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The Physio insights Podcast by Runeasi
Welcome to The Physio Insights Podcast by Runeasi, your trusted space for real conversations at the intersection of science and sport.
Every two weeks, we sit down with passionate clinicians, biomechanists, and rehab experts to share the insights, tools, and stories shaping the future of running performance, injury recovery, and movement science.
🔍 Created for physical therapists, gait geeks, and rehab specialists who care deeply about helping athletes move better, faster, and stronger.
Hit subscribe and elevate your clinical game!
Welcome to the Physio Insights podcast presented by RunEasy. I'll be your host, doctor Jimmy Picard. I'm a physical therapist, running coach, and team member here at Runeasy. On this show, we have real conversations with leading experts, digging into how we recover from injuries, train smarter, and use data to better guide care. Whether you're a clinician, a coach, or an athlete, we're here to explore what really matters in rehab and performance.
Jimmy:Let's dive in. All right, Chris, welcome to the Physio Insights podcast. Good to have you.
Chris:Yeah, thanks Jimmy. I'm excited to see you guys start up a podcast and you know, you've had some great guests thus far and you know, it's always a privilege to be able to talk to you and compare notes.
Jimmy:You were high on the list of guests who wanted to get on ASAP. Maybe we can start with you just filling the audience in on your PT philosophy and how that has evolved over the course of your career.
Chris:Yeah, for sure. And I would say that when I I was very spoiled, and I sort of somehow don't even know how to explain, I somehow got involved with this really incredible group of people when I was at University of Delaware. So I started off just as an open major when I was an undergrad, transferred to Boston College thinking, you know, hey, go into finance and management information systems, try and make a bunch of money and life will be good. And I got up to Boston College, and it's a great school, academically. But I realized that I was sitting in a financial accounting class one fall.
Chris:I'm thinking, no way in hell is this what I'm gonna be doing the rest of my life. And it just hit me like a ton of bricks. And, you know, I made the decision to transfer back to the University of Delaware. And, you know, my older brother was sort of an impetus for, you know, nudging me to go to BC. But I was also dealing with a shoulder injury that ultimately required surgery.
Chris:So, you know, I was in rehab at that time, and was always fascinated by the rehab process. I had sustained a couple injuries from sort of, you know, exceeding my capacity as a young athlete. And I always found it just fascinating that PT got me back not only to sport, but at a higher level. And I also learned a lot about myself. So I think that was my calling.
Chris:And then once I got back to Delaware, I didn't even know they had a PT program. So I just started flipping through one of the the school bulletins and, you know, it dawned on me, they did have a PT program. And I was looking at some of the research that some of the faculty were doing, and I just walked over to McKinley Lab, which is where their PT program was housed at the time. It's since moved, to the southern part of the campus, and I just started knocking on doors. And Lynn Snyder Mackler basically said, I'd love to have you as part of my research team, and that kicked it all off.
Chris:And where I'm going with this is, you know, so I spent close to five years in her lab between undergrad and grad, and then I was an assistant to Doctor. Axe, who's an orthopedic surgeon. So, you know, I would get twenty to thirty hours of rounding with him going room to room, and I did that for three years. So I came out of school, and I was very overconfident. I'm like, I have this all figured out.
Chris:You know, I've trained with the best people. You know, Delaware's orthopedic program was exceptional. And, you know, I thought I could just swoop in when I got to NISMAT and just start fixing everyone's issues without really understanding their situation. And I've always, you know, prioritized relationships. You spoke to that from the outset.
Chris:But, you know, I would say that over time, you know, rather than going into these clinical interactions where there's a little bit of a hierarchy where I'm this quote unquote expert, and someone's coming to me to fix their problems. I look at this much more as when I connect in consultation with people that we're two equals, right? And I want to do away with any hierarchy whatsoever.
Jimmy:Was that true fresh out of school?
Chris:No. I always would spend time and I was good at listening. Yeah. I will say that I I feel like that I did well. But I still thought that I was this operator, if you will, more than an interactor, and I was doing things.
Jimmy:Remember there was a big post back, like maybe the Soma Simple group kind of talked about For sure. Remember this? Yeah. And that was when I was first graduating PT school. And that hit home to me as well.
Jimmy:Especially in most outpatient settings where you get the patients coming to you with that expectation of you as a fixer. And it can put so much pressure on you and it's hard to get out of it.
Chris:Yeah. So I would say that over time, that's really and I think deep down, I knew that probably wasn't the way to go. But, you know, I think you want to sort of flex and you have an inflated view of yourself and you're really what you bring to the table. So now it's like, I know people really have the ability to take ownership of their situation. They're not fragile.
Chris:They're not dependent. You can easily create a dependency as a clinician that you have to be careful of. But, you know, I would say that I'm not, you know, and I love this phrase, like this worried hand holder. Like when someone comes in, they're alive, they have a pulse, they're going to adapt if we create the right environment, but to really challenge them to freeze of explanation, own their shit, right? And I think everyone's capable of doing that.
Chris:And I also am pretty philosophical about this stuff nowadays, because I know that if I can get people to trust in themselves through this physical therapy process, that I've seen this time and again, it has this ripple effect. So they get on the other side of this injury and they're like, wow, I was able to do this. And they get reacquainted or discover this newfound confidence in themselves, and you sort of see them start to blossom in other areas of life. You know, there's some great, great people out there who discuss coaching, and they talk about how you're touching a leaf, you know, which is at the end of a branch on a tree. But when you touch that leaf, you're affecting the branch to the tree trunk all the way down to the roots.
Chris:And I think that when we are working with someone, not only are we helping them, but if that person starts to blossom, I think that can be transformational in society. And that's why I take every clinical interaction very serious.
Jimmy:And so you brought up this idea of instilling trust in the or getting the patient to trust themselves or trust their body again. Yeah. There's a saying I often say with patients is trust is lost in buckets and gained in drops, right?
