The Beyond Pain Podcast

Episode 51: Navigating Injury Recovery with Dan Pope

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Summary:
In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca welcome Dan Pope, a physical therapist with a rich background in sports and injury recovery. 

The conversation delves into Dan's personal experiences with injuries, the importance of understanding the psychological aspects of rehabilitation, and the protocols for returning athletes to their sports safely. Dan emphasizes the need for thorough testing and preparation to ensure athletes feel confident and ready to return to their activities after injury. 

In this conversation, Dan Pope discusses the complexities of surgical decisions in sports injuries, emphasizing the importance of patient education and informed decision-making. He highlights the need for quality physical therapy and the challenges of misinformation in pain management. 

Additionally, Dan shares insights from his experience writing a book aimed at empowering coaches and consumers in managing orthopedic issues.

Takeaways:

It's helpful to hurt yourself to learn about injuries.

Understanding the psychological aspect of rehabilitation is crucial.

Return to sport protocols should be individualized based on the injury.

Athletes often return to sport too quickly after injuries.

Regular testing and benchmarks can improve psychological readiness.

Force plates and dynamometry are valuable tools in rehabilitation.

Building strength and confidence is key for athletes post-injury.

Injury recovery is a learning experience for both therapists and patients.

Communication between therapists and athletes is essential for success.

Sending patients to sports psychologists can enhance recovery outcomes. 

Surgery can sometimes be the best option for athletes.

Conservative care can waste valuable time in recovery.

Not all injuries require surgery immediately; it depends on the individual case.

Education is key for patient decision-making regarding surgery.

Physical therapists are well educated and capable of providing quality care.

inding a therapist who understands your sport is crucial for effective rehabilitation.

The book writing process is long and requires significant effort and detail.

Coaches should learn to manage pain effectively to support their clients.

Misinformation complicates pain management for consumers, making it hard to find accurate information.

We aim to empower consumers with accurate information to make informed decisions about their health.

Joe Gambino (00:00)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino. I'm here with our other host, Joe LaVacca This podcast can be found on Instagram, Beyond Pain podcast on YouTube, cupsofjoe underscore PT. And you can find both of us on Instagram at joegambinodpt for myself at strength of motion underscore PT for LaVacca. And we do have a guest today, Mr. Dan Pope. He is just a man off the street that we picked up today.

And I will just leave him the floor to intro himself in and tell our listeners more about.

Joe LaVacca (00:29)
Yeah

Dan Pope (00:35)
Yeah. Thanks for having me. It's, it was very cold out there and I'm glad to finally be inside with a roof over my head and a little bit of food. I appreciate you picking me up today.

Joe Gambino (00:45)
It's always a pleasure.

Joe LaVacca (00:47)
Yeah,

it is probably pretty cold up in Mass, right? Because it's been freezing in New York. It's been absolutely a brutal start to, I guess we could call this spring, or is this like fake winter, or I don't know what this is.

Dan Pope (00:58)
I

So about a decade ago, when I moved to Massachusetts, I took my expectations and just brought them extremely low. Usually during March, it's still winter. And then may it's pretty much still winter, you know? So if we have any sort of warmth, then I just, I'm like, yeah, awesome. But if it's terrible, like, yeah, that's kind of how it goes. But yeah, it's been bad. Uh, we had snow this morning, had about an inch. So I don't know. It is what it is. Right? I'm not in Canada. I have some friends in Canada. That's way worse. So it's okay.

Joe Gambino (01:06)
Ha ha ha ha ha

Joe LaVacca (01:22)
geez. Yeah.

Joe Gambino (01:24)
my God.

Joe LaVacca (01:29)
There's always a

bright spot. But I guess that the weather thing though, I mean, you probably had, mentioned that you're from Colorado when we were just chatting before. The Colorado weather here, is like beautiful 99 % of the time. And then you just get like 18 inches of snow out of nowhere or a hail storm for like 10 minutes out of nowhere. And then it just like goes back to being great. So what, was there another intermediate stop for you? I forget, cause I remember you're from Colorado, beautiful weather.

Dan Pope (01:30)
Yeah, yeah.

Yeah.

Joe LaVacca (01:57)
You had

to lower your expectations probably for other reasons, we'll, we'll, you know, we'll leave it. We'll leave it at that with Massachusetts. You know, they're, I'm sure they're all good people, even though they're Red Sox fans and Patriots fans and all that stuff. Was there another stop in between? I feel like there was one more stop if I remember correctly from your course.

Dan Pope (02:10)
Oh yeah.

So I'll throw a little wrench in there. I actually wasn't born and raised in New Jersey until I was, I would say mid to late twenties. And that's when I went to Colorado and I went to Colorado because my wife got a residency out there. So I followed her out there. Stayed for a few years and then I moved to Massachusetts, but yeah, spent the majority of my life in New Jersey, uh, Southern New Jersey, mostly, but basically been all over the place in Jersey, Southern New Jersey, Northern Jersey. I went to school Rutgers, which is considered, you know,

Joe LaVacca (02:15)
Mmm.

That's what it was.

Dan Pope (02:38)
central Jersey, New Jersey's hilarious because it's a tiny state, but people identify strongly to certain areas, you know? but yeah, that's kind of my background.

Joe LaVacca (02:48)
Yeah, well, it's like the same thing with Long Island and Staten Island. I mean, I'm born and raised in Staten Island. Joe's over out there in Queens, but you know, you have to represent the side of Queens, right? Joe, was, what are the wars, what are the neighborhoods in Queens that are rivals to each other? Where do you want to be from Queens and where do you not want to be from?

Dan Pope (03:01)
Mm-hmm.

Joe Gambino (03:11)
It's, it's not necessarily rivals, but Queens Boulevard, kind of not Queens Boulevard. A story Boulevard kind of separates the two sides of the story in a sense. So you have like one side where I, where I was on, you know, that was the better side. And then on the opposite side of that, it was just a little bit more residential. mean, you have dipmars and stuff where there's a lot of stuff to do, but anyone who lives over there thinks that's the better side. So, you know,

Joe LaVacca (03:23)
Alright.

Well, obviously,

You

Joe Gambino (03:38)
It is what it is. like to spend time on both sides. So yeah.

Joe LaVacca (03:41)
Very good. All right.

Dan Pope (03:42)
Yeah.

Joe LaVacca (03:43)
Well, Dan, we got a very important question that we have to ask everybody on the show. And that is, how do you take your coffee?

