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Oct 19, 2022

What MDs & Orthopedic Surgeons Want from Sports Physical Therapists

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Dr. Yoni Rosenblatt: Welcome to the True Sports Physical Therapy podcast. Dr. Dreese, thrilled to have you here. Thrilled to have you educate sports PT's around the world, there are about six of them listening right now, so they are gonna learn a ton from you I am sure. Start please by
introducing yourself to those sports PT's.

Dr. James Dreese: Sure, thanks Yoni, pleasure to be here with you. I am really looking forward to discussing sports medicine, it's a topic that obviously is near and dear to my heart and one that I really enjoy talking about. I'll go back to college, I went to Penn State University, I stayed there for medical school, Did my residency in orthopedics at the Hospital for Special Surgery in New York, and then went to Pittsburgh with the late Freddie Foo and spent a year working with him and honing my craft initially in practice for two years down in Charlotte, and then I've been in Baltimore since that time in 2005. Been at med Star since 2013. So about 20 years of experience in practicing sports medicine, taking care of a variety of different teams at the college and at the professional level now, contributing as well, so it's really been a fabulous career up to this point. I love taking care of athletes, I love taking care of recreational athletes and athletes who really are competing at the High school, collegiate and professional level too, so they have many of the same demands, a little bit different at the higher levels of sports certainly, but still a real motivation to get back to sport and to stay involved at the highest level that they can.

Dr. Yoni Rosenblatt: It's really... That's awesome. I even learned just a little bit during that bio that you just shared, and it actually points to a lot of what I wanna cover today, talking about some of that higher-level athletes that you cover, just fill in a couple of gaps for me and the audience. You currently work with professional football. Right? 

Dr. James Dreese: Right.

Dr. Yoni Rosenblatt: Tell me about that.

Dr. James Dreese: I've been an associated orthopedic team physician with the Ravens since 2013, and then also at the collegiate level too.

Dr. Yoni Rosenblatt: Okay. That's the pinnacle of some people's career, I love that you left that out in your bio, but awesome that you do that. I've seen that you are doing an unbelievable job there, and then what do I always give you a hard time about with your bio that I wish you shared more? Come on.

Dr. James Dreese: I played football in college, which honestly was one of the most enjoyable experiences of my life, certainly, and from a competitive sports standpoint, I grew up playing a lot of sports. My life really revolved around sports growing up, and through college, it did as well, but that really was the pinnacle of my athletic career, was the ability to compete in Division 1 football.

Dr. Yoni Rosenblatt: For Penn State? 

Dr. James Dreese: Right.

Dr. Yoni Rosenblatt: Okay. It's important to share that stuff, and here's why it's important, I was just working with an athlete that you performed an outstanding operation on with his ACL. I said, "Do you know Dreese, he's a football player?" He's like, "No, he wasn't." Like, "I'm telling you, he was a football player who played at Penn State." So it's not just that you played football, it's that you played at Penn State. Your patients wanna hear that, I think.

Dr. James Dreese: Yeah, I think it's an interesting topic. I think it is probably less important that I played at that level and more important for me that I understand the locker room, the dynamics with the coaching staff, just everything that surrounds sport in the way that athletes deal with injury, having suffered through several of my own, I think it gives me a unique perspective into how that works, and I do think that has proven to be beneficial to me, certainly.

Dr. Yoni Rosenblatt: No question about it. So your patients I think wanna hear that. I know on our side, on the True Sports side, I love promoting our staff, our clinicians that have competed at a high level, the athletes, the patients themselves love hearing it. I think your audience, this audience loves that you are a punter, 'cause you left that out also, at Penn State. I love that because I spend a lot of time with specialists that compete on Sundays, and they are meticulous, to say the least, and I think that shows through in some of your work, so it's my pet peeve, but share that.

