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Jan 18, 2023

5 Mistakes Sports PT's Make and How to Avoid Them with Dr. Dillon Caswell

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Dr. Yoni Rosenblatt: Thank you so much for tuning into the True Sports Physical Therapy Podcast. As always, I wanna hear from all of our listeners, I wanna hear what you think of this episode. I wanna hear who you wanna hear from and how we can just get better at offering you outstanding ways to become better sports PTs.

Dr. Yoni Rosenblatt: Reach us at true sports PT on Instagram is the quickest way to drop us a line. Also, we are growing like wildfire, and we're looking for awesome sports PTs to join us. If you're motivated to provide the very best to your athlete that's standing in front of you, you wanna be doing it in True Sports. We have 101 care for 45 minutes every single time in state-of-the-art facilities with room to run, throw, jump, everything your athlete needs to get better. So shoot us, shoot us a DM at True Sports PT on Instagram.

Dr. Yoni Rosenblatt: This conversation with Dr. Dillon Caswell really taught me a lot. It teaches me how we can get better at being sports PTs, which is what this pod is all about. He does a great job of highlighting the five mistakes that he sees sports PTs making. But also really gives us feedback in a guide to get better and correct all of those mistakes, and he does so from really a place of humility. I enjoyed the conversation greatly. I hope you will too. He teaches us how to be better sports PTs, and really how to be better people.

Dr. Yoni Rosenblatt: We've got Dillon Caswell with us to really enlighten us on all things sports rehab. Dillon's one of The Prehab Guys, which is just absolutely taking over the internet or has taken over the internet. I'm excited to learn about what it is that The Prehab Guys are and what they stand for. And also about Dillon yourself.

Dr. Yoni Rosenblatt: So let's start there. Dillon, tell us about yourself and how you got to where you are?

Dr. Dillon Caswell: Yeah, for sure, man. Well, thank you for reaching out and having us come on the show, we're excited to just chat and get more information out there, so thank you for that. So I'm a doctor of physical therapy, I'm in Syracuse, New York. And I remember being in PT school, and I remember sitting there through some of these courses, and I'm sitting there, I'm like, "I wanna be a sports PT. I don't wanna do this bioscience stuff, neuro is really confusing. I don't wanna do neuro."

Dr. Dillon Caswell: I remember my neuro professor going, "Every patient's a neuro patient, whether you work in ortho, in sports, it's all neuro." And at the time I was like, "Okay, whatever." So I started practicing, going out on clinical rotations, and I remember just being pretty burnt out from the PT field, and I'm sure you can attest to this.

Dr. Dillon Caswell: That you get out there in the field and you just see how reactive the care is, and that a lot of clinics are just not really treating people as people, they're treating them as an injured body area. And I was just really kind of burnt out from it to the point that I was like, "Do I really wanna finish my doctorate in this? Or do I just wanna go be a strength conditioning coach or a CrossFit coach?"

Dr. Dillon Caswell: 'Cause it seemed more fulfilling and I didn't have to deal with the sick healthcare system that we were being confronted with. So I remember, we're picking our clinic rotations, I'm in my second year of PT school, and one of our professors goes, "Alright guys, there's this clinic. It's different."

Dr. Dillon Caswell: And I just remember being like, "Awesome, sign me up. Like different is what I need in this case." And I remember walking into this clinic and it was Goldwyn & Boyland that David Boyland owned and I walked in and I was like, "Man, I don't know if this person's here because they hurt their knee, their ankle, their shoulder," because of the movements that were being done and how people are being cared for, and I was like, "Wow, this is it. This is incredible."

Dr. Dillon Caswell: So from that experience I got to learn how do we treat people as human beings, as individuals, not as a body part that's injured. How do we take care of this person that's in front of us. And it was a phenomenal, great mentorship. Went on to get my SCS, started teaching at the university, and then in 2020, I put all my eggs into the sports therapy bucket, COVID happened.

Dr. Dillon Caswell: So my whole schedule is gone, the athletes I was working with, they're like, "I got some off time, I'm not gonna keep training." 'Cause we thought it was gonna be like two to three months, so everyone was just like, "I'll just take some downtime." So I'm sitting there and for the first time I had time to think and reflect on, what is my mission? Like, what is it that I wanna do as a healthcare provider? What's the message I wanna spread to people?

Dr. Dillon Caswell: At the time, The Prehab Guys were looking for content creators, and it was just perfect timing that I linked up with them and came on as a content creator. I started off writing articles, creating content, and then that led into me hosting our podcast, The Prehab Audio Experience.

Dr. Dillon Caswell: And so now I do that, that's my main role is hosting that, and then I also create all of our programs that we have that are available on our new app. So it's been an awesome, awesome journey so far, and I always tell people that you might have a plan A, but there's a plan C that's probably better for you than that Plan A that you had.

Dr. Dillon Caswell: 'Cause I was like, "I'm gonna work in the NFL. I'm gonna be an NFL physical therapist." And I look back and I'm like, "Man, luckily, that didn't work out," because now I get to be in this position and where I have some more flexibility and freedom and can really pursue my personal mission along with The Prehab Guys mission.

Dr. Yoni Rosenblatt: That's really awesome and it's a great story. You're absolutely right, a lot of times that NFL life or pro sports life is glamorized, and God knows it's oftentimes a mess. So I think you might be right in terms of dodging that bullet. But what I also heard was you taking a minute and having time to understand where you are and what your options are.

Dr. Yoni Rosenblatt: That's what I love about what we're doing here, what this conversation is. There's so many opportunities for one to take, so many paths one can go down with this doctorate. You could do a million things, right? But you taking the time to figure out, "Am I happy where I'm going? Am I happy where I am? How do I problem-solve?" That's really an awesome lesson.

Dr. Yoni Rosenblatt: And so you've got The Prehab Guys that you're creating content, you're doing the podcast, but you're also treating, right?

Dr. Dillon Caswell: Yeah, yup.

Dr. Yoni Rosenblatt: So tell me about that world?

Dr. Dillon Caswell: Yeah, I think you bring up a great point that that time to think, that a lot of times we equate busyness to fulfillment, and that's not the case. At that point in my life I was working 78 hours a week, super busy, which was great, I got a lot of reps in, a lot of experience, a lot of networking, but I was not fulfilled.

Dr. Dillon Caswell: So taking that time, any provider that's listening, that's feeling really burnt out, take that step back and just evaluate and see, "How am I feeling? What is it that I wanna pursue? Am I on that path?" But to your question, I'm still treating with my own company where I'm at in Syracuse, New York, and there's a few reasons why I've continued to do that.

Dr. Dillon Caswell: One, I open up my own company just to have flexibility, like it was a necessity of flexibility with traveling out to LA and some other locations, that it's easier for me to have my own company and I could talk to myself to see, "Okay, do I need... Can I take that time off to go out here and to have my own patients schedule that I can switch to virtual, to in-person, to their house, to mobile, and have that flexibility without having this hierarchy of things that need to be paperwork filled out to go out to a certain place?"

