Latest / The Layback Podcast / Jeff Steuck, PT, DPT, with Kinetic Sports Medicine and Performance (Ep. 38)

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Jeff Steuck, PT, DPT, with Kinetic Sports Medicine and Performance (Ep. 38) · The Layback Podcast

0:00
Hey everyone, welcome back to the Lay Back podcast.
0:02
Joining us today is Doctor Jeff Stuke.
0:06
That is so fun for me to say because Jeff was a teammate of
0:09
mine at the University of Dayton.
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He's now a physical therapist at Kinetic Sports Medicine and
0:15
Performance located in Wisconsin.
0:18
He is specifically at the Delafield location now.
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They have a couple of spots, but I'm so excited to talk to Jeff
0:24
today. It's kind of this cool
0:27
reconnection moment where Jeff and I were teammates.
0:31
We went our separate ways. He was a freshman when I was in
0:33
my grad year. I went on to start the New
0:36
Orleans Sports Performance Institute.
0:38
Jeff had a few more years of college baseball to knockout and
0:41
lo and behold, he gets into physical therapy.
0:44
We're doing our flex pro grip stuff.
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We get a call from his physical therapy group.
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I fire up a Zoom and I see Jeff's face.
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And I think a little bit before that, I think I started seeing
0:54
him on Instagram and just appeared in some videos.
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And I just was like, I know that guy.
0:59
I know, I know that guy. This is just so out of context.
1:02
There's no way that's Jeff, but I swear it's Jeff.
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But anyways, I'm rambling now, Jeff, I'm going to kick it over
1:09
to you, pick up the pieces. Thanks so much for coming on and
1:13
please just give us a look into your career thus far.
1:16
Yeah, thanks for having me, man. It was kind of funny.
1:19
We were, we're exploring new technology within our clinic and
1:22
my boss Michael was like, have you heard of this group?
1:25
It's called Flex Pro Grip or something like that.
1:27
And I was like, yeah, I'm pretty sure.
1:29
Like I know the guy that created it sure enough reached out to
1:32
you and now we're here. But no, it's it's been fun
1:36
reconnecting with you. Like you said, we were teammates
1:38
my freshman year after that, kind of like went our separate
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ways. After I finished playing
1:44
baseball at University of Dayton, I ended up just going
1:46
back home during COVID. And then that was kind of when
1:49
my whole PT journey started. I ended up taking a gap year and
1:52
just working, but then finished up grad school, started working
1:56
in the traditional insurance based PT world.
2:00
Got lucky enough that one of my clinical experiences was here at
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Kinetic Sports Medicine and Performance.
2:06
They like me enough to hire me and I'm here.
2:09
So it's been a, it's been a fun journey so far, but I'm really
2:13
enjoying it here. Good.
2:15
I'm glad. And I want to ask a few career
2:19
questions before we get into the greater baseball injury
2:23
landscape. I obviously know what positions
2:26
you played, but I'm going to be honest, I forget some of your
2:29
own medical history. Did your own experience kind of
2:33
influence this path he went down?
2:35
Yes and no. Like I I'd always had an
2:37
interest in some type of like sports rehab realm.
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So like thinking like athletic training, sports medicine,
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something along those lines. And I think part of it was even
2:49
in like, even in athletics in college, right?
2:52
Like our team mates would be banged up all the time.
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And like, you're seeing them in there getting treatment.
2:56
And just like the mental toll it takes on somebody when they're
3:00
out for a while. Like, that can be hard.
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And I always found myself kind of like gravitating towards
3:05
those guys and like, trying to help them through it.
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And then even just like the experience with working with
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athletic trainers, part of me was like maybe doing physical
3:15
therapy might be a little bit better.
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So I never really had any like major injuries myself.
3:20
Biggest one was probably just like a high ankle sprain, which
3:22
was fun to rehab. But other than that, like I was
3:25
relatively healthy most of the time.
3:27
So like I can't say that you had like I had this major injury
3:30
that kind of led me down this path.
3:32
It was more so like something I was always interested in and I
3:35
ended up, I ended up being able to follow it all throughout
3:37
college. So I'm happy for that.
3:40
And what was your major at Dayton?
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It was pretty physical therapy. So like I, I did that basically
3:46
the entire time because like that was kind of the thought I
3:48
had like throughout those years, there's always like a little bit
3:51
of like, is this what I want to do?
3:53
Like maybe should I switch to this?
3:55
But I end up just kind of sticking it out and in the end
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it ended up working so. Yeah, well, it all played out
4:01
properly. I'm happy to see that you
4:04
actually were able to put what you majored in to a career that
4:08
happens so little these days. It's.
4:10
Crazy like the amount of our teammates that are just in these
4:12
like business degrees or like these just like very generic
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like broad degrees. And here I am doing pre physical
4:20
therapy and it's like one of a few that were in like any type
4:23
of science at all. Yes, yeah, your, your classic
4:27
baseball team is going to be COM majors, business majors.
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And it doesn't matter anyways because probably 75% of the team
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is going to go into sales. Anyways.
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And just try to make as much money as possible getting on the
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phone lines. Oh yeah.
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But no, you, you had to go a different route and I applaud
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you for it. So you are helping people on the
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daily. You said before you got into
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more the sports world that you're in now, you were in more
4:56
traditional insurance based physical therapy.
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So what is that transition been like?
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Like what was the normal clientele base in the
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traditional setting versus what you're working with now?
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In the traditional setting, you do see like a very broad
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population of patients, like I saw as young as like 10 or 11
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all the way up until like the 80s.
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And so it varies definitely from like patient to patient.
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But it was a lot of like post op, right?
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Post op, just like low back pain or just like general pain.
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But for the majority it was like a post op population.
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So it was a lot of post operative protocols and like
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working them through that. So like you got your total knee,
5:40
total hip replacement, things like that.
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For some of the population, they were very like, yes, like, I
5:45
want to get better. I want to be able to do XY and
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Z. But for some of the population,
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they're just kind of like, I just want to be better, make me
5:54
better. Like there wasn't that much and
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this wasn't for everybody. But some of the patients that I
6:01
work with, it almost felt like they just, like, expected me to
6:04
do the work for them. And like, yeah, like, I'm here
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to help you, but I can't. Like, I can guide you along this
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path. You can, you can lead a horse to
6:12
water, but you can't make it drink, right?
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That's kind of what I had to battle with when I was there.
