How to Find the Right PT, and Tips for Learning as a Health Professional with Zak Gabor PT, DPT, CSCS

How to Find the Right PT, and Tips for Learning as a Health Professional with Zak Gabor PT, DPT, CSCS

February 9, 2023


Brett Scott


Brett Scott  00:01

All right. Welcome back, everybody. Today I have my colleague here, Zack Gabor. So Zack, he’s been one of the first people that we had a long chat at dinner one time when I was finishing PT school that basically said, yeah, man, you should go start a cash PT practice. And it’ll be awesome. And you’ve got a unique experience in the fields. And I ended up doing it. And we’re five years along in that journey now. And it’s been quite a time and Zach’s been someone that’s mentored me before in the past. And Zach is someone that has been tremendously influential in the field of physical therapy, especially for new grad pts. And people really just looking to improve their clinical reasoning, their skill set, and how we can help change people’s lives as clinicians and providers. So Zach, thanks for coming on. So he was the founder of the level up initiative, and now is the co founder of Cal U, which is an online continuing ed company for basically new grad pts. And he’s done a ton to just change the way we think about a what we’re supposed to be thinking about critically, and getting a lot of new grads to feel more comfortable with their skill sets. But also, the big thing being communication, I think, as a PT myself, and in the practice, we have, we see a lot of people that have failed, due to the constraints of the medical system and the constraints that are put on providers. And, Zack, you’ve done a lot to change that. And there’s a lot of cool stuff I see coming out from the people in your community. And it’s a very strong community, too. So I commend you on that. And today, we really just want to talk about, you know, that whole growth and learning process as a new grad, or as someone changing career paths, getting into a new field, whether you’re a trainer or a coach, or you’re someone that’s you know, looking to find a new provider, maybe you’ve been all around the mulberry bush and can’t seem to find the right fit for you. We can talk a little bit about that as well today. So thanks for coming on, Zack. And where do you want to start here?



Yeah. Thank you. Thank you for the intro. I’m not I’m not sure I’ll first say thanks. It’s been cool to like Time flies, I still remember the dinner I still remember you coming to shadow, I believe in the Medford location clinic when I had first started there. And it’s been cool to see you just get after it. And continue to pursue this because it’s definitely not easy. And you were doing it before. It’s a lot more popular now. So it’s been it’s been cool to see that success. So congrats. Yeah, I don’t know, we could we could start with talking about some big picture things for for newer clinicians or new, like trainers in the space and maybe talking about some blind spots that I think a lot of us have when we first got into the fields.


Brett Scott  03:01

Yeah, so me and Zack are actually on a call yesterday talking about some business stuff here. And one of the things we’re talking about marketing wise and looking. So I have another company called neuro PDX. We’re looking to help clinicians with continuing education and improving their clinical skills. But one of the big problems is finding that blind spot, right. And so let’s go back to kind of what you’ve done with level up. So part of level up. And these are four the big buckets of things that are missing in clinical care these days that are so overlooked, even by me, as a young clinician coming out, it was like, Oh, we want to talk about communication in school, like now I want to learn about joint mobilization. And, you know, teach me how to manipulate someone’s spine, where like, that’s cool. And that helps sometimes, but take us through the four big buckets, I guess of what that stands for, and how that’s supposed to make a difference.



