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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
I've been doing this for more than 10 years, and the learning curve just keeps, you know, going up. And I, by no means, feel like, that I'm at the end of that learning curve. Like, I I really learn every day. Welcome to the doctor JJ Thomas podcast.
Dr. JJ Thomas:Hey, everybody. Welcome to the doctor JJ Thomas podcast. I'm JJ Thomas. And today, I have my very dear friend and special guest, doctor Johannes Rodel.
Dr. Johannes Roedl:Welcome. Thank you. Thank you, Katrina. Thanks for having me.
Dr. JJ Thomas:I, I gosh. I'm so honored to have you here. I was telling I was telling doc before we started how, you you know, one one of the reasons I wanted to have you on is because I've found through my relationships with doctors like you that I've been able to help more people. We've been able to help more people collectively, collaboratively together than I think either one of us could maybe on our own. So today, one of the reasons I was excited to have Doctor.
Dr. JJ Thomas:Rodel on is not only to share his gifts and talents and skills as a musculoskeletal specialist, and an interventional radiologist, but also just, his experiences with collaborating with physical therapists like me. And, and I'm hoping it can benefit, UPTs out there as well. Side note, if you're a patient or a a regular person and watching, you'll learn a lot too because he does some really cool things that maybe would help you. So, anyway, we'll get started.
Dr. Johannes Roedl:Thank you, Che Che. Thanks for having me.
Dr. JJ Thomas:Yeah. So I thought I'd share with the group a little bit first about your background. If you could, out of your words, kinda tell me, first of all, in your own words, how you do what you do, and then also a little bit about your background and and what led you into musculoskeletal radiology.
Dr. Johannes Roedl:Yeah. Of course. So I, I grew up in Germany and I I did medical school there and, then trained in, in Boston for 10 years and then came to Philadelphia. And my specialty is really, it's a little bit of a strange niche. I always say strange because it's, not as common because I come from the radiology from the imaging side.
Dr. Johannes Roedl:So I did, radiology, intervention radiology, and then specialize really in the orthopedic system. So what I do is, I do orthopedic procedures, but I don't do surgeries. So I I'm really, and it's what really is along with the lines that you said earlier. I'm in between what j j does with physical therapy and surgery and that that kind of entire space in between is what I what I cover. So a lot of it is an injections of biologics, you know, prp stem cells and that background, having that background in radiology and intervention radiology, which are really the experts in guiding needles in the right space that helps me to, you know, get those biologics and and prp treatments in the correct, tendon muscle or in the joint space.
Dr. Johannes Roedl:And I think this is kind of, the somewhat different, approach to a lot of other, folks who work in that area that, I do have that intervention radiology radiology background. Also from an imaging perspective, I'm trained in reading MRI's. So when patients have MRI's or need MRI's you know I can directly relate to that and help in the interpretation as well. And then ultrasound is the main tool that I use for diagnostic purposes to so to to make the diet right diagnosis. And then also, I use ultrasound to guide the needles in the right spot.
Dr. JJ Thomas:Yeah. That's one of the things I've loved about working with you is well, first of all, back to what you said about the skill of being able to look at the imaging. And and I think, you know, you you that rolled off your tongue so easily and and because I know you do that every day. But but as a as an outsider watching you do your work, I think that's so valuable as you said for patients who are trying to figure out their next step. Like, is there a next step to go see the orthopedic surgeon?
Dr. JJ Thomas:Is their next step to just continue on the conservative physical therapy track with us? And I think what I've seen through my work with you is that you have developed such a, a rolodex, if you will, or or or a a history of this case looked like this. We treated it this way and it responded well or or it didn't respond well. That you're really able to help patients make those decisions. Yeah.
Dr. JJ Thomas:And that's been really fun to be a part of watching you.
Dr. Johannes Roedl:No. I agree. And I think, with ultrasound specifically, because you are someone who comes from the movement part of, you know, medicine, so everything is in motion and that I'm a big fan of that as well. The problem that I have had with MRI in in training is that it's static so patients are flat, you know lying in the scanner and you don't see like joints attendants in motion with the ultrasound machine. And this is really the same ultrasound that we have been using for decades.
