, and read their stuff, go to the meetings, you know, whether it's, uh, Amsc or going to CSM and listening to those people speak. I mean, that's where you have a chance to interact and engage and, you know, we have some really great people in our profession that'll spend some time with you if you just, if you just reach out. So use the resources around it too, for.
Mike:Yeah, I agree with that. You know, our, our sports performance thing that you started is, has done such a great job building community, um, you know, within, you know, that shared interest, which I think is really neat. So again, find that group of people that you can geek out with. I think that's, that's fun too. So, um, Awesome. What's coming up next for you, Dan?
Dan:Uh, actually this week I'm really excited. I'm coming out to your neck of the woods. Actually, I was asked to be a part of, Yeah, I am. I was asked to be part of this, um, this bridge Enhanced or bio. Against ACL reconstruction where they're, you know, they take the, basically trying to get that naturally they're redoing the protocol and I was asked to be on a panel to make that happen, uh, or to be a part of putting that together. So, um, yeah, I'm really excited about that. I leave here in a few days for that and it's just, uh, there's a meeting, uh, it's about six hour meeting round table with some orthopedic surgeons and I'm not quite sure who else is on the. The pt, you know, staff or faculty for this. But I'm really looking forward to that. Um, I'm, I'm continuing to teach. I, uh, I, I put some, I, I just put my performance enhancement course online. I'm probably gonna do a few more of those as well. Um, you know, so that's, again, I put more of'em online, I should say. Um, That's, that's probably mostly what's, what's next for me. Um, but I think, uh, just from a personal standpoint, you know, just trying to trying to work on how to be a first grade basketball coach and just, just, just sharpen, just sharpening the acts as a dad and husband and father. So, yeah.
Mike:I, I, I, I'd be lying if I, if I said that, I, I haven't gone to YouTube to look up like the rules of field hockey and lacrosse and all these sports. I didn't play growing up with kids, so
Dan:right? No, that's exactly right. So,
Mike:That's awesome. Um, and, and what's your website again? I'm gonna put, this is gonna be in the show notes for everybody, but your website where you have these courses and everything where.
Dan:It's Ortho athletic edu.com. Um, yeah, that's where, that's where all those are. And like I said, I typically do, uh, four different courses just cuz it's the stuff I like, the stuff I emphasize the most. But I certainly have catered courses specifically what folks want. So, and I do enjoy doing it. I, I much prefer live rather than online. Uh, there's, uh, I think it's just better to do. I'm a little more animated in person and I can demo more stuff, so, but no, I, I, I do enjoy for.
Mike:There's the gap for online, but you know, you need in person as well. I completely agree with that. So that's awesome. So awesome. Well, Dan, this was amazing. Thank you so much for taking time out to do this, uh, sharing all this great knowledge with you. Uh, hope to talk to you again in a future episode. Thanks so much.
Dan:Likewise, Mike, thanks for having me.
