E55 | Keep It Real Talk #6: Having Options and Patient Outcomes

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On today's episode, Greg, Doug and Trevor #KeepItReal while talking having options & patient outcomes. Links of interest:

• Christie Aschwanden Podcast

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Episode Transcription: Going on now until September 10th. At noon, we are running a free giveaway of our moving foundations course and exercise database. Visit our Instagram account @resilientPPT to learn more and enter. If you've already purchased these prizes, we'll get you our next course or provide a future discount of the same value either way. We'll make it work so you can benefit as well. Hope to see you there. Before today's episode, I want to ask for your interests. We'd like to open our, keep it real episodes up to you, the listener and have discussions on topics driven by the content of this podcast and our social media. If you're interested, we'd love to hear. So by dropping us a message on our Instagram, our handle is @resilientppt. Thanks. Welcome to the resilient performance podcast. I'm boasting today. Trevor wrap up here with my partners, Greg and Douglas on keep it real. Number seven. Is that what? This is a six, six. Wasn't it. I gotta look that up. What we do this, um, one of the things that we want to talk about first was something that young clinicians struggle with. And we always get this question from our students that we have is how do we choose the right exercise? Um, and kind of what is the right exercise as if there's only one intervention based upon what we're seeing that's applicable when in fact there is millions and you can choose pretty much anything as long as you have a good rationale. So you guys want to start talking about that. Yeah. And you know, when people say like young clinicians, it's not like we're like these master clinicians or like, you know, you know, a paddle on like, we're going to show you. Um, I think that's a great question because. I don't know if there's a way to definitively answer it. I'll go back to, you know, some, uh, eighties, nineties movies, analogies. You remember from the movie city slickers with Billy crystal, there's a point where they're, you know, two of the members of the group, I think are these, uh, these brothers that own like an, an, uh, an ice cream company. And at one point they're eating dinner. You know, with, with curly passing around the, uh, you know, the pot of whatever hot food they just made. And, you know, these two brothers say like, we can pick the best ice cream for any meal. And, and Billy Crystal's like, okay, like, I'm going to challenge you. And he names like some, some random meals, like sea bass and something else. And they, like, they look at each other and like thinking really hard for a couple seconds. And then one of the brothers says, Rum raisin. It takes a deep breath as if like he just answered this question, they high five each other. And it's like, how the hell do you know that? That's that's right. And they said something like, well, you know, when you sold this many millions of dollars of ice cream, you know that you're right. But when it comes to exercise, how do you really know that? You're right. I mean, you can have your test retest, so you're testing something you think is meaningful. It could be range of motion. It could be. You do a certain exercise or activity like you run my knee hurts when I run, you do an intervention and then he doesn't hurt anymore. Now maybe, maybe then he doesn't hurt in that moment. Maybe the knee is going to hurt when they go home and then, or, you know, 24 or 48 hours later. So even in that one session, like, did you make a change that was meaningful? It's hard to know that I don't even know if we have ways to truly know that it's like, you have to have some test retest because it's not going to be perfect, but you have to have something. And then a lot of times, you know, and this is kind of like a double, the secret to think about what we do. We think that what we're doing is so like kind of specific and perfect that like, you know, Oh, like we have such an influence on people. And I think that, you know, if I'm being honest, I don't know if you guys feel differently. I feel like it's hard to say like an exact percentage, but the majority of like, what I feel like I do with people is I give them permission to move. Because nowadays, like, if anything hurts, everything is so pathologized. It's like, well, you know, like my knee hurts when I run, so they either stop running on their own or they go to another medical brighter. He says, Oh, like, you know, you shouldn't run, you shouldn't do squats. Like there's a million things that you shouldn't do. And sometimes like if there's a really, really acute injury there's tissue damage yet, like you should not, you should rap. But I think a lot of times like rest and just. Cutting off that activity is over prescribed. And so even if you just have somebody do something to prove to them that it's not dangerous, that alone can be very, very valuable and therapeutic and you didn't really do anything great. You just gave people permission. So at least for me, like what I'm trying to do with people as I have kind of like a sense assessment and I'm looking at, okay, like, do you have any gross