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We set out to talk with physical and occupational therapists, along with other healthcare providers about the state of healthcare, hot button topics, and treatment options in different healthcare segments.
Welcome back to another episode of the Freedom Talks podcast, everybody. This is your host, Joe Ogden, and we're here with Trenton Raymond, who's also our physical therapist out in Brookfield, who was nice enough to join us from his fellowship on Marquette. So Trenton, thank you. And then we're also here. It's been a while since we've had an interview, so now we don't have to listen to just me give a short podcast information.
Joe:We're here with doctor Stone out in Franklin. Doctor Stone, thank you for joining us today.
Dr. Stone:Thanks so much for having me.
Joe:Especially, it sounds like he had a emergency surgery today too. Yeah.
Dr. Stone:Just a bad ankle fracture, but came together really nicely.
Joe:So Surgery was
Dr. Stone:successful? Absolutely.
Joe:What happened with the patient?
Trenton:He,
Dr. Stone:he was at work and fell off some scaffolding and had a pretty gnarly fracture that we had to fix through 2 different approaches. So had him, flipped on his belly for the first part and then flipped him back onto his back for the second part and three plates and a bunch screws later, he, he should be all, hopefully, all set up. So
Joe:Doctor Stone, tell us a little bit more just kinda about, you know, where you went to medical medical school, some of your training. Just give us a little bit of your background for listeners that may not be familiar with you.
Dr. Stone:Sure. So, I grew up in the area. So I grew up in Mequon, went to Homestead for high school, and then, decided that I wanted to get out of the Midwest for a little bit. And we have a bunch of family out in the northeast, mostly around Boston. So, so I went out to college out in western Massachusetts and then, went to medical school in the Bronx at Albert Einstein where he saw a lot of different walks of life out there.
Dr. Stone:Really interesting place to to see see medicine, firsthand. And then, went to Tufts for residency for general orthopedics training, and then followed that with a 1 year fellowship in Santa Monica, for sports medicine, and really enjoyed that out there for a year. And we're we were able to do some sports coverage out there as well. So covered a a couple of the professional soccer teams and a bunch of colleges and, had a lot of fun for a year. So now we're back here, closer to home.
Joe:I saw you've seen basically all spectrums of the US. You go to school on the East Coast.
Dr. Stone:Exactly.
Joe:Training on the West Coast and now back Yeah. In the Midwest.
Dr. Stone:Yeah. The back to the best part. So
Joe:Was it always your plan to come back home?
Dr. Stone:No. No. Not at all, actually. So met my current wife when I was a chief, so my last year in residency. And, she is from outside of Philly and thought we'd probably go out west or stay out east, honestly.
Dr. Stone:And just with the job market, it was right at my 1st year of practicing here was COVID. So
Joe:Good start.
Dr. Stone:Yeah. We're a great start. So so she was finishing her fellowship in Chicago and, it just ended up working out that this ended up being a good place for both of us to practice. And she's, an anesthesiologist over at children's and and, really likes
Trenton:So, doctor Stone, with your training being kind of across, you know, the country, I know in physical therapy, there's trends in care. Sure. And in medicine that can, you know, like the East Coast will be ahead of something or maybe behind, and then it kind of travels across the country where you start hearing what people are doing in other areas. Can you speak to that? Is that the same thing with your training?
Trenton:Like, is how does Midwest Medicine compare to, like, the coasts? And, you know, is there anything we're ahead of or behind on here?
Dr. Stone:I mean, I think we're always trying to treat the, you know, the group of patients that we're seeing in any given location. Right? So, you know, you're you're always individualizing care to a large extent. So, you know, out in California, you're seeing a lot of, you know, super fit people who are, you know, you know, they're hiking and biking and and being really active outside all the time. You know, it's, I think a little bit different in the Midwest in terms of, you know, what you're seeing and treating, especially, you know, you know, I I think, you know, in general, people probably aren't quite as active.
Dr. Stone:So your just your your your goals of care are just a little bit different. And that being said, you know, we have some really active 70 year active 70 year olds that I think are super, you know, consistent with what I would see in fellowship all the time, but it's just a different population out here. I think a little bit some more similar to East Coast, in that way. And yeah. I mean, I I think that's as far as physical therapy, though, I think the physical therapists generally are pretty well trained across the country, and I think we do pretty similar stuff, especially in sports medicine.
Dr. Stone:So, like, you know, a standard, you know, accelerated ACL rehab protocol, for example. Like, that's pretty standard across the board, you know, in the United States now. Same with, you know, I think there's a fairly wide variation in in cuff rehab protocols that's, you know, from physician to physician. So those you know, I I think in general, though, the physical therapists are are a really strong component of of our patients' rehab. I mean, I I tell patients I do 50 percent of the work on the day of surgery, and then you and your physical therapist, your physical therapist is your best friend, and that's the other 50%.
Dr. Stone:So, you know, work hard with them and you'll have a good outcome.
Joe:Yeah. That's awesome. I think that's the biggest thing too is just because you mentioned rotator cuff and ACL. I feel like post COVID because we were just talking about before we started the podcast, there's such a digital age now post COVID because during COVID, I don't think anybody had better things to do, but start this, you know, more video and and documenting a lot more of how we do things, what what we do. I feel like the ACL and rotator cuff now, it's it seems like there's a really general concise information of this works really well.
Joe:This is how we should rehab it correctly. This is the surgery that works really well, and then patients, I feel like, are having a little better outcomes.