Chris:1000%.
Jimmy:You're presented with this injury, all of a sudden you lose trust in that body part, you lose trust in yourself and your ability to train. And depending on where you are, like how chronic of a condition or what's going on, sometimes I find that is the hardest thing of patient care is getting them to trust their body again. I had a patient yesterday ask me who's going through a very tough time with an injury, she's just lost all trust in her body. And literally it was one of the exercises, she had one exercise to do, which was just a leg extension. And she asked, how do I know if I'm doing it right?
Jimmy:How do I make sure I'm doing it right? Like she doesn't even trust herself to do a leg extension correctly. So like, yeah, do you have strategies to help with this? Like, what do you think?
Chris:Yeah, I mean, often, without trying to shift the focus to me, you know, just stuff as simple as like, I share my story in my About section on my website. And I think that that is oftentimes a talking point where people know that I've been sort of in deep dark places myself as an athlete as well as a person. And I think that that, you know, makes me a little bit more relatable. And, you know, they also know that, hey, if if he was able to do it and he had some of these, like, pretty involved orthopedic conditions that, you know, maybe I can do this too. And that's a lot of the silent videos.
Chris:I mean, it was always like, show me, don't tell me, right? So just to say, hey, here's an exercise. But I think that requires really being in the moment with that person and making sure that you're not distracted. And I think that's one of the challenges that certain people who are in busy outpatient settings, if you're running around going from one patient to the next, it creates this low level of distress or anxiety that becomes palpable and people pick that up. So but yeah, I think it really depends on the person in their situation.
Chris:But you also have these sound bites like, hey, rule number one, load the tissue with the issue, that our nervous systems are primed and get better through repetition. So don't worry about that first repetition. May be a little bit, you know, perhaps it's uncomfortable. Maybe it's not perfect in terms of a form or technique, but through repeated exposures, that you're going to get better at this and your body's going to adapt.
Jimmy:Yeah. So going back to like your your philosophy with rehab and how it's evolved, it sounds like communication, building rapport is kind of like at the foundation of your practice. Is that right?
Chris:Yeah, I think the first thing that has to happen is people need to feel seen and heard. Because if you don't start there, I think everything else takes a backseat, you know. And that person's not gonna trust you. They may not buy into what you're doing. And I think a lot of people who have been a part of the medical system almost feel like they've been dismissed or someone's so quick to jump in to render some treatment or intervention.
Chris:And this doesn't mean you need to spend an hour on the subjective, but make sure that you let that person voice some of their complaints or frustrations. And then I think you can start locking arms.
Jimmy:So giving them the place or the time to speak, I think I was going through Nathan Carlson's course and he talked about this really resonated with me. Like in PT school, I remember specifically going through like the subjective exam, like skills building them, and the teachers teaching you to rein people in when they start going off on tangents. And Nathan had a point where he's like, there very rarely are there actually tangents. So that you're always picking up something valuable from those.
Chris:Yeah. And I think that's just creating a safe environment and also being curious about what that person's saying. Not sort of like because I think people sense if you're trying to rein them in. Yeah. And that just will create a disconnect from a therapeutic alliance standpoint.
Chris:So yeah, let people talk and you never know where that could end up. You may find out something that really impacts, you know, maybe the need to make a referral. I've had a couple instances where I'm like actually concerned about, you know, there potentially being an abuse situation. And if you don't let people, you know, take that conversation where it ends up going, you may completely miss that.
Jimmy:Yeah. And so I think I'm also going through your course and you start your course with this lecture on therapeutic alliance, motivational interviewing, and all the things we're talking about. If we move on, like are there other pillars of your rehab that you think we should, that all of us should be aware of and make sure we're doing?
Chris:Yeah, I think that one of the things that I see clinicians have a tough time with is really trusting their gut, or their intuition or their hunch. And I think that, you know, you get that intuition from blending hard data with soft data, if you will. And I think you have to be careful of making assumptions. So I had an athlete that and this is outside of physical therapy. This is more an athlete I'm coaching, which is you're operating in a different capacity.
Chris:But she I had this hunch that, like, something was off. And in my mind, I thought it it pertained to fueling, like, you know, I just started getting a sense, like, why she's doing these these challenging training sessions, and she's always reporting that they didn't go well, and she's sort of tired and lethargic. I'm thinking like, okay, I'm seeing the training session, know, seeing her comments, and I'm like, you know, there's a fuel and consideration here. And I also think that there's some stuff in terms of her life and her ecosystem that, you know, I definitely have formed some thoughts on, but those are assumptions, and you don't bring those to the table. But I just engaged her, and and look, I could be wrong a lot of the times, and I think this opens up dialogue, but I said, I have this hunter instinct that just we're missing something here.
Chris:Am I right? And she's like, it's funny you mentioned that, because there's a lot of stuff that I feel like, you know, we should discuss or get into that I haven't been forthright with. And that just opens up, you know, there's the opportunity right there.
Jimmy:What do you think? Do you think most of us are too afraid to trust our instincts? Like we're just not, we're not going to open up? Yeah.
Chris:And I think that don't bring assumptions to the table. So I've had people in a that I've consulted from a physical therapy standpoint, and I say, hey. Thanks for giving me a lens and a you know, the moving parts, but I still feel like there's something that I'm not appreciating or I don't feel like I have a grasp of? Is there anything else going on that you think ties into this situation? And they're like, you know what?
Chris:I have this asshole boss at work, and all they do is undermine my efforts. And I've never dealt with this. And, I feel like they're just getting in the way of me advancing in this company. And I just it racks my brain. I'm thinking, that's it.
Chris:Like, that's really important. And that may be the first time that they've ever actually disclosed that to someone, because maybe they're a private person.
Jimmy:Yeah.
Chris:And so
Jimmy:Yeah, and so this is like, you're well, so I guess what do you do with that information when you get it?