Yeah, so the first month it’s, it’s I hate How corny and like pop psychology this term has become quote unquote, growth mindset. But if I were to describe it in different terms, it’s really about cultivating more honest introspection, and humility and awareness. Because I think for a lot of us, when we go through school, we spend a lot of money we spend a lot of time studying. And a lot of the times we’re not really exposed to other bigger, broader kind of concepts that may be actually challenging, what we just spent a lot of our time and money learning. So it can be really difficult to acknowledge that the things that you are learning may not be as right as you thought. And to make matters worse, the harder pill to swallow is the fact that we’re learning that a lot of the things that we study in school, when we take that as gospel and apply it can I actually be harmful or have negative consequences for the clients or patients that we work with. And that takes a lot of humility and awareness to be able to kind of swallow that pill and do something constructive about it. Because it doesn’t feel good to kind of have that, it’s really your whole identity gets kind of rocked. So that’s where we start in the first month is really just about like, you hear a bunch of different people sharing about their different experiences and kind of overcoming that and super helpful to just see that vulnerability. You know, that’s kind of what we’re after. With that as well. month two gets into critical thinking. The thought there was that and, you know, this is big thanks to Romans, you know, fat, like, original creator of neuroprosthetics. You know, he really helped me learn how to zoom out and appreciate like, multiple different lenses of care. And that really resonated with me, because I felt like in doing that, it allowed me to uproot, still appreciate the things that I learned in school, but also understand the negative consequences of it, and also learn how to provide even better care with different models and find the linking themes across all of them. Because I think there’s so much dogma in our, in our profession. And so I think the thought with critical thinking month is that we want to equip students and new grads with the ability to think more broadly and be able to zoom out so that they can kind of weigh how irrelevant maybe some of the nitty gritty things we learned in school are. Spoiler alert for a lot of things are probably not as relevant as we thought they were. But it doesn’t mean they’re not important. And that critical thinking piece is what allows us to really make that decision. So I think that’s like a non negotiable in terms of when I’m looking at or referring to trustworthy providers, I want to make sure that their clinical reasoning and their, you know, their critical thinking is on point, because to me, that shows that they care about providing the best level of care, and that they’re flexible in their approach by being able to use multiple different models to inform it. And then really, the last two buckets are on communication and listening. Like you kind of mentioned before, it’s not sexy, it’s not something we really talk about in school, it’s not something I wanted to learn about in school. The reality is, it’s something we do every single day, because that’s literally the majority of our interactions with patients is hopefully listening and communicating with them both verbal and nonverbal. But I know for me, I think a lot of PTS especially are indoctrinated into, like, you know, I never really gave a you know, what about the subjective portion of the exam, like listening to the patient’s story, I wanted to get to the objective testing, find all the problems wrong with them, fix the problems, fix their pain, Bada bing, bada boom, but humble pie like you realize that and listening to their story, you’re actually able to appreciate so much more of the probably relevant clues that may be involved in their pain. So for example, working with a weightlifter, if they just came in, and I was like, oh, yeah, you’re, you know, you’re bombing out your squat, or you have a massive but wink at the bottom of your squat, because I just took some course. And I thought I was a hotshot, but I didn’t even I didn’t even ask about their programming, or their recovery, or any of those things that could be a huge player in the development of their pain. So it’s a lot about that stuff, navigating difficult conversations with patients that come in with very firm beliefs about why they hurt that may be not super helpful, and how to navigate those in a sensitive and constructive way. So that’s like the bread and butter of what we are kind of founded on.


Brett Scott  08:52

Yeah, it’s been, I mean, I went through the level up courses as well as a newer grad. And still, today, I reflect on some of those pieces and those values of what we’re trying to do as a provider here. And looking at that big scope of like, Did I hit all these buckets with this person? And, you know, every time I go to the doctor’s for something, and you know, for a host of different issues, it seems like most of those things are missing. It’s like, to me, the problem with the medical model now, is that, you know, these insurance companies dictate a lot of care. A lot of cares, dictated by hospitals, and hospitals just want all these, you know, doctors, providers, whatever, to just kind of be sheep and check the boxes and move on to the next person, you know, make the profit margins grow higher, and like I had someone the other day. So I have the diagnosis of ankylosing spondylitis, and I luckily found it early. Manage it. Well, I’m doing really well. I have a woman that came in the other day used to go to the gym six, six days a week. She has the gene for it, she has the antigen for it. She has all the symptoms of it the flares, the searing SI joint pain, like her T spine really doesn’t move much at all it can. It’s super sensitive. And they’re not treating her for it, because she doesn’t have an actual fusion yet. And it’s like, no one has listened to her. And like she came in the other day for a second visit. She’s like, you know, so good to sit and just talk like we didn’t even get the treatment. We literally did like, basically 45 minutes of subjective interviewing. Yeah. And I did, it took me 15 minutes to be like, okay, yes, we have, you know, pain from the lumbar and si region, we have a thoracic spine that doesn’t move, you can’t breathe. You’re you used to be able to put your palms on the floor. Now you can’t even bend to touch your knees. It’s like, I am going to be here. Like, I was like, you know, we’re getting you into a rheumatologist. And I’m gonna go with you because you need someone there to, like, help represent you. Yeah, she’s like, I’ve never felt so cared for. And just she’s like, for the first time since dealing with this for five years, I feel listened to. And I was like, Ah, thank God that like those things, those are the pieces that like, make you feel good as a provider that connect you with someone. And it gives them a gleaming hope of getting better, too.