Dr. Stone:Yeah. I mean, I think dissemination of information, I think we're getting better at, and, you know, AI is helping us a little bit in that regard as well. So I think people are able to access information a little bit better, than they used to. You know, know, that being said, I still think it's helpful to see a professional to really give you a a a more thorough, comprehensive perspective on some of these things, especially with regard to rehab because, you know, if you if you go into surgery with the wrong post op expectations, then I think that really throws people for a loop. And I'm really honest with them.
Dr. Stone:You know, to start, you know, with an ACL, it's 9 months of rehab and same thing with a cuff. It's often 9 you know, 6 6 to 9 months of rehab. You know, and and you just have to be honest with people about those things to to start off, and it's a big time commitment.
Joe:In the 9 months, I mean, I won't speak for Trent. I'll let Trent answer himself. I feel like too, especially with ACL and rotator cuff. I mean, I guess this could be applied to any surgery, but I feel like those 2 specifically is sometimes the negatives of the digital age is that there's this unrealistic timeline of this is my senior year of, you know, football. I wanna play baseball in the spring.
Joe:I just tore my ACL November 9th, and I'm having surgery November 15th. And it's
Dr. Stone:like Yep.
Joe:I hate to be the bearer of bad news, but it's gonna be a little bit Yeah. Probably longer than that. I don't know know how you feel, Trent.
Trenton:I think I agree totally is that, like, the dissemination of information is good to an extent. But then you hear of 1 NFL player like Adrian Peterson who comes back in under 9 months, and now we think that that's a standard. And it's just not. Yeah. So I totally agree, like, having realistic expectations prior, to surgery.
Trenton:But then post is just saying, you know, these are the standard timelines. Like, that guy was kind of an anomaly. So it it's tough because you hear the good stories, and we think that's the norm.
Dr. Stone:But For sure. And some of this is you know, I tell patients, like, look. This is just biology, and we can't hurry the biology part of it. We can hurry to a certain extent the rehab protocols. We know what works at certain time frames post op.
Dr. Stone:And and, again, that's where a really great physical therapist comes in. So if if we're if we're playing both parts of this puzzle and we're and we're trying to to get people back as quickly as possible, then I'm all for that, but you also don't wanna rush that timeline.
Joe:And speaking of patients, what is the patient population that you typically work with? Or even body regions, if that's an easier way to answer.
Dr. Stone:Yeah. I mean, I think I can answer maybe both of those. So right now being early in practice, you know, I'll see pretty much anything. And if it's not in my wheelhouse, if I'm not the right person or the best person to take care of that patient, then there are plenty of people in our practice who I feel very comfortable sending people to. So, I think there's a huge mix.
Dr. Stone:I mean, I think, you know, the patients who come into the office, for general hip and knee problems are oftentimes are just, you know, arthritis problems, and those people are a little bit older and maybe a little bit more sedentary on average. But there's also, you know, the trauma population. I take a fair amount of TraumaCall, and those are, that's a totally different population, and usually fractures or, you know, torn tendons or ligaments. And then we have our younger sports population who are, you know, active active people, who are, you know, have ACL tears or, you know, similar problems like that, and and that's that's a different cohort. So, I see a little bit of everything.
Dr. Stone:And and, again, if I'm not the right guy to do the surgery, then I'm not gonna be the one doing it. That's great.
Joe:Now early in your career so far, what are you noticing that you're, you know, kind of tending to want to see more or some of the methods that you're leaning towards more as a as a provider?
Dr. Stone:Yeah. So, I mean, my love is still sports medicine. So I think the more sports I see, the happier I am in the in the operating room. So I I I love doing arthroscopy, and that's why I did a 1 year fellowship for that. So, anything in that vein with shoulder, and knee is is my preference.
Dr. Stone:But, I mean, I still do a fair number of hip and knee replacement, shoulder replacements, and, a fair amount of trauma. So fracture work and and all those things are interesting and and, you know, again, kind of, I think, make you a more, well rounded surgeon because you can take parts of one surgery and apply them to another, and and then you don't kinda forget your orthopedic basics too. So, so for right now, I think that's great. In the long run, certainly moving more towards sports would be my preference. But
Trenton:I think that's great. In the past, you and I have chatted about, like, cartilage injuries.
Dr. Stone:Mhmm.
Trenton:And how that's kind of kind of niche, but also, like, maybe an underserved population. And just can you speak to, like, some examples of those injuries? And, you know, we want our listeners to understand, like, what, you know, what that is and how they can get to you if that happens.
Dr. Stone:Sure. So I think cartilage, yes, cartilage definitely is a little bit of a niche thing within sports medicine. And and we did a fair amount of cartilage work out in my fellowship, which is why part of why I enjoy it, and and, I think it's a it's a really gratifying surgery. So, to give maybe your audience a little bit of a sense of what that is, that's usually patients with a focal cartilage defect. We're not, you know, treating arthritis this way.
Dr. Stone:So if you if your whole joint is is, you know, worn away, this is not for you. This is for, say, you know, a younger person who has an ACL tear and also has a cartilage defect from that original injury, and then we can address both the ACL and that cartilage defect at the same time. There are multiple methods to do that, and that's certainly another discussion in the office where, you know, a professional, you know, guidance can be helpful. But, yeah, that that stuff is really interesting, but also is a a long rehab process, and I'm sure you guys know that from taking care of MACI patients or osteochondral allograft patients. You know, it it makes things a little tougher, but I think is a, you know, again, a really gratifying way to help to preserve a joint in the long run for for our younger patients, especially.
Trenton:Yeah. Awesome.