Chris:I just try to say, what's the bigger picture here? And I think that it first just starts with acknowledgment for them to actually verbalize exactly what they're thinking, because otherwise, those thoughts fester. And I firmly believe a lot of stuff like that can start manifesting in the form of MSK complaints. And that's not a stretch. I lived in New York City.
Chris:I've seen some weird, wild, wacky stuff. But if you get people talking about it, I think that becomes therapeutic in many ways.
Jimmy:Yeah, it makes me think of a woman I've been consulting recently. She works in tech, super busy job, chronic knee condition that's just been in and out of different doctors, seen all the specialists, nobody's found anything wrong with her. And one of our last calls, just broke down crying about how stressful her work situation has been, how she hates it. She's trying to get husband just left his job and they're relying on her income for the past six months. So she's under all of this pressure.
Jimmy:She's lost her outlet of running and surely it's contributing in some way. And I think you're right, it's like just getting her to open up. Like she said, like, you're the first person I've talked to about this. It puts you in an interesting position though, because we are at the end of the day, we are physical therapists, not psychologists. And it's like, you're in this gray zone at times.
Jimmy:How do you how should we handle that?
Chris:Look, if you're dealing with humans, you're dealing with emotions. And I think that, you know, you're not trying to, you know, make some diagnosis, but you're just trying to say, what are what are the contributing factors to this person's situation? And maybe that opens up the discussion to say, hey, you know, have you ever thought about discussing this with a counselor, psychologist, psychiatrist? But I think that, you know, don't shy away from discussing or letting people share those emotions because that's part of it, you know. Yeah, it's physical therapy.
Chris:But, you know, if you're working with humans, no matter what field you're in, you're dealing with emotions on some level.
Jimmy:Yeah. I feel like a lot of PTs are afraid to because you feel like you're overstepping in a way, even though, like you said, you're not diagnosing and you're not often you're not even offering a recommendation, you're just listening.
Chris:Yeah, and it's funny how therapeutic that can be.
Jimmy:Yeah, it makes me think of what are your thoughts on this is kind of along the same lines, but like patients like this patient I'm describing, she's also somebody who is grasping so tightly to a successful outcome, like that's all she's thinking about. And I see a lot of times when I have those patients, those are the ones they have the hardest time getting back. They're like holding, they're trying so hard to do everything perfectly, following all your instructions exactly right, and maybe overdoing it because they're so committed like most runners are. And it seems like a lot of times those people, they're so caught up in the outcome that they're just not doing well. Like, have you seen that as well?
Chris:Yeah, for sure. And I you start to have concerns about perfectionist tendencies. But I think that one of our roles is self discovery, asking people questions that no one else has posed to them. So they start to conjure up, you know, their own thoughts, perspectives, and solutions. That's empowering to me.
Chris:I think that with an out, like, as a consultant to a lot of people, they hire me because they know that I have some degree of expertise and experience and have helped other people navigate this with success. So we are focused, you know, on a particular outcome. And oftentimes, once they reach that goal or outcome, you know, they move on. Great, you know. But I think that if you're engaging with a patient, and it's more you're mapping out a plan of care, that that's a little bit of a different beast.
Chris:But I always say F outcomes. It's my goal is for people to have self discovery along that way, and to have moments.
Jimmy:And so for that self discovery, are you just trying to engage them more? Like, ask them, like, what do you think we should do in this situation? Or how are you doing that?
Chris:Yeah. You know, and sometimes they may say, well, what do you think? And I'll say, well, I can share my suggestions with you, but I also have zero expectations that someone follows my suggestions. If they fall into the T, I'm actually a little bit concerned. Yeah.
Chris:Because I think that, you know, that starts to basically almost fall into perfectionist tendencies and making sure we do everything to the T.
Jimmy:When I used to see a lot more, like when I worked in a traditional clinic and I would see a lot more post op total knees for instance, and the ones that ended up needing like manipulations under anesthesia, they were always the type A person who was just trying too so hard doing everything, doing the exercises three times a day. Those are the ones, it was hard because those were the ones I was seeing that were getting stiff, tight, they needed It wasn't the one that was sitting on the couch, chilling, relaxing, watching Netflix.
Chris:Yeah. Yeah. There's sort of this, you know, low level almost anxiety about worried that they're not gonna have this this perfect outcome. I've seen that pattern too, for sure.
Jimmy:Yeah. So then, yeah, like continuing with your philosophy, evolving things like, I'm just curious because I I don't really know this. We haven't spoke on this before, but interventions that you that you used to do, that you don't do, like, what does that look like?
Chris:Yeah. I would say that I've become much more hands off. So, you know, I used to do a lot more work at the level of, say, the lumbar spine, you know, I would get into muscle energy techniques, you know. I was very fascinated by a lot of, you know, the stuff that say, positional diagnosis early on in my career, you know, I thought there were certain therapists who had these magic hands. And, you know, I think that that's really fallen by the wayside.
Chris:Right now, you know, when I connect with people, it's like, okay, you know, let's clearly define point A, where we are now, understand where that person's coming from in terms of their past medical history, social history, athletic background, and take the time to, you know, ask some questions so I have a good appreciation of the backdrop of life. So and then from there, just being, you know, calculated with my loading programs and taking a little bit more of a minimalist approach or prisoner's dilemma approach, you know, as Dan John would say.
Jimmy:It's funny you bring Dan up because I was gonna Sorry to interrupt. I was gonna ask about that because I recently read Interventions. Yeah. And I know he was big on what you just brought up, which is figuring out where the heck this person is right now. Because so often it's like, we think we're doing it, but maybe like, are you really like understanding where they are right now?
Jimmy:But yeah, sorry to interject.
Chris:Well, because I think if you don't identify where point a is, and I talk about that in the course, that's the whole idea behind your clinical examination and the physical performance test. Does this person have a knee effusion? Can they do a lateral step down? Because, you know, that's going to ultimately dictate the crux of your plan of care. Right?
