Nov 09, 2023
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Dr. Yoni Rosenblatt: Welcome to Dr. Jonathon Gardner, back to the True Sports family, first time on the True Sports Physical Therapy podcast. Thrilled to have you here, Jon.
Dr. Jonathon Gardner: I appreciate you having me. I've listened to a few of them so far, so I'm pumped to be on.
Dr. Yoni Rosenblatt: And by few, you mean all of them.
Dr. Jonathon Gardner: All. All.
Dr. Yoni Rosenblatt: Thank you so much for listening. I really appreciate it. Jon, you've had an unbelievably quick ramp in your career. It's been awesome. It was awesome to have you as part of the True Sports Family. It's awesome to see where you've gotten to, and I can't wait to kind of learn where you're going from here. Just give us some background as to what it is you do currently.
Dr. Jonathon Gardner: Sure. So I'm a performance physical therapist and strength and conditioning coach here at Charlotte Hornets. Definitely more PT side, but I've started to dabble a little bit more in the weight room in terms of the return to play continuum here this year. So I guess you'd call me more PT than anything else. But I've been here for... This will be my second season. And obviously, prior to that, I was with you guys over at True Sports for...
Dr. Yoni Rosenblatt: Not long enough.
Dr. Jonathon Gardner: Three? Three years?
Dr. Jonathon Gardner: Three years. And then made my way back south.
Dr. Yoni Rosenblatt: Awesome to see where you've gotten. Okay, give me one word you would use to describe your professional life as an NBA physical therapist.
Dr. Jonathon Gardner: Ooh, one word.
Dr. Yoni Rosenblatt: One word.
Dr. Jonathon Gardner: One word. I mean, I think a good word NBA-wise or pro-sport-wise in general is probably pressure, right? These guys are multi million dollar assets, if not million with a B instead kind of stuff. Right? And they're performing for multi billion dollar organizations. And at the same time they happen to be these one in a million genetic freaks that play sports at a level we couldn't even begin to comprehend, right? So I think understanding the responsibility we have as sports PTs in that realm to kind of take care of these guys and prep them to play and obviously extend their careers and earning potentials as much as possible. It is a high-pressure environment. Again, whether it's more the private practice stuff, like what you guys have going on, or if it's actually in pro sport. So again, I think pressure is probably a good word there.
Dr. Yoni Rosenblatt: Yeah. What was your welcome to the NBA moment when you really felt that pressure?
Dr. Jonathon Gardner: I mean, I think it's when you realize how many different stakeholders are in the room, right? Like, you always kind of operate in private practice, right? You get to treat the way you want to for the most part. Obviously, companies have standards and stuff like that that you've got to live up to, but your treatment methodologies and stuff like that are kind of yours. Not to say when I'm here, my treatment style is compromised by any means, but again, you've got GMs and owners and head coaches and agents and the players themselves who are very on top of what's going on and their rehab processes and stuff like that. So it's just, there's more hands in the pot, so to speak.
Dr. Yoni Rosenblatt: And when did you first feel that?
Dr. Jonathon Gardner: I mean, I think it was probably with my first long-term rehab here, right? Obviously, we won't go into specifics and stuff like that, but again, there's lots of questions about timelines and when are they going to be back and then if a timeline is missed or it's not looking like it's going to be met, that comes with more questions and more scrutiny and that sort of thing. And again, that's pressure not only on me but obviously on the athlete as well, again especially 'cause we didn't have as much team success as we wanted to last year. So again, anytime you're missing a piece from that puzzle, again, there's just a little bit more angst around the building, so.
Dr. Yoni Rosenblatt: Yeah, yeah, there's so much at stake. So, on the regular, when those timelines or initial thoughts as to when an athlete will be ready or recovered, etcetera, when those aren't met, how quickly are those other stakeholders, whether it be GM, owner, player, in your face?
Dr. Jonathon Gardner: I wouldn't say so much that they're in my face, but I mean, I think for better or for worse, and more often for better, there's constant communication in this realm of physical therapy. I mean, again, we have daily staff calls/meetings where we discuss status of everybody on the roster. There's a member of the coaching staff on there, and then everything that goes into that call is then reported up the chain to... We can make practice plans or game plans or whatever the case may be. So it's pretty instantaneous, right? Again, I'm fortunate enough that I've got a head of medical who sort of tackles all the agent stuff. So I'm not catching the brunt of those questions. But for the most part it's pretty constant communication. So it's not like I don't know it's coming when it hits me.
Dr. Yoni Rosenblatt: Yeah. And so how would you say you handle that pressure being in that position? What are your secrets to staying even as you so clearly are?
Dr. Jonathon Gardner: [laughter] I mean, I think the biggest thing is you... I think the more data you have and especially the better you document stuff and the more you keep tabs on how guys are progressing and stuff like that, so it's not this giant ordeal when he does miss the timeline. Again, I'm in constant communication, so we're... I don't know what that was. I mean, we're in constant communication, so again, if it's looking like timelines are gonna be missed or extended or whatever the case may be, I think it's known well ahead of time. And I think it's important to sort of be transparent with that stuff and not try to be the superhero and be like, I'll just kind of make up for this on the back end somewhere, or we'll rush something or whatever the case may be. So yeah, I think that's probably the gist of it.
Dr. Yoni Rosenblatt: I think that makes a lot of sense. That doesn't sound so different than here in the outpatient world, where you're gonna be ahead of things if you're coming from a place of honesty, right? You're gonna be... By not being the hero, or being very transparent that I don't have all the answers necessarily, but I'm there to help you, help the athlete, help the GM, help the agent, help all those stakeholders, and say, we're in this together, right? And so that way you don't get pushed into a corner. It's the same thing in the outpatient world where a surgeon calls me, if I'm telling patient one thing, I'm telling a surgeon another, that's gonna ramp up that pressure, that's gonna put me, I don't know, behind the eight ball. It's probably the same there. Would you agree with that?
Dr. Jonathon Gardner: I would. I would. Again, I think it's transparency is the biggest thing and making sure that information is clear and concise and whoever the stakeholder is that that information is digestible to them. So again, not speaking PT to my GM. He doesn't want to hear about ortho kinematics or joint angles or whatever the case may be. He needs to know if this guy can play and if he can't, why? And if he is going to be back, when? Sort of stuff. So again, simplifying that kind of stuff for those people and then obviously dealing with other people in the medical department here, you can have more of those free-flowing medical-based conversations and stuff like that. Just making sure it's easily digestible to each party involved.