Dr. James Dreese: Yeah, I would say, I think there is tremendous value in sport for young athletes in particular, in terms of teaching them life-long lessons in different parts of sport that I think make you better at sport, from time management to dedication to dealing with hardship and managing injury and coming back from disappointment, dealing with loss in sport. I think all of those are really valuable lessons for athletes. And I think that those things have really benefited me in life in general as well, so I am someone who certainly is a big proponent for the benefits of sport for young people and teaching them some life-long lessons that benefit them and moving forward in their lives.

Dr. Yoni Rosenblatt: You really make it clear in the way you communicate with your patients. It's one of the reasons that I value this relationship so much, and one of the reasons I'm so excited to share some of those specifics. We're gonna play a little game, we're gonna talk about what we wish or what we would want the other profession to do more of. I'm gonna tell you what I would love orthopedic surgeons to do more of. You're gonna say the same thing about sports PT's. Okay? 

Dr. James Dreese: Okay. Alright.

Dr. Yoni Rosenblatt: I'll get started. Okay? 

Dr. James Dreese: Alright.

Dr. Yoni Rosenblatt: I would love if orthopedic surgeons would stop showing their patients those little circle pictures, no one knows what the hell those mean. Can you stop doing that? 

Dr. James Dreese: Yeah, that's fair. I think it is those little circular pictures that you talk about are arthroscopic photos, and they I think are an important part of trying to really illustrate to our athletes and our patients their injury, the treatment for it. But yeah, I think to someone outside of orthopedics, it probably is a little bit difficult to decipher exactly what it is. So I think there are ways to help with that, and you can mark on the images what the injury is and what the treatment is but in and of itself, I think that the images themselves probably don't do a great service in terms of how to move forward. I think they're helpful from a documentation standpoint for me. I think it's important to document everything we do because it affects rehab and it affects recovery and a lot of other parts of that postoperative process, but in and of itself it's not. I think the conversation is more important than the illustration.

Dr. Yoni Rosenblatt: Yeah, yeah. Okay, duly noted. I do remember when you came in and taught True Sports physical therapists about meniscectomies, meniscal repairs. That was really eye-opening. I've heard you speak a number of times on podcast specifically about meniscal pathology, and it's unbelievable. I do remember in the back of that presentation raising my hand as you were pointing out to all of us sports PT's where the meniscal tear is and what... I'm like, "Doc, I don't know what we're looking at." And I saw everyone else in there being like, "Yeah, we weren't taught that." So maybe it's not that you guys should stop using it but definitely the sports PT's gotta get better at understanding that stuff, the patient has no idea. So for what it's worth.

Dr. James Dreese: Yeah. I hear you. The other important thing too that I think is such an important part of this, of managing patient injuries and making sure that the rehab is directed toward the injury is the line of communication and the education between the physical therapist and the orthopedist because there's a lot that we can both learn from each other, and I think to the extent that we can do that, it benefits our patients, and that's just a small part of it. But I think the conversation in the relationship part of it I think is the more important part there, but there's a lot to be learned in both ways there, and I certainly whole-heartedly believe that I've benefited tremendously from some of the feedback and some of the education that I've gotten from physical therapists with regard to patients and their rehab afterwards. So I think it's a symbiotic relationship for sure but it needs to be a two-way conversation for it to really work well.

Dr. Yoni Rosenblatt: Yeah, and you've definitely been outstanding at that. Okay, your turn.

Dr. James Dreese: Well, I'll say a couple of pet peeves. One of my pet peeves is the process following ACL reconstruction, where patients are classically told that they can ditch their crutches and continue to use their brace. That one I think despite... There's just a couple of things in rehab afterwards that I really stress with patients. One of which is they need their crutches for four weeks to help protect themselves from the standpoint of their knee, but also just from people around them, and the crutches really do that. The brace does not do that.

Dr. Yoni Rosenblatt: This is straight ACL still, four weeks crutches.

Dr. James Dreese: Yeah. We're still at a point somehow out in the community that there's a belief that braces are protective for patients with ACL injuries. And the purpose to the brace afterwards, as you well know, is that patients don't have enough good quad control to be able to ambulate with any kind of a normal gait pattern, they can't do a straight leg raise, they don't have enough quad control, so the brace is to help them with that, but once they regain that, they really don't need it anymore. If anything, as we know, it inhibits their quad firing and it also makes it very difficult for them to reach terminal extension, which is such an important part of the postoperative rehab process. So I would say it's the continuation of the brace and the discontinuation of the crutches that I continue to try to get out there and make sure that patients are knowledgeable about and try to get that into the physical therapy realm too.

