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Oct 26, 2023

The True Guide to ACL Rehab

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Dr. Yoni Rosenblatt: Welcome back to the True Sports Physical Therapy podcast. This one I've been waiting a long time to record. I got my dear friend, my dear business partner, the COO of True Sports Physical Therapy, Dr. Timothy Michael Stone. You just created an unbelievable course. You are now a co-educator on All Things ACL. As we launch the True Sports Guide to ACL Rehab, what makes this ACL course awesome? 

Dr. Tim Stone: Well, I think there's a few things that really set this course apart from others that we've seen. I think some really big things. There's been a large movement away from the in-person course type atmosphere. So we tried to piggyback off that a little bit and really create a course with an online presence, something that you can access in the clinic real-time with your patients. So the first one is definitely that ease of access to it. The second piece really is we try to debunk the plethora of options and confusions surrounding the best way to treat an ACL. So I felt as though when I first came out of grad school, I had a good grasp on exercises and movements with a good strength and conditioning background, but I just didn't really know how to put it in place at the right time with the right patient and just simplify this whole process.

Dr. Tim Stone: So we really set out as our main goal is just to make sure this course is really succinct, really clear, and really simple, a nice stepwise approach to treating ACLs. And then I think the third piece that I really find interesting that's maybe slightly different to a trend in what's going on today is that we're seeing this huge shift in towards this criteria-based approach to ACL rehab. That's beautiful. I think it has its place for sure. But I think our patients don't really understand where they stand during that time frame when they're doing the rehab. And as clinicians, part of generating buy-in and getting great success is really being able to explain where a patient is along the process. So we tried to marry both the criteria-based approach with the time-based approach so that people can really understand this is what you need to move on. And this is a time frame that we would expect you to do that in. But if you fall outside of that time frame, maybe you're going a little bit faster, maybe you're going a little bit slower, you still have something to fall back on to be able to give people context to where they're at in this.

Dr. Yoni Rosenblatt: Yeah, you make a good point as you kind of explain that overarchingly, which is the therapist needs to know where the patient should be. That's step number one. Step number two is what do you do when they're not there? And I think this ACL course kind of speaks to that. How do you speed things up like they're killing it? How do you scale things back if they're struggling with things like motion or anterior knee pain? And that kind of comes up over and over again and really drives home the point, which is the therapist needs to know where the patient should be along the continuum. So should the patient, you just made that point, right? The patient has to understand where am I in this 9-month, 12-month horizon? And what am I doing to consistently get better? Is that something that you find you're constantly explaining as you rehab these patients? 

Dr. Tim Stone: Yeah, I mean, I think everybody wants their ACL to meet the timeline approach of a protocol that's sent from their surgeon or one that they've followed and learned a lot. But I think, I just don't know if I've ever had a patient that's met those standards, like week to week.

Dr. Yoni Rosenblatt: Yeah.

Dr. Tim Stone: And so it's more common to have somebody fall somewhere outside of that guideline than to fall within it.

Dr. Yoni Rosenblatt: Yeah.

Dr. Tim Stone: And so I think it's just difficult to have this guide, which isn't really realistic in everybody's case, because everyone's an individual. It's a bit more of like the autistic side of rehab versus the science side of rehab. So yeah, I think just having both those touch points of just giving a general idea of where I am chronologically, but also like where I am from a metric based perspective as well, gives you really good context to what to do next or how to speed up the process, or maybe even how do I need to hold this patient back because of some new tissues that are in their body that you can't stress, even though some of the things that they're showing you would suggest that they should do that from a musculoskeletal perspective.

Dr. Yoni Rosenblatt: Yeah, yeah. I always say that I've rehabbed probably thousands of ACLs and none of them are the same. They all fit within a given context, but they're all so unique. So I have a patient come into me, I do a lot of talking to parents and coaches to try to explain this, which is here's the beautiful, easy pattern you're going to go along. This is the quote unquote protocol. Every single ACL I've ever seen struggles with one piece of this. Maybe it's motion, maybe it's quad recruitment, maybe it's anterior knee pain. It's usually one of those three. Maybe it's the mental side. Just get ready for that. And that's what I think this course does is prepares both the patient and the clinician to say, if it is not a million percent smooth, 'cause it never is, how do you handle that? How do you scale that? You're so good at wrapping your patient's head around that. I think that's what makes you uniquely suited to deliver so much of the content in this course. What else would you say makes you uniquely suited to co-teach a course like this? 

Dr. Tim Stone: Well, I think like you said, Yoni, we're doing this day in, day out. There hasn't been a day at True Sports since I started here six years ago, where I haven't treated an ACL.

Dr. Yoni Rosenblatt: Yeah.

Dr. Tim Stone: So, I think this is our bread and butter. It really wasn't what I set out to do in going into the sports world. I really had a love and fascination of hip rehab and things like that. I thought that was going to be really something that I could bring to the table. And then after doing this, being in this niche of sports PT, it just kept coming and just kept coming and just kept coming. And I think that was something that wasn't necessarily going after. But then I started to develop this love for treating it. And I think it just is such a cool rehab process because you get to, one, take someone who's just exited the operating room and is on the table and can't walk, can't shower themselves, needs help going to the bathroom. And then you get to, at the highest level, put them back on a professional sports field where they're generating millions of dollars of income. I mean, that transition period is just really, I think, very unique to most rehabs. Just the ability to see dozens and dozens and dozens and, like you said, probably close to a thousand by now. That really, I think, sets us apart from other courses or other people that teach courses. It's really like that practical application of experience with patients that makes us uniquely suited.

Dr. Yoni Rosenblatt: Now, you have this unique approach now and experience level. You've seen thousands of them, right? Tell me about your background that makes you uniquely suited to deliver this information.

Dr. Tim Stone: Yes, I think this is more of a general question about what we should do as PTs to position ourselves to best rehab our patients from a personal perspective.

Dr. Yoni Rosenblatt: Yeah.

Dr. Tim Stone: So, what can I do to help me gain context around where my patient is in their life? And so, I was fortunate enough to play sports at a relatively decent level and play at the collegiate level and have a little bit of success there. But also, I think it's true for a lot of sports PTs, have some injuries, have some surgeries, and go through the rehab process myself. So, Personally, I had surgery when I was in grad school. It was a really great way to absorb the didactic portion of a course whilst going through that rehab process for myself as well. So, I think that was really interesting. And then I think, last but not least, it's just your willingness to train and try things for yourself first before you put your patients through them. So, I think maybe not necessarily to the same intensity or weight level as some of our...

Dr. Yoni Rosenblatt: Pros? 