Dr. Yoni Rosenblatt: Yeah. Yeah. Dude, that's an awesome lesson that we can take away from a guy like you functioning with that level of athlete, with those levels of stakeholders and apply it to our world of the outpatient sports model or the private model. Got to be honest, got to be transparent. So I think that transfers really well. You hinted at it a couple times where you have all these stakeholders and you have all these other players involved in outcomes. Can you lay out what the performance staff and size looks like in the NBA, or at least with the Charlotte Hornets?
Dr. Jonathon Gardner: Sure. So I can only speak to the Hornets. We have one of the smaller overall staffs for sure. So our head of player health is also our head athletic trainer. I'm the only physical therapist on staff currently. And then we have three other athletic trainers, two strength and conditioning coaches, a sports scientist, and we just got a dietitian. So that makes up our performance staff. And then again, across the league it varies. I mean, you see other ones that are very heavy PT based. You have others that are kind of like ours where it's heavy athletic trainer. You have staffs that have six or seven strength coaches. So again, it just varies based on organization.
Dr. Yoni Rosenblatt: And so you have that staff that you just described. They're in charge of the health of how many, how many athletes?
Dr. Jonathon Gardner: We can carry 15 on the roster, including three two-ways, so up to 18.
Dr. Yoni Rosenblatt: Okay. And that's it? At any given time, you're in charge of 18 athletes?
Dr. Jonathon Gardner: Correct.
Dr. Yoni Rosenblatt: Do you do anything with G League?
Dr. Jonathon Gardner: I do not, no. I mean, when they're in town and in market, like when these guys are part of training camp and stuff like that, you'll obviously have interactions and stuff like that, but we do have a different staff that makes up G League. So that's two athletic trainers and a strength coach.
Dr. Yoni Rosenblatt: Okay. And you travel with the Hornets wherever they go?
Dr. Jonathon Gardner: I do. I do.
Dr. Yoni Rosenblatt: Dude, okay, and tell me what life on the road is like.
Dr. Jonathon Gardner: I mean, it's busy, right? So it's a lot of travel, but I mean, me and other members of our staff have had conversations about... I mean, it's hard to complain about travel when it's chartered flights and nice hotels. So again, you're staying at really nice places in really nice cities for the most part. So on that front, it's not too, too bad. But again, it's work, right? So, I mean you land in the city at 3 AM and you get off the plane, get on the bus, get to the hotel. You don't go to bed, right? I'm going to set up the training room to make sure it's ready for the next morning so that we can prep for practice and that sort of stuff. And again, you're doing treatments right before you get on the plane. You'll do treatments, right when you land. You'll do treatments before shoot around, you do treatments after shoot around, pre-game, post-game, etcetera. So again, traveling is fun, right? You get to see some cool cities. You obviously get to interact with other staffs and stuff like that. But it's work.
Dr. Yoni Rosenblatt: Yeah. Yeah, it's work. Food?
Dr. Jonathon Gardner: Food is good. Food is good. Too much of it.
Dr. Yoni Rosenblatt: What's that look like? How does that work?
Dr. Jonathon Gardner: So, I mean, we've revamped our food here. So, I mean, we have chefs in-house who make stuff two or three times a day, depending on what kind of day it is, whether it's game day or practice day. Food on the plane, food when you land. And then, obviously, you're going to these nice cities where I'm lucky to be on a staff with a bunch of vets in terms of how long they've served in the NBA and stuff like that, so they know all the cool spots and stuff to go so. I've eaten some pretty good food.
Dr. Yoni Rosenblatt: That sounds amazing. So you're saying if I ever get one of these jobs, they'll make me kosher food.
Dr. Jonathon Gardner: I would assume they'd be able to find it. Yeah.
Dr. Yoni Rosenblatt: Okay. Put some feelers out there. See what they can do about that.
Dr. Jonathon Gardner: I got you.
Dr. Yoni Rosenblatt: When you fly from New York to LA do you get a bed on that flight?
Dr. Jonathon Gardner: No bed.
Dr. Yoni Rosenblatt: What does that mean?
Dr. Jonathon Gardner: I mean, it's just a chair. It's like a carved out charter flight, so it's a nice big chair but no bed.
Dr. Yoni Rosenblatt: Does anyone have a bed?
Dr. Jonathon Gardner: No, no. It's like first class seating for players and then bigger chairs for everybody else.
Dr. Yoni Rosenblatt: Okay, okay. Thank you for clarifying that. I know that's a burning question that I got when I told the masses that I'm having Jon Gardner on. They said, ask him about the bed situation on planes.
Dr. Jonathon Gardner: There are no beds on the planes. No beds on the planes.
Dr. Yoni Rosenblatt: Okay, thank you for answering that. Okay. So now that you've described a little bit of the system and the rubric and the team, a player gets hurt, let's say, 'cause we're gonna dive into some knee pathology, 'cause I know that's a passion of yours. I'm sure you see a ton of it. Walk me through what happens from the time that player says to anyone, hey, my patellar tendon's bothering me.
Dr. Jonathon Gardner: Sure. So again, every team kind of operates differently. So again, I'm only speaking from a...
Dr. Yoni Rosenblatt: Hornets.
Dr. Jonathon Gardner: Hornets' perspective, right? So we split our roster evenly amongst athletic trainers and PT. So I have my three, four or five guys that I'll manage throughout the year, whether we have prospect or just, again, preventative, daily performance care type stuff. So again, normally whoever the provider is for that player, their point of contact. We've done a really good job here where the training room is not like this forbidden zone where guys don't want to be with me. It's a very welcoming thing. And again, we approach it from the idea that it's performance care as opposed to rehab. It's somewhere that you can come even if you're not hurt and we can tune things up and make stuff feel just 1% better throughout the year. So I'd say you don't get a whole lot of guys hiding injuries or anything like that.
Dr. Yoni Rosenblatt: That's awesome. And by the way, a credit to you because I mean more of my experiences in the NFL world, it is not like that in 90% of organizations and franchises.