movement, deficiencies and people can argue about, does that even matter? Like, I think that. You're you're a human being before you're a basketball player, a track athlete before you're a grandparent that wants to pick up kid. Like I'm not looking for, do you have, you know, 40 degrees versus 38 degrees on one side or the other I'm looking at like, do you, do you have something? Are there any Greicius things where it's kind of like that kind of, you know, put your antenna up, try to address those and then, okay. Like if you have trouble in a painful activity, let's assume that we got rid of that low-hanging movement fruit. Let's try that activity. If it, if it, if it's pain free, great. Now we'll try and get you on a program to figure out like how to maintain that or build up to your old workload. So the whole load management thing, I think load management is important and progressive overload, but I think that you have to have to address, you know, the underlying movement, quality aspects of that, even though it is an ambiguous term. Um, and then if you do your table stuff, you do your test retest and the table stuff cleans up, but they still have. Pain or lack of confidence, whatever activity they care about, then it's like, how do we duplicate that activity as much as possible and maintain as much of a, a training load as possible without exacerbating symptoms. So if their knee hurts, when they squat, it might be in a back squat, maybe in a different kind of squad, it doesn't hurt. Or if there something hurts when they run, well, maybe it only hurts after two miles. In which case we'll cut your mileage down. Maybe it only hurts at a certain threshold of speed. Maybe, you know, any kind of running hurts, but if we do a skipping drill or a progression to running, or even a level plan metrics, role that somewhat netics running in terms of the elastic qualities and stuff like that, that doesn't hurt. We'll do that. So it's like, how do we address the global stuff detached from the activity? And then how do we address, um, how do we get as close as possible to what they want to do, and then develop a good program to build up tolerance? But even with those things, it's impossible to say like, if, what you did, how do you evaluate it? Because there's so many ways to do that. So, yeah. Yeah. It's like, yeah. Yeah. Like a couple of you said that stuck out to me in terms of. Okay. Going back to what the root of that question is. It's like, why didn't you choose something? And it's always based upon an assessment of what we think one of the major limitations or one of the major factors that should be preventing them from, from moving efficiently or effectively, or safely or whatever, and then taking that, you know, orthopedic or more typically biomechanical evaluation and choosing something that should improve a wetter, whether it is like a range of motion or mobility restriction or. Excuse me, or like elasticity with the skipping example or strength or whatever, and then retesting it and seeing if there is an improvement. So from the assessment, there are so many things that you could choose it just based upon like, what lens are you actually viewing? What is causing that limitation or what is causing their they're the reason that they're in, in seeing us what's what do we think is kind of causing that? So our intervention is always based upon what our own rationale and what our own thinking is, but that doesn't mean that like I'm right. Somebody else could choose a completely different intervention for a completely different reason and get the exact same outcome as me. So just because like something work doesn't mean that something else would have worked too. And I think that's an important thing for people that see it's like, just because the thing I chose did get the effect I want. It doesn't mean that's the only thing that could have gotten that cause people, especially on line, people started speaking. So dogmatically, like. This only, this is the only thing that you can do for this symptom. You know, something really a blanket statement like that, which is so misleading to people. Um, if you don't understand that everything works, it just has, there's so much context, like, like you're describing that influences why things work and that's, uh, so many reps of treating patients makes as has helped us understand like what, what that lens is and, and what are some of the different factors that can influence how, how an intervention is actually. Uh, perceived by a clinician. And I remember this, you know, it makes me think back to when we were all students. And I remember certain like nuggets of my clinical experiences just kind of pop out and like, uh, I remember more clearly. And one of them was with Alan Gruver in Arizona where, you know, it's almost like he had to sort of draw out an answer from me of like, okay, well, what are they missing on the table? Okay. Okay. What do you want to do? It's like, well, uh, well, there's a million different things I can do. So how do I choose what I want to choose? So he's like, doesn't matter, choose one, just choose one. It doesn't matter. Pick one, try it. If it doesn't work, then pick a different one and you can do that over the span of weeks too. Like, it doesn't have to be in that one session that you were fixing everybody with one exercise. Cause that's