Dr. Yoni Rosenblatt: I love that. That's super helpful. You want them on crutches for weeks, just ACL? 

Dr. James Dreese: Right. Yeah, isolated ACL, four weeks of crutches. Now, if there's a meniscal repair, obviously that's gonna be a different plan. That's gonna be a longer period on the crutches, typically six or seven weeks.

Dr. Yoni Rosenblatt: But that is super valuable to know, to hear that that's a surgeon's preference, that's awesome. I'm gonna jump in. I'm gonna tell you another thing that I wish MD's would do or not do. I wish orthopedic surgeons would stop clearing athletes based on a Lachman's test and how long it's been since surgery. Why does that exist? 

Dr. James Dreese: Yeah. That's such a big... There is such a big conversation behind that. Clearly, if we talk about the evolution of ACL rehab, I think one of the factors that is most effective, that is the ability of some very prominent athletes to return at six months and one day to compete and to do well, and moving forward, the reality is that for most athletes, that's not the case. It is the time that they're most at risk for suffering recurrent injury, many of them are just not ready at that point. And I think one of the biggest advances that we've made in ACL recovery rehab return to play in the last 10-15 years is eliminating the calendar date as the primary determination of return to play, and now it's really a rehab, it's a rehab determination. It's functional testing, it's proprioception, it's all these other things that we test now. And I tell patients all the time, "Look, you're likely to take seven to nine months to return at your optimal level to reduce the likelihood of recurrent injury as much as possible but that's gonna largely be a decision made in rehab and not a decision that we make in clinic, because your knee is gonna feel the same to me every time you come back. If it doesn't, we clearly have a problem, but it's gonna feel the same at six months, seven months, eight months, your quad control is gonna be better, but it's really your functional testing that's gonna change during that time, and it's gonna best predict when you can safely return."

Dr. James Dreese: So that's very different. That was not the case 10-15 years ago, Cybex testing was... We do this isokinetic testing, Cybex, and that was really a determination of when an athlete from a functional standpoint was deemed to be ready to return in addition to the calendar date. So I think we've made a ton of progress there, we're much better now, and we continue to still have limitations with regard to ACL return to play but in terms of trying to manage good decisions in terms of when someone's ready to return to play, I think that has been a big step in the right direction.

Dr. Yoni Rosenblatt: You're making it clear why you and I get along so well clinically. Okay, so give me one more. Is there anything else that sticks out to this? 

Dr. James Dreese: Yeah, I've got one more. So the other thing that I continue to really stress with patients, but there's something inherent in the human brain that just makes it difficult to understand, is the need to regain full terminal extension immediately post-op and not focus on flexion. So all too often, I talk a lot with patients beforehand about the importance of regaining terminal extension within the first week, particularly for patellar tendon graphs but there still seems to be this human interest in phenomena of really focusing on flexion. Flexion is somehow in the human mind as being the best indicator of success in rehab immediately post-op. And as we all know, we have a couple of months to get flexion back really. It's really that immediate period post-op when extension is so important, so I always... I just find it perplexing and it's somewhat paradoxical that we continue to see patients have a difficult time sometimes getting their extension and for the focus clearly to have been more on flexion, I think we're getting better at it, but it continues to be a challenge. And it's a very limiting condition, as you well know, trying to get that flexion or the extension back once they are more than a few weeks out, for sure.

Dr. James Dreese: So if we could all just really focus on extension, I think that would be a big step in the right direction immediately. You can do some flexion, but focus on extensions.

Dr. Yoni Rosenblatt: Yeah extensions, I totally agree with you. Some of the things that might help with that is getting those patients into the PT quick, and I think that's been an uphill battle also. I think surgeons possibly, rightfully so, hearing some of those pet peeves, are leery to put their repairs in the hands of the PT too early. Am I wrong on that? 