Dr. Dillon Caswell: But the other reason that I continue to treat within my own company is that I love treating people and they give me the inspiration to then create programs. And a good example of this is this past weekend. I traditionally work in rugby and hockey and football, and this past weekend I had an opportunity to work with performing artists, the group of Anastasia that was coming through Syracuse at the Landmark Theatre.

Dr. Dillon Caswell: So I took on this opportunity, it's just wow, this is a great learning experience, it's a population I don't normally with. What are the similarities between performing artists and rugby, hockey, football? And the fun part about it is after that, now I get to come home and I get to think about, oh wow, we can create a whole new program on the app specific to performing artists, and I now have an idea of what their lifestyle is like because I've worked with that population, versus trying to guess it.

Dr. Dillon Caswell: So a lot of people always ask me, "Where does the inspiration come for these workouts or for these programs?" and it comes from the people that you work with and getting reps in and recognizing patterns and then programming for those patterns.

Dr. Yoni Rosenblatt: That's awesome. You seem like a truly introspective individual, where you're consistently kind of analyzing where you are and what you can gain from whatever is in front of you. That's a great quality, that's a quality that will serve anyone well, really in any profession. I've seen it work beautifully in physical therapy, I've seen those new graduates come out and say, "Hey, I wanna do sports," they get into a true sports clinic and maybe it's not what they thought it was.

Dr. Yoni Rosenblatt: But how introspective can you be? How can we be a teammate to you as an employer? How can you be a teammate to us as an employee, to create a teamwork to say, "Alright, how do we set you up for success? What do you wanna do?" And you have to be able to answer that. "What do you wanna do? And what's your ideal workplace?" It sounds like you're really good at that.

Dr. Yoni Rosenblatt: So that's awesome. That's awesome that you are able to keep juggling both in the air and they really compliment each other beautifully. Tell me about Prehab Guys, if you had to sum up who they are and what you guys do?

Dr. Dillon Caswell: Yeah, for sure. So it all started back in 2016 with Mike, Arash and Craig. And they were actually students at the time. So it was pretty funny, through undergrad I never had social media. At that time, it was probably more like MySpace, Facebook was like up and coming, people are getting on Instagram.

Dr. Dillon Caswell: I never had social media because I thought it was pretty funny because it bugged my family and friends that they couldn't keep up with what I was doing unless they called me, so I thought that was hilarious. So I'm like, "I'm not making social media, because I want you guys to call me so I can update you with what's happening."

Dr. Dillon Caswell: But in the time I'm in PT school, the guys are in PT school at USC, and it all started at USC's basement where the guys have gotten back from clinic and they were seeing this reactive healthcare system and just had this thought of, "Why don't we be the change? Why don't we be the change that we're talking about?"

Dr. Dillon Caswell: "We're sitting here talking about how the health care systems failing people and how a lot of these injuries that we're seeing don't need to be treated 'cause people can do this on their own. So how do we start doing that? How do we give control back to people? How do we give them the right information at the right time?"

Dr. Dillon Caswell: So that was the early beginnings of it, and I remember I'm in PT school at Upstate Medical University, and one of my best buddies, Tommy, he's on Instagram, he shows me The Prehab Guys account. He's like, "Dude, you should get Instagram just to follow these guys, because look at the stuff they're posting. And they're right around our same age, like this stuff is cool, you should be following this." So it was actually the first time that I was introduced to The Prehab Guys.

Dr. Dillon Caswell: So it's cool to fast-forward to 2023, or like each time I get to go out there and hang out with them, it's just so cool that it all kinda worked out that way.

Dr. Yoni Rosenblatt: That's really awesome. And so how did you get the gig? 

Dr. Dillon Caswell: I always say this to people, never feel like you're too good to apply for something. Always humble yourself. So the position that they were hiring, they posted on Instagram, and this position was basically...

Dr. Yoni Rosenblatt: I assume you had Instagram at this point?

Dr. Dillon Caswell: I had Instagram at this point.

Dr. Yoni Rosenblatt: Okay. Good move, good move.

Dr. Dillon Caswell: Yeah, yeah. So background story with that, I was on the CrossFit medical team and I would go around to the regional events and provide venue coverage for that. And when I first got accepted to it, I sent the director an email and he was like, "Dude, you gotta get Facebook. We communicate through Facebook."

Dr. Dillon Caswell: So I'm like, "Can you just shoot me an email?" and he goes, "Get a Facebook account or you're off the team." So I'm like, "Okay, yeah, yeah, I'll get a Facebook account." So I got Facebook then, and I was like might as well make it Instagram. I actually started enjoying it. I found that like social media, it can be very harmful or it can be very beneficial depending on how you're using it.

Dr. Dillon Caswell: And I just found that if I'm following the right things and I'm surrounding myself with the right things, that social media is super beneficial. You can scroll through it, follow some good research, you get really good tips and things like that, so you can make it beneficial. So that was good.

Dr. Dillon Caswell: So yeah, this time had Instagram, had social media, and they were looking for a position that they would basically film an exercise and then you would type up the description for that exercise, so they're looking for an undergrad Kinesiology major. And I was like, "You know, I'm gonna send in this application. I don't have any patients right now, I'm just chilling in my apartment. I might as I'll be doing something productive."

Dr. Dillon Caswell: So I sent them a application and they were like, "No, fill out this application." I'm like, "Okay, cool." So I fill out this next application, no idea what I'm applying for. Craig gets a hold of me, he goes, "Hey, you wanna hop on a call? Do like a Zoom interview?" I'm like, "Yeah, sure."

Dr. Dillon Caswell: Hop on the call, we go through the interview, we chatted for like an hour and a half, and we both were like, "Oh damn, we should probably get going," 'cause I'm on the East Coast, he's on the West Coast. He's like, "Man, it's probably like midnight for you over there." I'm like, "Yeah, I should probably get off the call."

Dr. Dillon Caswell: Great call, got done with the call and I was still like, "Man, I don't even know what this position is for, like what am I applying for?" So shot me back the email a few days later and was like, "Hey, content creator. Would you wanna come on as a content creator and start with articles?" and then it kind of progressed from there, which was awesome.

Dr. Dillon Caswell: But it all started from applying to a position of like, yes, we have our doctorates and we have specializations and all these credentials, but it's always good to humble yourself and go look. It doesn't mean that because I have this, that I shouldn't be doing this other thing to serve people. So it's like, I'm not "too good" to write an exercise description. This is serving more people than I'll be able to serve in my clinic, why would you not wanna jump at that opportunity? And then you start small and then it just kind of builds from there.

Dr. Dillon Caswell: So yeah, it's been awesome, and the company has really grown from... It started off as this content company, like let's get out as much education as we can, YouTube videos, Instagram posts, TikTok, Facebook, articles, you name it. This content, we were just pushing it out to give people as much education as we could.

Dr. Dillon Caswell: And then we brought in the exercise library, which was more meant for clinicians and providers, that they, instead of writing out on this piece of paper an HAP for somebody, they have the exercises that are being described both verbally and with audio and with the visual of the video. So you put it together, send it to your patients, and now they're more confident with their HAP.