Dr. Jonathon Gardner: Right. So again that comes down to my boss, head of player health and then the GM as well who's also kind of cultivated that culture. So again props to those guys for having that stuff in place. It was like that when I got here, so it's not like it's anything I've done by any means. So yeah, whoever the provider is, there's point of contact there. Player says hey, this is bothering me. Again, we have the luxury of having team [0:15:27.4] ____ doctors sort of on our beck and call and it is not a hassle to get imaging here, right? So again, agents play a big role in that as well. So again, the guy says something's hurt, it's lingering, let's go get an MRI kind of stuff. So we can get imaging pretty quickly. And then you just sort of start to lay out that return to play continuum from there, if it's something that requires time off or if it's something that can be managed sort of conservatively.
Dr. Yoni Rosenblatt: Okay. So a player says, hey, my patellar tendon hurts. If it's one of your five guys, they tell you and then you manage it and then there are other... What? You're the only PT, so who's managing the other call of 10 guys?
Dr. Jonathon Gardner: The other athletic trainers.
Dr. Yoni Rosenblatt: An AT.
Dr. Jonathon Gardner: They've got the other guys. Yep.
Dr. Yoni Rosenblatt: Okay. And then so you... They come in that next day, you land at 3 AM. They get some sleep, on their way to bed they say hey, Jon, my knee is bothering me. You say okay, meet me in the training room at 10 AM. After you get seven hours. What do you do? What does that evaluation look like?
Dr. Jonathon Gardner: Sure. So, I mean, I think over the years it's become more simple, right? Coming out of school you do every special test you can imagine. But I think the biggest thing is keeping it super simple at this point. Number one, for speed, so I can again effectively communicate as quickly as possible that like, hey, this guy may not be in shooting around today or whatever the case may be. So again, I'm looking for a fusion, any sign of a fusion. I'm checking range, right? So I'm looking at flexion extension, making sure that we've got some sort of terminal knee extension. Again, for us, I'm working with these guys all the time, right? So I can pick up those little nuances where something feels a little more stiff or if they've got some extra tenacity in quads or if they are starting to look atrophied or whatever the case may be there. I'll do strength, so we have a dynamometer that we can kind of travel with if I need to.
Dr. Yoni Rosenblatt: A handheld dynamometer?
Dr. Jonathon Gardner: Yeah, through valve, so just the dynamo that you can get quick strength stuff with. And then your classic assess above and below, right? So if I know that this is a chronic ankle guy, I'll look down there. If it's a chronic hip, groin, abdominal wall type stuff, I can look up there and see what we've got. So, I mean, that's it for the most part, with obvious emphasis on... I mean, I'm going to try to load it, right? I think that's the biggest thing in the evaluation process is you've got to see what sort of load it can tolerate. 'Cause, again, if you can't tolerate an isometric sitting on the table with me pushing against you, odds are you're probably not going to...
Dr. Yoni Rosenblatt: You're not playing.
Dr. Jonathon Gardner: Tolerate basketball stuff real well. So again, I think load tolerance is probably the biggest thing we're looking at early on.
Dr. Yoni Rosenblatt: And all of these guys have baselines of strength documented so that you can say, hey, here's your norm and here's where you are today?
Dr. Jonathon Gardner: We're in the process of that. I'm trying to headline that moving forward just to make sure that we've got data. The tough part with that in the pro sports world is these guys are asked to do a million things. So you gotta be real picky about what it is that you want this guy to put effort into, so that you make sure you get a good effort out of it. So again, if I'm like, hey, we're gonna run through a lower quarter isometric screen, you may get two good strength scores and they're gonna be like, I need to go shoot. And then they're gonna blow through the rest and that data's not gonna mean anything. So it's simplifying your data collection process as well to make sure that you're not just doing it for the sake of doing it and stuff like that. But we are trying to do something systematically to sort of have, even if it's just an isometric score, on the isokinetic machine that I secured this year.
Dr. Yoni Rosenblatt: Good work.
Dr. Jonathon Gardner: Just so we have some sort of baseline.
Dr. Yoni Rosenblatt: Okay. What's preventing you from doing... Everyone reports to camp, everyone gets on the force plates, everyone gets their ISO tests, now we have your baseline, now you go shoot. I mean, that's a five minute screen if you have the right tech.
Dr. Jonathon Gardner: Sure.
Dr. Yoni Rosenblatt: Why can't you do that?
Dr. Jonathon Gardner: I mean, theoretically you do, right? It should be that simple. But that's pro sports, right? Again, depending on where guys are at in their career, they may have experience with that machine where they know a player who's gotten on that machine, gotten tested and then they got traded, right? Or did not get another contract or whatever the case may be, right? So again, that's where it's being real picky about what it is you're gonna test and also making sure that you get it implemented, right? So for me, that machine got delivered two weeks ago, so it's like end of pre-season.
Dr. Jonathon Gardner: We've already done, I mean, we've done force plates, saliva stuff, these guys wear connect on chips every day, et cetera, right? So, we've got tons of stuff on them. They're towards the end of training camp. They're exhausted and sore and ready for real games to start. And I'm gonna go ask them to, can you kick into this immovable object as hard as you can for three seconds for me? So again, I think it's a process that we're gonna try to get down so that we do have that data kind of stuff. And again, you do have certain guys who are more inquisitive than others who want that stuff more often, you have other guys who could not care less, they just wanna go hoop.
Dr. Yoni Rosenblatt: And so that's you by the way. So how do you address that? Let's call it conflict of interest where you, Jon Gardner work for the Charlotte Hornets, your cheque is signed by, probably used to be Michael Jordan or someone with the Hornets, right?
Dr. Jonathon Gardner: Sure.
Dr. Yoni Rosenblatt: And so the player knows that, and the player's thinking, wait a minute, he reports to management. I want someone on my side who's looking out for me. How do you walk that very fine line?
Dr. Jonathon Gardner: I mean, I think it is very similar to the relationships you start to build with patients in the outpatient setting. And again, I think that's one of the things that sort of lended itself to my early success here is the depth and breadth of the patient types that I got to interact with at True Sports, right? You just learn how to talk to different people in different ways. And it's always an education process. Again, there's a lot of why am I doing this? And again, if you can communicate that effectively to the athlete, why is this important, why I need that data to be able to help you kind of stuff, as opposed to like, oh, I just need a number so that we have it in a database so that when it falls off a certain percent, I know to tell a GM to ship you out or whatever the case may be, right?