Joe:Now is that something too that is also evolving as time goes on that the type of surgery, how it's done, patient outcomes probably too, I'm sure goes into that and just how they're being rehabbed?
Dr. Stone:Sure. Yeah. I mean, I think the I think the techniques for that are always evolving, and I think there's a lot of new technology coming out every year. You know, I a couple things about that. So one is, you know, when we go to these meetings every year to to keep up on the literature on this stuff, there is actually a separate orthobiologics, foundation.
Dr. Stone:So I try to make sure I go to that every year. It's a one day, thing just to kinda keep keep you up to date on all the new stuff around cartilage and PRP and Yeah. Acid and all the new stuff that's kinda coming out in that vein. Certainly, you know, 20 years ago, microfracture was the kind of gold standard for trying to treat chondral lesions. That has totally gone in the opposite direction now.
Dr. Stone:We know that the medium to long term results with that are really quite bad. So I think, you know, anyone who is trying to treat cartilage injuries, we're really trying to do the right surgery first as opposed to trying a microfracture and then doing a secondary surgery where the outcome may not be as good.
Trenton:So as far as those, I'll say evolving techniques or maybe, like, as new research comes out that older strategies aren't as, you know, optimal. What things are you finding yourself gravitating towards, that are more successful or at least are showing promise?
Dr. Stone:Yeah. Sure. That's a great question. I think osteochondral allograft is a great, solution for, again, focal cartilage defects. So, so that basically is taking a donor femur typically, and taking a plug of cartilage and bone, sizing that to match a patient's defect, and then using that as new tissue.
Dr. Stone:And that's really it's a fun surgery to do. It's a little bit of a tough recovery for patients. It adds a little bit, at the beginning, but, again, I think the outcomes for that are really good. There are some more novel, cartilage replacement options coming out on the market that have good short term results, I would say. Mhmm.
Dr. Stone:But I don't know if we have the medium to long term results yet for me to wanna offer that to patients yet. So, so that's something that I think is is in the works, but not quite there yet.
Joe:Yeah. What is, the is it surgeon to surgeon dependent on what techniques they wanna use? Or how much do you need, like, research wise to be like, oh, okay. I think we should do this on on patients. Physical therapy, I mean, things come out whether we see them online for, oh, try this technique.
Joe:This this helps. It's relatively safe. Mhmm. You know, dry kneeling, we found by accident through research, really, through a placebo effect, and now we've proven that it works. How does it work from the orthopedic perspective?
Joe:I mean, is there years years worth of research and then we're like, oh, no. No. This definitely works. Definitely do this with patients.
Dr. Stone:Yeah. So, I mean, a lot of this comes down to actually insurance coverage. So, which which is sad to say, but
Joe:The true reality of health care.
Dr. Stone:That's the reality is, you know, we're not going to get things paid for if insurance doesn't cover them and patients don't want especially for cartilage lesions, you know, these things are these surgeries are really expensive. Yeah. So to for example, to get an osteochondral allograft, that's probably in the range of 10,000 or so dollars just for the graft. And that's not that's not the surgery. That's not the anesthesia.
Dr. Stone:Wow. That's not the medical equipment. So It's
Joe:just the graft itself.
Dr. Stone:Just the graft. Wow. And that graft is sized for you. It is never frozen, so you're getting something that's totally fresh, because we want the chondrocytes, the cartilage cells, to be alive and well when you get that graft and ready to integrate with your with your bone and your cartilage. So so for example, you guys have probably heard of the bare ACL at this point, so the bridge bridge enhanced ACL repair.
Dr. Stone:So that recently, has not we've we have good medium term data on that. So we've started offering that to patients who come in and want something like that. And and that's pretty much what I'm looking for, is at least good medium term results. So I know that in the 2 to 10 years after surgery that we're not seeing anything bad. You know, this is just like adopting any new technique is generally I don't wanna be on the immediate side of things where I don't have good long term results, but I also don't wanna be too far on the end on the other end where I'm not offering things soon enough to patients who could benefit from a technique that we maybe haven't done enough.
Trenton:So, doctor Stone, I know one of the last times we were, covering the golf event together, you were in the process of, reading new research and kind of on editing journals. Correct? Or somewhat of that role? Staying up to date on the research and just being part of that, I think, is super important in health care. You know, with physical therapists, we're we're trending towards way more evidence based, research based care.
Dr. Stone:Mhmm.
Trenton:I know you're on top of that all the time. So I think that's awesome. Can you speak to that a little bit about your roles of, like, how you support the research, how you're involved in the journals, and just how you use that clinically?
Dr. Stone:Mhmm. Yeah. Yeah. I mean, so so we I I guess I should say, I, you know, try to read as many journals as I can, at least skim things because there's there's so much stuff coming out now that there's just no way to read everything. I mean, some of these journals come out twice a month.
Dr. Stone:There's there's just no way. So at least kinda skimming articles where you can read an abstract and get a sense of, like, oh, this article applies to me and my patients, where something might be more applicable. You can kinda do a deeper dive into those particular articles. I also, I review for arthroscopy, which is the one of the really high end, sports journals. So I review probably, between 10 15 articles a year for them.
Dr. Stone:And, you know, again, being able to kind of critically review an article is a good way to also be able to read articles and and, you know, say like, oh, this is a good article, and this is not a good article and why that's the case. And Yeah. You know, again, you don't wanna just take an article at face value. You wanna be able to critically evaluate those things.
