How To Understand Movement Complexity with Dr. Jeremy Paster

You're listening to the PT Profit podcast, episode number 136. Today I'm sitting down with Dr. Jeremy Pastor and we are breaking down how to understand movement complexity. Are you ready? Let's get started.

Hi, I'm Beverly Simpson, former fitness manager turned online personal training business owner and this podcast is where smart fitness professionals, including trainers and clinicians, discover how to increase client performance in movement, package and position their products and services and get out of their own way so that they can increase their revenue to live a life that they love without sleazy sales. Welcome to the PT Profit Podcast.

Thank you so much for pushing clay on another episode of the PT Profit Podcast. I'm your host, Beverly Simpson and if this is your first time here, welcome. I'm super pumped that you're here and today is going to be an awesome, awesome episode because I'm bringing to you Dr. Jeremy Pastor, who founded the Game Changer Physical therapy in New Jersey to change the current landscape of healthcare as we know it and understand it today, which we actually break down and talk about inside of this episode. With education as a founding principle, he has created an environment conducive to learning and strives to provide a deeper understanding understanding of symptoms and how to address the underlying cause. We talk all about root cause issues inside of this episode as well as fully understanding that each case needs to be looked at through an individual lens and have an individual approach. And Jeremy gives some insight into his process and how he's able to really look look drive adaptation for his patients as well as fully understand what is causing change and what isn't and gives you some insight as to where you can get started when really understanding complex concepts. You'll hear in this episode just how committed Jeremy is to a patient centered approach to eliminate long lasting Simpsons without the overuse of painkillers and unnecessary surgical interventions. He is dedicated to a lifetime of learning through continued education courses as well as broadening his knowledge of interdisciplinary approaches with a deeper understanding of complexity of the human body. He offers a unique and innovative approach to rehab. In fact, he is bringing to you the very first, he called it volume one of the Game Changer experience, which is going to give the coach or clinician an understanding of how to really look at complex movement situations, how to guess, test and assess and I know I talk about that a lot inside of marketing principles, but the same is true for movement and you're going to hear us talk about it inside of this episode. We talk a lot about how it's not possible to Learn in a vacuum. And Jeremy shares his experience of learning through the community through a collective, which is part of the reason why he's creating this first ever in person course. So be sure to check the show notes because space is limited and spots are already filling up, so you're going to want to grab your spot sooner rather than later. Dr. Jeremy grew up in New Jersey and played baseball in high school, where he had the privilege of returning as an assistant coach in 2019. He later earned his bachelor's in biology while playing collegiate baseball in college before moving on to receive his doctorate in physical therapy at Drexel University in Philadelphia, Pennsylvania. He's been afforded the opportunity to work with a wide range of patients throughout his career. Dr. Jeremy has been afforded the opportunity to work with a wide range of patients throughout his career, which he breaks down inside of this episode. So without further ado, let's go. Go ahead and roll that interview.

What's up, Jeremy? Thank you so much for joining me on the show today. How are you?

Good, I'm good. Thanks for having me.

Oh, I can't wait to dive in today. It's going to be an awesome conversation. So for those of my listeners who have not had the pleasure of learning from you, knowing who you are, I'd love for you to just start share with us a little bit about who you are, who you serve, and how you got there.

Okay.

So I'm Jeremy Pastor. I am a physical therapist. I'm the owner of Game Changer Physical Therapy in Freehold, New Jersey. I. Who do I serve? I serve. It's a wide range of people, but I would say majority of the population that I end up seeing are the people that have either very specific sports performance based goals and have been introduced to me through people that know me now, or they're people that, on the other end of the spectrum, have had five, 10, 15 years of pain, have been to many different PTs or rehab specialists, and just haven't been able to identify how to address their pain in a way that they'd be happy with. So very, very eclectic group of patients. But I really enjoy working with both those groups. So I don't really like to niche down any further than that. Um, but yeah, how I got here, I came out of school kind of working at your traditional outpatient, kind of like mill type of PT job, you know, decided that that setting wasn't necessarily for me. So I kind of quickly made. Made a change in my career and I think that that change has significantly impacted where I am today, really Partially by luck in the sense that my next job, I just happened to work closely with people that introduced me to the concept of just never being happy with what you think, you know. So I do give a lot of credit to that company and the people that I happen to work with, because when you surround yourself with people like that, it just kind of instills that work ethic in you. And then also you're pushing each other because we happen to be interested in the same things, you know, So a lot of my former coworkers and I used to learn together, used to chase the same things, used to come back to the office and constantly talk about things and, you know, from there was there for a number of years and just kind of circumstance and timing allowed me to open my own thing. And that company was super supportive of it too, which I'm always grateful of. And then I've been open Since September of 2019, which apparently is almost three years ago now, even though to me it keeps feeling like a year.

Yes. Because the blip. We had the blip.

Right. So, yeah, you know, just kind of learning about the business side of things along the way.

Yeah, I love that. You know, I think there is so much magic in the in person settings of connecting with co workers and the learning from the collective, I think is a very undervalued skill in, I'll say any industry is because we think, oh, you know, people want to learn in a vacuum. And that's just not the case. So I'm curious, as you've been really working in pain science your whole career, what are some of the common misconceptions in the industry that you feel like are doing patients a disservice?