Dr. Dillon Caswell: So then it grew into the exercise library, and then as we kept going, we're having a meeting a couple of years ago, reflecting on the mission of, are we giving people the opportunity to take control of their health? And what we realize is that posting a thing on Instagram or having an eight-minute YouTube video, it's a great start, but it's not giving people the direction that they need.

Dr. Dillon Caswell: And people needed programming, they needed a four-week or eight-week or 12-week program, depending on the injury that they had, that went through step-by-step that if you have this, this is how you take care of it. Here's the movements we would do, here's a recommended rep scheme, and here's a training support video.

Dr. Dillon Caswell: So it really grew into this thing that now allowed us to develop our own app in-house that we just released last year, which we're really excited about, because if people have an injury, they don't have to go immediately to get imaging done or to wait four weeks to get into a provider's office.

Dr. Dillon Caswell: They can download the app, look at where's my injury, and the app will help put you into the program that's recommended for you, and you can get taken control of this thing with active solutions from the palm of your hand. So we're really excited about that. We feel like, okay, we kinda have these three different streams that are going out, we're still pushing content, we have the exercise library, but now we have this thing that we truly believe is gonna get us to achieving that, the mission that we're on.

Dr. Yoni Rosenblatt: I love that. One of the things I heard you hit on was the founding of The Prehab Guys, and the way these guys took a step back, kind of similar to what we were talking about previously, right? Taking a step back and assessing, "Where are we? What's the problem we can solve? And how the hell do we solve it? Right?

Dr. Dillon Caswell: Yeah.

Dr. Yoni Rosenblatt: And they did a great job of that. It resonates with me, it sounds like something that I love. Because that's kind of how I found my practice too. Eventually you get tired of learning what not to do. And you wanna start learning, "What do I want?" And that's what The Prehab Guys did. What do they see is the best way to deliver our skill set, and you guys have come up with unbelievable ways to do it. It's really... Yeah, it's really cool to see.

Dr. Yoni Rosenblatt: Okay, so that dovetails beautifully, especially your social media piece, which is, I wanted to talk to you about the five biggest mistakes that PTs make in sports rehab today. 'Cause they're millions of mistakes, there are millions of awesome things. I guarantee you just this morning, I saw a bunch of athletes. I guarantee you, I made some mistakes when I joined them.


Dr. Yoni Rosenblatt: So I don't pretend like I'm not making some of these mistakes. But let me ask you this, what is... We'll trade back and forth. Let's start with you, the number one mistake you see sports PTs making today?

Dr. Dillon Caswell: Yeah, I'm so glad you brought up that point to start with, of we're not having this conversation to be on a pedestal and say that we're perfect PTs and that we don't make these mistakes. Because every mistake that we're gonna talk about, we can guarantee that you and I have made these routinely and it's like... We're never after perfection, we're after progress. And purpose creates progress. So the more purposeful we are, then we can create progress and become better clinicians.

Dr. Dillon Caswell: So anyone listening, if you hear one of these mistakes and you're like, "Oh crap, I did that this morning," don't beat yourself up from it. You're doing the best that you can with the knowledge you have at your hands, and now it's just let's keep adding to that. So it's okay to look back and go, "Oh, I messed up. Let me move forward." I remember when I first started practicing, I used to tell runners that they need to contract their core when they were running.

Dr. Yoni Rosenblatt: Love it. I love that.

Dr. Dillon Caswell: I look back now and I'm like, "Dang, that is the stupidest cue I could have given these runners, because now they're flexing down as hard as they can, like trying to run, but their body is not even rotating side to side." So I look back at that, I'm like, alright, hopefully those runners just started running and were like, "Okay, no, that doesn't work," but you learn from that and then you move forward.

Dr. Dillon Caswell: So don't beat yourself up too bad if you may get of these mistakes because we've made mistakes and we're probably gonna continue to make mistakes in the future. We'll look back 10 years from now and go, "Oh yeah, remember those five we talked about? I have five other ones, or 15 or 20 other ones." You just, you keep learning.

Dr. Yoni Rosenblatt: Yeah. Or maybe they're not mistakes, right?

Dr. Dillon Caswell: Right. [chuckle]

Dr. Yoni Rosenblatt: Maybe these aren't mistakes. But currently, right?

Dr. Dillon Caswell: Yeah.

Dr. Yoni Rosenblatt: I mean, you're talking to a dude who spent a long time just preaching, "Don't let your knees go forward. Please sit back into... " Okay, today I look back and look back and like, "That guy was an idiot."


Dr. Yoni Rosenblatt: But now I'm learning. And so, like you said, the best that we got for today. So go ahead, with the dose of humility, what do you got?

Dr. Dillon Caswell: I think the first one is not getting enough information in the subjective history. Like first day that you're working with this patient or with this client, whether is this physical therapy, whether this is performance realm, whether it's a combo of both, but getting as much information as you can about the particular case.

Dr. Dillon Caswell: A quick example I can give of this is that it's very typical that someone would say, I work a lot in the CrossFit population, they'd say, "I hurt my back deadlifting." And so we would go, "Okay, there's something with a hip hinge pattern, there's probably hamstring weakness, there's probably erector de-conditioning. We just need to load these things up and get him back to it."

Dr. Dillon Caswell: And hey, if you're doing that, you're already ahead of the game. That's great. But let's take it that next step further. Because it was a deadlift. Well, how much weight was on the bar? Right? What was the workout? What was it coupled with? What did your warm-up look like? Especially in a deadlift population, they probably don't get hurt on the first rep, it was probably on the 55th or the 110th rep that it happened.

Dr. Dillon Caswell: And what was the workout? Was it a seven-minute metcon? Was it a 30-minute one that you were pacing it? But what were the demands of that activity surrounding it that then led to that injury? And then another thing with that is, but what was your day like going into that workout? Did you wake up way, super stressed, didn't get your coffee, work didn't go well, everything gets pushback, you go to the gym just to try to clear your head a little bit, but you're still carrying all these day stressors, that's gonna change the way that you perform the activity, it's gonna change the way that you move.

Dr. Dillon Caswell: So maybe it's not their form, maybe it's not that they're weak, maybe it's that they were too stressed out going into that week. So we have to ask all these questions, especially in that population, because then we can use that to reverse engineer like, "Okay, we don't just need to deadlift, I need you to deadlift 30 reps coupled with toes-to-bar."

Dr. Dillon Caswell: Coupled with me maybe talking some trash to you to try to recreate that environment, with music playing, with a friend going next to you. So the more information that we can get, I think we can start to understand injuries a little bit better.

Dr. Yoni Rosenblatt: I love that. You're describing having a reason for everything that we do and assessing what we do, are we doing ideally. Why did you just ask that question? Why am I gonna ask you your pain score zero to 10? Because that's what they told me to do in university? Or am I getting somewhere, right?

Dr. Dillon Caswell: Yeah.