Joe:I feel like this goes into what we kind of talked about before we started the podcast with, you know, some of the the time that providers, both physical therapists, doctors, put into social media, which is the same with research, is I feel like it's hard to find time during the day or the week to stay on top of everything. I mean, even
Dr. Stone:Absolutely.
Joe:I'd I'd assume Trenton gets the emails from whether it's the Journal of Sports Medicine or the some of the manual therapy stuff. I mean, it it feels like it's 5 emails a day on
Dr. Stone:Absolutely.
Joe:This research article on this, this, this, and this. I find a hard time to keep up as well. I don't even know how to keep it organized quite honestly.
Dr. Stone:Yeah. And it I mean, it's enough you know, we don't have the resources in a in a private practice setting to really do research. So I think, you know, my goal at this point is just to kinda keep up with that as much as possible and then also, you know, contribute to the to the body of literature by doing reviewing. But, like, yeah, I mean, you guys are in the same spot. It's it's really tough to keep up on everything, and you can try to be, as much as you want, an expert on everything, but, realistically, you're not.
Dr. Stone:I'm sure you're doing a bunch more with the PhD program now. But yeah. I mean, it's it's a challenge.
Joe:Thank god Trenton went to Marquette. The best and the brightest go to Marquette. Now doctor Stone, where do you think the the future is in some of these cartilage operations? Or, like, where can they go?
Dr. Stone:Boy, I the the holy grail of medicine is in orthopedics is regenerating cartilage. I mean, if we didn't have to do hip and knee replacements because we could get to joints before they go into this, you know, catabolic cascade where they just start degrading, then yeah. I mean, that that true that truly would change everything. I mean, we do, you know, hundreds of thousands of joint replacements every year. So, you know, again, I think, you know, when when we're talking about treating the whole joint so, you know, again, say you come in and and you have an ACL terrible, it's not like we we don't just look at the ACL.
Dr. Stone:We look at the meniscus. We look at your cartilage. We look at the other ligaments in the knee. We're looking at your alignment. We're looking and making sure everything else is good because we wanna be we are as a sports surgeon, especially you are you are a joint preserving surgeon.
Dr. Stone:So when we're talking to patients, we really wanna be
Joe:Mindful of the
Dr. Stone:mindful of all of those things. Yeah. Yeah.
Joe:And I guess speaking of, you know, that too, since Trent and I are are physical therapists, we'll kinda connect the, you know, the, orthopedic part to the physical therapy part. Do you notice as a surgeon the tissues in patients that are more if physically fit's not the right word, but physically in harmony that you know, I've seen physical therapists regular the regularly, they're moving well. Do you notice that their tissues heal better, the operation goes easier versus someone who may be more sedentary?
Dr. Stone:There is no question that that is the case. I consistently even with my older patients who are going and getting a hip or knee replacement, I mean, if they are not moving well before surgery, I have them go to I call it prehab. Like, I have them go to physical therapy because I you know, again, part of this is expectation. So if they know what to expect post op, they will do better.
Joe:It makes it so much easier.
Dr. Stone:And the other part is, you know, if you go in more limber and you're stronger, then you will have an easier time. I don't you know, I don't know if I'm necessarily going to see the differences in a short term prehab in terms of tissue quality, but I think the patients just in general have a much easier time, rehabbing afterwards. So, I think that's where there's a huge bang for your buck in that. And and I don't know if patients, until they do it, they they realize that. But but they come back and thank me later.
Dr. Stone:I mean and and they the therapist know too. I mean, you you guys know how effective that is.
Trenton:And I
Joe:feel like that's something too that I've I've act I just had this conversation yet today, actually, with a patient about this. She's she's coming in for prehab before knee replacement. I feel like as health care providers, we assume this sometimes because we do this every day that oftentimes we don't specifically say to patients clear enough that how important it is to come for prehab before a knee replacement or what whatever the case is. Just to get your body used to how things are gonna go because it makes it so much easier. I I would assume you agree, Trenton, just to get a quad set going, just to get a straight leg raise going, just your body knows how to do it.
Joe:Because after a knee replacement, I mean, that that quad is done for a little bit.
Dr. Stone:Yeah. Would you agree?
Trenton:Yeah. I totally agree, and there's there's literature to support, like, muscle mass, you know, presurgery and outcomes and rate of return. But just that, again, like doctor Stone and you were talking about, familiarity with exercise and the comfort of, what to expect, like what pain is good and what pain isn't good. Adherence to post op protocols and home exercise plans is a lot of times dependent on their interpretation, what they feel and do. So a lot of that is attributed ahead of time so that the outcomes for the surgeries that you guys put together can be a lot better.
Trenton:So I'm all for it. But yeah.
Dr. Stone:For sure. Yeah. I'm and, again, I I tell patients, like, look. Physical therapy is a a low risk, high reward situation. Like, you I highly doubt anyone's gonna hurt you in physical therapy if you have a good physical therapist.
Dr. Stone:But, yeah, I mean, especially even in the sports world, it's not just knee replacements. It's, you know, say you have an ACL tear and you your motion is really bad. Well, we're not gonna do surgery on you until your motion's better, assuming there's nothing else wrong with the knee. But, you know, yeah. I mean, we again, we want you to go on as limber and as as strong as as we can without, you know, wasting time.
Dr. Stone:Yeah.
Joe:And I think that just leads to everyone just being happier overall. I mean, I feel this way as a therapist. I would assume, you know, you feel this way as a surgeon too. Even if it has nothing to do with us, it sucks when a patient comes back worse or things aren't going well because you're doing everything you can possibly do to help them. There's just a a bad connect somewhere that things are just not going the way you would anticipate because the patients get so frustrated because they're just things aren't going the way they want.