Well, I think what I always say is the biggest mistake that I see anybody make, anybody, whether you consider them like super high level, if they're kind of more cookie cutter, the biggest mistake is thinking that things work in isolation.

Right.

So, you know, there, there's one end of the extreme where I don't necessarily agree with this thought process, but, you know, there's your clinician who receives a script that says whatever, right shoulder impingement, and they don't even perform an assessment. They feel like, I know exactly how to treat this. They have impingement because it's weak rotator cuffs, and they start chasing the right shoulder immediately.

Right.

So that's obviously an exaggerated example, but it happens way more frequently than we give it credit for. So that's one end of the spectrum. On the opposite end of the spectrum are I'LL say clinicians or coaches who I think are really motivated to learning and new things, who dive really deep into complex concepts, who can probably speak really well on these things. But then in practice, they're still like, oh, right shoulder impingement. Okay, I need to get this motion back from the right shoulder. This exercise does it. And I think it shows that, like, we're still kind of missing the big picture. Even though, like, we have the work ethic, we have the desire to chase super complex things, which is great, but we're applying it in a way that kind of proves that we don't really understand the depth of what we're actually doing for people.

So it's kind of like people try to learn how to swim while reading a book.

Yeah. It's just maybe it might be the way in which people are trying to acquire the information. It may be, you know, maybe they just don't have the direction to be able to almost be guided through practice. You know, it could be anything. Maybe. Maybe they're applying it exactly how they understand it.

Right.

And they're just not deep enough into their journey to fully understand how to apply it. You know, everyone's obviously going to be slightly different. It's just consistently what I'm seeing. Not just like, I guess on social media, because that's how I'm able to potentially consume what other people are doing, but also through patients that end up coming to see me.

Right.

There are patients that end up seeing me who, at least in their words, have tried things similar to the stuff that I'm doing, in which case I dive deeper into. Okay, well, tell me, you know, what did you do in past attempts? Right. Like, I really dive deep into, like, who did you work with? That's not really my intention to kind of go there, but I want to know, like, what things have worked for you, what things haven't. And that's how I'm kind of getting this idea of, like, all right, you know, this is a pretty common. I won't even say just mistake. It's just. It's incomplete.

Right.

It's. There are parts where, like, those things are appropriate, but it's never going to be the only answer.

So when you're, you know, when you're hearing this and receiving this information from a client, essentially, or a patient, I'll say, you know, how do you assess? Like, can you walk us through a little bit of your process? Because how do you assess what is. Because. Right. It's context based on. How can you determine what is you know what is actually happened from previous sessions, regardless of who it is, versus the filter of the client. Like, is this an adherence thing from the patient or is this an incomplete process?

It's a perfectly fair question. And I don't think that I'll ever truly know that.

Right.

Because you never know 100% what's happening when you're not there. But at least to be specific to your question, if we're talking about the same exact activity, right, the same exercise that I would give them, I watch them do it first before I teach them how I would do it. Right? So, but like you said, right. It doesn't necessarily mean it's the fault of, say, another clinician if they don't know how to do it. But if they're leaving another clinic and this is like their homework that they have to do and they're not executing in a way that's going to get them results, that is our fault.

Right.

And I even tell patients that myself. Like, I, I'm very honest with my patients to the point where I will take blame in anything because they need to know that I need to do a better job to make sure that they understand what I'm teaching them. So, you know, if it, if it happens to be an exercise where I would choose the same thing, I watch them do it first just to see, like, okay, you went somewhere else for four years. I'm exaggerating, right? Like, you went somewhere else for a long period of time. Like, you should have these basics down. Otherwise, how do we get past that? And it's the way you're doing this isn't going to get us the change that we want. And again, I would always say that differently to the patient. Other times they'll show me maybe homework that they're doing. And I'll say to myself, again, I'll say to myself, that's not appropriate for this person. And it's pretty easy to see why.

Right?

Like, like, that is just not the appropriate exercise. It's not hurting the person. Right. It's not like doing damage to the person. I don't mean it like that, but it's like, it's really easy to see, like, just through a simple assessment, like, they aren't appropriate for that right now. So again, I would not expect that to yield the potential benefits that if we just chose the right variation, like the power that that would potentially have. So I guess things like that kind of point me in a direction to say, like, probably weren't maximizing the efforts that we were giving and also, like, let's be real, they're in my door now, right? Like, they're, they're on my table. So whether that's, it's typically outcome based as to why that happens, but obviously there is the interpersonal aspect of it, of just like being able to build that rapport and have that relationship and make people feel, feel heard and, you know, being able to respond in a timely manner. Things like that matter. So I'm not discrediting that. But like, typically people don't leave someone if they're getting the exact results that they want. So, you know, kind of group all that together and then I just become super hateful and.

