1:18 What are the parameters for a student-athlete to return to play?

2:00 Return to play protocol is a graded 6-phase progression for return to exercise necessary before returning to competition

2:38 “Asymptomatic at school, they have to clear that before we can even talk anything field related.”

3:00 Athletes typically don’t usually start going to physical therapy with Mike Keenan until phases 2 and 3 of the Return to Play protocol.

The phases of the Return-to-Play protocol for concussions.

3:46 There is always a conversation between the physical therapist and the sports medicine physician so that a student can be cleared to continue in the return to play progression.

5:00 How Dr.Eck approaches the Return-to-play protocol with the physical therapist, the athletic trainer, and the parents.

5:50 “I can’t emphasize enough how important it is for physical therapists to communicate with and offer our observations to the physician or sports medicine doctor, knowing we don’t call the shots”- Mike Quintans

7:45 The importance of the athletic trainer in later phases.

8:05 The role the athletic trainer plays as the student returns.

9:15 What a follow-up evaluation looks like with Dr. Eck.

9:50 Does the sport a student plays change Dr.Eck’s evaluation?

13:00 Dr. Eck sites a study from March 2021, “Musculoskeletal Injuries And The Association With Previous Concussion History: A Prospective Study of High School Volleyball and Soccer Players” that found that if a student had a concussion in the last twelve months, they are 87% more likely to have an acute noncontact lower extremity injury.

16:00 Q urges better holistic testing to mitigate the overall risk of injury

Lighting Round

21:20 What are we doing right in regards to concussions?

23:00 What could we be doing better in sports medicine regarding concussions?

24:00 What is your biggest takeaway from recent research in concussion management?

25:00 How do we mitigate the risks and severity of concussions?

29:45 What needs to happen for us to reduce the risk of concussions overall?

32:35 Their take on the 70-30 breakdown.

34:50 “It’s very rare that I see an individual and they’re not going to get some sort of referral.”

34:50 “It’s very rare that I see an individual and they’re not going to get some sort of referral.”

36:50 Often times concussions will lead physicians to uncover underlying conditions that have gone unrecognized, especially in teenagers.

37:40 How many visits does a PT usually see the average concussion for?

38:40 “The faster you get in [to PT], the faster you get better.”

CONTACT

Dr. Brandon Eck

Orthopedic Associates of Lancaster.

Michael Keenan

PTW Ardmore 

Today, we will be discussing everything concussions with two of the best in the business: Vestibular certified Physical Therapist and Athletic Trainer - Mike Keenan as well as Dr. Brandon Eck. Mike was on the podcast before to discuss concussions as was Dr. Eck in which we discussed his experience and roles in sports medicine specifically endurance athletes and the services he provides.

Dr. Brandon Eck

Dr. Brandon Eck is a sports medicine physician that earned his undergraduate degree at Villanova University where he ran track and field for the Wildcats. He then earned his medical degree at the Philadelphia College of Osteopathic Medicine. He completed his residency in family medicine. He also completed a sports medicine fellowship in Blacksburg, VA in which he served as a team physician to Virginia Tech and Radford University. Dr. Eck has extensive experience in treating athletes of many disciplines and is dedicated to the treatment of both athletes and non-athletes with orthopedic injuries, including sports injuries, overuse injuries, fracture care and concussions. He is the Team Physician for U.S. Ski and Snowboard

Michael Keenan

Michael Keenan is a dual credentialed Physical Therapist and Athletic Trainer, Mike has been working in Sports Medicine and Rehabilitation since 2008. During this time, Mike has worked with patients of all ages and physical abilities from pediatrics to professional sports while with the Pittsburgh Pirates Baseball Organization. He specializes in vestibular and concussion-based treatment. I have had the pleasure of working with Mike Keenan over the past several years. I can say with the utmost confidence that he is the best I’ve seen at treating concussions – whether the patient was in an automobile accident, work-related accident, or as a result of an athletic trauma or injury.

3:30: What is a concussion? 

4:40 What is the difference between a traumatic brain injury (TBI) and a concussion?