Dr. Tim Stone: Pros, linemen, like those kinds of things. Professional lacrosse players, I might not be able to put as much weight on the bar, but I do understand what it feels like to be at an 8, 9, or 10 out of 10 RPE during a rear foot elevated split squat, or how it feels to decelerate, change direction for a 90-degree or 180-degree turn. So, I think that's a really important piece I feel that PTs should go after, whatever intensity that is for you, but just to feel what it's like to do the drills is super important when you're trying to teach and coach the drills as well for your patients.

Dr. Yoni Rosenblatt: Yeah. I totally appreciate your humility in that answer. You did win a national championship in college, which is something that a lot of therapists potentially have not done. I think if you didn't have that experience of winning a national championship, playing for Salisbury, I think the way you make that up is by reaching those RPEs yourself, right? Is by putting yourself through the movements you're then going to ask your patient to do. I think that's imperative, and that should be highlighted. A kin in my world is I've never thrown a baseball 95 miles an hour, but I've thrown a baseball as hard as I possibly could through severe elbow pain. I know what that feels like. I can then try to take those life experiences and apply that to the patient.

Dr. Yoni Rosenblatt: And I think we're going to get to it maybe a little bit later, but that's a big piece of creating buy-in. And I think this course does a great job of giving the therapist the tools to create that buy-in from the patient. And without that buy-in, you're not going to get outstanding results. You could give them all the science in the world. If you don't create that buy-in, you're not going to get the results that you want, more importantly, that the athlete wants. So, don't belittle that national championship, but you make a great point of, "hey, have I hit the RPEs? Have I done the movements? Have I worked on a box jump? Have I worked on a single leg box jump? Have I tried to teach myself how to change direction appropriately?" Because only through that are you then going to be able to relate to your patients. What we've done in this course is given the therapist the tools to take themselves to the gym and try to teach themselves how to do it. Because only through that are you then going to be able to kind of relate it to your patient. Anything to add on to that? 

Dr. Tim Stone: Yeah. I would just say, I think, just to piggyback on what you're saying, that a big portion of this course is movement principles, planes of direction, different forms of loading. As you said, I think it's great to have a sports background or played sports at a high level. You don't need to. Take this course, look at some of the exercises. We give you some really practical programming sheets as well, some Excel spreadsheets that you could just take these exercises and program for yourself.

Dr. Yoni Rosenblatt: Yeah.

Dr. Tim Stone: I found myself doing that all the time when I first got out. Actually, what's really interesting, just from more vanity perspective, I think we're challenging, and we'll get into this more, quadriceps function and strength so much in this. I was playing in a local washed-up men's league this summer and there was one of our guys was shooting pictures and I saw a couple shots of me playing and I compared what I looked like now to what I looked like back in college. My quads are twice as big. And I think whether or not that's good way or bad way, I think I've absolutely, like my own training changed the level of quadriceps strengthening just from this process of rubbing off on me. So, I think you can do the same. If people are interested in taking this course, when they take the course, just use those little programming templates. Throw some of the exercises or the movement options or principles that we have on there, and just put them into your own programming and try them out. See how they feel for you.

Dr. Yoni Rosenblatt: Yeah, yeah. You got to let it bleed into your own life. I've heard you make that case before where it's when we talk about work-life balance, very often, it's that work bleeding into that life, right. And so, you've developed a pair of quadriceps that now can stabilize your knees by virtue of the fact that you've incorporated some of this training into what it is you do on the daily. There's definitely value there. Also, you mentioned some of the information that we provide in this course gives you a lens through which you can see all of the information that's out there. I think times have changed so much. I'm just a little bit older than you. And so, when I came out of graduate school, there wasn't information available. And that was the biggest hurdle to jump.

Dr. Yoni Rosenblatt: Where do I get this stuff? How do I find out how to teach change of direction? I had to go and find an outstanding speed coach, a guy named Courtney Green, to teach me those things, how to change direction efficiently, effectively, and then try to apply it to what we do. Now, it's everywhere. Information is everywhere. What the True Sports Guide to ACL Rehab does for you is it gives you a lens through which you can filter good information. And so, now, you can say, I know my athlete needs to be doing X. Let me go find information that fits into that rubric. So, that's another reason I would encourage everyone listening to give this course a try is it gives you the foundation through which you can build upon and see and dissect and digest outstanding information. So that's something I always struggle with. It's like, oh my God, there's so much stuff out here. This simplifies that. So, as we put together this course, give me the biggest challenge that you think this course solves for.

Dr. Tim Stone: So I think it's just a drastic increase in speed of your ability to take what's evidence-based into practical-based applications. So, you were just almost touching on it just a second ago. But when you come out of school, you have such a research-oriented background. You spent a lot of time in college looking through papers, seeing what is truly evidence-based. But that third pillar or second and third pillars of the practical application, what works well for a patient.

Dr. Yoni Rosenblatt: Yeah, what do you do with it? 

Dr. Tim Stone: Right. How do you do that? Studies don't really look at how to treat an ACL from the first minute to the 45th minute that you have them in their office. And so, this course really, really breaks that down, makes it really, really simple to digest. What should I be doing now? What should I do next session? How many times should I see you a week? We even sort of break things down simply enough as to, we all know that we should get on a bike to improve range of motion, or maybe we don't.

Dr. Yoni Rosenblatt: Now you do.

Dr. Tim Stone: Now you do. [chuckle] Yeah. But, we teach you how to safely and effectively get on the bike, get off the bike. I know when I first started, I had my first ACL and they're trying to get on the bike. I'm just in this total mind-eff of like, "I'm gonna kill this person. They're gonna fall of. If I bend it too much, is this going to cause issues down the road? Am I going to increase swelling? Does their meniscus handle this?"

Dr. Yoni Rosenblatt: Yeah, yeah.

Dr. Tim Stone: We talk about all those little basic things that I feel like I had questions when I first came out of school that I was fortunate enough to have a mentor like you walk me through. But if you're in the middle of nowhere, this is a course that will help really give you that mentorship and just speed up your ability to treat the next five that walk into your office.

Dr. Yoni Rosenblatt: Yeah, yeah. I've seen that in your career, how you came on to the team about six years ago. I did my best to try to teach you my theories and the way I approach ACL rehab. And now I've seen every single therapist that we've brought on benefit from your tutelage. That's what this course does. It takes Tim Stone. It takes all the outstanding PTs. And by the way, one of the world's preeminent surgeons, it takes them and it puts them on your computer screen, so they are your mentors. You are now the mentor to all the people that are going to download this course and take it. And it decreases that learning curve really quickly. And you do a great job of dispersing that information. So I think that's another massive benefit. Too often, you take a course and it's well, studies show that you need blah, blah, blah, blah. This course is Tim Stone holding your freaking hand and helping you get your athlete to where they need to be. That's worth its weight in gold. So I think that's really powerful. You remind me of one of the first ACLs I saw was a 300-pound, very mobile individual playing rugby, he tored playing rugby, played collegiate rugby.