Dan Pope (03:53)
Oh, black usually, unless it's too hot. In that case, I'll put a little cream in there, but I'm addicted to caffeine. I've got a drug problem. Let's be honest here. I'm in it for the, uh, the energy, you know, but I love coffee, all types.

Joe LaVacca (03:56)
All right.

How many cups are you drinking a day?

Joe Gambino (04:11)
Very good.

Dan Pope (04:13)
I don't even know I think it's tough because it depends how big your mug is. I Mean, I'll say I drink like Three cups, but really it's probably like 72 ounces, you know, mean depending on how big your cup is though I'm not sure I make a pot in the morning. I try to finish it. So I've got a problem

Joe LaVacca (04:24)
Yeah

Alright, very good. when

you say hot, are you talking about like if it's too hot outside, you'll like try to cool down the coffee or is it actually like temperature hot? Like it's just like too hot. Alright.

Dan Pope (04:38)
I'm just trying to get that in the system. So too hot. got to cool

it down with something. There's cream. It's going in there. Sometimes I put some water in there. bet the coffee aficionados are like, this is a psychopath, but that's how I do it. I guess.

Joe Gambino (04:49)
No.

Joe LaVacca (04:51)
I've

never heard of the water. The water's a new one, Joe. We gotta try that one.

Joe Gambino (04:54)
Mm-mm. Yeah,

that's a new one. I don't know if I'm gonna... Now, I would rec... Like, if I had like a cold brew and I found it too strong, I would cut it with a little bit of water. That makes sense to me. But to cool it off a little bit, I feel like if you really enjoy the coffee, that I would just water it down, no?

Dan Pope (04:55)
Ice cubes sometimes, just anything.

I like both of it, but if it's too hot, it's going to burn my mouth. And if I want to be caffeinated, I gotta do something. You know what I mean? I can't wait. have zero patients, I guess. Yeah. Clock's ticking, man.

Joe Gambino (05:16)
You just can't wait like the two more minutes for it to cool down.

Joe LaVacca (05:22)
Clock is tickin'. Clock is tickin'.

man, God, that's really great, dad.

So look, we got a lot of other questions for you. You'll be able to completely redeem yourself today and get everybody back on your side. But the other question that we like to start with is your past and mainly your injury past. This is something that you've been very open about, you know, at least throughout the entire fitness pain free certification, sharing your story. So for those who've never heard it,

Dan Pope (05:37)
Nice, good.

Joe LaVacca (05:58)
We were wondering or hoping if you could dive into that a little bit and maybe just share how it made you or shaped the clinician you are today.

Dan Pope (06:06)
Yeah, for sure. When you guys shot this question over, uh, prior to the podcast, I thought it was an interesting one. hurt myself all the time. I'm currently hurt a little bit, you know? Um, it's funny in terms of my history, it's, it's very long and extensive. And I guess the big thing is that as a physical therapist, it's helpful. It's helpful to hurt yourself. Um, because you can learn more about the injury, how it goes, then help other people. Right? It's like being any other sort of expert. You go through it yourself. You learn how to.

I think it helps. think it really helps. It sucks. Obviously. Um, but yeah, very helpful. Um, you want me to share specific examples or the recent ones, or what are your thoughts?

Joe LaVacca (07:01)
Yeah, sure.

Why not? whatever you think would be helpful or what maybe the most current one that's you're battling we could start there.

Joe Gambino (07:05)
Yeah. Yeah, go

current or the most impactful, I'd say pick a lane there.

Dan Pope (07:11)
Well, one of things that's been interesting lately, say is that my biggest background, background in any sort of sports or like physical activity has been strength training and in strength training and also some running, there's a lot of overuse injuries and they're handled in a specific way, mostly tendonopathies I'll say. more recently, don't, don't ask me why I decided to do this, but I took up Brazilian Jiu-Jitsu.

which is a lot of fun. I've been doing a few years now and there's a lot more ligamentous injuries. And I'll tell you what, that's a very different beast. And I was lucky when I played a lot of field sports and court sports growing up, I never had a major ligamentous injury, like an ACL tear, right? I did have some in terms of shoulder instability. Um, but once I started Jiu-Jitsu, I got a lot of ligamentous injuries. I dislocated my shoulder, high ankle sprain, LCL injury.

And it's very different than the typical kind of slow pain comes on with the course of time. Then have this nagging injury that you can kind of keep training through. We have to be smart. When you have a major ligamentis injury, it almost like you have to pump the brakes immediately a lot. And you can't necessarily push through it quite as much. And sometimes it turns a corner a lot faster than let's say a tendinopathy. think ankle sprains are a good example where you sprain your ankle.

And you can't walk on that thing. And sometimes that's for a week or two. And all of a sudden you're back to sport like three weeks later, which is nuts. And the same thing goes for like a shoulder dislocation. Um, and I'll tell you what, that's not a good thing. I wouldn't say, I will say that for a lot of these ligamentous injuries, people go back way too fast. And I think the literature supports that particularly with like a lateral ankle sprain where folks like this is hilarious, but I've read this in a study from NCAA division one athletes.

The average return to sport time after lateral ankle sprain is 1.5 days, which I think is consistent with what I see people just like limp it off. They roll their ankle badly. They go back to playing and there's like a 50 % recurrence rate. It's like the highest recurrence rate of any orthopedic injury. So, um, what is neat about these is that they do turn the corner quickly. They're very devastating when they occur and we probably need to do a better job of rehabbing those. Um, but those have been interesting.

And getting back to my activities has been a whole new learning experience for me. And I think this is one of the reasons not to change the topic too much, but you kind of have to find a physical therapist that really understands the activities you want to get back to. So even for myself a couple of years ago, I really like wrestling and combat sports and jujitsu, but having done it for a few years now and hurt myself a few times, I understand it way better. I'm a much better physical therapist now because I'm actually doing the activity myself.

And I've hurt myself a few more times. And I've also rehabbed a bunch of my friends that are now in the, in the sport and they enjoy it and I enjoy it. And it's just been really good. You know, I know a lot of folks will say, I hate it when I get injured. It's the worst. I, I strained my calf like three days ago. It's a chronic issue for me. I hate it. It's getting better, but it always teaches me something. And, you know, just teaches me respect the human body a little bit more every time it does happen. So.