Dr. Johannes Roedl:You know, in in pregnant women to to image babies, we use that now for the last really 10 years has been taking off in the, orthopedic system, the musculoskeletal system, and we can image and see tendons and joins in motion. So when I have a patient, I always do dynamic imaging. So I look at the extensive attendance, the 5 a pitcher baseball player at the U. C. L.
Dr. Johannes Roedl:The on the quadrant ligament in motion and we can stress that joint and see how that ligament acts. And you can do that, you know, with MRI or or x rays. So that's the the huge advantage of having that, that ultrasound from a diagnostic perspective.
Dr. JJ Thomas:That is that is. I I had the pleasure of getting to watch doctor Rodell do his thing one day and and it was definitely one of the highlights of my career. And that was one of the things I was most impressed upon. Like, as physical therapists, we, you know, we train our physical therapists and we we are trained ourselves to to do special tests and to see, you know, if if it's gapping or to feel if it's gapping. But that's such a subjective thing, sometimes really hard.
Dr. JJ Thomas:We're listening to pain, but you can literally see inside it while you're doing this dynamic testing. It's really cool.
Dr. Johannes Roedl:Yep.
Dr. JJ Thomas:The other thing I found really surprisingly interesting when I was there with you was, we had a case where, I believe it was a football player. Football lacrosse. Anyway, he had a a pretty large hematoma, and I I just watched you drain it. I was like, I never, you guys, you could literally just see this, like, suck out of his ad it was an adductor. And I'm like watching it, like, I was like a kid in a candy shop.
Dr. JJ Thomas:I was like, that's amazing. I mean, some of the stuff you can do for just getting you know, I mean, obviously, inflammation has its purpose and and and there's potentially a need for some of that inflammation to facilitate, healing. But also, when an athlete needs to get back, it can sit there and, like, I describe it to patients like marsh water, it can inhibit the healing too. So Yeah. I found it really cool that you could see that real life as well.
Dr. Johannes Roedl:No. Exactly. I mean, that's just really, going back to using ultrasound then for for procedures, like you, it's very difficult to do any of those procedures blind. And we we always thought that even the easiest injection, like a knee joint injection, we always thought that experienced orthopedist would have a close to 100% rate of success of getting into joint. But there have been studies actually that did show it's way below that.
Dr. Johannes Roedl:So And you know, it's it averages out to about 80%, you know, so which is not bad. But if you, if you have 10 patients, 2 of them do not get the ideal
Dr. JJ Thomas:Yeah.
Dr. Johannes Roedl:Injection in the right spot as a patient, you just don't want to be in that, you know, in that in
Dr. JJ Thomas:those percent sounds great unless you're in the 20%. Exactly. You know?
Dr. Johannes Roedl:So that that's the advantage really of with ultrasound that you are, it's basically guaranteed, you know, if you have the experience to do procedures that you get in the right spot and this is something like a hematoma aspiration, you really have to find that that pocket in that hematoma which you can only see an ultrasound to really be able to drain it. And the same with we always talk about injections and biologics like what is the best is it prp is it stem cells But it all starts really with the image guidance. Like it doesn't there's no value if you have the best product, the best PRP that is out there but if you don't get the peer p like in the exact spot where it has to go it's completely useless. So that's why I think that it can be overstated, like, how important, like, ultrasound really has become for for orthopedics in general.
Dr. JJ Thomas:Yeah. I'm glad you said that because that's something we try to stress with our with our participants in our courses in general. Like, especially with dry needling, it's like, you can teach someone to needle, but if you're not needling the right spot, it's the same exact thing. Like, a lot of people are needling just the the painful areas, but they're missing the movement. You said yourself, like, we're we're movement we consider ourselves like movement diagnosis.
Dr. JJ Thomas:And, and, yeah, if you're not needling the right spot, it's the same thing. It's not gonna help.
Dr. Johannes Roedl:Yep.
Dr. JJ Thomas:So that's that's awesome. I, yeah, I wish I, you know, I send so many of my patients to you and exactly not only because of that, but because I know actually, I even watched doctor Rodell when I was there. He's one of the first docs that I've seen in the office really do a test retest. Like, he he you know, you took the time to actually do an assessment instead of just sort of putting going right to the imaging. Like, you also used all of those clinical, tools and and matched up what you saw movement wise with what you're seeing on the
Dr. Johannes Roedl:Yeah.
Dr. JJ Thomas:On the imaging.
