Physical Therapy for Orthopedic Conditions

Episode 22
Physical Therapy for Orthopedic Conditions

Learn more about the transformative world of physical therapy in the latest episode of OrthoInform. Physical therapists Patrick Cristi, PT, DPT and Juliette Dassinger, PT, DPT deliver invaluable insights on the myriad of benefits both physical and occupational therapy can offer. From enhancing mobility to alleviating pain, they uncover the ways that PT can be a pivotal element in improving quality of life, promoting healing, and ensuring optimal functioning of the body. Join us and learn more about how physical therapy fits into an overall wellness regimen.

Hosted by Eric Chehab, MD

Eric Chehab, MD

Hosted by  Eric Chehab, MD

Dr. Chehab is an orthopedic surgeon with fellowship training in sports medicine and shoulder. He provides advanced treatments for anterior cruciate ligament injuries, shoulder injuries including rotator cuff tears and shoulder instability, and soft tissue and bone trauma.

Episode Transcript

Episode 22 - Physical Therapy for Orthopedic Conditions

[00:00:00] Dr. Eric Chehab: Welcome to IBJI's OrthoINFORM, where we talk all things orthopedics to help you move better, live better. I'm your host, Dr. Eric Chehab. With OrthoINFORM, our goal is to provide you with an in depth resource about common orthopedic services that we provide every day. Today, it's my pleasure to welcome Drs.

Juliet Dassinger and Dr. Patrick Christie to discuss the role of physical therapy for orthopedic conditions. Both Juliet and Patrick are doctors of physical therapy. Dr. Dassinger is originally from Morton Grove, Illinois, and attended Bradley University in Peoria, Illinois, for receiving her bachelor's degree in health science.

She attended A. T. Steele University's doctor of physical therapy program, Mesa, Arizona. As a 2020 graduate, she came back to Chicago to begin her PT career and joined Illinois Bone Joint in 2021 with a passion for treating patients in the orthopedic setting. Through her time at IBJI, she has developed her clinical skills to help patients through rehab after surgery, educating patients on those experiencing chronic pain, and promoting health and wellness to her patients.

She is also certified in dry needling and blood flow restriction. Juliet is the Assistant Facility Manager at our Highland Park location. She became a clinical instructor taking on Doctor of Physical Therapy students through their student clinical experiences and taking on a facilitator role for IBJI's Grand Rounds, which is an opportunity for clinicians to learn from each other as part of our continuing education.

Juliette is involved in the Illinois Physical Therapy Association, working on multiple committees, and in 2022, she was named an Association Leadership Scholar through the American Physical Therapy Association. One of Juliette's fun facts is behind the scenes. She is an executive producer for one of the profession's well known podcasts, PT Pintcast, sharing great physical therapy conversations over a drink of your choice.

We have coffee here this morning, Juliette. And then Dr. Christie, his doctorate of physi is a doctorate of physical therapy from Midwestern University in Downers Grove. He completed his degree in May of 2018, and he completed his Bachelors of Science in Psychology at Clark University. and Dabuk, Iowa, where he was also a two year member of the men's volleyball team, which finished third in the NAIA national championships in the 2013 2014 seasons.

His clinical interests include sports medicine, return to sports training, joint replacement surgery. Rehabilitation and fall risk reduction. He is a firm believer in the bio psychosocial model of healthcare with an emphasis on establishing relationships far beyond the rehabilitation continuum. Patrick is grateful for the opportunity to interact with patients of all different backgrounds and feels as though it is his duty to empower his patients to take control of their bodies in order to return activities that they love and want to do.

Outside of the clinic, Patrick is most likely at the gym, indulging in international cuisine, or rooting for a beloved Chicago sports team. He is a diehard Cubs fan, Bears and Bulls fan, and enjoys attending games whenever and wherever possible. So, Patrick and Juliet, thank you so much for... being here for OrthoInform.

I just want to say, first of all, you know, I, I will tell my patients frequently that therapists are some of the kindest and most ambitious people you're going to meet. And they're so kind because they want to get you well. And they're ambitious because they'll stop at it. They won't stop at anything to get you well.

And I remember when I had my own. injuries and surgery. And I was a typical doctor and a terrible patient and wasn't doing any of my therapy. And I was three months in after a rotator cuff repair and I could hardly move my arm. And I thought, Oh my God, am I ever going to get my arm back? Which I need for doing my job.

And thanks to the physical therapist, I got it back, but I'll never forget that sort of dark space. I was in like, man, oh man, I might not ever get this. And having. The physical therapist shepherded me through that recovery process, even though I'm on the, I'm in the know here, like I know what this is supposed to be like.