6:17
And then on top of that, like you're dealing with a little bit
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of the insurance world where like you got to try and get
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visits approved, things like that.
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Like sometimes the patient that needs it the most will only get
6:28
like a couple and then the patient that's ready to be
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discharged, they have a whole bunch of visits that they can
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use. So luckily we had a front like a
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front desk staff that handled a lot of that.
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So I didn't have to deal too much with it, but like you're
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still involved with it, you're still involved with the patient
6:45
care, like the plan of care. So that aspect of it could be a
6:48
little frustrating and. I'm curious about that insurance
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world I guess paired with you leading the horse to water and
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hoping they would drink. How much of your protocols, I
7:02
guess, or your day-to-day workouts, we're just trying to
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check boxes of what insurance would want to see versus you
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putting on your kind of true sports Medicine Hat of like, oh,
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we need to build this athlete back up so they can make these
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cuts or get back on a field versus note.
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We just need to show they regain range of motion.
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Once they do that, great, they're released.
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No, that's a great question. I would say that myself
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personally, I always tried to take my background in athletics
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and even just like training and then even my experience when I
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was a student here at Kinetic and always tried to integrate
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that with any patient that I could, right?
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You're not going to be able to have 80 year old Gertrude doing
7:49
like depth drops from like a box, right?
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She's probably not going to handle that too well.
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Like you can still teach her how to do proper bracing, do a PAL
7:58
off press, things like that, or even just like working sit to
8:01
stand, right? Like is your knee coming over
8:03
your toe or like, are we not doing that?
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So I, I definitely tried to incorporate some of those
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aspects within my care is just very dependent on like what the
8:14
patient could or couldn't handle.
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But then you are also limited by like, yeah, maybe I have this
8:20
patient in for an hour, but there might be a patient that's
8:23
kind of overlaps with them. So how am I going to manage 2
8:26
patients at once? Do they really get that like
8:29
specialized care and like attention or am I trying to like
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micromanage a bunch of things at once in my level of care has to
8:37
kind of be brought down. So there there was a little bit
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of that within it. And that was one of the things
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that kind of, I guess you'd say, put a sour taste in my mouth.
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I have, I have all the respect in the world for the other
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physical therapists that are out doing that.
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I just felt like that wasn't the right place for me and that
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moving to a more out of network cash based practice was the much
8:59
better option. So I'm.
9:01
Guessing you also struggled a little bit with holistic
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treatment versus kind of spot treatment because I know you're
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getting APT script. Often in those cases when you're
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dealing with insurance pay to treat a very specific injury or
9:20
ailment versus now that you're out of network or cash based,
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you can look at the athlete as a giant puzzle.
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They may be coming in with shoulder pain or elbow pain, but
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you can say, oh, hips are misaligned.
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We have this ankle mobility issue.
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Let's focus on that. And those might be building
9:41
blocks along the way versus when you're in insurance pay.
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All they want to see is what we did for the elbow, what we did
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for the shoulder. 100% no. Like lots of times you'd get
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that script and it's just straight up shoulder pain.
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You're like, OK, like let's check the shoulder out.
10:00
Like yeah, I might check like the neck because sometimes that
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can refer down and I might check the elbow, maybe the wrist,
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right? But lots of times you're just
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working on that shoulder. So if you do anything else,
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insurance might not fully cover it, right?
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So he's kind of fighting that battle.
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Whereas yes, here patient will come in and it's shoulder pain.
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But like as a baseball player, right, Like is your shoulder
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painful because your strength numbers are off from internal
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rotators, external rotators? Do you have enough thoracic
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rotation? How's your scapula moving right?
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And like, there's all these pieces of the puzzle that we can
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look at. We're still going to treat what
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you're coming in for, obviously. But like, because we aren't
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under the scope of insurance, we have more freedom to treat
10:45
patient holistically. And so yes, like that has been
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something that has been very nice about transitioning to this
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role is that you're not as confined and like what you're
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doing for an instance, some of our patients like they'll come
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in shoulder hurts in a couple visits, like it's feeling better
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and they're like, all right, like I'm going back to training
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now. What do I do?
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Like, OK, well, let's check your quad and hamstring strength.
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Let's check your hip strength. Like where are those numbers at?
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Like what is your training plan look like?
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Oh, I don't really have one. Do you want us to help program
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for you? That's something that we can
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kind of do. So it helps us just kind of like
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build the athlete as a whole. And you get to kind of follow
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through more with them because you build a little bit of a
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stronger connection I would say. And you are like trying to help
11:30
them get to their goals and like you get to be a part of those
11:32
victories and that that is very rewarding.
11:35
For sure. You stole the words out of my
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mouth. I I think we might have phrased
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it a little bit differently, but I was about to say one of the
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benefits that you have now is you can play the whole spectrum.
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You can constantly go from PT to performance training.
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And then even given your background, you can have some
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skill based discussions and figure out how all those
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different prongs play into the final goal of being as
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successful as possible at the dish or on the slope versus just
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having to stay in one lane and rely on that solely.
12:11
Yep. And like we, we still, I will
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say we still practice within our scope of practice and we have
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resources that we can refer out. It's like nutritionist, we have
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people we work with. We can always do that.
12:21
Like sports psych, we have people that we're connected with
12:24
that we can always send out. So there's some aspects of the
12:28
athlete that we we don't really fully work on.
12:31
Like we might be like, hey, like, is this something that's
12:33
kind of going on? Do you need help with that and
12:36
point them in the right direction?
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But we're still able to do a heck of a lot more here than I
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was in the insurance world. Yeah, no doubt.
12:45
That is really cool that you guys can refer out to sports
12:48
psych that I think that shows good understanding of the injury
12:54
recovery process or the return that these athletes face.
12:57
It's a reoccurring theme on here, but the process isn't just
13:01
physical. There's a massive mental hurdle
13:04
that everybody needs to overcome and you can have those
13:07
conversations with anybody, but sometimes it does need to
13:11
escalate to a. Professional, right?
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And yeah, and everybody's different too, right?
13:16
Like 11 athlete, they might be able to bounce back super quick
13:20
and they're fine. Then you might have the athlete
13:22
that's just nervous to run right after, like an after an ACL,
13:28
right. And so we're ever going to like
13:30
force that upon them if they're not ready.
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But like we will lay out the objective backs of like you can
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do this. We will try some drills and like
13:39
try and get them to do it. So in a way we see people enough
13:43
that we almost become their psych because like they trust in
13:47
US and like they can tell us some things.
