Taking Two Weeks Off After an Injury: When Rest Helps and Hurts

This is session number 88 of the Performance Place Sports Care Podcast. The freeway ends here. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey everybody, welcome back. It's another beautiful week here at the Performance Place Sports Care Podcast. I'm Dr. Sebastian Gonzales, and thanks again for joining me and spending an hour, one hour, with me, because these things are long. I know, I know. I've had a little criticism over the past, actually, couple weeks on that.

Some people said, well, they're really long. And I was like, don't you drive? You drive farther than I do to work. I drive, like, less than five minutes to work, but I go for walks in the morning. I go work out. These people are like, yeah, they're just a little too long. And I said, okay, well, that's fine. Why don't you read it? So I started making transcriptions. So everyone, if you want the notes to this one, number 88, just go to ptsportscare.com slash 88, and you'll get the notes. So today we're going to have on a great guest, which is Dr. Quinn Henich. He's a doctor of physical therapy, actually in Orange County, pretty close to me.

And I reached out to him because I see that he's very innovative, I think, because he's trying to bring sports medicine to, I think, a higher realm. He seems to have a better vision of how to get people to the activity level they want to be at. And so when I reached out to him, I thought, hey, why don't we just talk about something that's very common to people, especially for athletes or at least weekend warriors, when you get an injury, you hear someone say, why don't you take two to three weeks off? So I said, hey, Quinn, we should do this on how to defeat the take three weeks off healthcare system.

And so we're going to go into a little bit of that today, and if there's merit to actually taking time off, as well as a bunch of other clinical pearls that I think that patients and clinicians will learn quite a bit from this one today. So Dr. Quinn, you can reach him, by the way, at clinicalathlete.com. That is where he actually is beginning to create more of a provider base for people that are, I like to say, they're athletic clinicians. So if you're an athlete, you want to find someone who's an athlete to work with you because you understand. All right, they might not tell you to take two to three weeks off if it's not merited and so on.

So that's why I thought Dr. Quinn would be a great one for this podcast here. So I know that you've got to follow my personal story because I try to drop little bits of myself in every single podcast. The signs on the freeway, they confuse me all the time. And this one, this one in particular lit me up because I was looking at it. I was driving down the 101, and I looked at it, and we were in kind of a desolate stretch, and it said freeway ends here. And I kept driving, and about 10 seconds later, it said freeway begins here. And I was like, what is that? You know, like what merits that there's about a 50-yard stretch or less, probably like 100 yards, I guess, that makes it so that's not a freeway anymore.

What is it, a highway at that point? So I remember assessing the freeway at that point, or I guess highway or non-freeway at that point. And it was very, it was kind of a little gravelly. It was almost like no man's land, like it was no man's land. I mean, no one probably took care of the freeway right there. So I'm guessing it was like California said, hey, I'm not going to take care of it. And local cities like, nah, it's not mine either. Hey, maybe this is the U.S.'s problem. But anyways, there's stretches that are not technically freeway. So look around. You might be driving past one right now.

Freeway ends here. Freeway starts here. What the heck does it mean? I don't know. But apparently it's important enough to put on a sign. So as we get into this podcast, by the way, if you have not checked out the review page already, please go into iTunes and review this for me. I would love, love to hear what you have to say. Any feedback is good feedback. Even bad feedback, good feedback to me. And if you have not gone to my website already, p2sportscare.com slash patient portal, or actually just go through and you click on patients or professionals. And there's going to be useful information for patients to learn there.

And there's going to be useful information for clinicians to speak better and educate to their patients on there. So that's my goal in life is to leave a lasting legacy that patients can understand better and clinicians can understand and communicate to patients better. Simple as that. So without any further jibber-jabber from me, we're going to hear from Dr. Quinn Henich from Clinical Athlete in Orange County. And hear what he has to say about the three weeks, take three weeks off healthcare system. Here we go. Okay, everyone. Welcome on Dr. Quinn Henich. Hey, Quinn. Hey, yeah. How's it going, man?

Thanks so much for having me on. I appreciate it. Yeah, man. I'm glad to have you on to share your story because I think there's not – I really think a lot of the patients and whatnot, they don't see the other side of who the doc is or who the people out there who are doing the work. So I thought you'd have an interesting story. Might as well just go into a little bit of you. Spotlight. Yeah, so, you know, I – oh, okay. Here we go. Probably, you know, there's probably similarities with my story and many others who are in this field. So I'm a physical therapist. I currently reside in Southern California and I have a little office in Newport Beach in which the office itself is attached to a big gym.