It was incredibly helpful. And so you bring patients who present to you at their physical worst and you bring them to their physical best. So, anyway So glad you're here, and I just wanted to get be a facilitator in your discussion, and maybe we'll start with what you feel like, how would you describe your role as a physical therapist?

[00:04:22] Dr. Juliette Dassinger: Yeah, thank you, Dr. Chehab, for having us here today. And it's great to be with Patrick for this conversation. I, I describe myself as I like how you put it where we're the ones that help guide through that treatment and sometimes there are ups and sometimes there are downs. We are those ones to provide that patient education to give them the expectation on where they should be through their timeline of rehab.

It's interesting because something I learned in school is the top two things that physical therapists do provide is patient education and therapeutic exercise. Sometimes we might be Thinking, okay, I'm gonna be coming in maybe for some hands on and some exercise, but I would say really the number one thing is patient education.

What I tell my patients is if you can describe what we did today to someone else outside of the clinic, that's where I've done my job.

[00:05:09] Dr. Patrick Cristi: Yeah, I think you're right on in that, in that we are facilitators. I think it's one of those things where I like to think as the, the physical therapist as, as a collaborative partner.

with the patient, right? So we always, you know, I tell my patients all the time that we are your advocates too because it can be a daunting experience, especially if this is your first time or if it's a, it's a post operative procedure where you don't really know, you know, how long it's going to be or when you're going to get back to certain things.

So we're kind of your guide in that and, and, and educating and, and facilitating getting back to that point. You know, it starts from the initial evaluation, right when you walk through that door getting to know your story. That's how I kind of describe it is, is I want to know your story, where you're from, how you injured yourself, and, and kind of what your views are and, and kind of guiding you through the process from start to finish, especially on day one.

So I think it's one of those things where I think our role as physical therapists is so unique, because we do get to see you. Sometimes two to three times per week for four to six months. So we get to know each other very well. And I think that's, that's one of the great things about our profession is that, you know, we build these kind of these lifelong relationships throughout your rehab.

So, you know, aside, you know, beyond the exercises that we give you and the interventions that we, we take you through, I think, you know, that collaborative partnership and friendship that we establish, I think is something that's really unique to our profession. Yeah.

[00:06:36] Dr. Eric Chehab: And I got to say, I think it's. Part of the therapeutic intervention is that relationship that you develop and do so skillfully.

We have so many patients coming back singing the therapist praises for all the work that they do. And again, it's very gratifying on So, hear it as the surgeons, but I, I'm sure we may hear it more than you do. So just so you know, we have, you know, hundreds and hundreds and hundreds of, of very grateful and, and thankful patients for the work that you do.

 what, what is the typical patient experience like?

[00:07:12] Dr. Patrick Cristi: Yeah, I, I think, so it, it starts out with your initial evaluation, right? So we, we, when you, when you come in, you know, with, with what we have at IBJI, we have a lot of access to a lot of your story prior to, to, to seeing you. So we go through your history, we go through certain things in terms of what you're coming in for whether it's a surgical procedure or an injury that you had that's non surgical.

And again, one of those things we like to do is get to know your story, take measurements, see where your baseline is, and then what your specific goals are. So we have. You know, demographically, we see folks that are athletes, we see folks that are recreational athletes, the kind of our weekend warrior type of folks.

So it always has to tie into why are you here and where do you want to be at the end of the day when all is said and done. And, and, and with your story and with the measurements that we take we use those to kind of drive our interventions and our exercises. So it's specific to you and what you want to do at the end of the day.

So again, we're very goal oriented and, and we like to be, have this be a collaborative effort. So it's, again, it's a partnership with the patient and the therapist and office and also the, the doctor team to get you where, to where you want to be. What

[00:08:29] Dr. Juliette Dassinger: I tell my patients is for all patients I walk through the door, I give them all the credit.

Some, I would say one of the number one reasons they come and see us is because they're in pain in some way. And they're hoping the person that I meet is going to help with that. And I always find that It's such a thrilling process as being a physical therapist because they are already putting trust in the person that they match with, just by scheduling wise, and and they're hoping, okay, I hope this person I can get along with through the duration of my care and they can help me out.

And that's something that they may or may not figure out day one, same with the physical therapist. Just like what Patrick said before is that we do. I already know somewhat of your story, but it's so interesting how many times I meet someone during that first evaluation where it's something different than what I've seen on paper or have expected.

And something that I always like to tell patients is you may be coming into something similar as someone else. Let's say you had rotator cuff repair. I would say that's quite similar between some of our patients that we have come through, but everyone has Different lives, different expectations, different physical demands that they need to get back to.

