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Dr. Steve Derrington of Derrington Orthopedics on why rehab after PRP decides the outcome, learning sono-anatomy early, and why basic-level care gets left behind.
Dr. Steve Derrington, a fellowship-trained PM&R physician and owner of Derrington Orthopedics, Interventional Sports and Spine, a Regenexx practice in Carlsbad and Laguna Hills, California, joins Colin Rigney. He trained as a D.O., spent a dedicated residency month at Jefferson with ultrasound pioneer Dr. Levon Nazarian, scanned cadavers alongside the anatomy, and did his fellowship with Dr. Marko Bodor in Napa. Steve explains why the magic of ultrasound lives in the oblique views, how an MRI can under-represent a rotator cuff tear that ultrasound shows, and what fluoroscopy and ultrasound teach each other. Then his AMSKU Global Summit topic: rehabilitation after orthobiologics. A patient who got PRP elsewhere was told to treat it like a post-op shoulder; Steve explains why that is not right, how his patients get a rehab plan with movement guard rails instead of sets and reps, and why PT partners who communicate build trust and better outcomes. Plus setting expectations before a procedure, running a self-pay practice for an active Southern California population, patients who arrive with AI-organized histories, and his view of the next 10 years: if you offer basic-level care, you will be left behind by someone doing it at a really high level.
Register for the AMSKU Annual Global Summit '26, Saturday 5 December 2026, fully online
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Chapters:
0:00 This week on From Probe to Practice
0:24 From Probe to Practice
0:42 Episode 14: Dr. Steve Derrington of Derrington Orthopedics
2:18 From osteopathic medicine to PM&R and orthobiologics
3:34 A month with Dr. Levon Nazarian at Jefferson
4:34 Fellowship with Dr. Marko Bodor in Napa
6:50 Blind injections on mission trips
7:48 Sono-anatomy on cadavers
8:52 The magic lives in the obliques
9:09 Ultrasound and fluoroscopy, learned together
11:25 Beyond point and shoot: diagnostics
12:40 When an MRI under-represents the cuff
14:05 The next step in his learning
18:02 Does teaching make you a better doctor?
21:03 His summit talk: rehab after orthobiologics
22:14 Why early PRP research was all over the place
23:44 How much better could outcomes be?
24:11 Tissue repairs under tension
26:03 Rehab protocols after a procedure
27:08 "Treat it like a post-op shoulder"
28:17 MLS laser and modalities
28:55 Working with PT partners
30:01 A trust accelerator and outcome booster
31:28 Setting expectations before a procedure
32:43 PTs asking for his protocols
33:51 Orthobiologics are not swapping the syringe
34:32 An honest, non-surgical evaluation
35:23 Practicing in Southern California
36:11 An active population that wants back in the game
38:04 Running a self-pay practice
39:02 Why he chose orthobiologics
40:45 From Napa to Southern California
41:29 Ultrasound early in residency
42:18 The next 10 years
43:44 Basic-level care gets left behind
44:07 Will insurance change?
45:13 AI-informed patients
47:09 Imaging at home?
48:32 Dr. Derrington at the AMSKU Global Summit
49:23 It doesn't feel like work
50:21 AMSKU Annual Global Summit '26
From Probe to Practice is a weekly podcast on musculoskeletal
ultrasound — diagnostic scanning, ultrasound-guided injections, and how
MSK ultrasound changes the way clinicians practice regenerative and
musculoskeletal medicine.
Hosted by Colin Rigney and Ryan Martin, founders of the Advanced MSK
Ultrasound Center, who have trained clinicians for years and bring the
reps to prove it.
This is not a 45-minute monologue on probe physics. It's a high-energy
dialogue about what actually happens inside a practice: the diagnostic
gaps nobody mentions, the injections that miss and why, the referrals
you didn't need to make, the business of integrating ultrasound, and
the case studies that only come from tens of thousands of scans. Plus,
in Ryan's words, "a lot of dirt on each other."
Every episode is built around one promise: take something you learned
from a podcast on Friday and implement it on Monday.
For physicians, regenerative medicine clinicians, sports medicine
providers, anyone preparing for the RMSK exam — and anyone who works
alongside them.
Because you can't diagnose what you can't see.
New episodes weekly. An Advanced MSK Ultrasound Center podcast.
[0:00] Narrator: This week on From Probe to Practice.
[0:03] Dr. Steve Derrington: So as that continues, that's just going to keep ramping up. And, you know, more and more people are going to be looking for what we're offering. And they're going to be able to be more sophisticated with what they're looking for. So if you're offering basic level stuff, you're going to get left behind by someone who's doing it at a really high level. So
[0:24] Narrator: An Advanced MSK Ultrasound Center podcast, From Probe to Practice, hosted by Ryan Martin and Colin Rigney, produced by Jason Kitza at NGG, NeedGreaters.com.
[0:43] Colin Rigney: All right. Welcome to episode 14 of the Probe to Practice podcast hosted by AMSKU, the advanced musculoskeletal ultrasound center. Today, we have a special guest with us, and I wrote an intro for him. You know, today's special guest, he speaks our language. He's ultrasound anatomy precision, putting it all together in a way that clinically makes sense. So Dr. Stephen Derrington is a PM&R physician specializing in diagnostic MSK ultrasound, image-guided interventions, and regenerative orthopedics, as well as an educator and a published author in the field. Steve we're pumped to have you on the show and you know friend of the show friend of a personal friend as well and you know just thanks for making the time and any excuse for us to get together and have a cool discussion is worth it for me yeah
[1:30] Dr. Steve Derrington: Yeah, 100%. Yeah, thanks, Colin. Appreciate it. And yeah, I mean, we get so busy with our lives. And we see each other a couple times a year that finding extra opportunities to catch up is always nice.