Chris:And I think that people don't clearly identify point A, and then they just start throwing spaghetti against the wall and seeing what sticks. Know, and I think with lower limb tendinopathy and bone stress injuries, you need to pretty you need to be not perfect, but you need to be calculated and make sure you have some semblance of what point a is.
Jimmy:Yeah. So what you're saying is you've gravitated away from kind of more hands on techniques evolving to this leg loading program, it sounds like. Understanding where they are, having a strong understanding of how to load the tissue.
Chris:I would say the other thing that has really changed is I'm pretty blunt with people. Once we establish rapport, and I also think that one of my pitfalls earlier on in my career is I would make concessions. Now I'm saying there's got to be an accountability factor. Because if you're not doing your shit, what are we doing here? Right?
Chris:This is your situation. And I think a lot of clinicians are afraid to have some of those more blunt conversations. If you take the time to establish alliance, you don't need to be rude about it, but just to say, hey, we mapped out this plan of care And you said that this is really important to you. But when I look at whether or not you've done these exercises, oftentimes they're not getting done. And I'm just trying to make sense of this because you're telling me it's important, but your actions are inconsistent with what you're saying.
Chris:Can you help me understand that? You know, or maybe I have this wrong. And people are like, damn, no one's no one's sort of called me out before. Yeah. And I think that's really important because how does that person grow and evolve and have self discovery if they're not going through the stuff you discussed, right?
Chris:It's like, what are we doing?
Jimmy:Yeah. So along those lines, how are you doing that? Is this a phone call with the patient? Is this like
Chris:It all depends on, you know, someone's preferred communication. I think that if you are going to do this in an email that you really need to take a step back before you send that email, right? And just to make sure that it's not misinterpreted. Sometimes if say, if it's someone of an older generation, you know, I'm probably more likely to pick up a pick up the phone and give them a call. Sometimes it could be through text or the messaging feature on the EMR.
Chris:But, yeah, I think that accountability is really important. My kids know this really well. And also, if I'm working with someone, if I were to consult someone and, you know, and I didn't hold up my end of the bargain, well, again, I think that that detracts from what we're working towards.
Jimmy:I have a two two part question, like, with the plan of care that you would create with a patient, or a client, however you whatever you wanna call them, are you pretty explicit in expectations moving forward of what you want to see get done? And how do you lay out the expectation?
Chris:Yeah. So I consulted a few people in the past few days and I tend to spend more I'm a point in my career where I have a little bit more luxury in terms of controlling my schedule. So I'll spend ninety minutes, sometimes two hours with a patient or client, depending on the context, and then I'll send them a detailed email that for the next four weeks says, okay. I'm gonna have you do this strength or drill program three times a week on nonconsecutive days. And I make it so there's no excuse.
Chris:They have all of the information, video hyperlinks, a framework in terms of sets, reps, auto regulatory training, and I send that to them. Right? Yep. The first point of accountability is if they don't email back and say, just wanted to say thanks for the session and let you know that I got the program, I message them. And I say, hey, hope you're having a good day.
Chris:I just wanted to double check, make sure my program didn't end up in spam or trash, right? And that's my first like tug on their shirt to say, hey, are you with me? Did you get the program? What's up? Yep.
Chris:Because if they don't, if someone sent me a program like that, I'd be like, hey, thanks so much for the time. Found the session really helpful, and it's so it just puts me at ease to have a roadmap. That would be a response that I would give if some if I knew someone took the time to do that. Now, again, you have to part with expectations, but that's my first accountability check, right? Okay.
Chris:And if I'm working with an athlete where I have their program in TrainingPeaks, for example, you know, and I see a bunch of red, meaning the program that training session didn't get done. I'm saying, hey, just wanted to make sure you're okay. You know, I see this red. Did you do the workout? That's another just so I am always trying to keep keep tabs on people, because this is about behavior change.
Chris:And if they can't be held accountable, then maybe we shouldn't be working together, or it's not the right stage of change for them to really commit, right?
Jimmy:Yeah, there's that saying like, how many therapists does it take to change a light bulb?
Chris:What's the answer?
Jimmy:One, but the light bulb needs to be ready for change.
Chris:Yeah, yeah, that's great.
Jimmy:Let's like hone in, I'm just curious, on patient. So when you a patient, does a typical plan of care look like?
Chris:And when you say plan of care, like what I'm mapping out for them in follow-up?
Jimmy:No, I guess more like, so you see them for this extended eval where you spend a lot of time upfront with them, getting to hear their story, doing your objective exam, finding, establishing point A, and then laying out the plan. You having them come back to you every week? What does follow ups look like? What does that session What's the plan of care laid out? Not just exactly what you're doing, but how often are you seeing them and how are you holding them accountable?
Jimmy:How often are you doing?
Chris:Yeah. So I I can maybe bring up a a couple different cases. So I saw a woman two days ago, and she's relatively new to running, you know, has a decent athletic background in terms of softball, volleyball, and, you know, she's sort of developed an interest in basically leaning into running. And she at one point may have tripped off some hip soreness. It was bilateral.
Chris:It was lateral aspect of the hip. So no history of bone stress injuries, no risk factors that we would be concerned about. And when we connected, I said, look, you passed all these physical performance tests with flying colors. There's no concerns I have from an MSK standpoint. And I think that she may have been worried about perhaps some throwaway comments that people made like, oh, your hips are off, stuff, you know, slides.
Chris:I took her through the objective, the table exam. I took her through the functional assessments, and I had her hop on the treadmill and everything checked out. There's some stuff I could really nitpick with in terms of her treadmill analysis, maybe she'd benefit from a little bit of a nudge with her cadence or step rate. But I said, look, you're already you're running. I think you would benefit from maybe upping your running frequency by one day a week because she was running twice a week, and one of those was a longer run.