And it’s, it’s, it’s not that it’s easy to do. But it’s like, it’s such a seemingly simple thing that could have such a profound impact. Like, I mean, that exact vignette that you just shared is I can’t tell you how many times I’ve had that happen, where they’re like, Wow, this is literally the first time I’ve ever actually been listened to by a medical provider. And you’re like Jesus, like, I feel like I’m doing the bare minimum by doing that. But yeah, it’s it’s a kind of a messed up system.


Brett Scott  11:55

Yeah. And so let’s talk about the critical thinking piece of things. I think that’s probably the most in depth one, we can go down as sure as as two people here that have kind of gone through this and been humbled by a lot of it by the same mentor that we’ve shared over the years. And, as we talked about yesterday, you know, I was guilty of this when I first came out of school, and I think it still goes on today is that a lot of people come out. And I don’t think this is just PT, I think this is all types of different schooling and industries and everything else. But there, my view of it before was, and sometimes this is actually true to in my opinion, is there are these old school people that have been doing it their way stuck in their ways, they’re not keeping up to date on the literature, whatever they do, what they were trying to do when they left school and have just kind of been, you know, going through the motions with it. And then you have these new grads coming out that are taught the bio medical model of you have a herniated disk, you have pain, because you have a herniated disc, which isn’t true. And then we start teaching them pain science. And we don’t want to put our hands on patients anymore. We think we’re better than our professors, because, you know, we’re more up to date on the research than them or so we think. And there’s a lot of in between there. And there’s so much gray area, especially in this fields, and there’s so much the bait, and the jury’s always still out on everything. So where can we start with that?



You know, you know, I will start with one of my favorite quotes. You know what being wrong feels like? Feels like being right. It feels like being right. Being wrong by Katherine Schultz is an all time must read, I think for anyone because it really humbles you to the blind spots. And I, I think it speaks to, like this process, this repetitive process that happens where it’s like, first you go through school, and you spend all of your time studying all the things you learned in school. And if you don’t have any professors that expose you to anything else, you come out thinking you’re hot shit like me, because I graduated at the top of my class, I knew my biomedical knowledge inside and out. And my, my confidence was so high. But I wasn’t aware of anything. I wasn’t aware of any of the conflicting models. So then, what happened was I learned about pain science and or the biopsychosocial model. And then immediately it’s like, everything I just learned out the window. I’m like, Oh my God, how could they have taught me that I feel like now I’m the knower of things and they still don’t know anything. And, and now it’s like I just have this new sense of overconfidence, about a new set of knowledge that I have, only to be humbled. You know, six months later a year later to years later. And it’s this like, iterative, iterative process that continues to happen. But the degree of like, like the steepness of the of like the drop, from like the overconfidence to being humbled, gets little, like smaller and smaller as you develop this skill of critical thinking, and learning to assess for blind spots, and holding things with a little more loosely so that you’re not getting so wrapped up into it. So I think that would be a starting point for the discussion. But I just love that book. Because everyone, like everyone thinks that they are right, but it’s like, you don’t know what you don’t know. So how could you feel wrong?


Brett Scott  15:38

Yeah, exactly. And the thing I’ve seen too, with some students and things is, they come out, and they have this utter confidence about everything they’re doing, and it’s gonna work. And you know, maybe we put our hands on someone. And oh, yeah, the range of motion is better. Cool. But was that the issue that was actually causing anything? And is that going to stick around for the long term? And there’s so many other factors here? Did they get better? Because of you? Was it time? Was it placebo? Like, what actually got them better? And I think a lot of people don’t actually stop and think about that.



Well, and it’s hard because we’re a, it’s a, there’s several reasons. I mean, part of it is that the system is so high volume that I don’t think a lot of clinicians even have time to think critically. Thinking critically about that stuff is exhausting. Like it demands cognitive resources from you and energy resources. And it also doesn’t feel good to be wrong. So I don’t blame people for not thinking about that stuff. It’s kind of a pain in the ass. You know what I mean? And to make matters more complicated, people get better. Right? So they’re like, Oh, I got people better. So like, why should they have to question it. And I guess for me, it kind of has always been like an integrity thing, where I felt like, my integrity was compromised if I was okay with providing something I knew was not really supported fully, or had really shaky evidence to support it. Or if there are better ways to do it. I felt like I was compromising my integrity as a high value provider that really cares about providing the best level of care for my patients. So, you know, that was enough of a driver for me, but it’s it’s tough. I don’t blame people for it. It’s a really weird landscape we’re in?