Dr. Yoni Rosenblatt: I just remember exactly what you just said, like praying to God I could get him onto this rickety-ass bike in the clinic that I was working in, and he slid off the pedal, like slammed down and both of us thought he re-tored his ACL, right? And just the fear that I felt, that the patient felt in that time, now he didn't re-tear it. But had I had a course like this, I'm not making mistakes like that. I'm approaching the bike as simple as it is appropriately, I would have done it at a better time, perhaps when he could have had better control, that's what this course does. It is truly how you rehab an ACL. And what you're hitting on is exactly why we started this practice and why we call it True Sports Physical Therapy. Because it's taking all the evidence base, all the research, everything from the lab, how do you apply it? And that's the gold here is. We can all read studies, but how do you actually get that athlete to exactly kinda where they need to be? Does that makes sense? 

Dr. Tim Stone: Yeah, for sure. Totally agree.

Dr. Yoni Rosenblatt: Okay. So when you looked out at the landscape of physical therapy, continuing education and there's so much already out there, specifically as it pertains to ACLs, what did you notice was lacking? 

Dr. Tim Stone: Yeah, I think you also mentioned it a second ago, I think there's either this one camp where it's like so evidence-based that you go and take a course and you either sit in it live and you get lectured at for the whole weekend. It talks about what does the research show on strength, or what does the research show on range of motion, or what does the research show on re-tears or glute-med function and injury prevention, and all these kinds of things. Or you go into courses that are produced by really large conglomerates that are probably seeing less of these on a daily basis than what we do. So we attend to that kind of research and we're really interested in making sure we keep up to date on those kinds of things. But this really comes from a point of what it is that we do every single day.

Dr. Tim Stone: And I think we, as a company, if you are a PT at True Sports, you will see more of these on a yearly basis than anywhere else at any other institution. So there's really no better people to learn from in this course than the PTs themselves that work here. So that, I think is really what separates this from a lot of the other courses that I've sort of seen that are out there. It's just like a much better, practical, real-life situational application.

Dr. Yoni Rosenblatt: Yeah. One of the things you do that's so awesome is applying your strength and conditioning background. I think that's something that was so needed in the landscape. There's so many courses on what that patient is doing on the table. Very rare is it for me to see what the athlete is doing at month three, four, five, I find that as a clinician, very challenging, a very challenging point of the rehab process, because now you're not a physical therapist. Now you're a sports physical therapist. Now you're a strength coach. And so, how do you load? When do you load? How do you isolate? I think more importantly, and the course does a great job of it. And by that, I mean you do a great job of periodizing, and how do you plan appropriately? When do you pull on that strength and conditioning knowledge? 

Dr. Tim Stone: Yeah. So I think immediately. I think from day one when we're trying to gain quad recruitment, we're already manipulating sets, reps, tempo, we're utilizing blood flow restriction, NMES, all those things fall within that strength and conditioning world of progressive overload. I think mostly however, I think you need to really rely on it in that advanced strengthening phase of rehab. So we've included a specific phase that looks at that particularly. But we also include it in the earlier phase of loading as well. I think as you move through the rehab, and this was probably a really large challenge for us, as we were going through the course is day one, week one, and month one, you can almost write out on a piece of paper exactly what you want the patient doing on each one of those days to meet those goals. And we've done that, that's awesome...

Dr. Yoni Rosenblatt: And that's what you did.

Dr. Tim Stone: So that's an awesome piece right there if you're unsure about what that looks like. But after you get them off the table and they start independently walking, the variables just increase exponentially. You have all these different options that you can apply in your programme into these patients. So what we really attempted and thought we've done a really good job of is in those early and advanced stages of strength training, really break it down as simply as possible and as linearly as possible and from a movement pattern perspective so that we give you these different directions of movements to utilize. And I think that is like a huge piece of this, is now we're just decreasing the variables or the decision-making that the PT has to make as they go through this process. So that's probably where it's applied most common.

Dr. Yoni Rosenblatt: Yeah. You make an awesome point there because I jumped to month three and four as massive challenges and that's when you become a strength coach. You just said you're a strength coach from when they walk in. And I appreciate that correction because too often, and we go over this every single interview you and I conduct of a perspective teammate in True Sports is what does that first session look like? Well, why did you choose this amount of time to have them do, let's call it a prone hang or a heel pop, right? Is that enough time? What do we know about tissue adaptability and how much intervention or input do we need to provide? That's the strength coach. It starts on day one, not on month three. So I stand corrected, but that's a really great point.

Dr. Yoni Rosenblatt: And you did do an awesome job of kind of lining that out and giving the therapist a rubric of how do I work through these stages and how do I work through these stages always keeping in mind that my intervention has a purpose, not just because it says so on a piece of paper, but it has a purpose to achieve this given goal. Extension you got to provide enough time under tension, right? Hypertrophy, what are your parameters, right? Recruitment. What am I trying to do? How long am I creating those holds so that that brain can begin to talk to the desired muscle? So I definitely kind of appreciate that point.

Dr. Yoni Rosenblatt: It's also, dude I wish I would have done this when I looked at graduate programs, when I was going to school is look at maybe what you want your specialty to be in my case, orthopedics and sports, and then look at the institution and look at the people teaching it and where is their focus? How many ACLs have they seen? I'll take courses and I've taken courses to get to this point. And I'm learning from clinicians that live in a lab. I'm learning in clinicians that see one, two, three ACLs a year. You see one, two, three ACLs in your morning session. And that's really powerful. And that's what this does is it speeds up that learning curve just from all that experience. So I think there's a tremendous amount of value there. So sounds like a great course. Sounds like a course I wanna take, sounds like a course I had a small hand in creating. So walk me through those steps and phases of the True Sports guide to ACL rehab.

Dr. Tim Stone: Yeah. So there's the really, I would say like generally three to four big buckets of phases that we then break down further. So the first one is the early intervention, and then second one would be early loading, we have advanced loading, and then we have more of your return to sport phases. So those are like the three broad overview or four overview.

Dr. Yoni Rosenblatt: Say 'em again, break them down again.

Dr. Tim Stone: So we have the early post-op. Okay. Then we have our early strength. Then we have advanced strength and then we have our return to sport.

Dr. Yoni Rosenblatt: Yeah. And you put in milestones? 

Dr. Tim Stone: Yeah. So in between those phases, there are a lot of different moving parts. And so we brought in different phase chunks within those larger phases to sort of teach and educate on how to reach this goal. But also on how to decrease those variables that we spoke about. So for example, in our initial phase, we put in an entire session of what we do on day one. We do exactly what we do for week one. And then we do exactly what we do for up to month one, where we're getting the patient back to walking independently.