Dr. Johannes Roedl:No. It is it is really a fascinating field. And at the same time, you know, what I said so far, everything sounds easy, but it's also very humbling. I mean, I've been doing this for more than 10 years, and the learning curve just keeps, you know going up and I by no means feel like that I'm at the end of that learning curve like I really learned every day and you know, the potential is still so much greater, there's so many more advancements in technology we will have the next few years and I'm really just, yeah, proud that I'm able to be part of the other group in that field. So I'm really excited about the future.
Dr. Johannes Roedl:But it is it is very much, you know, something that you can't take for for granted. I mean, it's really something that takes practice experience. And then as a physician, we always have to stay humble Mhmm. And, continue to educate yourself, learn, you know, talk to colleagues, go to meetings, talk to other experts in the field like you. And I think that's something that that special connection we have had is, that that makes me so much better in my job, like knowing what you can do from with your group here and you know that that's important I think for any specialty to to keep reaching out and not only in your own specialty because after a while you kind of you lose the big picture.
Dr. Johannes Roedl:Yeah. So I'm always looking to really stay in close contact with, orthopedic surgeons. Yes. Physical therapists like you, trainers, athletic trainers when it comes to the sports teams. That's really where I learn most these days.
Dr. Johannes Roedl:So it's it's it's huge.
Dr. JJ Thomas:I think and we all learn from each other. Like you said, I do think when when it's about the patients, that's the other reason I think you and I connected right away is like our our true mission is really to help the each patient. And so as you said, if you're really if we're really gonna help patients, the best we can do is learn learn about other professions that are treating the same type of patients with same type of problems. So that when our patients need their services, we can refer them appropriately. And that is like there I mean, so many times now that I have this relationship, it's so much easier for me when I have a patient where I'm like, oh, I just don't know.
Dr. JJ Thomas:I'm like, go see Rodel. Go see Rodel. You know, it's it's so much easier.
Dr. Johannes Roedl:Yep.
Dr. JJ Thomas:So I'm thankful for that. I know you're always learning. I know you also are doing a research project. Right? Currently?
Dr. Johannes Roedl:Yeah. We always Let me talk about that. There's I'm still like very close, involved in research with the university and, one of the main things I'm I'm working on is really figuring out, like, what the the ideal biologic is. Like, is is it PRP? Is it, stem cells or specifically bone marrow aspirate injections that I mainly perform?
Dr. Johannes Roedl:And then I have several, like, projects that I are ongoing with the professional sports teams where ultrasound is really also becoming, extremely valuable, especially, like, during the games. You know, I do ultrasounds there diagnostically where you can then decide, if someone has, let's say a hamstring injury, is it a a minor injury during a game where it's really very subtle and the player functionally can still do, what he has to do in during the game, we can send them back out. If it's something more serious and more moderate grade strain, then we completely pull them out of the game. So Awesome. This is something that we weren't able to do really in the past.
Dr. Johannes Roedl:So these are examples of, like, the professional level where ultrasound, just as much as for our weekend warriors and regular patients, has made a huge impact. So that that's exciting. So I do a lot of research in in that area as well.
Dr. JJ Thomas:Yeah. On the on in the in terms of, like, the rapid testing rapid ultrasound testing to see where where we go from there?
Dr. Johannes Roedl:Exactly. Like and basically in game, you know, during the sports games.
Dr. JJ Thomas:That's great.
Dr. Johannes Roedl:It it will really be in orthopedics. I think it already is, but it is kind of the aside from the physical exam, almost like the, the the the next best thing or the partner of the physical exam, I would say. You know?
Dr. JJ Thomas:Yes.
Dr. Johannes Roedl:Where ultrasound will will just completely take over Yeah. The diagnostics. Because you can't have a an MRI scanner. There are some sports stadiums that have them, but it's it's really not during the game because it takes us, you know, it takes 20, 30 minutes to get an MRI. The ultrasound, I can within, like, 30 seconds of, and I can make a diagnosis.
Dr. Johannes Roedl:So that's just damn priceless, you know, especially in the sports world.
Dr. JJ Thomas:Yeah. And you mentioned, like, I know we just had you come out recently for a talk on on the benefits of PRP versus stem cells, and, I would love if we talk that a little bit. And and also, I will say, you know, when you and I first started working together, I I believe I even called you because I was like, okay, doc. Like, people are talking to me about let's actually go here for a second. People are talking to me about stem cells and I I came to you asking about the difference between bone marrow aspiration stem cell versus, you know, umbilical cord, stem cells and, can we get into that a little bit?