Chris:I said, don't get too fixated on that long run. Let's let's maybe try and get you to three to four days a week of running on nonconsecutive days and do some strength training on the other days. And don't worry about what anyone says about your running form right now, because I know through exposure that she's gonna self optimize. That's what Izzy Moore showed in 2012 with recreational distance runners. So that's one of those situations where you don't wanna overwhelm her with data.
Chris:You wanna say, hey. Look. Like, give her a pat on the back to say, you're doing a lot of good. Let's make these simple tweaks. Let's add a walking warm up and cool down.
Chris:Let's nudge your running frequency a bit. Let's tighten up your strength and drill work because I thought that, you know, there is some opportunity there. And then I sent her a follow-up email and I said, hey, for the next four weeks, this is what I would think of in terms of a sensible training program for you with the drills. And why don't we do this? If you're going in the right direction, stay the course.
Chris:If you wanna reconnect in four to six weeks, maybe we can sort of tighten things up a little bit more. So I didn't think there was any pressing need to follow-up with her. Right? It was sort of to maybe bring bring her a little bit closer to running enlightenment in terms of best training practices, but she didn't have an MSK complaint. It was almost like PT is yeah.
Chris:I can see why you connected with me in consultation, but you're a young, healthy woman. Like, I don't want to medicalize you. And if I tell her to schedule these follow-up appointments, the message that I'm sending to her is that, hey, you need to see me as an expert, you know, because I'm concerned about, you know, a, b, and c. That wasn't the case. Yeah.
Chris:Versus someone who has a bone stress injury that I consulted where I'm like, hey, we have to put some guardrails in place. We need to be very judicious as you initiate this return to run program. I actually wanna have you come back in four to six weeks because there's some stuff with your run easy data that I wanna just see how that changes with some of the work that we're doing. And we need to be vigilant about nudging your running, but not introducing too much speed work right now. So, yeah, it really depends on the person.
Chris:But I generally don't see people more than, you know, a handful of sessions at most. Most of the time, it's like two to three sessions spaced out over four to six weeks. But my advantage right now is I have just countless resources. I have video files of every exercise. So when I send a follow-up email, I'm basically mapping out someone's plan for the next four weeks in a very detailed but easy to follow roadmap.
Chris:Right?
Jimmy:Yeah. So you really lean into handing over control of the situation to them. You say, here are the tools based on what I saw, based on your diagnosis, go do this stuff. You don't need to come back to the gym or to my clinic and have me watch you do your squats. Like you're trying to empower them to take control, to take ownership of the situation.
Jimmy:Do you think that's something we do well as physical therapists or as a profession?
Chris:No, I think we're terrible at it. And I think that's why everyone wants to cut reimbursement, because they're saying, half of these freaking visits, like, people don't need to come in. Now, I am not operating in a postoperative capacity to the extent that I have previously in my career. So if someone has an ACL reconstruction, yeah, that's different. Those first six weeks are really critical to make sure that we get full knee extension.
Chris:We get the knee calmed down. We re start restoring quadriceps function. We regain range of motion, cause there's some volatility there. And same goes with post op shoulder procedures. But I think primarily focusing on runners and triathletes where we're managing their situation conservatively.
Chris:And I don't think people wanna necessarily I'm a little bit further removed from Seattle, I'm a fee for service provider. I'm trying to do this in a cost effective manner without compromising what that athlete's looking to achieve.
Jimmy:Yeah, and I think like coming from my early career, it was one of my biggest frustrations. One of the last clinic positions I had, expectations were that I saw fifty percent of my patients three times a week. And I saw I had zero post ops on my schedule and they wanted all my patients coming in three times a week. And I felt like it waters down the profession, it gives us a bad name, people think this service is like a twenty minute back rub or a band exercise. And so I think it's a shift in the way we think about it, but we are not personal trainers.
Jimmy:We don't need to just sit here and count your reps. We need to empower the patient, give them the tools that they need to get themselves better. And we're their support staff. We're riding shotgun. They're telling us where they're going.
Chris:Exactly.
Jimmy:I'd like to take a moment to thank our sponsor, RunEasy. RunEasy is a running and jumping analysis tool that helps provide objective data on things like impact loading, dynamic stability, and symmetry. I've been using it in the clinic for the past three years and I love how easy it is to add to my evaluations. Not only that, but it backs up my clinical reasoning and helps me with my decision making process when I'm doing exercise prescription. So if you're a physical therapist or running coach, head on over to runeasy.ai and book a demo.
Jimmy:If you're lucky, it will be with me. Well, yeah, just we're gonna switch shift gears hard here. You brought up gait analysis and looking at a runner's gait. How how has that changed? Because I know early in your career, you had instrumented treadmills.
Jimmy:Is that right? You had access to that?
Chris:Yeah. Well, I mean, when I was at NISMAT, we had access to a lab. When I was at, you know, in Lynn's lab at Delaware, you know, you had force plates, you had a Vicon camera system. I mean, you had all the bells and whistles. Very impractical though, when you're in an outpatient setting.
Chris:Yeah.
Jimmy:So how is your, the way you analyze someone's gait or the value you place in that, like how has that evolved over time?
Chris:I think like many people, I didn't always take the time to watch people run, especially like the first few years of my career. I think it's really important to watch someone run, right? Running is a hierarchical skill. Rich Willie and Irene Davis did a nice study. Like, can strengthen the hip abductors, you can cue people with a squat, and you may improve their hip abductor strength.
Chris:You may improve their squat mechanics, but that doesn't carry over to running. Right? So respect the fact that running is a hierarchical skill, which means at some point during that plan of care that you have to watch that individual run, right? And I think that especially goes for people who, you know, are initiating a Return to Run program after an injury. So, you know, I do a lot where I'm combining a qualitative analysis, which is the essence of treadmill analysis, strike sound, step rate, speed, surface shoes, slope shanks, swing step width, right?