Dr. Tim Stone: And then we head into that more strength and conditioning portion. So we have our initial loading strategies. And so this is where patients will start to really develop like a competency around squatting, lounging, single leg tap downs, posterior chain exercises, things like that. In that more advanced stage that comes after that, we're looking at all those same or similar movements, plus a couple more that we probably wouldn't attempt in the earlier phase, but we're also much more complex loading patterns or different ways to sort of challenge the tissue in ways that you might not be able to, or load the joints as you might want to in that earlier phase.

Dr. Yoni Rosenblatt: And you don't get that stuff out of a textbook. And that's what I love about this course, playing with angles, playing with tempo, playing with pace is something that doesn't really show up in the studies. That's where the rubber meets the road, that's where you're actually showing the clinician, here are the things you've gotta think about, and we give you options as to how to put it in the program. It also does a great job of explaining. What do you do when you're seeing them three days a week? You know you have to get to X. You need full range to get out of that early phase, right? You need really good quad recruitment to get out of that early phase. So that's the way you break up your individual sessions. Today's theme is motion. What have I done to get that athlete's full range of motion or the second visit of that week? Today's theme is recruitment. What am I doing to help them get that recruitment so that we can get them off that table? You're playing with all these variables as you move along the rehab process, you have to pick a given goal for that session, this course shows you what those goals should be and how to achieve those goals.

Dr. Tim Stone: Yeah. And I think also too, like to your point there, one thing that I found confusing when I was going through this, when I had the ability to work with someone three days a week is what does that look like compared to the person that I'm working with two days a week, or should I work with this person five days a week if I can? And so we actually specifically broke down how you could look at your sessions from a two day a week perspective and a three day a week perspective, just because in that outpatient environment, that's probably the most likely way in which you're going to see these patients. So there's differences to the rehab process when you have the ability to see them two days a week versus three days a week. And we talked about that, the programming and the Excel spreadsheets that we provide within those phases, we change those based on how many times you're seeing the patients during the week as well.

Dr. Tim Stone: So it just sort of like, I felt I really struggled, when I'm seeing someone two days a week and you get into that later stage when you're trying to do some cutting and lifting. Well, once you move into that phase, if you're doing twice a week, you've now just stripped one day of strength training because you have to bring in the plyometric portions or the change of direction stuff. So how do you manage that? What do you do with that? Should it look like you train all body parts equally on the first day and then do a change of direction? Or should you do a little change of direction on both days or should you really target quads for the most part on that first day and move into the change of direction on the second day? There's a lot of questions around that. And we sort of break that down in this course and compare that to options where you can see a patient a little bit more frequently as well.

Dr. Yoni Rosenblatt: Yeah. It also gives you a few levers to pull and options because that patient's gonna come in, if they're still looking really weak or they don't have awesome recruitment, then it can color, it can give you options. You need to be doing more of this at home because we only have twice a week, or you're doing great with that stuff. Let me teach you some of the rhythmic drills and the timing drills because that's where you're struggling. Take those at home. When you come in here, I'm gonna show you how to load this thing. So you got to meet that patient where they are, your addition and this really was all you in terms of adding it to the course of giving the therapist those Excel spreadsheets to pull from. I haven't seen that in courses. It really doesn't exist elsewhere. I think that's super unique about the value that you're really providing. So let's dig in a little bit clinically. Walk me through what you think is the most complex portion of The True Sports ACL rehab course.

Dr. Tim Stone: Yeah. So I think I mentioned this as you move along the course, or in general, as you move along patient's rehab process, the earliest stages have a lot less variables attached to them. There's one, two, three goals that you're working on, the movements are really simple. But as you go through your rehab and you get to those change of direction phases, the return to sport phases, the complexity, the variables, the speed at which you're trying to like watch somebody do something and see what they're having issues with gets a lot more difficult. So I would say in general for ACL rehab, that is the most complex portion of rehab, and I think too, that's what we were really challenged with when we're producing this course. Well, how do we simplify that for people? But also not put them in this box where every single one of your ACL patients ends up doing the same change of direction program when they come back.

Dr. Tim Stone: So, we really tried to derive different principles of these stages, whether it was like open and closed environments, whether they were contact or non-contact or whether they were what we call like chaotic or non-chaotic drills, those are the kinds of pieces that we broke down the later stages of change of direction into. And then we filled in the blanks with some examples of those exercises, but we talk about looking on YouTube or looking on social media or taking other courses in strength and conditioning where you can then get this bucket of what's a contact, chaotic, closed environment drill, and then pick an exercise that you've seen or a drill that you've seen elsewhere and just like plug and play into that specific portion or that specific goal for that day. And I think that's difficult to do.

Dr. Yoni Rosenblatt: I think it's really difficult to do. I think one of the reasons it gets so much more complex as we move along the rehab process is twofold. One, you don't get this in school. Like they can't teach you this complex stuff in school 'cause they have to be talking about EKG or they have to be talking about wound care or burn care or whatever the hell else they're teaching you. So you never get to those later stages. And I see that a lot as we interview and we talk to newer graduates or people that are working in a more general population, there's just not enough time and experience with that later stage stuff. They're busy spending time with their TKEs. And that plays back into the previous point, which is finding a mentor that only does this. So I think that makes it complex. Secondly, and really simply, I think is planes of motion, right? And so when you're getting your flexion and extension, it's basically one plane. Once we're out there and say we're back to throwing or cutting or dodging. Holy cow. So many planes, right? And the course does a really good job of breaking down the planes that we're looking in.

Dr. Yoni Rosenblatt: And that's the way you progress the athlete. If I had a nickel for every time I worked with an NFL athlete and he tells me, "yeah, we're doing some change of direction stuff, and we're doing some resisted running." And I'm like, "well, have you learned how to move in all of those planes?" And they're like, "what the hell does that mean?" I'm like, "well, have you learned to move laterally in the frontal plane? Have you worked on box jumps? Have you worked on deceleration acceleration in that plane? Have you worked on it transversely? Have you worked on rotation?" Too often, that stuff is totally skipped. It's okay. We're at month three, so let's start running. What have you done to get there? This course, you do a great job of breaking that down vis-a-vis planes of motion, I think is the lens you look through.

Dr. Tim Stone: That is a big portion of it. And what I think again, to like piggyback off you right there is if you're giving an athlete a specific drill and your goal is to look at how they move in that transverse plane, well, there's not a ton of drills that happen on the field where you're only gonna move in the transverse plane.

Dr. Yoni Rosenblatt: Right.

Dr. Tim Stone: So how do you pick or design a drill that predominantly moves in that plane, but still has a sprinkle of some other things, but it's just not the major piece that you're looking at. Now when the athlete goes ahead and completes that drill or is doing that drill when you're giving them feedback, how do you give them feedback on the transverse plane portion of it, because that's your goal. How do you make that part better and sort of leave the other pieces to the side.