just not really how it works. So, you know, I remember picking some sort of reaching exercise for somebody's shoulder. And it was like, looking back I'm like, that was kind of a dumb exercise. Yeah. Like dumb, because I wouldn't pick it now, but it's still fit the rationale, why I would want to choose that exercise. And I think that then leads to a, when we have students now, you know, they they're, they're going back to the, you know, to the, to the same way that I was, or you guys might've been where it's like, okay, you pick this specific one exercise. Like, why did you pick that one exercise? And for me, my answer is always now, what does this exercise do? Like what, what are we doing here in this exercise? What's the goal of the one or two goals that we're trying to achieve with this exercise? So let's say is that some sort of hamstring exercise to get more hip extension or whatever it is. Um, they'll they might have that answer, like they're limited in hip extension. So I want to do something to activate the hamstring, like, okay. So that's what this exercise does now do 10 different things in the same exact position in different ways, variations, different Heights or whatever. And they're all correct. And then it goes just back to what you were saying about us, just having reps. Um, and that's what students don't have, but it's like, So daunting as a student of like, I have to pick it up the thing, and there are so many different things, like you said. And, um, and then it's also a matter of, you know, at the right time picking the right thing. Cause people will, people will things like clamshells or, you know, things like that. It's more a matter of like, when, when are you using clamshells or why are you using clamshells if it's somebody that hip surgery postop, like they probably needed to do some clamshells initially like to just desensitize the area because the muscles working, like who cares, it's fine. It doesn't matter. Like they're going to graduate from that in a week or two or three anyway, but that's the initial jumping off point and you have to give them something to do. They need exercise, they need to move. And that's goes back to what Doug you were saying. You're giving them. The, uh, the, okay. Are you, you're giving them the thumbs up to move in whatever way. It just might be this clamshell exercise because that's where they're at. And then, yeah, like I would then say like, probably shouldn't be doing clamshells week, you know, week 40 after an ACL surgery. Like he probably shouldn't be done at all. You probably shouldn't be doing so. Anything else? That's a little bit more bang for your buck at that time. So yeah, something can, like you said, Trevor, everything works. Um, but it has to be for the right reason at the right time. And then like, then you can kind of just pick whatever you want, as long as it comes, satisfies those, those two factors. Yeah. Maybe this is like a philosophical question, but it's like, who's the arbiter of whether it's working. I mean, to me, that should be the patient. And I think that people, people, you know, are usually pretty good about deciding what they like and don't like, so we don't need, you know, like an expert to tell us what computer to use. We're using zoom right now. Like we didn't, you know, have like an authority on computer science, tell us to use that. We just kind of figured it, like it works for our purposes. There could be something better, but we're happy with it. You know, you buy your, you buy your car, like all these things, you can do some research, but not that like medicine is a perfect analogy because there's some like very complicated disease processes where like something could be wrong with you and you can't perceive it. But for what we do, it's actually like pretty. Pretty clear cut. Like they're in pain and only they can tell us if they're in pain and there's no objective test for it. So if you do something and it reduces their symptoms, that they're not as much pain, like you can ask them because there's no better judge of that than the person than the patient in front of you. And then their function. I mean, we have tests of function, but if we say, okay, like what are your goals? Well, like, go try the thing that you were afraid to do. Can you do it now? Yes. Like, do you feel confident doing it now? Yeah, like only they can really answer that. I'm not saying every aspect of medicine should be deferred to the patient because there are some things that do require much more like objective testing, but for what we do, there's a lot of subjectivity. And, and that's why like even conflating medical diagnoses with, you know, physical therapy can be problematic because like, no matter how important we think we are, we're not actually directly addressing a medical diagnosis. We're trying to. Improve function and get people to move systematically. And, you know, there's an expertise required to do that safely and appropriately. And I think that we often feel like, you know, as a profession that we have to, we have to like kind of, um, tenant, we're doing something that we're not, when, what we're doing is still pretty important and just embraced that. Um, but I think that like the patient is the arbiter, not us. And I think if we, if we're very clear about like, Hey, you, you drive the train here. You tell us