Chris:And that's going to give you a pretty good lens into things. And I also love that because it's qualitative, it's easy to explain to people. But I also think that in certain instances, that you really want to get a quantitative analysis too, to make sure, you know, as Jay DeCerri always says, I don't know if he said this on the podcast that you had him on, but you can't see forces with the naked eye. Not even Jay, who's probably done more treadmill analyses than anyone else in the So, you know, I think that you want to pick up, is there an avoidance strategy? Is there some kind of asymmetry that demands exploration because they're having unilateral lower extremity complaints?
Chris:So, you know, the woman that I saw on, I guess it was Wednesday, I just took her through the S's of treadmill analysis. She's a newbie runner. I didn't feel like I needed to, you know, put the Runeasy belt and start getting her confused or, you know, going down the rabbit hole with some of these metrics. You know, we could bump her step rate up a little bit, but outside of that, I just said, let's really just zoom out and, you know, as I mentioned, let's up your running frequency a little bit, introduce these drills, and and go from there. Now the fellow who I consulted or saw and follow-up yesterday, I have not been able to to do a treadmill analysis on him, and he does a lot of his training on a treadmill, so it has salience.
Chris:But he is someone who's recovering from a sacral bone stress injury, which we know fueling is front and center. So we got him into the hands of Rebecca McConville, and he started going in the right direction. He's back running now. I need to make sure that he is not taking an avoidance strategy. And oftentimes, will not pick up on that if you just do a qualitative analysis unless someone has a marked asymmetry where they essentially are running with altered mechanics or a hitch in their giddyup.
Jimmy:So what you're saying in that situation, you're saying that visually watching this runner run, you will not see that compensation strategy, but it's there, it's happening, and you can use tech like RunEasy to see that.
Chris:Yeah. And I have a great case. There's a young high schooler. He's off to a school in the Northwest here. He'll be running at one of the premier programs.
Chris:But he was sent to me with a diagnosis of a hip flexor strand, which you and I both know and a lot of people who listen to this podcast, you know, that's a bone stress injury and a distance runner till proven otherwise. So but he was running 40 to 50 miles at the time, and, you know, his mom, very sweet woman, was adamant that, you know, I watched him run during that initial consultation. So before that, he couldn't tolerate a side plank. He he passed most of the physical performance tests. His single leg hopping didn't look as explosive as it did on the non involved side.
Chris:But when I put him into a star side plank, so left sided involvement. So when he went into a side plank with the left leg down, right leg abducted, collapsed to the ground instantaneously. So he was running. He had this vague thigh pain. He has a hockey background.
Chris:He should be able to hold a side plank like that for a solid thirty seconds. I mean, that's a that's a high load functional assessment. But, like, there's no way. That doesn't make sense. So I said, look, my instinct is not to put your son on the treadmill.
Chris:He's running 40 to 50 miles a week. So I'll put him on, but I'm not gonna have him run for more than three to five minutes. So fortunately, I have that run easy belt, and we put it on, and you saw this huge avoidance strategy where he was not wanting to load that left lower extremity. And when you sum it all of that information, you're saying his nervous system's protecting, he can't directly load through that lateral hip. He has vague thigh pain, and he's running more than 20 miles a week, and there may be some fueling and, like, poor sleep hygiene, like bone stress injury.
Chris:You know, got an MR. He had a grade three femoral shaft bone stress injury. But you can use a run easy to say, hey, like, mom, look at this, you know, and to the kid, like, this doesn't make sense. So part of my return to run decision making with him, and when we finally started to clear him was when that normalized. Now you may not expect, you know, once that bone stress injury heals and he's able to directly load with the side plank, you may not have the data look pristine, but you shouldn't see that same avoidance strategy.
Chris:And I think this has salience if especially if you're working with someone following, say, a calf strain, Achilles tendinopathy, for sure if someone's coming off of an ACL reconstruction. You know, it's just giving you that much more of a granular lens into what's going on. I think postpartum, right? These are just such great use cases. And that's where I want that quantitative analysis.
Jimmy:Yeah. And I think it can be helpful. Like, when I first got RunEasy three years ago, I had a small tear in my posterior tib. And it was one of these things where I was trying to hammer through a bunch of runs. And I thought I was Going back to you can't see these things.
Jimmy:I've sent videos of myself running to my PT friends, no one could see anything. I put the RunEasy belt on and you can see this huge asymmetry left versus right in my stability. With these cases that you're describing, it seems like we also have to be interpreting the data well too, because it's like, you could see that avoidance strategy, but not call it an avoidance strategy and think they just need to start loading the other that side harder, right? You're like, oh, you should be like, let's make you symmetrical.
Chris:Yeah. Well, and I think that's where if you combine sound clinical reasoning with tech like this, that's when you're lethal as a clinician. To your point, if someone doesn't have sound clinical reasoning, which, you know, it's ever evolving even with us, right? It's not like we've arrived at this point, like, come on. But, yeah, you wanna make sure that you do a comprehensive examination.
Chris:So when you see that, you're like, I'm seeing an avoidance strategy. That's not just this asymmetry that we correct, and that's going to solve this problem. And that's critical.
Jimmy:Because I know part of my role with RunEasy is onboarding new users. And it's one of the things I try to help them understand is like, even if the one side looks worse, we got to understand why is it worse? Do we load that side? Or is this like what you're saying, like an avoidance strategy? And it is fun, think, like, to add tools like this to to what you're doing to beef up your assessment.
Jimmy:It's not replacing, like you're saying, it's not replacing our qualitative assessment. It's supporting it.
Chris:Exactly. I think the other beauty of this is, you know, you also get to see the impact of your your queuing, right? So I use it a lot from a biofeedback standpoint where, you know, once I explain the metric to someone, I just say, hey, just change this. I wanna see what you come up with. You know, some of the ways that people may try, they may try to quiet their feet, they may try and turn their feet over a little bit faster, you know.
Chris:But here's a feedback. Try and correct that. Do you see that red bar? I want that to go like more to orange, if not yellow or green. So to me, it's very much an alliance tool.