Dr. Tim Stone: And so that's what makes this portion much more complex. But as you said, like just being able to break it down into the planes and then break it down into like the intensities of the drill makes it a lot more simpler. And on top of that, I think if you are a new grad or if you are new to this, I think we do get planar movement in school. So we do understand those things. And so all you're doing is trying to place that knowledge with a much faster, more aggressive, more ballistic type movement. So if you can make that jump, then it sort of puts the puzzle pieces together and it makes it seem much more simple.

Dr. Yoni Rosenblatt: Yeah. So if we take a small step back from that change of direction, although, we'll come back to it. One of the pieces that I struggled with mightily was the hypertrophy phase. And that's one of my favorite phases of the entire ACL rehab course. Just give me your overview of how to approach the hypertrophy phase and how you know your athletes ready for that.

Dr. Tim Stone: Yeah. So, they are going to have some level of hypertrophy training from day one again, obviously. But when you get to the meat and potatoes portion of it, you're starting that advanced loading, that's where you're gonna see like a majority of that muscle size change. And so I think the important pieces that are involved in this phase are really just progressing the different loading patterns that we do in that earlier phase. So if we've created some competency like with body weight or a lighter level lows, just to ensure that the patient's able to move through those different movements. Now when we get to that hypertrophy phase, this thing needs to be freaking hard.

Dr. Yoni Rosenblatt: Yeah.

Dr. Tim Stone: Like it's gotta be a battle. Like you should be working. And you can see again in our programming and things, like you need to be working in eights, nines, and tens of your RPEs, right? 

Dr. Tim Stone: We're no longer working in our 6s like we were in that earlier phase where we're just trying to develop the ability to do the movement. Now like you should fail once a time in PT, right? Like things should be that difficult that when you come back the next time, whatever tissue group you were working on the time before is fried, and then talking about the programming, the PT can come in and say like, "well, okay, now we don't need to work on that today 'cause we can give you 48 hours to kind of like recoup rest. We'll work on some different groups or some different movement patterns that won't really stress those. So I think the overarching theme of the hypertrophy is that it needs to be really hard.

Dr. Yoni Rosenblatt: Yeah.

Dr. Tim Stone: And you're following along that principle of progressive overload. Okay. So the recording of your weight needs to be really good so that you can increase the next time they come in. The RPE needs to be recorded so that you can kind of match that every single time. So I think those are like the big pieces that are really important in terms of like how to address hypertrophy in patients with ACL reconstruction. And then I think the last little tidbit would be a little bit of that tech side of things would be you have to have blood flow restriction. You can't get through this phase effectively without some sort of limb occlusion. And I might add NMES to that as well, just to include the recruitment as well as increasing hypertrophy. But I just think now it's so accessible and relatively cheap that if you want to treat patients and you want to get their limb size similar and you want to give them ability to down the road, show better absolute strength and then show the ability to produce ballistic movements, elasticity, stiffness, all those kinds of qualities, you can't get there unless you fill the hypertrophy bucket first. And I think you need blood flow restriction to do that.

Dr. Yoni Rosenblatt: Yeah. I think you need blood flow restriction and I think you have to force the athlete to use that limb appropriately, effectively, and force them to work hard. That's the biggest thing, right? We have to provide enough stimulus and that's where you're using that RPE. I think therapists are really worried to do that. I don't know if it's like this misconception of what the graft can handle, or even by the way, where the graft is tensioned. One thing this course provides the therapist is confidence in that, which we know, which is you've gotta ramp that stimulus to create growth. It's exhausting to watch patients come in having tried to been educated elsewhere to do these bilateral squats and they're invariably going to live on their unaffected limb. And so one of the things I love about this course is it's easy to say, oh, well go unilateral. That...

Dr. Tim Stone: What is that? [laughter]

Dr. Yoni Rosenblatt: First of all, what is that? Second of all, how do we do that without killing their knee? 'cause you got the pain? 

Dr. Tim Stone: Right.

Dr. Yoni Rosenblatt: And we don't want to incur any other types of damage. And so there's so many pearls and ways to work around that to get them to use that limb and to get them to do it at a high enough RPE or stimulus to force growth. You mentioned that one of them is BFR, one of them is e-stim, but how do you isolate that limb that's the gold in this course. And I feel like that's what made this section of the rehab process the most enjoyable to me because it used to be the most daunting. That's really tough to get the athlete to work that freaking muscle hard enough for it to grow when you're working around pain or whatever other maybe misconceptions you might have.

Dr. Tim Stone: I really, lemme take a little more of a dive onto that single leg use or that unilateral use piece because we talked about like these concepts and these broad categories and we're sort of describing you need to do hypertrophy. The same thing. Like we're talking about these things that we're taken from a book. Now doing a nine out of 10 RPE on a rear foot elevated split squat where all the rate of perceived exertion is on the back leg. It's a one out of 10 on the front leg, right? Or the exercise is just not designed well enough to really produce what you wanna get out of the front limb.

Dr. Tim Stone: So are you meeting the goal that you set out with every single rep that you do with a patient? And is a huge piece of what we talk about is the exercise that you're doing truly unilateral. I think broadly PTs are not great at classifying what buckets exercises fit into. And so we classify them into your bilateral, your split stance and then your truly unilateral based exercises. So I think those split stance or like B-stance positions, people refer to them as a lot, get bucketed into this unilateral. Well, for someone with two healthy knees, I think you could maybe push it towards that side of things because they're just using the leg that's not working as like a stability piece.

Dr. Tim Stone: When you're dealing with someone who has an injury to the knee or they have an ACL reconstruction, their body is trying to protect them from stressing that knee at all costs. And so now the B-stance or that split stance limb use really becomes an overload of the healthy limb and not the limb that, that we're trying to work. So whilst we do some split stance based activities, I think predominantly we really need to spend most of our time in that unilateral position. So if we need to add upper extremity supports to take a little bit of load off that limb, I think that's a really important piece of this. But how do we remove the other limb from the equation? One is can't pick bilateral and you can't pick B-stance movements for people that are just gonna cheat no matter what. And then two is, are we getting out of the exercise what we think we're getting out of it? 

Dr. Tim Stone: Because if we're not seeing that or if there's a disconnect there, that hypertrophy is, you're gonna be scratching your head six months down the road saying, "man, like they're reporting eights and nines for this whole entire time. But like the limb hasn't grown from a circumference perspective at all, or it's one or two centimeters bigger." Well, you have to hold yourself accountable, look back at what you're doing. Were they really sitting on that leg when they're doing the exercise and, well, let's check the circumference of the other limb. Did that grow exponentially? Because if that happened, now we really gotta look at our program and say to ourselves, "crap. I think we were training the other leg and not the leg we're supposed to be training.

