Jan 04, 2023
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Dr. Yoni Rosenblatt: What's up guys? This is Yoni, your host of the True Sports Pod. If you have thought about developing a specialty, a niche within sports physical therapy in your practice, this is the conversation for you. You're going to hear from Dr. Colish, who has done an unbelievable job of developing his niche within sports PT, specifically to the lacrosse community, how he did it, some of the hurdles and obstacles he overcame to set up that specialty, and also some of the downsides of setting up a specialty.
Dr. Yoni Rosenblatt: It's really a wide ranging conversation that's going to help you really get focused and as always, become a better physical therapist to the athletes that you want to treat. Without further ado, here's my conversation with Dr. Colish. Welcome back to the True Sports Physical Therapy podcast. Really excited to have Austin Colish with us today. Dr. Austin, we're going to talk about your niche in sports physical therapy. I want to know about your professional history before we start talking about your specialty in the profession. Tell us what brought you down to Baltimore and how you got started in the profession.
Dr. Austin Colish: Sure. Yeah. So, I'll start with my educational background. I went to DeSales University for undergrad. There I studied sport and exercise physiology. I got a minor in biology and psychology. Then directly from undergrad, I went into PT school at Rutgers. I'm from New Jersey originally. PT school brought me back home. During my time in undergrad though, I spent a lot of time in the strength and conditioning world. DeSales University is right by Lehigh University. I did a 300-hour internship there with the strength and conditioning program at Lehigh. I spent a lot of time in the weight room. I got really comfortable being around high level athletes. That kind of directed my path into PT but also into specifically sports PT.
Dr. Yoni Rosenblatt: Did you have a moment during that educational process when you were like, "I want to do sports PT"? Because having that strong bio background, I'm sure you could take it in a lot of directions. What was that kind of eye-opening moment for you?
Dr. Austin Colish: Yeah. I tell students all the time. I get asked this question a lot. "Hey, did you always know you wanted to be a PT?" I've never been injured. I never did PT. I didn't know what PT was until I went to PT school. And so I didn't make that decision until my junior year. I was like, crap, what am I going to do with this degree? So, yeah. No, I always wanted to be around athletes. It's something I really cared about and fell in love with but I didn't really know until I was looking at my career options. I was like, okay, either I go and get my master's in sports science or something like that, exercise science and then pursue a coaching career, or I find out about PT. I often talk about how my first year of PT school, you're learning sit to stand transfers and acute care management. I was like, what did I get myself into?
Dr. Yoni Rosenblatt: What did you think you got yourself into?
Dr. Austin Colish: I don't know. I thought it was like I was going to be in healthcare, so that was exciting. Definitely the fact that it was a doctorate program, that was super enticing as well. I just thought I was going to help people through movement. Obviously, exercise as a medicine modality was something that was really exciting to me but I didn't know what that meant and I was not mentally prepared for neuro and all those really tough classes in PT school.
Dr. Yoni Rosenblatt: And then, so at what point do you find that sports world in grad school?
Dr. Austin Colish: Yeah. This is going to sound a little self-promoting but it was you guys. It was True Sports. I think this will segue into a little bit about the topic that we're going to talk about today. It really starts from the network that I had built. It wasn't really what I had planned for. It was Musculoskeletal 1 in PT school at Rutgers. We had a TA, so she was only there on occasion to come and help out in the classes. She played soccer at Hopkins.
Dr. Austin Colish: And she knew Erica Suter, who at the time was a strength coach with Jay Dyer, who is a legend in Baltimore County and in the lacrosse world and she was also friends with Nicole Clark, who had worked with us. It was just kind of like talking through her. I was asking her about her time at Hopkins, and she shared with me that she knew some people down there and that she had heard of some people who were doing sports rehab. And I was like, well, that sounds awesome. To my exposure up to that point in PT school, all other sports rehab, "Sports medicine", it was just a geriatric clinic that they said they did sports physical therapy.
Dr. Yoni Rosenblatt: That hits home for me because that's how I started my career. I took my highest-paying gig, which was a massive mistake coming out of graduate school, and I just spoke to a patient who recently went back to that clinic that I started at. He sent me a picture of the sign in front of that clinic that still gets me riled up in the morning because it says sports rehab on it. Every day I would walk into that clinic, and I'm like, this isn't sports rehab. That certainly resonates.
Dr. Austin Colish: Yeah, no. It's something I got pretty passionate about because, again, I was leaving undergrad, feeling great. I played lacrosse in college. I was very involved in the sports world. Then again, that first year of PT school, it's like, okay, we're going to teach you really basic stuff, which is very valid. There are patient populations that need that help. That's not where my heart lied, and that's not what motivated me. But yeah, from there, I found you guys on Instagram. This was in 2018, maybe, 2019.
Dr. Yoni Rosenblatt: And so your Instagram handle at the time was?
Dr. Austin Colish: LaxNomad.
Dr. Yoni Rosenblatt: And today it is?
Dr. Austin Colish: So we still have LaxNomad.
Dr. Yoni Rosenblatt: We do.
Dr. Austin Colish: Our professional PT council, LaxRehab, obviously inspired.
Dr. Yoni Rosenblatt: Obviously inspired. So the reason I know about LaxNomad is because you obviously used it as a networking tool because I think you reached out to Jay, Coach Jay Dyer, like you mentioned, with LaxNomad. Jay hit me at that point, whatever year that was, 17 maybe, and said, who's this kid, LaxNomad, and what do I need to know about him? That's pertinent because you were developing your network already with a niche, not to be confused with niche, a niche that you saw a future to in LaxRehab.
Dr. Austin Colish: Well, no, I didn't see the future. It was just something I cared about. I just loved lacrosse, and that could be a whole separate pod about how I came into lacrosse. But even to this day, it's just something I want to be around. But I think that speaks to a greater point. I don't know that you necessarily need this massive roadmap, and I think that's the beauty of social media in today's day and age, and that's why it's such a useful tool is because I never thought I'd be sitting here in this chair across from you on a podcast three, four, five years ago. But I distinctly remember those first couple of DMs to Tim Stone, who was the Lax doctor at the time, and to True Sports PT, who I didn't know who ran that account.
Dr. Yoni Rosenblatt: I do. Yeah.
Dr. Austin Colish: But it's crazy how that network, and that just started from those small conversations with that TA, which then led me down in a trip to visit Erica Suter in Jay's gym in an attempt to meet Jay.