Chris:Like, you're saying, hey, look at this. Like, let's lean in. You know, I and I think that I had a guy recently who was coming off of a tibial bone stress injury, and, you know, he's a two twenty four marathoner, but he runs with a very low step rate. And I do think that has salience to his situation because he's dealt with recurrent bone stress injuries. Obviously, a lot of other factors at play.
Chris:But when you did pull the step rate lever with him, you saw a lot of these metrics improve. And he was sort of like, wow. So if you can help people use it to have these moments, they're bought in. Right? So I think it's really powerful in that regard.
Jimmy:Yeah, and I think we should probably, we should try to add in like one of the graphs of what you're referring to, because it's really cool when you see the data graphed out, you're like, here's you running at 150 steps per minute. Here are your metrics above. And then when you hit 165, here's how all that data changed. And it is crazy when you see that. And it's like instant buy in from the patient.
Chris:And I also think for clinicians who are listening to this, when you do go to make a change, don't expect the data to just instantaneously improve because that person's nervous system, they're going through a learning process. So I've had a lot of clinicians say like, hey, I upped their step rate, but the data got worse. I'm like, well, did you give them like five minutes? Right?
Jimmy:That's funny you say that because that's like, that's a frequent conversation I have as well as like, we know it's going to be less efficient initially. Sometimes, like I think I've seen a graph you posted before where it's like almost instantly you saw everything improve. And that's amazing when that happens, but that's not every time.
Chris:Yeah. That's the exception of the rule. Yeah.
Jimmy:I was onboarding a pretty big wig in the PT rehab world, that was a question he had, because it's like, it didn't make the big change initially that I was expecting. I'm like, that's not a reason not to do it. Because I'm also going to rely on the subjective feedback of the patient. They say, oh, I feel smooth, I feel like I can do this. Let's do it and let's see what happens.
Chris:Yeah, and very much like, you know, when I'm coaching people, you're triangulating all this data. You're like, okay, here's what their run easy is saying. Here's what they're subjectively reporting. Here's what I'm seeing from a qualitative standpoint. So I think it just gives you that much more of a refined lens into someone's situation.
Chris:So I think with footwear, the footwear industry is a minefield to me right now. I think that you want to understand, like, especially with all these crazy stack heights, okay, we can sit here and pontificate on what the shoe is doing. But, you know, with a lot of the performance coaching clients that I work with, as well as post injury, you want to see what happens to their data when they're in different shoes. If someone's like, oh, I love this shoe. Let's see, you know, how it behaves under different conditions.
Chris:You know, let's see if you have a carbon plated shoe. Okay. Well, let's look at it at conversation pace, and then let's look at it at threshold pace, you know. And I think that can help people from a performance standpoint.
Jimmy:Not to come into it with any assumptions either, because what I've seen is like everyone's individual. And I was just showing somebody this data. I had a guy, it didn't matter what shoe he was wearing or what pace he was running. His score was like between eighty six and eighty eight. And it was like that even one of those was with like a Vaporfly on running at race pace.
Chris:Yeah, interesting.
Jimmy:Other people it's like every pace is different. You see a huge difference with like a plated shoe versus a non plated shoe. So it's everyone responds uniquely.
Chris:And I think that, you know, I'm not working with these demographics to the extent I have in the past, but my mom was out here over the summer, and she had basically tripped off something with her knee moving a piece of furniture on her porch and probably had a degenerative meniscal tear that got stirred up. But, you know, I also wonder to what extent you can leverage this if you're in a more general outpatient capacity, where you're looking at someone after a knee replacement, after say, maybe they've had, you know, a meniscal tear, you know, are they at risk for falls? Is there some way to determine from a risk stratification standpoint? Because I think that obviously, it's gonna pick up anything like lack of smoothness or jerk in the system to an extent. So I know that obviously, I've gotten pigeonholed.
Chris:Are people, you know, on this listening to this, you know, the focus is on running. But I think that if you broaden your mind, that this has much greater salience than just to running.
Jimmy:Yeah. And like with RunEasy in particular, like with the new, like the jumping modules, opens it up to a whole new, basically like any lower extremity patient that I work with. I'm going to be assessing their single leg hop, double leg hop, getting data to show what that looks like, versus just saying, yes, it looks like it lacks power, I can now actually show that it's lacking power and show what it looks like.
Chris:Can I just expand on that too? I think there are certain people who are very quantitatively driven too. So if you're saying like, hey, here's the data, right? That's going to land with them to a much greater degree than some like, I'm pretty laissez faire with a lot of this stuff with my own training. Like, I know if I can't, like, be explosive on that leg.
Chris:So but I think that if you understand someone's mind style and how they process information, that you can really leverage this stuff.
Jimmy:Yeah. It's funny. It's like a coaching client of mine who I work with through you, very data driven. And he like, when I told him about RunEasy, he was like, I want to see this. Me get it.
Jimmy:Give me the belt. And runners are like, I've kind of evolved and I am now on the other side of this. But like data driven is like a big thing with most runners. So it's cool to have it as a tool for them. Yeah.
Jimmy:So moving along, last thing I wanted to ask you about though is the role that mentorship plays in physical therapy. Like, is this something you feel like is missing from the profession?
Chris:I think mentorship is critical for personal development. And I always look to people who have done the thing that I'm looking to do. So if I were to go and climb Mount Everest, I'd want to be getting on the phone with Nims Persia, for example. So I think that mentorship is critical. And I think that if we speak to our profession, I mean, I think that's probably one of the benefits of going through a residency or fellowship.
Chris:Right? But I I know that I've been to say fortune is a massive understatement, you know. So my mentors were first, Steve Hoffman. I mean, he was whether or not he realizes this, he was the first PT that got me really thinking, like, this PT world is really cool. My high school tennis coach who taught me relationships are everything.