Trenton:Yeah. Yeah.
Dr. Stone:And that's not, you know, it's not always the patient's fault. And, again, I think that's that's kinda going back to the expectations part as, you know, I, you know, I spend a fair amount of time just talking to patients preop about what what to expect postop. And and, you know, I can spend, you know, a little bit of time with you in the office and go through that. But if you spend some time with your physical therapist preop, I think that's really invaluable. Like, it truly is.
Dr. Stone:Even a visitor too makes a huge difference.
Joe:And I feel like we're seeing it more and more now, which hopefully that leads to more in the future. Great. Which kinda goes to what we said earlier. A lot of it also comes down to the big barrier of insurance, which I don't know how it affects you guys, from your, realm of health care, but sometimes it really hinders what we can and can't do, which is really unfortunate.
Dr. Stone:Yeah. Yeah. I mean, I think from
Joe:And not bashing the insurance company. It's just, again, the reality is how it is.
Dr. Stone:It's frustrating. I mean, we all wanna do the right thing for the patient at the right time, and we don't want that to be measured in dollars. We want it to be measured in a good outcome. So, no. I'm right there with you, and it's it's frustrating.
Dr. Stone:You know, we're constantly trying to just do the right thing. And, luckily, I think in orthopedics, things are fairly black and white for the most part as far as, like, you know, you're injured or you broke this or this is worn out or
Joe:This is what's going on. This is the service.
Dr. Stone:And this is what you need to have. I think that's a little bit more gray in a lot of other areas of medicine. But, you know, with physical therapy and and, obviously, there's a there's a lot of confluence between physical therapy and orthopedics. So it's you know, you guys are an essential part of what we do and, appreciate that very much. So
Joe:Now since since we're on the topic too, in your experience, what do you feel or what do you value is important when working with therapists? Is it the communication, looking at, you know, when we send a note over? Hopefully, therapists are sending notes over when, you know, patients are following up with you. Do you look at specifically what we're doing, or what do you value?
Dr. Stone:Yeah. So, a couple things. So one is communication, and I my preference honestly is direct communication just with the physical therapist. So, anyone who wants to talk to me, I in my I'm available. Like, call me, text me, do whatever you need to do to have the patient get the outcome that we both want.
Dr. Stone:And I think the other thing is just spotting trends early. So if people aren't moving in the direction that we need to move, then catching those before it becomes an issue, what can we do to adapt or change what either I'm telling pay the patient in the office or what you guys are doing in in therapy to to again get to the outcome that everyone wants?
Trenton:Well, doctor Stone, I know in our experience working together, that's been the reality is, you know, when I reach out to you or when other providers have shared that, you're very open. And I think that's something that, not all orthopedic surgeons are, you know, and and not all physicians are and not all PTs are great at communicating. So I think having those relationships and, patients understanding that that's what you value and that's what we try to do to match that goes a long way with their outcomes too. So, I mean, no, that's appreciated, but I want the listeners to know too, like, those direct communications help with outcomes, you know, when things aren't going well or when they are going well. So I think that's pretty awesome.
Trenton:After shadowing you in your, clinic as well, I've you know, it's it's clear you've had, like, you're either a natural or some great training at just that education piece, communicating to patients about, you know, expectations and things. Can you speak to that a little bit with your training, or is that just kind of something you've naturally developed? Or because I know with residencies and fellowships, there's all different focuses and Yeah.
Dr. Stone:I think I think a lot of that comes down to having some good mentor in residency, honestly. I mean, I think, you know, I think in had great, you know, mentors and fellowship as well, but I think especially, I think you learn a lot when when you're doing your pediatrics rotation, actually.
Trenton:Okay.
Dr. Stone:And you have to learn to talk to both the patient and the parent because you're really treating both of those. And and, you know, I'm still you know, we're always trying to to change our language to be more understandable, more applicable, and and you have to change that depending on who the patient is and what they're what they seem like they're understanding and what they're not understanding. And, and some of that, you know, again, when you're when you're forced to talk with a kid and an adult, I think you really learn to to focus that skill a little bit. I had a really great, pediatrics mentor, doctor Braun, who's just fantastic, and he was, I felt like, always just the best at talking to patients and just making it simple. You just wanna make it as simple as possible.
Dr. Stone:And and I think when when you simplify and, again, just speak to the patient like another human being, it just it makes things much easier.
Trenton:That's awesome. So for our listeners who wanna find you, right, can you just speak a little bit to, you know, tell us again kinda the company, locations, where you kind of treat, and all that? Yeah.
Dr. Stone:Yeah. So so I'm I I work at Orthopedic Institute of Wisconsin. So we, I see patients mostly at our office on 31st and Rossen, down in Franklin, but I also see patients in Racine. We see some patients at our Mayfair Clinic on Burleigh, and those are my main spots as far as operating. We do most of our work at the at West Orthopedic Specialty Hospital or at Dimash, which is just down the street from our Rossen office.
Dr. Stone:And, yeah. I'm happy to see, again, happy to see anything, but certainly, I lean more towards the sports sports stuff. And, if I'm not the right guy, then I will find you the right guy. That's awesome.
Joe:Now just kinda speaking too of, you know, patients that you see and, you know, kinda starting down here, has it been 4 years now post COVID?
Dr. Stone:A little over 4. Yeah.
Joe:How do like, for us, growing our practice as as therapists, it's really up to our front desk staff having a good relationship with them on, you know, this is what I'm good at treating. This is what I feel comfortable. These are some of the methods that I use. Does it work the same in the orthopedic realm too? You have a really good staff that just make sure they get the, you know, correct patients, or is it kinda whoever has an opening come come on in and build it that way?