Dr. Yoni Rosenblatt: So that's super important. So every single question you have... This is the way I look at it. Correct me if I'm wrong. You have... You know what joint that they're complaining about, you know what their complaint is. Here's your list of things that could be causing those symptoms in your head that you could come up with. I'm sure you'll leave some things off.

Dr. Yoni Rosenblatt: Every single thing you do in that evaluation, especially in the subjective, should help you either rule something in or rule something out. Can you cross it off the list or can you continue to include it and support it? And those are the questions that you're asking.

Dr. Yoni Rosenblatt: The other thing you said, which I loved, is was this an AMRAP? Was this EMOM? Was this... What was the workout? You're speaking their language. And you're communicating with them, you're connecting with them, and you're getting awesome information for a reason. It's not gonna change my impact, or my intervention, I should say, if they say two out of 10 versus three out of 10.

Dr. Yoni Rosenblatt: It will change my intervention based upon where they're pain occurred during that workout. So ask that question and stop wasting your time with the pain scale.

Dr. Dillon Caswell: Yeah. [chuckle] I couldn't agree more. It's like we do the pain scale, it gives us some type of number, most patients don't even wanna truthfully answer it because they're like, "What does this even mean? What does this number even mean?" And yeah, we tend to go through the motion of getting that number, but you said it so beautifully, why? What's our rationale of getting that number? How does that guide our interventions?

Dr. Dillon Caswell: So many times sports PTs, they just, they don't know where to start with an individual. I always say, if you don't know where to start, start by getting more information. That's gonna guide you to what you should be doing. We have all these special tests that really aren't so special anymore, with what we're learning, and really by the time that we get to that part of the assessment, we should already have a great idea of where we're going with this. The special test is there just to further rule in this hypothesis, or because we wanna rule out some other things just to get it off the table.

Dr. Yoni Rosenblatt: Yeah, absolutely, and I think that's something that I've come around on. You talk about mistakes that we've made. Very clearly, I would make a ton of mistakes with my special tests placement and the ones I was choosing, and why am I doing that? I just memorized the algorithm, right?

Dr. Yoni Rosenblatt: So it's not until you get good at connecting with the patient and coming up with your own hypothesis, then you can support it with those special tests. Do that makes sense? One of the biggest mistakes I see, and this is why I'm so excited to have you on the pod, is sports PTs coming out of graduate school and just living face down in social media and letting that dictate the way they treat.

Dr. Yoni Rosenblatt: Here's the caveat, and you already hit this, you said there's so much good that can come of this given tool like social media, and I think that is a rule that applies to everything we do. You can use something to such outstanding benefit. It can also become a serious detriment. Social media can be a massive detriment if you don't know how you're using the tools.

Dr. Yoni Rosenblatt: You can get great exercise ideas, you gotta have the background and the hunger to know when do you apply those. Now Dillon, what do you say to that as the social media king?


Dr. Dillon Caswell: Yeah, I would say that I tend to teach other PTs that it's not necessarily about the tool, it's how it's used. You can use a hammer to drive a nail and give a structure a ton of stability. At the same time you can use a hammer to completely deconstruct an object. So like you said, it's having that reference of when and why would I be using this.

Dr. Dillon Caswell: And it's funny because Dan Lorenz is a PT that we look up to, that has really brought strength and conditioning into PT and written a lot of great articles on this, but he always jokes around that he doesn't have a social media because the things that he posts would be so freaking boring that nobody would wanna watch it.

Dr. Dillon Caswell: And we do have to remember that in the social media game, a lot of people are going for click-bait, they're going for attractiveness, they're going for these things that are trying to draw you in. I don't wanna call out accounts, but this once, I see it on Sports Center a few times that they show people at the bottom of the pool holding their breath doing a farmer carry and sprinting.

Dr. Yoni Rosenblatt: "It's very important." What? [chuckle]

Dr. Dillon Caswell: And I'm like, "When the heck would we use that?" And why is this training this hard? But it makes you watch it because you haven't seen it before, so it has that surprise element. But why the heck would we be using that? What's the point? Do a farmer carry on land, that's gonna be way harder than doing it at a pool. Holding your breath, that's impressive. All credit there.

Dr. Dillon Caswell: But yeah, it's making sure that we're creating context around it. So when we post, we try to put a lot of context to it that we're using this exercise, this is a condition in which we're using that exercise. But don't stop there, go to the article that it's in, go to the podcast that it's in, go to the YouTube video that it's in.

Dr. Dillon Caswell: Shoot, send us emails with questions on it so that we can further guide you so that you know how to implement this thing, versus seeing a post and just going, "Oh yeah, I should give that a shot." Context is everything. Context is everything, for every patient that you're working with, everything that you're seeing posted there. It's not, "Okay, yeah, I'm gonna use this." It's, "How am I gonna use this? And why would I be using this?"

Dr. Yoni Rosenblatt: Yeah, and I think you bring up a really good point with that, I think it's such an awesome outlet, social media is a huge benefit to our practice, to our profession, because it can spark great ideas and creativity. I love the combination of, yeah, go to Instagram, look at these crazy exercises. I don't know about a farmer carry under water, that makes no sense.


Dr. Yoni Rosenblatt: But find some useful exercises and then shoot over to PubMed, "Hey, is there any evidence that an exercise like this would work for this outcome?" Or whatever it is your goal that you're trying to achieve. So I think that makes a lot of sense. Okay, so you already shared your number one. Give me number two.

Dr. Dillon Caswell: Yeah, number two, I think it goes back to number one. I think each point will probably back to number one. But number two, it relates to that example that we're giving of what's happening in that person's day. And we're gonna sum this up is their internal load. So what is our internal load?

Dr. Dillon Caswell: External load is the work that you're performing, whether it's a workout, whether it's your training session. Internal load is in how your body adapts to it. Internal load is what makes you human, right? It's your stressors, it's your sleep schedule, your relationships, nutrition. All these things are impacted by that.

Dr. Dillon Caswell: So we tend to do pretty good at having these questions about external load, but we have to dive in deeper to internal load and make sure that we're not missing something. Another example I can provide here is that this will save someone six weeks of physical therapy, if you're able to ask these questions and get down to it.

Dr. Dillon Caswell: But I was working with a police officer who had hurt her back. Mind you that she's carrying around a belt and wearing a vest day after day after day, her core is not weak, she's not a weak person, she's built up capacity for these things. So I ask her, "Well, how'd you hurt your back?" "Well, I was throwing a towel into my washer." That mechanism of injury does not make sense, that someone in this condition or in this shape, that that would create a biomechanical injury. So that kind of alerts you that something more is happening here.

Dr. Yoni Rosenblatt: How do you dig in there? It's a great example, how do you dig in to find that out? What are those questions to measure it?

Dr. Dillon Caswell: Yeah, that's a great question, because there needs to be a little bit of trust built before you just dive into it. The person's not walking in the door and you're like, "Hey, give me your deepest, darkest secrets that lead up to this point."

Dr. Yoni Rosenblatt: Bad for business.