Joe Gambino (10:28)
Yeah, that's a, I like that breakdown. mean, I've on this podcast, definitely shared my experience with, back pain a whole lot. So I'm with it sets, but it definitely gives, it gives you a different lens to look at. I think, when you're trying to help somebody, mean, I feel like most of the people that I see, are these like long-term issues that that kind of pop up over time, but I'm actually curious, you know, with you mentioning, the rear current rate at 50%, these ligament, this injuries, people go back too fast. Is there any sort of.

you know, guidelines that you would put into place so that someone would feel like they would know that they're ready to return back to sport or back to whatever activity they want to do.

Dan Pope (11:08)
Yeah, there's a lot of them and we're, we're currently doing a lot of this at champion. So I work, for the listeners at champion PT and performance, it's a sports physical therapy facility. And we kind of pride ourselves in the fact that if you walk into the clinic and you're like a 60 year old, you might feel out of place because a lot of places that call themselves a sports physical therapy clinic, they'll have mostly geriatrics, which is the most common population that

know, people need physical therapy services for. So not knocking that, but a lot of places will call themselves a physical therapy facility that specializes in sports. And they really don't for us. It's the opposite. If you're a normal person and come into our facility, you might feel a little bit uncomfortable because you're like, Holy God, like it really is mostly like, let's say like high school, middle school, college professional athletes there. Right. So we see a ton of sports. my bosses are pretty well known in the sports physical therapy world. So Mike Reinhold was the president.

of the sports academy from the American physical therapy association. he's just transitioning out of that role. Lenny McCrean is also my boss. He'd been very active in the sports community for years and years. they publish a lot of research in that realm and currently we're trying to update our systems for return to sport. So this is very relevant, you know? and I think it's, if you're really in the sports physical therapy world and worked with lot of athletes, this is probably not groundbreaking news.

But we do a lot of return to sport and criteria based testing, right? Um, I think one of the biggest ones is just doing regular handheld dynamometry. Um, and I think the lateral ankle spring is a little tough because it's tough to measure ankle dorsiflexion inversion, eversion planar flexion, but to bring it back to something more simple, let's say after an ACL reconstruction, you really should be doing this. We have to test someone's knee extension, strength and hamstring strength. And we use handheld dynamometry.

And we're looking for around 70 % LSI or limb symmetry index before we initiate things like plyometrics. We'd like to see around 80 to 90 % before returning back to any sort of sports specific drill, right? We're looking close to that 100 % before we return back to sport, but we use a lot of different things, right? So it's not just looking at limb symmetry index and strength at the knee. We're also looking at things like rate of force development. We're also looking at torque.

to make decisions about how we progress over the course of time. We're very blessed. have a lot of technology, so we use force plates as well. The force place gives us lot of data about symmetry with jumping. also give us information about different types of jump. So jumps that have a very short ground contact time versus a longer ground contact time. We want both of those as an athlete. Certain sports need more of one particular type of plyometric versus another. We can assess that. We can see if it's progressing over the course of time.

We're just messing around now with something called the 10 any sprint. So we can look at more horizontal jumping and sprinting. We can see how much force people are putting into the ground with every single step, which is amazing. We can use all these things to make smarter decisions about when folks are able to return back to sport. So we put a lot of thought and effort into our return to sport testing. We also put a lot of thought into our return to sport protocols. One of the things you'll see in a lot of literature studies is that people have to complete a protocol. So they have to go from.

Joe LaVacca (14:30)
Mm-hmm.

Dan Pope (14:39)
And it varies based on the individual also varies based on the surgery or the injury that they had. So we're going to return a lateral ankle sprain a whole heck of a lot faster than we would an ACL reconstruction, obviously, and the rate at which they return back and go through the stages can be variable depending on how severe the injury is. So if you,

can't walk after a ankle sprain and there's no fracture. Yeah, we're going to go a little more slowly, but we'll start rehab right away. if you do have something where you can start to run on that right away, then you're going to progress much more quickly. Same thing goes for like a hamstring strain injury. You might be able to still run after hamstring strain injury, or you might not be able to walk. And those can have two different timelines and turn returning. And it really depends on how fast people progress through their stages and how strong they get over the course time, how fast the range of motion kind of returns. So

It's a lot of information. Does that kind of answer that at least to a degree?

Joe LaVacca (15:34)
Yeah, I think it, I think it does. one of the things that I was wondering as you were going through a lot of the return to sport protocols that you guys have, and I know how diligent you guys are just from following you on social media and how your thought process all lines up. And one thing you shared when you were talking about picking the right physical therapist, you know, not only somebody that understands what you want to get back to, but maybe is involved in your sport understands, you know, the,

grit and the grind that it takes has gone through injuries in the past. Like it sounds like everybody at champion probably has, including yourself. So with all the return to sport, jump, plyometric, things like that, I'm sure there's a lot of psychological variables that come into play for injured athlete. And it really made me think about that when you were talking about the suddenness of something like a ligamentous injury versus the

build up of something that you can see kind of coming with that tendinopathy or it's getting a little bit more irritable each time. So do you guys have any specific protocols or things that you like to use to help your athletes get that psychological edge or help them cope with maybe some of that anxiety, depression, not going back to their sport?

Dan Pope (16:47)
Yeah. I think the big one are just psychological readiness questionnaires. There's a lot of them and there's some that are specific to like ACL. I can send some over if you guys want after, the listeners want to take a look at the ones I recommend, but largely you can give a questionnaire just to see how well they're doing. we do know that folks are often not confident in their ability to return. And I think I've shared this stat on social media, but after ACL reconstruction,

only around a 30 % of athletes will do any sort of plyometric testing before they're kind of discharged for their sport. And my first thought is like, if no one is even doing any sort of jumping in their program, they're not going to feel ready in any way whatsoever. So I think the biggest thing, and I am dumbing down the whole process by saying this, but you really have to do your due diligence as a physical therapist, just progressing them through all the stages, you know,

So if you build their strength and then you're testing your athletes and you're giving them an idea of the benchmarks and they're seeing their strength improve over the course of time, they're seeing themselves hit these benchmarks. You start with easy plyometrics. You see where the deficits are. You're being specific about the exercises. Athletes see that these deficits are going away. You're filming them. You're looking at their movement. They see how their movement wasn't good. They're starting to see how their movement is improving. You take them through more challenging drills.

more sports specific drills. You're taking them through drills over the course of time. It looked just like their sport. You're looking at how fit they are. You're giving them drills that maybe match the sports specific demands from conditioning perspective. have the right strength. They have the right power. They have the conditioning. They've been doing this for months and months and months. Their readiness is going to be a whole heck of a lot better than someone that just didn't go through that process. We haven't even done any sort of psychological interventions, right?