[1:42] Colin Rigney: Yeah so you know yeah that couple times a year right so we're on faculty at OrthoSono in Las Vegas typically where it's held led by Dr. Buford and you know I think that's where we met correct that's where I met you in person I think with social media we're always connected and then intertwined personally
[1:57] Dr. Steve Derrington: I saw your I saw your lifting videos during COVID. And I was like, who's this PT guy? But yeah, I think that's where we met in person. And yeah, it's been great to connect to Mike, you know, put personality and put, you know, put connection to what you see out there.
[2:12] Colin Rigney: And you know Ryan and I we're big fans of what you do I think you're I think you're an amazing teacher and really just getting started right and so if you wouldn't mind Steve tell give us a little bit your background and your story and how you how you got started with ultrasound specifically like how did you see that you know making sense for your practice and, you know, just share that with us.
[2:18] Dr. Steve Derrington: Thank you. Yeah. Yeah. So, yeah, I kind of see, you know, my path has been kind of an interesting path and I'll kind of quickly go through like the how I got to doing PM&R and orthobiologics and then like ultrasound fits in there. But, you know, when I was looking at what I want to do after college, I had thoughts about going to med school earlier in my career and then and then kind of went away from it and then came back to it. And then I found osteopathic medicine, which fit really well with me, comprehensive mindset, body's ability to heal, structure and function in a relationship. So that really that really spoke to me. And that's where I started. That's where I went to med school in Kansas City. I actually got introduced to a doctor that had been doing prolotherapy for a long time and got initial exposure into regenerative medicine before I knew much about it at all. Fortunately, found out about PM&R, went that route. And that's where a couple of things happened. That's where my exposure to ultrasound started. And that's where kind of a deeper dive into orthobiologics happened. So you probably know the name Levon Nazarian, who was at Jefferson at the time when I was doing residency there he's editor former editor of Journal of Ultrasound in Medicine and we actually have PM&R radiology doesn't have a dedicated month with him PM&R has a dedicated month working with him in his in his clinic and he is like ultrasound wizard he's the guy that is like in the most positive way ever like the dorkiest geekiest like into you know ultrasound and like figuring things out and problem solving and like I got to see ultrasound done at like the like top level from the beginning, I was first of all, like, holy cow, like one, how cool is this? And like, when we got opportunities to get our hands on the ultrasound, it's like, this is kind of hard. This takes some time to like, make sense of what you're even looking at, much less moving the transducer around. And then eventually, that was the next step. I put a needle and watch it and get to where I need to get. So that obviously scratched a really big, you know, itch for me. And as I got into understanding about orthobiologics, I chose my fellowship with Marko Bodor in Napa because of how close their relationship was and the ability to really continue to dive into ultrasound during fellowship and be able to take it from the diagnostic side of things to the applications and being able to take that tool to help with diagnostic and with procedures you know all over the body that we obviously now treat yeah
[5:09] Colin Rigney: Yeah. Yeah. So yeah, Levon Nazarian, he was one of the first courses I ever went to when like 2011 or 2012. He was, he was, it was like seeing Michael Jordan in person to me. It was Like, whoa, the gap between where I was at and where people like him are like, it's amazing. So you got to you got to do a rotation with him.
[5:33] Dr. Steve Derrington: We rotated for yeah for a month we spent you know every day with him and then I was able to on like random afternoons I wouldn't have clinic for some reason I would go to his clinic and I even set up a cup I had like an elective like couple weeks so I was able to you know I spent as much time with him as I could and then some of my other co-residents that were interested in the same kind of stuff you know we'd find our you know other ultrasound machine that wasn't what he had but we'd just practice on each other and we just get the reps and like get comfortable with it and you know take as many opportunities as we could especially when you had the access to him to be able to keep learning and keep seeing so yeah super fortunate that was something that was just part of our curriculum not something that as we know as we teach other people it's not part of their training at all and it's like I gotta figure this out when I'm when I'm out like I was able to have that foundation to build on through fellowship and then and then beyond yeah
[6:11] Colin Rigney: Feedback. That's so big. So I want to stay on this for a second. So talk to talk to the audience and maybe share some more of your story. You can take more depth than you than you need take some time about the foundation like how important was that foundation of learning sono-anatomy first prior to just you know pointing and shooting with a needle yeah
[6:51] Dr. Steve Derrington: I mean I so in med school I did a couple mission trips went to Guatemala went to Dominican and we were doing injections but completely blind and actually remember on an elective rotation before I went into PM&R in a clinic and yeah doing blind injections and you're like you know simple knee injections should be easy but it's like bumping into cartilage patients are going oh I don't like this and I'm like I don't know where I am I guess this is how I do it but the nice thing was pretty quickly every other injection that I saw was image guided and I was like oh this makes things a whole lot more simple helps you to be more confident where you actually are so having that foundation to be able to start to see the sono-anatomy and actually with our pm and our rotation or with our pm and our residency we had literally cadaver anatomy each year so we had three different years where we were looking you know we were actually on the same cadavers that the med school had but we'd be looking at the musculoskeletal anatomy in you know in real life in a cadaver and having the ultrasound and kind of having your brain start to put this together because if you're only used to looking at textbooks or MRI slices as you know like translating that to ultrasound and like how you can move the ultrasound every single way like getting that 3d picture in your head of like where am I and what am I looking at is challenging so I felt like I was building up that foundation kind of concurrently like the ultrasound application it was kind of bringing them all up together yeah
[7:24] Colin Rigney: -huh. So that learning ultrasound and translating it to the three-dimensional body, you know, we're all taught the short axis, long axis, two-dimensional imaging modality, but is it really? Ryan and I talk about this all the time is like some of the magic really lives in, yes, you have the foundation, short axis, long axis, understand it, probe, slices, that sort of thing. But once you get the foundation for it, then we always say like the magic kind of lives in the obliques, right? So like tell us about, and you're also traditionally trained and classically trained in like fluoroscopic guided procedures, correct?