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But yes, like we can always be like, hey, like I think you
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should talk to so and so about this.
13:54
They're a great sports psyche might be able to help you kind
13:57
of overcome this boundary. And so we will, we will always
14:01
refer out in cases like that. Right.
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I do think it is worth highlighting.
14:07
You said it a couple times already.
14:08
Now the objective measures that you guys rely upon, because yes,
14:14
we, we've discussed it already, it is multiple things that go
14:19
into the recovery. It's both the physical and the
14:21
mental and all the hurdles you have to overcome in the process.
14:25
But the more objective data that you have, often times it becomes
14:30
easier to grasp how far you've made it or what's next, what's
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coming on the horizon. So if you could kind of go into
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what objective data capture looks like for you guys, what
14:42
are measures that you utilize, What's technology you utilize?
14:47
And I guess how can people access that stuff?
14:50
Yeah, that's a great question. So I'll use baseball for an
14:54
example, right, Baseball podcast.
14:56
The easiest way to kind of translate that.
14:59
First off, we use handheld dynamometry a lot.
15:03
We also use a system of like pull dynamometers.
15:06
So it's very similar, except instead of pushing into it,
15:09
you're pulling it apart and that measures the force output.
15:12
So we'll use that to measure shoulder strength in a couple of
15:16
different ranges. So the first one is just
15:17
shoulder scaption. We're checking out how strong
15:20
the scapula is. There's a saying you can't fire
15:23
a cannon out of a canoe, right? So if your if your scapula, you
15:27
can't keep it stuck on that rib cage, you're probably going to
15:30
start dealing with some shoulder problems.
15:31
So if you look at that, the next thing we'll do is we'll look at
15:34
shoulder internal and external rotation strength up in the 9090
15:38
position. We recently switched to this
15:41
through some of like our continuing Ed.
15:42
We kind of learned more about that before we were just
15:45
measuring it down in neutral. But if we talk baseball, your
15:49
arm is not going to be down in neutral anytime you're throwing
15:51
a ball. So it's more important to really
15:53
like take those measurements into account up in this range.
15:57
So when a patient comes in dealing with shoulder pain,
15:59
we'll run them through those at least just to see where their
16:03
numbers are. So we use a system that's called
16:05
Kinvent. It's attached to our tablets.
16:09
We'll test both arms and then it gives us, it does the math for
16:13
us, but it'll give us like the asymmetry percentage.
16:16
And so like we can use that. We'll then compare strength of
16:21
the external rotators to the internal rotators because
16:25
that'll tell us a lot about like what the shoulder can and can't
16:28
handle in a throwing motion. So for example, I did eval the
16:32
other day, patient came in and their ER strength and IR
16:36
strength was basically 1 to one. From the research that we found,
16:40
we typically want the ratio to be .8 to .9 ER to IR.
16:45
So internal rotators are always going to be slightly stronger
16:48
than the external rotators. And part of that reason that we
16:51
want it to be within there is because it allows the most
16:54
stability during that throwing motion, right?
16:56
When we talk shoulder joint, anytime we're in that laid back
17:00
position and we're rotating through, there's going to be an
17:03
anterior shear force on the front of the shoulder.
17:05
So it's really important to make sure that those numbers are
17:08
within this acceptable range, might be like slightly higher,
17:12
slightly lower, but we're always shooting for that.
17:14
And we found that patients that deal with shoulder pain
17:17
typically fall outside of those ranges.
17:20
So that's one instance that we're checking things like that.
17:24
We're also going to do like a full mobility screen to not just
17:27
like range of motion, but we're going to watch it move, right?
17:30
Like what does your push up look like?
17:32
What does your thoracic rotation look like?
17:35
Can you do a single leg squat right?
17:37
You're a pitcher? Like do you have single leg
17:39
stability or is that a weak link?
17:41
And so we'll kind of run through all those things and that builds
17:44
a bigger picture of what the athlete looks like.
17:47
And then from there, we base our practice on the objective
17:50
measures. So if your internal rotation's
17:54
super weak, we're going to hit that hard, right?
17:56
If your scapular strength is really weak, we're going to hit
17:59
that hard. And then we will typically
18:01
recheck strength every four to five weeks or so.
18:06
It gives us like a decent time range to like make changes and
18:11
see those changes. You're always going to see like
18:14
some level of change from the first time you test somebody to
18:16
the second. Part of that is just like
18:19
getting comfortable with the testing and like understanding
18:22
how to actually like complete the test.
18:24
So there's always that aspect of it so that like four to five
18:28
week range is typically what we shoot for.
18:32
I have a very specific question about the ERIR stuff that peaked
18:37
my interest, the numbers you threw out there.
18:40
I don't spend a lot of time at the shoulder.
18:42
Obviously I've been much more of an elbow guy.
18:45
Over the past few years. But you you talked about kind of
18:49
this ideal of that .8 to one or .9 to one as opposed to a one to
18:53
one. .8 to .9 yeah. OK, sorry point 8.8 ER to .9 IR,
19:02
is what you said correct? Close.
19:04
So like if we take the ratio of external rotation to internal
19:08
rotation, so we divide external rotation strength to internal
19:12
rotation strength, we want that to be within .8 to .9.
19:17
OK. And stronger internal than
19:20
external is what you said? Yes.
19:22
OK. So thanks for thanks for walking
19:25
me through that. Yep.
19:27
If we're talking in terms of like major alert, red flag, are
19:31
you more worried if somebody is coming in with that one to one
19:36
that you talked about with this athlete that you just did the
19:39
eval for the other day or someone that shows up with like
19:43
a .6? It depends.
19:46
OK, that's a, that's a classic. That's a classic answer.
19:49
So like for example, the kid at EVAL the other day, he wasn't
19:53
coming in with any shoulder pain and he's in his winter like shut
19:56
down period, right? So he's not doing any high level
19:59
throwing or throwing very aggressively or with high
20:02
intent. So right now it's a great time
20:04
for him to one come in and get checked out, but also to
20:08
continue to work on it if we're talking in the midst of a
20:11
baseball season and you're dealing with some slight
20:15
discomfort. And you come in and you're
20:17
showing that then, yeah, like this is something we really need
20:20
to take care of because if you continue down this path, just
20:23
throwing more, it's going to accentuate some of those.
20:26
Like the pain might even cause more weakness into the joint.
20:30
So that's just going to lead to further injuries down the line.