So I think as a physical therapist, one of the best things you can do is just prepare athletes extremely well. And then I think that what you'll find is that their psychological readiness questionnaires get better and better and better as a result of the PT being better. Right. And I think the other part is that sometimes folks have to have their expectations lowered and this stinks. But if you look at return to sport, like especially for ACL reconstruction, um, and this has been

point of contention recently, due to a recent study showing that that nine month mark after ACL reconstruction might not be everything, but largely nine month mark is important after ACL reconstruction. have a good amount of research to show that if you delay return to sport until nine months, that risk of injury goes down, which is a very good thing. but a lot of folks are not ready until way after nine months, right? Depending on the study you look at, if you're doing any sort of return to sport, battery of testing, a lot of folks aren't ready until month 10, 11, 12.

Right. So it might take longer than a year. And certainly some folks do get back at five months, but a lot of folks, once you get to nine month Mark, their psychological readiness is poor, but they haven't passed the battery test to return back yet. They're really not ready. Right. So it doesn't, it makes a lot of sense to me that some folks are just going to report. don't feel ready to sport because you know, the nine month Mark, when they may have been told by their surgeon or other folks that they should be ready to return back to sport or not. I mean, their performance doesn't reflect that. So

make sense. They may not feel that way. And it gets important. If, an athlete doesn't feel like they're ready to return back to sport, um, that probably aren't ready unless they do have some sort of true psychological issue where they look amazing and they're well prepared. And if that's the case, a lot of times I just kicked the can to another professional. I'll send to a true sports psychologist that can talk them through this because there is an extent to how well I can prepare people psychologically.

I think as physical therapists, have to be aware of the importance of psychology. And there are a few things we can do with our skillset. But if you truly have someone that has a problem with things like anxiety, depression, stress is another big one. And I think oftentimes just sending to the right professional is going to be important. And, you know, it's, it's going to increase the patient's outcome and it's unfair to the patient if you don't do that. So that would be what I would do.

Joe Gambino (21:02)
That's fair. I like that. And I just, uh, when you just mentioned that 30 % of people, uh, that don't have any sort of return to sport testing. that just makes me think every time I haven't worked with ACLs in a long time because I'm virtual now, but every time I remember with an ACL person, the first time I asked them to jump on their affected leg, there's always hesitation. So imagine never having somebody jump and then saying, all right, like just go back and play soccer or go back and play basketball or something like that. Like they 1000 % wouldn't feel ready. So that's, that's interesting. Um,

Dan Pope (21:31)
close

my mind.

Joe Gambino (21:32)
Very

interesting stats. I I don't know about I don't know if the listeners want the same thing, but

Joe LaVacca (21:36)
No, I think, I think, you really bring up a nice point to Dan and I appreciated the connection to the objective testing. Um, cause a lot of my clients will always ask me, you know, how do you, how do you know I can do this? And I was like, well, your tests told me, know, your special tests told me the, your force output told me the fact that you were able to do, you know, 15 single leg squats off the bench told me the fact that you were able to do. So I think it is really important for those listening is like. To not just be told you're ready to do something, but to actually have it proven to you.

is so much more valuable. It ties into the story. And I really always see those confidence things go up. And I'm like, look, I don't know if there's a perfect number that's ever gonna exist in the literature with like getting your quad back, you know, to this number and then that prevents the ACL. But I think more and more like reestablishing that trust, not only in their bodies, but in their process, I think is really, really important. So thanks for sharing that connection for us.

Dan Pope (22:30)
Yeah, for sure.

Joe Gambino (22:33)
Yeah, and switching away. sorry, Joe. Go ahead. Yeah, well, I'm going to switch it up. So if you have another question on this topic, go for it.

Joe LaVacca (22:34)
No, no, no, get, get.

Yeah, no, think just sticking with the surgical ideas, because I know we've been bringing up now ACL. You know, we're talking about that recovery process. And again, the connection of like, that's a sudden sort of ligamentous thing. I know there's some things popping out now that people can go without surgery and a cross-bracing protocol and stuff like that. But my question to you dealing with all these athletes is maybe switching gears to the other side of the injury, right? Like these like nagging things that are building up.

where surgery becomes an option or a doctor tells one of your athletes, hey, we can go in there and clean this up, whether it's maybe a rotator cuff or maybe some meniscal pathology in the knee. So I was wondering for you and Champion, are there times where you're looking at an athlete and you're like, yes, go get the surgery. This is going to give you your best chance of your outcomes. then simultaneously, there every one or are there any processes or procedures that you're like,

Definitely avoid this one at all costs.

Dan Pope (23:41)
Yeah, this is a good question. And what I will say in my background as a physical therapist, I was kind of averse to surgery, which I think a lot of physical therapists are. they want to try to heal things with exercise. And I think in a lot of cases, obviously exercise is warranted. What I will say over the course of my career is a lot of this has flipped where I am much more open to surgery. And I think a lot of this comes with getting smarter, learning more about different pathologies.

learning when it's more appropriate to have a surgery versus not also networking with good surgeons as well. being a little less scared of the process because some cases you might be spinning an athlete's wheels for months to years when if you just got the surgery, they'd be back faster. And the thought is like, well, why did we waste so much time doing conservative care? You sold this to me as the right way to go. And there's definitely times where people jump the gun and that's definitely a problem too. And our knowledge is

always changing. think, you know, a good example would be slap tears. You know, surgeons are doing less and less slap repairs. Um, particularly for higher level athletes and throwers in particular pitchers, even more specifically where we used to do a lot of slap repairs. Now we're finding the outcomes aren't quite as good as just to kind of let them go and hoping they can rehab, but they may get to a point where they're not improving. And then you may need some surgery. Um, speaking towards injuries that would potentially need surgery right away.

think if you have a traumatic anterior instability, shoulder dislocation, that's one of the big ones, particularly if you're young. So the younger you are, the worse the outcomes are. So if you're like even 11 years old and you have a traumatic dislocation playing football, your likelihood of getting back and not recurring, particularly if you play some sort of impact sport, like rugby or football, very slim, you're probably going to have another dislocation and you keep spinning your wheels. problem with those dislocations is that