So that's something I emphasize that your experience here is not going to be the same as the next person next to you. And I want to make sure that whatever that goal is, four, six, eight weeks, couple months, even down the line, depending on what you're coming in for, that you are meeting those goals. What I tell my patients is the purpose of me being a physical therapist being here is It's for you to be independent in your own health and well being.

[00:09:58] Dr. Eric Chehab: So, we're talking stories and goals, right? Exactly. And I, I, I, yesterday I met a patient who had a fall and Broke their arm, broke their proximal humerus. That's the story, but only of their injury. And then the real story was the patient had to be with her daughter in a week to take care of the young children so that the daughter could attend someone close to her's wedding and she was so afraid that she wasn't going to be able to be a part of that for her daughter and going through all these arrangements.

So, there's the story of the injury. But then there's the big story, sort of the context of the injury, and you must get that. Story in great detail.

[00:10:45] Dr. Juliette Dassinger: We do, and what I like to say is putting it through a story and making your, like anytime we have that initial evaluation, creating that story for either if I'm working as a team with another coworker or even to the doctor, for me to be able to get all that information so that you understand, okay, this is the injury, but what other components are involved with this injury and how this is gonna affect this person, this patient, you know, down the line for the next few weeks

[00:11:09] Dr. Patrick Cristi: or so.

Yeah. Just to touch on that, Julia, I think you said that. That perfectly is is it always ties it into the why right when when we take patients through exercises Especially for folks that are not as familiar with it, you know, it's always you know there are some interventions that are sometimes uncomfortable or things that you haven't done before or Haven't done in a long time.

And, you know, in those cases where, you know, when, when patients feel like they're, they're being challenged in a way, I always try and tie it into that bigger story. Like you said, Dr. Chehab of why are we doing this in the first place? Why am I having you do multiple reps of, of squats or shoulder raises or things like that, that are challenging.

And I always like to tie it into the why. So whether it's, you know, a person that maybe hurt their shoulder and, you know, they're a new parent and At the time, uh, of their injury, they can't really take care of that child. Um, it's, it's, I always like to tie it into remember you have that kiddo at home that needs to be taken care of and things like that.

So kind of push through these 30 seconds of, of, of repetitions and, you know, so we can get closer to having you more independent and, and taking care of your duties as that, as, as a parent. So I think again, it goes back to that bigger picture and it's our job as physical therapists to kind of remind.

Those, you know, are patients of why we're doing this. We're not doing this just to, you know, you know, at the end of the day, we're trying to cure and relieve your pain, not instill pain, right? So it's always kind of keeping, you know, those blinders on of why we're doing what we're

[00:12:40] Dr. Eric Chehab: doing. And so, um, you know, you talked right off the bat about patient education and then therapeutic techniques.

And so patient education, I would imagine, isn't just about anatomy. So, so take us through some of the things that you're looking to educate patients about with general conditions or postoperative care, um, for an injury or condition that they

[00:13:02] Dr. Juliette Dassinger: have. For sure. There are some patients who actually love learning about the anatomy and sometimes I'll go that route.

And there are patients who want to know why they're having pain or, um, how am I going to be able to get back to this physical demanding thing that I need to do, either if it's something work related or, um, something else or. Um, human performance, things of that sort. And I have to continue to remind patients as well as, you know, the purpose that they're here.

But with patient education, um, I really do walk them through each intervention on why we're doing this. Because once again, my purpose is to make sure that patients are walking out of there understanding everything that they've done here is going to make them better, improve their performance to meet their goals.

What's funny is something, um, this is a quote that I've heard before that I find quite helpful We do science. I would say physical therapy and being a doctor is science, right? So science isn't finished until it's understood. So if someone can walk out of that clinic and understand, okay, I'm doing this to help my own body, then that's where the real true outcomes will come from.

[00:14:09] Dr. Eric Chehab: You know, it's interesting. I think education in of itself is pain relieving. So when patients have an understanding of their condition, it can help Take down the level of anxiety that typically amplifies people's pain. And so that education part in of itself can be pain relieving. What are your thoughts on that?

[00:14:31] Dr. Juliette Dassinger: Of course. Like I, I know some people will say, how long am I going to be in treatment for? How long is this going to take for me to heal? I think providing timelines, providing pretty strict expectations ahead of time to say, Physical therapy, I use two words, patience and determination. Please know, use your determined goal to continue through the patience of the healing of your body.

So I think setting those expectations right off the bat. Okay, it may be slow for the first four weeks after surgery. We'll progress after four weeks. You may have some soreness with new things that we do. Um, so I say those first few visits are going to be more education base so that we can already have a guideline and a base of Patients moving forward on what to expect at each each stage of rehab.