No, no. You know, so I'm curious, will you, can you walk us through an example? And it doesn't have to be like a client example or a patient example, but can you give us an example of, you know, an exercise selection that you understand why a clinician picked it and then what caused you to change the course? Like, what did you see? Like you said, you know, it's pretty easy to see that that's not going to work for them. So can you give us a tangible example of how you've seen that in practice?

Well, I'll be very honest right now. So again, I, I always kind of like simplify things into two boats. But on one end, if someone is seeing me after seeing like five other people, like, I've got the ultimate cheat code. As long as I'm listening, right? Like, I, they're not seeing results. So if I know what they did, I know that that did not create results.

Right, Right.

Like, or at the very least how they did those things that did not create the results that we want. So I already know what kind of doesn't work for these people.

Right.

And again, it could be execution, but at the same time, it's like if they just did, you know, five exercises with someone that they saw for six months, they're not happy with it. Are they going to come to me and I'm going to expect to give them the same five exercises that they just decided? Like, I just paid somebody else all this money and I'm not happy. Like, okay, so you're, you're telling me one small difference with this exercise, right? So like, there's the human element there that is very intentional in my mind as to what I choose for people if I know they have experience with other clinicians. But more times than not, it is just the fact that I don't fully agree with the process that maybe they used elsewhere. So I think that the most common one that I see and the simplest one that I see would be someone using like a low level exercise. So think like a 90, 90 position, laying on their back with their feet on the box or feet on the wall. Because it is a super common exercise that people give to patients and it's a great exercise. There's nothing wrong with the exercise. But then when I'm assessing the patient, the first thing that stands out is they have 60 degrees of hip flexion, or hell, maybe they even have 90 or 95 degrees of hip flexion. But if we put them in that 90, 90 position, it's like bringing them to the edge of what their maximal range of motion is. So, you know, like bringing them to the very end range of their motion is probably not a position where they're going to be able to like really coordinate the exercise correctly. So we might be better off at least teaching principles of the movement or just like foot contacts, hip contacts, things like that, like those aspects of the movement in a range that they could more easily access. So the smallest change is doing the same exact activity, but just within a hip flexion measure that they have available to them. And if we wanted to, we could even progress back to 90, 90 after they've kind of like bypassed that range and where that's no longer just kind of tinkering towards the edge of the cliff. So that, that's probably the most common thing that I see would be at least an example like that where someone's put into a motion where just simply through the assessment, I would never go there because they just don't have that degree of range of motion.

Now what causes that? Do you think that, that people have a hard time assessing or clients have a hard time communicating that this is the end of their range and people can't see that, or they just don't know, you know, they don't know what to look for, you know, because people don't know what they don't know.

Well, I don't, I'll never think it's a client's fault because we don't feel those things right. Like as the patient, what we feel is a stretch, a pinch muscle. And again, if it's not communicated well enough to us from our clinician, we have no idea what we're supposed to feel. We don't know what a right sensation, a wrong sensation is. We just kind of do the movement because somebody tells us like, this is what you need. I'll never blame the patient for not Knowing that that's not the right exercise for them. I think that it could be a couple of things. I think on the clinician side, it could be maybe they are doing an assessment, but they are, I'll say, a little bit more lenient in their assessment than maybe I would be for the same test. Meaning they're not necessarily being as strict with identifying where does this range of motion end. Or maybe just they're not super skilled yet in being able to properly identify certain ranges of motion because there is precision in it, even though it is like one of the simpler things we do. And I say simple meaning like, on the surface it doesn't look super complex, but there are ways to just use range of motion to guide our decision making. So it is important to at least be consistent within yourself with how you're identifying it.

Right.

Because there is no necessarily, like, perfect way to get these numbers. But then on the other end, it's sometimes people are. People learn or just want to learn in like a very cookbook fashion, right? They want to know this kind of like algorithmic way of treating where it's like, hit this exercise and then this, this, this, and they're doing that and they come up with that plan before even deciding, like, what outcome did this exercise create? They already know I want to go from here to here to here to here. And maybe those are the only ways that these people know how to attack something specific in their mind. So it's. It sounds bad, right? But like, when your only tool is a hammer, everything looks like a nail, so to speak, right? Try and fit these, like, these exercises to. To the person, right? Like, it's just, it's like, oh, yeah, you have hip pinching. Like, all right, do. Do these four exercises. And again, like, if you already decide that before taking your assessment into account to decide if those are the right variations for them, even if the principles behind them could be, you know, sound principles, you're just not going to create the change that you want. And then it becomes a cycle of. It's the same outcome for that person as if they were to go to, you know, these mom and pop meals that everybody wants to, like, put down that just throw them on the bike and heat and stim and all that stuff. It's like, okay, like, I agree that that's not the best treatment strategy, but just throwing super complex things at people and not understanding where, why, how, when is no different with the outcome, right? Like, that's how I feel.

Yeah, no, that's.

I'd like to Put at the end, in my opinion, so that.

No, fair enough. So, you know, I'm curious, in your perspective, you know, how do you. Because I do think there is a difference between. And I'm curious how you navigate. Navigate it because there can be a difference between what is part of the process in terms of delivering a result or delivering an outcome versus, you know, and staying the course versus the idea of, oh, no, we need to course correct. This is not the right exercise for this patient. How do you navigate that nuance? Because I feel like it's a nuance.