When they come out the first time, almost always cause damage. So usually that's a bank art lesion. If it's traumatic anterior instability, as they continue to recur, you can start knocking off bone. So you start taking chunks of the glenoid off. You can also cause impact fracture, Hill Sachs lesion to the humeral head. And what can happen is that the surgical intervention is more and more invasive over the course of time to try to correct that. If you knock off enough bone, you can no longer do a bank art repair or you can, but the

outcomes might not be good. And you're looking at something like a ladder J procedure. Now I have to take part of the coracoid onto the glenoid. so it's just one of those things you won't let have happen over and over again. It's been a few folks in the UFC world. I'm trying to try and remember, I'm not going to say anything because I'm to mess up the person name, but people enter their careers because they have dislocation, have a dislocation, have a dislocation. They don't get the surgery and now they can't come back at all because

The shoulder is too messed up. And sometimes at least advanced osteoarthritis. is obviously it doesn't happen to everyone. And I'm, I'm just kind of putting fear into people's minds, but that does happen. Right. I've seen that happen a lot of different joints. I've seen that happen in the hip. So cross fitters that have a hip tear kind of keep pushing through this over the course of time, they can no longer get labeled repaired or they get some osteoarthritis. point they can no longer get hip label repair surgery. So it does happen in that joint as well. Um,

The rotator cuff is another one where it's a bit of a toss up. And I will say that I've become a less conservative person over the course of time. So there's a lot of optimism now in the social media world. think rightly, rightfully so about rotator cuff tears, just because if you look at data about rotator cuff tears, even the larger massive ones tend to improve over the course of time with physical therapy. And that's a good thing, right? We know that the bigger the tear gets,

Oftentimes the worst the outcomes are from rotator cuff repair standpoint But if you have a younger person with a larger rotator cuff tear We know that's probably going to progress over the course of time And the thought is if you don't repair it then over the course of time they make it worse And then if they decide to get rotator cuff repair eventually They may not be able to because it's gotten to the point where it's retracted and they can't bring it back Where the retraction is so bad that the outcomes are going to be worse

And I think the folks that would say that we'll look at the data. It looks like you could, you can rehab that. Most of the research and rotator cuff tears are in sedentary individuals. have someone who's very, very active that wants to be able to do, let's say push jerks for the rest of their life. I don't know if the best option is to treat that conservatively. I think for that individual, you might want to send them back to the surgeon sooner because we know that the repair cuff repair is going to do decently. Well, we have some great research that shows that.

cross fitter specifically do well with rotator cuff repairs have really good return to sport rates. I would potentially push them to get surgery a little bit faster other than, rather than just tell them that like this could be handled conservatively. So time will tell it. One of the hard things. And you would think we have this data for the rotator cuff is that we don't have data to show like, okay, I'm 40 years old. I have a large rotator cuff tear. I get surgery and I want to see how my shoulder is 30 years later. Right. Cause that's really what I care about.

or I don't get a rotator cuff repair and we'll see how the shoulder looks 30 years later. And I continue doing, let's say CrossFit or some sort of like intense weight lifting from my shoulder. We don't have that data. And one study that we have from Moose Mayor, it's funny. It's this study I quote all the time and the guy's name is hilarious, but they're 15 years out currently after full thickness rotator cuff tears and looking at outcomes for surgical repair versus a concerted treatment. And the surgical repair group is outperforming

you can serve a treatment group at this point. You will have well controlled trials or one or two years out showing there's no difference between surgery versus conservative care. But the big thing is like, I want to know what 15, 20, 30 years down the line looks like. That's more important to me. however, these folks aren't doing CrossFit. aren't doing high level stuff. So I don't know. I don't look at research all day long. Like a, like a classic researcher PhD does.

So I do think this is a nuanced discussion best served by folks that are more experienced with this. But I also just from reading the research myself, it, it's not clear to me that one intervention is going to be superior to another. so I would say that it's a, it's a coin toss from that perspective. And I guess what I'm getting to is that it's very different from injury to injury and person to person. So it's almost like tough to just say, you know, surgery is good or bad.

Um, it really, really depends on the injury and the person, right. And how the rehab goes, just because I've seen folks in the spine, let's use as an example. And I think you'll see a ton of research. shows that. Conservative is equal or better than things like microdiscectomy and fusion, right? Cause those are the scary ones are like, Oh, I never want my patients to get a fusion surgery, but I've also seen high level crossfit athletes, um, or just high level recreational folks who get.

fusion surgeries and, or micro discectomies. They do extremely well. And return back to sport and they feel really good. I've had folks where they've had disc problems, say a disc herniation. And I'm just telling them like, Hey, hold out on this, hold out on this. I think you can turn the corner. Eventually they're just like, screw this. I'm going to get surgery because I'm dying. And after the surgery, they feel like a million bucks. Right. So I do think that you have to follow the literature. have to know the outcomes of these procedures.

educate the patient. No one can serve his right approach. Know how long you should try conservative before you decide. But I, I've definitely kept people in misery longer than they should have. And I think sometimes like spinal fusion surgery is good example where, people are just used to the horror stories, but they never hear in the success stories. And I have a Rolodex of success stories in my head. I just have to keep in mind. It's like, well, I've seen a lot of folks do really well with this to get back to a high level function where it was a good procedure for them. So.

Yeah, it's great. It's hard to answer that question.

Joe Gambino (31:45)
No, that's a hundred percent. I'm curious because usually, I mean, I'm not working with high level athletes that are professional level or anything like that. But a lot of times if the conversation comes up, tell them it's like, you have to weigh risk rewards here, right? And like what we want to kind of get back to. So I'm curious really where, and I'm it's different person to person, but how do you go about like having those conversations with your patients and educating them and helping them make the decision for themselves?