Dr. Yoni Rosenblatt: Was he there?
Dr. Austin Colish: He was not there. But it was also, you know, then that exposed me to you guys, and that's how I heard, hey, right down the street, oh, you're in PT school? Well, they actually treat athletes in a gym. And I was like, what? They treat and have a gym? Yeah, they have turf, and they have a lacrosse net. I was like, what? And they're all doctors of physical therapy. So that was really exciting. And again, I attribute that moment of driving down, I'll never forget, that 5 a.m. Drive, because I think Nicole's first patient was at like 7:45. So I left early that morning, spent the whole afternoon with her.
Dr. Yoni Rosenblatt: Coming from Jersey.
Dr. Austin Colish: From Jersey, met her. And then, you know, it was off that meeting, and then I can't remember if I met Tim that day. I don't think I did. I was pissed I missed him, too. But jumping forward, I was supposed to be for my third clinical rotation. I was supposed to be in Arizona. I found out two weeks before that my CI at the time had moved jobs. So I was out for a rotation. And then I remember thinking like, what am I going to do? So I hit up you guys. Hit up Nicole. Hit up Tim. Hit up you. And I was like, hey, so I need a student rotation in two weeks. Can I come down? And, I mean, that kicked things off. And I had only had that opportunity from that initial DM message on Instagram.
Dr. Yoni Rosenblatt: So a couple good points that I heard there, or interesting points. One is you could have had this grand plan to put together this niche, and you thought this would be the future of sports rehab, or at least your future. You know what they say, man plans, God laughs, right? It didn't matter if that was your plan. And I think it's hard to like, if we fast forward now five years, we don't know what's going to be available to us. So I think you're right in correcting me like, hey, this wasn't my grand plan. I just love it. So that's one piece to take home, like, follow your passion, what you love. But all I hear is hustle. That's all I hear. And that's all I've seen from you in the last two plus years since you've been working with us, more. But it's the hustle to say, I'm going to meet this person. I don't love where I am, middle of neuro, in Jersey.
Dr. Yoni Rosenblatt: At least that's the way I would have felt. I wouldn't have loved that. And so how do I find or craft something that does get my juices flowing to be excited about my profession? That's one. Two is I'm going to go anywhere. I don't care if it's Baltimore. I don't care if it's a random gym. I don't care if the coach who I went to see isn't there. That happened again with PT. Like, you didn't get to meet Tim. But you keep hustling. You're in the car for two hours. You're just going to make it happen. You got to take those leaps in order to get you, in order to set yourself apart. We get tons of DMs. Everyone does, right? Everyone is so accessible now. How do you make yourself stand out? That's one thing I heard that's hustle. Is there anything else that you would say made you stand out from the pack?
Dr. Austin Colish: From like a professional standpoint?
Dr. Yoni Rosenblatt: I'm happy to hear personal, but yeah, let's stick professional.
Dr. Austin Colish: Yeah, no, I think it just goes back to topics you've touched on this pod before but...
Dr. Yoni Rosenblatt: I'm sure there are a lot of first-time listeners, so remind us.
Dr. Austin Colish: Yeah, no, internships. Like I said, I spent a lot of time in the weight room at Lehigh. I did like a 300-hour plus internship there. I learned a ton from those coaches and I think just being open to different opportunities. I think a good example in recent memory is things that Deemer has done where he's had shooting clinics or events like that just popping in. I think that's worthwhile too as a clinician. You can't know everything and there's a lot of good professionals who have different experiences, who approach movement differently, and I think just being a sponge and taking all that in.
Dr. Yoni Rosenblatt: I like the way you've developed these experiences that are adjacent to your specialty. I joked with a total joint surgeon. He called physical therapists ortho-adjacent, and I really took offense to that. That really pissed me off. But in this instance, this primary silo of sports physical therapy, but you're surrounding yourself with all these adjacent specialties, right? Strength, coaching, the Deemer classes of the world, the strength world with Jay or within Lehigh. I think that makes you a really strong kind. I love seeing that.
Dr. Austin Colish: Yeah, no, totally. In PT school, really after deciding to not quit after hearing about you guys and seeing that there was a light at the end of the tunnel, that's kind of where I doubled down. I got my personal training certification. I pursued the CSCS. I did strength and conditioning as a personal trainer in PT school in a garage gym type of setting. And then I also coached high school lacrosse. So I took my first coaching gig and all those things make me who I am today as a clinician. I think that helps relate with the patient population that I see. But again, that just makes you a little bit more diverse and allows you to help speak to what we do every day.
Dr. Yoni Rosenblatt: Let me tell you what else I think it did for you is gave you this awesome team concept as a leader, as a leader on the team, but also a member of the team. So walk the audience through your path, your career path once you got down to true sports.
Dr. Austin Colish: Yeah, I mean, it's been a crazy ride, but I graduated 2020 right the midst of the pandemic. So my last clinical rotation actually was cut like two weeks out. Then we were all home. I didn't get a graduation. We graduated via Zoom and...
Dr. Yoni Rosenblatt: You didn't miss much. [chuckle] Go ahead.
Dr. Austin Colish: So, yeah, no, graduated in May. And then, you know, after I took boards early to kind of be ready to rock and roll, I think it was like a week or two after that Zoom graduation. I got on the phone with you. We talked about kind of what that would look like of me come down here.
Dr. Yoni Rosenblatt: I'm going to make you back up because you do your rotation here when...
Dr. Austin Colish: That was, it was my third rotation. So, yeah. And going back to what we talked about, like the "sports medicine." I did a three, four month rotation here with, to this day, some of the best clinicians I've learned from and had the opportunity to be around and then went back home to a minor league baseball facility in Bridgewater, New Jersey. I thought that was super exciting.
Dr. Yoni Rosenblatt: Well, you're a baseball guy.
Dr. Austin Colish: I'm definitely not a baseball.
Dr. Yoni Rosenblatt: Should be, though.
Dr. Austin Colish: But I was super excited to continue to work with athletes, even if it wasn't lacrosse players. And I found out it was connected to a hospital network and it was just all post-op like knee replacements. And it was just a feeder program. So we didn't actually get to see any of those guys.
Dr. Yoni Rosenblatt: That sucks. Before you leave the rotation at True Sports, you make a point to try to get a meeting with me.
Dr. Austin Colish: Oh, I demanded it.
Dr. Yoni Rosenblatt: You demanded it.