Dr. Yoni Rosenblatt: I'll ask you a simple question, which is how do you know you're getting what you want at a given exercise? 

Dr. Tim Stone: Yeah. So one is develop the parameters around the exercise that minimize the variables that can kind of come about in the exercise.

Dr. Yoni Rosenblatt: So selection.

Dr. Tim Stone: Selection first. So if you can get someone to shift their knee anteriorly enough, we know that's gonna increase squat. So how can we set up the environment to ensure somebody does that? So one way that we'll teach this is for any of our single leg or split-stance exercises, we'll ensure that there's a target for them to go forward to. Okay.

Dr. Yoni Rosenblatt: To push their knee to hit.

Dr. Tim Stone: Towards. Yep. And so that knee sort of travels over the toe. We know there's better quad recruitment there. The other piece that will go with this is what's happening at the trunk. And actually one of our colleagues posted this recently arguing that the trunk position is probably more important than the knee position. Now, I think both those things come into the equation. So in terms of trunk position, we're trying to look for a more vertically placed trunk. So how can you set up parameters surrounding that to ensure that that happens? So that might be a wall right behind their back. It might just be tactile cueing to ensure they're kind of beating those cements. So setting up the demands of the exercise that really decreases the ability to move outside of what you're trying to get.

Dr. Tim Stone: So that would be like the biggest bucket. If they're not showing you what you want them to do in an exercise because there's too many variables involved, adding 50 cues never results in what you want to see.

Dr. Yoni Rosenblatt: No. Makes it worse.

Dr. Tim Stone: It just makes it harder and worse. And then you spend so much time and then you get out of the exercise and you're like, man, I just wasted that integral opportunity I could have been working the thing I wanted to do. So just shift, change the exercise, dump it, and go to something else. We find that's a much better way to hit what you want to hit.

Dr. Yoni Rosenblatt: Yeah. And then all the way back to what you started with is try the exercise yourself. How do you cheat? How do you run away from your knee or quad? I think it's totally worthwhile. When they're done with the exercise and they come in the next session, how do you know that the last session was worthwhile? 

Dr. Tim Stone: Typically I'll try to watch them come down the stairs, and if they look like they're buckling down the stairs, it's we're in a pretty good place. And then we're just asking the patient like, even in the same session, how did that go? Where do you feel it work? Was it hard enough? Was it challenging enough? Is your leg shaking while you're doing it or is it the back leg shaking while you're doing it? But yeah, definitely the next day, I think it's, one, just watching them walk in as we always do. I think the stairs is a really good way to see like as they go down stairs to see like if they're kind of like having issues. You know you hit quad pretty good, but then you're just following up and talking to the patient. So I think putting your hands on a patient here comes in handy. So if you really, really tried to work on quad hypertrophy or just stress that like anterior chain in general.

Dr. Tim Stone: Just like putting your hands on their legs and feeling their muscles and asking them to squeeze and saying like, "is there a different level of soreness here in the one that we're trying to hit versus the one that we're not?" I mean, those are very, very simple ways to do it.

Dr. Yoni Rosenblatt: But often overlooked.

Dr. Tim Stone: For sure. For sure.

Dr. Yoni Rosenblatt: "Is your quad sore? What can I do to make your freaking quad sore? It's not gonna grow unless it's sore." So the other thing you mentioned there was when you were talking about cues and ways to constrain an exercise to get out of it that what you want, you use the example of tactile cues using a wall. In my head, I was like thinking we put a foam roller in front of their knee so that their knees... These are nearly no cost options. And I think too often we get so fancy with lights and bells and whistles for cues, whereas we've been able to rehab before we got force plates, before we got BFR, before we had stim units in office, we were able to use very simple things to achieve the desired goal. Fancy isn't always better. John Wooden said, don't be fancy, just be good. And the way you're good is using that what you have because you know your goal, that's what you get out of the course. Now, you know your goal. We make that really clear. You make that really clear in the course. You don't have to get too fancy to achieve those goals. The next phase that I really see therapists needing some tutelage around is the plyometric phase. So break down the course of how it addresses The plyo phase.

Dr. Tim Stone: So we start in this sort of like pre-running, pre-plyo type section. And so basically what we're trying to do there is to achieve some of the same joint angles that you might get when you're doing plyometrics or change of direction exercises for that matter too. But not incur the same amount of forces that go through the limb. And so one way that we do that, we show that in the course is just by adding a lot of speed to your drills. So you might unload them but add more speed to that triple flexion, triple extension piece that the limb's always gonna go through when they're doing plyometrics or running. Another way is doing them on two legs versus one leg. So we talked about trying to get away from the bilateral stuff, like when we're talking about the hypertrophy and strengthening phase, but here we sort of like bring it back in, right? Because we can decrease the load by 50% to that limb.

Dr. Tim Stone: So that's a really important piece in sort of seeing if the patient's like comfortable getting their knee to that position at those speeds. So that's the pre-portion, all your typical sagittal plane-based movements, your lateral and transverse-based movements applied with those thoughts. So we're still following that like planar movement piece. And then we move into the truly plyometric portion of the course where we have a specific phase or a specific section that fits into our advanced loading phase, where we really break down plyometric drills from a planar perspective, a limb use perspective, bilateral single leg. And then we really dive into this major concept of extensive versus intensive plyometrics as well.

Dr. Yoni Rosenblatt: Yeah. Those are all nuances that I feel like there's no way in hell you're getting those in grad school. This is clearly that next stage. Too often, we see athletes just progressing to a run, just like we were talking about with change of direction based on a time perspective. They haven't done anything fast. And so they go from a heavy load, your hypertrophy phase, to this running or force production phase, and they haven't done anything fast. Maybe it's starting with an exercise you know they can do. You know they feel it in the desired muscle, let's say quadriceps with a squat, let's say. Can you speed them up? Can they do it quickly? Playing with the rate can be equally as effective as playing with the load, at times more effective. That's definitely something that I learned watching you move through this course and the goal that's inside this.

Dr. Tim Stone: I think one thing here, too, to understand is that we've taken such a better approach at the testing piece of this to ensure that patients have the physiological qualities to be able to produce those movements when we ask them and have set up parameters that you can see within the course as well to know that someone's ready to run or to know that someone's ready to do heavier plows or to know that they're ready to return to the field. But I'll say this because I used to be quite a hater on the testing side of things. I just didn't feel the practical field test that we had unless you had a Biodex in your clinic. You were able to really produce results that gave you any better insight into where the patient is and where they were going forward. Now, I think we have been able to ditch some of the older testing and really look at the ones that we really, truly value and that we really think represent good quad function for the most part. But in throwing all of that out, if you didn't have the ability to test someone, you should be able to subjectively or quasi objectively be able to see if someone's ready to do these different drills by just progressing the drill.