And they've got, you know, adult training classes and youth classes and they've got weightlifters and athletes throwing stuff around and then people who want to feel like they're athletes. And so it's a fun atmosphere and that's where my clinic is attached to and that's been – you know, that's a dream of mine to have an environment like that. Started as a – going to school as a strength and conditioning coach. I'm a Midwest guy. So I grew up – I was born in Denver, Colorado, but I grew up in Indiana and spent most of my – all of my childhood and most of my young adult life there, my school life there.

And so when I went to college, I was going to be a strength and conditioning coach and that was going to be my deal. And I kind of got a glimpse of the university setting and realized that, you know, I'd be working 70 hours a week with, you know, lots of responsibilities and not that much pay. And I would probably do that for a long time, you know, slowly work my way up. And so I was like, ugh, forget that. You know, I'll go to the private sector. And that was really cool too, but it didn't have the security and the benefits of the other stuff. And so I was like, wow, there's – you know, where else can I go here but still kind of use this passion for just athletics in general.

And I felt like physical therapy was at least another door, you know, could give me a little bit more opportunity. And so I went back to PT school in 2010 to the University of Indianapolis is where I got my physical therapy degree and graduated in 2013. And, you know, just a short four years later, here we are. So I've been kind of running a little solo private practice out of a gym right from the very beginning. So it's been a learning – it's been a learning, you know, experience as far as like business is concerned. But definitely as far as the clinical work because, I mean, as you know, you know, you get out of school and the real learning begins.

It's cliche to say that, but it's so true. And then athletically, I played football at a small college in northern Indiana called Valparaiso, a small D1AA school. And then after undergrad, I found the sport of weightlifting, which I fell in love with. And so I've been doing that ever since for about seven years. So it's good. And a lot of my clientele, you know, perform similar things. And so we can kind of speak a common language. So it's nice. Cool. I actually – question on college was – so that's – it's abbreviated Valpo, right? Valpo, yeah. Is – how old are you? Are you like 28, 29? Are you 30 even?

I'm 30 years old. 30? There is a – I have a friend who played baseball there. It's a small school. I don't know if you knew Andrew Bynum. Andrew Bynum. I mean, the name sounds familiar. I know why it does. Andrew Bynum. But it might sound familiar because, yeah. Basketball. Not the same guy, probably. It's not. It's possible. If he was there from 06, anywhere from 06 to 09, then I'm sure that he and I crossed paths. Yeah. I was just kind of curious. Actually, funny story. I'm with his – that name. He said one time his grandma got a – they looked in her bank account and there was a lot of money in there.

And the next day it was all gone. So it was a glitch on the system. He could have just ran with it. Hilarious. Yeah. Well, cool. So you originally worked with then – would you consider the lifting population or the athletes you were working with originally before PT school, were they – did they have injuries at all? Or were they always normal? Or how is the job any different now, really? So that's a really good question. That's part of what got me to think about going to physical therapy schools because, of course, nobody was healthy or ever – it was like if we have a whole gym full of healthy athletes, I mean, that's just like an oasis.

It's a far. It's not realistic. So that was part of the deal. I could write – as a coach, I could write a good program. I could coach the lifts. We could – it was all about performance. But if somebody was injured or if we were overloading to the point of sensitization or pain or something like that, I didn't really know how to manage that stuff very well. And I didn't – and I felt it was out of my scope because it was. And that's what kind of got the wheels turning to this, like how can I bridge this knowledge gap that I have? And then, again, going back to physical therapy school, I thought that that would be a nice bridge.

I'd learn how to be able to manage these things. So I don't necessarily think the clientele has changed much at all. I think that I'm just better equipped at being able to kind of have one foot in both worlds. And so managing much more of the clinical side now but also being able to collaborate with strength and conditioning coaches, sport-specific coaches, and be able to speak their language too so that we can all be on the same page. And the athlete now has a team where everybody's not just kind of pulling him one way or another, which I think happens a lot. The coach will be saying one thing.

The PT or healthcare professional will be saying another thing. It's very confusing. So, yeah, I think it's a very similar clientele, team sport athletes, weekend warriors, barbell sport athletes. But I'm able to kind of manage the two worlds a little bit better. And it's more of an integrated blend now. So when then – I'm trying to think of any barriers that you might have that I know that I've experienced some. Are you now able to access like say they went to their orthopedic and can you now call their orthopedic and say, hey, here's what's going on with them. Here's what I'm seeing. Maybe we can co-manage.