Dr. Austin Colish: I demanded it.
Dr. Yoni Rosenblatt: Frustratingly so.
Dr. Austin Colish: I remember telling everyone who would listen to me, I was like, hey, I got to sit down and talk to Yoni. Because prior to that, the only other time I had interacted with you was at the quarterly. I walked into Timonium and you go, LaxNomad. And then that was it.
Dr. Yoni Rosenblatt: That's not true because I remember I think co-treating Deemer class with you at some point.
Dr. Austin Colish: Oh, yeah. Me nerding out probably.
Dr. Yoni Rosenblatt: There you go. Okay, so we sit down before you leave your rotation here, 2019-ish. And you say what? What's the point of the meeting?
Dr. Austin Colish: I just wanted you to know that I was really interested and impressed with what you've built and I wanted to be a piece of it. I think that was like the biggest thing.
Dr. Yoni Rosenblatt: And super valuable because that sticks in the back of my mind as someone doing the hiring at that point to say, okay, great student. Heard great things about you from your CI. Followed your story a little bit, obviously enough to know your Instagram handle. And then it gives some color to the conversation that happens later, which is, do you want to come here and work? So I think that's totally worthwhile and valuable is the sit down, the face to face, make a connection. That seems to be what you're really good at.
Dr. Austin Colish: Yeah. And I think I've had a lot of success from that, part of that is making the effort to do it. I think part of it just being right place, right time. Something you said to me in that meeting is something I pass down a lot to people that I'm interviewing now for us at True Sports. And do you remember what that was? It was like the last thing you said to me.
Dr. Yoni Rosenblatt: That I said to you?
Dr. Austin Colish: Yeah. Yeah. In that meeting before I kind of went back to do my final rotation back at school.
Dr. Yoni Rosenblatt: Don't screw it up?
Dr. Austin Colish: No, you do say that a lot, though. You said stay relevant. And that really stuck with me. And it's something I tell people all the time. I think that just speaks to the hectic world we kind of live here inside this little bubble, but I think it's important. I think if you care about something, you got to keep chasing it down.
Dr. Yoni Rosenblatt: So what does stay relevant mean to you?
Dr. Austin Colish: Well, in that context, it was probably just like sending you DM still through Instagram as I finished up school. But to me now, whatever that looks like. Right? And I think there's probably an art to that. Like you don't want to be overzealous about it and be annoying, which is certainly a thing. But whatever that means, email, text, Instagram, I think social media, again, lends itself as a platform today to make it so easy to get connected. And it's a complete disservice if you're not utilizing that.
Dr. Yoni Rosenblatt: Yeah, I think you got to utilize that. You're exactly right. There's a serious art and it's really psychology of how do you stay relevant? How do you stay in touch? How do you stay front of mind without overdoing it? And so I'll tell my patients, you text me once, maybe you get a response. Just make sure you hit me a second time. And continuing to try to double down on that. In the social media world, it's maybe you comment on a post, maybe you do a DM, maybe whatever it is. But it's like these light touches to stay top of mind. They say in the financial world, before you make a sale, it's nine points of contact. Nine. So a financial adviser who's probably listening to this pod has to hit their target audience nine times before they say, yeah, I want to give you some money and invest with you. That's a huge amount of points of contact.
Dr. Austin Colish: For sure.
Dr. Yoni Rosenblatt: Right? But make sure you're hitting a few because like you said, it's a hectic world. So coming back to you developing your niche. What was the first thing you did when you put boots on the ground? You're employed here in our Timonium location at True Sports to say, hey, I'm the lax guy. I want to treat the lacrosse world. What did you do?
Dr. Austin Colish: Yeah. Well, one, I had to familiarize myself with the MIAA. I remember on that offer letter to me, you said like, welcome to the MIAA. I had no idea what that was. I was like, what is that?
Dr. Yoni Rosenblatt: But you took it anyway.
Dr. Austin Colish: I knew what Boys Latin was.
Dr. Yoni Rosenblatt: There you go.
Dr. Austin Colish: I knew what Calvert Hall was. And that's just from being in and around the lacrosse community. I actually didn't understand what that meant contextually. And I didn't understand geographically where Timonium was and its proximity to all those schools in the area. And it was only after maybe that first month or two and after having my hundredth lacrosse eval that I realized, okay, this is what Yoni was talking about. And this is why he kind of saw me for that location. But, yeah, I think it was the first six months I was just trying to get my feet underneath me and clinically making sure that I was sound. I had a great team around me in Timonium. Shout out to Chelsea. We miss her dearly.
Dr. Yoni Rosenblatt: The goose.
Dr. Austin Colish: The goose. And I think having a great team helped me do that. But then kind of sitting down and thinking like, okay, well, how can I make sure that my entire patient caseload is the lacrosse individuals I want to see?
Dr. Yoni Rosenblatt: We're going to dive into that because that's such an important piece. You sitting down and being intentional and deliberate and meaningful with your next actions is gold in and of itself. I wish I saw that more. I see it a lot, but I wish I saw that more. Sit down, figure out what your ideal schedule is and then attack it after you've covered the basics.
Dr. Austin Colish: Yeah, no, I think that is only like you allow those opportunities just basically based off of how we do our workflow and our work schedule, though. Right? If this was a different work situation where I didn't have as much flexibility in terms of who I could see or who I could bring in, and it was just like, hey, you punch and you punch it. You treat, you treat. I think kind of having those tools to play with allowed me to be successful in that regard. But yeah, I was seeing three or four lacrosse kids a day and I was like, man, I love this. And being able to put a stick in someone's hands and integrate that into their rehab. So, yeah, and my idea was like, okay, well, I've had success through Instagram. Let's just make a professional PT account.
Dr. Yoni Rosenblatt: And right then, LaxRehab is born.
Dr. Austin Colish: LaxRehab is born. Yeah.
Dr. Yoni Rosenblatt: And you start doing what with LaxRehab?
Dr. Austin Colish: Yeah, I think just so much of like how we treat at True Sports is we just inherently have a ton of videos. Our home exercise programs all done through our own app that we have videos. So I had a ton of videos of my lacrosse players. And if you scroll back to some of my earlier posts, it's just like if anyone was doing anything athletic in that lacrosse world, I was just posting and making reels, making posts about that. So, again, I didn't really have a clear vision of what that would grow into or what that would become. But it's I understood that there is a process that you just got to start, just put content out and kind of go from there.