20:33
So I would say if it's in season, my alarm bells are going
20:37
off a little bit more than if it's in this out of season
20:41
period when they're not really throwing.
20:43
I still think it's important to address it on both ends of the
20:45
spectrum, but we have a little bit more time to work with it in
20:51
this offseason versus in the summer.
20:54
OK. That makes sense.
20:56
So I I appreciate you running back through that and maybe
21:00
maybe you provided a decent segue here.
21:03
You guys are up north, you are in Wisconsin.
21:06
So there is, at least from my perspective, more more of a
21:10
traditional winter shutdown. Yeah, but of course, there's
21:14
facilities everywhere. Some of the most well renowned
21:18
National Baseball programs now are out of Wisconsin.
21:21
I know you played for a massive organization with GRB, right?
21:25
Yep. Isn't GRB raise?
21:26
Yeah. And then there's the Styx
21:29
organization as well. I think that's the other one up
21:32
there. They're now a part of GRB.
21:34
Classic. OK, so there's there's still
21:37
this massive travel ball influence in just because it's
21:41
winter doesn't mean guys aren't training or hitting or throwing.
21:45
They're just not necessarily competing against other people.
21:49
So how do you guys integrate what you're doing, whether it's
21:54
from an assessment standpoint, assisting with training and with
21:58
the more traditional winter training ARC model?
22:04
It's very dependent on a patient to patient case, right.
22:08
We have some long standing patients that we work with
22:11
pretty continuously and those are the guys where it's more
22:15
here's our plan going forward. We might have like a dedicated
22:20
shoulder routine that we want you to do X number of times a
22:24
week and then we're going to continue to monitor you
22:27
throughout this winter period. Other guys are in this phase
22:31
where like they, they might have been injured in the summer,
22:35
couldn't throw. And so we're trying to work
22:38
through this period of like, how do we build up some level of
22:43
workload on your shoulder without overdoing it so that you
22:46
are ready to start building up in the winter and ready to
22:49
compete in the spring. And so we don't always handle
22:53
that all ourselves. We do have a lot of connections
22:56
in the area. So like sticks, for example,
22:58
we're pretty close with them and we know the coaches well.
23:01
So we can communicate with them and say, like, hey, this player,
23:05
like I think this would be a good idea for them.
23:08
What do you think? And then we can collaborate with
23:11
it. So we, we do have a very
23:12
collaborative approach here. I would say as far as like the
23:17
training side of things go, some programs they kind of handle
23:20
their own training from like a speed and agility and just like
23:24
overall like lifting regimen. There are tons of options in
23:28
this area that are excellent. So we can always like help point
23:32
people in the right direction if they need that.
23:35
But if they do like decide that they want to work with us, we
23:38
can always accommodate them and try to make like make them the
23:42
best athlete possible so that they're ready to compete in that
23:46
springtime period. I don't know if that fully
23:48
answers your question or not. Yeah.
23:50
I think I have the benefit of knowing a little bit more about
23:54
what you guys are working on and trying to do with providing
23:58
assessments. And because of the model that
24:03
you guys have in the Midwest, all these kids who play for the
24:07
travel orgs have facilities that they go to as well.
24:11
It's not just like they're done with baseball and they go play
24:13
basketball or wrestle or something else.
24:16
That's that's almost a minority at this point.
24:18
Whereas years ago, if it was winter, you played basketball.
24:22
If it was fall, you played football.
24:24
If it's spring, you play baseball.
24:26
If it's summer, you're still playing baseball.
24:27
That just doesn't exist as much anymore.
24:30
Now there's so much more specialization.
24:32
I will be a guy that you'll never find complaining about
24:35
specialization because if kids are in love with the sport then
24:39
why wouldn't you train it? And also their training should
24:42
probably be good enough anyways that it isn't just the only
24:47
thing we do is throw, so you're never learning these other
24:50
skills. The only thing we do is hit, so
24:52
you never learn these other skills.
24:53
Their training should be good enough to handle what those
24:56
other sports might expose them to.
24:59
So yeah, the whole specialization debate, that's
25:02
that's a different story. I'm sorry for going on a
25:04
tangent, but I really wanted to get into how you guys have
25:08
created this assessment model to support all these organizations,
25:13
facilities, high schools, to provide them with invaluable
25:18
information that they can use this kind of longer training
25:22
window to make significant changes and hopefully be healthy
25:26
for the coming spring. Yeah, No, it, it all stems back
25:30
to day one when you come and visit us, right.
25:33
Our typical evaluation is between 60 and 90 minutes and
25:37
that's a full and thorough evaluation, right?
25:40
So we're going to look one, we're going to hear your story,
25:43
right? What's going on?
25:44
Like what are you dealing with? What are you asking help wise
25:47
from us? Like what can we do for you?
25:50
And then from there we go into like a movement screen, check
25:53
range of motion and then checking the strength measures.
25:56
So all those things combined kind of paint that picture of
26:00
like what does this athlete need?
26:03
Or like where can we make like what's the lowest hanging fruit
26:07
essentially? So that's kind of where we will
26:09
typically head 1st. And so the way we work being out
26:14
of network is we will typically see patients one time a week or
26:20
10:00 to 12:00-ish weeks, depending on like how many, how
26:24
many visits the patient buys. So typically in like the first
26:27
couple sessions, one, we're still trying to get to know the
26:30
patient. Two, we're trying to start these
26:33
changes and like if they're coming in with pain, right,
26:36
we're trying to limit how much pain they have and make them
26:38
feel better. From there, we kind of phase it
26:41
into more of that like strength and conditioning type style
26:46
treatment. So we're doing a lot higher
26:48
level stuff. I had one patient the other day,
26:50
he came from the typical insurance based BT and by the
26:54
end of the session, you could tell he was just kind of like
26:56
beat and I looked at him and I was like, you OK.
26:58
And he's like, yeah, it was just a lot harder than I expected it
27:01
to be. It's like, yeah, we're, we're
27:03
going to push you here. But anyways, like then towards
27:06
the back end of that treatment, we start spacing it out a little
27:09
bit more. So what it looks like then is
27:12
we've done 7 to 8 weeks of PT, right?
27:16
Your symptoms are gone. You're getting stronger.
27:19
And we know that based on the testing we've done here, here
27:23
are X number of exercises that I want you to start implementing
27:28
in, say, your warm up routine, right?