Brett Scott  17:27

For sure. And you’re what do you do to graduate PT? School?





Brett Scott  17:34

Okay, so yeah, you’re a couple years ahead of me. So I was 2017. But I feel like I’m at the point in my career now, where I’ve gotten enough reps in now, but I’m nowhere near where I want to be. But when I was a new grad, I was like, Yeah, we’re doing all the things. We’re fixing everyone, everyone’s getting better this and that. And it was like I was so shut out to the things I missed, almost. It was like, you wanted to blame the patient, like, oh, and sometimes, you know, the patient, it takes two to tango here. Like, I don’t put that monkey on my back to say, you know, hey, I gave you the resource, I gave you this and that, like, if you aren’t, or if you’re gonna go against me, like, that’s one thing, right? But now it’s like, okay, I’m at the point where I’ve seen all the things and with the big help of remez, to have putting all these different perspectives together, seeing that they can all align and, and play well, when we really understand them well, but being able to reflect on everything, too, and feel okay enough to be like, you know, what, I missed that, or, you know, a new case comes in, it’s like, oh, you know, what, I think this other person have that same thing going on. And I missed that there. And it’s building pattern recognition over time. And like, you know, Connors, younger, a younger PT than me, so he’ll be looking to case and, um, one of my main things I’ve always told him is like, Hey, you got to look at the forest and the trees, every single one of them, and then like, pick, which one is the bigger problem here, that we might need to zoom in on a little bit, or zoom out, you’re like, you’re looking too far at this. And at this point, like I’m, I’m not old enough, and I haven’t been doing this too long where I’m jaded and don’t give a shit and like I’m out of touch with the literature and everything else that’s going on either. So that piece of critical thinking right now is really the biggest part of me continuing to grow my practice. Like I did a lot of continuing education up front. I’ve taken a lot in and like I used to think like I take a course you know it all and now it’s like, I’m now back to like, digesting courses that I took two three years ago. Like we took the Greg layman course a great course. And there’s still things I’m unraveling from that and and learning how to piece them together for certain patients in a certain way.



Yeah. Yeah, no, those are all good points. And I would say that is, we kind of spoke about it. But like, the number one quality that I look for when when I’m looking at, like a super skilled clinician, is that ability to assess the, you know, how relevant are the forest and the trees, every single tree. And I think school teaches us one lens of looking at all the trees. But the problem is, there’s also other lenses of looking at all the trees, and there’s a lot of lenses of looking at the forest, and how the trees interact with the forest. You know, we miss a lot of that stuff. So there’s a lot of shit going on that we need to be thinking about. And you’re right, and you know, and I think as a profession, we tend to, on a whole make a stink of things that probably aren’t like, we probably tend to zoom in a little bit too much at times, where we’re just missing big picture stuff that needs to get done. But I definitely think there’s the flip side of that where there’s the jaded clinician that has kind of gone through that first existential crisis of feeling like nothing they learned in school matters. And now you don’t give a shit about any of the more like, you know, zoomed in things that may matter and may be relevant. So it’s like finding that balance. I think part of it just takes time. But like having mentors to help you learn how to reconcile all that with, like, a balanced approach, I think is the way to go.


Brett Scott  21:22

Yeah, and it’s interesting now, too, so for, for me in the way I saw it. So, you know, when when I was in school, there was no talk in school still of pain science, but it was out there. So I somewhat similar to you, it sounds like like I was a psychopath in school. I want to know, all the clinical tests, I want to know all the biomechanics, all the biomedical stuff,



I remember I remember when you came to shadow and you were harder, like, you know, Deaf I related to that. So like, I totally feel you there.