Dr. Tim Stone: If you want to understand someone can do a single leg hop, well, you can start them on a tap down. If they're successful on a tap down, load the tap down. If they're successful at loading the tap down, strip the weight, do the tap down really fast. Add some load to a really fast tap down and then break down the different portions of jumping. Can they decel the limb effectively by just landing on it eccentrically? Can they get off the limb by just accelerating off of it, but not having to deal with the landing component of it? Now, you've just been through this whole process where you can say, okay, they've had no problems with all those things. That might be two reps at each thing. It could happen all in one session or it could happen over a month or even longer, but you're now able to say with really high confidence, if I move the needle 1% beyond breaking down those two portions of jumping and landing to just jumping and landing like it's supposed to be, I'm really confident that person's gonna be able to do that without having a 85% QI or whatever it is that you're looking for.

Dr. Tim Stone: So I think while that, when you're new at this, you might not be as good at making those jumps, the testing is really, really important. And I think it does really help us with the blind spots that we have as PTs when you think you're there and you're not there. But also, I think what this course does a really good job of is helps arm you with the ability to assess the patient's progress from a subjective or quasi-objective perspective to see if they're ready for the next level.

Dr. Yoni Rosenblatt: Yeah. I love that because it gives the therapist the ability to progress a patient post-op ACL really smoothly without needing force plates. But if you have force plates...

Dr. Tim Stone: Use them.

Dr. Yoni Rosenblatt: Use them. And we have an expert that teaches how to use them inside of this course. If you have a tin deck, use a tin deck. It's $150. It's a step down from all that information you can get from force plates, but we're gonna teach you how to use a tin deck. If you don't have any of those, Tim, in the last two minutes, you just taught us how to assess the athlete, progress the athlete without any of it. We want to give as many levers to pull as we can to therapists in this course, and that's exactly what's in this course. Dude, there's a lot there. There's a lot there to dive into, and we'll definitely cover a lot more. As we look to wrap this up, just give me what did you learn while you produced this course? 

Dr. Tim Stone: The first thing that I learned was nothing to do with PT. That's just how difficult it is to be on camera. I have the utmost respect for people who do that on a daily basis. I think it's really, really difficult.

Dr. Yoni Rosenblatt: You did great.

Dr. Tim Stone: Thanks. You did too. My issue with that was as soon as the light turns on, I just completely forget... No idea what I'm gonna say. We did a little dive into using a white ball with some bullet points and things like that, and then we finally made the executive decision. For me, I needed to have a teleprompter. Embarrassingly enough, I had to write my thoughts and feelings down on a page and then read them...

Dr. Yoni Rosenblatt: What were your feelings? What feelings did you include in that? 

Dr. Tim Stone: Nervousness.

Dr. Yoni Rosenblatt: Nervousness? 

Dr. Tim Stone: Yeah. For the most part. It went much smoother beyond that. I don't have the ability, as you do, to ad lib and swerve and come back to the right point at the right time. [laughter] That really helped me do that. That was probably the most challenging piece to me. I think the clinical stuff, regurgitating what we already know. I actually did find it much easier when I'm cueing or talking about an exercise that I do. I didn't need any of that stuff then.

Dr. Yoni Rosenblatt: That's what you do.

Dr. Tim Stone: That just felt so natural to do that and to show those things. But the intros, the meat and potatoes on this terminology and that terminology and things like that, I really needed a lot of help with that.

Dr. Yoni Rosenblatt: So, to the millions of people that are gonna download this course, just cut us some slack on those intros. They're gonna get better. They're gonna get better. What else? 

Dr. Tim Stone: I think it challenged us. We produced this course one time and then we sat down to evaluate it. It had all these tidbits that we felt like we offered that other places don't. But we didn't feel like it had this comprehensive approach from day one all the way to the end of the field. And like, what do I do if I'm with a patient that's six months in and I'm scratching my head over how to get them to the next level? We sat down after filming for three months and putting it together over six months and said, "look, I don't think this is... "

Dr. Yoni Rosenblatt: This isn't good enough.

Dr. Tim Stone: It's not good enough. And so we took a dive back in. We restructured the whole thing. Just communicating and figuring out what is it that we do? What is it that we do without thinking about that other people have to think about to begin with? How do we articulate the importance of these different concepts? I think that's what's so tough about producing a course that has a really good 360 degree view on the rehab of anything. It's like a lot of these things like brushing your teeth after a while, you go through them. But they weren't like that six years ago for me. I did have to write those things down. Coming up with the ability to show the basic steps on how to do this, but also giving people the tidbits that really have been able to separate us in True Sports in general, like in this field of treating ACL reconstructions, that's tough to put on paper. So I learned a lot about actually doing the rehab whilst... And now apply that to my patients.

Dr. Tim Stone: I'm applying this course to my patients every day because it gave me a lot of structure, a lot more structure to my programming, a lot more structure to looking at when to get feedback from a patient or when to jump to the next level. I think that was a really, really big piece that I learned from doing this course.

Dr. Yoni Rosenblatt: Yeah. It comes across just in terms of the way this finished product, the way you took that look and tried to figure out how do we program it appropriately. I think it's really nicely organized and it will be evolving. We're gonna get even better at it. I'm sure we'll do an ACL rehab part two.

Dr. Tim Stone: Can I flip those questions back around on you? 

Dr. Yoni Rosenblatt: All of them? You wanna do another hour? 

Dr. Tim Stone: Let's do another hour. We'll do this all day. What do you feel like you felt was the most difficult portion of completing this course or putting a good product on paper? 

Dr. Yoni Rosenblatt: Not settling. I think getting feedback, being open to feedback from clinicians, from Dr. Dreese, who you hear from in the course, from you as a co-presenter, and being able to go back to the drawing board when necessary, I think was a massive learning experience for me. To go back, assess what you've done. Is it good enough? Does it meet our True Sports standard? Is it gonna help every clinician? Is it gonna help the beginner? Is it gonna help the vet? Is it clearly articulated? That was really tough for me. I hope I learned from that. I hope I got better with that process. Any other questions? It's not a podcast until the guests ask questions.


Dr. Tim Stone: What's your favorite part of the course, Yoni? 