Dr. JJ Thomas:So more honestly, my intention here is for therapy for patients to understand because I do think patients hear stem cells and they sort of think they don't really know where they come from.
Dr. Johannes Roedl:Yep.
Dr. JJ Thomas:And I think there are even therapists out there who aren't sure exactly where they're coming from and and what's your experience with that?
Dr. Johannes Roedl:Yeah. No. That's a that's a great question because it's so there's so much out there, in the public and a lot of misinformation and patients are, I think, being promised a matching wand, you know, with stem cells, but it's really not that easy. Yeah. I mean, the the short answer, and then probably my frustrating answer is that it really depends on the patient.
Dr. Johannes Roedl:You know? So that's why, for me the most important thing is to, you know, see the patient examine the patient, do the ultrasound review any other imaging that has been done, MRI's etcetera. And then also look at the patient's goals and you know, is the patient a professional athlete, a weekend warrior or someone who doesn't do sports at all? And at the end, any of those treatments, you know, might be right for that specific patient. But I always feel that when it comes to stem cells and prp that prp has been so successful really and we have significant data that I usually in most patients start with PRP also because the the access and getting prp which stands for platelet rich plasma.
Dr. Johannes Roedl:So it's really for you guys who are not familiar. It's done by a simple blood draw, so it's very easy to get. So the patient gets a blood draw, the blood goes in the centrifuge and the what we isolate from the bladder are the platelets because the platelets are the cells that release growth factors and your body naturally uses platelets to heal injuries. So if you have a cut in your arm, the body basically sends platelets there to heal that cut. And we are basically trying to replicate the body's response by, doing a blood draw and getting those platelets and injecting those platelets into the injury.
Dr. Johannes Roedl:Let's say you have a hamstring tendon tear or tennis elbow, common extensor tendon. So we basically use your own body for healing. And the reason why I do like prp is because it's it's very safe to get, you know, those cells and the outcome has has been generally very, very good. You know, it depends on the injury and and severity, obviously, but overall, patients do very well. If patients don't respond well to to PRP, then, I usually go to the more, more advanced biologics, which mainly in my practice is the bone marrow.
Dr. Johannes Roedl:Yeah. So instead of a blood draw, we we draw, bone marrow, which is actually it it looks similar to blood. Yeah. It's a little thicker and it has stem cells.
Dr. JJ Thomas:So cool.
Dr. Johannes Roedl:And, and those stem cells can they're a little more potent than than platelets, so they release, different growth factors. And they also, at least in theory, we think that those cells can develop into like cartilage cells and and the cells of the muscle of myocytes that can then really heal injuries even better. So that's overall, like my approach, is to start with the least invasive Mhmm. And
Dr. JJ Thomas:And the more studied.
Dr. Johannes Roedl:And the more studied Yeah. And and really the one that had has proven results at least in in in most practices. So that's why in general, going back to the first statement, it depends on the patient. But if you ask, like, in general, I would say, like, PRP first and then Yeah. And then bone marrow.
Dr. JJ Thomas:Can we talk a little bit more? I remember when you came and talked with our crew about about some of the benefits and some of the ways you do your procedures. You talked about the different percentages. Like, how diff I didn't realize until you came and gave us that talk that different docs will do different percentage of, I think, platelet versus, right? So
Dr. Johannes Roedl:Exactly. So there's one big, group of PRP. One is called leukocyte rich and one leukocyte poor.
Dr. JJ Thomas:Yes.
Dr. Johannes Roedl:So the platelets are high in both groups, but it's the leukocytes that make the difference. And leukocytes are, the white blood cells, and those are cells that cause inflammation.
Dr. JJ Thomas:Mhmm.
Dr. Johannes Roedl:So really depending on on the condition, in some conditions and some injuries you really want inflammation. And that's mainly conditions that are chronic. So if you have someone with chronic patellar tendinosis
Dr. JJ Thomas:Yes.
Dr. Johannes Roedl:That has been going on for for months or even years, you really want to stress and stimulate. And the white blood cells are perfect for that because you inject those with the with the platelets and, that causes inflammation and the body really wakes up
Dr. JJ Thomas:Yeah.