Brett Scott  21:56

But at the same time, I was still open to I was like, What is this PRI thing all about? You know, I study all day. And then at night, I listened to podcasts about like, the extras in the field and watch YouTube videos on all these differences. Like, what is PRI? What is this? FMA? What is DNS? What are all these different things that I’m interested in, that seem like they might be, there might be a bigger a better solution to what I’m learning in school. But to be able to take it all in now and keep reflecting on a has been something we’ve done, but now it seems like school has been getting up to date, would you agree schools are getting up to date with pain science literature and in teachings or no? Not on a whole? No. So what I’m kind of observing now is so in the cash based world, so I’m part of a big mastermind group in the cash and hybrid physical therapy clinics. And I was talking to there was like, 15 of us clinic owners out here, complaining about the new grads, that a lot of them are coming out as like these pain science, hard O’s, that’s, you know, their their set of like, this is the way we need to do things and everything else is wrong. And a lot of them don’t even want to put their hands on patients, which might be good for certain people. But there’s also people, when you’re coming in, you’re paying $250 an hour or so want to be touched want to feel cared for in that way. There’s like something we might or should do. It’s an expectation of the patient. And some of these clinicians are just refusing to do it because of some of the literature that stated you know, it creates a dependency model, x, y, z, which to a degree it can. But now it’s almost like I see the ball shifting back the other way of like, we’re starting to see that like, oh, you know, there was some clinical practice guidelines came out saying like, yeah, dry needling actually can work and be helpful for certain situations, and things like that, ya know,



and yeah, I mean, there definitely is a rise in programs adopting more kind of pain, science and BPS type of stuff, but that’s the thing, right? It’s like, even now, like, as someone that was a pain science, Harto, and pain science evangelist, you know, I’ve changed my stance a bit as well, where I have a lot of critiques and issues with really the PhD like, kind of like the classic pain science neuro education paradigm, that is the paradigm that’s very much starting to become more and more apparent in school programs, because it can kind of have this like interpretation that’s a little bit radical and over the top, where we’re repeating similar problems there that we were with a very biomedical model. So it’s one of those things that it’s like the same way I feel about the biomedical model. It’s like you need to know this. You need to learn it, but you all You need to take it with a grain of salt. I need to know your blind spots like when people ask me if they should take a Lorimer Moseley course or, you know, Adrian lo course I’m like, Yes, you absolutely should learn about the PNP paradigm, but you need to take it with a grain of salt. And you need to take it with being aware of some of these blind spots. Because if you drink the, if you drink the Kool Aid too much, there’s a lot of negative consequences that can happen from that as well. So it’s like continuing to be humbled, and not get too wrapped up into any one thing, especially when they’re kind of polarized.


Brett Scott  25:33

Yeah, for sure. And so the whole thing about that, and then wrapping that into the growth mindset, I think is another big piece of what we need as providers is. We always want to be growing and flourishing. And it’s like, some of us have grown so far to go in this polarizing spectrum of care of, let’s only do pain science, or let’s only do biomedical. And I think that’s kind of one of the whole problems, too, with the medical model now is like, there’s just there’s so much overlap, or there should be overlap between professions. And there’s not it makes it hard for patients to actually get what they need. So actually, I’m doing another episode today with an EMT specialist who’s trying to get the Ear, Nose and Throat community to start working with dentistry. But there’s like such a divide in the scope of practice and everything because like, Sleep Apnea is something that’s a huge issue for a lot of people and affects health in a lot of ways which, as a physical therapist, sometimes we can actually address with people and help them with some of it in certain ways. But I’m actually like a candidate for a signing plasti and septoplasty and but, you know, I went to the doctor. And, you know, I told them, You know, I had a hard time breathing, and that’s all they really asked him that she gave me medication that’s only try these for six weeks. I came back. And she’s like, her answer was, okay, those didn’t work. I think you should see an allergist, but we can do surgery to. Yeah, I was like, well, well, you didn’t even ask if I snore. Yeah, which I snore like a chainsaw. But you know, she didn’t take my blood pressure. She didn’t. Yeah, asking me about how I felt when I wake up in the morning or anything else. And you know, she might be, you know, a sniper of a surgeon, but it doesn’t make you feel cared for when it’s like you leave that office and you’re thinking, what does she actually know about my condition? Like, is this and so my thing leaving there? I was like, maybe I do need surgery, but I have no idea because she didn’t look at anything. Besides, she took a six foot tube and shoved it up my nose. And then did a CAT scan. Yeah. And said your anatomy is okay. But it’s like, okay,



well, yeah, it’s it’s brutal man.


Brett Scott  28:00

So, so going into the growth mindset thing of how do we get clinicians? Or how do we even find clinicians that we, as patients know, are doing the right things, to to help you as a patient but aren’t so extremist in their view of, of this is what we need to do. Because, you know, I heard a saying a while ago, it’s like Baker’s bake fighters fight and surgeons cut. So how do we know we’re going to go somewhere and get an unbiased opinion that’s best for us? And how do we, how do we, as providers do that too?