Or is there less of a barrier now that you're a PT? I think certainly in regards to even being able to communicate with those other healthcare professionals, I don't think if a strength and conditioning coach is going to call up the ortho, I don't think that's going to apply. He's probably not going to get to the doc at that point. So that has certainly – has helped. It's helped me to be able to kind of be on a level playing field with the other providers and other experienced providers, not just MDs. But, yeah, so that's certainly been – I think that though the barriers even in that sense are still there.

You know, it's hard – sometimes it's hard for me to get to the doc. I can't ever get them on the phone or I can't – you know, me and another healthcare professional. Or maybe you like to sing in a different tune and the athlete is kind of stuck in the middle. But I think now though I understand how to have the conversation. So even if we are differing somewhat, I can – we can discuss things professionally and be on the same level. In that regard, I kind of come to at least a consensus that's going to be best for the person as opposed to before. I couldn't speak that language. If I disagreed with something, I couldn't necessarily articulate why.

And then that's also a problem because I can't necessarily support why I think I should be – you know, we should be doing something else, right? So it's definitely helped my ability to manage those situations, to communicate with other professionals, coaches or healthcare professionals. So that's been fantastic. The barriers – you know, I think the same barriers for me as they were before is just compliance with the person, you know, with the client or the athlete. It's just listening, mostly listening to the things that are like our lifestyle modifications, not even like the exercise – yeah, do these exercises.

But also like maybe try to hone or tone down the things that are recreating the exact symptoms that you're coming in the door for. Like we have to kind of come at it from both ends. And so that's always a struggle with any – I think with any healthcare professional because we're only seeing them for a very small amount of time. And it's kind of on them to manage their case, you know, with us guiding the way. So I think compliance is just the biggest hurdle. I don't necessarily think that's going to change. And yeah, we just got to get better at educating, I guess. I hope for the best. Yeah. I thought the same thing too.

Like I know compliance is like – I feel like it's gotten better for me at least with recommending over the years. But it's still very like – I feel like we know pretty much what works from a research perspective. But then the underlying variable, which we can't control, is the patient and their understanding. And I don't know where we can make this any better for them because it seems like with the internet being around, it should be very easy to find good information now, right? Gosh, you would think. Because sometimes it makes it harder because there's so much information. You know, you get in – I have people that come in the door and they've already played Google Doctor, you know, for the past however long.

You know, sometimes when they're coming to see me, it's like the last straw. Like, okay, fine. I'll actually go see a real person. And then by that time, though, they've been researching on their own and they've read, you know, 107 different opinions and different blogs and videos. And sometimes – so sometimes it makes it more confusing because it's – they don't have the filter, you know, to be able to sift through what's valid and what's not. Like a child safety one like on Google? Yeah, exactly right. And so we have that conversation too. You know, when I – I have a little intake questionnaire, obviously, that I like to have people fill out before they come in.

And a lot of those questions have to do with their beliefs and their expectations. So not only expectations for what they're going to get with me but also their beliefs in regards to their situation. What do you think is going on? What have you – you know, why do you think what you – or did you have therapy or treatment before? Did it help? Did it not? Why do you think it did? Why do you think it didn't? So all these questions kind of give me an idea of the psychosocial aspect of who's walking in the door. And that way we hope that some of these conversations aren't surprises. Like they're going to know what they're going to get from me.

I know kind of like where they are mentally with the whole thing. And I think that helps because then we can – I can really streamline the education. Because I think going back to what you said, you know, how do we make compliance better? I think we just get as best that we can at educating and setting realistic expectations and boundaries. I think you don't – I think you get decreased compliance when somebody doesn't understand why it's important that they follow the recommendations. And so if you're up front about that and create some awareness right away, you know, and set it realistically, then I think that helps.

Yeah, yeah, I forget – I forget the question. Yeah, that was funny. Before I have everyone on, like if they've had podcasts or a lot of videos and stuff, I just binge listen to or watch their stuff to make sure I'm – I try to hit things that they haven't talked about yet. And I listened to one this morning. I think it was Fly Fast or something like that. And then the same thing happened. And you forgot the original question there. All the time. I just go off. All right. I'll try to make them really, really confusing from now on. Okay. Well, crap. I forget where you were then. See? Damn it. Yeah, I know.