Dr. Johannes Roedl:And tries to heal that that tendon. Boom. And it's it's damage
Dr. JJ Thomas:It's like it's cute. Right?
Dr. Johannes Roedl:Like Exactly. Like you you tell your
Dr. JJ Thomas:body Yeah.
Dr. Johannes Roedl:Wake up. There's something wrong. Yeah. It gets inflamed and then the body will respond and will try to heal. And you can and on the prp systems and most of them, you can basically pick, you know, it's a simple button in the preset
Dr. JJ Thomas:So cool.
Dr. Johannes Roedl:If you want leukocyte rich, so you want the leukocytes in your product, in your PRP, or if you don't want them. And
Dr. JJ Thomas:That's great.
Dr. Johannes Roedl:There are some injuries where you don't want really the white blood cells, you don't want inflammation that is usually true for joints because it's it's not a good idea to inflame a joint too much. Yeah. You can inflame a tendon, but inside a a joint that usually has not not good effects overall, so the inflammation should stay down. Like, if you have a patient with a cartilage defect, you really don't want to inflame that cartilage more. You want this to get the good cells, the platelets, but then kinda let it rest.
Dr. JJ Thomas:You don't want to see it as a threat. That's how we would talk about it probably. Right? Like, you don't want
Dr. Johannes Roedl:the body to see it as a threat more. Exactly. So in joints, usually we stay with leukocyte poor. So, not many leukocytes. And also if someone has an acute injury, for example, if we have, a muscle injury, a muscle strain on Monday morning after the football game on Sunday.
Dr. Johannes Roedl:There's already enough inflammation that your body if something happened yesterday there's enough inflammation you don't want to add on to that inflammation. Great. So we stay away from the the white blood cells, the leukocyte rich PRP. So we do the leukocyte poor there.
Dr. JJ Thomas:Yeah.
Dr. Johannes Roedl:So that's really the the big, the the two big groups are leukocyte rich and leukocyte poor PRP.
Dr. JJ Thomas:When we were talking about the chronic cases, I was thinking, you know, I know some docs I don't know how you feel about this, but some docs for a while, it seemed like the the standard was doing like a a 10otomy with the PRP, injections. Do you still do that as standard if you're doing like a leukocyte rich, or not always? Again, I'm sure it depends on the patient, but what are your thoughts on that?
Dr. Johannes Roedl:Yeah. No. That's a great question. So I I still often do it because the great thing about the tenotomy is that you, for example, going back to the extensor tendon at the elbow with the tennis elbow that there's often so much scar tissue that has built up Yeah. You know, when it with the tendinosis that it's good to go in first and loosen up, release that scar tissue.
Dr. Johannes Roedl:It's almost like a debridement, and that also creates space for the PRP. Sometimes the tendon is so tight and so scar that when you try to inject prp, there's no space to go anywhere and with the tenotomy with the needling first, you really break up the tissue release some of that bad tissue and then you have space for for the prp. So in the vast majority of patients, I do the
Dr. JJ Thomas:the anatomy,
Dr. Johannes Roedl:you know, the the needling before.
Dr. JJ Thomas:That's great.
Dr. Johannes Roedl:Hamstring also is a good example. Eductor, origin, that's usually pretty pretty aggressive, 10otomy.
Dr. JJ Thomas:That's great. That's all really helpful information. And how do you what is your frequency like if you see someone for a PRP injection? How when do you like to follow-up with them usually?
Dr. Johannes Roedl:So I, I give every patient my my email also, and there's some form of follow-up, mostly over the phone about 2 weeks. I would like to hear from them. Just to see how they are, you know, giving any other instructions regarding rehab pt if they're ready to to go back and and ramp it up in in pt so that the 2 week follow-up is the first one and then it really totally depends on the injury. But I I usually like staying in close contact with patients because especially with the PRP there's often like a series of 3 injections. So I I bring them back and that that also depends on the injury.
Dr. Johannes Roedl:But a common protocol is like one injection and another one, 6 weeks after the first and then another 4 to 6 weeks. Yeah, I
Dr. JJ Thomas:love that.
Dr. Johannes Roedl:The second one, the third one. So that that's, like, a a common protocol, but it also depends really on the injury.