27:30
So then they go out for a couple of weeks, they try that, they
27:33
can come back, be like, yeah, man, that really worked.
27:36
My arm felt great when I started throwing, but I was a little
27:38
sore after like, what do I do now?
27:41
And we can kind of address that, right?
27:43
So long winded answer of what we kind of do is we take the
27:47
patient from that initial visit into trying to help form
27:52
something that they can maintain for a longer period.
27:56
Part of your question was also like how we communicate with the
27:59
coaches, right? So we're very close with a lot
28:02
of coaches in the area. So if they send us somebody,
28:06
we're responding like that night that week with like, hey, this
28:10
is what they showed, this is my opinion.
28:12
Like maybe let's shut them down for the rest of the fall because
28:16
they're not going to miss out if they don't play this fall,
28:19
right? And they're going to be better
28:20
off if they don't. So we can kind of communicate
28:23
with them on that end. Ultimately, it is partially
28:26
their decision. Like we are the medical movement
28:30
experts in this case, but these are also kids that are usually
28:35
trying to get recruited to go play baseball.
28:37
And so they have the knowledge of this is a big showcase that
28:42
we need to try and get them to play because there's going to be
28:45
a ton of coaches there that'll see them.
28:47
So in that those instances we do try to work with the player and
28:50
the coaches, he will almost bandage them up to get them
28:54
ready to be able to play so. Yeah, and it helps that you
28:59
understand the industry as well. And when I say the industry, I
29:03
mean the baseball industry. You've been through it, so you
29:07
have your finger on the pulse when it comes to going down to
29:10
Jupiter to play in some tournament.
29:12
But you're also smart enough to say, look, kid, you throw 76 mph
29:19
right now. Getting healthy and getting
29:21
stronger is way more important than you going down to Jupiter
29:25
to just get told you're not ready.
29:27
Right. No, 100%.
29:30
I think with my background, it does lend some credibility in
29:35
some of those cases with like, yeah, like maybe we don't focus
29:39
on this one that's in two weeks, but we focus on the one that's
29:43
in eight weeks that you're probably going to be in a better
29:47
spot to participate in, right. And so I have, I have found that
29:52
that helps a little bit. It's not like the only point of
29:55
credibility I have, but I have been able to connect with a lot
29:58
of my high school guys just from being like, yeah, like I played
30:02
in the WWBA or like I played in this tournament, right.
30:05
And so like we have that cool connection point from that
30:08
regard. And even just like growing up in
30:11
the area to like, I'm familiar with like the baseball world,
30:14
this small world, of course you, you end up knowing somebody who
30:18
knows somebody who knows this guy.
30:20
And like you can make those connections with the kids.
30:23
And that's honestly been one of the funnier parts about being
30:26
here at Kinetic, I would say. So sticking kind of the same
30:30
theme we mentioned those tournaments kind of mapping out
30:34
that I guess treatment plan now it now it's a completely
30:38
different treatment plan from we need to regain range of motion
30:41
by X state. Now it's we need to prep for X
30:46
tournament or X showcase. So I do think it's awesome that
30:51
you've been through this before. Like you said, it is a point of
30:54
credibility. Obviously to the parents and to
30:58
the world of physical therapy, your credibility is going to
31:01
school, but to the kids, your credibility is you play Division
31:04
One baseball and you played in all those tournaments.
31:07
So I I'd really like if you could break down now how you
31:14
communicate with the different parties, how you separate your
31:18
communication, not, not just like talking to these coaches,
31:22
but how you explain to a high school kid that might be dealing
31:26
with an injury for the first time.
31:29
How are you able to connect with them?
31:31
What is most important? What's the wording you use?
31:34
Are using high level terms? How do you meet the athlete
31:37
where they're at? It's a great question.
31:40
Again, it's very dependent on a case to case basis, right?
31:45
So let's take like a sophomore baseball player for example.
31:49
We know the new shifting world of college baseball when it
31:52
comes to recruiting guidelines, even team sizes now and things
31:57
along those lines. That's kind of driving where the
32:01
baseball world is going, right? It always kind of falls back to
32:05
that. So with that sophomore, right,
32:09
he comes in and he's just like terrible arm pain.
32:14
Shouldn't even be throwing a ball right now, right, With that
32:18
kid. Like, I'm going to look at him
32:20
and his parents and be like, in a roundabout way, saying like,
32:24
we're still young, for one. We have a lot of room for
32:27
improvement. There's going to be this next
32:30
summer, next winter that you're going to have in front of you to
32:35
be dialed in in order to get seen.
32:37
I would probably talk a lot more specifically based on like the
32:41
tournaments and stuff that they want to do, but I can't think of
32:44
any off the top of my head right now.
32:45
So that's what I'm going to go with for an older say like
32:49
junior going into senior year where everybody ends up getting
32:53
recruited and ends up committing for those kids, it is very like,
32:58
what do you want, right? Do you want to be that stud D1
33:02
player, right? And you want to go to that big
33:04
SEC school, OK, what's your plan of attack to get there and how
33:08
can I help, right? If I think what you want is
33:13
going to be detrimental to your future, I'm going to tell you,
33:16
hey, I don't think you should do this.
33:18
That's my opinion. My medical advice would be let's
33:22
sit this out or let's wait until XY and Z falls in place.
33:27
At the end of the day, the decision is up to you.
33:30
But here's here's the objective data that we have and why I
33:34
think you shouldn't. And usually like parents are
33:37
very receptive to that. But as as a former athlete, I
33:42
get that drive to go and compete, right?
33:45
So like, I can't ever fault a kid for like wanting to go and
33:48
compete, wanting to play with his friend, but at the end of
33:51
the day, like I do have to be the bad guy sometimes and like,
33:54
say, no, we we can't do that or we shouldn't do that.
33:57
And so that's just like the kids with the parents, it is always
34:02
just being very upfront with them.
34:05
Like, hey, I know this is a big showcase or this is a big
34:09
tournament, but you also have these ones that you can go to
34:15
later in the summer. What if we sent this one out,
34:18
make sure we get things wrapped up nicely and then we can send
34:22
them down there, right? As long as everything kind of
34:24
falls into place. So you there is a little bit
34:27
more of like management from both a patient athlete and then
34:31
to a parent side. So obviously the parents want
34:34
what's best for their kid and you're always going to try and
34:37
do that for them. Sometimes the athlete isn't
34:40
always like very happy in the end, but at the end of the day,
34:43
like we're always trying to put the patient first and like what
34:46
their best interest is. I think you nailed it when you
34:49
said sometimes you have to be the bad guy.