5:15 what the most important thing Dr. Eck and Keenan have learned about concussions since their fellowships and training.

6:00 Keenan is in the unique position of seeing concussions at the beginning and the end. 

7:35 How are concussions diagnosed and how have these practices evolved?

9:30 What does the Sideline concussion assessment tool - SCAT 5 test consist of?

16:00 What does concussion diagnosis look like in the clinical setting after the initial evaluation on the field?

19:45 How does a physician dictate what the appropriate next steps are?

23:00 If something like the Impact test is available from the school or sports team is available it will be taken into consideration.

24:30 Getting a psychological evaluation and treatment is especially important for student-athletes to determine care protocol and school accommodations.

26:00 The importance of having a good rapport between the physician, the physical therapist, and the patient.

28:35 How often are clinicians seeing a patient within a week of the initial injury?

30:30 Dr.Eck shares a study from the Journal of Neurosurgery in Pediatrics about the association of time to clinic visit with  prolonged recovery in Pediatric patients with concussions.

33:30 Average Symptom Severity and Related Predictors of Prolonged Recovery in Pediatric Patients with a concussion (2020) found that symptom severity along with delayed evaluation related to prediction of prolonged recovery.

39:30 What is symptom grading and how does Keenan use as a flag system with patients?

40:20 Dispelling the old myth that someone with a concussion should be told to rest completely.

Stay tuned for Part 2 next Tuesday

Season 3, Episode 6 | Podcast #42

Today we are joined by Dr. Ken Kearns, a Board Certified, fellowship-trained shoulder and elbow orthopedic surgeon who specializes in arthroscopic surgical procedures, joint replacements, minimally invasive procedures, as well as upper extremity fracture care from the clavicle to the elbow.

Dr. Kearns completed his undergraduate studies at Colby College in Maine then onto medical school at The University of Toledo School of Medicine. Next stop, Orthopaedic Residency Program at Thomas Jefferson University Hospital. While a resident, Dr. Kearns was recognized by several orthopedic organizations for his research and leadership. Last stop, Dr. Kearns didn’t go far for his fellowship. He was accepted to the internationally renowned Thomas Jefferson University Hospital/Rothman Institute Shoulder & Elbow Orthopaedic Fellowship Program.

Dr. Kearns has been published in numerous specialty medical journals on topics specifically related to rotator cuff tears, shoulder instability, and shoulder replacement. He’s been with Philadelphia Hand to Shoulder since 2016.

1:10: New research available about shoulder instability stating that shoulder injuries should be repaired after the first injury rather than the third, which was the previous recommendation.

3:15 The two things that keep your shoulder stable - static and dynamic stabilizers

5:00 Make a judgment call on if therapy is the way to go after 4-6 weeks, not 4-6 months

6:00 How a labrum is repaired and normal-tension is recreated

7:50 What does typical recovery look like using Baker Mayfield from Cleveland as an example.

10:55 The problem with Sully braces

11:55 The 6 grades of ligament separations

13:30 Grade 3 is the one that people go back and forth on whether surgery is necessary.

14:00 The surgical procedure for shoulder separation repair - arthroscopically assisted repair

20:30 Typically rotator cuff tears are the gray hairs and wrinkles of the shoulder or traumatic cuff tears.

21:50 Story from Dr.Kearns’ fellowship with a current hall of fame Hockey player

23:03 Very few professional athletes, besides Kobe Bryant, have come back to play after a cuff repair.

23:57 A case Dr.Kearns saw with a competitive weight lifter in her 40s. Her cuff tear was hanging on by a thread, Dr.Kearns repaired it and won her next international competition, was doing awesome and she is back after 4 years with a similar injury.

28:00 There are so many better exercises you could be doing for your upper body than the bench press.

28:21 There are two terrible things for your shoulders, shoulder press, and bench press

29:10 People get intimidated about seeing a doctor - “My job is to get the person back”

29:40 There are very few things that I will ultimately say “you need to have them fixed” and its usually not a sports injury.