Yeah. I mean, I'll give the preface to it as saying, if we're talking specifically about improving movement capabilities, right. Like, we have to provide that context to understand. Like, what does it mean by, like, the right exercise? It's like, well, you need to specifically spell out your goal before being able to say how to determine if it's the right exercise. Right. Because, you know, if someone's goal is more on the training side of things and it's to improve, like, their maximal strength, it's like, well, that right exercise is going to be different than maybe what we're about to talk about. So context is going to be super important. Also, when people are just trying to consume information, if there's no context provided, they're going to take that and they're going to try and just fit it to their population. Even though, you know, I might not even be talking about their population. So I think the easiest thing, and I say easiest and I'll explain why it might be hard for some people, the easiest thing to do is have, assess, reassess, type of methodology. This is true of everybody, but especially with patients that I can, excuse me, that I consider to be complex, after every single exercise, I get them back on the table and I see what change that we made. Every single. Every single exercise I do one exercise, I recheck, I do the next exercise, I recheck. And the reason is. And again, we're talking about improving movement options, improving range of motion.

Right.

Improving certain table tests that just we use as a proxy to determine if this person is adaptable, if we want to use that word.

Right.

If I were to give them, let's just say, five exercises over the course of the hour session. And even if I was like, you know, super good at what I do and know that I need to reassess them after the session.

Right.

Which is great because most people don't do that. So I applaud even people that just go that route.

Right.

If after that hour, they get back on the table and I reassess, and it looks like the motion didn't change at all. Where did we lose it? We have no idea. Did we lose it? Did we never recapture it?

Right.

Like, did all five exercises create no change, or did first exercise create positive change? Second exercise, Second exercise, that's hard. Completely recaptures all the motion that we want.

Great.

Third exercise, we completely lost it. And then the fourth exercise, the fifth exercise just made no meaningful change. I don't know.

Right.

And it could be any combination of that, but we don't know if we're just waiting till the end. And now we check at the end and we say to ourselves, we didn't create any change. This plan sucks. Like, well, had you checked, the first two were the right exercise variation, done the right way, extremely effective for this person.

Right.

There was something in the whole process that then became less valuable.

Right.

Didn't create the change that you're looking for. So I'll tell you right now, there's in the. In the setting where people are seeing multiple people at the same time, which 99% of the time are not their fault because these are typically employees of other companies. Right. So I can't blame the clinician. But in those settings, it's most likely not possible to have this level of precision.

Right.

So now their environment is impacting their quality. Even if they wanted to, to do this.

Right.

Because they've got on the low end, three people in there overlapped over the course of the hour on the high end a lot more than I feel comfortable even saying.

Right.

So they're either at a different table with another patient, maybe they're able to give five seconds of attention to somebody while they're doing their exercise. Whatever the case is, there's not a chance that if you have multiple people in there at the same time, that every single exercise you're going to be able to recheck these things to make sure that your plan is correct. So now what? Potentially, and I'm not, I'm using myself as the example because we're having the conversation. But obviously I'm not unique as being the only person in the world that could do this, but in the potential of something that could take me one session, which patients still don't fully understand or appreciate, but what could potentially take me one session could take somebody else who knows exactly the same things that I know, who knows exponentially more.

Right.

Whether it's three sessions or 20 sessions.

Right.

If they're not able to identify what things are creating the change? They're going to miss some things and it's going to take a lot longer to basically like, guess because it is guessing, right? Like, if you can't give that level of attention, maybe it's a more educated guess than, you know, other groups. Who knows, right? Like, we could argue that until we're blue in the face, but, you know, they're just, they're not going to create that change. So we just need to be as precise as we possibly can, understanding that there's always going to be limitations in anything that any of us do. But that's, that's what I use to, to determine if we're creating change. And obviously you're always coupling those changes with the patient's symptoms because that's what they, you know, that's what they care about. That's what they're coming to you for. You know, and I have that conversation with the patients too. It's like this is my proxy to see if we're creating the change that I want. But I need to know what you're feeling too, to make that these things are going hand in hand.

That's so good. So I just had a curiosity, one clarifying question. Do you stop and reassess after every, in every session? So if someone comes to you and they're, you know, you're working on a rehab program essentially that you know, is going to take, you know, six weeks, you're literally stopping and assessing after every single exercise. Like every session.

I wouldn't say every session depends on who it is. It would, it would have to be very case by case to be able to explain what drives me to want to do it. Because I should also be very clear. Majority of what I see is not post op and not even to say that like, these things aren't important for post op cases. But, you know, there are certain people's rehab or training processes that like, you know, yeah, they just need to kind of commit to a plan, come in and work over a period of time. What I will say is if I'm, if I see someone who is having a lot of pain, who is super limited in certain things and who I'm not seeing as like their changes coming easily, that's when I really want to make sure that yes, after every single exercise, like, even if. So the way my, my gym is set up is my treatment area is in its own room and then there's a full kind of, you know, gym kind of like in this out outer space. So even if it Means like, we're out there. Yeah. I'll be like, all right, back in the room and let's recheck. If that's someone who I feel like I need that level of precision with, if it's somebody that, in my opinion, I feel really confident with the plan that is helping to maintain the changes that we're making, I might just kind of commit more towards having it look more like a training program. But then I'm always still rechecking at the end of the session. So in the perfect world, we would always check after every session, in my opinion, or I should say after every exercise. It's not always as feasible. But if it's somebody who you're having trouble creating change with, I think you make it feasible because then that's what's more important, rather than trying to just fit 15 random exercises in an hour session.