Dr. Yoni Rosenblatt: And good content, I would put focus on. What I love about your content is that it's not just putting a stick in someone's hand and having them stand on a BOSU, although that shows up. It's purposeful lacrosse content, understanding what it means to split dodge, to roll dodge. How do we put that into an exercise program? How do we capture that appropriately? Early on in my career, very honestly, especially when I started treating lacrosse because I didn't know the sport, it was more the former rather than the latter. I think you've helped me understand the latter. What are those specifics of the sport and how do we attack them with therapeutic exercise? Did you struggle with that early on?
Dr. Austin Colish: Yes. And I think part of it is like the lacrosse brain that knows the skill side of it, but also the biomechanic side of the rehab side. And it's just kind of like... It's practice to be able to blend those two together. But I would make the argument, even if you don't know lacrosse, in order to be a very good sports PT, I would make also the argument, in order to be a good PT, you need to know biomechanics. Humans can only move in a select number of ways. Granted, there's a lot of different variations of that.
Dr. Yoni Rosenblatt: There are a lot of ways.
Dr. Austin Colish: But if you can understand, okay, how do you throw a ball? If you can understand how someone throws a ball, a football, a baseball, you can understand how someone shoots a lacrosse stick, more or less. So I think it starts there.
Dr. Yoni Rosenblatt: I think that's well put, thankfully, because I'm a baseball guy and I took all my baseball world and tried to apply it to lacrosse. Just so people understand, when we talk about MIAA and Calvert Hall and Boys Latin, these are prep schools within the Baltimore landscape. It is, lacrosse is Baltimore's football.
Dr. Austin Colish: For sure.
Dr. Yoni Rosenblatt: Right? And high school lacrosse here is high school football in Texas.
Dr. Austin Colish: 100%.
Dr. Yoni Rosenblatt: It's the same thing. And so just understanding the level is important, but also the expectations on these athletes. How quickly can we get them back? How can we move them along? Everyone's looking at D1. Kids who don't start on their high school team are getting D1 offers to play lacrosse across the country. So just understanding the level of athlete that you walked into. That's what I meant by MIAA. Coming back to the clinical side. What are some of the pearls that you picked up that you want to share with the next generation of lacrosse specific physical therapists?
Dr. Austin Colish: Yeah, I mean, I think, again, it doesn't just apply to lacrosse. If you care about basketball, if you care about football, whatever your sport is, I mean, I've treated a professional ultimate frisbee player. Like, I don't really know ultimate that well. But again, I understand rotation that's required through the human body. I think you got to figure out what your group is and then see how you can integrate yourself in that community. Again, not everywhere is going to be the X sport hub, right? Like that's... Baltimore's definitely that for lacrosse.
Dr. Austin Colish: That's why I came down here is because I want to be around that. But I think if you can find like what that community is, integrate yourself into that. And I think you have to coach. I think coaching is a piece of that. I think playing is great. I don't know that it's a requirement. It definitely helps. I know that that's a big piece of when I have a initial evaluation, when an athlete comes in, I make it a point to say, what school do you play for? What position you play? What hand are you? I think those little things speak to, hey, okay, this person who's sitting across from me in this clinical setting understands.
Dr. Yoni Rosenblatt: I think it helps with understanding. Don't make it just lip service. What position do you play? What's your dominant hand? Start creating, what's the rest of that session? Maybe it comes back up. In comedy they call it a callback, I think, where it's like you can make a joke and then come back and reference it later. And it really lands beautifully. Same thing that when you take that athlete, say it's an ACL, what hand are you? Which side do you like going to towards cage? Okay, even if it's not that visit, maybe it's three months down the road. Hey, you know, I know you're a left hand dominant. So that means you're going to want to dig this right leg into the ground and shoot left. And because of that, we need to do this exercise. That's beautiful.
Dr. Austin Colish: Yeah, no, I agree. And that's something that I utilize a lot, especially for that end stage ACL patient. Also having like that mechanism of injury is huge, too. So, unfortunately, a lot of times when these lacrosse players come and see us, they're at a recruiting event. So there's video of it. And I think actually being able to have that video and I always make it a part of my return to play end stage rehab. I need to put that athlete in that position again. A lot of times it's like that super high speed split dodge or something like that. And we spend a lot of time working on that because I need to know that when you're out of the clinic, out of my eyes on the field, I need to know that you can do that confidently.
Dr. Yoni Rosenblatt: I love that you were going back and watching video, to your point, I bet you you watched ultimate videos when that ultimate Frisbee player came in. I know I work with a ton of very high level specialists in football. I can't tell you the amount of video I have watched on punters. I've never punted a ball in my life, at least not well. But to understand the drop, to understand the angle of the ball, to understand where you want those laces. But by the way, and this... Hopefully people who are listening have heard this on the pod, long snappers, I mean, there are... How many long snappers are in the world? I've treated a few very high level ones. Understanding that, how many rotations, where should those laces be? What does the arm need to do? What does a dominant arm need to do? What's the non-dominant arm need to do? What type of hip hinge has to... All this stuff. Then there's blocking. What leg do you step back with? This whole world like to really get into the weeds. That's where experts are made.
Dr. Austin Colish: Yeah, for sure. And that's something I found an appreciation for when I did my student rotation here, because I think a lot of our clinicians think that way. And I think that's a product of kind of like what we push for here. But again, it's to your point, that's how you become a good clinician. It's not just, okay, do a leg raise, do a squat. It's okay, well, no, we're going to do this sideline hip abduction. Your pelvis is going to be rotated anteriorly. You're going to get into a little bit more hip extension. Don't roll back. Those little details go a long way clinically, I think.
Dr. Yoni Rosenblatt: I think they go a long way to building relationships. I think they go a long way to outcomes.
Dr. Austin Colish: For sure.
Dr. Yoni Rosenblatt: You got to mind the details. That's super important and obsess over those. I love that. But going back to my question of what you learned here, I wanted to know clinically, what did you learn to treat the high level lacrosse player? Not just building a network, marketing, but clinically, what light bulb has gone off in your head in the last year or so?
Dr. Austin Colish: Yeah. Again, I think it's being able to look at how the experts in the sport are teaching those movements. So, like Jules Heningburg, someone I follow a lot, he has his Juke Lab. That's like his content online. He teaches like a split dodge, a jab step a lot. He's not using biomechanic language, but I can turn on my PT brain and see, okay, what are they actually teaching? And then think about, okay, how does that relate to my patient who's six months out and needs to be able to do that in three or four months in a high level competitive environment? So, again, I think it's just like being able to be a biomechanist. You got to look at human movement and think about, okay, how does this apply to my athlete?