[00:15:16] Dr. Patrick Cristi: Sure I think it's one of those things too with the patient as education aspect from my end is as a therapist I want to be a great listener It's one of those things where a lot of times when we ask patients to kind of describe that You know going back to what I said earlier their story we can kind of Bits and pieces of, you know, as they're talking, me as a therapist, I can, I'm starting to formulate a plan, right?

And it could be one of those things where, you know, you kind of read the room of some folks like Juliet says, you know, they want to know everything about their condition, everything from the anatomy to the physiology, to the mechanisms. And some people just want to know the bullet points of, you know, especially from a surgical standpoint, you know, sometimes they don't want to know the finer details of it, but just...

You know, you know, what do I have to do right now and how approximately how long is this going to take? And I think one of the more challenging things as a therapist too is when you're dealing with multiple multiple body part type things, um, or more complex situations is how do you approach that especially on day one?

Because I always say in my head especially for those more complex cases you're not going to get everything on that first day and and and for most Patients in general, I always like to think of their, their rehab and their plan of care as an ongoing assessment. We have this thing in physical therapy.

It's test, retest, right? So, test where they're at, do some interventions, retest it later that day, test it later that week, right? And, and we try and keep it as objective as possible so we, we have, you know, precise measurements and, and certain numbers that we're kind of, you know, going by to, to, to help drive, again, drive our interventions.

So I think, you know, with that too, uh, that education piece that we're talking about it's one of those things where I think the better the patient understands their condition. The more control they're going to have over it. And like you said, Dr. Chehab, that can be so therapeutic. And that understanding of, even if we don't do anything physically, the fact that someone listens to them that kind of guides them in terms of you're going to be okay.

This is the game plan moving forward and I, and I tell kind of the younger clinicians and, and, and some of the more guarded patients is that even though we don't get everything right away today, we at least have a game plan. We have a direction of where we're going. And sometimes just having a few, you know, a few exercises and a direction and the fact that someone listened to me I think is so healing and, and, and, and just that.


[00:17:45] Dr. Eric Chehab: Yeah. I mean, obviously. The science is a big part of it, but there's an art to this as well that, that, that

[00:17:52] Dr. Juliette Dassinger: There's a relationship

[00:17:52] Dr. Eric Chehab: you're building, right? Yeah, without question. And, and, and so in addition to the education, you mentioned some of the therapeutic modalities. Let's just review some of those.

So let's say you have a patient with a painful shoulder or a painful knee. What, what are some of those? Broad objectives that you have from as a physical therapist to help the patients recover from the pain they're experiencing from their painful shoulder or knee. Of

[00:18:16] Dr. Juliette Dassinger: course. Um, something that Patrick just mentioned before is test retest.

So on that first visit, we try to see what's that motion, what is that activity that is painful. Something I call that is my comparable sign. So I Note that at the initial evaluation, raising your arm increases pain, hypothetically. And so then through interventions that we do, it can be hands on or hands off.

Sometimes I like to start hands on because I think that builds that rapport with patients right off the bat. I can show them these are different muscles or regions or bones. involved with why you're limited with raising your shoulder. Um, I think even two, just therapeutic touch, we like to call it soft tissue mobilization, I think helps with relaxation and I think gives patients a better idea on certain areas of their body that are involved with their deficit of raising their arm overhead.

Same with even providing range of motion, so I can even define the difference between, okay, you're Why you can't raise your arm is more muscle related because when you actively raise your arm, you use your muscles. But if I bring your arm back and now you're nice and relaxed, you can go full range.

That's a hypothetical story. But, um, so that even provides that patient education plus rapport plus relationship building right in the first few sessions with some hands on work. Not saying everyone needs hands on work, but I think that helps for patients understanding. Okay, this is what I need to work on moving

[00:19:36] Dr. Patrick Cristi: forward.

Yeah, I think it's one of those things where Any sort of interventions that I like to incorporate we always have a goal of where is this pain mainly coming from, right? So especially when we have Some folks that come with generalized pain without any distinct mechanism. We always try to identify maybe the one to two primary causes of that pain and where it may be coming from.

Is it coming from your muscle? Is it coming from your joints? Is it something neurological maybe that that we might have to address? So we always try and identify Where specifically or what areas or systems that are maybe causing that pain and starting with that. So as Juliette says, so this could be our hands on work where we do, like she says, soft tissue or joint mobilization to help reduce the stiffness, the tightness, and essentially maybe some of the sensitivity to that area.

And then on top of that, we always like to follow up with more active interventions. So these are our strengthening exercises, our mobility and stretching exercises. So that's kind of the continuum is, you know, we do what we call those passive interventions, usually to start out the session to warm things up, to get things loosened up.