Dr. James Dreese: Yeah, I mean great comment. I think historically, physical therapy was not started for several weeks or sometimes a month following surgery. And the reality is that some people in whom range of motion is not gonna be difficult, it didn't affect them from a range-of-motion standpoint, it obviously impairs their quad recovery, it impairs a lot of other things. There's a lot of benefits to being in PT immediately, but my feeling on that is, if the reconstruction is not good enough, structurally sound enough to be able to withstand early isometric and early range of motion exercises, it's going to fail regardless of how long you wait. And the reality today is that reconstruction is strong enough for that. Accelerated rehab programs have clearly been shown to be more effective than delayed programs. There's tremendous benefit. I try to get people into therapy, as you know, the next day, if possible.

Dr. Yoni Rosenblatt: Yeah. And we love that.

Dr. James Dreese: Get in there, get your knee extended, get to work on edema control, get on your crutches, just get comfortable with the situation. And then importantly, recognize challenges and problems that exist early in the rehab process, the earlier you recognize those, the more you can mitigate those. The later into the process it is when you start to realize that you're having a hard time with something, the harder it is to get...

Dr. Yoni Rosenblatt: Get in trouble.

Dr. James Dreese: So if your goal is to return to play at seven months or eight months, the best way you can initiate that process is to get into therapy right away, get on top of the swelling, get your quad moving, get things working early in a protective way, obviously, but that is gonna give you the best chance of recovering faster and meeting your milestones and just ultimately having success.

Dr. Yoni Rosenblatt: Hey guys. This is Yoni with the True Sports PT podcast just taking a quick break to let you know that our practice is growing. We have availability on our team, for outstanding sports physical therapists. It doesn't matter if you're new to the game, it doesn't matter if you've been out of school for a while, if you wanna treat athletes, we are the place for you. We have outstanding benefit packages, great starting salaries, and more importantly, it is the ideal place to treat elite-level athletes. Just reach out at We also wanna hear your feedback on the podcast, maybe there's a guest that you want me to have on, maybe there's a topic you want me to cover, reach out, same email address, We can't wait to hear from you.

Dr. Yoni Rosenblatt: Yeah, I know from our standpoint, we're terrified of getting even that patient in 10 days post-op, there are docs that absolutely right now turn to the patient after a procedure and say, "Okay, in 10 days, I want you to start PT." Even at 10 days, they come in, they've been sitting in that brace but they're sitting slightly flex, and if that's a BTB, it can be hell getting that to extension for a therapist and patient. What I try to explain to the patient, and jump in here if I'm wrong, I say, "Whatever I'm doing to you now, even though it's painful," when I'm pushing them to terminal extension, "your knee's already been here because Dr. Dreese put you in terminal extension after he closed you back up. Does that happen in the OR? 

Dr. James Dreese: It does, and I think the ways in which reconstruction is performed and the ways in which the fixation is performed is designed to try to give the patient the ability to terminally extend their knee. The brace common is an interesting one in the sense that there is also a misconception that if you're in your brace, your knee is straight. When in reality, there's no brace that really gets your knees straight and keeps it straight. A lot of people have hyperextension of their knee, they can't get in the brace. There's too much movement in the brace to maintain you. In particular, when some kind of a buttress is placed behind the knee, the knee is gonna assume a flexed position even in the brace, and it can be a couple of degrees but if you wait too long to try to get that back, that can be really difficult to do. So much more effective than in years past, the use of CPM's to try to rehab patients early on rather than go to therapy. We know that was a failed experiment.

Dr. Yoni Rosenblatt: Even though I still see that.

Dr. James Dreese: You still see it somewhat, not as much as before, but still see it somewhat. Clearly though, the most effective early intervention there is to get to rehab immediately with a knowledgeable therapist who knows how to get your knee in the right positions, how to get your quad working, how to protect the graft, and how to get rehab moving forward, but also in a way that that's protective, but is aggressive in the right ways that get you moving in the right direction and helps you to just get started on having success.