34:52
I would flip it a little bit because thankfully I'm not the
34:55
one that experiences it as much. I'm seldom the bad guy right
34:59
now, but you're more a voice of reason than anything else.
35:02
I guess if we're just looking at it as cup half full or cup half
35:06
empty, I guess if we do the half full, you're the voice of reason
35:11
as opposed to half empty, you're the you're the bad guy.
35:14
No, I I think that's fair. But that's why you guys do all
35:17
the objective measurements. It's why you do the assessments
35:19
and then it's why you create a treatment plan.
35:22
You can actually map out and give reason as to why two weeks
35:27
doesn't make sense, but eight weeks from now does, or 12 weeks
35:31
from now does. Tried and true.
35:33
You guys have done it forever, and it's in the literature, it's
35:37
in the science. It's not like this is just
35:39
witchcraft. Sometimes it feels like
35:42
witchcraft when it's two weeks and the patient feels better and
35:44
you're like. I'm magic.
35:46
Yeah. Yeah, I nailed this one.
35:48
Yeah. But one thing I wanted to go
35:52
back to this is what was slipping my mind earlier.
35:55
But what can kids do on their own for assessment?
36:00
Like we talked about your assessment process, it would be
36:03
great if every single kid or parent listening to this could
36:06
have access to what you guys are doing or what other physical
36:09
therapists are doing. But what to you is kind of
36:14
objective information that's relatively accessible to the
36:20
regular baseball player. I know that might be tough
36:23
because you can just go back to what you guys have in house or
36:27
what you do, but maybe maybe go back to you as a kid.
36:30
What do you think would have been super useful now when you
36:34
look at 16 year old Jeff Stu trying to get recruited?
36:38
That is a tough one to answer. So we obviously we do have a lot
36:42
of like technology that we use it that isn't the easiest to get
36:47
your hands on necessarily. Like it's not that cheap.
36:50
You have to pay software license, right?
36:52
And that runs on like a yearly basis.
36:55
So there's things that like you need to buy in that sense.
36:59
I think if I could go back and tell 16 year old Jeff and give
37:04
him advice, it would be along the lines of training, right?
37:09
What I did or training when I was in high school or high
37:12
school team did have like a lifting program that we would do
37:15
and I thought it was pretty good for the time being.
37:19
Then once you get into like college and you start doing the
37:22
training at school, you're like, whoa, I, I think I missed the
37:26
mark on this one. So I think if I could go back, I
37:30
might have tried to maybe join like a facility that did
37:35
baseball specific training. There's one local one up in the
37:39
area here, it's called BRX. That's technically where our
37:42
second location is at. It's within there.
37:45
But they do a pretty good job of training baseball players and
37:48
just athletes in general. They will do like a full
37:50
assessment as well and from there build the training plan
37:55
for the athletes. So I think if I could go back,
37:58
my advice to myself would be maybe trying to do something
38:01
along those lines. It's not necessarily like an
38:04
objective test or measurement that you can perform on
38:07
yourself. I guess the other way, like a
38:10
young athlete could quantify, like where they're at is just
38:15
tracking their numbers, right? Doesn't necessarily have to be
38:20
velocity, doesn't have to be ERA, doesn't have to be batting
38:24
average, right? But like, if you set a goal, say
38:28
I want to be able to back squat 315 lbs by senior year, where
38:33
are you at? How are you progressing there?
38:36
That's a very objective way of measuring if you got there,
38:40
right? Like what is your weight each
38:43
week? Is it going up or is it staying
38:44
the same? So I think that's something that
38:47
can be underlooked sometimes, but I think it's definitely
38:50
starting to grow in today's youth.
38:53
I think those are two great pieces of advice, honestly.
38:56
I know I put you on the spot. That's what happens sometimes
38:59
when we don't go over questions ahead of time.
39:01
But your encouragement to seek out some sort of professional
39:05
assistance is super valuable. And I think that is at least
39:10
becoming more prevalent. But there are so many people
39:13
have done what you are trying to do before.
39:15
And when I say you, I mean you the athlete, anybody that you or
39:20
I, you this time being Jeff are talking to, there's been another
39:25
baseball player, there's been another pitcher, there's been
39:28
somebody else with forearm pain. You aren't the first, you're not
39:32
going to be the last. And there are people that are
39:36
there to help you through these things.
39:39
So whether it's going to get assessed, whether it's a one
39:42
time call with Zoom or just finding a quote UN quote mentor
39:47
to work with, there are people that are ready, willing and able
39:51
to assist. So I think that's a good piece
39:53
of advice. Of course, you and I can say
39:55
that from our positions where we provide services to help people.
39:59
So maybe it's a little self-serving, but we're in this
40:02
industry for a reason because we want to help people and get them
40:05
on the field, get them healthy, see them perform.
40:08
But then on the other side, anybody who has a gym.
40:13
At their school or in Anytime Fitness or anywhere they work
40:17
out, they can track something. Now it might not be velocity
40:22
based training or it might not be your vertical jump test or
40:26
the most fancy thing in the world, but what you said is
40:29
perfect. You can gauge improvement in
40:32
some capacity, whether it's a stopwatch on your iPhone or it's
40:35
just wait on a bar. And at a minimum, if those
40:39
things are going up, you're probably getting better.
40:43
As long as your form and technique is good, yes I would.
40:47
I would agree that yes, you're probably going to get stronger
40:49
in that sense. And I guess if you look at youth
40:55
development, often times getting stronger is the lowest hanging
40:59
fruit. Correct.
41:01
It also depends. So I I would argue especially at
41:06
like a younger age, right, if we're talking like that 12 to 14
41:09
year old range, I've had a handful of patients come in from
41:13
that age range and you watch them try to do a push up or a
41:17
squat or any type of body weight movement and they are still
41:22
learning how to use their body. So I think at that younger age,
41:26
it's more important to be comfortable in how and know how
41:30
to move your body appropriately before we start loading you up
41:33
on a backswat right? Can you do a body weight squat
41:37
to significant depth without your knees caving in or your
41:41
back flaring out right? Like can you, can you just be a
41:44
good mover first? I think that's a piece of the
41:46
puzzle that's missed often times.
41:48
That's something that we definitely try to hit here is
41:50
like, can you just do the basic movements?
41:53
Can you do squat? Can you do a push up?