And then we always have to follow it up with some sort of active intervention to sustain those changes that we make with. are passive stretching mobilization techniques.

[00:20:58] Dr. Juliette Dassinger: And I think what's important as physical therapists, our goal is to get patients independent. So it involves that active use of your body and with exercise so that over time you'll learn that these are the exercises I need to do to continue to be consistent to over time improve my...


[00:21:16] Dr. Patrick Cristi: and on top of that, Juliette, I think it's one of those things, and this is another common physical therapy term, is carryover, right? So, it goes back to the why of when we strengthen certain muscle groups, when we work on certain techniques, there has to be carryover to what they have to do on a daily basis.

So, whether it's reaching, you know, Getting up and down from a chair, getting in and out of a car, walking's a big one. So there's always a purpose to why we're working on certain individual things to contribute to, to, to the whole, right? So that's why, you know, it's one of those things where there are some patients that, you know, they come in, they say, Oh man, the.

The soft tissue techniques feel good. It's like, can we just do this the whole session? And it's one of those things where I say, you know, insurance probably won't like that too much, but It makes it happen, yeah. And I always like, and on top of that too, you know, we understand that, you know, it feels good, but at the end of the day too, from a scientific standpoint, and in our background as doctors of physical therapy, we know that The more active interventions give you the best bang for your buck.

That's ultimately, you know, going to drive and enhance your ability to do certain things, whether it's standing, walking, whatever it is that you're trying to get better at, we need you to kind of do those things and be specific with them in order to get better at it. You know, I jokingly say, you know, we're just not going to put our hands on you, and then all of a sudden you're, you know, you're going to be able to squat or go up and down the stairs right away.

You know, you actually have to do component parts of that, and that's what our job is to do, is to guide you to do those things. But it ties back into those therapeutic... Active exercises. And then, you know, on the side, you know, a lot of patients, you know, they, they do like the ice, the heat, the ultrasound, some of these other interventions that we use to help mitigate your pain too.

So these are all tools. That's part of the greater whole.

[00:23:03] Dr. Juliette Dassinger: Of course. And just like what you mentioned before, and I did the test retest. So you as a patient, if you are doing exercises and you're seeing progress, oh, I can reach farther. Oh, I can do more squats than before. That's when you know that you're improving.

So that's why we go back to that one sign that's been bothering you and test retest each time.

[00:23:21] Dr. Eric Chehab: So those two concepts, test retest, carryover do you... Tell that to patients, say, listen, we're going to test retest and we're doing this now So that carries over into other parts of your life outside of the therapy gym.

Do you educate them on that? Or is that's like a secret thing they have in your mind. Do you share that with your patients? I

[00:23:37] Dr. Juliette Dassinger: would say the test retest I do because I'll say day one This is the thing that we're trying to work towards. I think over time we sneak in the carryover Showing them like we're gonna be doing this exercise and then once we test retest a few times, it's like, okay, you can see Over time that we've been doing this and now you're raising your arm higher.

So there's that carryover, um, from now till four weeks from now when we test again.

[00:23:59] Dr. Eric Chehab: Okay. So let's, let's change gears a little bit. Are there, there are obviously certain conditions that are really kind of fun to treat, to be honest with you, that where patients can predictably get better. And, and so what are some of the, your common non operative conditions that, that, you know, really lend themselves well to.

Be getting better with physical therapy.

[00:24:20] Dr. Juliette Dassinger: Of course, something through my introduction that I treat is your long standing pain, chronic pain, and pain management. In my clinic in Highland Park, I see a lot of people who come through with either cervical, thoracic, or lumbar type conditions, and that's your spine.

So people who experience Low back pain for some time has tried different things and Hasn't really found that one thing that has made them better. Yeah, I think with that And I know that's actually that's one of the main conditions that are more common ones that we see in the clinic is low back pain but it comes with Expertise for trying to find, okay, what was that thing that's been triggering throughout all these years and finding that patient who we're realizing, okay, maybe it's more leg strengthening or okay, like we you are experiencing maybe nerve down your leg.

How can we start to educate and bring that pain back to where it's located? And I think also educating on Location of pain. You may feel it in this area, but it may be coming from this area. And I think a lot of times patients begin to have those light bulbs like this makes a lot of sense and going back to even just the education provides that reassurance and really does help to Lower those pain levels even mid

[00:25:38] Dr. Patrick Cristi: session.

Yeah, yeah Myself and Glenview, we have a huge demographic of post operative replacement surgery. So our knee and hip joint replacement surgeries I kind of call them our bread and butter because we see a ton of them over there and I really enjoy that population too Because just in terms of from a time frame So, from a time frame perspective, they're usually up and walking six to eight weeks out of surgery, which is almost crazy to think about, especially for folks that are unfamiliar with, because I think it's one of those things where, well, I'm getting these new prosthetic parts and, you know, I'm probably going to be down and out for like a year on a walker and kind of these preconceived notions and, you know, they start therapy right away, usually.