[9:13] Dr. Steve Derrington: Yep pretty
[9:14] Colin Rigney: So talk to us about, talk to us about that difference. Did you learn ultrasound first or was this concurrent with your fluoroscopy training?
[9:24] Dr. Steve Derrington: Concurrent because we got exposure to some of the Rothman puma r docs in Philly and they do a lot of fluoroscopic guided spine procedures so we got I got kind of an exposure more or less the same time there but yeah I mean with I mean it's always important with the setup but with like with fluoroscopy and spine it's like getting the angle right getting this here getting your trajectory and like checking all your angles here and you got to be pretty dialed in with like these positions here it's less like kind of customization and fine tuning with the with the setup but with ultrasound like you said once you get used to here and here you got to get comfortable in between there so you know I think I was learning some of that you know early on with ultrasound but definitely during fellowship because this is one of the things and if you know Marko at all like he's another super smart like, I mean, getting to one of the benefits of the fellowship was getting to see how his brain thinks and trying to kind of follow that a little bit because, yeah, there's so many times where you have like this set up here and you're like, okay, this rotator cuff looks a little bit, but, you know, let me, oh, I go here and you go, okay, there's where that tear is, or here's where that tendinosis runs.
[10:42] Dr. Steve Derrington: And being comfortable with like fine tuning that position, one, to make that diagnosis completely not just in the short and the long where is it it's like well in this oblique view here it's actually this and then just I use it all the time with injection setup where just based on the anatomy based on what the position the patient can even get in you know where's that angle to actually get in there it's not those true planes like you mentioned it's let me fine-tune this and find that window where that's best and if I can and know where what I'm looking at is, even if it's not that normal slice, then I can, I can get there.
[11:18] Colin Rigney: Yeah. So staying on this, you know, Ryan and I work with a lot of clients who have been classically trained in fluoroscopy and pain management PM&R or anesthesia pain and have done a pain fellowship. And they've yet to, or they weren't exposed to it, didn't have the opportunity and only had the time to like take a few courses and dabble and got good enough to like point and shoot. But to truly understand the Sano anatomy, sounds like you got that foundation like way early on. If you were to speak to somebody about having the skill to not just point and shoot with the ultrasound and fluoro but like from a diagnostic perspective and the soft tissues to augment your clinical reasoning and does that enhance I mean so I mean I know the answer but I want to hear your I just want to hear your journey with it like how did it enhance number one your clinical skills and if it enhanced your fluoroscopy skills in any way if at all
[12:23] Dr. Steve Derrington: Yeah. So I think clinically a hundred percent, like being able to see the real picture and not just the slices of the pictures in the structure of how you're supposed to set it up. Yeah. You just have that much, I mean, it's just like, it expands the amount of information that you get. I talk to patients all the time, you know, contrasting MRIs that might under-represent, you know a cuff that I see under ultrasound and you know and some of them even will show you like the slices and you can see the gaps in between the slices like I get all this information in here not only just like going scanning side to side but also like you said that changing the angle to get that so you know you just have to have enough I think reps to have it make sense in your brain of where all this information is and try to gather as much of it as you can so you can make that you know complete accurate diagnosis you know with fluoro I'm not sure how much it enhances fluoro it does you know kind of change the way I think about it and I will sometimes for you know complicated cases where you've got you know spinal heart you got fusion hardware in there and you're trying to like how do I get to this facet joint like I think I feel more comfortable making modifications on my setup angles because I know that sometimes times to get a good shot under ultrasound, I've got to go a way that is not in the textbook, but you know, you find that way to, you know, to get comfortable outside of that, just standard setup to, you know, to see where you need to see.
[13:15] Colin Rigney: Yeah and obviously I mean understanding the soft tissues in the area to just navigating it certainly can't doesn't hurt do you so we asked we always ask our some of our guests this is Like, as you've grown as a doctor, as a person, as a dad and all these things, like, how do you see your learning journey? Like, what, you know, you've come all this way. Now, what's the next step for you? What are some black holes, gaps, like, things that you want to attack, whether it's clinically or elsewhere in your practice?