Dr. Jonathon Gardner: It's always performance based sort of stuff. And again, if you can correlate it to on-court stuff, that will typically go over better than... They don't care what their quad torque is, at 60 degrees per second, right? They care that they can decelerate and keep Trae Young in front of them, right? That's where they're at with it. So again, if you can explain why that value is important in terms of on-court performance, I think it goes over just a little bit smoother and you'll probably get a little bit more buy-in.
Dr. Yoni Rosenblatt: Jon. You don't realize the gold you're providing with that very calm but astute answer, which is if we're looking through the lens of I am just trying to help the person in front of me regardless of your setting, that is always gonna land better. And unfortunately, I see a lot of times in the pro world where it's, I'm doing this test because my boss told me to, or because this is the way the team does it versus what you just laid out, which is we're doing this to help you. I only care about helping you, here's how it's gonna work. By the way, here's an example of where I'm gonna use some of this data to make you better, to make you more money, to keep you healthier, et cetera, et cetera. I think that goes a long way. So I don't know if you've thought about it like that, but that's what I'm kind of taking away from it.
Dr. Jonathon Gardner: Sure. I mean, I think that's... It's a patient first mentality, right? Just because I changed setting and it's a pro athlete rather than a CrossFit weekend warrior kind of thing, they still have goals and stuff they want to get to. So the better you can communicate with them and relate to them and understand where their head's at with stuff, I think it just makes it an easier process.
Dr. Yoni Rosenblatt: Yeah, for sure. How much time do you have with these guys to do, like in the example I'm giving you of patella tendinopathy, how much time do you have to assess them and then to treat them on the regular?
Dr. Jonathon Gardner: So I mean, it depends, right? So obviously, if you've got a true long-term rehab, if they happen to be post-op or whatever the case may be, right? Obviously you... I can sort of dictate schedule in terms of like, hey, rehab is the priority at this point. We're not doing stuff on court, we're not doing as much in the strength and conditioning realm, right? So, I get the allotment of time kind of stuff and I can sort of manipulate schedule to some degree. In season, these guys have designated shooting times every morning before practice, you've got practice, they're always gonna wanna shoot after and stuff like that, right?
Dr. Jonathon Gardner: So, I think some of that goes back to the very first question with the pressure, right? So again, time's limited. I think that that'd probably be a misconception is that like, oh, you're around them all the time. You can just rehab for four hours. Those guys don't wanna be here that long. They wanna show up, do their work, get paid, go home, right? So it's understanding that I've got 30 minutes, so I probably need to choose whatever's the most efficient and effective modality intervention or whatever the case may be for that day. So I mean, I'd say on average you've probably got like 30 minutes.
Dr. Yoni Rosenblatt: And is that 30... Yeah. Okay. So that's 30 minutes one-on-one with one of your five Charlotte Hornets.
Dr. Jonathon Gardner: Sure.
Dr. Yoni Rosenblatt: Okay. And is there a case or a time when that's three hours of rehab, if you, let's say you have six guys and you get 30 minutes, are you spending six hours of your day rehabbing?
Dr. Jonathon Gardner: To some degree. Again, it's very player dependent, right? Some guy may just need, they'll come and say just quick stretch or whatever the case may be, right? And you run them through a movement prep and see how they're feeling, address tissue quality and just make sure nothing is out of whack or anything like that. But again, it's just running them through range of motion stuff, making sure they feel good and then off they go. So again, that can be 15 minutes. And then you're user documenting or running around helping other people out or whatever the case may be. But yeah, there are days again because I'm the PT, right? So I will occasionally take over some longer term rehabs. We'll swap guys or whatever the case may be, if we feel like it's warranted. So again, theoretically if I have all the post-op guys, that could be... I'm seeing that guy for 30 to 45 minutes before or I'm seeing him for 30, 45 minutes after sort of stuff. And again, you're doing it every day from whenever training camp started until, knock on wood, playoff run is over.
Dr. Yoni Rosenblatt: Yeah. And so how do you get a guy to graduate from you? I think one of the biggest fears, and I see this playing out at various levels of competition with athletic trainers, of once you take a guy on your caseload, he's gonna be on your caseload forever. So how do you manage that?
Dr. Jonathon Gardner: I think, again, because it's all performance based here, right? It may not necessarily be... It's probably not a bad thing if they're continuing to see me, right? And you can continue to check the box and make sure that we're addressing some of these qualities that we felt like were worth rehabbing, right? So, in terms of like... I would love for all my guys to be quick stretch guys or tiny little activations and stuff like that. And again, that's always the goal, it's to have these guys in a routine where, you know, obviously... Who said it? Cory Schlesinger was like, sport's not healthy, right? So the idea that these guys are gonna come in every single day, a hundred percent, all they're gonna need is a quick stretch, it's just super far fetched. It's not gonna happen. But again, the hope is that, again, assuming you've kind of cleared up any significant pathologies through the rehab process and stuff like that, and you get these guys back playing and stuff like that, it should just be tune up type stuff where I'm not having to...
Dr. Yoni Rosenblatt: Spend all that time.
Dr. Jonathon Gardner: You know, 30 to 45 minutes on a knee or an ankle or something like that. It's more holistic and collaborative with sports science and strength and conditioning staff to make sure these guys are tuned up the best they can.
Dr. Yoni Rosenblatt: Yeah. Okay. So I know you love loading diseased tendons, right?
Dr. Jonathon Gardner: Sure.
Dr. Yoni Rosenblatt: So with this patellar... Am I right about that?
Dr. Jonathon Gardner: You are.
Dr. Yoni Rosenblatt: Okay. So in this patellar tendinopathy case, once you get into loading, when do they become strength and conditioning? When does strength and conditioning say, you know what? I'll handle the Bulgarians, you do your needling crap. How do you navigate that world?
Dr. Jonathon Gardner: Sure. Again, I think one of the benefits of us having such a small staff is there is such constant communication, and collaboration and stuff like that, right? I'd like to think that I've not taught, but again, shown some of the strength guys some various loading methods that they maybe not have thought of. And again, they're running me through stuff that I've never even considered as well. So again, I think having that collaboration back and forth makes it easy so it doesn't turn into a silo situation where you're stepping on toes. Like, this guy's supposed to be in strength training, why is he doing rehab? I'm doing that later, et cetera.