Dan Pope (32:13)
Yeah. I try to tackle it from the get-go. I let them know. Um, someone comes in, I'd say good example would be hip, laboral, uh, tears, right? So I've been burned by these over the course of time. I probably have a laboral tear in my own hip. I've been dealing with off and on. I've just never gotten any imaging. I just stick my head in the sand and I'm just like praying and hoping for the best. You know, we'll see what happens over the course of time. Uh, do what I say, not as I do kind of thing, right?

but we do have some interesting literature on hip labral tears, essentially showing that, if you don't get surgery for these, if you wait too long, your outcomes can be worse. Right? So some of the algorithms you'll see in research studies is that you trial conservative care for around three months. If things are not getting better, we're not starting to improve. And I think there's a difference there. So if someone comes in and their hip is killing them,

and they have a hip labral tear and you start physical therapy and three months later, they're improving. I said, keep going. It's not like you need to get surgery at this point. Just keep going. But if they're not making any progress at all and are worsening and you've given it three months, then you might want to consider surgery because if you don't, then you might be worsening their longterm outcome by not considering it. Right. So for that individual, as soon as they come through the door, we diagnosed them with hip labral tear, right? I'll say it might not be a bad idea to go see

a surgeon if we're not improving over the course of time, twofold, right? Because I want to make sure that I know what we're dealing with because I might not be accurate with my diagnosis, right? Although I think for hip, labral tears and FAI, it's pretty black and white. think it's, not one of those things where you're like, it's just still pretty gray. I don't know what's going on. You can kind of tell if someone has FAI, you know, I think other pathologies can be a little bit confusing, confusing. And sometimes you have to send back to the doc to get some imaging to see what's going on.

think FII is a little bit more clear. I'll let them know like, let's say four or six weeks, you're not improving. Let's go, um, set you up an appointment with a local hip surgeon. And we're lucky. We have a lot of good surgeons in our network. So I know that I'm not saying to someone who's going to jump the gun and just say, let's do surgery right away. But I know at least for them, we don't consider surgery soon enough. Then we might end up doing a disservice to them. And the other piece is that doing a corticosteroid injection into the hip can be very helpful in the rehab journey.

So if I'm not sending back to the doctor and there's other diagnoses that are similar to this, I think frozen shoulders and like, like obvious example, they need additional interventions with physical therapy oftentimes. So if I don't send them back to the doctor and I don't like suggest that a corticosteroid might be helpful, I may really reduce the ability for them to heal over the course of time. So I just let them know from the get-go. I think this is what's going on. Most of these not pull some stats, right? I'll say, I try to be very hopeful and say, okay. Eight out of 10 folks with FAI.

It's better over the course of time. Right. I just take this data straight from studies I've read around two out of 10 of those folks will need a corticosteroid injection. Right. And then about 50 % of those folks who do really well, the injection won't need surgery. And around 10 % of those folks will go on to get surgery long-term. Right. So I let them know from the get-go. Here's the other piece. I mean, for my own hip, I started with some FII symptoms, like eight years ago, 10 years ago, and my symptoms have been up off and on for four years. Right. Now I'm in a really good place. I,

very rarely feel my hip. It doesn't give me much trouble. Right. And maybe I'm destined for arthritis. I don't know, but like that three month Mark, I often feel like is not enough time for a lot of folks. Um, and you can let it go for longer, but it's just important that you understand that we do have resources shows if you delay too long, that's also a problem. So I try to educate people as much as possible from the get-go. And I try to remove myself a little bit from the decision-making process. I'll let the patient try to sort that out themselves, you know, but at least I give them the information to make their own decision.

I feel very strongly at the end of the day that we're a service-based industry. want to serve people as best I can. So I want to give them the best data that I can to make their own decision, right? Put the power in those hands. don't want to push them either direction. But if I think that they need to know like, Hey, if we wait too long, you might not do as well. That's important. Cause I personally pissed off if a physical therapist never told me like, Oh yeah, you had a labral tear. And yes, there's data that shows you wait too long. That's a problem. Cause if you spin your wheels for years and years, and then, you know, again, I've

been practicing for long enough where I've been burned, where I have a patient that has FAI, they go and get some imaging, have a labral tear. And like, I'm going to try to treat this conservatively. They go too long and essentially they lose joint space. And that's not what happens to everyone, but some folks it does. Now they can't get labor repair because they have too little joint space and no surgeon is going to do that surgery anymore. So the outcomes aren't great. Now they're staring down the barrel of a joint replacement surgery and there might be 40 or 50 years.

And now your long-term outcome is like, I don't know. Like we might have to have multiple revisions. Now we may have set you up for failure. And I've seen enough of those folks over the course of time. And human beings are funny because when you see one of those, now it's like taint your whole vision. He's like, no, I don't want this person to have like advanced hip osteoarthritis. Not the normal, but as a human being, like that sticks out in your mind and we still have to, you know, just keep in mind, a large majority of folks are fine. And that's not going to happen.

but it does happen. So I think that we just need to be level headed and then give people the data to make the decision. I personally feel in some ways, social media has made us a little bit weak, right? It's almost like, I hate this, right? I think that people should get all the data to be able to make their own decision. I dislike when physical therapists don't give patients

an idea of what they think the diagnosis is because they're afraid of scaring that individual. I try to educate people on the diagnosis as much as I feel like I can, because I know we know that it's really hard to give someone accurate diagnosis, particularly for like the spine, for example. But I think it's our job to give them a diagnosis, particularly they ask for a lot of patients really want that. And they're not getting that from physical therapists. And then you have to do a good job of reducing that fear, right? Because we know that when you tell someone like disc herniation or nerve,

Sometimes it gets people really fearful and I'll ask folks and say, have you gone down that rabbit hole of learning what a disc injury is or nerve injury? sometimes the only knowledge someone has is like, and I always say, this is my courses. You may have heard this before, like uncle Larry, uncle Larry got disc herniation when he was 22. Every time we go Thanksgiving dinner, I got to sit next uncle Larry. Uncle Larry is always pissed off cause his back is hurt for the past 30 years. Right? You got a spinal fusion and

Ever since then, you can't sit down for more than five minutes. And he's like the biggest grumpster in the world. And if you hear that you have a disc herniation, now all of sudden you think you have Larry's trajectory. Right. So I do think it's important that we ask him questions about what folks believe about their pathologies and then just give them really solid education. the very first thing I'll say after I tell someone, I think they have a disc injury is like, man, these can heal just like anything else. Right. Cause if they don't have that knowledge, but they have prior information that scares them.

They might be going down like a dark path. It's not so good. So I think that we do our best job of diagnosing and then decrease any fear, surrounding that.

Joe Gambino (39:35)
I like how you brought that down. I'm curious, know, with all that information that you just said, you know, like giving something some time and seeing if it gets better. If not, then, you know, making some decisions from there. You know, not everyone's going to see a damn pope or Joe Lovato. So we're looking at like the physical therapy, you know, even just rehab as a whole. How can people really kind of know if they're getting good care? What is the added benefit of seeing someone like yourself?

How can people, know, almost like be an advocate for themselves in a sense when they just go to the closest place to them that insurance takes?