Joe:Or even, you know, you going out and and doing more marketing and and self promotion?
Dr. Stone:I think it's a little bit of all the above. So, I think it's certainly your partners helping you out when you're early in practice and getting you the right set of patients. And and it's hard it's hard to build a practice these days, I think, or harder than it used to be. It used to be very much call based. So you take a bunch of ER call and you develop relationships with patients and you do a good job for them treating their fractures or, you know, whatever it may be, and then you eventually see their family members and you see their friends, and and that's kinda how you built that.
Dr. Stone:That's gone a little bit, I think, to the wayside. I think, a lot of it's just based on primary care, physician referral sources. So having good relationships with your primary care doctors is is just invaluable, and and realizing how invaluable their care is to your patients as well. I mean, they're perhaps the most critical, you know, avenue toward that patient getting good medical care. And then, you know, it still is somewhat call based.
Dr. Stone:So still taking trauma call and and seeing patients in the ER and, again, just having good relationships with those families. That is huge.
Joe:It sounds like the primary care physician is the one that everyone needs to talk to. They're the they're really the the triage person, send everyone to the right place.
Dr. Stone:They are. I mean, I think they're the most underappreciated Oh. Person in medicine. You know, they do
Joe:I just talked about that with someone today too.
Dr. Stone:Oh my gosh. They you know, you know, I I love orthopedics because we have it's it's again, it's fairly black and white. You have a problem. You something's broken or worn out or whatever, and then you do whatever to fix it. And I think patients are super appreciative of that.
Dr. Stone:You know, you're really playing the long con in in primary care. It's, you know, you're you're looking out for that patient's health 30 years from now, and, it's just really underappreciated. They do they do so much work for for patients, and we should be really grateful for that. I
Joe:would agree. Now one thing too I I had a question about earlier, we'll kinda circle back. As physical therapists, sometimes there's treatment methods or ideas that kind of just gain a bunch of steam, and then research kinda comes out and doesn't really necessarily prove that it works the way we thought it does, but it doesn't necessarily hurt the patient either. So we're not, you know, harming them by any means. In your experience or your profession, does some of that stuff happen too where all of a sudden this type of method is like, oh, every bunch of people are doing it because it's it looks really good, and then you find out a couple years later, it's like, oh, no.
Joe:That wasn't exactly what we thought.
Dr. Stone:Absolutely. Yeah. I mean, it's I I sort of think of this like fashion. There are trends
Joe:Yeah.
Dr. Stone:And they, you know again, I really when I'm starting to do something new, I really wanna see, you know, good at least medium term results before we're starting to do something because I don't want patients to have adverse outcomes 10, 20 years from now and then have done a, you know, a 100 or 200 of these things and have people coming back to me being like, well, I'm having this and that problem and saying, why didn't you think of this ahead of time? So we wanna do things that are, you know, tried and true to a certain extent. I mean, I think the same thing probably applies in in the therapy world too. Like, you know, I think a lot of newer newish things. So I since I'm not a physical therapist, I'll let you guys speak to that as the experts in the room.
Dr. Stone:But yeah, I mean, I think things like dry needling and blood flow restriction and, you know, all these things that I think have better evidence are really helpful for patients, especially people who are trying to get back to sport faster. And you have to find the therapist who's willing to do those things to get the patient to where they need to go.
Joe:Well, I think too, at least from my perspective, I'll let I'll let Trent speak too. My goal with especially sport related individuals, And I mean, I apply that to a lot of people. I think everyone can be an athlete because that promotes being healthy in general. And I don't care what it is. I mean, you can just work out 3 days a week but high intensity.
Joe:Evidence just shows also to the patient, in my opinion, that I'm doing everything I can that's supported by literature to do the best possible treatment and put together the best treatment plan possible for you so that they also see that we're doing everything we can both from my point of view and then if they have a surgery from the surgeon's point of view that we're doing everything we can to rehab you correctly. Yeah.
Trenton:No. I think those are, I mean, just great points on both ends. The it's fun to look at the trendy new things, and sometimes they're awesome. You know? But, again, to your point of tried and true, there's, there's, you know, tons of literature to support certain strategies that you don't wanna abandon, you know, to just put all your eggs in the basket of this new trendy thing.
Trenton:So I think a lot of this stuff, at least me personally, I'm kind of trickling this stuff in and seeing if it fits for the individual, but I'm not abandoning, like, you know, our go to stuff that we know works. And I think that's a great way to approach it, especially on an individual basis. So some of your surgeries, you know, the patient might have a totally different presentation in the next one, and maybe needling isn't for them. Right? So I think that's something we try to do.
Trenton:I think most therapists do, but at Freedom, I know we do. We're we're doing a thorough evaluation, a comprehensive, you know, strategy formation of how do we tackle their their problem. You know, not the surgeries, that person's problem. So I think that's something you can follow the research and and stay up on it. And obviously, social media is fun for getting people coming in the door saying, Hey, have you heard of this?
Trenton:You're like, yeah, I'm gonna wait a little bit. But no, I think, I think it's cool to stay up on it, but, a lot of the trendy stuff, you kind of wanna wait and see to make sure it's okay. Long term. Sure. So Yeah.
Dr. Stone:Now are you guys doing a lot of blood flow restriction for your younger patients who are, you know, again, post ACL, get trying to get back to sport and, you know, at least offering that kind of stuff. Are you seeing the results on that?