Dr. Dillon Caswell: Yeah. [chuckle] But you have to tease it out, right? So okay, you hurt your back, let's do some objective testing, let's do a side plank endurance, let's do GHD isometric hold. Let me see you do a deadlift, how is this changing your pain response? Because if it's muscle or tendon, it's gonna change either for the better or for the worse as we start loading it.

Dr. Dillon Caswell: So we start loading it and the patient starts realizing that, "Hey, nothing's changing. This is weird." It's like, "Yeah, I kind of agree with you. There might be something more that's happening here." When we have pain, it may not just be due to symptoms in a tissue. A pain response, this is a threat to losing meaningful activity.

Dr. Dillon Caswell: "What threat do you think that you're potentially losing, if you feel comfortable to share that?" So then that usually opens it up that they're like, "Well, you know what? Something did happen in my life," and for this potential person, they were starting to go through a divorce when they were throwing that towel in there.

Dr. Dillon Caswell: So okay, now instead of doing the six weeks of loading to make sure that her back is strong and her core is strong, she's able to realize that and go, "Oh, I just need to do really some self-love to get myself feeling good and to de-stress a little bit. Maybe I need to go on a week vacation, maybe I need to not take as many overtime hours. Maybe I'm filling this emotional thing that's going on with me with more work and more busyness."

Dr. Dillon Caswell: So it led to that, which was two sessions in this other six-week thing and Dr. Tim Gabbett, who has become a really great mentor, I was at his course and he said, "If we can't have the difficult conversations, why have the easy ones? And I really took that to heart.

Dr. Dillon Caswell: Especially in sports PT, you gotta have the difficult conversations and be ready for these things. I think the research is showing more and more of that internal load. I haven't worked with an athlete that was having the best time of their life, they didn't have stress and then they had an injury. There's always a life event or stressor that's proceeding that injury happening. So we have to do our due diligence to understand that and help guide them through that.

Dr. Yoni Rosenblatt: I mean, you're bringing... You're bringing pain science to the forefront, and merging that with our sports model, the way it's usually termed or coined. And it's funny because you said you're not a neuro guy, but I love that you're bringing from so many different disciplines to your athlete.

Dr. Yoni Rosenblatt: Remember, the athlete in front of you, we make a mistake... This is not on my list, but it should be. We make a mistake of saying, "This is just an athlete. All he has to do is take this ball and run 10 yards and cut and move." No. He's gotta live, he's gotta think, he's gotta feel.

Dr. Yoni Rosenblatt: Yes, he has to have the physical capacity, there's so much more that we're treating. Why are you just telling me this, Dillon? I could have used this knowledge years ago.


Dr. Yoni Rosenblatt: And that's why we're sharing it with everyone out there. But really powerful stuff. I wanna change gears a little bit with my number two, because in my current role as CEO of True Sports, I'm doing a lot of hiring, a lot of training, a lot of treating. But I get to hear the stories of the PTs, that's what inspired me to really start a podcast like this, so that I could speak to those sports PTs and hear from those sports PTs. So DM us at True Sports PT. There you go.


Dr. Yoni Rosenblatt: But what I hear, 'cause I have a lot of financial conversations with our PTs, is these loans. I think a massive problem with our profession, the way we feel that we need... I mean the trickle-down effect, the way we feel like how we need to treat, the way we feel like how we have to earn, is a direct effect by how much these schools cost to get your doctorate.

Dr. Yoni Rosenblatt: So it just breaks my heart when I hear about these massive loans that PTs have taken, are taking or considering taking to get through maybe a private school education or a more expensive state school. I think that's a massive mistake. I don't... I really... This one, I don't think in 10 years I'm gonna look back and say I was wrong about. But tell me if I'm wrong about this, Dillon?

Dr. Dillon Caswell: I don't think you're wrong about that at all. And it's the reimbursement rate once you're out compared to how much you're paying, it doesn't match up. So it puts, like you're graduating with all this debt, you're already at a disadvantage, and the biggest thing I would say is just you gotta have a strategy.

Dr. Dillon Caswell: You either need to have the strategy of, I'm paying this thing off as soon as I can and I'm gonna work a lot of hours to be able to do that, or I'm just gonna go long-term with this thing and pay the minimum and then have it be forgiven in 20, 30, 40 years or whenever that may be.

Dr. Dillon Caswell: But you gotta have a strategy and you have to do the strategy that's gonna create the most peace and most comfort in your life, that you don't have this weight on your shoulders all the time of this thing happening. Because it might prevent people from wanting to start a business because they have to take out another loan, but their passion and their deep desire is to do that.

Dr. Dillon Caswell: And I would say that if that is your deep passion and desire and you have good mentorship, don't let the loans scare you. Do what you wanna do and become fulfilled. Because when that happens, the revenue stream will follow it.

Dr. Yoni Rosenblatt: Yeah. And I should think you and Prehab Guys as an example for now there's so many ways to earn when you come out as a PT. It used to be you just treat patients. If you can get creative about it and have a plan, have a strategy, then maybe it makes sense to take that big loan, taking a step back, you mentioned that earlier, assessing where you are and what you wanna do. Putting together a plan makes a lot of sense when looking at some of those private schools. I think that's how you fix it.

Dr. Yoni Rosenblatt: I didn't think until we're actually talking now about that trickle down effect of owing so much money and how it can fuel bad care. How it can make you make a clinical decision... I don't know if a clinical decision, but a professional decision to say, "Hey, I'm gonna work in this clinic that's gonna pay me more," and they treat a million patients an hour. How many people are affected by the fact that you have a massive loan at home?

Dr. Dillon Caswell: Yeah, yeah, absolutely. I see this all the time with new grad PTs that they're all going into traveling PT. Which isn't a bad thing by any means. But the reality is that when you're a new grad going into travel PT, you're typically going to a location that other people didn't wanna go to. You're typically going to clinics that people didn't wanna go to where you're not getting great mentorship.

Dr. Dillon Caswell: And your first few years out of school, when you graduate, you have the bare minimum is to not harm anybody. But you need mentorship to get to that next level to know, "How do I care for this person? How do I recognize patterns? What should I be using?" And that mentorship the first few years out of school is so important. Really at any point, but those first few years, it's critical.

Dr. Dillon Caswell: But I see so many young PTs that are going right into travel PT because they're getting paid more and they can start chipping away at the loan debt, but then they're hurting their career in the long run because they're not getting good mentorship.

Dr. Yoni Rosenblatt: Yeah. And maybe a strategy there is... I mean, we've implemented a really nice bonus structure within True Sports to say, if you want this and you wanna make some more money, great, here's how you do it. If not, cool. Here's how you take another path. But also how do you become a content creator. Right? How do you generate revenue on your own. How do you figure out, "Hey, I'm gonna do some home care on the weekends, so I can treat sports during the week." There's so many ways, like we said earlier.

Dr. Dillon Caswell: Yeah, there's so many options. There's so many options out there.

Dr. Yoni Rosenblatt: It's an exciting time to be a PT.

Dr. Dillon Caswell: It really is.