Dr. JJ Thomas:And so I know when I heard you say that when you came to to lecture with us, that, that made sense to me because of tissue healing time. Therapists, like right? Like, 4 to 6 weeks for soft tissue healing time. So if he's doing PRP in a in a soft tissue area, that makes complete sense to me. Another question that I know I remember picking your brain about, because it varied.
Dr. JJ Thomas:Like, when I first started hearing about PRP procedures being done way before I even met you, many docs at the time were recommending, like, strict rest for, like, a long period of time, like, 6 to 8 weeks. And it was as a therapist, I was like, oh my god. I need to keep them moving. How am I gonna do this? So, and I know things have changed, I think, on the research front with that.
Dr. JJ Thomas:And so if you could maybe speak to that a little bit.
Dr. Johannes Roedl:No. Yeah. That that has really completely changed. When I also started like 10 years ago, we had patients, you know, for p o p around the ankle tendons in the boot for like 6 to 8 weeks. Yeah.
Dr. Johannes Roedl:And then in arm slings for rotator cuff p a p and other things and that completely changed. So we'll be never really immobilized anymore and patients. It's really very simple. Like I tell patients that there's nothing you can do after the prp to undo it.
Dr. JJ Thomas:So
Dr. Johannes Roedl:you you can stay almost as active as you would like. But I know that the first week, you know, they probably
Dr. JJ Thomas:had a tonotomy and yeah.
Dr. Johannes Roedl:Exactly. They can't do much. And the reason why I say that that there are no limitations at the beginning is that, I want patients to not be scared at all Yeah. Of moving. And all they do at the beginning is really just, you know, getting around, like, daily activities.
Dr. Johannes Roedl:Yeah. It depends on the peer p where you give it but usually patients do have soreness especially the 1st 2 to 3 days. So and then it's really getting back into pt pretty much right away and there is there's some like a short ramp up but it's really not like it used to be in the past. Yeah. We are having patients rest like 6 to 8 weeks.
Dr. JJ Thomas:So thankful for that.
Dr. Johannes Roedl:So that's that has really completely changed.
Dr. JJ Thomas:And because I work with you so much now, I just wasn't sure if that was a you thing or a trend thing.
Dr. Johannes Roedl:So I'm
Dr. JJ Thomas:glad to hear it. Sounds like it's a trend in general with most docs that they're that they're getting rid of the the long immobilization period after it.
Dr. Johannes Roedl:Totally. I mean Yeah. Like, just to I mean, when I said that, anything is tolerated, I mean if someone has a let's say a grade 2 hamstring strain or like a high grade tear of the let's say the patellar tendon. I don't want patients to start running, you know, like Obviously. Like week 2, but I I don't want patients, for example, with the patellar tendon, we had them on crutches, you know, so that has changed.
Dr. Johannes Roedl:You know, we have them walk right away if they're less tolerated.
Dr. JJ Thomas:Because well, I think also what we know now too is that, basically, the PRP process is stimulating a a healing process. But if you're not using that area, then the brain isn't even gonna isn't gonna capture it as much because it's if you're not using it, then it's it's not gonna integrate it. Right? Yeah. So I think, like, from our side of things, I think what I encourage therapists to do in our office is, like, let's say it's a grade 2 hamstring strain, like, we would still treat it the way we're going to treat it by honoring the inflammatory process and honoring the muscle healing process in in a sense, like, maybe we'll do muscle activation exercises, but we'll start with isometrics so we're not putting too much stress on the contractile mechanism itself.
Dr. Johannes Roedl:Exactly.
Dr. JJ Thomas:And just letting that letting that good juice just sit there and do its thing.
Dr. Johannes Roedl:Yep.
Dr. JJ Thomas:But also integrating it neurologically and vascularly etcetera.
Dr. Johannes Roedl:Exactly. Yeah. That that's where everything is moving that direction. I couldn't agree more.
Dr. JJ Thomas:Yeah. What what else do you see? So I I wanna pick your brain on this and I, I hope you feel free to speak freely, but you know a lot of therapists are now starting to get into like getting ultrasounds themselves And I know you and I talked about it briefly, and I, like, you know, I would be lying if I didn't say there were times I was I wasn't I was tempted. Like, we treat a lot of jujitsu athletes and arm bars, like, elbow, you know, they're so common. And sometimes I'm like, I wish I could just look at this real quick, but I also know it would take I don't know that my accuracy would be so great anyway.