That same day to get them up and walking, and it sounds kind of strange to think about it. It's like, you know, I just had the surgery. The physical therapist in the hospital is already trying to get me out of bed. I just had surgery a couple hours ago. It's possible,

[00:26:34] Dr. Juliette Dassinger: everyone. This is kind of crazy. You were up and walking, doing stairs, day zero.

Yeah, and

[00:26:37] Dr. Patrick Cristi: typically for those patients, you know, it's, it's, it's, we call them post op day zero, right? On that day, they start walking, they start putting weight through that, that leg. And, and usually they'll have about two weeks of home health therapy. And then after two weeks they come to see us in the outpatient orthopedic setting and, and, and we're raring to go.

So it's one of those things where usually within the two to four week time frame they're, they're weaning off of their walker. They're weaning off of their cane. And, and again, in, in, in the context of that, you're talking about. So, within a month, usually, that they're walking, usually without a device in most cases.

So I think in that regard, and it's one of those things in, especially during this time in the summer where weddings and graduations are going on, it's one of those things where, you know, I think it's very rewarding for me as a therapist to say, hey, within a couple of weeks, you're going to be able to walk down that aisle with your daughter.

You're going to be able to walk and dance at these weddings and these parties. In a matter of time before you even know it, you're gonna blank and all of a sudden within a couple weeks, you know, if we stick to this game plan, and that's part of the selling point with this too, is like, this is the game plan.

We stick to it, we do your exercises at home, which is another piece of education that we emphasize daily. Yeah, more often than not, these patients, it's just so rewarding because the time frame of when they can get better and and how relieved they are and how independent they become again is, is, is incredibly rewarding in my eyes.


[00:27:59] Dr. Juliette Dassinger: something, oh, sorry about that. And then something I have to remind my patients is your experience is not going to be Like another person's experience, so you might be both having, you know, right knee replacements, like your neighbor might have a right knee replacement, so is you, but I would say everyone responds differently, um, everyone has different outcomes, like different expectations, but your physical therapist will definitely be your guide throughout that journey.

[00:28:20] Dr. Eric Chehab: So I, I heard this expression and from a patient, I feel like I learn more from my patients than, than from any other source, and they, they presented this notion that I've sort of, I'm, I'm, I'm, I'm just sort of rearranging a little bit, but the idea that the surgeon plants the tree and the physical therapist helps the tree grow.

Oh, I

[00:28:42] Dr. Juliette Dassinger: like that. I like

[00:28:43] Dr. Patrick Cristi: that. I never heard of that one. I really like that. I might steal that one. Please

[00:28:46] Dr. Eric Chehab: do. So, you know, the idea that, you know, we, we might put in the ACL, we might reattach the rotator cuff, we might put in the total knee or total hip plant, hip implant, but But that has to grow and develop and become part of the patient and become functional for the patient.

So I like that analogy a lot. I'm just curious what you guys think about

[00:29:06] Dr. Juliette Dassinger: that. I absolutely like that. And I tell my patients where we're helping you. This is your journey. This is your body. You're the one choosing to come here and to go through this process. Of course, doctors recommended post op and we recommend it too for therapy after.

But, it's really their choice to come and be guided by us as physical therapists through exercise. And if they're seeing change, that's the most important thing. Sometimes they'll say, Oh, do you see a difference here? And I will say, of course, I'm noticing like these different observations, things of that sort.

But I say, the biggest thing is that you're noticing change outside of here, because this is your body. One goal that you're wanting to get back to. So I think we do help sprout into that main goal or that that place where patients wanna be. No, absolutely.

[00:29:47] Dr. Patrick Cristi: I I always tell patients all the time that everybody within this relationship has their role, right?

So like you said, Dr. Shaha, you know, you, you, you kind of plant that seed and, and it's, and, and it's our job as therapists on the outside to help kind of let that grow and, and cultivate and, and blossom. But at the same time, the patient also has to meet us. in the middle here and, you know, do those home exercises, follow those precautions or those restrictions that you may have at a certain period of time to make sure that What you plan is, is, is healing properly and appropriately, right?

I know sometimes this can be a challenge for some folks that are very independent and, you know, for the rotator cuff repairs that you see often, you're like, I have to stay in this thing for how long? I was,

[00:30:29] Dr. Eric Chehab: well, I was that patient. I was like, Oh, I don't want to come out in a week. And I know better.