Yeah. You know what I hear about, what I'm really hearing from you as I'm listening to you talk is the importance and the drive and the need to really fully understand on a case by case, individual approach versus the cookie cutter, one size fits all type of program that I feel like so many people fall to, not even necessarily from the fault of their own, but just from the way the system is set up. Like, you're not going to be able to have that high level of attention when you have to see five people in 30 minutes or five people in an hour. It's just not possible to be able to look at it. You have to look for the shortcuts.

Yeah.

Yeah, that's hard. That's hard. Okay.

Yeah.

So I'm, I'm also, you know, one of the things too that you said, I heard you say, is that you're looking for an outcome or a result pretty much instantaneously. Like what is. Okay, great, so an instant result. So what is the. How long does it take the body to adapt that new pattern, that new result?

It's going to be different for everyone. It just is. The reason being is because the reason I, the way that I look at it is we're able to. What we're doing within a single session is almost seeing like what the body's ability to change is.

Right?

And again, I tell people this, I don't sell it as a magic trick. I tell people like, like, you know, when they're basically falling off the table because they're like, how the hell did you just do that in five seconds? I go, whoa, that is literally a party trick. You know, this is not. If you Walk out of here. It's very possible you lose it by the time you get to the car. Unless we create a plan that creates meaningful change and we'll only know based off of like, hey, what do you come in next time? And how are we able to maintain these changes to see if the plan that I'm giving you at is creating change to see if anything you're doing throughout the day is going to interfere with change, right? And again, there's exponential variables. So I always tell patients that my long term goal for everybody is that they just train the right way. My goal is not to keep them with me forever because there's never a time that we're ever going to get the volume of activity of the exercises that I give somebody, or the hands on stuff that I give somebody. It's never going to surpass the volume of movements that have got them there in the first place. It just, it's never going to. No matter how long somebody wants to stay with me and chooses to or has the means to, like, that's completely up to them. I leave that up to the individual, right? So how do we get the volume of movements? How do we get the volume of stress? How do we get the, the volume of specific adaptation? You know, if you're training three to four days a week and you're training an hour to an hour and a half, and you're doing whatever, 20 to 35 sets of exercises during that, that hour, it's like, all right, that times, three to four times. Nobody has an end game to training, right? They just, okay, today's Monday. This is the start of my next week, right? But everybody hopes to have an end game of rehab. It's like, I'm out of pain. I'm doing the things that, you know, my PT and I deem to kind of like say that I'm, I'm good with all this. So I would much rather someone think about training because they don't have a finish line. They have goals, right? They want to get stronger, they want to whatever, be in better shape. Maybe it's sports performing goals, right? But like, rarely do people say, okay, great, I got there, I could stop going to the gym. They just commit, right? It's just, they just commit to it. The people that enjoy it, right? They're just like, all right, great, like, I'm gonna keep going. So I'd rather get them to buy into that than ever think that they need to stay with me a day longer than they need to because I'm just not Doing what? I don't know what they think I'm doing. Probably I'd rather instill that type of work ethic and drive because that's how they're also going to get the volume. In which case it's not thinking in such a short term point of view, it's thinking about the long term and eventually. Right. As long as they're doing things with specific intent and specific understanding and if they have the means, like maybe they could work with people that could specifically program for them, or I could do it for them.

Right.

Like that's going to drive specific adaptation. And we could always get super specific with what the individual needs. But as much as that'd be great, I don't think 100% of people need that, especially if their alternative is doing nothing. My bias for them is that it would be great, that would be the best for them if there was some way to quantify it. But if the alternative is nothing, it's like I just want to get them to buy into something long term first. And we could always tinker with it over time.

Okay.

Yeah, that's good. Just to shift directions for a second. I'm curious to know, can you walk us through your process and how you are? Because we talked a lot about the assessment. You talked about range of moment, range of motion. Can you talk us through a little bit of what does your assessment. What are you looking for when you're assessing your people's movement? Oh, that was a big question. Okay.