[14:40] Dr. Steve Derrington: Yeah. I think, you know, the phaser amount now, I went out for a decade now and, you know, I think I've got a lot of skills, but the nice thing is when we surround ourselves with people at OrthoSono or I teach with IOF too, like I take every opportunity I can to like, let me hear them explain this or let me like see them work on stuff because there's all these little tips and tricks that we pick up individually and they come to where it's just like, oh, this is just what I do or this is how I think about things, but we all think differently. So, you know, I know enough to know that I don't know everything and I want to take advantage of opportunities where I get to be at a course. I'm not paying to be at the course, but hey, there's knowledge out there. So I think just kind of having that awareness of there's still more out there there's always things that you can get better with there's still you know always things that you can you do to understand differently and I take advantage of that as much as I can because yeah professionally in the practice I want to be able to deliver the best you know care that I can and I know that I don't have you know I don't have infinite knowledge I don't have everything completely you know, understood. So how do you think about this and, you know, how can I take that with me?
[15:55] Colin Rigney: Yeah sometimes we fall into the trap sometimes we often fall into the trap of like we're supposed to know everything right and you know I like you having access and just being able to be around people and absorb knowledge and it's like it's such a cheat code to be at some of these courses and number one and just hear you know something you've heard and know like you've heard it you know countless times but to hear somebody explain it in a certain way that resonates like oh I never thought about it like this and or you know how the you know the evolution of how non-surgical management of you know orthopedic conditions is trending you know and to have like this access to the latest data on what that is and so I it's about communication for me I want to I want to like unders like hear as many people explain these things in as many ways as possible So I can, I can have like a sim like that and take it into like how we can now teach people better. Right. Because I, you just fall, some of you fall into ruts and you fall into, you know, we, as much as we try to avoid it, dogma and like just have an open mind to first of all, like be wrong and know, like know what you don't be smart. And like you said be smart enough to know what you don't know and like it's such a it's such an it's a it's a really it's a really great community to be around because the humility level with just about everybody is very high and that brings your guard down a bit at least my is my experience and it's just so cool to you know first of all be a part of it number two have a chance to now impact others through what we learn you know so like with your with your experience as a teacher you know do you see yourself like expanding in that expanding as a teacher and a professor like how do you or is that something you want to just continue to do as you are like in parallel with your practice yeah
[18:24] Dr. Steve Derrington: I think that's part of the natural trajectory and, you know, I've been doing a lot more, I mean, over the last like three years, especially in kind of progressively doing more where, you know, more kind of hands-on teaching, more lecturing, like that's slowly growing as, you know, people invite me to be part of it as I get to be in different networks and you know as you know when you're when you're teaching you've got to know things really well you got to be able to explain it well that just helps elevate you and then again you get these opportunities to be around other people and you get to learn from them so you know inherently that's going to make you better even if you're the one that's supposed to be you know teaching so I think that's part of where I want to take it I don't know if I'll ever end up building you know courses or have that be you know a huge part of what I do because I love the clinical side of things but having more of that a little more of the of the education part of that is kind of where my I'm starting to trend for
[19:01] Colin Rigney: Do you find that teaching makes you a better doctor teaching other people yeah
[19:25] Dr. Steve Derrington: Sure yeah I mean it has to I think it has to you know because again you've got to find a way to explain things other people can understand you're getting questions as you're teaching you know whether it's you know after a lecture or with the hands-on table training and it makes you think differently And yeah, it, you know, whether or not they're meaning to, it's challenging the way that you approach things and the way you thought about something in the past. So you know, if you can take that input in and process it, then it should make you better on the backside.
[19:57] Colin Rigney: Yeah it's I mean certainly I see this I see a very similar and to me being you know being a full-time teacher essentially is what we do and communicator there's always it's always this journey of like I want to be the best communicator possible and some days like you evaluate yourself you really fell short or somebody asked you a question you felt exposed you know and then you go like you know trying to fill that gap but it's also like a way to look at is like very positive like oh wow okay that was a really good question and I you know I here's my best response but I don't I think I know somebody else here who can probably explain it better than I can you know and so constantly using the teaching experience as a feedback loop for, as a kind of grinding a stone for me to get better, us all to get better as, you know, as professionals. And so that's how I, that's how I choose to look at it. So with my transition into the, our annual Global Summit is coming up in December and it's December 5th it's fully online and the theme is the next decade in your hands and so you're one of our speakers and first of all thank you for thank you for sharing and contributing to it you know I want to just get a little teaser from you as far as what you've been working on and developing for the summit and then a tease of like what the next 10 years might hold for the field yeah