37:45 Dr.Kearns asks “What is the point of the Arm bike”

38:00 Q is anti-machine as a physical therapist.

38:30 Arm bikes don’t really make sense and cause more irritation than they help.

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Dr. Ken Kearns Philadelphia Hand To Shoulder Center

Today we are joined by Dr. Ken Kearns, a Board Certified, fellowship-trained shoulder and elbow orthopedic surgeon who specializes in arthroscopic surgical procedures, joint replacements, minimally invasive procedures, as well as upper extremity fracture care from the clavicle to the elbow.

Originally from Ohio, Dr. Kearns completed his undergraduate studies at Colby College in Maine then onto medical school at The University of Toledo School of Medicine. Next stop, Orthopaedic Residency Program at Thomas Jefferson University Hospital. While a resident, Dr. Kearns was recognized by several orthopedic organizations for his research and leadership. Last stop, Dr. Kearns didn’t go far for his fellowship. He was accepted to the internationally renowned Thomas Jefferson University Hospital/Rothman Institute Shoulder & Elbow Orthopaedic Fellowship Program.

Dr. Kearns has been published in numerous specialty medical journals on topics specifically related to rotator cuff tears, shoulder instability, and shoulder replacement. He’s been with Philadelphia Hand to Shoulder since 2016.

2:55 What led Dr.Kearns to his career path and to stay in Philadelphia.

4:00 How orthopedic surgeons are looked down upon in the medical world

5:00 How Grey’s Anatomy has represented orthopedics poorly. (Yes, Dr.Kearns still watches)

6:26 Dr.Kearn’s experience at Jefferson University

How specialization plays a role in medicine especially in Philadelphia and New York.

8:45 The variety of injuries and surgeries an elbow and shoulder orthopedic surgeon sees in a day.

10:25 The difference between a fellowship and a residency for doctors.

13:20 How Dr.Kearns ended up at the Philadelphia Hand and Shoulder Center. The competitiveness of the Philadelphia medical scene, especially in Orthopedics.

15:00 The dilemma with marketing yourself as a doctor.

17:50 Building connection and relationship with patients and colleagues. The importance of respect and rapport when treating a patient.

21:00 The importance of talking directly to kids when they are the patients.

25:00 The most common shoulder and elbow sports injuries Dr.Kearn sees on a regular basis with athletes and weekend warriors.

26:00 Why Dr.Kearns and Q are seeing more Tommy John Elbow injuries - tearing the ligament on the inside of the elbow due to overuse in baseball. - Your arm is not designed to throw a baseball.

32:16 Labral tear symptoms and presentation.

34:40 The importance of treating the whole person and treating each case individually.

35:00 “My role is to help you make an informed decision about what’s best for you”

36:00 The role of imaging in diagnosing and treatment

38:40 “Full disclosure, I still do these things but the worst thing you can do for your shoulder is bench press and shoulder press”

39:30: “90% of your diagnosis comes from what your patient tells you”

40:00 The range of recoveries and outcomes that aren’t easily predictable.

Dr. Ken Kearns Philadelphia Hand To Shoulder Center

Today we are joined by Dr. Dawn Gulick professor, entrepreneur, and research leader in the field of physical therapy as it applies to sports medicine. Today we will be discussing the landscape of getting into PT school, what PT school consists of, Dr. Dawn Gulick’s experiences in the field of sports medicine, and her mobile app called iOrtho+.

Dr. Dawn Gulick earned her bachelor of science in athletic training from Lock Haven University, her master of physical therapy from Emory University, and a doctorate of philosophy in exercise physiology from Temple University. Dr. Dawn Gulick is also a certified athletic trainer and a certified strength and conditioning specialist.

Dr. Dawn Gulick is a professor of physical therapy at Widener University in Chester, Pennsylvania with over 25 years of teaching experience. As a clinician, Dr. Dawn Gulick has owned 2 private orthopedic/sports medicine practices. She also provides athletic training services from the middle school to the elite Olympic/Paralympic level. As a member of the USA Sports Team, Dr. Dawn Gulick has provided medical coverage at numerous national and international events and has been the medical provider for USA National Teams since 1993. Dr. Dawn Gulick is the author of 4 books.