Dr. Yoni Rosenblatt: Just grab that extension. Yeah, so really points well made. Obviously, I've spent a bunch of time rehabbing your patients, and that's been awesome. You make it easy. I wanna get into sports PT's who are looking to develop some type of referral source. What is the best advice you can give to a PT to say how that PT is gonna earn the trust or gain referrals from a surgeon? 

Dr. James Dreese: Great question. I think it's obviously a competitive world out there, there are a lot of people that wanna be involved in the care of athletes, but I think the best ways for me, and when I talk to other people in orthopedics, I serve as the fellowship director for a sports medicine fellowship, and I think just in terms of teaching the fellows, it's about a...

Dr. Yoni Rosenblatt: That should have been in your bio.

Dr. James Dreese: I know. Sorry about that. It's about developing relationships. It really is. And part of that comes with introducing yourself, part of that though comes with having success too. Part of that comes with patients having success and patients... Obviously, I want my patients to have a good experience in physical therapy, physical therapists want their patients to have a good experience in surgery, so I think those relationships are dependent on one another, but it starts with an introduction and it builds from there, and it just comes down to a level of trust between both. It's not that it's easy to initiate but I think over time it grows. And in sports, as a sports medicine provider, you have to be willing to work hard over a long period of time to build your reputation, people have to see that you take good care of patients, that you have success, that your athletes do well. We can never prevent further injury from happening. Aut I think there's a lot of things that we do to try to help our athletes. And that's where I think that the relationship between the physical therapist and the orthopedist is so important in trying to educate patients and give them the best chance to have success that they have.

Dr. James Dreese: I tell people all the time, "If you did a state-of-the-art ACL reconstruction 10-15 years ago, and you did that same reconstruction today, you would not be deemed to be probably doing what's in the best interest of your athletes. So we have to continue to involve... We have to evolve, we have to get better at what we do, and that comes through learning and just a lifelong dedication to the learning process itself and getting better. I sure do hope 10 years from now, we look back on what we're doing today and we say, "We're better. We're better than we were then." So I think progress is good. But that relationship is really an important one, and like I said, one, that it's a two-way street. It goes back and forth. So I benefit from the experiences that I've had, and I would hope that the therapists feel like they've benefited from some of the experiences they've had with me too.

Dr. Yoni Rosenblatt: Yeah, no question. It sounds like you're echoing the idea that an older physical therapist once shared with me, I was so gung-ho coming out of graduate school about the business side. I always thought I would own or manage my own physical therapy clinic and practice, and so I was hounding him while I was in graduate school about, I don't know, some ridiculous business questions that I probably thought were really intelligent at the time. And he's like, "Shut up and become an outstanding physical therapist. Stop worrying about the other stuff." And I think that it was hard to hear at that point, especially 'cause he was related to me, but it was hard to hear that I was so hungry, but that really is the hallmark. If you can show the MD that you're trying your best to get that athlete better as quickly and safely as possible, eventually that will resonate, but that has to be the bedrock.

Dr. James Dreese: Parallel to that, I remember conversations having with one of my mentors when I started in practice and having some difficulty dealing with some of the competitive practices that were involved behind the scenes in taking care of patients. And I remember talking to him about that, and I remember his advice to me was, "Just take good care of your patients. That is the one thing that more than anything else will build your practice and develop you." And I think it's been the best advice I've probably received in training, I think if you just simply focus on taking good care of patients, all the rest of that will take care of itself. In the long run, certainly I think that is the best strategy, and it's how you're gonna have the most fulfilling career and have the best success in the things that you wanna do.

Dr. Yoni Rosenblatt: I also think referral sources see it when you're, I don't know, stepping outside your lane. So I think MD's will see it if the PT is being too aggressive, let's say, or being too sales-y, let's say, I know patients see it from the MD. I just had a patient that I sent to you to look at their knee, and their feedback to me was, "Dr. Dreese just told me what he thought should be done, how he would do it, and then he wrapped up the conversation," as opposed to other clinicians he saw which said, "Okay, and we can book you tomorrow." I think just having the confidence in your skill set saying, "This is the best path, you can use me or you can use the guy around the corner but this is how I would do it." I think really resonates with a patient. I think it's the same thing that resonates with referral sources.