Dr. Jonathon Gardner: So again, making sure that there is that constant line of communication where if I know that for me today is gonna be a heavier quad load on the isokinetic machine, we either tag team that and I make sure that we're making it a quad day with the strength guy, or I'm like, that's all the load. I want to go through that tissue today because we are gonna go up and play and we're gonna get plenty of quad load there. Let's just do hips and hammy's as Tim would like to say, right? So, again, I think because we're in a smaller facility and we're all right next to each other, that's a very easy conversation. That's a... He finishes on the table with me or in the training room with me or the weight room with me, and I just go to the strength coach. I'm like, I did this, this, and this. Let's try XYZ. And again, my two guys have been amazing since I've been here and it hadn't been an issue, so.
Dr. Yoni Rosenblatt: You are...
Dr. Jonathon Gardner: I can't speak to other orgs.
Dr. Yoni Rosenblatt: You're blessed. You're definitely blessed. Now I just wanna make sure, 'cause you and I used to work for a guy that would always say the word again, and that meant he was pissed off at us. That's not what you're getting at when you tell me again, this is...
Dr. Jonathon Gardner: No.
Dr. Yoni Rosenblatt: The way we talk. Okay. Okay, good. Just wanted to clear that up. [laughter] Okay. So as the guy who taught me so much as it pertains to loading diseased tendons, I'm dying to know what have you learned from that strength world or else wise since you've been there that you didn't know before you got there?
Dr. Jonathon Gardner: Sure. I mean, I think the biggest thing is it is a load tolerance issue, right? Whether you buy into the doughnut hole or the doughnut theory or whatever, Cook and [0:31:47.4] ____ Malle Harris and all those guys sort of argue about with it, right? The tendon is dysfunctional, the knee extensor mechanism is dysfunctional and therefore it's not accepting load very well. So again, I think some of that goes back to just simplifying it and trying to dumb it down. The knee extensor mechanism is not tolerating load. What can I do to improve the odds of that tolerating more load? So I've gotten very simple with my loading as well. I think as I came up, my exercise prescription was a little bit elaborate. I'd have bands everywhere. I'd have accommodating resistance this place or whatever the case may be. Everything was a compound movement. What's the buzzword sports specific type stuff? I'm gonna make it look like across...
Dr. Yoni Rosenblatt: It's on the court.
Dr. Jonathon Gardner: Whatever the case may be. Yeah. And I think one of the things you recognize as you move up in levels of athlete is like, these guys are the best compensators in the world. You think you are loading that quad and you are not. He has shifted it into his glute, it is all in his calf or he's moved his trunk or contorted this way or that way. And again, he's gonna hide that load and sort of stress shield, right? So the one way that you avoid that is you put them in a seated leg extension machine and you say push. And there's only one way... That way it's gonna move or that they'll see the isokinetic data change or whatever the case may be.
Dr. Jonathon Gardner: So I mean, I think simplifying it very early on, number one, I think you can show these guys the deficit earlier, 'cause they're like, I jumped 40 inches. What do you mean my quads are weak? And again, you put them on an isokinetic and they've got a 45% difference or they can't even touch body weight torque or whatever the case may be. And again, it's less to show them that they're weak, but it's like you're performing at this level of sport with lack of strength. Imagine if we do get this number up. So, again, sometimes it's less about like, maybe you don't have pathology, but again, we talked about that screening type stuff. If I know that we are lacking some strength, maybe that gives that guy that extra gear or whatever the case may be, so.
Dr. Yoni Rosenblatt: It's funny you mention that because I think the best addition we've made here at True Sports since you moved on is getting just about all of our locations any extension flexion machine, which costs like 250 bucks because we put all this investment into force plates, and getting really good at getting sports specific. And we very rapidly learned, put them on a goddamn knee extension machine and you're gonna see how weak they are. So I think that...
Dr. Jonathon Gardner: Absolutely.
Dr. Yoni Rosenblatt: Yeah. That really goes a long way. So if that's what you're doing anterior knee-wise, you are the heel float king, what have you started doing posterior chain wise or gastroc?
Dr. Jonathon Gardner: Sure. So same sort of thing, you tease out. I think the calf is interesting, right? Because of where it's advantageous it's sort of where it's strongest. So it's at that stretch position. So I've even gone the opposite of heel float. Heels on the ground now and you do more ISO push in that stretch position.
Dr. Yoni Rosenblatt: Tell me what that looks like. Break that all the way down as if I am not a PT.
Dr. Jonathon Gardner: Sure. So I'll do like a seated calf ISO push, so I'll put them... I'll find 10 degrees of dorsiflexion. I'll have some sort of immovable object on their thighs and it's push as hard as you can, as fast as you can. And you're looking at rate and peak force and just how much torque that they can... Kind of that lengthened angle.
Dr. Yoni Rosenblatt: That makes a lot of sense. And then how do you do... You do the same thing with a locked knee to isolate gastroc versus soleus?
Dr. Jonathon Gardner: Yeah, so we don't have a Smith machine here. The only way I've played around with it is we have like a Keiser squat. So you can just have a guy... You can load it up as heavy as you want and then push as hard as you can. So it can work.
Dr. Yoni Rosenblatt: I bet you, the thousands of Australian physios that are listening to this just stopped listening when you said we don't have a Smith machine. [laughter] Dude, that's crazy. Is that on your wishlist?
Dr. Jonathon Gardner: Next facility. Next facility.
Dr. Yoni Rosenblatt: Is that coming?
Dr. Jonathon Gardner: We're getting a new private facility. Yeah.
Dr. Yoni Rosenblatt: Okay. So Smith machine. What else is on that wishlist?
Dr. Jonathon Gardner: I got my isokinetic, so I'm good there. What else do I want? Belt squat would be nice.
Dr. Yoni Rosenblatt: I can't believe you don't have a belt squat.
Dr. Jonathon Gardner: No belt squat.
Dr. Yoni Rosenblatt: That's unbelievable that you're rehabbing seven foot athletes without a belt squat. That's...
Dr. Jonathon Gardner: These guys can squat, I'll tell you that. Most of these guys front squat, so they do pretty well with it.
Dr. Yoni Rosenblatt: I bet. Okay, so as you're assessing the, let's say, in the patellar tendon case. How quickly are you getting towards plyometric? Because we talked a lot about isometrics, but these guys do plyometrics for a living better than anyone in the world. So how much education are you doing with plyometrics or interventions?
Dr. Jonathon Gardner: I don't do a lot.