Like, I know better. And then I just did, I was doing so terribly and you know, I was like, Oh my God, I, I, I know better. I've been looking back on it now, like how silly it was, but I wasn't watering the tree. I was just sort of just letting it be there. And it was incredibly naive of me to think that anything other than a bowel outcome was on its way.

And really it was with the help of the therapist that. It really turned it around, like, in a really dramatic way. And I, I always encourage my patients, particularly after surgery to, to do the physical therapy. Partly because you guys have seen it a thousand times and for many patients is their first and only time through it.

And that perspective that you have that you can share is so incredibly important for patients. And not only can you share that perspective, you can share it two to three times a week. For four to six months and and really guide them step by step in the recovery process From one phase to the next. Yeah

[00:31:31] Dr. Patrick Cristi: I think it's you know a classic line that I use with my patients who are who are wondering if they can kind of push The envelope a little bit is it may not be a big deal in like in your head But to your shoulder or your knee that just has surgery.

It is a big deal I think it's one of those things where again we want to give that that That respect and and and the same thing with like when you're doing home improvement stuff as a non professional You want to do it right the first time it may take a little longer But do it right the first time right and take it step by step, you know And and and again give it that time give it that that proper healing Um in order to make sure that we have the best outcome possible because at the end of the day That's what we're again goal oriented.

That's that's what we want is that best possible outcome. And that's why it's a, it's a process. It's not an overnight thing. And it's one of those things where, you know, we're almost kind of those guides and those parents of saying, you know, Hey, make sure you're wearing that sling properly, or let's make sure that brace is fitting properly.

We understand because we hate those things as much as, as the patients do. And we're, we're trying to get you out of those things as soon as we can, but we want to do it safely. And we want to do it strategically. Of

[00:32:34] Dr. Juliette Dassinger: course, and every patient that walks through the door, just know that you have a team behind you that supports you.

We're, uh, us as physical therapists, we do communicate with the doctors and the doctor's team to make sure that you are, you know, meeting those expectations that you are, those meeting those goals at each step along the way. And if there is ever an issue, hypothetically, this is one that we can all discuss to see what, what's going on and what's that next step that we can do.

[00:32:59] Dr. Eric Chehab: Now, if you could give patients Advice before they begin physical therapy a couple of pearls here What would be let's say two pearls you could provide? to patients Before they even start physical therapy. So Juliet I'll start with you.

[00:33:16] Dr. Juliette Dassinger: It's funny I feel like I just have three words and I'll put two and two together and I mentioned it before.

You can use three. Three words. Overachiever. I'm someone I'm very concise. I'll just give it to you Frank. Patience, determination, and consistency. All right. This is not an overnight success. I don't think any human is an overnight success. If you are, please reach out to me because I always want to know how you can do that.

Just be determined. Know where you want to be. I think if you set that goal right away or know, Okay, I want to be this type of person. I want to do this in four, six, eight weeks. Um, your outcomes are going to be much more grand than you just going through the process and not knowing where that end game is.

And consistency, I would say us humans, we, you have to, you know, do your 30 reps of biceps to see strong muscles, right? So it's the same thing of being consistent through the exercises, attending physical therapy, and Gaining that education on why you're here is going to provide you a much better outcome at the end of your

[00:34:12] Dr. Patrick Cristi: treatment.

Yeah, I think for me number one is, is going in with an open mind. You know, you're gonna go through things and hear things that you may be a little uncomfortable with. Another thing, I have a lot of like analogies and things like that I tell my patients. So one of the common ones I say is, uh, You know, especially if it's going to be a longer duration rehab.

I always say, you know, if you're a patient person, this is going to work great for you. If you're not a patient person, you're going to learn to be patient. So, you know, it's one of those things. It's one thing or the other. You're providing a new skill for them. I'm just saying. Yeah. So it's one of those things where, you know, going with an open mind, I think it's one of those things where, you know, what we provide and what we educate.

For you, it's stuff that, that we, we know works and we know that has been researched. And which kind of leads into my second point is, is trust. So trust your, your doctor team, trust your therapy team, and third, trust yourself. Because I think a lot of times it can be a little frustrating and, and just like Juliette said earlier, there's, there are going to be ebbs and flows and highs and lows.

I always say therapy is never linear. It's one of those things, you know, as long as we're trending upwards, you might have little bumps along the way, but it's never going to be a straight line. I don't think anyone

[00:35:21] Dr. Juliette Dassinger: has ever had that.

[00:35:25] Dr. Patrick Cristi: That's a whole other podcast. Yeah. Small world here, but yeah, so I think it's one of those things where, you know, you keep those things in mind.

