The Art of Constant Learning with Physical Therapist Andrew Squire

What is going on everyone. Welcome back for another episode of the Modern Pain Podcast. This week we're speaking with a member of the Modern Pain Care community, Andrew Squire. I think it's important to have clinicians on the front line on the podcast to get their perspective and really daily struggles that they're facing. We have a good conversation with Andrew's journey, methods he's been encountering and his work on his own critical thinking skills. A lot of what he spoke about really resonated with my own journey and I think it'll resonate with your journey as well. I hope you enjoy the episode.

This is the Modern Pain Podcast with Mark Kargela.

Welcome to the podcast, Andrew.

Thank you, mark. Thank you for having me. Hey man, it's good.

Yeah, absolutely, man. It's good to have you on the podcast. We've had some chats. Andrew and I have talked online multiple times, definitely digitally, but also we've had a few phone calls, just kind of some mentoring and discussion type stuff about where he's at in his career and things. And it's always good to have like somebody who's on the front line of clinical practice to come and talk. I think sometimes it's always great to hear the researchers There's nothing wrong with the researchers but the translational piece of like what are those stuff all fit in the clinical practice is always a definite challenge And there's so many things out there And we'll talk today a little bit about some of the various methods. You know, having spoke to Andrew in the past. There's been some discussions of some of the methods he's come across, some of the similar ones that I've went through, and some of the struggles he's had as far as rectifying it with what current science and things will say. So we'll touch upon that in the podcast. But I know your journey to a relatively pretty decent extent, andrew, but the folks that are listening may not. So I'd love to hear if you can introduce yourself, tell folks where you're at, what you're up to and maybe your journey up until today, yeah.

I've been a physical therapist for about 11 years now. I graduated from U of M Flint, the University of Michigan, flint, back in the summer of 2012. And you know, i'm on my fourth you know job since I graduated and have had many experiences treating a lot of different conditions, ranging from anything you could see in an orthopedic outpatient clinic, and then I've treated a lot of vestibular vertigo cases, you know. and then in that time period, you know, i've I have got the experience to work out of state. I worked in St Antonio, texas, for over a year, which was a very rewarding experience for me. I am also now working for the University of Michigan And beginning of 2022, i saw that there was a job posting and I was content with what I was doing, but just, you know, kind of gave it a shot and, you know, ended up getting this job. that's really hard to get a, it's really hard to get a position there, and so it's been over a year And so now I'm kind of a little more specialized not that I call myself a specialist, but I am seeing more of a narrow range of cases that range from low back pain, neck pain, anything that's chronic, technically a few. I still see like balance and conditioning, which I saw, you know, many years or during my time before I worked at U of M. But yeah, so I've been, you know, been working over 11 years. I'm not seeing certain things anymore, which is unusual for me. So like I'm not seeing a lot of like rotator cuff repairs or ACLs and even total knees We have like a like a sports section in our clinic that get a lot of those, but I still they still like there's some carryover if they're needing help. I'll still be able to pick up some of those cases. but I don't see if that's a stimulus anymore which I do sort of miss. I felt like I got really good at that But which is a whole. it's a whole. nother you know avenue in the you know in my experience, since it kind of is different from I'm sure I don't know if you treat vertigo you know I do some of the basics of the.

You know BPBV, canalith repositioning maneuvers and things like that. But we have, i'm lucky, i've been fortunate to work with some vestibular specialists who have all the equipment and can put friends or lenses and all the things on and, you know, do some pretty in depth treatments. So I've always, if it's beyond what I can screen for and I we have the ability to kind of pass it on pride of folks like yourself who've probably done some advanced training and things to to really kind of take a little bit further than just the basic BPPV type identification treatment.

Yeah, and I've actually never gone that way into it either myself, you know, just treating just that they are things for in the public, people don't know what's going on with them. But anyways, you know, i've been a therapist for, you know, over 10 years and still feel like I know very little in some sense with you know treating a lot of things that come through the door, as you know, i'm still. I'm still like, i still feel like I'm at like an advanced, beginner level, and I'm not saying I don't, you know, have any confidence in what I do. It's just more of humbling, you know, just being humble, than how I look at things, because you know we treat people and everybody's different, and that's something I always, you know, remind myself about that just because you know one thing works for somebody doesn't mean it's going to work for everybody else. And you know, in the last couple of years I've, you know, been, you know, listening to a lot of podcasts about critical thinking and have learned how flawed that is for a lot of us, including myself.

