Sheth Neil, Georgetown, Dr Mark Sheppard discussed on Evidence In Motion Clinical
Welcome to another edition of the I.. M. Clinical podcast. My name is John Childs and and joined by my co host. Dr Mark Sheppard as always days and we are privileged to have on the show of physical therapist who works actually with us at Texas physical. Therapy specialist Dr Neil. Sheth Neil completed completed the sports residency back in two thousand seventeen or so and really brings a unique perspective to all things certainly physical. Oh therapy but particularly related to strength training and so. We're really looking forward to having Neil on the show neil welcome to the clinical podcast. Thank you guys for having having them really excited so neil to get US kicked off if you would just give us a brief bit about your background maybe where you went to. PT School and sort of how you got into sort of the path that you're on now. Okay so I went to school in Philadelphia at the University of the sciences. It was a direct program so I actually didn't have to do the. Gre Three in reapply. I was just sixers don which is exciting. After that I was really well by my second year I really wanted to do. A sports. Resin team started looking looking around what I could apply to. and Luckily I am sports residency in Georgetown which XP was open and they took me on and finish that in twenty seventeen after the exam in March twenty eighteen. And now I'm down in San Antonio with one of our sports clinics where I get to mentor. The incoming residents now do a lot of teaching with that. Neil thanks for that background if you would talk a little bit about your perspective on strength with training and sort of where you think strength training sort of fits if you will and where the sort of the state of strength training I asked the question because you know oh manual therapy was sort of the decade of the two thousands and maybe overemphasize perhaps relative to strength training and it seems like the pendulum maybe swinging the other direction. Now where like all everyone talks about is like cross fit and those sorts of things. And it's like it's gone the other way so I'm just curious is like what's your perspective on strength training and what's the state of it within the profession. He adds though this really excited about. If I get to fired up just calm me down if you guys need need but again on tirades in the clinic all the time but as ours when I think I actually think that this is the biggest area that we need to improve on as a profession. Kind of like what you send John Worth starting to swing in the other way. I definitely sealed up but I think a lot of issues are that Patients are under loaded and under dosed as far as strength training principles and a lot of people. Just don't implement proper. Strengthening like thera bands are good to start with his initial seen in acute injuries. But after that initial phase there needs to be a shift to load it and having some awaits actually being put on these patients in. I could see that this so boxes. Something Neil that many people probably will resonate with and you. You know it's interesting because when you're in clinic you see you know thera bands everywhere at you know different types awaits that are usually hand weights right. If you go I went to the everyday. Outpatient clinic are even one within the hospital. It's kind of like those are the staples but you don't really see anything that can actually load people. You the heavyweights and it always kind of bugged me in two different ways one is like why is that the case too is I wasn't really comfortable understanding ending how to load people with squat racks or different types of bar. Waiting things landmine stuff like that. That took some time after I graduate sweet so when you talk about you know where the state of strength training or are really the prescription of exercises like where do you feel like. We miss the mark doc when it comes to these types of things so definitely go with the Swat rack being so at when during residency in Georgetown and even at us or as lane location. I I actually bought thought squat racks for both of those the Knicks in order to low deebo in a when I was little headed that about it but he got the point of it uh but then he was really from the beginning where in school and highly had maybe an hour a week for half a semester of going over any any strength and conditioning related things and that. Just trustees us into the clinic three graduate and we're still doing those eysenck three he by ten therapy and everything similar movements everything. Everyone gets the same cookie cutter approach and there needs to be a shift to that loading being an challenging the patient with actual weights and Neva bodyweight movements is fine but there are just not enough to have any tissue up tation Shen prevent long-term injury in. I think that also comes back to us practising what we preach. I liked to Charles Myself personally in the gym and with other colleagues of mine as far as Hauer thinking about exercise dosage. How a training myself in it leaks into how I treat? Patients Asia's Neil. Could you expand on this a little bit like you give in clinical example of like how you are implementing proper dosage. This is general as it relates to. Let's say strengthening someone's quadriceps muscle if they're coming in for let's say anterior knee pain like how does that look from your perspective when you're dosing dosing. Is it okay that provide a case about actually have a really good one for nepean young So with this. He's like a thirty three year. Old Male in the navy is all him a year after he fell on his knee and has had an tierney pain. Ever since and through the medical carousel paracel he was just