Dr.Gulick is the developer of the mobile app called iOrtho+. The app has been positively reviewed by numerous organizations and has been adopted by dozens of universities to supplement their orthopedic curriculum. The app, iOrtho+ has been sold in over 14 countries.  Dr.Gulick is also the inventor of an orthopedic device called the Mobil-Aider. It has been cleared by the FDA & was launched in 2021.

Caitlin Kowalke (Comfort) won the Illinois state title in cross-country her junior year of high school. She went on to run cross country at the University of Wisconsin-Madison, Where she became a two-time second-team All-American and a two-time Big Ten Champion in the 5,000 and 10,000-meter events. Upon graduating Caitlin began a professional running career and took on a volunteer coaching position for the UW women's cross country and track team. Caitlin then went on to a professional runner, then transitioned to the half and full marathon distances. She attributes many of her successes as an athlete to the support of my family, my collegiate coach Jim Stintzi, and former coach but forever friend, Stephanie Rothstein Bruce (a sub 2:30 marathoner).

Today, Caitlin continues to run. Caitlin lives just outside of Madison, Wisconsin with her husband Tom, and her two daughters, Rose and Joanna, and her step-daughter, Stella. At the 2018 Madison Marathon, she qualified for her second Olympic Trials Marathon. On February 29th, 2020 in Atlanta, Georgia she toed the line with two of her Wisconsin-based athletes who she also coached to Olympic Trials qualifying performances.

In this episode we cover:

Where did your passion for running come from and how did you start?

6:00 At what point did Caitlin realize you were good at running?

10:00 What’s it like being a mother and training for the Olympic trials? What it was like to train for Olympic trials just six months after giving birth?

14:30 How Caitlin started coaching runners after being a runner in college.

What services Caitlin offers to runners with to runners of different experiences.

21:20 How Caitlin helps runners who want to run as a lifestyle change rather than for a race?

24:00 Caitlin’s training philosophies and personalized approaches.

27:00 Caitlin’s Rules of thumb for early marathon runners

I believe in creating programs that challenge the athlete while building confidence and keeping the risk of injury low.

30:00 What Caitlin’s Marathon training cycles typically look like for 16 to 20 weeks.

34:00 How to change your running plan to increase speed and lower marathon time

38:00 How the app VDOT 02 helps Caitlin’s coaching

41:00 Running Rewired

46:00 What kind of cross-training should long-distance runners be participating in?

53:00 How Caitlin manages injuries during a client’s training.

54:00 Don’t push through the pain

57:00 Quick 5

Running Rewired and Science of Running

[email protected]

Dr. Milt Zgonis, M.D. is an Orthopedic Surgeon with Penn Medicine and the Co-Director of their Human Tissue Laboratory. He received his medical degree from Albany Medical College and completed his 6 year residency and lab research with Penn Medicine. He then went on to complete a fellowship in orthopedics and sports medicine at Duke.

Lisa Victorius, PA-C is an alumna of South Carolina University and completed her Physicians Assitant Education at Rosalind Franklin University of Medicine and Science in Chicago. They have worked together for over seven years.

1:30:00 Milt Zgonis’ and Lisa Victorius’s backgrounds in athletics and medicine.

2:45 How a background in sports and athletics has helped Victorius and Zgonis while practicing medicine.

3:20 The identity crisis athletes have when they sustain an injury.

4:00 How Zgonis’ love for martial arts growing up and his sister had an ACL tear that resulted in major complications pushed him into the field of sports medicine.

5:00 How Dr.Zgonis’ experience at Duke University’s Athletic program prepared him to work with professional athletes in the Philadelphia area like the Sixers.

9:00 What is a typical patient that Dr. Zgonis and Victorius see? Why there is no average patient, and how each one is so different

10:00 Zgonis’s focus and passion for meniscus research and innovation

12:00 How Zgonis approaches meniscus tears and what innovation is happening in the field regarding meniscus reconstruction

12:45 if a joint is going to be repairable it’s going to be before its all macerated and wreck any repairable tissue

14:20 What about the meniscus makes it so easily compromised and why is it so difficult to repair?