Dr. Yoni Rosenblatt: You don't do a lot?
Dr. Jonathon Gardner: I really don't. Again, if anything, I'll try to make it more of an extensive based plyometric where it's more like POGO-ish, for lack of a better way to describe it. So going for quick ground contact, making it more foot and ankle driven with the hopes of, again, using some of that lower leg musculature and the foot musculature to sort of dampen the force as it goes up the chain. And again, you can get some of that stuff through force plate data and stuff like that. If this guy's just a huge knee dominant guy, then it's like, okay, he's probably got what he needs there in terms of loading that tissue. Let's see if we can keep the knees sort of locked and keep it out of it. When we do keep some of that stretch shortening cycle work, then we'll do more of the extensive POGO type stuff to start off with.
Dr. Jonathon Gardner: And again, it's also understanding that these guys are going to, they're still going to go upstairs. They're still going to shoot. If they don't do it when you're in the building, they're going to come back later and do it and stuff like that. So again, it's more of an education piece on, I mean, I know load management it's just a big buzzword, especially NBA-wise. But it's letting them understand, as of right now, that tendon is not tolerating that load. So we just need to be careful with it. And it's helping coaches and stuff understand that as well. But in terms of my side, it's probably significantly reducing the volume with me, with the understanding that they're going to go play. So they're going to get plyometric volume and stuff like that. So it's on me to take the box of more that isolated, heavy, slow resistance type stuff.
Dr. Yoni Rosenblatt: Yeah, that makes sense. When you're doing some of those POGOs, are you barefoot?
Dr. Jonathon Gardner: More often than not, most of these guys don't train in shoes, which is nice. Don't have the prettiest feet in the world, but they do take the shoes off when we train and stuff like that.
Dr. Yoni Rosenblatt: They're probably gross. Are they taking the shoes off because of you or you feel like that's baked into the NBA culture at this point?
Dr. Jonathon Gardner: I know it's kind of baked into our culture. You just kind of take your shoes off in the weight room. 'Cause we just want to see how you move without the shoe on. Again, depending on what a guy has going on, I may want that stiffer shoe on to give them more support and added sort of pop to some of their jumping and stuff like that. But if I'm just going for tissue compliance and GPP work or whatever you want to call it, I'm probably going to take their shoes off just so they can move through a different range of motion. I can watch how their foot moves and stuff like that, since these shoes are not the greatest, they look cool, but probably not the best for feet.
Dr. Yoni Rosenblatt: Yeah, yeah. Yeah. I can imagine. Who has the worse feet? NFL running backs or NBA shooting guards?
Dr. Jonathon Gardner: Ooh. Oh man. Probably running backs still. They ding theirs into the turf and stuff like that.
Dr. Yoni Rosenblatt: You might be right about that. Except I feel like pedicures are really catching on in the NFL world. Has it made it to the NBA world?
Dr. Jonathon Gardner: Not here. Not here.
Dr. Yoni Rosenblatt: Except for the rehab staff.
Dr. Jonathon Gardner: Exactly. Exactly. We do weekly. Weekly.
Dr. Yoni Rosenblatt: Okay. That sounds like a great night out. Yeah. Okay. So what types of technology, modalities, interventions have you found to be really impactful since you've gotten to the NBA that maybe aren't available in the private practice setting?
Dr. Jonathon Gardner: I mean, force plates are the big one. I know they're becoming more readily available. So I wouldn't say so much it's having the force plates. It's having my whiz of sports science guy and then our analytics department to sort of build these databases out for our guys so that we know that when we ask these guys to do weekly jumps, it's compared long term and short term sort of stuff. And they've got the metrics they're dialing in on, and then I can have my input and stuff like that. So it's not only just having the plates, it's having someone who interprets them pretty well. I think, or I like to think anyway, the isokinetic machine is going to be a game changer in terms of how we rehab and how we can kind of pinpoint stuff. And again the hope is that, at some point, it's part of the draft process as well, right? You get an idea of what these guys can produce torque-wise rather than looking at a Y-Balance or an FMS in terms of movement quality. It's like, well, we know basketball is a sport of decelerating and jumping. That's typically a knee extensor thing.
Dr. Jonathon Gardner: So let's see what these guys look at in terms of quad and hamstring type stuff. So I'm hoping that that's a game changer for us. And then modality-wise, we have an extracorporeal shockwave unit that has been a game changer with some of this chronic tendinopathy type stuff. So that's been cool to use, especially again, coming from private practice, especially with True Sports. We weren't a modality company, right? We had an understanding that these people had movement dysfunction. So the goal was to get them up and moving. And if they wanted to ice later, they could ice and stuff like that. So now being in a realm where I have athletic trainers and that's like, that's not all they do, but that's their jam. They understand that stuff, like having a better understanding of how to manage early swelling. When do they like to start icing? When do they like to start contrasting and stuff like that has been a great adjunct to what I do as well. So even just the basics of getting into some of that stuff again, it's been cool.
Dr. Yoni Rosenblatt: Give me some nuts and bolts there. When are you using ice? Have you gotten into BFR as a recovery technique? And how much use is electric stim in this recovery world?
Dr. Jonathon Gardner: So we don't do any of the tens type stuff. We don't have units like that. I have a portable Russian unit that, much to the chagrin of my knee guys, I use a lot for the quad. But again, none of your classic ice and stim by any means. If anything, it's a game ready. So again, you're typically letting that. We're compressing the... Like if you get an ankle sprain, you're compressing it ASAP. I think that's the biggest thing is compress it. Good set of horseshoes around the malleoli to keep that swelling out of there. And then alter weight bearing as much as you need to. You kind of let the natural inflammation stuff take care of it for first 24, 48 hours. And then you can start icing contrast type stuff for pain management, swelling management, and that sort of stuff.
Dr. Yoni Rosenblatt: Okay. Now, that natural swelling that you're letting the body do its work, is that affected negatively by the fact that you're icing immediately or game readying immediately? I feel like that's both sides, right? You want...
Dr. Jonathon Gardner: I mean, you get both sides of it. So some of it's the traditional way. I'm not the first one to go to ice. I would rather just compress it and leave it or put them in a boot or whatever the case would be to take some of that, the weight bearing forces and stuff like that off of it. But again, I have the luxury of working with these people who have been in high performance sport before I was out of middle school. So, they're like, I've done this for 30 years, it seems to work. So again, you sort of take that and run with it. So again, it's a case by case basis for sure.