Dr. Yoni Rosenblatt: I really... It was just before I got out of grad school, but I remember clearly the old "ultrasound, stim, evaluate and treat", and that's on a doctor's script. And if it didn't say that, then you weren't getting it. And so, man, how far have we come that you're sitting... You can create revenue as a PT from your house. It's nuts.

Dr. Dillon Caswell: Right, that's awesome.

Dr. Yoni Rosenblatt: Okay, give me another one? 

Dr. Dillon Caswell: Next one I would go into, so we talked about external load and internal load, but shifting back to the external load, I think another critical mistake is under-loading in rehab. And shoutout to the strength and conditioning coaches out there. Because a lot of times they end up picking up our slack of we have de-conditioned the athlete and then they're cleared to go back into their sport, and the strength and conditioning coach is like, "Well, okay, I know you're rehabbing your knee, but your capacity sucks now. Your overall strength has gone down."

Dr. Dillon Caswell: I think it's on us as rehab professionals that you can get creative with this. If you have someone that's post op ACL, maybe it's the first few weeks where we're hammering knee extension, we're trying to get quad activation going again. There's no reason that we can't super set that with an upper body cycle where they're sprinting, getting their heart rate up, getting lactic acid floating around, now let's go and do a knee extension during your rush break.

Dr. Dillon Caswell: But it's one of my biggest pet peeves is that we let athletes become de-conditioned during the rehab process. We gotta keep them going, we gotta have fun with it. So sometimes I'll have athletes bring in game film, and if they're on the bike, it's not just peddle around for 10 minutes, get your legs warm. It's I want you to watch you play your sport.

Dr. Dillon Caswell: When you sprint in your sport, I want you to sprinting on your bike. When you're jogging in your sport, I want you to jog on the bike. But let's cue it to something to keep you conditioned through this rehab process. And then there's the conditioning of that actual area. And sticking with the ACL example, quads are so under under-loaded.

Dr. Dillon Caswell: This area that we're treating, we need to keep loading it progressive overload and get it strong. We need to get it stronger than what it was before. And we can't compare it to the other side if you're not training the other side, 'cause now we just have two weak sides and now you have increased risk for injury.

Dr. Dillon Caswell: So that one side, that's the uninvolved side, keep loading it, keep getting it strong. The involved side, push that one further to get to there as long as the person is tolerating it, but we have to do a better job of loading our patients that we're working with.

Dr. Yoni Rosenblatt: Yeah, no question. I love your example of it's almost like a systemic load, where if you can't load that exact joint, let's put some type of load through the entire system to create that hormonal response, to create that systemic response, to encourage growth. The body forgets really quickly how to produce mass, doesn't it?

Dr. Dillon Caswell: Yeah, absolutely.

Dr. Yoni Rosenblatt: And so I think you're right, really good strength coaches are awesome at that. We need to do a better job as PTs to uphold our end of the bargain. We should be awesome strength coaches ourselves if you're treating athletes. So that's a really great point. That's something that I totally, totally agree with.

Dr. Yoni Rosenblatt: And I think it's what separates, I'd say sports PTs from PTs. I think I would go that far. Just in terms of the way the current construct is. If you wanna be a great sports PT, you better be great at loading an athlete. In all the different angles.

Dr. Dillon Caswell: Yeah. And go shadow strength and conditioning coaches. Go learn from strength and conditioning coaches. This is a field that's been loading people for way longer than PTS have. So go learn from them. Don't be embarrassed. So again, like humble yourselves of like, yeah I have my doctorate, but most of the time you graduate PT school and you have no understanding of how to load somebody physiologically.

Dr. Dillon Caswell: So go learn from the people that are doing this and create those relationships where it's a better pass off of like, "Hey, we got the rehab done, now the strength and conditioning coach, they're gonna take you the rest of the way and get you back into that game ready shape." And the strength and conditioning coach is gonna be praising you, "Thank you. I can focus on this and not have to worry too much about this injured area like I used to have to," so definitely collaborate more as much as you can.

Dr. Yoni Rosenblatt: Yeah, I think that it's also to highlight that on that end of the spectrum. The other end of the spectrum is get your ass into an OR. Find a doc, go into clinic with the doc, learn that side, so that we now we're an awesome go between. Now we're taking from clinical on the OR table, let's say operating table, all the way to the weight bench. That's magic. So I think that'd be totally worthwhile. Talk to me about another big mistake that you see sports PTs making?

Dr. Dillon Caswell: I think I'll go off at that point of what you just mentioned, more collaboration. There's this weird turf war with athletic trainers and PTs. I've been blessed in the sense that the athletic trainers that I was working with when I was doing my SCS, they were phenomenal. They were so welcoming.

Dr. Dillon Caswell: And honestly I was a little nervous, 'cause I knew this turf war that was going on, and I was like, "I don't wanna step on toes, I just wanna be here to learn." But you have to understand that there's things that athletic trainers do that are better than what sports PTs do, and there's things that sports PTs do that are better than what athletic trainers do.

Dr. Dillon Caswell: And one of those things is evaluations, like quick evaluations. Sometimes in PT, we complain that we have 30 minutes to do an evaluation. Luckily, with cash bag I get to do an hour, and I'm sure you have a set up where you get a little bit more time with people, but sometimes it's like, "Oh I only have 30 minutes to do this evaluation."

Dr. Dillon Caswell: Well, imagine having 30 seconds to an evaluation with 50,000 people watching you and this million dollar person is relying on your assessment to know if they can keep doing this thing that provides their income or not. So their ability to make these quick decisions in pressure circumstances, we don't get that in PT school. You don't get that from shadowing.

Dr. Dillon Caswell: So when I teamed up the athletic trainer, I'd go out in the field, but I was just shadowing and just in awe of how quick their decision-making is and how they get to these answers. But once the athletic trainer was like, "This isn't an emergency, let's go ahead and get off to the sidelines," then she would pass the athlete off to me, I would go into some treatment and return to sport to see if this person is ready to go back into the game. So now she's back eyes on field, as I'm doing a quick rehab with this person.

Dr. Dillon Caswell: It was a great system, we both knew each other strengths, our weaknesses, and we combined to ultimately give the athlete and to give the team a better experience. And that's what it's about. So I think we need to stop these turf wars and we just need to come together more and more. Like you said, this full line of care. When that happens, it's magical. Like athletes are better taken care of, teams are happier. You're happier as a provider. That's the model. That's the model that we need to get after.

Dr. Yoni Rosenblatt: Yeah, and it comes from humility, right? How do you tear down silos, it comes from humility, knowing exactly what you just said. That there's every single AT out there knows something different than you know, and their skill set is simply different. The same thing by the way, goes for chiropractic.

Dr. Yoni Rosenblatt: If I had a... There are great chiros out there that are unbelievable with their hands and are incredible at diagnosing, and there are also some of them are awesome at the rehab side of things and the loading side of things. But we have to be able to have that conversation. We have to be able to talk that language and discern, "Hey, who's in it for the patient?" That's what it's about, who's in it for the athlete that's in front of you? I think that's really well made.