So that is a journey. That is a journey I, you know. I recommend everybody take that journey to like one of the classic book thinking fast and slow with Kahneman and Tversky. We'll link it in the show notes, that's. That's a book, but there are a lot of great podcasts I'll have to have, andrew, you know, toss me some some links and we'll throw those in the show notes as well. But when you really step back and take a 10,000 foot view, this whole, we push a lot of the thoughts you know both in you know, when we work with folks at university, where I work, but also when we do some of our con at stuff, just to kind of take that 10,000 foot view of your thinking and think about your thinking, this metacognitive, metacognition process that we often don't And we don't recognize. You know how flawed our thinking can be and how biased it can be, until you really step back and take a look at man, man, i, you know I'm pretty much functioning on a lot of theory that when I really have to step back and take a look at it, it may not be as firm and grounded as as much as we'd like it to, which I like what you talk about man, and I think that's why I've always appreciated conversations with you as you come in with an intellectual humility which I think we all need to have as far as a purposeful, humble attitude. As you know, we're not the sage on the stage, the the Batman that's going to come in And I know it all and I'm going to fix and, and you know, cure every human that I see in front of me because one that's going to set you up for a massive crash course to burn out, because it did when I had a little bit of that attitude with my manual therapy, jedi pursuits in the past. So let me know, i'd love to hear, because I you know, talking to you in the past, it's been interesting to hear your journey. I want to kind of parallel us a little bit of mine, but what's been your journey with, like what you came out of school with as far as thinking was like the way to treat and maybe the method you were maybe focused on at that time Maybe it wasn't a particular one, but and then maybe what you've kind of come across in your career and how that's kind of shaped where you're at maybe you know, i think again that's talking about the professional roller coaster we all ride where we get these new techniques and this new training and it's like the next best thing and everybody on Monday we're going to just be, you know, coming in and be a savior because you know I have this new skill set, and then it kind of over time becomes an, you know, not bad. Obviously we add things that can be very helpful, but there's not a one size fits all approach with people. But I'd love to hear and folks would love to hear, kind of your journey with that.

Yeah, i think it starts for where a lot of people are at in your clinical rotations. I did have a very. I had like three long clinical rotations and one that sticks out to me was I worked with My clinical instructor and this clinic, the culture was everybody was trained in the the University of St Augustine Courses, the, which I found to be very intensely detailed, and Still I've never gone through any of those courses in person. But that's something I would still consider doing based on how my memory of how Specific the manual therapy techniques were. But at the same time, even though they were all manual therapy trained, they were Exercising a lot of their patients. You know 80 to 90 percent of the time. So a lot of it was like joint mobilization, manipulation, focused, not a lot of soft tissue. And so my clinical instructor Still somebody I keep in touch with to this day, excellent clinician, his name is Brent Betzold, he's in the Saginaw area but he, you know, taught me know you get the joint moving, just get that, get that patient moving with exercise. So He also kind of like challenged my thought process. And we were taught in my school about muscle energy techniques. You know the myofascial Release and the. You know the trigger, you what. There was 10 names for the same thing trigger point therapy, trigger point release therapy, myofascial release, i mean I could, i could name it all, but it was the same. You know it was kind of labeling. You know the soft tissue work and he kind of challenged my thought process on that. That. You know the research is scrutinizing a lot of that and You know what you were taught may not be, you know, true scientifically. And this is probably With saying that, i'm sure me you could go down a big rabbit hole with that discussion in itself. But uh Yeah. So I graduated PT school and then I did get the opportunity to. I did a manual therapy, you know paid, you know training through where I worked and I got to learn a combination of joint mobilization, manipulation, myofascial work and taping. But I think, because this seed was planted in my head about, you know, questioning what I know I just always questioned is this the best thing for the patient? and sometimes I've gotten myself into trouble with, maybe, you know, questioning that out loud to the wrong person and you know some people just get very defensive on these subjects. And you know, 11 years from now, 11 years from that time period I probably would have changed how I said things, or you know, because I being, you know, trying to argue with someone to be right, it's not really what's to gain. So, you know, you know I went through that. But then, a year into my practice, they let us. They were offering like the McKenzie training, so they let like a few of us take it. I asked my clinic director. I said, can I please take this because I feel like I'm stalling with a lot of my low back pain patients. And He said, well, you can take it. We're not a McKenzie clinic, you know, um, but you have. Can you host the course? and so which didn't? that wasn't too much to ask, it was just, you know, the instructor came, i showed him where he could sit, i told people where they could eat. You know, i passed out the flyers or the course packs and stuff like that. But, um, the guy that taught, um, he practices in Syracuse, new York, and I think I got lucky because This teacher spoke to me, because he was, he had a very great sense of humor Um, he practiced with Robin McKenzie back in the 80s And so he was way into it where that's all he did and for me I like that because I wanted to learn. I wanted to learn McKenzie, the McKenzie, you know, approach from somebody that wasn't wishy washy about it. So, um, that kind of was another like You know. Next phase of like how I started, challenging the way I thought about In my treatment, you know, for helping people.