Dan Pope (40:13)
Yeah. So what I will say, and I kind of hate when people do this, I think physical therapists are very well educated. And I think we're a little biased at champion. get a lot of smart students that really want to become good physical therapists. So I'm a little bit biased there, but I think the quality of physical therapists, at least that I see particularly students are, very high, right? So one of the biggest things that

I get question-wise because I have an online educational business and I've really tried to target coaches and clinicians, but inevitably I get a lot of folks that comment towards me and say, I tore my labrum or I have a meniscus injury. You know, it's what I'm doing appropriate, right? What should I do? And I'm almost always just trying to push people to see a physical therapist, see somebody because we're pretty good, man. We get a lot of education, if anything, we're overeducated. So I think the standard is actually pretty darn good, right?

So I think step one is like, go see a physical therapist. And I think oftentimes when people come out and they complain about the physical therapy they've gotten, it's because maybe the physical therapist didn't establish good rapport or maybe the person was skeptical and didn't believe what the physical therapist had to say. Because sometimes when I dig into what some folks that tell me that physical therapy didn't work, they just didn't listen to the therapist. didn't believe that they didn't try this stuff. Right. How many times have we seen that? Right.

But what I would also say is that I do think it's important as a consumer to find a physical therapist, at least understands what you want to get back to. Right. I mean, if someone comes to me, I just had this the other day. So I have a powerlifter patient of mine and she really trusts me and she's referred a lot of patients back to me. And it's a lot of folks that like powerlifting. I have a lot of experience there between those folks for a year. I feel like I have a good handle on it. And she's like, my friend has a 13 year old daughter. She felt a pop in her hip when she was doing a split, right?

And I was like, yeah, I think I could help her out, but I have a coworker, his name's Dave Tilly. And he's like, speaks nationally in terms of rehabilitation for gymnasts and dancers. Right. And I was like, you should go see him. And the first thing I told Dave, I was like, I have this, um, patient of mine who has a friend whose daughter felt a pop in the back of her hip when she was doing a split. Right. Dave's like, Oh yeah. It might've been like a growth plate injury to the rectus femoris. And I was like, I would have misdiagnosed that.

Cause he sees those all the dang time. Right? So it would, if she came to see me, like I would probably like, it seems like maybe the recs femoris. don't know if there's like a tendinopathy there. Maybe I would get around to it. But it goes and see Dave, Dave is like, yeah, that's what happened. You know, here's the next steps. Here's what you should expect. He's extremely good with that. So it just like cuts a lot of steps out of the rehab process. Maybe I'd be able to struggle through that and get her to where she needs to be and rehab it. But for someone like Dave, it's like, it's his bread and butter.

You know what I mean? So seeing someone who understands your sport is, just super helpful. They get it. They understand it. They know the nuances of it. it's like having just like cheat codes, right? To success for those patients. So I do think that you go into a clinic and then you just, you look around, you see what they're doing. You can ask questions, say, Hey, you guys have experienced working with baseball players. You have experience working with lacrosse or whatever sport it is. And, hopefully the clinic doesn't just lie to you. You know what I mean?

Cause I think as physical therapists, have to understand our limitations as well. I refer out a lot. I have no problem with it. If someone has a question, I'm like, Ooh, this seems like it's pelvic, you know, pregnancy postpartum or like pelvic floor oriented. We have a good network of those folks. I'm like, if I'm trying to like treat those, like we have a good network of certified hand therapists, folks that are really good at the foot, know, we refer out, you know, I want to make sure that the patient is served well. And I think that just, it makes our community stronger.

right? If a patient can go to a clinic and the clinic can say, Hey, you've got something very well served by, you know, Joe down the street. And then they go to Joe and they have a good experience. And I think there'd be less people on YouTube saying like, I had a bad experience with my physical therapist. You know what I mean? So I don't know. I think about that a lot. We're trying to elevate the standard of our care. And sometimes you're in place where maybe there's no local physical therapist who can do it, but

As a consumer, do think you have to do a little due diligence, you know, call the clinic up, see if they have any experience, know, drive by the facility, see if they actually have, you know, this is particularly important for sports, right? Do they have the equipment that you need? Do they have like a little space, a little bit of turf? You know, they have experience working with those folks. You can kind of dig into that and see, you know.

Joe LaVacca (44:46)
That's a, Dan, the one thing that I keep hearing then, and I think it shows in your social media. think it shows in your educational content, just helping people make the best decision together. So I really value that. really respect that. I really think that's an important message that people should probably pull from listening. And I think they are. So I just wanted to say thank you for advancing the profession forward in that way. The other way you would advance the profession recently, my friend was writing a book.

Dan Pope (45:14)
Ha ha.

Joe LaVacca (45:14)
with another gentleman that I highly respect, Mr. Dean Somerset, called Rock Solid Resilience. I was hoping you'd flash it for us. There it is. Beautiful. Love that cover. Nice and shiny. Look at that. So the book is called, yeah, well, wait, I'll be standing by the mailbox. The book's called Rock Solid Resilience. I wanted to give you a couple minutes to speak about it and maybe share

Dan Pope (45:19)
Yeah.

yeah, check it

Joe Gambino (45:29)
Joe, should be waiting for our signed copy to come now.

Joe LaVacca (45:43)
What was the most surprising thing you learned in that process? Because I'm watching my fiance Courtney write a book and I am just blown away by how much work goes into these things and how much detail oriented like certain things have to be. So share a little bit about that if you will. yeah, what'd you take from it?

Dan Pope (46:05)
Yeah. the book writing process was very interesting and just give you a little background of, know, my history of creating content. Like I I've been creating content since like 2008, right? I've made like 30 to 40 courses over the course of time. I've written a ton of like eBooks. I've done a ton of self publishing, right? I'm creating content all the time. So making a book,

Was in some ways natural and some ways not. This is the first time I've ever been able to work with a publisher. We worked with human kinetics, which was really cool. and it was a neat kind of experience for me. it was a kind of interesting way that I was even recommended for it. So my co-author Dean Somerset, I believe he was approached by human kinetics and he always wanted to write a book and they wanted to do some sort of book that revolves around kind of lifelong health with

And they also wanted to have some sort of physical therapist as a co-author just to increase the authority, but also help people from an injury management standpoint. And Dean asked around a little bit. I don't know if you guys have heard of Tony general core. He's like another kind of popular online trainer, but I'm buddies with Tony and Tony reckoned in me, which was interesting because I like Tony and I've been following Dean for years, but I never met him.

Joe LaVacca (47:21)
Sure.