14:40 What is the meniscus?

16:00 Why the meniscus has almost no healing capacity?

17:00 The mechanical effects on the rest of the body after a meniscus injury

18:20 Why we don’t have a good way of predicting what people will be like long term?

19:00 When and why are Arthroscopies needed to treat meniscus issues?

20:00 How has the dynamic between Dr. Zgonis and Victorius as a PA worked so well in their office for the past seven years? How Victorius approaches educating the patient to supplement Dr.Zgonis’ work.

23:00 What complex procedures are they seeing in their office?

28:00 Patients want a doctor’s honest opinion and candor

32:00 The trust that physicians and physical therapists need to have with each other 

Contact

Dr. Milt Zgonis and Lisa Victorius, PA-C

Dr. Scott Davidoff is a physiatrist at Main Line Spine in King of Prussia, PA, located about 20 mins from Philadelphia. Dr. Davidoff earned his undergraduate degree from Emory University in Atlanta and his medical school degree from Temple University School of Medicine. He then completed an internal medicine internship at Hahnemann University Hospital and subsequently returned to Temple University for his residency training in Physical Medicine and Rehabilitation.

After his residency, Dr. Davidoff completed a fellowship in interventional pain management/sports medicine at Orthopedic and Spine Specialists in York, PA.

Dr. Davidoff is board certified in Physical Medicine and Rehabilitation, Pain Medicine, and Sports Medicine. He is currently serving as President of the American Board of Pain Medicine.

Dr. Davidoff has undergone extensive training in various fluoroscopically guided (X-ray guided) procedures used to treat neck and back pain. He additionally specializes in regenerative orthobiologic medicine, including PRP therapies, to help treat an array of painful conditions.

Contact

Main Line Spine

Mainlinespine.com

610.337.3111

In this episode, we cover:

3:40 What does a physiatrist do?

5:10 What is the training required for becoming a physiatrist?

6:30 What other specialties might be getting this sort of fellowship in sports medicine or pain management?

8:00 Dr.Davidoff’s focus on treating the whole person

8:50 Providing patients with the attention they deserve and a host of options that will best serve them.

10:15 What are the benefits of telemedicine in physiatry and how will it change in the future?

14:00 What types of patients is Dr.DAvidoff as a psychiatrist typically seeing in his office?

14:45 What is the difference between patients with acute and chronic spinal injuries or pain?

16:20 How Dr.Google has taken over and has both given patients education and misinformation.

17:00 Patient education and communication across providers.

20:10 What different treatment options Dr.Davidoff provides in his office at Main Line Spine?

23:30 How does Dr.Davidoff go about deciding the best treatment option for a patient? 

27:00 There is no one size fits all with treatment, it’s really individualized.

28:00 What is Dr.Davidoff excited about in the field of physiatry and pain management?

28:15 What is regenerative medicine? What are the benefits of stem platelet-rich plasma (PRP) injections? How does regenerative medicine help with stability and structure?

36:07 Who is a good candidate for PRP

41:00 What is the typical presentation of patients with back pain?

42:10 Different categories of back pain. Axial pain ( neck or back pain) vs Nerve related pain that radiates to other extremities.

45:30 Spondy Spondylolysis in athletes, especially young ones, and Carson Wentz example.

51:30 A structured and gradual Return to Play program for athletes.

53:20 The Opioid crisis and pain management and the future of opiate therapy.

What's happening Performance Therapy Nation? We are getting ready to kick off Season 3 of the podcast and we are so grateful to have you all here. 

This season is full of specialists bringing their absolute best so make sure you are subscribed and following us on Instagram @onqperformancetherapy

Mike Q looks back at the amazing guests who joined us in Season 2 and gives a sneak peek into season 3's line up. He also shares an exciting work-life update. 

Let us know what you thought about season 2 with a 5-Star review!