So Yeah, i, i just will continue because I I just kind of get in with what you were talking about. It's. It's interesting because I think I've talked about this on the podcast before. I used to actually actively dislike the McKenzie method. Mainly I had come out of st Augustine's training where it was very Super specific. Some things definitely were helpful not saying it was, but I think a lot of science has kind of moved on past some of it But it was a little bit more in the old school very segmentally specific, evaluate, very segmentally specific and and really you know, things that were trained, you know, to think about with our hands that maybe now, back then that was believed to be the way that we could do it and and it was, you know, train that way. But So again, not liking McKenzie because it went so far against everything that I was known like I had to get in there with my hands and Wiggle and and determine from at zero to six scale, what was the Great of, you know, mobility at each individual facet joint. And then I got these people who are just Backbending and flexing people and that's it. No segmental specificity at all, you know. And then of course we cook up these thought processes of like you're just creating stenosis and you're just crashing. You know smack and facets and you're just shearing on that CT junction with all these things all founded in nothing. But you know fear and and kind of Insecurities. You know that we all carry as clinicians of like. You know we don't want our way challenged and There's just, as you've mentioned, so many different ways to get about it. But and it was interesting to hear you with you talking about Your clinic called shrug Oh, we're not, or your clinic director at them, we're not a mckinsey clinic. I mean there's there, it's. It still amazes me how polarizing the mckinsey method is. Granted, there are folks that are a little bit too dogmatic into And in that exists in any system, to where they only see everything through that lens. And I mean there's definitely even the mckinsey system. There's the categorization of other, which is a lot of things where, um, we, you know you need more than just that in your toolbox. But as you kind of have progressed with mckinsey one, how did that? how do you feel that it impact your practice? and then, um, how is it you? I think you got kind of labeled and I we talked about before we went on air here. It's like you were the men mckinsey guy then, that the You get kind of pigeonholed into this system and things. How did that go for you and how did you kind of look at that and how have you feel like you've kind of evolved with that training?