Dr. Yoni Rosenblatt: Ready to get in the weeds? Jules is working on that. Give me an example. He's teaching what?
Dr. Austin Colish: So, one of the moves that he talks about a lot is a jab step.
Dr. Yoni Rosenblatt: Okay, great. Jab step. Jules is teaching a jab step. You have an ACL that walks in, they're three months post-op. A jab step means... How would you break that down as a biomechanist?
Dr. Austin Colish: Yeah, so it's essentially like a 45 degree lateral step.
Dr. Yoni Rosenblatt: Okay, what's at 45 degrees?
Dr. Austin Colish: Their...
Dr. Yoni Rosenblatt: The foot placement is 45 degrees off their pelvis?
Dr. Austin Colish: Yeah.
Dr. Yoni Rosenblatt: Okay, what's their shin doing?
Dr. Austin Colish: They're getting into like a positive shin angle. So, anterior translation of the tibia.
Dr. Yoni Rosenblatt: Okay, I love that. And so, they're 45 degrees off their alignment of pelvis. They're sitting at a positive shin angle. How are you going to translate that into an exercise in that session three months post-op ACL?
Dr. Austin Colish: Yeah, I mean, three months.
Dr. Yoni Rosenblatt: Six months, ten months.
Dr. Austin Colish: Yeah, sure. Yeah, no. I think, again, it's... And this is a lot of how I structure my Instagram videos is, okay, hey, what's the end movement? And then how do we piece that up to kind of deliver into that? I think from a clinical standpoint, start with the basics, right? Isometrics, can you hold that position? Can you get into a low lunge? Can you get into a single leg squat position and hold that? Can you feel that movement? Can you move through it eccentrically? Can you move through it concentrically? Can you do that with power? Can you do that with load? Can you do that with an open environment?
Dr. Austin Colish: Can you do that reacting off my hands? Can you do that reacting off my voice? Can you do that reacting off a ball? I think there's like a lot of different ways you can build that up. But again, a lot of those principles are like... That's not different than how a strength coach would teach some change direction stuff or even load someone. If someone's never lifted before, you're not going to put 3000 pounds on their back with a barbell back squat and get them to move body weight. Then you're going to load them through like a goblet squat and then go through there.
Dr. Yoni Rosenblatt: I love that. I hear different angles of resistance that they need to both control and produce. And I think I've seen you do it beautifully in the clinic of how do we mimic that jab step and how do we mimic it and let the patient and the athlete own it, get confidence in it, and also just have the robustness of tissue to withstand it? I think that's what you're describing. And the way you peel that back on your Instagram, but also in the clinic, is really beautiful. Are there other influences? You mentioned, Jules, are there other resources that you would say to a burgeoning lacrosse specific clinician that they need to go in and research?
Dr. Austin Colish: Yeah. And I love to think that there's all these like super hungry lacrosse PT's out there. If that's the case, please DM me and let me know because I'd love to create a network.
Dr. Yoni Rosenblatt: It's LaxRehab, right?
Dr. Austin Colish: LaxRehab. But I think, I don't know that lacrosse is there yet in terms of having this massive amount of resources. I know this is conversations we've had before off the pod just about how much infrastructure there is for something like baseball or something like football in terms of, okay, if I'm a pitcher, I want to get really good at pitching. What do I do? You can easily go online, find a whole strength and conditioning program for that. You can easily go online and find rehab programs for that specific to baseball players.
Dr. Austin Colish: I would love to get to a point where we have that for lacrosse players. In terms of resources, I think a lot of the lacrosse community is baked into the idea that you have to give back and you have to grow the game. And I think there's a lot of people who either are... They have strength backgrounds, they have coaching backgrounds, and you'll see a lot of these players who go and have 10 year careers playing pro and then they're coaching. So being able to tap into those are massive resources.
Dr. Yoni Rosenblatt: I love that. I think you're right about baseball. But 20 years ago, I would assume, believe it or not, that was before my time. I would assume that wasn't there. And so it had to be created, created probably like guys like you. You look out and you see the Mike Reinold's of the world, the Eric Cressey's of the world. These are known clinicians and professionals that you know and you're a lacrosse guy. Right? But but they became these upper echelon providers. I think we're starting to see that in lacrosse world. There's no question about it. I think it's guys like you. I think it's guys like Tim Stone. I think it's Deemer Class and Matt Dunn. Yeah. Jay Dyer of the world. I've had awesome conversations about movement analysis, film breakdown with Cookie Carr. She's a player/coach and an excellent at all of those. Are there other clinicians that are doing what you do that I missed in that summary? Jules.
Dr. Austin Colish: Yeah. I mean, Jules is part of it. I think the Faceoff Academy does a really good job of, again, taking a super specific lacrosse position. And that's like all they do and that's from the minds of like Greg Gurenlian and Jerry Ragonese. Those guys are super instrumental. And again, by the way, also accessible on social media. I've interacted with those dudes a ton. I think, again, part of that's just the lacrosse community. I lose my mind whenever we have a pro player come in and everyone's like, who's this bum? Right? And then meanwhile, an NFL guy, I'm like, oh...
Dr. Yoni Rosenblatt: Who's this bum?
Dr. Austin Colish: This guy plays sports.
Dr. Yoni Rosenblatt: Yeah. And but that's okay because you're so passionate about it. I think it's true in other sports also where guys are that involved in giving back. And I see guys get into very high levels rapidly. There was a guy who pitched on the Israeli national baseball team. His name's RC Orlan. He made it up to triple A. I think with the Indians organization, finished with baseball really quickly. High level coach, opened up his own facility down in Virginia. And you see this with lacrosse also. And I think it's because things are so accessible.
Dr. Yoni Rosenblatt: I think guys like Deemer, guys like you, guys like R.C, they're so humble that it makes it very easy to go out and try to gather as much information from people who are just totally interested in paying that forward. I mean, we've had some big names on the pod who are these PT titans that are just interested in talking about what they're so passionate about. I think it plays into both pieces of this conversation, which is building your network, but also building your clinical skill set. So accessible these days. Now that you are the LaxRehab. Give me a negative of creating this niche if there is one.