[21:42] Dr. Steve Derrington: Yeah. So thanks again for the invitation. Happy to be part of it. Last year was awesome. I loved what you have and this year looks, I mean, it looks better. I was looking online on who all is participating and it's a rock star lineup that you guys are able to put together but this year I'm gonna be talking about rehabilitation after orthobiologics so obviously that speaks to you a lot you know being a PT but that's one of the things that's you know the field has been weak in different ways over you know the last 20 years or so and as you probably know some of the early research with orthobiologics PRP in particular was all over the place and like how well we even characterized like what this PRP was sometimes very lacking. And some of the, some of the heterogeneity and the, and the outcomes were like, oh, PRP works for knee arthritis. No, it doesn't. Well, yes, it does. No, it doesn't. We're like, well, let's get granular and understand why. And we're really doing a good job of, I think, understanding, you know, the indications and the, and the things that make what you're actually injecting have a better or worse chance of success. But PT has been kind of, you know, on the side and a lot of times not even part of the conversation of, hey, is PRP helpful for condition X, Y, or Z? And as we know, how we use our body, whether it's just biomechanically stressing our arthritic joint or how are we loading our tendons and how are we moving our scapula as we're going through different, you know, overhead ranges of motion, that impacts that tissue and how it feels and how it can be strengthened and how symptoms can get better. So why aren't we asking the question often enough of well if we do a really good orthobiologic treatment and we have good guidance on how do we move to make sure that we're not reproducing or kind of just continuing the feedback of these biomechanical changes of what we did to get us here like well let's clean those up and give a good biologic stimulus to get things better like how much better could our outcomes actually be if we're controlling for that side of it afterwards not just on the front end of what's our blood draw volume what's our dose did we hold NSAIDs all these kind of things like well let's get up people optimize you know afterwards not just hey we're done go about your way and we'll check in with you and see how you're doing
[23:57] Colin Rigney: So yeah I mean we actually in our on our small group mastermind for our AMSKU program yesterday we had a discussion around rehab in orthobiologics and the theme was tissue repairs under tension and you know we it wasn't a deep dive into like protocol but just overarching like concepts and you know and I shared a document with you as far as like some rehab programs and stuff and we're slowly putting that together making it more uniform the biggest thing to get across and from the physician side it is you know on the rehab side I've been rehabbing orthobiologics patients since 2013-14 and how we used to do it was we didn't really know and so we treat it with kid gloves and almost you know in some cases like it's still appropriate to treat it like a post-op condition and then you can just progress them faster but for certain things like no we don't have to do that we can we can start number one loading it sooner and then using some tools to augment it that we didn't either fully understand or even have back then things like MLS laser extracorporeal shockwave has been around but we just like honestly didn't like it wasn't a thing to me up until maybe five six years ago, and using those as tools to augment the process for nociception and just get the body comfortable with moving into some new, dimensions again, or ranges. And so, you know, where do you have, like when you, and staying on this concept of the rehab piece I really like it obviously when you when somebody comes through your program you're doing orthobiologic do you have a set protocol for most of what you do like when you hand it off to your rehab partners or it like tell us about that like what does that look like for you
[26:18] Dr. Steve Derrington: Yeah so we've got we've got protocols for most of the things that we treat certain things are nuance and it's you have to kind of massage what we have in place there but everybody's getting a rehab plan afterwards and ideally that is being coordinated with a formal physical therapy program and then oftentimes progressing towards you know more personal training to kind of help them make those steps from kind of the foundational work to a higher level function but 100 they're getting that and it's yeah obviously like you said you shared your guys' protocols. Our timelines are pretty similar and the kind of things we're doing are pretty similar because a lot of it's based on stuff that's been out there before, but it's figuring out how does that integrate with orthobiologic stimulus as part of the, as part of the rehab plan. But yeah, there's, you have to have that because I actually saw someone earlier this week that got PRP at another clinic. I got, you know, one or two tube draw, like when it's really low quality PRP at a surgeon's office and I was like you know I can't do PT for a month they told me to treat it like a post-op shoulder like that's no that's not right I mean that's kind of analogous to you know back in the you know I mean this predates any of my training but oh you got an acute back aggravation let's just bed rest for eight weeks and get you really deconditioned get your core really weak and then I guess we'll just build you back up from way worse than where you were so yeah I think that structure and guidance is super important one for the outcomes and we'll see how the data continues to come as we do a better job with our with our research and our data collection but you know that's going to help invariably it's going to help patients get better outcomes they're going to feel more confident in the guidance that they're getting and they're going to be more involved as a active participant in their progression not just oh I had this procedure I'm waiting for it to work and that'll just go about my way like you've got to have more of that buy-in from it so yeah everybody's getting that and like you're saying we've got MLS in our office using all these different modalities to really augment what we're doing from pain from pain you know pain inhibition nociceptive changes but also like how is this actually helping the tissues to respond differently, faster, or maybe better
[27:37] Colin Rigney: Bed rest
[28:40] Dr. Steve Derrington: Than not utilizing them. So finding that combination of things that are really gonna amplify things maximally is I think where a lot of our minds are going.