Well, when I came back from McKenzie A, i just I applied, i just gave it a shot with the patients I met Probably had someone would say I have what Monday morning syndrome where I suddenly my belief has changed. Maybe that's true. I mean I didn't think critically enough to know that's what was happening. but I just I had somebody with like bilateral, like sciatic pain. nothing I was doing was helping them. And then I mean maybe this is all like anecdotal, which it is anecdotal, but you know who's how could. I don't know if this is what helped them specifically, but once I started having you know him do repeated extension, his pain was gone. So that was like a starting point And I think my colleague saw me utilizing it And I got, i would say it's been more positive than negative. You know some people would ask me can you take a look at this person and see if you know what you're doing could help them And really always enjoyed doing that. But I never went around calling myself a McKenzie therapist. And I was only I had only done McKenzie A. I didn't even get to be yet And I did them kind of spaced out. But I remember I was. There was a resident, it was probably my third job And I had probably gone through McKenzie C or D by the time. I was like six, seven years out And really nice guy. But he came up to me and said oh so I heard you're the McKenzie guy. I said am I? I didn't, you know I'm not. I mean I don't have the credentials So I can't really say that. So I've never said that. But I kind of always had this like reputation, a good friend of mine. He'll sometimes take a jab at me or send me a text message about McKenzie doesn't work for this and that And it's like supposed to insult me. It's like I mean he lived to be in his nineties. I wasn't even a thought when he discovered this type of treatment in the sixties. So it's nothing I take offense to. It's same thing with manual therapy. People get hung up on the manual therapy that they do And which great that people are defending it. You know, and I still utilize manual therapy. That's another rabbit hole discussion that could, where I've, you know, changed how I look at that or apply that. But I think we graduate PT school so mechanical minded that we, and probably because we have schools that are more facet driven, then you'll have another school that's disc driven. I know there's a school in Michigan that is very Colton born driven, which is great stuff too. It's just that it's based on what you were taught, so I kind of blame things on. Well, this is what I was taught, that's what I, you know, that's what I learned at first And I know we could go down the discussions of different fallacies. You know post hoc and the authoritative fallacy, like we're, and I'm probably still, you know, dealing with that in some aspects, because I go to a course I learn something great And I think it's great And I it works for certain people that doesn't for others, and then maybe I changed my mind. So my mind is always sort of changing.

And you know what, to me that's a representative of a good critical thinker, like if your mind is set and it's like in stone and concrete. I think I'd be more worried about folks where they're treating the same way and the same system, with the same rigid thought processes, that they did when they, you know, were first out of college. You know, i agree with you. I think the mechanical mindset of like I got to identify and fix people is so ingrained in students And I just read a post I know Bruny Thompson was on the thread and I don't remember who started it, but it was kind of alluded to. You know this the ability of a healthcare professional just to step back and not have to, like, jump into this leader paternalistic, I need to, you know, talk to you and identify the thing I'm going to do to fix and just give the patient space to express what they're dealing with and things. Obviously there are times and of course we're still doing our differential diagnostics, our red flag screening and all the good things that make sure we are identifying things that might need, you know, to be fixed catechon or whatever it may be for certain patients. But you know, having that ability to not, you know, to step back and not feel like I have to be the guy that fixes people. Where I can help guide people to really truly fix themselves. I think we give people a stage to express the human body's ability to, you know, adapt and recover. We live in societies that, i think, push people to maladaptive behaviors, maladaptive beliefs and things. Where, you know, healing and recovery is often a hard thing for people to deal with with some of the things that they're surrounded with in their environment and various things, and I think it's just hard. With that being said, where we're talking about that stepping back and not having to be this person to fix, how has that kind of been with you? Like what have you felt has helped you in that journey? It sounds like you're really not putting a lot of pressure on yourself to always have the answer and be perfectly correct and right. You're humbled in your encounters to where you know there's might be a myriad of different ways that this might help somebody, or a myriad of different ways I can help this person. But how have you come to that point? Like, what were the things in your journey that maybe helped you kind of step back from Batman and maybe be more of that, alfred, that we continuously talk about and we rip off Rod Henderson. He listens, maybe or not, i don't know. But, rod, we love you and we appreciate all the great stuff you've talked about in the past. But anyway, how does that journey went for you?