41:55
Can you do a inverted row? If you can't do a pull up right?
41:59
Like, can you do those movements?
42:00
And like, being able to do them will get you a little bit
42:04
stronger, but it's also going to set you up for success down the
42:07
road when you start loading up that barbell back squat.
42:11
Right. Yeah.
42:12
So I guess we we should have started with the coordination
42:15
piece. So yes, once you're coordinated,
42:18
strength is probably the lowest hanging fruit for I I guess
42:22
later stage high school. Kids.
42:24
Yeah, absolutely. Yeah, and of course, I called it
42:28
strength, but you can easily measure speed as well.
42:31
Go out to your football field to track a parking lot, mark off a
42:35
distance and use the stopwatch on your phone.
42:37
Objective measurement shouldn't be that hard to achieve.
42:42
It might not be, as you said, the most advanced
42:45
technologically. It might not be flex program, it
42:48
might not be the convent stuff that you guys are doing.
42:52
But you can figure it out one way or another, whether it's
42:55
duration, speed, strength. I think they even have apps that
43:00
measure your vertical based off of like an iPhone video.
43:04
So like, you can, you can always look into that.
43:06
There's tons of ways to objectively measure improvement
43:10
outside of just a handheld dynamometer or a force play,
43:15
right? You can, you can be creative
43:19
even and like trying to figure that out.
43:21
But yeah, I I think that's something that I would push kids
43:25
to try to explore. OK, now, now we're going to flip
43:29
a little bit. We're going to go back into kind
43:32
of, I was going to call it long term care.
43:35
I don't even know if this is the the proper way to label the
43:39
arena that I feel like we're entering.
43:41
But I'd love if you could kind of talk about how you have seen
43:48
in your short time in physical therapy thus far, but how you
43:53
have seen throwing programs change, specifically return to
43:57
throw or return to performance is probably even a better way to
44:02
phrase it. But how have you seen these
44:04
things change? What are things that you guys
44:06
are now utilizing? Or if you're putting on your
44:10
creative hat, what do you think still needs to change for these
44:14
things to get as good as they can be?
44:17
I think these things are always going to remain in a constant
44:21
state of changing, right? You can use one throwing plan
44:26
with a patient and it goes great, but you try and give it
44:29
to the next guy and it fails miserably.
44:32
So I wouldn't say that there's ever like a perfect plan.
44:36
There's always a plan that needs to be adjusted.
44:40
So one thing that we will do is post TJ now we throw them on the
44:45
Flex Pro grip. Beforehand, we would use a pulse
44:49
sensor. We still use those for a lot of
44:51
guys, and that's one way to kind of measure workload.
44:54
So based on the workload that they've accumulated in the week
44:57
of training, we can adjust the following week accordingly,
45:01
right? If they're getting too high,
45:03
we're going to lower that workload just to make sure
45:05
everything is still in that acceptable range.
45:07
Other ways that we kind of used to move the chain along, I guess
45:12
you could say is distance and velocity within a throwing plan.
45:17
Being in Wisconsin throwing in the winter, probably don't want
45:20
to go outside, right. So you're probably going to find
45:22
a cage somewhere to throw. So there are there are charts of
45:25
perceived effort and associated velocities that we will use
45:30
based on their previous Max mound velocity.
45:34
So we can use that to kind of drive the workload and build it
45:39
back up. But it is very dependent on one
45:43
where they hurt or were they like coming off of surgery,
45:46
right. So that kind of changes
45:48
timelines might be able to get a little bit shorter of a timeline
45:52
if they were just dealing with some soreness in the season and
45:55
we're just trying to build back up to a certain workload.
45:57
If they were injured coming off like TJ shoulder surgery,
46:01
anything along those lines, it's probably going to be a little
46:03
bit longer of a rehab throwing cycle just because you missed a
46:08
lot of time and we need to rebuild of that base workload
46:13
that you have in your arm. So when we use pulse two, we
46:18
track velocity and distances and we use those to kind of progress
46:21
throughout the throwing plan. But at the same time, if you're
46:25
throwing week six of the throwing plan and your arms
46:29
hanging afterwards, we're probably not going to progress
46:31
you to the next one. We're probably going to have you
46:33
repeat the week before or maybe stay at the same 1.
46:37
So then that just changes it to an extra week or two.
46:40
So like there's never a set in stone plan.
46:43
It's always evolving and our patients are constantly like
46:47
giving us feedback. Like this week went well this
46:50
week, my arms hanging. I just feel super tight this
46:53
week. Like what should I do?
46:54
And then we can kind of reassess and adjust on just a whim.
46:58
Basically, I shouldn't say a whim, but like patient will like
47:01
message us and say like, hey, like I'm going to like I'm going
47:05
to start my throwing plan for this week.
47:07
Like last week didn't go well. Like I had a lot of soreness.
47:09
What should I do? Like, OK, like we're going to
47:13
repeat the week before and we can respond super quickly.
47:16
And that's just you. Have to be agile.
47:17
Yes, you do. I know what.
47:19
You meant by on a whim, but I guess it's all in the phrasing.
47:22
Agile effectively means the same thing.
47:24
But yeah, you have to be ready to adjust.
47:27
And I think you highlighted I guess one of the buzzwords.
47:31
I was kind of looking for the buzz terms early on.
47:35
You mentioned what you do with one might not work with another,
47:39
and that highlights the importance of individualization.
47:42
Yes, we know what the path might look like or we what we want it
47:47
to look like, but all the things that you said, soreness might
47:51
pop up. Throwing might have been tougher
47:54
because somebody spiked their workload unintentionally.
47:57
Like it could have been a really good day that then led to a shit
48:01
week because they pushed it on one day because they felt great
48:05
and then they're hanging as a result.
48:07
And then, yeah, maybe maybe we have to take a step back or we
48:12
pushed it too hard in the weight room because things were going
48:15
really well. It's so hard because we're
48:17
always fighting those razor thin lines of perfect to potential
48:22
failure because that really is such a thin line.
48:26
Yeah, 100%. You have to be agile.
48:28
You have you have to be ready to adjust your plans at any given
48:31
moment. I also of course I'm
48:34
appreciative that you mentioned Flex program.
48:36
It has been awesome to work with you guys so far.
48:39
Where we try to tie in is with the strength component, try to
48:43
add some objective feedback to that return.