if what we're doing is working, that makes the process that much easier, um, than, than, you know, cause otherwise like I don't, I don't know who the judge is. Like I don't, I don't think it's us. It really is them. Yeah. And I think that was just because I was just gonna say, I'm now more like commonly with the right patient. It has to be the right patient. I'll ask them. At a certain point, you know, maybe I've seen them a few sessions or a couple of weeks or whatever, and I'll actually ask them now, like, how do you think this is going? Like, what do you think you need? Like, are there things that we aren't doing right. That you think should be used or, or you found helpful previously or, um, and I mean, the answer is typically like th they're typically pretty happy and maybe they'll say like, you know, I really liked when you, like, you did this one thing. Yeah. This one manual technique that maybe we haven't done as much recently or whatever. Like I really liked when we did that. So I might do it more. Um, but part of it, like you said, dog is like, we're here for them. Like, I don't care about what the internet tells me what I should or shouldn't be doing. Like I'm going to, I want to give the patient what they need. And if they're telling me, like, I know this thing is going to help me or I feel like it has helped me and I need more of it. Like I'm going to do it for them. Um, obviously I'm not going to be doing something that is dangerous or sort of it doesn't. You know, fit in into my bucket of, of helping them like out of my scope or whatever, but that's something that I feel like I'm doing more of now. And I, again, that goes back to that has to be the right patient. Cause I wouldn't do that with every patient. Maybe the patient who is being told by five different people, things that they need to be doing, um, which is hard, hard enough to deal with. Like you kind of have to stay, stick to what you stick to your guns, so to speak and. Really go based on like your experience and your knowledge of, instead of saying like, what do you want, because what they want might be like, I just want to lie on the, on the table and like put my leg up and throw a bag of ice on there. Cause that's what this person told me to do. So again, it's to be the right person. I think so much of like the better we get at listening to clients. To know, to understand what they want, I want to do. And what they think is kind of going on helps us helps the interventions that we choose and the things that we do like so much, um, cause ultimately like they know the function that they want to have and they have whether it's right or wrong, they have some idea in their head and the more we can ask them, good questions about the things that they're experiencing, the better information we'll get. And I think the quicker intervention or more directly. Intervention that we can give them. Like, I had a, I had somebody last week who, um, his, like his, his left low back was tight. Yeah. When he squatted and one of the things that he wanted to be able to do, he felt he couldn't rotate. And I was like, you can't rotate in what positions, just give me an example of that. And he said, when he does, uh, the chair position and rotates and yoga with his significant other, that he just feels his left low back, restrict to gum and limit. I'm not going to stop. And I was like, okay, he had a bunch of other, you know, Pape rotation, limitations, stroke, rotation, whatever. I just had him go on his stomach and I put my forearm in his QL and he goes, Oh yeah, that's it. And after a couple of minutes, he stood up and he could rotate and he could squat and his back holds a lot better. It's manual therapy. Does it work like it's like, well, why did that work? And it's like, I can make up a terrible reason that is going to be confusing and make it sound like I'm doing voodoo, but it's, we give them simple explanations and help them improve their functioning, which is what this person's coming and looking for. They're not looking at not coming in, looking for in depth explanation as to all the different things that possibly could be going on. They want to improve their function. And if we listened to them and understand what they're telling us, we can help improve their function sometimes relatively quickly. Yeah. And even with that, I mean, it's, you know, It worked like you don't know if in 24 hours, it went back to being the way that it was, but you don't have 24 hours with them. So you can only do what you can do. And I want to go back to what you were saying, Greg, because I think that some people can kind of misinterpret maybe or overly extrapolate what we're saying and say like, Oh, well, all these guys do is like, whatever the patient wants. And so like an extreme scenario would be like, you have somebody coming off an ACL surgery and like, all they want you to do is. You know, compress their knee and do NEBA molds for 10 months. And like maybe there are some people where that's what they want, but I would say that it's a common thing of what do they want, but you also have to ask the right questions too and put them in the right scenarios to help them see things. And so if somebody says like, I want to go back to playing whatever division one basketball, and all you did was rub their knee. At some point, you're going to, if you're