Well, you know, i still want to be that person, you know, when that patient's in front of me, i want to be able to help them. I think that actually comes from most. I think most people that go to PT school are empathetic and want to help people And that's what the PT schools want. So I would say that it's probably an okay thing to be somebody that wants to help that patient get better. But I know that it can go to a point where it becomes about your ego if it's about you getting them better. If that's, i mean, i'm sure that at some point you know, i, you know, you know, gave people's getting better credit to me, or sometimes people would be better when would not give me credit And I thought you know how come I'm the one that did this. So I would say that that's probably gone away. Where I would take things personally, like, especially in the first few years, i, you know, caught myself getting kind of irritated, you know, and I guess, like one patient I can think of, he had a first rib thing. This is back when I was like, really into all the muscle energy techniques and trying to, like, you know, manipulate things and, you know, get people better with, like doing direct things with my hands. But he I manipulated or mobilized the first rib. He felt somewhat better. And then he said he was at like a play park and he was chasing his daughter in this tunnel and he said he felt his rib pop. And he came back and said, yeah, i chased my daughter down this tunnel and my that rib you worked on popped. It wasn't you that got me better, it was me chasing my daughter down the tunnel. I just was like, okay, you know that's. I mean at that time I took it personally, which is stupid. It's like you know now would be. He's better, that's. All that matters is that the person is better. But I wish I paid attention more in the research methods class about, you know, post hoc fallacy, where every time somebody got better I thought it was because of a led to Z, because of what I did. So I would say that's probably the biggest thing that's changed. And you know, over time, as I did get into pain science about, like you know, six years ago, i don't know if anybody ever taught me that pain is not equivalent to tissue damage all the time. So that was a game changer for me. But, um, but yeah, so, and also, every time I went through these different thought processes I made the mistake of not paying attention to the context of the situation. And I know that in the modern pain you know, of course, that you and Jared put together you guys talk a lot about context. And I came back from a Mackenzie course And the guy that taught because they brought actual patients to the Mackenzie course they had a patient that had back pain And she she was giving the instructor a hard time like Well, what about my MRI? And he said I don't treat MRIs, i treat people. And she kind of was like Oh, wow, like he said it, that this it was after like maybe two to three days of him treating her. And and then I came back to the clinic and I had this patient. She was in her 80s, a very like tough lady that you know I should have been thinking about what I said And she was like, well, you never talked about an MRI. And I repeated that to her And it didn't go well for me like it did for him. And then I remember going through, you know, like the pain science, everybody that goes through pain science will. You know, jack March has talked about this. You know he went down that. You know pain science rabbit hole, explaining the pain to the patient. So that's where a PT school. Maybe PT schools are better because I graduated over 10 years ago, but or maybe I just missed this in our lecture. But talking about context, you know communication, stuff like that some of these things are, you know, my fault I could have. Some of the situations are no brainers too, but it does come from a place of like wanting to be that person that gets done better And that can be very toxic if you go too far with that.

Yeah, and I think there's probably a difference too, like I think we all want to make people better. It's just do who, like you mentioned, who are we giving that credit to? Does it need to be us being the hero of the story where we're doing some of this amazing mannip? or look at the man I needled you in 14 different places And you know, and all those things can change pain and especially in the short term, and that might be the little hump that bumps somebody into a good, better direction that gets people on a good path. There's nothing necessarily wrong with it as far as as long as we understand the context around it. I know we had chat cook on last week or two ago and spoke about, you know, some of the different non. You know specific effects, contextual effects, clinician beliefs and all these things. I just think we really create context implicitly that have a great impact on how people respond to what we do. I think being more aware of it and being purposefully aware of it, being informative with patients about it and not, you know, relying on, obviously, just placebo to get people better. Obviously, there's ethical and different discussions we can have around that, but you know I also with you talking about the pain sites. You know things we share. Whenever I've taught courses, as far as I have myriads of failures on the pain science front, of pain-splanting people and missing the mark on that. So, again, choosing the right patient at the right time for communication being your primary mode of intervention and trying to make sense of pain when there might not be a year that's receptive to it or a need for it in the first place. Sometimes we just want to, like you said, get that Monday morning syndrome where everything is a pain science patient After your pain science course you took on Saturday and Sunday. So yeah, it's interesting. Some of the issues we fall into as clinicians. I think it kind of is just a common thing over time. What would you say to like somebody you're 11 years up from the fine University of Michigan, you know, go blue, i love I haven't graduated from there, but a lifelong fan. Why is the Buckeye fan? We won't talk about that just because I want my marriage to stay healthy. But it's been a good two years, let's just, we'll just leave it at that. But yeah, what would you say to some clinicians coming out of school? We've alluded to some of the challenges like you really get trained in this very mechanical mindset of identify the problem and fix the problem And yet the clinic shows us that that doesn't always work And a lot of times it doesn't work because the problem is much more than a mechanical only issue for a lot of people. Sometimes it is, and there's definitely time people will fracture, sprain ankles and do things where it's pretty very much a tissue driven issue and they have very adaptive beliefs and behaviors around it And there's not much to be explained on the pain front. It's just like let's get people back in the world with, you know, just a little traditional rehab. But how would you like help a student who's coming to your clinic Maybe it's a first year who's just started at the university mission? They managed to squeak a job over there. Even though it is a hard place to find a job, it's a great place to work from everybody I know that's worked there. What would you recommend they do to maybe prevent, you know, some of the missteps you and I both have had in our careers, to maybe shortcut some of the challenges that maybe you experienced?