Dr. JJ Thomas:It would take a long time whereas you already have it. So I'm just curious what your thoughts are on that on therapists who are considering.
Dr. Johannes Roedl:No. I think it's awesome. I mean, I I totally encourage that. I mean, I'm I'm excited when I see, like therapists getting into that or athletic trainers with the teams with the sports teams because it's really it would be sad if you would lose out on that technology and and like everyone can learn and you guys also have the huge advantage that you know the anatomy, you know, because that's always number 1 is like you already know like where attendants attach, you know, which tendon is is where, so you have a huge advantage. It's I think that the it takes a little bit of time though, you know, like I think it's it's it's easy to, to get like overly confident at the beginning.
Dr. Johannes Roedl:But on the other hand you would also realize that
Dr. JJ Thomas:There's so much to learn.
Dr. Johannes Roedl:At the beginning when you look at at any structure and ultrasound and you really have to look at 100 of patients to know, like, what is normal
Dr. JJ Thomas:I mean, I feel that.
Dr. Johannes Roedl:So I think that's,
Dr. JJ Thomas:just knowing being humble with it at least. Yeah. Right? At first and knowing your limits.
Dr. Johannes Roedl:Yeah. And and as I said earlier, I'm, like, still humbled every day, by everything I do. And and I think with ultrasound, especially at the beginning, it is it is a lot I mean that it's not like one of the for example what I always say is like learning cat scan x-ray and MRI is so much easier because it's, it's a static image. Yeah. And you can, you know, there are books you can look up or read an anatomy pictures where everything looks the same as on that MRI.
Dr. JJ Thomas:But if
Dr. Johannes Roedl:you have an ultrasound, you are the one who is taking the picture. So first of all, you have to make sure that you image the right spot. And then, it's everything is is also not as pretty, like it's prettier to look, everyone can see an x-ray, okay, that's the the humorous, that's the femur, you can see the bones Yeah. You know? On ultrasound, it's not like that.
Dr. Johannes Roedl:The picture is pretty abstract. Yeah. You know, it's all like gray and white pixels. So, I think that the my bottom line is like I would definitely learn it. Like I encourage everyone to get into it because it's I think it's the future and it's it's fascinating.
Dr. Johannes Roedl:And, you know, everyone will love it. You know? Yeah. Once you get good at it, it's the best thing. It's great for patients, but it's also it's not easy.
Dr. Johannes Roedl:No. You know, that that's it's not something that you can pick up over Yeah.
Dr. JJ Thomas:So don't expect to buy this unit and then all of a sudden be diagnosing things.
Dr. Johannes Roedl:Right.
Dr. JJ Thomas:Right.
Dr. Johannes Roedl:Exactly. It takes it takes I mean, I would it takes years Yeah. You know, to get really good at it. Yeah.
Dr. JJ Thomas:So what so I guess with that, I would love to be able to help that kind of along those same lines. I'd love to be able to help therapists as I told you before the show started. I I would love to be able to help therapists and other clinicians embrace this type of relationship that you and I have with our with our patients and and so I would love to hear from your perspective what you look for in a in a physical therapist that you'd like to collaborate so that maybe they could mimic some of that and have have those good working relationships for the sake of our patients?
Dr. Johannes Roedl:No. I think in general in medicine, I think number 1 is always communication. Like if I I think a physical therapist who is brave enough to reach out to other physicians I think is key. Like if I only get you know the physical therapy, you know you guys have always a report, I'm not sure how it is with elusive your insurance based. Do you get the report that
Dr. JJ Thomas:Totally.
Dr. Johannes Roedl:That for me is, no offense, but it's, it's not nearly as good as having a direct conversation. So I think and I know that time time wise that's not always possible but I think if you really want to embrace that relationship, and I think it benefits the patient obviously at the end, like, you you would have to pick up the phone Yeah. And try to, you know, talk to the physician because that's really number 1 for me is communication. And then and then someone who is also, like open to maybe doing things like a little different or outside the box who is open to, you know, especially if you have complicated patients to be open to like new things because I think the problem in medicine, you also have sometimes you get into your ways that you have been doing for for years, even decades and you just don't want to get out of this. But I think, there are patients where you have to, you know, otherwise you just we are lost and you have to, you know, be open to if we as physicians have ideas that you could try differently or the other way around if if you feel like, hey, there's something not quite right with this patient.