Dr. Yoni Rosenblatt: Do you see, because you are responsible for five guys, do you see that an intervention to a Jon Gardner athlete is different than the guy who reports to the trainer?
Dr. Jonathon Gardner: I mean, yeah. I definitely think we do a lot of stuff similar, our movement prep, like we call it, it's just have a guy run through a squat lunge, bear hold, all these different things. It's similar. It's the same for every player. Again, it's like a checklist to run through. The general "quick stretch" is pretty similar person to person, but in terms of dialed in interventions for my specific guys, it's probably very different from my athletic trainer counterparts.
Dr. Yoni Rosenblatt: Yeah. Does your ankle sprain get treated differently than David's ankle sprain?
Dr. Jonathon Gardner: Not really. No. 'Cause again, I think, these guys have been around for longer than I have. So I think good practitioners are good practitioners. Some of the tiny nuances may be different. I may be a little bit quicker with some of my plyometric stuff or dribbles or return to run type stuff than other people are. Just because that's the experience that I've had in outpatient. Again, you get these kids come in and like, I have a tournament in two weeks. I've got to be able to go. So it's like, all right, we're going to push the envelope and stuff like that. So again, it's doing that responsibly here. 'Cause again, these guys are worth a little bit more than than your average club lacrosse player, so.
Dr. Yoni Rosenblatt: They make a little more.
Dr. Jonathon Gardner: Yeah. Make a little more. Good point. Good point. So yeah, it's keeping that stuff in mind, but then also knowing that if I do get stuck, I can go to them and be like, hey, this isn't really sticking. And then we'll try other stuff. I'd never used... I don't know if you guys have them yet. The blackboard type thing, the ankle stabilizer, foot stabilizer tool. I'll send it to you. It's cool. It's different ways to attack the foot and stuff like that. I hadn't seen that other than just Instagram videos prior to getting here. And again, you go through it with these guys, it's like, oh, it's the same thing as what I would try to do on a slant board. You can just sort of manipulate the calcaneus versus the midfoot or whatever the case may be. So again, it's being able, I guess being humble enough to be like, I'm stuck kind of stuff. And asking for help from the other people.
Dr. Yoni Rosenblatt: That's pretty awesome that that's the culture there. I know that's not the regular. Okay. So that sounds like there's a ton of awesome stuff and tools that you've come across that are new and different. What do you think at pro sports is the biggest waste of time that's currently being utilized? Not necessarily Hornets.
Dr. Jonathon Gardner: Biggest waste of time.
Dr. Yoni Rosenblatt: Yeah. In baseball, we call this eyewash. What is really just a freaking joke that, oh, we've been doing this for years so let's keep doing it.
Dr. Jonathon Gardner: Oh gosh. I mean, my strength coaches would tell you it's dynamic warmup before practice. These guys don't care. They want to get through practice and get out of there kind of stuff. So we've joked about that before. Again, you're trying to get these guys to do an A skip and they're making fun of you for doing the A skip. And I'm like, well, you're doing it wrong. So again, it's stuff like that. In terms of other stuff that's just like, why are we still doing this? You still see people, I'm not a huge fan of FMS. So you still see that as a screening tool and stuff like that. I mean, I think there's some value to it. We'll run through it with some draft prospects to see if a guy can move and stuff like that. But in terms of something that you're dialed into, in terms of your own players performance, I don't know why you would continue to use stuff like that, that's been proven to, again, I would say 90% of my guys would fail the FMS.
Dr. Yoni Rosenblatt: Yeah, for sure. I think 90% of everyone fails the FMS. And what's it going to tell you? It's going to tell you, you got tight hips. It's going to tell you have tight shoulders and you probably have weak hips. So just like everyone, it's crazy that FMS is still around. And Gray Cook would argue with you. He would say that he never really... Well, he would say that's not why he created the FMS. He would say that he created the FMS to give you a baseline and kind of what to work on, not to predict injury, certainly.
Dr. Jonathon Gardner: Yeah. So again, I think we certainly don't use it as any sort of predictive tool when we're doing it. It's literally like, can this guy squat at all? Do his shoulders move at all? But again, I think hopefully moving forward, you get more of that out of table exam, and probably taking them through a... Again, you could probably take them through a mock lift and figure some of that stuff out.
Dr. Yoni Rosenblatt: Yeah. Pretty quickly. Okay. So, what do you think the future of elite level sports PT is?
Dr. Jonathon Gardner: The future of elite sport PT. I mean, I think it's constantly trying to tweak what that return to play continuum looks like. And again, trying to push the envelope, obviously responsibly on how fast we can get some of these athletes back. And there's a big, big movement with some of the cognitive stuff in terms of control chaos theory with return to sport and stuff like that. So again, with sport PT, is there a way that we can start to do that? Like VR is obviously becoming a big thing. We've played around with it a little bit, but I mean, they're coming up with technologies where you can put a guy on the floor and he can look around and analyze film, doing that kind of stuff. Are we going to be able to do that kind of stuff while a guy's doing quad sets while he's post-op ACL? So again, you're keeping them engaged in that way.
Dr. Jonathon Gardner: And again, that helps some of that neurocognitive sort of delay that these guys have when they get back, where it's just like, I just feel like a half-step slow, but all their metrics and movements and stuff look good. It's just the processing speed. So I think it's starting to dive into that sort of stuff. And then I think sport PTs are going to continue to have to adapt and be multifaceted. You've got to have a strength background. You've got to know something about sports science, unless you happen to be at an organization that has five PTs, four sports scientists and stuff like that. If you're a smaller staff like us, my ability to be able to have more of those in-depth conversations with my sports scientists about what I'm seeing on the force plates or whatever the case may be is probably beneficial at this point. So again, for the PT coming in, it doesn't... Not saying that you need to be the force plate expert, but if you can speak the language, I think that's hugely important.
Dr. Yoni Rosenblatt: Yeah. It's interesting to see where it's gone. I think when I first got out of school 15 years ago, it was how well can we speak to doctors and surgeons? And now it's like, how well can we talk to strength and conditioning, or by the way, even position coaches or speed coaches? I could definitely see that being the future. That VR stuff is really interesting to me. I could totally see that eventually making its way into our world, into the private sector.
Dr. Jonathon Gardner: Absolutely.