Dr. Austin Colish: Yeah. So, I'm of the mindset that if you're good at everything, you're great at nothing. So I actually think specialty is great. And I often tell patients that you should be selective of your health care provider in any facet and you should be able to ask questions and they should be able to have answers for you. I wouldn't want to get my ACL repaired from someone who does shoulder replacements all day. I think the same idea can be applied to the world of rehab. So I'd make the argument. I don't know. I love seeing lacrosse players. I think I'm pretty good at it and I'm pretty content in that way. I think a downside of owning that niche and feeding it is just the social media side. And I think that's like all consuming. I mean, there's not a day that doesn't go by where I'm not scrolling or refreshing or looking at my phone. I would say that's probably the biggest drawback.
Dr. Yoni Rosenblatt: Yeah, but that makes you American. I think everyone's doing that.
Dr. Austin Colish: Yeah. Yeah.
Dr. Yoni Rosenblatt: So I'll give you a drawback. I'll play devil's advocate. I'll play overbearing business owner. Austin, stop with this lacrosse crap. I need you to see everyone. I can't have you just specialize in this very small subset, even in Maryland. I need you to see the knee replacements. I need to see the low back pain. ACL patients that play lacrosse can only come in from three to eight. I need you to be busy from 10 to three.
Dr. Austin Colish: Yeah. I'd make the argument that it's not just those high school guys. I see college men and women's players as well as the pros. But I think those skills translate. Like, yes, I treat a lot of lacrosse players. But being able to talk to a patient, I think, again, goes back to just being a good clinician, being able to listen, be empathetic. That applies. So, I do treat more than just lacrosse. But I don't know that that's necessarily a bad thing in that, again, a lot of those skills translate to other sports as well, so.
Dr. Yoni Rosenblatt: At the end, I think it's how you sell it. Right? It's how you relate it. So I think that's a good counterpoint. Obviously, one I agree with. But for the sake of argument. Okay, how about this? We live in Maryland. We have two, three, four clinicians that already specialize in lacrosse. They've done it at the highest levels. Austin, I need you to see other sports, baseball and soccer. Stop with this lacrosse crap. Your counterpoint.
Dr. Austin Colish: I'll treat them too. I mean, I can. It's that's not... It's just again, I think there's a difference between my passion and what kind of pushes for the social media drive. Again, social media is not the only thing that's generating business. It's largely a passion project, and I think it helps promote True Sports as a greater entity. And that is more of the impetus behind that. But I've treated many soccer, football, basketball players. I will continue to do that.
Dr. Yoni Rosenblatt: I know you have. I'm just playing a part. Here's what I love about lacrosse as an outsider. I didn't... You've seen me handle the stick. Very few have.
Dr. Austin Colish: Makes me so nervous every time you pick up mine. [laughter]
Dr. Yoni Rosenblatt: It makes me nervous, too. We're not alone. My patients are also terrified. But here's what I love about the sport. And here's the way I would sell it, that lacrosse specialty. It's this awesome combination of size because there's some big ass dudes on that field. And they're hitting. Strength because of that hitting piece. Then there's this crazy component of soccer where it's just endurance, guys are on the field, especially in the international game for minutes upon minutes upon hours.
Dr. Austin Colish: Yeah. It's crazy.
Dr. Yoni Rosenblatt: It's crazy. Then you have these... You have to cover large swaths of turf rapidly. So it's speed. So that gross motor. And then it's this crazy fine motor of... Especially with a long stick, knowing where that thing is, knowing where the ball is moving and be able to throw that stick up in the air and intercept a pass or put touch on it as you throw it cross field, it's this crazy amalgamation of athletic endeavors and skills. If I can rehab that, Yoni, I can rehab anyone. You're telling me you you're a pitcher and you stand in a circle and it's totally repeatable every single time. And you have some shoulder pain. Dude, I just rehabbed a guy who's 6'4, 220, runs like a deer with crazy fine motor skills to be able to shoot like trying to shoot stationary on the run. I got this whole pitching thing. Send me your baseball players. And that can be applied across a million different types.
Dr. Austin Colish: Right. No, I agree. I totally agree.
Dr. Yoni Rosenblatt: Of course you do. It's just another piece of what I do with sports because I walk into orthopedics specialists and say, if I can rehab the professional athlete whose life and salary and family's well-being relies on his ability to perform physically, I can handle your rotator cuff repairs.
Dr. Austin Colish: For sure. And that point is that scaling, being able to progress regress, again having a foundational understanding of like what is this patient's goals? Where are they clinically and functionally? And then being able to either, okay, the exercise was too easy or too hard and adjust from there. I think that's the same in sports, it's the same in life. And I totally agree with that.
Dr. Yoni Rosenblatt: What's the future of lacrosse rehab? What's next?
Dr. Austin Colish: Yeah, that's a great question. I think, kind of like I mentioned previously, being able to grow sports performance, but also sports rehab as the sport is growing. I mean, we've seen a ton of change in the last three, four years even with the inauguration of the PLL. So we have now this massive new professional lacrosse league that has signed on with ESPN, you can go on TV and watch lacrosse games. Growing up it was a struggle to find film to be able to watch it. I grew up in the YouTube era, so I had that thankfully. But I wanted to be able to just in the same way that everyone else, the rest of America sits down Sunday night to watch a football game, I wanted that for lacrosse.
Dr. Austin Colish: So I think as the sport continues to grow and as we get more players involved, we get more coaches involved, I would love to create some form of network or contribute to that in terms of rehab performance, player skill acquisition, whatever that looks like. I think we need more resources for those players. I see it a ton here in Baltimore. But again, I'm only so passionate because where I grew up in New Jersey, my hometown didn't have a team. That's where the name Nomad comes from, because I was traveling everywhere just to play a game. So I think we have a little bit of that mis-balance in terms of those lacrosse hubs like New England, Long Island, Baltimore. There's a lot of lacrosse there. But the rest of the country and the rest of the world kind of needs to catch up. So I think kind of continuing to push that along.
Dr. Yoni Rosenblatt: I've seen you do that nicely in your own, in your own backyard, integrating yourself with great strength coaches and adding this rehab component, prehab injury prevention or minimization to those offerings. I could totally see that spread out. What about clinically? What's the next step for the lacrosse rehab community?
Dr. Austin Colish: Yeah, I think we need... I don't know if it's a protocol, but I have a running list on my phone of like big to do's. And one of the first things I wrote on there was like, damn, I need a upper extremity return to shooting protocol.