Dr. Johannes Roedl:Like, did you look at that, maybe see him again and or her and and and look at that part, you know, the injury? I think you're missing something here. So I think thinking outside the box, you know, within the realms of, like, obviously being, doing the right thing and being, you know Being
Dr. JJ Thomas:crazy about
Dr. Johannes Roedl:it. Crazy?
Dr. JJ Thomas:Yeah. Exactly. Exactly.
Dr. Johannes Roedl:I think that's important. So those two things, communication and having the willingness to think outside the box are for me the most important.
Dr. JJ Thomas:I'm glad to hear you say that because I know you're you're very, deliberate with the way you treat in terms of you you honor the research, but but I think a lot of clinicians on in my world sometimes honor the research so much that they forget to ask they forget to look outside the box like they forget to ask we don't get answers in my opinion unless we ask questions and I think sometimes the therapist want so badly to honor the research that they forget that maybe the research is 10 years old by now and like they have to look at the patient and still ask questions. Yeah. So that's that makes me so happy to hear that. And the communication thing, I'm glad you said that because, you know, now I've been a PT for, oh, god, 24 years now, and and having these conversations with docs is very easy because of established like, I feel like I feel confident in my conversations with docs and so, but I remember if you're a new therapist listening, I remember like those first phone calls calling doctors, and and I will say if you are a new therapist it's worth taking the time to organize your thoughts before you call them because if they're willing to get on the phone with you and they're as busy or busier than we are, I a 100% promise you, then you wanna make sure you're valuing their time.
Dr. JJ Thomas:So my advice to you guys based on what doctor Rodell says is, like, spend 10 minutes before you call them back and get your thoughts organized on what they need to know so that you're honoring their time, so that you're not rambling on and trying to out what your point is. When you call them, you have a mission and you need to know you need to tell them exactly what they need to hear for their patient, and that's gonna make your relationship with them a whole better.
Dr. Johannes Roedl:Yeah. No. I agree. And I think you'll be surprised how how much it's really appreciated by physicians too because I think for us also the other way around is the same. Like we feel like you know should we try to call someone maybe they because you guys are just as busy, you know, is it really do they remember the patient?
Dr. Johannes Roedl:Is it complicated? Are they not in the office? But it doesn't hurt to
Dr. JJ Thomas:reach out
Dr. Johannes Roedl:to try either way you know and I think I've never had a conversation with a physical therapist or really any other the healthcare professional was involved with a patient where I hang up the phone and I was like that was really useless. There's always something that we get out of it and even if it's ending nowhere, it's still like, okay, at least we know that's, that's off the table or, you know, so I think, it never, never hurts. And usually you know, it's the right thing to do.
Dr. JJ Thomas:I'm glad to hear you. I'm glad you said that because I think therapists are sometimes intimidated to call docs. So it's really good to hear. And they think that that that note is a way of honoring their time, but I agree with you. I always felt that way.
Dr. JJ Thomas:I felt like the note was a little bit impersonal and not really giving the juice of what they needed to hear for those patients. Yep. So that's great advice. Well, thank you. This has been so awesome.
Dr. JJ Thomas:Thank you so much for sharing your knowledge and taking the time to just sit with us and, kind of explore the realm of both what you do for therapists and patients who don't really know of the worlds of a of a musculoskeletal radiologist. And, I know I always learn something every time I'm with you, so I'm sure they've learned a ton. So thank you so much.
Dr. Johannes Roedl:Thank you. Thanks, JJ, for everything you do, and thank you to everyone who's listening. We really appreciate all the all the hard work you you put in every day.
Dr. JJ Thomas:So if you guys, if you're in the local region check out doctor Johannes Rodell. He's very local and you can find him easily by a Google search, or you can reach out to me, DM me or whatever and I'll get you in touch with him, but he's very useful, in the Philadelphia region And if you're not in the Philadelphia region, I encourage you to go out and, find somebody almost just like him. There's nobody just like him, but if you can find somebody almost just them, then you're gonna be in good shape, for you and your patients and your business. So go forth and be awesome. Thanks.
Dr. JJ Thomas:Take care.
Dr. Johannes Roedl:Thank you, guys.