Dr. James Dreese: Yeah, I think everybody has their own style. I firmly believe, I tell the fellows all the time, we should never... You should never try to talk someone into having an operation that they're not ready to have, that they just simply don't feel like they're ready to undertake, because largely in sports medicine, these things are somewhat elective. These are largely elective procedures. So I look at my role as being: Trying to educate patients about the injury they have, talk to them about different treatments that exist, and then in as much as possible, making a decision together about what's the right path forward. And I think that works for some people better maybe than it does for others, it's not necessarily the right approach for everybody but I really like it to be as much of a combined decision process as possible because ultimately, there's more than one option. And as I tell patients all the time, you have to be comfortable with the decision before moving forward because there's no guarantee it's gonna work out perfectly the way you want it to but at least if you have come to the decision that this is the right thing for you and you're ready to move forward with that, it just helps a lot in the process afterwards.

Dr. Yoni Rosenblatt: That highlights actually something which I'm pretty sure you taught me about 10 years ago, which was, things that can predict a successful outcome from ACL surgery are a quiet knee, a knee with full range of motion, some good quad control going into surgery, and the patient's understanding of the path of both surgery and rehab, and all of those equate to an outstanding outcome. I would have thought as a PT that that last piece, their understanding of the process wasn't as predictive. I remember you teaching me pretty clearly that it is indeed a big piece of what's gonna happen, and that plays into your education.

Dr. James Dreese: Yeah. Take the ACL for instance, there's two competing timelines involved in rehab, one is the timeline that we have, which is somewhat arbitrary in orthopedics about when different activities can begin. You can get off your crutches at four weeks, you can typically ride the stationary bike within that period of time, you can do the elliptical at two months, you can jog at three, you can twist and pivot at four. That's one timeline but the other timeline that is more important is the functional timeline, so if your knee continues to have an effusion and you have poor motion, trying to progress to jogging and cutting is not going to be successful, so it has to be... You have to take both of those into consideration, and I think a functional timeline really is the one that has to predominate there but I think it's easier for people if they understand beforehand that it's not just two months and one day until you do this activity, it's when you have full motion, your effusion is nearly gone or gone, and your quad control is good. Those are more important predictors of success, and I think when you try to force those activities without meeting those milestones, you really set yourself up for disappointment and potentially a higher risk of reinjury, without a doubt.

Dr. Yoni Rosenblatt: Yeah. Okay, bringing this portion to a close, if there's one thing that you wish a sports physical therapist knew or understood about an orthopedic surgeon, it would be what? 

Dr. James Dreese: Well, I think specific to the orthopedic surgeon itself, I think physical therapists are actually very knowledgeable. I tell people all the time that your physical therapist can give you really good advice about a lot of different decisions in that process. Physical therapists understand that, not unlike all other occupations, orthopedic surgeons have certain areas where they have more experience and other areas where they don't have as much. I would say I think one of the things that I always tell patients also is that one of the things you don't ever wanna do is to ask your orthopedic surgeon to do something that they don't feel comfortable or have experience in doing. So if you're seeing an orthopedic surgeon that's never done a meniscus repair before, you don't wanna ask that person to do a meniscus repair, if you're seeing someone who's never done a hamstring ACL reconstruction, it's probably not a good idea to ask that person to do that.

Dr. James Dreese: Life is about experiences, and I think with that comes a lot of wisdom, so I think just understanding what levels of expertise are in different skill sets is important, and I think that's something though, that physical therapists for the most part, they understand it, patients get good advice all the time. I get people referred to me by physical therapists, not infrequently, and it's typically because the therapist has said I've treated their patients before. And his patients do well, they rehab well, they do well, they return well. And that I think is invaluable to athletes and to patients. So I think that that for me is an important adjunct to anything that I can tell them. When they hear it from multiple sources, they hear the same thing, I think it really has a bigger impression on them and makes them more comfortable moving forward.