being responsible, you have to put them in a scenario, but somewhat like mimics, you know what they're going to do on the court. And. You know, obviously in a very progressive and safe way. And so if you get someone in like four months after a surgery, they can't, you know, on a single leg jump onto a one or a two inch box, you could, you could say, okay, well we've been doing what you want, but your goal is also to play basketball. So you're seeing that, like, we have to kind of reconcile those two things. So you have to, you have to reconcile the goal with what they want, but you also have to have to like at the test them and use that, that rehab process treatment process to put them in scenarios where. They're they're, they're, they're able to determine if they're meeting their goal and you don't do that just by lying on a table so you can take it. Yeah. I don't know if you know our listeners, dog, we, our listeners are, are awesome. And they definitely wouldn't extrapolate that out of anything that I said. So they might not the internet and the rest of the internet might take it as, yeah, we're doing too far. Obviously there's a, is it balanced between your expertise and giving somebody like what they think they want, but you know, if somebody truly wants to function at a high level, Like, you're not going to get them to function at a high level. You just do totally passive things. And if they do get to a high level, then they succeeded in spite of you, not because of you. So there's, there's definitely a balance there. Yeah. And it's also, people have every, right. Like if someone's functioning at the level they want, they have every right to want to come in and just have you do passive things now, especially if they're willing to pay for it, whether or not that's medically necessary and like an insurance scenario. That's a different factor, but let's make it really simple and say, people are just paying you cash. Like if they, if they want to come in and like they said, look, I'm fine with everything. I can do whatever I want. It just feels really good. And I think that I, whatever I play tennis or golf better after you give me a massage, then that's totally fine. And you, you might decide like, look, I don't want to give you a massage for an hour, but as long as it's kind of, it's honest and everyone's transparent about what they want then. Then I have no issue with that. Um, I, I, I mean, I, I do see a lot of like quote unquote, healthy individuals in New Jersey, you know, cash clients who are, you know, maybe in season and I'm seeing them because they throw a baseball like all week very hard, pretty often. And like, I wish when I was their age playing, playing sports, that I had somebody to rub my arm. It just feels so much better and you feel so much more prepared or ready to move the next time you need to throw again. Um, so that's like, that's like a big part of the baseball culture is the manual work that you might do. Um, and this is probably more so at like the professional levels where you're getting that, that you have that resource readily available. But, um, you know, that a lot of the kids that I'm working with are, are able to access me on a regular basis for manual work. And again, it's like. No therapists might say like, Oh, that's not medically necessary, but it's like, yeah, if it's cash, I'm not dealing with insurance. And they're already on a training program with like, I can see their strength coach on the gym right there, and they're doing everything else that they're supposed to do. Like who am I to tell them that, you know, I'm not gonna do that. Cause I don't think it's helpful where like, well, a hundred percent think it's going to be helpful because you're sore and getting rubbed out is going to feel really good. It's like, if you're sore and you foam roll, like that's going to feel pretty good when you're done. So like why wouldn't. And my thumb or my elbow helped as well. That's something else. That's also just helping the patient achieve their goal and improve their phone, you know, and that example is somebody who wants to be able to throw a baseball pretty hard and do it a lot and do it every X amount of days. So it's like, you're still giving them what they want, where we're our assessment. And it was like, you may feel better subjectively in a moment and can they do what they want to be able to do again in a couple of days, then they have to go out and pitch again. Yeah. That's sometimes like, sometimes they actually like, you'll lose limited mobility after you throw a hundred pitches, like you might lose some shoulder flection or, or whatever. And like the knee like really, really do need it. Otherwise it's just going to get worse and worse. So thank you for that. Even those examples, Greg, like when you work with those, those people you're not coming in and just blindly doing exact same thing, you still do some sort of brief assessment with those kids. Right. Yeah, no, it typically turns out to be the same thing, because I know them so well. And, um, you know, they tend to have seen me for a while, but yeah, there is, there's always some sort of biomechanical reassessment every time, but yeah, I mean, I could, I could probably name three, three high school pitchers or college pitchers right now, and exactly this they'll be sore after they throw your