Well, i do try to take a student, if I could, once a year, maybe every other couple of years. So, with that experience of being a clinical instructor, i openly talk about my mistakes, which at one point I probably didn't talk about, like I probably swept things under the rug, like that first three to four years of practice because I didn't want to accept the. You know, come face to face with some of the things I could have done better, and I mean some of the stuff I've already talked about in this podcast. I will just go into some stories of like things. I did that I should have gone the other way. We did have a physical therapy assistant student at my clinic and he, if he was free, he would come hang out with me. So that's probably the most recent experience I've had with you know, teaching him things from. Based from my experience and things I used to believe, things I believe again or don't believe as far as like going, talking about techniques and the biomechanics, but probably, to answer your question, like I said, i'm talking about the things I should have done better in the past, in which these things will continue to happen. I think that's probably the hardest part of being a physical therapist is. you know you're not going to have perfect days in the clinic. You're going to have. You have to be vigilant. That's probably my, my number one recommendation is that you have to be, you know, very aware of certain things, especially when it comes to red flags. I have, you know, had situations where I sent someone to the ER or referred them to the urgent care, the ER, or at my job we have like a nurse team And doing that, has you know, helped that patient, you know where, calling a doctor or sending a note. So I would just say you got to be proactive. If you're, if you're not, if you're, reactive, this job is going to eat you alive, in my opinion.

Yeah, no, i agree, i think you know recognize, you know we had a camera or if it was Adrian or somebody who talked about. You know the basics. You know school gives you the basics And if you'd ever get around to experts who are clinical experts, they do the basics well, perfectly, every time, because they're just methodically good at the basics. You know we talked about in sports of, like the fundamentals of basketball or whatever it is that you know that the superstars are just amazing, perfect at them at all times. So being good at the base and then recognizing to us students, like when you come out in the clinic your first couple of years, the instability that you experience isn't necessarily because you weren't given the appropriate tools to be used. It's just well. You may be missing a few, but they're not like new treatment techniques. It's learning to use one of the most important interventions, which is your communication in an expert way. And I would challenge you as a student to look at how some clinical experts operate and just how they communicate And the supreme confidence they exude to a patient and how they explain their interventions and what they're doing and explain the patient's condition and just get buy-in. They're almost selling their services and their ability to help somebody, to a patient, and which isn't wrong. I think we all do sales on a day-to-day basis. We're selling people. Why should they need to be doing their home exercise program? Why is exercising cardiovascular fitness worth it for them? who's dealing with diabetic issues or maybe weight challenges or different things? Yeah, but I think prioritizing your interventions of like maybe it's not the next needling course or minute course. Again, i'm not against any of those things. Again, i think they've. As with most interventions, they're myriad of ways for short-term pain modulation, but we can do better And by learning that, hey, how do I understand? how do I help really get in front of a patient and get them to start believing in themselves and their ability to recover? Maybe it is some of those interventions that buy you some belief, but maybe you need to learn that skillful strategy to be able to take that belief and push a patient to where they're doing better than when they're just laying on your treatment plinth and when they're getting back into their lives. How has it been with you for that transition to like being a very? I know we've spoke a little bit about this, maybe touched upon the past, where a lot of our interventions or treatments were done on tables where patients were moving. I know you've mentioned that you've been in some big exercise settings, but have you found any challenges in your practice to where trying to get patients from not wanting to lay or be, as clinician, not somebody who I needed to like fix them on the bed versus get them back towards things that point them towards some of their valued goals in life Has that been a challenge for you?