Again, beyond the physical stuff that you're going to go through, again, this is the other half of this. It's similar to any athlete. Is that, you know, you can have all the physical gifts in the world and all the physical attributes and skill set, but the mindset is huge in all this because it does, beyond the physical endurance, it's also very mentally So I think if you go in with these, these, these, these thought processes and, and, and this mindset, um, it can make the experience much more, uh, a much smoother experience.

[00:36:06] Dr. Eric Chehab: So I like that. Patience, determination, consistency. I, I think that sums it up really, really well. And I think if patients have that mindset of, of, you know, giving it the time that it's going to require to be determined that those goals are going to be met and to put in the consistent effort and to trust the care team that They will lead you down the path to recovery because again, we do meet patients at their worst point where they are been they've been physically injured or they have a condition that is physically disabling and painful and And we're hoping and and and working towards restoring to their best self And that's not an easy process and, you know, there's a lot of self doubt, I'm sure, on the patient side.

You know, we've experienced it, um, on the caretaker side. And, you know, those are just some obstacles that seem very, very daunting. But with all those four attributes of, of, of patients, consistency, determination, and trust, you can clear those obstacles.

[00:37:10] Dr. Patrick Cristi: Absolutely. And, and to kind of touch on that too, it always brings me back to when I was in PT school and, you know, quick story.

We were, we were discussing with one of my mentors of, of our first experiences being out in the real world and treating patients when we were in PT school for our, our rotations or our clinicals, as we call them. And one of my friends said, Man, a lot of the patients that I had were just like not in a good mood.

And then my, my, my mentor goes, well, think about it, you know, they're coming to you in pain. They're coming to you after an injury or surgery, or that can be really, really frustrating or, and, or lead you to a dark place. And he goes, it's your job to turn that around or to help turn that around. Right? So again, it's instilling that confidence.

It's providing that education on, on, on, on what happened and where we're going to go with things and providing that game plan. So, you know, I think that's what's so empowering about our job is that we have that opportunity with each and every patient, no matter what kind of injury it is, whether it's acute or chronic, operative or non operative, to change that around and kind of redirect them in the right direction.


[00:38:14] Dr. Juliette Dassinger: This might sound cheesy, but that's okay. Like I really do get excited waking up in the morning to meet my patients. And I'm that person in the clinic where I see someone finally doing a squat for the first time and my hands are up and I am clapping loud. That's okay if I have other people and on treatment tables, like why is she clapping?

But like, that's what gets me excited is just to see, okay, you just made progress. You couldn't do that two weeks ago, but wow, am I so excited that you just did that. And just imagine yourself two weeks from now, what you're able to do.

[00:38:44] Dr. Eric Chehab: My guests today are Dr. Juliet Dessinger and Dr. Patrick Christie speaking on physical therapy and the benefits of it. I'd like to thank you both for for being here today and just before we go, any parting thoughts?

[00:39:01] Dr. Juliette Dassinger: We like to call it a parting shot. Oh, there we go on the show.

[00:39:05] Dr. Patrick Cristi: There we go. Yeah. Love that.


[00:39:08] Dr. Juliette Dassinger: like that. My parting shot will be, we are human too and you are human. We're in a profession where we're humans helping other humans. So know that we really, we do understand. We listen. We want to engage with you. We want to help you get to where you want to be. And, um, like I said, I think way at the beginning, I really give you All the credit for walking that door because I want to do the best that I can to help you in any way to meet your

[00:39:36] Dr. Patrick Cristi: goals.

Yeah, I think for me, it's, it's, we're all on the same team. So we, you know, we don't do it alone. You know, we have our, you know, our great doctors that, that, that take care of you. We have everybody from the front desk to our rehab technicians on our end. Everybody's on your team and then everybody's is geared and locked in to get you to where you want to be.

So always know that you always have a support system with us. We're here to listen to your thoughts, to let you vent about certain things to a certain extent. But you know, it's one of those things where we, we, we really do enjoy what we do. I think it's one of those, again, another cheesy cliche line.

It's true, everyone. Um, but I think, you know, I, especially with our group here at IBJI, I think we, we really do appreciate. and value what you have to say as patients. Um, and we, we really take that to heart in terms of how we can Best provide the best services, interventions, anything that we can do to get you to your goals and, and again, tying into what I said earlier about your specific story and how we can be a part of that.

Well, I,

[00:40:39] Dr. Eric Chehab: I can't tell you how touching it is to see how gratifying your work is to both of you. And also you should just know how grateful all the surgeons are for the work that you do for, on behalf of our patients and, and, and again, making the patient experience. the best that it can be. So thanks to you both thanks for being here today, and um, look forward to tomorrow.


[00:41:01] Dr. Patrick Cristi: thank you. Thank you, Dr. Chehab, appreciate it.

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