Dr. Yoni Rosenblatt: Where we're able to include that stuff. I was just talking to someone in the Red Sox organization. They're like, it's not VR, but their ability to get a pitching machine that mimics spin rate of every single individual pitcher, put it behind the screen of that pitcher delivering his pitch and you get in the cage and actually hit off that. That's really powerful. I think there's more moving parts in NBA. But I could totally see VR kind of taking us there. I love that. It's a lot of interesting stuff. Okay. Are you, Jon Gardner, ready for your lightning round? The Eric Cressey lightning round.
Dr. Jonathon Gardner: Eric Cressey lightning round. Here we go.
Dr. Yoni Rosenblatt: Here we go. Please make it quick. Here we go. What most prepared you to be a PT in the NBA? Do not say True Sports.
Dr. Jonathon Gardner: I can't not say, it's the various roles that I had at True Sports, right? It's knowing how to be a part of a team sort of thing. I think that was big, right? I came on staff, staff PT, clinic director, had the fortune of growing into the bigger leadership role was sort of the regional type stuff and learning how to manage people and stuff like that. So again, I think being able to go across that continuum, it makes it easier to fall into a part of a team here since I've been on about as many different levels of a team as you can be.
Dr. Yoni Rosenblatt: Yeah. That's really interesting. Okay. Clinically, what have you changed your mind on in the last four years?
Dr. Jonathon Gardner: Machines versus your compound movements. So again, leg extension versus split squat.
Dr. Yoni Rosenblatt: Okay. What is the best advice for a PT that wants to crack into the NBA?
Dr. Jonathon Gardner: Know your stuff, be able to talk to stakeholders at whatever level they need to be able to talk to and network your ass off.
Dr. Yoni Rosenblatt: What is the best resource that you recommend for PTs looking to improve clinically?
Dr. Jonathon Gardner: I'm a big fan of...
Dr. Yoni Rosenblatt: Obviously, your Instagram.
Dr. Jonathon Gardner: Sure. My Instagram, you have to scroll back a little bit for clinical content. Erik Meira, M-E-I-R-A, The Science PT was huge for me in terms of just simplifying stuff. That's sort of what started the process. I know I had... I went and took his course with a couple of our guys when we were at True Sports kind of stuff. And again, I think it's fantastic. He's got stuff that's online or he'll do live stuff. So again, if you ever get a chance to listen to him speak or take one of his courses, highly recommend it. And then one of your other guests, David Gray, just the way that he looks at movement and stuff like that and sort of combines all these different realms, whether it's PRI or [0:55:41.7] ____ or whoever the case may be, makes it very movement based, has been good for me as well. So I'd recommend those two guys.
Dr. Yoni Rosenblatt: They're such studs. That's really good advice. Okay. Where is Dr. Jon Gardner in five years?
Dr. Jonathon Gardner: Ooh, if you ask my wife, we're still here in Charlotte.
Dr. Yoni Rosenblatt: Nice.
Dr. Jonathon Gardner: So we don't have to move again. Hopefully director of rehab, here or somewhere in the league, head of medical maybe. So we'll see.
Dr. Yoni Rosenblatt: Hell yeah. I love that. I do think that I'd like to see more of that. I do think that Jon Gardner, obviously, but I do think that that's the future of sports PT is PTs being head of medical.
Dr. Jonathon Gardner: Yeah. I would agree.
Dr. Yoni Rosenblatt: I don't think we see it enough. I think other countries see it, by the way, in the private sector also where the PT is the quarterback of all things, orthopedic, sports medicine, we get away from that doctor model. And I think we get away from the athletic training model. Certainly the PT AT, I could see, but man, we should be running crap.
Dr. Jonathon Gardner: I agree. I agree. Your knickerbockers got a good one.
Dr. Yoni Rosenblatt: Hell yeah. Well, they're the Knicks. Of course.
Dr. Jonathon Gardner: We'll see. We'll see. We'll see.
Dr. Yoni Rosenblatt: Of course.
Dr. Jonathon Gardner: He's a good one. Jesse Elis. So, oh, another resource, Rehab Code. That's Jesse Elis. I did his mentorship, which was incredible. And then obviously conversations spur off that. He's got a great network. He's been in the NBA for a while. He's VP of player health for your Knicks now. So maybe I can get him on your podcast. Who knows?
Dr. Yoni Rosenblatt: Ooh, I would love that. We'll connect offline about that, but that's awesome. Okay. Jon Gardner. I have loved knowing you for the time I have, not that that's ending. Tell everyone listening to this where they can find you.
Dr. Jonathon Gardner: I mean, I'm on LinkedIn. I'm trying to do more thoughtful posts, I guess, because again...
Dr. Yoni Rosenblatt: You're a grown up.
Dr. Jonathon Gardner: I'm not going to be throwing, you're not going to throw your athletes on Instagram like I did in the private sector. You can also find me on Instagram. So again, I've got some old stuff on there. I'm attempting to find a way to put out some new stuff and maybe get into some mentorship type stuff. I know I've talked to Tim about a way to do that. So maybe you guys will see a little bit more of me here soon, but Instagram @dr.jongardner23. And then just my name, Jonathon Gardner on LinkedIn. Happy to connect and talk with anybody about anything.
Dr. Yoni Rosenblatt: Yeah. Yeah. And you've been a model of that. So I appreciate you coming on, the absolute best Coker basketball player I've ever interviewed. So thank you so much for that.
Dr. Jonathon Gardner: Not anymore, but I appreciate it.
Dr. Yoni Rosenblatt: Thanks for your knowledge. And really the look behind the curtain, I think, it's really valuable and you come from such a great place of humility and obviously aptitude. So thank you so much for sharing all that with me and the audience. If you guys have any comments, if you guys want to hear more of Dr. Jon Gardner, if you want me to bring him back on and talk about Achilles tendinopathy, I would love to hear Jon wax poetically about shoulder pathology 'cause he probably sees none of that in NBA, but.
Dr. Jonathon Gardner: Just my own.
Dr. Yoni Rosenblatt: Just your own. But if you want to hear more, learn more, see things different, hit us up TrueSportsPT on Instagram. Guys, thank you so much for listening. Jon Gardner, thank you.
Dr. Jonathon Gardner: No, I appreciate you. Thanks so much for having me on.
Dr. Yoni Rosenblatt: Yeah, man.
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