Well, it is when, depending on how deconditioned the patient is, there are some patients that they'll be there for chronic back pain and they do make progress, but it's not like, from visit one to visit, you know whether it's 12, 15 or 18 visits where you know they're doing bridges on your table and then visit 18, they're, you know, leg pressing or doing total gym squats. And there's one gentleman I can think of who was happy with where he got, but every time we did like leg lifts with like a two pound ankle weight, he would get flared up. So we would have some of these setbacks and they were never really dramatic, but it was just one of those situations where I would love to get people everybody doing some form of functional activity. And then there's some cases where I mean you can in my opinion you can do that with everybody, but to the point where, like you know their monster walking across the gym lunging, holding five pound, you know dumbbells in their hands, that's, that's not going to be realistic for everybody. that you see.

So I would. So, so wait again. You're telling me, like not everybody can like pull a barbell off the floor and like deadlift, like it. We don't. Not everybody follows the Instagram hero story of grandma who's deadlifting 250 off the floor. You're telling me that's not everybody.

I mean I should be doing more of those things myself. But yeah, i, i mean I and that's that's like what you said. I wish that was the reality of physical therapy. And then there's some people that say, well, i get all my patients deadlifting at visit 12, and I don't believe it. But if that's true, then you know, more power to them, and that's where, that's where social media is.

Yeah, anytime somebody leads me off with all my patients do. I just think is are you really fitting patients to you're fitting yourself to patients? It sounds like you're fitting every patient to you And I I think I see the value. Like I get a little frustrated because you know this whole. You know you know the strength and conditioning. I'm not saying we don't need to get better on strength and conditioning principles, but the fact that we need to throw a barbell and dumbbell which may have meeting a patient nowhere near where they're at or we're nowhere near where they even want to be, like if you introduce it and say, hey, what would you think about this? This is something I think might help you And it's a co-created narrative where it's not you trying to like, shoehorn them into, like the next Instagram video, that you want them to be, the next senior citizen who's pulling a bunch of heavy weight off the floor, and you can kind of puff it out there on Instagram. I just get frustrated with our, our like. We jumped so far into these things where great. I think it's been a hugely helpful thing for us to be more conscious of strength and conditioning principles and things like that, but I ain't getting people strong, not a bad thing at all, but you know this, this zest that it needs to like. We're all of a sudden, now everybody has to fit that narrative where there are some people who that is not going to be them, never was, never will be. I'd love if everybody would eat well, diet, exercise and do all the lifestyle things. It just we're dealing with humans, man, and it ain't, it ain't going to be some sort of you know smooth ride where everybody just jumps, hook, clang and sinker with all these new, new ways again. That's why you need to be able to fit yourself And I think the biggest switch for most of us is to and I, all my patients are where I'm working to, where I'm trying to fit myself to them. I adapt, i adjust, i become that clinical chameleon that can really fit myself to them, that gets them the most up. You know I squeeze the most, you know, potential out of each patient. I can buy the, you know, fit my ourselves to them, versus the opposite. So a little rant there. I apologize for jumping in, but what? what do you see? is your, your trajectory going forward and what you see in the profession Now? where do you, where do you feel like you need to, and maybe even just as a profession where we need to improve our ability to help people? anything you're thinking about personally, or maybe just as a whole in the profession.

I mean, every day. I'm just, you know, slowly chipping away at, like, how I'm trying to become better at treating patients. I would say, since I'm newer to U of M, i really kind of like that. I don't know if I think about things in years, but, you know, over the next, you know, three to five years, just continuing to you know build, since I had a, you know I was my last job before this. I was there for six years So I established, you know, a clientele that you know people would come back to me. So I sort of started over with being in a different community, not that it's like very far from where I was working, but it's just a different city, a different setting. And so I'm getting to know everybody and trying to build that trust and rapport with my colleagues and the patients. I have a student coming at the end of the year And I'm looking forward to that. I always I've always had, you know, so far not going what I've had really good physical therapy students and I always learn a lot from them. I they come out with like a kind of they refresh you on how you see yourself in this job, and so that that's probably what I'll keep doing. I do it. I my my clinic director. He's given me the opportunity, if I want to, you know, specialize in spying where I would see mainly back or neck pain. But I still get, like you know, hip pain, the occasional like wrist or foot and ankle. So you know, those things I'd still enjoy seeing. I think that. You know I see myself as a generalist because I've just been treating mainly anything that came through the door for a majority of my career. But I guess this podcast is probably the most unique thing I've done in my career. So this has been, this has quite an interesting experience for me.