How do so how do we as providers become providers like that? Or how do we as providers, find providers? If we’re seeking medical care?


Brett Scott  28:48

If you’re a patient, not necessarily if you’re a provider, but if you’re seeking care as a patient? How do you how do you know? Or what do you look for in someone that, you know is, you know, altruistic in their their look on care and helping people? And then as PTS how do we or just, you know, clinical providers? How do we do that? How do we become that that growth minded individual that’s still in the right direction with things and not too extreme?



Yeah. So I think I can start with answering the second one first, because that’s an easier one for me. You know, I think the biggest thing we can do to do that is like you need to find role models that demonstrate that behavior. I mean, at the end of the day, medical professionals graduating or being influenced by wherever they go to school, whoever their mentors are, like, you know, these are the people that have direct influence on the characteristics and the values. So if they have role models that demonstrate this humility and desire to keep growing and having this balance thinking, I think that’s how we can have people grow into that because it’s a values based thing is the values they need to adopt not anything Notice, like, that’s what drives the behavior. I think that for like, clients or patients looking for medical providers, you know, step one would be like, are they even? Like genuinely? Are they even like genuine for a second about? Like, are they trying to even listen to you or ask you any questions? Or is it like, they literally just breezed in and breezed out and like, asked you to questions, touch your knee and then left. You know, like, if that’s what’s happening, that’s a red flag, like that’s, you probably want to go get a second opinion. I would say, if you find someone that’s showing that they’re actually genuine, and they’re listening, and they are open and transparent about kind of the different options, I think that’s something that would be a key for me is like, any provider, you’re going to, if you asked like a good question to ask them would be like, what are the potential different treatment options, because generally speaking, there are different options, whether that’s not doing anything, whether that’s this conservative method, whether it’s this other conservative method, whether it’s surgery, like there’s usually multiple things that can be done. And the patient deserves to have a clear, transparent understanding of what those different things are. And then the provider, given their expertise up, you know, based on the evidence of what might they recommend, combined with what the patient is thinking? But I don’t know, I feel like those would be some of the big, big things. And if you can, I mean, that’s I think, word of mouth. And, you know, like, having friends that you can ask, like, that’s huge, you know, to be able to find trustworthy healthcare providers,


Brett Scott  31:39

which is really hard these days. Yeah, so much that they’re even, not that they’re not trustworthy. It’s just the constraints of the system are insane on on the the medical system right now it is, but



that’s where so like, that is something that we’re working back towards. And so like when clinical athlete first started, they were a directory. You know, it was for providers who demonstrated these exact values that weren’t going to tell them to stop doing X because some bullshit reason. And so like, we’re building back towards bringing back another provider directory, because this is a huge issue. And like, in our Facebook group, every single day, literally every single day, we get at least, at least one if not multiple, PTS or clinicians or coaches seeking referrals for loved ones or friends, because they don’t trust people, and rightfully so most medical providers suck. So like, why would you like, I would want to get word of mouth. And so I’m proud of that community we’ve been able to build because there are a lot of really incredible, incredible providers who like demonstrate this type of behavior and provide this level of care for people.


Brett Scott  32:45

Yeah, I’ve been part of that, too. And I’ve been happy to be part of that, because we’ve actually gotten some pretty awesome patients from being on that directly that that use that to find us and love it. It was a very, it was always a very good fit for them. So shout out to clinical athlete there. Yes. For for being part of giving patients the access to getting the right care. Yeah, I’ll say too, I think it’s just kind of a shout out to the physical therapy industry in itself, but we go in so I actually had a girl this morning that came in for an eval and she had a partially torn ACL. The she heard it skin. But she does some some recreational skiing, nothing crazy. She does some hiking, and she works out in the gym and does some strength training on her own. And the surgeon told her she needs ACL surgery like she needs it if she wants to get back to normal life. She’s two and a half weeks out from getting hurt and she had full range of motion with minimal pain. She was able to score a an 18 on an FMS, which is a very high score, which means you’re moving pretty well for those that don’t know that. She had a negative Lachman test. Like I couldn’t really tell the difference between right and left. And I was like, I was glad she came. She’s like, I’m petrified of surgery. I don’t want surgery. And I was like, Yeah, I don’t blame you. I don’t really think at this point you need to go you know, if anything. We can rehab this conservatively that I know guys that are skiing that don’t have a an ACL. I have another patient I always had no ACL for 25 years and he’s fine. I got the worst thing is it ends up tearing and you still need surgery. I go but that’s always something down the road and maybe you’ll never need it. Yes, but you can never go back from a surgery but she went into this guy’s like, and I asked her I was like, how long did this this surgeon spend with you? She goes it was the quickest visit I’ve ever been to is probably three minutes. Yeah. And it was like, man, we just I think as patients we just need to realize like these providers should be asking us a fair depth of questions. It’s about who we are and what, what our life looks like and what we’re trying to get. And what is our goal of being here?