Joe:We try to at at least I'll speak from my perspective. I try to. The tricky part with some setups in the clinic is doing it right away. Sometimes it gets a little tricky because especially, like, we'll say a high school athlete, they're coming right from school. They've got a, we'll say, a 3 o'clock appointment.
Joe:They need to get out of school immediately on time. Mom and dad have to be in the parking lot to pick them up, and they need to get to their appointment within 3 minutes, and it's a 5 minute drive. So by the time they get there, by the time we get everything set up, it just kinda cuts some time out. So I do try and preface that a little bit that here's my goal. This is what I wanna try and do.
Joe:It's gonna take 50 minutes, and you have a 45 minute appointment. So we've gotta get all this in, try and be as prompt as you can. You use BFR too, don't you, Tran? Yeah.
Trenton:So at least 3 of our clinics, I believe all of our clinics have it. You know, we have it accessible and at least 1 therapist at each, clinic is, you know, using it in some capacity. For me personally, I would like more training on it and just seeing more research as I use it, like, at a bigger picture. But in in the small doses I've used it, I've seen some really cool outcomes and I I like the literature I've read. I attended, a lecture at, our national conference at CSM.
Trenton:I mean and it shows a lot of great healing potential, creates an awesome environment for for healing tissues. But, again, I'm not putting too much weight in that in where like, that's what I'm doing today only. So to Joe's point, you have to use it with the right patient with the right time. Yeah. But, man, I I think it shows a lot of promise.
Dr. Stone:Yeah. And I think to your point, you know, you only have so much time in the day to do therapy. So it's not you know? And and I tell patients the same thing. It's, you know, you're not a professional athlete.
Dr. Stone:You don't have your life is not built around sport. So you don't have time to exercise 4 hours a day and then do physical therapy and then stretch and then sit in a cold bath for an hour. And, you know, it's just not same. So you have to kinda figure out what makes the most sense for you, with the time that you have allotted. Yeah.
Dr. Stone:I
Joe:think going off that too, and we we kinda hinted at it earlier, and you talked about you can't rush biology. Have you worked or done surgery on some elite athletes where their rehab is going so fast that it just doesn't follow? It you know, ACL for instance. Right? We talked earlier that 9 months I mean, have you seen some of those instances where these elite athletes are ready to go at 6?
Dr. Stone:Yeah. I I mean, I think I think the literature would still suggest that 9 is better than 6
Joe:Right.
Dr. Stone:For in that particular
Joe:And some would argue 12 plus.
Dr. Stone:Exactly. So I think I think there is good evidence to show that every month you wait, the biology gets better and your risk of retear is lower. That being said, again, this is just about individualizing your protocol for each patient. So if your patient is a professional soccer star and their livelihood depends on them getting back to sport, then, yeah, maybe taking that risk at 6, 7, 8 months is worth it to them and to, you know, whichever team they play for. And that that's a discussion to have.
Dr. Stone:But everything everything is you know, again, we're you you both myself and and you guys, we're all always tailoring things toward Yeah. You know, what what does that particular patient need.
Joe:And from your perspective, like, for example, a cup a couple months ago, I had this with doctor Gordon. I think she was 6 months post ACL, and this this girl crushed it. Everything was Trent and I do the same return of play testing. She crushed all of it. There is nothing objectively objectively that I could prove to hold her back.
Joe:And I tried everything possible to show something that no. No. We've got we've got to hold it back. From your perspective, how do you ensure that the ligament is intact or healed enough to say, okay. The risk is still there, but it's also, you know, it it's applicable to try it again.
Dr. Stone:So I think functional testing like you're talking about is probably the best thing that we have. It's not perfect, but it does give us a much more dynamic sense of how patients are doing in a real life situation going back to sport. Now that being said, going back to sport is much less predictable. So, you you know, I think as long as the graft clinically feels good, you can back that up potentially with an MRI or some other imaging, and and with the the third part of that being functional testing. If all those thing all those boxes are checked, then then I think if you know the risks and benefits of going back early and you're making an educated choice, then that's up to the the patient and and the parents and whatever applicable situation that might be.
Dr. Stone:But, yeah, I mean, it's you're totally right. I mean, it's it's it's hard to keep those patients away from going back because they look perfect or near perfect, and that that's all about the time they put in into therapy. What do you guys
Joe:So it sounds like and correct me if I'm if I'm wrong. I don't wanna take words out of your mouth, which also was my hope out of this podcast too is the importance of all of us working together is the therapist communicating effectively both to the patient and to you via a note or calling you or texting you and saying, hey. You're gonna see Trenton today. This is what we've been doing. I think he's doing fantastic.
Joe:Let me know what you think. I'll adjust Planacare accordingly.
Dr. Stone:Yeah. I so I don't let patients go back to sport, I mean, in especially in the in an ACL situation without them being cleared by the therapist. So there's just no way they're going back to sports. So, I really I like functional testing. I like quantitative functional testing.
Dr. Stone:I think that gives people a good sense of where their deficits are and where they need to work on things. So I think you guys are you know, again, I can test I can test the ligament all I want. I can do a Lachman and an anterior door all day long. I can do a KT 1000 all day long, but at the end of the day, like, you functionally have to be ready to go back to sport. And that is a a dynamic assessment with your physical therapist.
Trenton:I think that's a a, you know, an excellent point. We were just having a discussion about how patients feel better before they're ready. You know, the pain is better. They're like, hey. I can do this thing.