And no man. You spoke about how this is your inaugural podcast. I'm happy that we were able to have you on and us be your inaugural podcast. Like I said, i have an opportunity to get to know you and chat with you. Over some time has been and you know, just hearing you talk to man, i think you have a great attitude and I wish more PTs had a humble attitude and more of a. You know serving not only your patients but you're. You're given back by. You know having students come in the clinic and mentoring them and you know trying to help them not have to navigate as much of the struggles that you navigated and most other clinicians, like we've mentioned, navigate as well. I want to respect your time tonight, andrew. I really appreciate you spending it with us. Anything else, where can folks find you? Are you active on any of the particular social media outlets? We got threads now. Man, threads from Instagram is the new thing, which now this is when it just came out we're dating ourselves this day. People are listening to this in the future. Threads is new right now. It's interesting just the social media experiment that's been going on. I've been, i jumped on it. It's just been a interesting. Social media. Still a fascinating place, sometimes toxic, but you know we don't need to go into there. But where can folks find you, sir?

I'm on Instagram, andrew SQ 2012. I mean, people are welcome to follow me. Usually, i'll be honest, i'll have physical therapy groups follow me on Instagram and I'll be unfollowed within a day because I think it's a private account. It's not like I'm, you know, it's not like your platform, where it's like a you know modern pain, you know different, you know specific, like professional factors. It's just, you know, it's just a private account. But if anybody's interested in you know contacting me, i mean, they're welcome to you know, look me up on there. But I really I thank you too. I really I think it's great that you have this podcast and you know there's. You don't have to do the podcast, but you're doing it. So that's the great thing in this profession is there's people that are going above and beyond, and you know there's people that research. There's people that are they're not just going to work nine to five. They're doing because you're passionate about this. I know that you love what you do And that's probably another reason. What keeps me going is meeting people like you too, because you know you're not dragging into, you're not dragging your feet in this profession. You want to make it better by doing which. I think podcasts are a great tool And I think that these are you. I mean I could listen to this podcast, for example, and even back when you and Jared had started it, i could have. You could have talked about orthotics, you know, first toe pain. I mean, there's so many different things you can talk about And I and I could have listened to any subject. So thank you for you know doing this.

Well, I appreciate the kind words. It's. it's been one of the things that I've been fortunate enough to find something passionate about, And I'm not probably a researcher. It's not something that really interests me of, of getting into biostatistics and all that stuff. Well, I'll probably do a little bit more of that, but I'm more interested in translating it to the folks like yourself, getting people where I can be that conduit of communicating this stuff to not only clinicians. you know we'll be pushing things to more of the patient sphere as well to help them better understand things. So I really appreciate yourself listening and being a supporter of modern pain care over the years. Always a good discussion with you, Andrew, So I appreciate your time tonight.

Thank, you Mark.

You're welcome, sir. So those of you listening, don't hesitate. If we'd love to see, have you subscribe on some of your podcasts, if you're listening on audio, if you could leave a review, that would be even wonderful For you. Those folks on YouTube, subscriptions are always appreciated. That way we can get this message out to more people. But we would also love to hear any comments. What's been your struggles as you've grown as a clinician? What if? what things resonate with you in this podcast? Would love to to hear what you all think on the comments section there on YouTube. But I'm going to leave it there today, but we will see you all on the next episode.

This has been another episode of the Modern Pain Podcast with Dr Mark Kargela. Join us next time as we continue our journey to help change the story around pain. For more information on the show, visit modernpaincarecom. Also visit the Pain Masterminds Network on Facebook for free education and resources. This podcast is for educational and informational purposes only. It is not a substitute for medical advice or treatment. Please consult a licensed professional for your specific medical needs. Changing the story around pain this is the Modern Pain Podcast.