Dr. Yoni Rosenblatt: One of the things when we talk about humility is, leads me to think about another one of the mistakes that I see sports PTs making, and that I've definitely made myself, is preparation for a given session.

Dr. Dillon Caswell: Yeah.

Dr. Yoni Rosenblatt: I don't care how long you've been a sports PT, you need to prepare for the session that is about to happen. Here's why. We went to school to help people. You wanna help people to the best of your ability, it will take preparation. The session will be better if you prepare. I don't need you to write out the note beforehand, I don't need you to spend hours doing it. I just need you to think about the patient before the door swings open and they walk in. You talk about like getting your ass handed to you, didn't you? Did you mention that? I don't know.


Dr. Yoni Rosenblatt: But when you talk about being humbled, when I walked back into an athletic training room to work as a sports PT very recently in my career, I've been in sports PT for 10, 12 years already, and then I'm tasked with treating Division 1 athletes on the 15th. Or when they're available. So it's like they'll have... It's the athletic trainer was just a different model.

Dr. Yoni Rosenblatt: You bet your ass the night before I am just prepping for who could walk in, how could they walk in, where are we, what they do last time they were in, etcetera. You gotta prepare, is one of my pet peeves and something that I love to kind of share and harp on. What do you think?

Dr. Dillon Caswell: Yeah. I mean, a couple of points in there. One, the respective athletic trainers in high school and school settings, because that last school bell rings and they have 50 to 100 athletes running into the training room. So now not only do they have to be prepared, but they have to kinda shift through of who actually needs a treatment and who can they send out. So that about...

Dr. Dillon Caswell: Like PT sometimes we get frustrated if we have three patients at one time, but you see the athletics trainers and what they're able to deal with that, and it's incredible. But yeah, I completely agree of the prep work, because when we go back to why is this person having a pain response? It's a threat to losing a meaningful activity and the uncertainty that's surrounding it.

Dr. Dillon Caswell: So if they come in and they're uncertain about, "Am I gonna get back to this thing?" and we're supposed to be the person guiding them, we're not fixing people, we're just guiding them to get to that next step. But if we come in and we're fumbling through our program, we're not really sure where they're gonna be at or what movements they should be doing, we're now feeding into that uncertainty loop and now their brain is predicting that, "Okay, I should be uncertain because the person guiding me is uncertain."

Dr. Dillon Caswell: So we need to be better prepped to be confident in what we're delivering, because their system, their movement system is gonna pick that up, and that's gonna be the, can they express their movements by the confidence that you're giving them, because you do have that plan prepped.

Dr. Dillon Caswell: So I absolutely agree that you'd have to prep. Like you said, it's not writing out your entire note beforehand, but it's where is this person out and what's the next progression that we need to do to get to the goals that we have.

Dr. Yoni Rosenblatt: Yeah, I love that. One of the things that helped me when I was just younger in my career was just coming up with options, right? Like, "I want to do fill in the blank." They're a couple of months out of ACL, I wanna do Bulgarian split squats. Well, if I do Bulgarian split squats and their rear foot is the affected limb and it hurts their patellar tendon graft site, what am I gonna do? How am I gonna work around it?

Dr. Yoni Rosenblatt: Well, I might do this, I might do that. I might go from something from a banded rear foot to a solid back foot. I might shift the load anteriorly. I might add a band support. Whatever, but at least I have three options.

Dr. Dillon Caswell: Yeah.

Dr. Yoni Rosenblatt: So just think about where to go.

Dr. Dillon Caswell: Yeah, for sure.

Dr. Yoni Rosenblatt: So maybe that's like a nugget you can kinda take with you. Tell me where you are, 'cause what I have listed next is modalities, passive modalities. This is before your time, Dillon.


Dr. Yoni Rosenblatt: But there used to be a time when we used to have passive modalities in the sports PT clinic. Tell me where your head is on those things? And I'm including electric stim, ultrasound, hot packs, cold packs.

Dr. Dillon Caswell: Where my head is with those is that I don't use any of 'em. It kinda goes against my values, my belief system. And really what we're doing with prehab is we really wanna empower people. Our bodies have incredible healing capabilities, to the point we're doing a podcast with Nick Hughes and we're talking about some new research showing that in a small percentage of the population that the ACL can actually heal on its own spontaneously.

Dr. Dillon Caswell: This thing that we used to think had no blood supply, had no healing capability, is actually showing that it can heal itself. So now we move away from that and we go into tendons and muscle strains or non-specific low back pain in these things, and I really wanna empower people that their body was designed to heal and that it can heal.

Dr. Dillon Caswell: We just need to figure out how to get them to that point. And by relying on things that are passive, one, the evidence doesn't support that, and two, we're not giving them control. And three, okay, if you wanna use a hot pack or an ice pack or these things, you can go use that at home, but if you're coming in and paying for a session, let me give you the things to teach you of how you can take control of the self to get long-term outcomes.

Dr. Dillon Caswell: I know the argument might be made sometimes, "Well, I need something short-term to open that window of opportunity to then get into loading." Well, there's a lot of evidence showing that isometrics are a great way to do that. We don't need to do eight minutes of pulse ultrasound with a heat pack and then tens and then get the same moving. Let's get it moving right away.

Dr. Dillon Caswell: 'Cause I think what that tells the person too that's coming in is that, "This is what's fixing me, and the other stuff is just to check the boxes." We're like, no, let's change that narrative. So I actually started my career as a physical therapist assistant, and in PTA School, that's what we learned, man, was modalities. Every week we had a modality check off. I was so sold on modalities.

Dr. Dillon Caswell: I actually remember this one time, the PTA I was working with, we had two cases of plantar fasciitis that were right next to each other, and he got ultrasound going on one side, and then he started a machine on the other side. So I was doing ultrasound on two different feet and I'm like, "I'm the best PTA in the world. I'm healing healing both feet at the same time."


Dr. Dillon Caswell: And I was in PT school as I was a PTA, and we went through modalities and like, "Hey, you can turn the machine on or leave it off and get the same exact response." I'm sitting there in the back like, "What was I doing?"

Dr. Yoni Rosenblatt: That's so smart. [chuckle]

Dr. Dillon Caswell: I was like, "Ugh." To the point that I actually stepped away from that clinic and started coaching CrossFit because I was just like, "Oh, this isn't how I wanna be working with people. I need to learn more about movement, more about loading and less about modalities." But I'm interested to hear your thoughts on where you're at with modalities?

Dr. Yoni Rosenblatt: Lock and step with you. Our clinics do not have ultrasounds, they don't have hot packs. I don't have a freezer in most of my clinics. So yeah, I'm out on them. It's all about movement. Now, the interesting part is where manual therapy fits into this, and when you talk about things that I've changed my tune on is sacroiliac joint dysfunction.

Dr. Yoni Rosenblatt: I came out of graduate school and I was taught by an absolute witchdoctor. And I mean that in the highest praise. The guy was a freaking magician. But he was obsessed with sacroiliac joint dysfunction, our ability to assess it with our God-given thumbs and how reproducible that was and how valid that was. And that's what I did.