No, no, it was a, it was a fair question. I think the reason why I make that face, I just, I recently had a conversation with my mentor and I made a statement that I like, I don't know, I was even partially embarrassed to say, but there, there are some things that I do that I, I can't explain because it's more intuition. And I just, I'm just not at the point yet with it being able to explain why my eyes went there. And if I even attempt to explain it, like it's not going to really do it justice and then it's really just going to confuse somebody. But I do my best to be able to explain. But on the simpler end, what I'm trying to do is I'm trying to basically understand does somebody have the available movement capabilities to do all the activities that they want to do throughout their day and throughout any specific activities that they're trying to do if they don't have the ability to move in that way? I want to try and reverse engineer what my assessment's telling me to try and understand what got them in this position in the first place. And then I want to just peel back layers of what got them there. So that would be like the, you know, kind of like assessment for dummies type of explanation where it's just. We're just trying to understand what is forcing them to compensate in a way that's then putting stress on certain areas that they're now experiencing pain in. Or if it got to the point where there was actual tissue damage, or even if we're talking about post op, which seems to be more predictable, it's like, well, what led to needing this surgery in the first place? Because that's what we need to do long term. If we're talking post op, immediate post op, we need to do, you know, like this immediate protective phase, which is still true, but long term, it's not just, you know, we didn't just like reset the clock and like completely, you know, say, okay, great, this is a new knee, so we could start from scratch. No, the rest of the body is still in impact. So what I do is try and understand how movement, or lack thereof, anywhere in the body is going to impact, how we're able to position certain joints and how we're able to coordinate certain movements. And then how we move and how we position joints is going to impact the stress that we're putting on different structures. The forces applied to the body, or the limitations can come anywhere else in the body that's forcing you to try and work around that. And then that could be putting a stress somewhere else. Does that make sense that I just. Yes, a little bit.

Right.

So no, no, no, that makes sense.

So I just need to get the full picture. Because if I don't get the full picture, and I think a right shoulder issue is just a right shoulder issue, I'm going to just treat the right shoulder. I'm going to just, you know, massage the shoulder, do whatever type of modality or manual therapy on it, and then think to myself, I need a strength, strengthen that shoulder. And if the issue that got them there was coming from maybe the other shoulder, maybe the hip, maybe it was even like a neck thing. Maybe it was even more complex than that, which I don't think we need to necessarily get into. And I don't catch those things, then the pain could absolutely go away in the shoulder. I mean, pain goes away through many, many, many different means. But is that rehab, right? Is that like skilled physical therapy? And is that doing anything to create positive change or is that just being there as time passes by and doing something to decrease, you know, their pain response. I think those are two very, very different strategies.

Mm hmm.

And, and again, this is why you say you can't learn in a vacuum. Like this is stuff that you have to be able to look at from, from the 30,000 foot view, narrow in and then come back out at that 30,000 foot view. Yeah.

So I'll tell you right now if you, if you want to understand how far this goes.

Yes.

Last week, first session, new patient, I had her do an exercise with her jaw and her big toe. Range of motion improved. And I'm not making that up. That is what happened. That is the only thing that I did with her on that day. And that was her first day. And I got there because she was introduced to this stuff. She was referred directly to me. I don't normally get super weird day one on people that I don't know. But like I almost did it more so as like a demonstration. It created that change. And I think that that's just saying like we're not just talking about like range of motion, even though we are proxy.

Right.

It's, it's a check recheck. It's something that is, I'll say, somewhat reliable in terms of being able to like compare self to self. But like it's, it is deeper than that in terms of what we're actually doing.

Well, and it goes back to your original point, which is that exercise does not exist or movement does not exist in isolation. That the whole body is a whole body and that we are, we are way more complex human beings than people like to, you know, people are going for the simple as opposed to understanding the ease and complexity.

Because in order to accept the fact that there's things that you don't know, you literally have to go into work feeling like you're doing something wrong. And people are, people are not comfortable with feeling like they're not the best at something. And I don't mean that in like a snobby way. Like it's okay, right? Like it's okay to be insecure about that. But especially for somebody who holds themselves in high regards in any field, right. And now be introduced to something that is basically saying everything where a lot of things that you thought you knew have just flat out been incorrect. You need to accept the fact that you have seen hundreds of people, thousands of people, and potentially did things that you're now telling yourself like, oops, yeah, right.

I can't tell you how many moments in my life, I've felt. And that's on all in any aspect. Aspect, right? That's where growth comes from, where I've.

Said, oops, I'm so to my first job, on average, I saw somewhere in the 70 to 75 patients a week range, right? Oh yeah, a week. It's the reason why it wasn't for me. So when I look back at that, and I was, or at least I feel like I've always been really good at like developing good relationships with my patients. Because even in that setting, right, Like, I would, I would do my best to spend time with people. I would do my best to walk over and check people on their exercises. But again, hindsight and also I was not practicing the way that I do now, right? So there's obviously a lot of variables.

Here.

But hindsight, like, not only was I, in my opinion, terrible at what I do, right. But I was also getting the degree of buying from these people that like, look to me almost like my patients now look to me. And that makes me feel even more guilty, right? Because now I think to myself, like, like even thinking about if you want to pick out a specific exercise or just how I came to the exercise that I was giving them, right? Like, because I remember my thought process. I still remember, like I'm doing a pretty much five minute evaluation. I had my aide who worked specifically with me and she was like my lifesaver, I'll tell you that much. And I still remember I had this like blank, like printer paper that I brought with me to the assessment because I'm writing things down thinking like, oh, I'm doing such like an important assessment. Look at how much I'm writing down. No one else is writing things down. And then at the bottom, at the end of the assessment, I would write down like eight exercises that I already knew they had to do. I have nightmares about this. And those exercises I would quickly hand to my aide who then needs to go, and they need to go online and they need to get these, these pictures and they need to print it out to give this person to tell them to do it at home. None of these, none of these. Maybe one did I teach the patient because after that I got to go and go to another patient. So then the aide needs to kind of just bring them through the rest, right? So like, I've been there. That was my first job out of school. No excuses. That was terrible, right? Like that. That is not what I do, but I've been there. And again, like, I was very fortunate in the circumstances that allowed me to, I say, escape.