next outing, because I just know them so well. And they know that it helps them so much to, to come in and have that treatment. So. That's helpful for them. Yeah. Like we always talk about everything comes down to, you know, what's the intent. So like, I know for me personally, if I had the time right now in my current state, or if I was a professional athlete, I would, I would hire somebody once a couple of times a week to like, so I could just lay on a table and relax, even, even knowing full well. But whatever change that occurs is totally transient. It's not going to be lasting. It's not creating like a, a permanent tissue or, you know, his logical change. Because even if for an hour, it's going to make me feel good and make me relax. I would do it now. If I didn't have somebody else's a professional, I just wouldn't call it medical treatment. And we wouldn't, we're not going to like charge an insurance company for that. Cause it's not tied to like a therapeutic goal. So again, it always comes down to intent. People have the right to want to lay on a table and have somebody rub them and make them feel good. And there are a lot of things that we do that we're chasing a temporary feeling. Like, you know, like, uh, like a surfer, right? That gets us endorphin rush from surfing. They can't surf for like a week straight, so they're doing it temporarily and they're, they're okay with the fact that it's not going to last forever until the next time they do it. The manual therapy or a passive modality is not different as long as you're not false advertising. And you're saying, well, you know, this is going to, this is your, this is your ACL rehab. Cause it's not, I mean, it might be a very small part of that, but it's not going to help somebody achieve like a really high functional outcome in isolation. We did a podcast last year with Christie Aschwanden who wrote a book called good to go. And it's, it's a book about recovery that I recommend to everybody. And it's kind of like, she makes the point that, you know, all these devices and people yeah. as they claim to have these products that like truly, you know, promote recovery. When I going to recovery is kind of an ambiguous thing. It's very subjective and it comes down to like the science by a lot of these things is very, very, um, Ambiguous, but if somebody does something and they like it, and even if it temporary makes them feel good, like as long as you know, we're not making any, any false claims, like there's nothing wrong with it in the context of physical therapy and like medical treatment, you know, going for like a massage to feel good. I don't think you could say that you're treating a medical condition by doing that in isolation, but in the right context, there's nothing wrong with it. And if that's what people want. And even to your point, Greg, like, if someone let's say. Is doing their ACL rehab and they're at like six months and they're beyond a point that they're like insurance company will cover it. They're working with maybe a strength coach where it's more cost effective. They're getting what they need from a functional standpoint. And they want to, you know, every two weeks get a massage from somebody. Cause it makes them feel good. And even if it's, even if it's like a placebo and just gives them the sense of confidence that like that's helping them recover from the really good training they're doing, like who cares, you know, Some of the stuff is just really hard to definitively say like, this is what we're doing. Did you have something to Greg? Yeah, that just took me out of my thought process. I was thinking, um, when you said the whole, the transient thing, I just find that it's like, cause there is that, that like idea in the physical therapy world that like, we only want to give interventions that are going to like fix people and it's going to fix the condition. It's going to fix what they're coming in for. It's like, I definitely felt that way. Um, You know, when we first started learning kind of practicing it's like your goal is to fix someone, but the long run practice, I don't believe in that idea of fixing anything. I don't think anything has ever fixed. If it's like manual therapy may give a transient sensation that goes away when they leave the building wherever. But like sometimes it doesn't, sometimes it does things need to be done consistently. Like, like exercise non-manual techniques are the things that people talk about that can fix somebody and teach them always new strategies. But we can teach people. Like teaching somebody a shed, it doesn't necessarily fix what they're coming in for. It doesn't fix their symptoms and just giving them tools and doing manual therapy is just one of the tools that can help people. If it's done consistently, help people feel better for a pretty long period of time. And I think. Um, just yet that, that idea of like things that we do, everything we do in our job is transient. There's a transient effect. If it's, if it's trying to get something stronger, there is a transient effect of strength. It may have a lot lasts a lot longer than manual therapy does, but ultimately like consistency and habits and movement. It's like, those are all the tools that we're trying to give to our people, which is why I really liked what you said at the beginning. I was like, all you're getting