[28:50] Colin Rigney: And when you when you refer out to PT how much of these programs are what you personally developed or developed in partnership with your rehab partners yeah
[29:01] Dr. Steve Derrington: So most of this is things that Regenexx developed a number of years ago, and they work closely with physical therapists. And then I've gotten to know several of our PT groups around here, and I'm pretty picky with where I send my people to. Who, you know, sometimes going to a big box kind of place, that's just kind of what the option is maybe. But ideally, it's someone that they're actually getting better care and attention. They're not getting just a bunch of modalities and literally handing them exercises and saying, go do these without any kind of, you know, evaluation of how well they're doing them. But that's the kind of they work from. And what we give out is not sets and reps, it's types of movements and kind of guardrails for progression. And then the PTs that we know open lines of communication but they kind of understand how to work with our with our patients and like how to advance them through this and how to use that to guide you know they're already you know excellent skills of like okay let me apply this and use that to guide
[30:02] Colin Rigney: Yeah it's you know you said it and it allows having a good PT program first of all the patients see that you're on a string with the with the PT and okay the right hand knows what the left hand is doing they're communicating That builds trust and they're more willing to meet you where you ask them to and be a stronger active participant in their own recovery just through that relationship alone. So, I mean, if it's a big for anybody listening who does a lot of orthobiologics, you know, many of you probably already hopefully have good relationships with your therapist. But it's such a such a trust accelerator and outcome enhancer having that good relationship. Relationship and it's certainly, especially because it's such a precise, you know, I mean, doing what you do, it's not like, you know, it's not like a surgical procedure where it's like, you know, taking a hand grenade and just going in there and then kind of patching it all up. And then, you know, off to rehab and, you know, the body, it's a different, it's a different rehab experience versus something like what you do, super precise, precision, violate as little tissue as possible but the potential for you know there's potential for flare-ups and the post-procedure experience seems to vary a lot with people and can you talk a little bit about that like how you how do you educate a patient coming in and you know you come to like the decision you're going to do a procedure how does that conversation go with the patient in terms of expectations
[31:47] Dr. Steve Derrington: Yeah first of all just setting up expectations you know going into a procedure is super important because some patients that they've done a ton of research they know all about orthobiologics you can have really good conversations others are like well this is just another shot right well it's like no this is not the same as a cortisone shot so clear on expectations on what the injection itself what that initial time period afterwards is when things get better like they got to understand that because otherwise they're going to come back a week later and say doc it didn't work you're like well not yet let's like it's this is just starting but like you said the better they are educated on what this timeline is they have that better buy-in and they understand it's going to take some time it's going to take some effort but being patient about it and doing it the right way is going to get them to where they want to be so I get a lot of feedback from some of the PTs again we work with and they get patients from other clinics as well and they're like we you're like can we use your rehab protocol with our other patients I'm like I can't tell you what to do but it's like you know a lot of times they're not getting any guidance from other orthobiologic treatments and I think it's really unfortunate so again having that relationship where they understand and we can be you know just walking you know in step is I think where we get some of our really good outcomes from especially with those PT clinics that know us and they're having just this continuity all across the board and when we talk two three months later you know it gets to where you need to go yeah
[32:56] Colin Rigney: They probably serve as a good referral source for you too right
[33:24] Dr. Steve Derrington: Yeah 100 yeah because I mean These are people that some of these clinics I've known for 10 years now, but yeah, you see some of these newer clinics that I might be finding, they start to send their other patients when they're seeing the difference in one of what we're just kind of doing and how we're offering things and what we're putting together and not just a la carte individual things and things I oftentimes comment differences in steroids and orthobiologics. We're not just exchanging the syringe and putting something else in there and doing the same thing. It's a complete different mindset. And they obviously PTs, they love that. It makes sense how we're doing things and why we're doing things and how we're starting to load things up afterwards. So yeah, they're like, this is the kind of approach that I want, not just, Hey, someone, you know, band-aided the problem and now you fix it, which is kind of how it is if we're just doing steroids and, you know, in like a, you know, assembly line PT places.
[34:26] Colin Rigney: And I and I'm sure that well and I know just from my experience anecdotally like most of the patients that come into our office as if I'm a PT generally they're looking to avoid surgery right and so having a place to send them to where you're not going to violate their trust I want you to see this surgeon just to have a consult to just even though like in it's in their best interest and it's you're doing it from a place of like you're not recommending surgery you just want to go I'm going to talk to a surgeon versus how about I have somebody who I work with who can give you an honest evaluation of what's going on not he's not a surgeon and can give you some good options as far as what could potentially be the next step you know that's that that's where you that's where you fit nicely where are you based out of by the way got
[35:24] Dr. Steve Derrington: I mean, Southern California, primarily in Carlsbad, North San Diego County, and then also up in Laguna Hills in Orange County. A
[35:33] Colin Rigney: It and so primarily San Diego and you're like your population right people would you say like where do most of your patients come from yeah
[35:47] Dr. Steve Derrington: Lot of them do come from, you know, these oftentimes PT clinics and other physician referrals and then patient referrals, because I've been doing this for a long time. So you're like, hey, this is where you got to go when you start having dinner with people and you're like, oh, this is my problem. Go see that guy. But, you know, people are obviously searching us out organically also. And, you know, all the website optimization, everything is super important. But people are looking to stay active because San Diego population, Orange County population, like people are, they want to be active. They want to golf. They want to surf. They want to hike. They want to, you know, ski in the morning and then hang out at the beach at night. Like people you know they don't want to be you know slowed down you know so they have motivations to do the work to get back to the things they love to do and being active is really part of you know their identity for the most part it's a it's a great stress reliever it's a social time I mean obviously you know pickleball tennis like these things are huge activities around here I think everywhere in the country but the population is eager to get back to do all the things that they love to do. Not just, I want to do basic function. I want to be able to get up out of my chair, which sometimes that's where people are at. But it's a, it's a population that is generally active, health minded. And they want to do things a way that is going to, you know, set them up for, you know, for intermediate, but also, you know, long-term success. They don't want to be burning bridges. They don't want to be doing things unnecessarily. So they're oftentimes dialed into like, okay, I'm doing all of the things, like what's the thing that I'm missing that's holding me back? And when they're in the right networks of good PTs or physicians that are helping them optimize these things, it's like, this is the step that's holding you back because the things that we're doing is not getting you there. So this is the key that can kind of unlock that progression. I
[36:24] Colin Rigney: Yeah and I mean you're in San Diego Southern California where it's just beautiful essentially year-round and so a lot of the that's a magnet for people that's a magnet geographically a geographic magnet for people who are just active in general right and so You want, I mean, you fit in nicely there. I want to transition into, because you're, I mean, you're uniquely positioned and have a very unique practice where number one, what you do, where you are, and you don't take insurance. Is that correct?
[38:10] Dr. Steve Derrington: Do for consultations, so kind of easier barrier to get in the door. But yeah, the orthobiologic procedures, for the most part, are not something that's covered. So it's a shared conversation after the evaluation of how do we manage this, not what does insurance say we do next.