Right.

But I mean, like, evolve as a clinician. Because in my opinion, though I met good people in that experience, had I stayed in that environment, there would have been nothing pushing me to get to where I am now. And hopefully, you know, from now, five years from now, I'll, I'll feel the same way.

Right.

About this. So. So yeah, I mean, I, I don't know if that's comforting or if I just completely damned myself by saying all that, but many of us have been there. It's just a matter of like, are you going to just accept the fact that like, oh, well, my environment, that's the best that I can do in my environment. Like, no, that's bullshit. Like, that's, that's just not true. That was my own fault. And I also happen to be super raw in just my education level to begin with. I've never been in that environment and done what I do now to know how those things would mesh well. Um, but also, like, I made a decision for myself that was not the environment that I could be in to provide the best care possible. And. And then I moved on. And then I moved on again. And now I get to build it how I want. And not everyone's built for that. Not everybody wants to do that. That's okay. But like, there are options out there if you feel like you're stuck in that.

Yeah. And I think that's so, that's so important is that, you know, a lot of people end up just getting, you know, in the mundane of, and being in the comfortable, because there is comfort in what you know. And it's easy to fall into that trap of feeling like, oh, there's nothing else. I can't do anything else. But that's just because you don't know what you don't know and there's so many other options out there for you. And then also I want to just reiterate too that, you know, especially I'm laughing because I, I've been there. That's, that was me too. When I first started working with moms, I realized oops after I, you know, because I had worked with so many moms prior to really diving deep into that world. So it's not about shame. So if that is you and you're like, wait, that's me, I'm doing all that. It's not about shame. It's about becoming aware. 95% of what we're doing on a day to day basis is just coming unconsciously and from our habits. And you can't change what you don't know, which is why.

Sorry. But it's also about like, knowing where to start. Because now, now what's happening is, I think it either it's potentially overwhelming for some people because they see. Maybe they see stuff that I post or, or the people that, you know, the, the circle that I travel in and they look at that and they're like, I don't even understand that language. Like, how do I even get there? Where do I start? And that's a super common question I think, think all of us get asked. It's like, well, where do I start reading? And it's. I like the question, right? Because they are. I think they're asking the right question, but it is a hard explanation. So that's, that's on us to be able to answer that a little bit better.

Right.

But in one respect, it's overwhelming because you're comparing like your chapter one to someone else's chapter 20, right. Or I should say my chapter. My chapter five. Right, my chapter five. And then there's someone else on chapter 10 and someone else.

Right.

So there's an element of that that I think is extremely overwhelming for people. And then there's the other element where they try and now acquire information through like, bits and pieces, right? That's why people are chasing the cookie cutter approach, because they so badly want to be different. Which again, is, is okay, it's great. But they're doing it in this watered down way where they're not actually doing what they're seeking to do, but they're telling themselves, like, hey, now I could say that this is what I do, something different. So they're like, they're starting at the end and then they're trying to work their way backwards and they're trying to mix and match random things and they don't even understand, like, the, the origin of some of these things to be able to provide it into the right context or understand where these things are coming from. And again, like, I'm not gonna, I'm not gonna criticize people because again, if I was back in that first job situation and I was ever introduced to this stuff too, my brain would probably be working the same way. I'd be super overwhelmed. I would think to myself, like, I don't have a clue what I'm doing, which I would be right? And then I would be like, what? How do I get this information as fast as possible? And if I were to tell you what my process has looked like, over the last six years, very few people. I'm not going to say none, because there's people that work harder than me, I would guess.

Right.

Like, very few people would just sign on to the stuff that I did over the last six years and more so before I was married and with a kid.

Right. But.

It was like an everyday thing. If you ask people at my previous job. So when my team at Parabolic, if you ask the. What do we have, like five people? If you ask us what we did on a daily basis, we enjoyed it because we had a great, great team and it was just fun to be at work. But, like, there wasn't a day that went by that we didn't do something educational. Not a day. And then it's like when I wasn't treating or wasn't trying to like, build the caseloads because I was a clinic director at the time. Like, if I wasn't trying to build the business, like I was learning every single day. That isn't. I wouldn't even say that's possible. That's overwhelming for people that are seeing 20 to 30 people in a day because then they have 20 to 30 notes they have to do at the end of the day because they have to get those 200 notes done by the end of the week.

Right.

There's other variables. People that have a kid, right. Like, my daughter just turned seven months, if I had her five, six years ago, do I feel like I have the time to put in the work that now allows me to maybe do that less frequently?

Right.