Trenton:Like, am I ready yet? So that kind of education and that shared decision on, hey. Here are your tests. You kinda meet it or, you know, here's where you're short. Here's where you're not.
Trenton:And then, you know, just properly prefacing, like, here are the risks if you decide to make that that choice to go to that sport. But, Joe and I use a lot of the same objective data on, and it's research based on, you know, if you can do these things, there's a lesser chance, but it's never 0. Right? It's just lesser. And to your point, you know, the longer you wait, specifically ACL, you're gonna reduce that risk of retear or injury.
Trenton:And so just using that education paired with objective data, I think, can go a long way.
Dr. Stone:Yeah. And the other thing I always say to patients is like, look. You did this once. Do you wanna do it again?
Trenton:That's really cool.
Dr. Stone:And usually usually, they're like, no. I okay. Maybe you're right. Maybe you're right. Maybe I should wait a little bit longer.
Dr. Stone:And, you know, and I I try to put things in perspective. You know, again, if if people aren't professional sports and their and their livelihood does not depend on that particular sport, then maybe wait a little bit longer, and you can do plenty of things to stay in shape until that day comes. And and there are an infinite number of sports to play, or activities to do that don't that aren't gonna tax your ACL like going back and playing soccer.
Trenton:I have one before that. Talk about infinite number of sports, pickleball. Uh-huh. Just out of curiosity, how many people are coming in the door post pickleball injury? Tons.
Dr. Stone:We are we're seeing it too. Tons.
Trenton:We're seeing it too.
Joe:Yeah. That's crazy.
Dr. Stone:Yeah. Tons, Achilles, patellar tendons, quad tendons. Whole big. Yeah. I mean, there there are a lot of tendon injuries, and I think they're just you know, people aren't used to stretching and lunging and moving in these ways that
Trenton:I don't know if you've played, but it's fun.
Dr. Stone:Oh, it's a ton of fun. So so I actually I used to play a lot of squash, and it's very similar, very similar movements, I think. So but I mean, you have to again, you have to be pretty blimp. Yeah. And I yeah.
Dr. Stone:I mean, we're we're seeing them all the time.
Joe:We see it a ton in Fox Point too. We're seeing I mean, I don't know how patients are presenting to you or even, you know, Brookfield. It's a little different demographic sometimes. But we see a ton of people in Fox Point where they use the example of, well, I used to play tennis, but I'm too old. So now I transition to pickleball.
Joe:And I I personally struggle to find the connection on how that makes sense. But because it's pretty quick. It's pretty back and forth.
Dr. Stone:It is. I think it's a little less running, so I think people think that it's like, oh, it's a it's tennis on a smaller court, but, like, it's a completely different game. Yeah. And and it comes with its own particular set of risks. And I'm don't get me wrong.
Dr. Stone:I'm really glad that people are staying active in
Joe:Oh, yeah.
Dr. Stone:Another sport and, like, it's a, you know, a way to connect with other people and all those great things about being involved, in sports. So, like, don't take this the wrong way. But, yeah, I think I think you just you have to stretch and, like, be ready to ready to play pickleball. Yeah.
Joe:Now I'm gonna assume, even though we've talked and it sounds like you're a pretty busy guy between work, research, and 7 month old baby at home, But I'm gonna assume that you like to be a regular guy every once in a while. What are some of the activities outside of work that you enjoy doing?
Dr. Stone:Well, so I had to give up running a couple years ago because my knee started bugging me. So I do spend a fair amount of time on my Peloton. But outside of that, I really like photography. I like cooking. My wife and I really like hiking, so we try to get outside as much as we can.
Dr. Stone:And on vacation, we, you know, kind of air toward the coasts where we can get towards the mountains. But I'd say those are the main things. And, you know, like you said, having a 7 month old and you guys have little kids at home too, you you know how much
Joe:Life changes quick.
Dr. Stone:Yeah. Yeah. Yeah. But yeah. I think I think that's mainly it.
Dr. Stone:But, yeah, Theo takes up a lot of our time right now. So Awesome.
Joe:That's awesome. Now, doctor Stone, is there anything else you wanna add in that we've missed that you wanna make sure that the listeners know about you or any information you like patients to know even before they come and see you? Hopefully, they can tell on this podcast super nice, friendly, open orthopedic.
Trenton:I would
Dr. Stone:try to be nice and friendly here. No. I mean, I think we touched on a lot of the key points. And yeah. I mean, again, if I think the thing that I would stress would be, I mean, obviously happy to see any sports and, you know, replacement kind of stuff.
Dr. Stone:But again, if I'm not your guy, and I will be very honest with you about that from day 1, and I will send you to the right person, and, we will set you up with the right physical therapist to get you better. And, it's a it's a team effort. So if you need something, come and see us, and, we're we're happy to evaluate you and and and get you better.
Joe:And do patients need a referral to come see you, or can they just call your office directly?
Dr. Stone:That's an excellent question. I think oftentimes they do require a referral from their primary care doc. Again, that's just the way that
Joe:The system works. Medicine works. Yep.
Dr. Stone:But, yeah, if you can if you can come without one, then I'm happy to see you for whatever it may may be. So
Joe:Yeah. Anything else, John? That's
Trenton:that's all.
Joe:Well, thank you very much for your time, especially on as we're recording this on Friday afternoon after all of us are done working.
Dr. Stone:No. This is great.
Trenton:After a trauma surgery.
Joe:Yeah. After a trauma surgery. No. We're
Dr. Stone:we're this is great. Thank you for having me, and, we appreciate all your hard work.
Trenton:So
Joe:Yeah. Thank you.