Dan Pope (47:31)
And it was funny because I feel like I knew him. If you ever read any of his social media content now, but his articles back in the day, he's very, friendly and personable. And when I first talked to him, I was like, I feel like I already know this guy. feel like I've been like, cause I had, I've been reading his stuff for years and years and years. And I feel like we kind of grew together. We're kind of similar age and we've been kind of creating content for around the same period of time. So that was cool. And then writing the book was, I don't want to say easy, but very natural.

And it was a little bit different for me because the typical avatar that I write towards and kind of try to speak towards our coaches and clinicians. And this book was made more towards the average consumer that just wants to strength train kind of lifelong healthy, which is my entire brand. But usually I'm speaking more to the clinical person, right? so I was a little bit different and it was fun because you can talk in the same language that you use for your patients all day long.

I tried to actually use a style that's similar to Dean, but she makes a lot of jokes when he writes. And that was actually a lot of fun for me. the thing I wasn't prepared for was just how long this actually took. So I want to say it was almost two years from start to finish. And we actually finished the book and I want to say like four to six months. Right. So this thing was completely done from a writing perspective within four to six months. And then the next like year, year and a half was all based around editing.

photo shooting, waiting for deadlines to occur, right? Fine tuning, marketing, everything else. And for my perspective, I'm used to like made a course, turn it around, do it fast. And I think I probably published like seven to eight courses in the time period where I started writing to when the book was published. So on the backend, I was like cranking out stuff while this slow moving behemoth was like being born. Right. And that was one of the things that

surprised me most, you know? So I even like some of the references because I deep dive on like literature before I do a lot of my content, as well as like some of my courses, like some of that stuff's like a year, year and a half old. it's potentially has changed and evolved since then, just because like the lit review happened a while ago, but it's a brand new book, you know? So just makes me laugh, but that was probably the most interesting difference is just kind of like how long and arduous the process was.

It wasn't bad, it was just slow moving.

Joe LaVacca (50:01)
Is there something you're hoping now that you wrote to a different audience right the consumer is there one thing that you're really hoping that they take from the book after they read it.

Dan Pope (50:13)
Yeah, I don't know. think, um, one of the things I feel kind of strongly about is that coaches and trainers and even the individual, so two things, a, I think coaches should have education about how to manage pain with their clientele because they're basically going to see it every single day of the week. And for whatever reason, physical therapists and healthcare providers have a monopoly on pain. Like, you know, if you have pain, you should see a doc.

you know, personal trainer shouldn't try to manage this in any way. And I think a lot of ways that's important. There's a medical red flag. If someone's like pooping and peeing in their pants and they come in with low back pain, they need to go to the emergency room, right? You're not going to like, well, let's try to squat today. Like that's not a good idea, obviously. So I do think that we need to be smart about what we do, you know, as a coach. So putting my coach hat on and making sure that you're not trying to be a doctor or physical therapist, but on the flip side, it's like your clientele is going to be

dealing with orthopedic issues every single day of the week. need to know how to manage that to a degree. And I feel very strongly that coaches should learn how to do that. And the other thing, and this goes for so many other industries as well, the amount of misinformation out there, the consumer has to basically just try their best to guess and kind of work their way through to find the truth is it's so hard. You know, it's so, so hard. I find myself.

having this issue too. Like, I don't know. I'm trying to like get my lawn better right now. Right. And I'm getting into it. And you see, there's so many contrary opinions out there. They're like, put the grass seed down here. No, don't do it now. You you showed it on two weeks ago and here's the reason why. And this guy's stupid because he's putting his grass seed down now. No, this guy's stupid because he's putting the grass seed down now. And I'm like, I don't know what to do. What do I do? When I put my grass seed down and that's what's going on with a pain problem.

So someone's knee hurts. They're going on Instagram and like one person's guy is like knees over toes. And then Joel Siemens, like, dude, not bend your knee. That's going to blow that knee apart. Right. And I think the consumer is just so dang confused. They don't know what to do. And that's really unfair. So I think that what I really tried to do and Dean tried to do is just give some sort of like level gray.

thought process, decision-making process that takes into account what we know from an evidence perspective and helps people figure out a way that they can manage their own orthopedic injuries, know when they need to go see a doctor, know when they can just kind of train with this and make some smarter decisions. because there's a ton of misinformation. It's hard. The problem is that that's not good from a marketing perspective, right? You know, what knees over toes guy does and what Joel Seidman does is great for marketing.

because they think in absolutes and people like that. It's kind of a black and white thing. It's very polarizing and it's sexy. But if you try to give something that's nuanced, it's not that popular and you don't sell many books, right? But it's also probably way more accurate. So that's one of the things we try to do. Um, and maybe we won't become as popular, but if enough people do this, maybe someone cracks, you know, the code and they'll get out there and help more folks. So I think that's, know, what we try to do at the end of the day is

Give something that's accurate, help more people put the power in their own hands and give something that's nuanced.

Joe LaVacca (53:29)
Maybe you guys need something.

Well, you got two fans here, my friend. We'll be picking up the book for sure.

Dan Pope (53:36)
thank you guys. Yeah,

Joe Gambino (53:37)
Mm-hmm. I was

Dan Pope (53:39)
yeah.

Joe Gambino (53:39)
just gonna say you get the the cups of Joe stamp of approval. So Yes, that's very it's the first one ever given so it's a high honor

Dan Pope (53:42)
Oh, nice. Yeah. I'm gonna put that on my website.

Joe LaVacca (53:47)
Yeah, it's very, very, very high, very

high here, Dan. Mr. Joe, do you have, I want to be respectful of Dan's time. Dan, you've been very generous with us. Do have any other closing thoughts or questions for Mr. Dan here? All right, all right. Yeah, Dan, thank you so much.

Dan Pope (53:49)
Regards, I like that. Yeah. Yeah

Joe Gambino (53:58)
I do not, I do appreciate your time though, Dan.

Dan Pope (54:03)
Yeah. Thank you guys. really appreciate you

guys having me on here. had a blast. So appreciate what you guys are doing for the industry and for folks like me. thank you very much.

Joe Gambino (54:06)
Hmm.

Joe LaVacca (54:07)
Alright, well...

Appreciate you, We'll definitely have you on for the second book. I'm sure you'll just be cranking them out now that you got it going. But yeah, man, no, this is great. I think there's a lot of value here for clinicians and patients alike. So we appreciate your thoughts. Joe, love you. Dan, love you. Listeners, we love you. And don't forget to come back next week for another exciting episode of the Beyond Pain podcast.