Do I spend six hours a day, every single day now doing it? No. But there are days where I'm trapped. I purposely trap myself in this room and kind of dive in. So you have to be able to find, like, the process that works for you. But you know, when I think back to it, like, I was just so motivated to have a clue. I'm not even saying to like, be the best PT ever, even though I do want to be that. But, like, I was just trying to be like, how do I even understand the slightest bit of this to be able to be better than what I am right now. Like, I wasn't. I wasn't watching like a two minute YouTube video and then like going and treating and thinking to myself, like, okay, I'm an educator now.

Yeah. I think that that is where true masters always say they. They become a master when they say I know nothing.

Right.

Is that there's a. You have to find that line of always being in that beginner's mindset of there's always more to learn and there's always more to sharpen. The side need to, you know, I want to say stay in the. No one ever just arrives at.

At the end.

Right. I think people are chasing this arbitrary. Like, once it's kind of that. Once I lose that last 10 pounds, then I'll XYZ once I get 10k a month, then X, Y and Z. Right. And that's just not. That doesn't exist. That's only essentially a story in the mind. At the same time, you need to put in the reps. Like, you need skill. Acquisition takes effort. You can't just watch a YouTube on deadlifting and then go hit the platform and then expect to win. Right. It's just not the. That's not how it works.

First off, there is no end.

Yes.

For anybody.

Right?

Even the people that you perceive to be at a point where you wish to one day be. If you talk to those people, they'd be like, all right. I mean, I don't have all the answers, but I speak. I still speak to patients that I had like four or five years ago. Not frequently, but every once in a while we'll come across it and they'll say something along the lines of like, don't worry. Like, I'm still doing that thing you gave me. And I'm like, oh, no.

Right.

Like, I have, like, I treated some friends in the past and I may have explained things in a super reduced way at the time. And. And then they're like, they're trying to now sound like an expert when they speak to other people. And then I'm caught in the middle and I'm just like, ah, how do I tell them everything I thought I knew? I completely disagree with now and then. So, yeah, like, it doesn't. It doesn't stop chasing you for the rest of your career. But I think if. If would. Would you. I don't remember where I heard this, but it was a phenomenal quote. I'm going to paraphrase it, but it was kind of like, you know, would you ever. Maybe it was David Goggins. Would you ever start sprinting if you didn't know where the end line was? It might have been David Goggins. That sounds like a David Goggins thing, right? Like, hell no, I wouldn't. Yeah, but that's just because I would die.

Right.

But you know, like, that's kind of the concept, right? It's like, there is no end game. You just need to kind of constantly Be working at a really uncomfortable level and appreciate the fact that like you're just gonna keep going, keep going. There's gonna be different hurdles along the way and you know, yeah, every, everyone's process is gonna look somewhat different.

Yeah, for sure, for sure. Okay, so I definitely wanna be mindful of your time. So for those of you who want to learn more from you, hang out with you. What are some of the best places I can send them?

Well, the first best thing would be the upcoming course.

So I'm pumped. I can't wait.

Yeah, it's volume number one. First one ever. March 19th, March 20th, game changer experience. So that's going to be a two day live course only available live in the gym that I work out of. So at Iron House Performance center in Freehold right now there's only like a handful of spots left because I am capping the number of people that are coming. So that's going to be, that's going to be fun. That's going to be interesting. It's the first time that I'm just standing up there for 16 hours. We're not even going to sleep. We're not even going to sleep. We're going to go through the night. Whenever it ends, it ends. Or whenever I drop. So that would be the most, the.

First place, best place.

Yeah, that's the most formal way to learn from me. Otherwise, I do my best to kind of get some quality stuff out on Instagram. What's my handle @gamechangernjpt? Had to think about that. So I just, you know, I try to provide some context to some things that people are learning. I try to make things as relevant to what people actually care to learn and not just drop like a five best exercises for hip pain. Because I just, I don't think that way. But who knows? That page will always evolve. At one point you'll see like the five best exercises for plantar fasciitis. And everyone's going to call me, you know, phony. I'll never do it. I'll never do it. It just wouldn't interest me. I'd rather Cancel My count first. There's not a whole lot on YouTube, but I do have a YouTube page. Maybe I'll get back to that one day. There's just only so much time in the day. But it exists. There's some stuff up there. Some old interviews with some physician assistants, some trainers, Cairo just kind of talking about some, some common interests and things like that. But yeah, otherwise I do work with people one on one both on a treatment level and on a mentorship level. I do have a number of pts that come and see me as a patient and almost double that as, like a mentor session to where we're working on things that they want to work on. But they're also learning as to, like, why I do what I do for them specifically. So I think that's pretty cool. That was something that just kind of came up and started happening, but I love it. And I also love that they have that level of interest and I don't know, I guess modesty to trust someone else with their treatment. But yeah, any. Anything that you're interested in, just kind of like, hit me with a DM and I'll just tell you if I do it.

Yeah. Love it. Okay, so we'll be sure to link all of that up in the show notes. So thank you so much for pouring into us today. I really appreciate it.

Yeah, absolutely. That was fun.

Cool. Talk soon.

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