Dr. Yoni Rosenblatt: What are you working on? What do you think that is now?
Dr. Austin Colish: Yeah. I mean, a lot of it's just like referencing protocols that exist already. Again, we have pitch count progressions for baseball. We don't have that for lacrosse. I would love to develop some type of low back thing. Again, now we're talking about more of the research side. I'm not a researcher. I don't really have interest in that. But I understand the need for that clinically to be able to have evidence based practice and being able to apply that to our athletes.
Dr. Yoni Rosenblatt: You're not far from a researcher. I think people make a mistake by saying research, you got to be wearing lab goggles and a coat and sitting in a lab somewhere doing research. I think you have a larger sample size than ninety nine percent of the clinicians in the country. So I wouldn't sell yourself short there. It's also when we look at the throwing protocols, research, I mean, experience. But research, like, do we know that two sessions of light throwing is better than one longer session of light? I don't know that that has been empirically proven. So don't sell yourself short there. If you're returning to shooting after knee, hip, low back, shoulder injury, what's the protocol you currently use?
Dr. Austin Colish: Yeah, I think a lot of it's individualized on the patient. Obviously, it depends. It's whatever presentation they're on, but it's all a volume dosage, I would think, for the most part, especially considering low back stuff or even ACL. Again, you have to hit those prerequisites in terms of is your knee stable enough? Are you strong enough? Do you have enough single leg stability, neuromuscular control to do that? And then it's okay, we'll not just go shoot for an hour and a half. It's okay, let's dose it small. The same way you would add weight to your barbell back squat. Sometimes it's like, okay, let's start with the bar. Is that 20s? Let's see what that looks like.
Dr. Austin Colish: Again, having that communication with your patient of how does that feel? Is it easy? Was it hard? Was it medium? I'm constantly asking those questions because I think so much of the therapy session, but also, again, on a mesocycle almost, over the course of three weeks. How did you feel doing this activity? How did you feel shooting today versus when we first introduced it two, three weeks ago? I think having that constant communication and I think in the world of rehab where we have such strong relationships with our patients, we're able to do that.
Dr. Yoni Rosenblatt: Give me more levers to pull. You said volume basis. So I've heard you reference a bucket of balls. You walk out to the field, you take a bucket of balls. Your knee is stable. Your spondy is solid. Your cuff is healed. Where do you start?
Dr. Austin Colish: Yeah, I mean, let's start with one to two.
Dr. Yoni Rosenblatt: One to two buckets of balls. How many balls is that?
Dr. Austin Colish: Depends on...
Dr. Yoni Rosenblatt: Okay, how many shots do you want them to take?
Dr. Austin Colish: Probably like, let's call it 25, 50.
Dr. Yoni Rosenblatt: Let's call it 22. So you go out and you take 22 shots. What are the other levers you're pulling with that?
Dr. Austin Colish: Yeah, so more times than not, I'm going to have them start stationary. And I think there's a lot of worthwhile time, again, for your lacrosse athlete, especially if they're post-op. Again, as long as you're not breaking any protocols, I want a stick in their hand because I know how important that is for the athlete. And even if that's you're in a cast and you're sitting next to a wall, throwing against the wall, I think that's important. But when we go back to the shooting progression, it's stationary. Right? Let's remove all the other stuff. You're not getting feeds from anyone. You're just working on placement. Or maybe you're working on the rotation and we're going to work out like a 60% shot speed.
Dr. Yoni Rosenblatt: Now we're talking, kind of effort.
Dr. Austin Colish: Yeah, a lot of that's determined by the individual. Right? So, yeah, effort, things like that. And then you just, again, add in variables. You add in those different principles. So shooting on the run, I think, is a way more complex movement than stationary shooting at 50%, obviously. So adding things like that, a lot of times thinking about my ACL patients, I'll go through a progression of linear running. Then we'll add in some of that lateral movement. We'll add in some of those change directions. So that 45 degree angle jab step, that will progress us into dodging. And then at that point, if you're dodging, you should be able to shoot. So then it's okay, well, let's shoot one day. Let's dodge one day. Let's have a day where we kind of combine that. Once I feel solid that they can do that clinically and safely, okay, now we're at the stage where our clinical goals have adjusted a little bit. You're going to be doing that on your own time outside of the clinic. Kids love that.
Dr. Yoni Rosenblatt: They do love it. Athletes of all levels love that. You hit what I wanted to hear, which is that effort level. It's what we talk about in terms of velocity. We also know that athletes very consistently want to talk about research over judge how much effort they're putting in. Let me rephrase that. They think that they're giving less than what they're throwing, so they under judge it. So when you go out and say, hey, I only want you to throw 50%. If you're looking at a gun, they're actually giving you more than that, even though they think they're at 50%. So just like an important tidbit, again, pulling from our baseball world and applying it to the lacrosse world. Eventually, I think, every cage will will have some type of radar gun on it that can measure velo.
Dr. Austin Colish: You think so?
Dr. Yoni Rosenblatt: I do. It should. Do you think it should?
Dr. Austin Colish: Yeah, that'd be great. That'd be a great statistic.
Dr. Yoni Rosenblatt: They're so affordable. They're so affordable at this point. It's everywhere in the baseball world, your pocket radars. Every pitching coach has one. I think that will help in the rehab side. Also in the performance. I know it's not everything, but it's a piece. I also think there are really awesome, super affordable ways to track movement in the pitching world that need to cross over to the lacrosse world. And I think stick path like we look at bat path can also help measure effort velocity of the instrument in your hand. How how valuable of a tool that would be?
Dr. Austin Colish: I think it's valuable, but the sport's just different. I mean, you see guys like Jeff Teats of the world who are just freaks in the way that they can handle the stick and put the ball in the net. It doesn't matter where they are on the field. Doesn't matter how hard they shoot.
Dr. Yoni Rosenblatt: That's... I totally agree with you. I'm not talking about assessing an athlete's abilities. I'm talking about returning an athlete to field.
Dr. Austin Colish: For sure. Yeah, no, that's that's definitely important. That's something that, you know, even we're looking into in terms of like the force plates and stuff. All that is definitely valid.
Dr. Yoni Rosenblatt: And I think that's the next stage, making it simple. Like if I had a nickel for every time I had a conversation with a sports scientist and they just start talking like we're sports scientists as opposed to sports rehab clinicians like give us the nitty gritty, make it simple, make it easily digestible to us and also to the athlete. I would love to see that. I think that would be the next stage of lacrosse rehab. What's the number one mistake you see sports PTs make when rehabbing a lacrosse athlete?