prescribed straight leg. Raises and Claude sets for a whole year a whole year. That Yup and he's never done anything else using unlike multiple providers that have changed anything else. So let me stop you there. So you're telling me. Has He seen the physical therapist before this time he saw one. Yeah Yeah Oh man for a short time that kills me to know that the two exercises were still kind of on his radar but anyway. That's crazy yeah so he had no audio to do and he is in the navy he was off duty getting ready to go back to think Iraq Many leaves at the end of this month so he can squat lower than maybe like fifty degrees of neath luncheon. He tries running he kinda Gallup's because he doesn't want to bend that knee so I'm getting some of this very avoid. We didn't an week in doing things that he needs to do with him. I we do something called the Quad Index and we have a makeshift shift version with a hand held item. OMETER cheap way to do it but it works that so there's research out there especially for post. The minimum criteria needed to running is actually eight weeks and eighty percent index. So we use that. Eighty percent is our measurement to start any metrics or impact work. He we started at a at thirty percent. Thirty eight or twenty seven something like that and yeah really really low. So where I started with him outside of the cloud. Odd Settings settings. Good right especially on your continuum it's good for activation in the new progressive straight leg raises for your control and then after that you again to strength endurance endurance. He'd Kinda like that stair stepping progression over him we used. We started off a lot because of his pain with movement. We start a lot with Jafar Ayar flourished and just loading him with bodyweight movement squats split lunges straight leg raise and then eventually eventually shifts to adding weight to all those movements and making sure on his scale on what I do. A lot of patients is and use the rate of preserved exertion. So if it's something I really want them and the challenge you had told me I want it eight plus nine hundred ten anywhere in that range and if it's not there for them we just keep increasing until it's a heavy enough weight where they're actually pushing themselves not just going through the movement. That's interesting meal like so you're telling me that you're using the R.. P. To actually actually understand the reps and potentially sets for which you does your patients is that kind of how you're using yes so with the RPG round like eighty plus. It's usually definitely more my strength side or even power so I the schemes typically x amount of sets for anywhere between two to five Canadian. Six wraps her up and then if I want to get a little bit later on there are definitely increased volume for movement pattern. That were working. Oh that's cool so you know to me it would make sense. That may not be the same number going back to your statement about the three sets at ten Dan. You know that you kinda see everybody's flow chart you know potentially So yours look a bit messy. If this was documented. They're not clean. Three by ten three by tens is something I get so upset about in the clinics and we even have a table that we all work on an I wrote are actually one of my residents wrote. Think before you buy I ten has to me if everything on your flow sheet is three by ten to me. It's lazy programming. Your there's no intent behind find what you're prescribing and my floggings are definitely messy every day. There's I don't write all the way on the left side. I don't know how your flu she'd looks on the left column elements of Big Open Blank. Were most people just write back through size and then it just carries on through that entire life of that flashy for me. I leave that that left side blanket. I write in each for specific day. What I'm working on with my plan is which exercise are going to help achieve that goal and definitely the numbers are very off kilter? There's some people who do like a four by seven five three or five. I even play a lot with strength and conditioning in the clinic to every minute on the minute at a certain load of do Amr APPs so definitely. The flu sheets varied day all over the place. There's intent behind the entire goal. Now is a great discussion and you know as you talk about like this case for example you know number one. I hope you consider perhaps publishing it if you're able to do that. So the researcher in me can't not suggest that so it's thing you can share and on that note what sort of of resources the you lean on whether it be journal articles are the particular authors that you follow when it comes to all things you know how to train patients and athletes in evidence informed sorts of ways. What are the resources that are your go to? I'm definitely big on social media. I follow a lot of physical therapists percent. Strength and conditioning coaches. Some of the big ones as far as in the P. T. Rome that put out a lot of content. Is Dan Laurenz or Eric. Mira or even Mike Reimann on those people I follow. That always have a good tweeter instagram post about it. Even John Rawson has really good things breath. I also have my strength and conditioning Certification so I do rely on the NFC as website as far as articles that are coming out and Alikhan challenge different athletic populations in the clinic. So those are my big ones even J. O. S. P. T. R. J. P. T. are a good example if those that are APD members and then on that note that same train of thought you know. I know you provide a lot of mentorship to residents. So what sort of structure do you have them reading articles on a regular basis. Are You doing journal clubs or you know what's the contemporary way that you really help mentor mentor..