Dr. Yoni Rosenblatt: My favorite part of the course, I would say, was bringing in an orthopedic surgeon. It's so unique. We don't know what the F happens in that OR, and he distills it beautifully and gives us insight as to why he's doing what he's doing. He's a guy who operates from a standpoint of trying to do what's very best for the patient. He has changed the way he does ACL reconstruction. I think that was eye-opening for me to hear. It's what I look for in a surgeon. When patients come to me and say, who should do my ACL rehab? It's those tidbits. I want a guy who's doing it a little bit differently than five years ago because we have new interventions. It makes me really nervous when a guy is doing exactly what he did when he came out of graduate school. That's across every profession, specifically with orthopedic surgery. I think that was one of my absolute favorite pieces of this course, is hearing from a renowned orthopedic surgeon. Okay, let's go to the Eric Cressey lightning round. Ready? Make it quick, Tim Stone. Here we go. What's the most important thing you needed to learn when you came to True Sports about rehabbing athletes post-ACL reconstruction?

Dr. Tim Stone: I think I would say that zero degrees of extension is not full extension or almost there on range of motion is not there on range of motion. By that, what I mean is if there's a 5% deficit in hyper-extension comparatively between sides or 5% on flexion, that really is going to dictate the outcome of the entire rehab. Your plyos won't look good. Your change of direction stuff won't look good. They won't be able to generate enough hypertrophy on the limb because they can't lock the knee out. They won't be able to generate enough turnover in their stride because their flexion is not similar or it just feels freaking weird for them to do it because it's not the same. When you're constantly driving that this is not the same as my other leg, this is not the same as my other leg feedback loop, it doesn't produce a good result. That's my favorite part of the course is that early phase. We stress that so well here to our PTs and all of our PTs can run it back, run back that first week to us exactly the same. It looks the same here in Glen Burnie where we're filming as it does over in Timonium where our PTs do this early on. That's a huge piece of this is just getting that early extension.

Dr. Tim Stone: I think that's probably the most important thing that I need to learn when I got here. Thankfully, I really got that from you. I think my first patient, I remember sitting in the back room of Fell's Point doing one of these and you coming in and throwing me to the wall, so to speak, but looking at it and you saying, "how's the extension?" I was like, "good," because her leg was sitting flat on the table. You walked over immediately, grabbed the heel, popped it up and couldn't get anything beyond that one degree of hyperextension and then test out the side. No, they have six or seven degrees of hyperextension. I didn't understand that and I think that's still an issue that we're seeing. That was a huge learning curve for me, but I think once I figured that out, things got a lot better really, really quickly.

Dr. Yoni Rosenblatt: Credit to you. ACL-wise, what have you changed your mind about in the last three to five years? 

Dr. Tim Stone: Yeah, I think I touched on this earlier with the testing piece. I was just really frustrated, I think, at what the research had shown in the practical field jump testing and things like that. I basically threw them out, because I didn't think that the triple hop from a subjective portion really...

Dr. Yoni Rosenblatt: It didn't matter.

Dr. Tim Stone: It doesn't show you the quality that you're looking at, which is, do they have proficient quad function in change-directional plyometric drills? I just felt like that wasn't being shown well. Instead of pushing it or trying to find more stuff, I threw them out and took that approach we talked about earlier too, where it was just sequential, a little bit sequential. I've changed my mind on that immensely, mostly to people, I would say. One of our former colleagues, Chelsea Cooman, she was huge in pushing me, challenging me to look into that stuff more. Actually, one of our PTs in this office, Rachel Noble, she came out of the Delaware program and just has a really, really innate ability to be able to make the tests flow within a session. That was another piece I hated, was when you do a test and you're only able to see the patient twice a week sometimes. It's like, I just waste half my training on this, and then they come back and their knee's all blown up from that, and you've got to take two weeks off from doing it.

Dr. Tim Stone: We've spoken a lot about how to integrate the tests into a session, so that one, you get PT buy-in, so the PT's comfortable at doing the test quickly and proficiently. It doesn't take up the whole test. Then, secondarily, how do you do it in a manner that doesn't blow the front of their knee up, like we're used to seeing if they have a BTB graft, for example. That's what I've changed my mind on, I think, mostly, is how can I integrate those testing measures into the rehab.

Dr. Yoni Rosenblatt: Yeah, that's great. Okay, last but not least, what's the most important piece of advice to a rookie PT rehabbing their post-op ACL? 

Dr. Tim Stone: Their patients or their own? 

Dr. Yoni Rosenblatt: Their patients.

Dr. Tim Stone: Say that question again.

Dr. Yoni Rosenblatt: What's the most important piece of advice you would give to a rookie PT rehabbing their very first patient coming out of an ACL reconstruction? 

Dr. Tim Stone: One, definitely, buy this course.

Dr. Yoni Rosenblatt: Buy this course, okay.


Dr. Tim Stone: Shameless plug right there. I think this is a really, really quick way to get better at this. If you've got your first one walking in the door, jump on this course, and you can take this course as you're treating the patient from day one all the way through the end. You can just use it as a confidence boost to help you go along. Outside of that, I think, mostly, we talked about this a lot, too. It's really learn the strength and conditioning principles surrounding how to get tissue to perform the way that you want it to perform. Being able to apply the tempos, being able to apply different sets of rep schemes, different loading strategies, and how to progress and regress within those. I think that's a huge piece of this. That's not just ACL rehab, right? That's just being a good sports PT or being a good PT in general.

Dr. Tim Stone: I think everybody needs to work on that. I need work on it now, six years out. I'm learning a lot of things from different colleagues who are newer in the field that have a really good background in the latest and greatest. But also, when you first start, it's just a huge bucket you need to fill. The quicker you can fill that, the better your patients will be because of that.

Dr. Yoni Rosenblatt: Yeah. You've proven, even in your delivery of that answer, that you're a lifelong learner. One of the things that makes True Sports unique is that we're always trying to get better. Tell us how you want to get that feedback so you can get better. How do we find you on Instagram? 

Dr. Tim Stone: Oh, cool. Yeah, sure. [chuckle] Okay. I really only post stuff or communicate through my Instagram channel, so @dr.stone.dpt. That's my handle. If you wanna look at some Squatober content right now, that's going on... It's terrible. I'm dying, but we're hanging in there. But yeah, I post a good amount of stuff on there about just the nuances of ACL rehab, different patients, highlighting different people, not always success stories, post some of the challenges that come with ACL. I am always up on that. DM me. I definitely look at it.

Dr. Yoni Rosenblatt: Too much.

Dr. Tim Stone: Too much.

Dr. Yoni Rosenblatt: Yeah, but it's real. I appreciate you. Yes, we're experts in the field, but nobody's perfect. We're always learning, so give us some feedback. Hit Dr. Stone on Instagram. Hit us @truesportspt on Instagram. We're always trying to get better. Tell us what you loved about the course. Tell us what could get better. We can't wait for all you guys to sign up for this course and to teach it both virtually, and then we're gonna start in person too eventually. Just share your feedback. We love doing it. We love building it. Just help us make it better. Find us @truesportspt. Thanks so much for listening, guys. There's way more to come. Bye-bye.


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