Dr. Austin Colish: Oh, that's a good question. I think something that could be improved again is understanding their position and the demands. I've seen this a couple of times where you have a close defenseman. And for those of you who don't know, they're the big dudes with the long sticks and they only play defense, working on like dodging mechanics or shooting. Yes, they're lacrosse players. They should be able to do that. That's not their goal. That's not their job. But again, that comes down with your subjective assessment day one at your initial evaluation. You got to know what they do and what their roles are.
Dr. Austin Colish: And again, even if you don't know lacrosse, that's a super easy Google search. So I think having like a good understanding of what the positional demands are would be one. I think another one is like, yes, I do love putting a stick in the athlete's hands. But in my mind, it's earned. It's usually at the end of session. There's usually a BFR cuff on and there's a little bit more intent behind that. It's not okay, we're just going to kill time and pass or put a stick in your hand. I think there's a level of importance behind your intent of like utilizing something like that, especially in the clinic.
Dr. Yoni Rosenblatt: I've seen you do a really good job of incorporating stick, the ball, because it changes the way the athlete organizes motorically. And so if their focus is on catching that pass, are they able still to control their valgus angles?
Dr. Austin Colish: Yeah. And you'll see like a lot of times, again, with my ACL patients when I'm doing that, yes, I'm catching a throwing, but I am laser eyed onto their knee, their hip, their torso and see what they're doing, because then that kind of helps me prep for, okay, what's their landing strategy? How does this athlete prepare for movement when they're not thinking about what the hell their knee's doing?
Dr. Yoni Rosenblatt: Yeah. What else is on your list of really important things on your phone? I'm dying to know.
Dr. Austin Colish: Yeah, we could talk about that.
Dr. Yoni Rosenblatt: What does it include? That sounds ominous. What else is on there?
Dr. Austin Colish: No, it's just...
Dr. Yoni Rosenblatt: That you don't want to share with the audience.
Dr. Austin Colish: It's just a list of to do's like all the notes I have to write.
Dr. Yoni Rosenblatt: Okay. And?
Dr. Austin Colish: Yeah, I'm trying to think.
Dr. Yoni Rosenblatt: There's no recipe on there.
Dr. Austin Colish: There's definitely recipes.
Dr. Yoni Rosenblatt: Which include? And for those of you not watching on YouTube, I'm watching Austin Colish rifle through his phone.
Dr. Austin Colish: I have... So I was actually terrified you were going to ask me what have you read recently?
Dr. Yoni Rosenblatt: What have you recently read?
Dr. Austin Colish: Because I know that's a question you ask a lot.
Dr. Yoni Rosenblatt: Really?
Dr. Austin Colish: Part of my list is a bunch of book recommendations that I've gotten from people whose opinions I really respect.
Dr. Yoni Rosenblatt: I saw Dr. Sinclair on there.
Dr. Austin Colish: And I've not read any of these yet.
Dr. Yoni Rosenblatt: You need to read Sinclair. It's gold. What else is on there?
Dr. Austin Colish: I've not read any of these. Radical Candor. I think that was a Matt Dunn recommendation.
Dr. Yoni Rosenblatt: Really? Tim Stone loves that book.
Dr. Austin Colish: Really?
Dr. Yoni Rosenblatt: Yeah. Dr. Tim Stone.
Dr. Austin Colish: Yeah. Atomic Habits. I think that was a Deemer recommendation.
Dr. Yoni Rosenblatt: Outstanding. Long time New York Times bestseller. What else? What else is on there? Don't just turn that off. I'm looking for really good information for the future PTs.
Dr. Austin Colish: Yeah, I mean, a lot of it's just like...
Dr. Yoni Rosenblatt: What's your favorite book that you've ever read, Austin?
Dr. Austin Colish: Outliers.
Dr. Yoni Rosenblatt: Because?
Dr. Austin Colish: I love that book, because I think it highlights you got to be the right person at the right time. And I think that's... I think that translates to a lot of my success in life.
Dr. Yoni Rosenblatt: The difference is from you and those case examples?
Dr. Austin Colish: They have way more money than...
Dr. Yoni Rosenblatt: Now they do. But not all of them. Right? But I think it ties back to the first thing we talked about was, yeah, you got to be the right person at the right time. But sometimes you have to create that right person. Sometimes you have to create that right time. You've done an unbelievable job of doing both of those. You formed yourself into this outstanding clinician because you can't be an awesome leader of a team, you can't grow professionally in a company, certainly not in this company unless you're awesome at getting patients better.
Dr. Yoni Rosenblatt: So you did that. You checked that box and you worked really hard to do that. And then you created the opportunity. You said, I'm going to Baltimore because I know there's some loose ends that I can tie together there and become the lacrosse guy there. And you created the opportunity. You put yourself out there and you came to Baltimore and then you grew within that company to expand beyond Baltimore to Annapolis, to Glen Burnie, to affect an entire company positively. That's the difference between you and outliers.
Dr. Austin Colish: Yeah.
Dr. Yoni Rosenblatt: Great book.
Dr. Austin Colish: It is a great book.
Dr. Yoni Rosenblatt: But it ain't you. I love the part about the Jewish lawyers. We can get into that in a different pod. I want to thank you so much for your time. Remind us again how we can find you on social.
Dr. Austin Colish: Yeah. Best way is @LaxRehab. My email is Austin@TrueSportsPT. And I'm super excited to engage and talk about these things. I actually get a lot of DMS and questions about, hey, I'm in the middle of America and I had my ACL. What should I be doing right now? I get a lot of those. That's awesome. That's why I created the platform. So definitely hit me up.
Dr. Yoni Rosenblatt: Hit up Austin Colish. He's been an outstanding resource to the company. True Sports Physical Therapy. Also to the patients of Baltimore, Maryland and really beyond. You have any feedback on this specific conversation, if there are guests that you want to have on the pod, hit us at pod@TrueSportsPT.com. I've had some awesome feedback through that channel. Just shooting us an email. You can always shoot us a DM True Sports PT on Instagram and now on TikTok. And that's been great feedback. The audience wanted to hear Austin Colish. So happy to provide that. But let us know who else you want to hear. Thank you for your time and thank you for your time.
Dr. Austin Colish: Thanks, Yoni.
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