48:47
So we, we've highlighted a bunch of objective tests or measures
48:52
throughout this podcast so far. I'm curious if there's other
48:58
things that you are looking for in a return to throw just for
49:03
more global health. So yes, we know Flexprogrip, we
49:06
talked about it ad nauseam, what it can do when we're looking at
49:11
the strength of the specific flexor muscles that we need to
49:15
function at the elbow and protect the UCL.
49:19
But I'm curious if you guys are also looking at, I don't know,
49:23
vertical jump measures or other those like convent scores during
49:28
the rehab process that might affect how you move a guy on in
49:34
rehab? We we definitely use the
49:37
objective measures to kind of guide that rehab back as far as
49:41
like vertical jumping, yes, we will jump athletes on the force
49:44
plates, but more so to track central fatigue, right?
49:50
Like if your numbers are tanked and you're jumping at like 75%
49:54
of your Max vertical jump, you're probably dealing with
49:58
some systemic fatigue, central fatigue.
50:00
And that should be addressed, right.
50:02
Maybe we take this week a little bit easier because of that.
50:05
So it is a constant like ebb and flow of like objective measures,
50:10
how they're feeling in general. Sometimes you can get a patient
50:14
to feel a little bit better just by doing like some dedicated
50:16
mobility or like, hey, let's double down on like our strength
50:20
and activation stuff before we start any type of throwing.
50:24
Sometimes you can kind of weave through those waters.
50:27
But yes, like we will force play jump, we will continue to
50:31
strength test and then we will use like the pulse sensor to
50:35
track workload as well. So yes, we're consistently and
50:41
continuously monitoring of the those objective measures.
50:45
There's not one like end all be all that.
50:48
If you get like a terrible score on this, we're shutting you
50:51
down. It's kind of like everything put
50:54
together, I would say. Trying to fill out the puzzle
50:57
the best you can and understanding if something's
51:00
down, we probably need something else that's up, or we're looking
51:04
for something else that's good, or the cause or the effect.
51:07
Yeah, it's that constant cycle. Well, Jeff, I, I don't have too
51:12
much else really. I just want to flip the script
51:14
one more time on you and talk about something Outside of
51:18
elbows, Outside of physical therapy, what else is tickling
51:23
your fancy these days? Well it is fall up here in
51:26
Wisconsin so that means hunting season so been trying to get out
51:30
in the woods as much as I can. The gun opener is this weekend,
51:34
so I will be I will be out in the woods dressed in bright
51:37
orange for most of the weekend. So I'm looking forward to that.
51:41
Other things that are kind of going on, I recently started
51:44
taking dry needling courses to kind of get get going in that
51:48
room. And so I've had a lot of like
51:51
interest spiked from that, just the way that the course I went
51:54
to taught everything. So been kind of diving down that
51:58
realm and begging my boss to buy some expensive E STEM units.
52:02
So we'll we'll see if we end up getting those.
52:05
But it looks promising. Yeah.
52:06
I think honestly, like it's a lot of work, a lot of trying to
52:10
take care of myself, a lot of trying to manage my patients and
52:14
it never stops, so. Yeah, I might need you to do
52:17
some work on my left hamstring because that thing's been
52:20
barking for a minute and I'm, I'm really thinking a couple
52:23
needles in the head of my hamstring could solve every
52:26
problem I'm looking at. We got to get you up here for a
52:29
visit at some point. That's right.
52:31
Yeah. I'm going to need to go through
52:32
that full assessment and I guess last thing I've got for you
52:36
before I let you go. I know it's not in the elbow
52:38
realm, but you've been working really hard on y'all's ACL
52:43
protocol. So I'd love if you could just
52:45
kind of open that up. I, I understand it, it's kind of
52:49
your brainchild or I know it's your teen's brainchild, but
52:52
you're, you're heading a lot of it.
52:53
At least your face is on it on social media.
52:56
So I'd love if you could talk about it.
52:57
Yeah, they've they've kind of made me the social media puppet.
53:00
I will not take the credit for the program though.
53:02
That is something that has been worked on for a while before I
53:06
got here, and that's thanks to the other therapist I work with.
53:09
So Michael, my boss, Brett, one of our other PTS, even Lauren,
53:14
Michael's wife who's also an owner here, they've done
53:17
tremendous work on that front. But our clinic, it essentially
53:20
opened because of two things. One, there's a pro guy who just
53:24
got Tommy John and he needed rehab done, so the clinic open
53:28
and then everything else was kind of designed around ACL
53:32
rehab. So ACL rehab is probably along
53:37
with baseball players. ACL is like the other biggest
53:40
thing we treat here. So we have a lot of systems in
53:43
place to help us with that. And part of that is like the
53:46
equipment we use, all right. We have dynamometers, we have
53:48
blood flow restriction training, we have the East End units, We
53:52
have all these, I guess toys. Toys are fun to play with when
53:56
you're working with a patient. Through a lot of practice and
54:00
trial and error with patients, we have a very solid plan that
54:05
we can set in place before the patient even comes in.
54:09
And that just comes from the experience of the therapist.
54:11
So like when I get an ACL patient, I can go and talk to
54:15
Brett, be like, hey, I'm getting a quad graph.
54:17
What are some of the big things that you think I should look for
54:20
day one, like even down the road?
54:22
And I can always talk to him about that.
54:24
They're always willing to help me.
54:26
So I cannot take full credit for heading that up.
54:29
I will say my face has been all over the social media.
54:32
I think I'm the new one. So they just kind of pick on me
54:35
I guess. Yeah, they got to utilize the
54:38
college athlete. Yeah, 100%.
54:41
Well, Jeff, I really appreciate the time today and I'd love for
54:45
you to share how people can either get in touch with you or
54:48
get in touch with the clinic in general.
54:50
You guys are obviously on social media so feel free to plug
54:53
whatever. Yeah, no, we're on Instagram,
54:56
Kinetic Sports Medicine and Performance.
54:59
You can also find us on the Internet at Kinetic smp.com.
55:04
If you are interested in booking like a free injury console, we
55:08
do offer those. Or even if you just want to book
55:11
like a discovery call to see if you'd be a good fit for the
55:13
clinic, those are probably the best ways to get a hold of us.
55:16
I myself am not really on social media.
55:19
My face is just plastered all over Kinetic, so yeah, those
55:23
would probably be the best ways to get in touch with the clinic.
55:26
Great. Well, once again, Jeff, thank
55:28
you so much. And to all the listeners out
55:30
there, thanks for laying back with us.