Dr. Yoni Rosenblatt: I treated like that until I started taking a ton of manual therapy education. I'm like, "Wait at a minute. Can we go over that literature again on our ability to actually assess the sacroiliac joint?" I say all that to say, those patients got better with me. When I was treating that side dysfunction. So what was it that I was doing that was making them better, and how do I double down on that stuff versus cut some of the fat?

Dr. Yoni Rosenblatt: So that's really passively, I'm a needler, I'm a dry needler. It's like a tool that you gotta be really strategic as to how you use it, and I think you use it differently based upon how the patient is presenting. And some of the research that you've done on your own to get a gauge of how well is this patient gonna do with this type of needling or that type of needling, I'll use some Russian E-stim, that's what we use, are any type of electric stim that's sitting around.

Dr. Yoni Rosenblatt: And that's really it. Grass stim is the same as my thumbs in my thought process and it's gonna prep issue maybe, but I wanna get away from that. Because of exactly what you said. Now, a challenge for me is, and I'm interested in your take, when I have a patient come in and say, "Hey, I feel better when we do the massage. So can we start with message?" Dillon, how do you deal with that?

Dr. Dillon Caswell: Yeah, it's a good point because there is evidence with manual therapy and short-term of how it can create these effects. I...

Dr. Yoni Rosenblatt: Hold on. There's another one then. If that's the case, let me give you another one. "Can we start on a hot pack? I just wanna start on a hot pack."?

Dr. Dillon Caswell: So it comes down to what's their belief system with the hot pack. What was their previous history of that injury? And maybe it was they were told before that, "You need a hot pack." Maybe their provider told them that, "You hurt your back, so put a hot pack on it." So that's been their belief system for the past 10, 20, 30 years.

Dr. Dillon Caswell: A good example of this is the RICE principle right? Rest, Ice, Compress and Ellevate. Robert Mirkin coined this in 1978. Fast forward to 2010 and he's saying, "Hey, you shouldn't be doing this anymore." 'Cause if you follow the evidence...

Dr. Yoni Rosenblatt: I love that he's saying that. I love it.

Dr. Dillon Caswell: Yeah, he's like, "If you follow the evidence, you'd see that this wasn't complete. Like this is not the answer." There's some evidence showing it may delay the healing process. But at the same time you watch movies and an athlete gets hurt, they're throwing an ice pack on it.

Dr. Dillon Caswell: So there's so many things that need to change that I completely understand why people would come in and say, "I need a heat pack." Or, "I need an ice pack." Or, "I need a massage done." Because of the belief system that has been established with that. So I always take it as, are they open to have the conversation on maybe changing their belief system and going away from that.

Dr. Dillon Caswell: It's always a really fun one to do because a lot of times we'll see people with osteoarthritis, this term that's just thrown out there a lot, and they'll be saying, "Well, I use like a joint rub, like BENGAY or Tiger Baum, and it makes my joint feel better." And I'm like, "Oh cool, then maybe your joint just needs to become hydrated, let's just dump some water on your knee."


Dr. Dillon Caswell: And they go, "Huh?" I'm like, "Right. This stimulus is not reaching down to your joint to change the perception. There's an input in your environment that then changes your brain's output. That's what's happening. So what if we change that input to something different? What if we change that input to movement?"

Dr. Dillon Caswell: "Because you can do movement wherever you're at. You might forget that tube of BENGAY one day and your knee pain is flaring up. Well, let's give you a strategy that you can use for this. Because ultimately it's the same thing with movement. Movements an input that change your output, it's just that movement can be completed almost anywhere that you are. There might be some places, like if you're stuck on a plane in the middle row, maybe not, but most places you can do movement."

Dr. Yoni Rosenblatt: Yeah, that's so educational. That's really an interesting way to put it. Thanks for sharing that. So as we wind down, I wanna know, you seem like a guy at the forefront of our field. You've done an awesome job of changing the way and allowing the way you think about patients and pathology and treatment to evolve. That is clear and evident. What are you super excited about that you're working on, that you think could push this field even further? 

Dr. Dillon Caswell: Yeah, I'm so excited, but that always comes with a dose of nervousness. But the past three years I've been working on this project and it ended up becoming a book. At first it was just my journal, it was my outlet, from how people are being mistreated. There's so much narrative that of people being told that they're fragile, that they're broken, that they can't do this activity again.

Dr. Dillon Caswell: And we just learned so much more, like we're talking around at the beginning of every patient's a neuro patient, and I've really taken that to heart. I've dove so much further into neuro than orthopedic stuff, because neuro, it tells us people's experiences, it tells us why they behave.

Dr. Dillon Caswell: And when I started working, I just, I got so angry at people suffering for long durations, and my personal mission became at first to, "I'm gonna get rid of suffering." And one of my colleagues challenged me and was like, "That's pretty stupid. Like, we need suffering." And I've come to realize we do. We need suffering, because if we don't have suffering, we wont experience full joy.

Dr. Dillon Caswell: But what I wanna change is the duration that we have of that suffering, and from that it led into this book that's called, Hope, Not Nope: Reclaiming Identity as a Lifelong Athlete in a Sick Healthcare System, and it's hopefully gonna be published here in quarter one of 2023.

Dr. Dillon Caswell: We have a couple of steps left, but I'm so excited to get it out there and just to empower people and let them know how incredible that they are, like how awesome their healing system is and how much they're capable of. And ultimately giving people back their hopes, giving people back their desires, giving people back the things that they've given up due to poor advice.

Dr. Dillon Caswell: We can do so much better, and I think the whole world becomes a better place when people are given this permission and safety to do the things that they've always wanted to do. And that's the messaging in this book. It dives into neuroanatomy, it breaks it down in simple topics.

Dr. Dillon Caswell: It doesn't go too far into neuroanatomy terms because they're very long and confusing, so we break it down into smaller terms, but then give people actionable steps to understand what creates their experience as a human. But then here's some steps that you can do to decrease your internal load to feel better and reclaim this identity as a lifelong athlete.

Dr. Yoni Rosenblatt: That sounds awesome. That is something our field needs. That's something our patients and athletes need. So I'm super excited to see that. How do we find out when that is released and published?

Dr. Dillon Caswell: Yeah, so on Instagram, my Instagram handle is Hope Not Nope, and that's where we'll be letting people know that it's published and you can get it. We're gonna have physical copy, electronic copies and an audio book. If people will wanna send me a DM from this podcast and say, "True Sports", the first three that send me that, I'll send them a free copy.

Dr. Yoni Rosenblatt: I just sent you that.

Dr. Dillon Caswell: I'm gonna send you one anyway.


Dr. Yoni Rosenblatt: I appreciate it. I mean, it sounds like a book like that, and really everything that you shared today is helping heal our medical system, and that's something that I'm excited to learn about, hear about and be a part of. Dr. Dillon Caswell, I appreciate everything you've shared. You've been awesome. Thank you so much. Can't wait to keep learning from you.


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