[38:30] Colin Rigney: So excluding, because you're a part of Regenexx, excluding kind of their work because they have like a program,
[38:36] Dr. Steve Derrington: There's a people that work for certain self-insured companies can have actually coverage for it. But outside of that population, everybody else is making a financial decision on how do I take care of my health. It
[38:49] Colin Rigney: So how, what made you like take that path? What made you, what made you, what made you take this path, Steve? Was that, you know, how soon after school fellowship? Tell us about that.
[39:01] Dr. Steve Derrington: Was really during fellowship because with Dr. Bodor, like it was kind of a hybrid, well, it was a hybrid clinic where we did quite a bit and really throughout that year, even more and more orthobiologic procedures. And we also had normal, you know, normal non-operative sports medicine, interventional spine work where, you know, cortisone injections, ablations, pain management, and kind of working back and forth with the surgeons before or after surgical procedures. Procedures. And over that year, you got a lot more continuity with patients instead of, you know, rotations during med school where you had one month and you're like, oh, I heard about this patient that was treated before. Now I see them, but it's not your patient along the course there. But during this year, I got to see patients who we treated with PRP for something and they would come back with their spouse or their, or their friend and be like, and also because we were in Napa, they'd bring a bottle of wine and say, hey, I'm doing so great. Like, you know, can you help my friend where the patients who we would treat more traditionally sometimes they would do great of course sometimes the steroids you know worked and knocked things out they could do the rehab and they were good but more often than not it was you know the occasional head scratching like that epidural didn't work but that anatomy lined up perfectly why didn't that steroid shot work or the hey here's my knee arthritis worked for three months worked for two months kind of get pain med refills and like everyone's kind of frustrated with that so I saw that split there and I was like, I don't really want to go down that route. I understand some people need management that way, but I have the skills and the knowledge to offer something different that I think is better. And if I can be in alignment with the type of patient that is searching that out, then we can do a lot of different things and not have to go the traditional route. I
[40:46] Colin Rigney: So from Napa, did you go directly to Southern California? What was that journey?
[40:51] Dr. Steve Derrington: Worked in Northern California for a year with the clinic that I ended up transferring down to Southern California because I had some different skills that the other doc in the clinic didn't have he didn't have the spine training so within yeah within a year after fellowship I was in Southern California and yeah we've been here for yeah nine years now I
[41:13] Colin Rigney: Great. So, I mean, that's, I mean, that's a pretty unique path. Not a lot of, not a lot of physicians number one got the got the amount of ultrasound training you did was that in residency yeah
[41:28] Dr. Steve Derrington: Was in residency yeah I was very fortunate to be exposed that early I think ultrasound is being integrated into a lot of residency programs now but it definitely wasn't common when I was going through it. So being able to be exposed to ultrasound and fluoroscopy, and then with my fellowship, developing the way to think of like, how do I apply these things to stuff that we're not doing now, but in the future, we're going to be doing something different. So I mean, every once in a while, I kind of think back on, yeah, the stuff that I was doing and how I would think, you know, first, second year out and like now what I'm doing. And yeah, you just have the flexibility to apply these skills to new problems as they as they come to you whether it's a completely different approach or just a new problem that you haven't seen in a long time but the patient that comes to you is who comes to you I
[42:14] Colin Rigney: So you just said something that maybe made me think earlier I asked a question about teasing the next 10 years so about the future so you've got the past right and how we've evolved over that amount of time since you were exposed to orthobiologics and in this form of MSK medicine what what's a you know what's the next 10 years for you what do you see yeah
[42:39] Dr. Steve Derrington: Think it's gonna be a lot of fun we talked about this at some of the conferences that we're at on like you know where things were five ten years ago like I mean your mind can take it all kinds of ways I think it's gonna be really fun it's gonna be really cool we're gonna have some great new tools we're gonna learn a lot more about which orthobiologics for which problem, which preparation for which problem. Again, I think the importance of the rehab and what does that structure look like for problem A, B, or C, we're just gonna be that much more confident about how do we best help people with these kind of musculoskeletal problems. And yeah, I think that's just gonna help us be better clinicians, provide better care, and patients are gonna be happier. And there's been a lot of progression, even, like I said, in my career, we're just patient understanding or at least awareness of this field at all. So as that continues, that's just going to keep ramping up. And, you know, more and more people are going to be looking for what we're offering. And they're going to be able to be more sophisticated with what they're looking for. So if you're offering basic level stuff, you're going to get left behind by someone who's doing it at a really high level. So extra motivation for all of us to continue to learn from each other, talking about so we can stay at the forefront of what we're offering. I
[44:02] Colin Rigney: And so yeah I mean next 10 years we don't know what we don't know what do you see anything going away like even like things that are like kind of good right now or have been good do you see is there any one thing or any trend that you see going away in lieu of something better oh
[44:23] Dr. Steve Derrington: Think, well, I mean, insurance is always an interesting kind of thing to think about. I don't think insurance is going away. I don't think steroid coverage for standard orthopedic things is going to go away. But I think that, again, as awareness comes out, more and more patients are going to be looking for ways to do things differently. So I wouldn't be surprised if this is a, it'll start small. It'll take some time to get there because the masses again probably don't even know about what we're talking about at all but as that awareness increases there's going to be public pressure to make that shift and that's going to be you know hopefully something that drives this to you know to change how traditional non-surgical orthopedic medicine is done yeah
[45:10] Colin Rigney: One thing we talk about is being like in the age of AI and like pretty much every week there's some new advancement where if you take a month off like you're behind you know and you know this and the population is right wrong or indifferent that they're they are coming in more educated and asking better questions even they don't know what they're asking okay because AI told them what to ask right but do you so like I see that as a good thing to be beyond to be honest because they want they still want some validation or like verification of hey I read this and this is like this is a better question than what we were being asked 10 years ago because of their access to information now that gives that gives you now an opportunity to like I mean some of what they're saying I mean that's it's kind of right, you know, but here's a, here's a little nuance to it. So have you seen that a lot in your practice? Like, you know, your business being AI searchable and patients coming in with their AI diagnosis or augmented diagnosis.