Dr. Yoni Rosenblatt: Yeah. I love that, and that's why this stuff is so important. You and I have spoken in the past about social media and the use of social media and some self-promotion, but it's so important for the clinician, the sports PT clinician to know the specialties that they're referring to. Like everyone should know that you're the meniscus whisperer. We should know that that's your bread and butter, you do tons of meniscal work. Not everyone does that. I recently heard you on a podcast, and it was just a throwaway line, but it landed with me was, you were describing your expertise and your background, and you said, "I do shoulder, I do knee, I work with athletes." Everyone says that... And then you said, "I don't do total joints." That line means a ton to me because I'm never gonna send you a total joint and I want a guy who is just doing sports med. I don't want a guy that does... "Once in a while, I'll do a total. Once in a while, I'll do this, that." I think that's totally worthwhile, to really know the expertise.

Dr. James Dreese: Yeah, I made a decision early in my career that if I was going to really focus on sports medicine, that I felt like doing arthroplasty would end up impairing my ability to be able to do that, and it's not to say that other sports docs don't do those things because some of them do and do a great job. I just felt like for me personally, I could do a better job focusing on my craft if the arthroplasty part was not really a piece of my practice. And honestly, it's given me the ability to focus more on some of those other things, so I don't regret that decision. I think I refer a lot of patients who need total joints to my partners that really specialize in that and do a great job with it, and they refer patients to me that have meniscal problems. So I think the relationship works well but it doesn't mean that folks that do some arthroplasty don't do a great job with that too 'cause I think some of them do, but for me personally, I just think I've been able to focus more in my career in not doing those things and really being dedicated to some of these other things we're talking about.

Dr. Yoni Rosenblatt: Yeah, and I love that. And back to the marketing side and building a relationship side, what I consistently say to our referral sources at True Sports is, "Do not send me everyone, do not send me your totals, do not send me your geriatric population unless they're getting back to sport and activity. Send me your athletes." That's why I went into this field, and I was shocked at everything else that came along with it, but that's my passion, it sounds like it's yours too.

Dr. James Dreese: Yeah, so my side to that same conversation is I tell athletes all the time, "Look, if you go to a physical therapy office and it looks more like a doctor's office than a gym, you're in the wrong place. You need to be at a place that clearly has the capability, the facilities to help you not only do your rehab early on, but make the transition to return to play. That's such an important part of the process." And I think that transition is the one that I think has been probably most lacking historically, is the transition from finishing physical therapy to returning to play, and it's in part physical therapy, it's in part athletic training for a lot of these athletes, but it really is an important part of the transition and one that certainly can really help to limit the risk of reinjury. So I think where they do their sports physical therapy is important. And I wouldn't tell someone with a knee replacement the same thing obviously, I think there's a different demand there. So I think the idea that one facility is not the right thing for everything is probably fair but I think for athletes in particular, they need to be at a place that has the ability to help them in that return-to-play capacity.

Dr. Yoni Rosenblatt: I think that it's obviously true, a sports PT, it's obviously true in the sports surgical world. You can't be great at everything. I think that's a lesson well made. This has been entirely enlightening, I really appreciate your focus on this, it's a little bit more wide-ranging of a topic in terms of how to develop relationships both with referral sources, with other clinicians, probably most importantly with patients. And I think you did an awesome job of covering all those things, so I really appreciate your time. We'll dig a little bit more into some specifics in another episode but in the interim, if you have any feedback for this sports physical therapy podcast, you can reach us at, and that means you want another topic, you want another guest, you let us know. You wanna work for True Sports, you send us your resume, Where can we find Dr. Dreese? 

Dr. James Dreese: I'm at Med Star, I also have my Instagram page, sports factories, but I'm at Med Star in Timonium and down in Ellicott City, seeing patients in those two locations.

Dr. Yoni Rosenblatt: Love it. Thank you so much for your time. Look forward to learning.

Dr. James Dreese: My pleasure, Yoni.


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