Well, yeah, and part of that is like patients learning how to advocate for themselves. And that’s where like you going in with your client, like, love that that’s awesome. But it’s like, you know, I think more people are starting to learn, like how, like, what questions to ask, and because if you ask, like, what is the surgeon going to do, like, run out and tell you to kick rocks? Like, they’ll I’m sure they’ll answer stuff. If if asked, and if they don’t have a good answer, then you know, for sure that you shouldn’t be doing that with them anyway. But, you know, that’s definitely something I would encourage clients to hopefully learn how to that skill of advocating for themselves a little bit more.


Brett Scott  35:45

Yeah. And I would say to another thing, and, and remez kind of taught me this is never believed someone that says always and never, always or never. And I think that’s true there. I think there’s always different options people have. And if you go into a medical provider, and they tell you, this is what you need, you know, unless the signs are obviously clear, like, if you had a positive full tear of an ACL, you know, she wanted to get back to playing soccer, she had a positive test for the Walkmans, whatever. But yeah, maybe you do need ACL surgery. But in many cases, there is no cut and dry to to the health and vitality that you want for yourself. So I think providers should be giving more options to people versus just being like, No, this is exactly what it is. You know, I have to go to my next patient. And this is what we’re going to do. And that’s it.



Yeah, 100% 100%.


Brett Scott  36:42

And anything else as far as like the growth mindset thing you went through in the modules or anything?



No, it’s just learning, learning how to continually humble yourself and want to humble yourself. It’s hard. It’s easier said than done.


Brett Scott  36:59

Yeah. And what was the last the last module,



I forget. So it was like when we originally created it, like listening was the third month and communication was the fourth month, then we ended up just making communication months three and four. as kind of a broad topic. And now Now it’s exercise. Now the last month is exercise. month three is communication. month four is exercise.


Brett Scott  37:25

Nice. That’s the big one we need in PTS exercise. So as far as finding the right PT, Zack, what do we want in a PT?



What do we want in a PT? PT? Well, if you’re going in, and there’s a jillion people running around the office, and it’s just pure chaos, probably, I mean, you may find some good people within those systems. But that’s really not a place you want to go. That’s not a place you want to be. So that would be like one step one from like environment, step two environment, you’re looking around the PT office, or wherever you’re at. And if you don’t see any sort of weights, or like any type of training equipment like that, that would probably be another sort of red yellow flag for me again, like there’s nuance if the clinic if the eval offices in a separate satellite thing from where the treatments are gonna go, whatever. But generally speaking, you’ll have an understanding that like, if you don’t see training equipment, that will be another yellow to red flag. But in terms of the actual provider, I mean, just what we just spoke about with the medical providers, like it’s the same thing like, are they brushing you off? Are they asking good questions? Are they, you know, genuinely listening and curious about what’s going on? And are they being open and transparent about what they think is going on what the different options you have to manage this are and getting feedback from you? You know, I’d say those are some of the big things.


Brett Scott  38:57

And I’m just curious, because you’ve been doing a lot to start to integrate the principles of strength training into physical therapy and physical therapy education, too. So where are we going with that? Because I think that’s the biggest thing and it’s the saddest thing about our profession is for the profession itself and for patients is, you know, when I went through school, when I was an undergrad as an exercise phys major, we had one lab on a Olympic weightlifting with Devin McConnell, who was an awesome strength coach, who’s now with I think, the Arizona Coyotes, but no one even could lift the weight in the class. Half of my class didn’t work out. And then the other lab we had we had one other lab and undergrad for lifting which was student led. And the person teaching the deadlift just said, yeah, you take the barbell and you lift it off the floor. So that’s not a deadlift that’s not a deadlift.