Chris:Lynn Snyder Mackler when I was at Delaware who really forced me to, you know, delve into the literature and to work hard. And then got to New York where I was, you know, around a really dynamic group of people between, you know, Mal McHugh, who's a director of research, Tim Tyler, Mike Mulaney, and I was working with Doctor. Axe. And then I got up to, you know, when I was in New York, I was also around this very skilled group of surgeons who, you know, I could walk in during any consultation. I could walk into the Operating Room with them so long as I scrubbed in, you know, and I've I've also had mentors in other facets outside of the PT world, you know.
Chris:So I think mentorship is critical. And and you're you're learning the ropes from someone who's done it before, and they're sort of saying, hey, here's some of the mistakes I've made. Here's some pitfalls to avoid. I also think to inoculate yourself against a fear of failure. People are like, oh, I'm sorry, this endeavor that you were involved in failed.
Chris:I'm like, oh, please, no, don't be sorry. You have no clue the learnings that I acquired through what you think of it is a failure. Your deepest deepest learnings always come from failures. Success, yeah, pat yourself on the back. Yay, me.
Chris:But, yeah, I think being able to compare notes with someone who's a little bit, you know, you're on a similar trajectory, they're just further down the line.
Jimmy:Yeah. I think, being a lot of the RunEasy users and, people I interact with are either solopreneurs, entrepreneurs with small, small businesses. And it's like, it can be lonely. And I think like the role of mentorship, it's kind of like coaching, like hiring a coach when you're an athlete. It's something most people should be doing, but we're not doing.
Jimmy:Why do think we're just scared of asking for help? Why do you think people don't get a mentor?
Chris:It's a good question. I feel like I need to think a little bit more about that. I mean, I think that there's a commitment phobia, to an extent. I think that there's obviously a time commitment. There's an accountability factor.
Chris:There are financial considerations. I think back to the last person that mentored me outside of our field as a woman who's a copywriter, a brilliant copywriter named Licia Morelli. And you have to work, and it's another thing that you have to give attention to. But every time I'm a very coachable person in my mind, but, you know, I came away from that. And was it cheap?
Chris:No. Get a lot of value out of it? Bet your ass I did.
Jimmy:Yeah. Yeah. It's funny. It's like, feel personally, I've done mentorship with you years ago with the running your business mentorship you did. But then here I'm at a new stage in my career and it's something I'm looking into again.
Jimmy:But it's man, the amount of times I or the amount of effort I spend just dragging my feet, like coming up with reasons not to do it, when I know it's like, it's something that I need for the next step. And yeah, it's just funny that we put up this resistance to doing it. And there's a lot of great options out there for even informal mentorships. Things like your runner zone is a great resource as a little mini mentorship with you just sharing your wisdom and other people in there sharing wisdom. But, yeah, anyways, I think that's a great place to kind of put a pin in this conversation.
Jimmy:Is there anything else you'd like to say?
Chris:Well, I would just say, I default to action. So I was talking about this with, with my wife Mimi, and we're very different in that regard. She'll really try and think some things through, and sometimes, you know, that's a blessing and a curse. I just am like, okay, let's roll. And and I don't overthink things.
Chris:I just get into them. But I I think there's a great book that you would enjoy and perhaps other people who are tuning in called Managing Overthinking, which is one from the Harvard Business Review series. Because I do think people oftentimes perseverate and ruminate over things. And I think having a default mode of action is helpful, because you're gonna make mistakes. I think people are afraid of that, and it becomes it's a roadblock.
Chris:So and I think the final thing I'd like to say about mentorship is I think it's really important, you know, to have someone audit you, to say, hey, here are your blind spots, and to be blunt and transparent. And, you know, I think that's something that a lot of people shy they're always trying to basically massage their message, and I don't think that's necessarily helpful in all instances.
Jimmy:Yeah. No. Awesome. Love it. Thank you for sharing that, Chris.
Jimmy:So, yeah, to wrap up, where can people find you? Most of most of our listeners should know, but let's hear it.
Chris:Just type in Chris Johnson PT online, and and you'll regret asking that question. The easiest place is my website, chrisjohnsonpt.com. That's sort of my central hub. I'm pretty accessible on Instagram at chrisjohnsonthept, the runner zone, which I run with Nathan Carlson. That's another great resource.
Jimmy:Yeah. And you you got a new course out that's been out for a couple months now, which I would highly recommend. I'm probably halfway through it.
Chris:So It's a behemoth. That's, as I explain it to people, it's my magnum opus. That's what I've learned through twenty five, almost twenty five years of being a clinician. I started coaching when I was 12 years old, which may sound a little bit silly, but I've been in the trenches from that standpoint. And I also am sharing everything that I've learned through my injuries, surgeries, as well as coaching a bunch of people across the injury to performance spectrum.
Chris:You know, I work with people who are newbies that just have a passion for wanting to take up running or triathlon. And I help a lot of people who they put food on the table through sport where the stakes are really high, and these people have commitments to sponsors. And that's been really interesting, you know, helping people navigate bone stress injuries who are like, look, if I can, I need to race? And what are you gonna say? Oh, no, you can't.
Chris:They're gonna do what they want. So you need to just make sure that they're informed of the considerations at play. Unless you think that they could run the risk of having a running related injury turn into a life altering injury, then, again, you need to be blunt with them and just say, hey, I can't be involved with this. If that's what you're gonna do, I have to remove myself from the equation and document it.
Jimmy:Alright, Chris. Well, let's leave it there. It was great having you. Thank you so much for your time, for coming on, sharing an hour with us. Looking forward to following you more on Instagram and all the cool posts that you're posting.
Chris:Cool. Thanks, Jimmy. And regards to your family, as well as the team at RunEasy. Yeah, thanks. Thanks again for having me.
Jimmy:Of course. That's it for today on the Physio Insights podcast presented by RunEasy. Would you like to share an interesting case, insight, or have a thought about the podcast? Comment below and don't forget to follow us for more episodes.