is all you do is get people to move. I completely agree with that. If, if everybody came in half the time, all I'm trying to do is just take off their training wheels. That's it, whether it is through really simple exercises, whether it is through manual therapy to make a drink, feel better. So they feel like they can move. It doesn't really matter what it is. All we're trying to do is just take off the brakes that people are walking around with all the time. Yeah. And if there's a real fix, if that exists, it's a, it's a process. Like you're never, you never really, like, you might be like formally done with physical therapy where it's like, okay, you can go back and play your sport, but. If you all, if you don't do anything after that, like maybe you just show up to practice, don't train in the off season. Then even if you don't get hurt again, like you're not really prepared. So it's teaching people like habits and a process. And that's why like, yeah, you can discharge somebody. It doesn't mean that you want to create dependency and say, you're going to need this forever. But like teaching, like you said, those habits where this stuff never, and even if you don't play a sport, like even if you just want to like, have a high quality of life when you're older, like if you stopped doing things like the, you know, Once you stop, then you're done. So even if it's not physical therapy in a formal sense, like if you're not always moving in some kind of a systematic way then yeah. Like then, then you're finished. I mean, that's, that's all we can really do. That's the process. Yeah. That's cool. Yeah, I was going to say, I think you said earlier that if you were a professional athlete, you'd be want, you'd want to sit on a table once a week or lie on the table and get a massage. I was like, I could use that right now without being, yeah, I would do it daily if I could, but yeah, part of the two, you mentioned, um, like recovery being very subjective and were, were physical therapists, always focused on the physical piece, but recovery, like if somebody feels like they're getting what they need and they're psychologically and mentally more comfortable. After working with you, like that's, that's a piece of it and that's part of their recovery as well. So that was all, I was really thinking that I forgot about. So I would recommend that, um, that podcast with Christie, maybe we can put it in the middle of the nose. She even talks about like the, you know, they did a study people who were like runners and like, after they ran, if they drank a beer or a certain number of beers that like help their recovery. And it's like, you know, in some people that show a bit of den some that it didn't, but then it's like, You know, some of the stuff common sense, right? Like to me, research, to show, if you have like a case of beer after you go for a run and you want to like, and you want to run the next day, probably it's going to hinder you in some way. But like, you know, if you have like one beer and part of when you have that beer is like, you went for a run with a group of friends and then like, while you're, you know, unwanting from the run, you're like, You're you're having social interaction, which there's like positive effects of that. Let's say like, while you're having that beer, you're having eating a meal slowly and enjoying people's company. Like if there's a recovery element to that, like, is it because you drank the one beer because like one beer shouldn't make that much difference one way or the other, right? Like we're not that fragile. And we're always, always looking for like that 1% thing. Cause you know, we've all seen the bullshit headlines where it's like a study comes out and somebody misinterprets it and it says like, You know, beer, beer is shown to help recovery and runners. It's like, okay, you know, now all of a sudden beers are performance enhancing drug, you know, but none of this stuff works in isolation. So again, it's like a lot of it's common sense. If you have one beer and you feel like that helps you to relax. And it also like you're doing it in the company of others, it could be good if you have like, You know, a six pack after you run, unless you have like freaking next, it's probably going to hurt you or it's not going to help, you know? So, um, she does a much better job of explaining this than I do, but I was looking for that 1%. I don't think we're that fragile that like anything and like a very small dose makes that much difference. I think it's more about, like Trevor said this process and how do you combine all these elements and how do they interact? And that's much harder to quantify and that's why. That's what we do in a clinical sense is we're not ever doing one thing. We're doing a variety of things that have interacted effects that are hard to objectively assess, which is why, when a student says, why did you do that? Or how do you know that it works? We're coming full circle here. It's really hard to, it's hard to know because everything's interacting. Yeah. Yep. Keep it real, real, real, any, uh, signs offs from either of you guys. For a job. Great job guys. Thanks for tuning in and everybody we'll see you next time as a thank you for listening, we'd like to offer a 10% discount on all [email protected]. 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