So you know what I hear what Here’s what I think is actually the biggest problem with the exercise that we do get in school is again, it’s kind of back to the paradigm or the lens in which it’s taught. We’re taught exercise through a very fragile model. We’re taught, we are taught exercise through an overly medicalized what we would kind of call a kinesio pathological model, aka, there’s, you’re moving in a, there’s a right and a wrong way to move. And, you know, we need to be careful about how we’re stressing certain joints, otherwise, they’re going to hurt or whatever, like, that’s the lens in which we are taught exercise in school. And that is a problem. Because even if people are taught, like a deadlift, or whatever, they’re usually coming at it from a very, you need to do it this way, or you’re gonna get hurt. Yeah, exactly, exactly. So it’s, for me, it’s even starting with just a paradigm shift of how we’re even thinking about stress and exercise. And, you know, again, back to this balancing act of like, it’s not like forum doesn’t matter. There’s an optimal for sure, but there’s no right or wrong, there’s a lot of nuance, and there’s a lot of gray. And we can generally adopt a much more movement optimist type of approach to exercise, which can still consider all of these very nitty gritty, biomechanical factors, but weighed in the context of how much does this matter for this person. And so that’s where I think exercise needs to go for this profession is, we need to stop making such a big stink and creating these unnecessary, unintentional barriers to people engaging the movement. And we need to learn how to give people more freedom and more options to engage in movement in a way that’s going to help them build confidence.


Brett Scott  41:37

For sure, and so are PT schools doing more now to integrate these things? I’ve seen some class some courses now out there are doing like a strength and conditioning aspect of PT, and things like that. But for the most part, there’s plenty of professionals I’ve talked to in the field to that just, I met up with a chiropractor that she was saying she like, understands or understands movement. But then I was like, Yeah, I think I need a trainer because I don’t always know if I have the right form. I was like, your movement provider? Out? How do you not?



Yeah, so i Same with the pain science stuff. There’s pockets of schools that are like adding electives, or they have good people teaching the electives, or they have good people doing like the thorax course. But I would say that it’s still very much a minority, because the majority of it is still very much the kind of overly fragile approach to exercise that are is still getting taught at the majority of PT schools.


Brett Scott  42:42

Yeah, for sure. And so, you know, for me, for Zach, for probably most of the people listening to this podcast, too, that are interested in health and movement, you should find a provider that is one that says some type of exercise personal experience with exercise, whether it be strength training, if you’re a runner, go see someone that’s, you know, does marathons or something like that, that really understands who you are, where you’re coming from. And that knows where you’re trying to get to. I think that’s the biggest piece at the end there. Yeah, definitely. So anything else you want to add? Zack, I know you got to wrap up here in a minute. No,



I enjoyed the conversation. I love the work you’re doing. So I mean, we ultimately we are I think younger professionals are stuck with the choice of like, you kind of got to kind of gotta make something happen. Otherwise, you might end up in a situation that you blink and you’re not super happy with it. So kudos to you and excited to continue to watch on.


Brett Scott  43:44

Thanks, man. Yeah, it’s crazy to think back in and see where where we are now. Now we have a podcast and like, I liked the other day, we got like 2000 listeners and things now I was like, Yeah, that’s right. But Zack, where can people find you?



Zack aboard dot DPT? That’s my Insta or at the level up initiative is the other Insta for the education company we run.


Brett Scott  44:12

How do you spell Zach? Za K. Thank you. So yeah.



Gabor GA br dot TPT.


Brett Scott  44:19

Yeah, check out his stuff. He’s got some awesome stuff up there for especially if you’re a new grad pt. And you’re looking to really make sure you’re doing the right thing not only for you, but for your patients. And they’ll humble you and make you a better person for it. So Zach, thanks for coming on. And we definitely ought to catch up sometime soon.



Yes, we definitely will. And shout out to you ml because they are one of the schools that are doing good things to add in pockets of some of these electives with strength conditioning and pain science. So just shout


Brett Scott  44:49

it up. Is that from our boy Kyle coffee,



it’s Kyle, but Dr. Fox has been putting Jenna Matera put me on and so I’ve been going back there every year to give my mom I paint science lecture and Jenna does an exercise lecture. So


Brett Scott  45:05

I invite



might be here now. All right,


Brett Scott  45:09

let me know. I’d love to do that. Yeah. All right. All right. Thanks, Zach. And everyone next time coming up on the show. We have Dr. Ken doula. We’ll be talking about the ear, nose, throat breathing, sleep apnea, and navigating the optimization of breathing for health and longevity. So stay tuned for that one.

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