[46:11] Dr. Steve Derrington: We're seeing that more and more I think just in the last week I had three people come and it was kind of consolidated but it's like here's my history here's the timeline line on things and helps the patient get it organized in their head but it's also really nice for me to see like hey let me go through the tier and then yeah you can you can ask questions or as they're kind of taking the next step of here's my here's my presentation here's my imaging what do I do about it you can help to kind of guide like well this is not quite right but here let's kind of walk through this but I always like patients when they're more educated because we can have a much better conversation much deeper conversation about what's going on what do we do about it what are their options instead of starting from talking about very basic stuff so the better they're educated coming in it's more fun for me to have the conversation with them and yeah they're already on that way to being invested in their care so they're already putting that front effort in and then now it's just like hey let's figure out the right plan and let's get you going yeah
[46:25] Colin Rigney: Story. Yeah. I see it as a very good thing. That that's one place I see in the next 10 years. I, you know, if you listen to Ryan's prediction where it's, I think he's kind of right. He'll be right in some areas like with that show Futurama, where somebody drops a package off at your door and there's like this AI toolkit to help you diagnose, whether it's some kind of imaging tool, ultrasound, at-home x-ray, that sort of thing is to prepare for your visit or just even get a diagnosis. Diagnosis. Do you have any thoughts on that? Have you thought that far ahead with it?
[47:44] Dr. Steve Derrington: I haven't thought that far ahead but I mean the way that technology is moving and the way that AI is progressing like I think you probably can't even think about what the possibilities are of what is what it's going to be like in 10 years because it's just it's just exploding and going so fast and as long as you have enough guardrails on things I think it could be done you know really well and it's going to be exciting to be part of it I'm glad that I'm not I'm not at the end of my career where I'm going to miss out on I get to I get to experience it yeah
[47:51] Colin Rigney: That's so Ryan. Yeah. Yeah. Yeah. Lot's in front of us, man. A lot's in front of us. Well, Steve, this has been great, man. Do you have anything else? I know I want to plug the summit Stephen Derrington is going to be one of our speakers and he shared a little bit of his topic today in rehab and orthobiologics and if you want to look at the look at the lineup the website is summit.amsku.com it's December 5th and it will be pre-recorded but you will have access to all the recordings and the questions and answers with people like dr Derrington here and so I highly recommend it it's a it's going to be an amazing day a lot of work to put this thing together but it's really for the community and Steve this is this is great just sharing a little bit of time with you guys we're in this because we just simply first of all it's fun we have a lot of fun doing it and like you this is a place that you know I'm really meant to be like I just it doesn't feel like work I really enjoy it and you know I get the same feeling when I when I meet you and people in the field like you so thank you again Steve and ladies and gentlemen
[49:37] Dr. Steve Derrington: You're welcome I agree I feel like I get to go I get to go for my daily job which isn't really a job because I love the practice that I have and love the people that I interact with and go to another fun non-job when we do we do teaching stuff so I mean being in control of what you do and how you do it makes a lot of things a lot more fun. So yeah, I'm looking forward to the summit. I'm going to watch as many of the lectures as I can because like I said, the people that are talking are awesome. It was great last year, first time. I can't believe how good it was and this year is going to be better and yeah, excited to see it.
[50:14] Colin Rigney: Thank you thank you all right ladies and gentlemen Stephen Derrington and that's a wrap thanks
[50:19] Dr. Steve Derrington: Thanks, Colin.
[50:21] Summit ad: 10 years ago, an ultrasound unit cost $20,000 or more. Now you can run one off your phone. So the question isn't whether you'll scan, it's what you'll do with it next. I'm Colin Rigney. I'm Ryan Martin. At AMSKU, we teach clinicians musculoskeletal ultrasound. On Saturday, December 5th, we're bringing the field together for the AMSKU Annual Global Summit. One day of MSK ultrasound and orthobiologics, fully online. No flights, no hotel, no closing your clinic. The whole day is built around four questions. Where does AI fit in ultrasound diagnosis? What's next in orthobiologics and regenerative medicine? Where does point-of-care ultrasound go from here? And what does the practice of the future look like? Dr. Don Buford, Dr. Scott A. Sigmund, Dr. Mark Pietropali, Dr. Ariana Demers, and many more. Three tracks, and every session has Q &A, so you can ask them yourself. Last year, clinicians joined us from five continents. Every session is recorded, so you keep it. The best moment in teaching is when the image clicks and you stop guessing. Train your eye trust your hand tickets are at summit dot AMSK you duck the next decade starts in your hands AMSK you AGS 2026 last year we wrote four