It's sickness. Okay. Well, then I guess I'll go back. So one of the main reasons I want to have you on is obviously I have an interesting story because of what you've created, the clinical athlete, which we will talk about a little later. But I feel like it's almost like it gets away from the take two weeks off type of mentality that probably a lot of the listeners have heard. You know, they get the word from their doc or their urgent care or even their chiro PT, whatever, you know. And is that – tell me what your thoughts are on that part first, I guess, before we go on. So I got a lot of them.

And it's not an easy answer because it's not – Do you believe in it? Well, so it's not that easy. I think I – when I do – I believe that when somebody doesn't have necessarily the knowledge to manage, specifically manage a certain case, I think that it makes sense to me then to say, okay, well, just don't do anything. Like that's a very safe recommendation. It's better than making something up and having to do something that like makes it worse or hurts them. So like I think just that blanket, yeah, if you don't really know how to manage this type of case, then sure, take two weeks off. The problem though is it's been – now it's been taken as this narrative as like that is what you're supposed to do.

That's the most beneficial thing to do is just take time completely off. And there are issues with that and what we're seeing out of the literature as of late is this whole thing of like workload management where your injury – let's say you're a runner and forget like what's wrong with your body. Maybe you're just having these overuse injuries because you're accruing such a high workload. It's beyond your body's ability to recover and adapt, right? You're just doing that chronically and so you have issues, whatever those are. But then what happens is if we take time completely off, then our bodies become deconditioned.

As an organism, we become less resilient to load. So now – and then what happens a lot of times is that people – because they took time completely off, like their pain desensitizes, their symptoms decrease and so they think that they're now back to where they were pre-injury. And not only is that not the case, they're probably actually a bit lower as far as fitness goes because they took time off. Being fit and having pain, they can go together. You can experience discomfort and still be fit for the task. So then if you take time completely off, now you're deconditioned and a lot of times they'll try to jump right back into the program that they were doing before having not prepared for it.

So I think taking two weeks off or take a month off, take this and that, it makes sense in an acute injury scenario. You know, I roll my ankle, it blows up like a grapefruit. Obviously, in that scenario, we need a period of time where you're allowing Mother Nature to do her thing, where you're allowing the inflammatory process to occur naturally or allowing it to decrease naturally. You know, if I have a blown up ankle, I'm not going to just do like 100 single leg jumps and just pound my ankle. That would be stupid. But that's not the same thing as saying don't do anything for two weeks. I think that our body's, yeah, so I think our body's response alone.

Okay, go ahead. No, you go. Oh, no, I am, let's just keep going. I actually didn't hit record on my other recorder. But it's okay, it's okay. This is all on, it's on, I got the video, so I'm going to blend these later. I've never, ever done that before. I had my heart almost stopped. Okay, go ahead. That's okay. I can repeat it, anything and everything. I think it will be okay because that video is going to hold strong. Yeah, yeah, yeah. Yeah, so and this goes with many different types of injuries. It really doesn't matter the injury. There's almost always a way to continue to train or continue to exercise that doesn't recreate or re-aggravate the symptoms that we're trying to make go away.

That's just the common sense piece. But that also allow us to at least mitigate losing fitness. And in some cases, if it's not that bad of an injury, we can kind of still continue to make gains. We just make modifications in the program. So while take two weeks off is a safe thing, it's not going to make that specific case or local injury or whatever it is maybe worse, it's not going to be great for long-term recovery or just kind of long-term fitness of the organism in general. So if we've got the knowledge to be able to modify workouts or modify movements and also have the knowledge of the healing response and how to manage pain, I think we can blend those worlds together to allow athletes to continue to exercise and train even when managing an injury.

And maybe that's what we're missing with the whole take two weeks off. So an example then with that turned ankle then, an acute turned ankle, then what are a couple things then you would right off the bat, like the first week, even the second week, want them to do probably if you're working with, say, a distance athlete? Well, we want to keep their engine up. So right off the bat, we're thinking, okay, what are some cardio implements that we can do that aren't going to aggravate your ankle? You got the bike is probably the one that I'm thinking of. Lots of low – there's like 10 different types of low-impact elliptical looking like things.

But like the point is like I could make a list. A lot of times what I'll do with athletes like that is I'll just make a list of things that you can do. So like cardio, you know, put a topic there of cardio, and I'll just list a bunch of the machines that you could do without recreating a pool. Anything – the point is pick one that you like, and then, you know, we'll program whatever dosage. But the point is let's try to keep your engine up or like mitigate losing that conditioning. Just because you can't run and just because you can't pound on that ankle right now doesn't mean that we can't do some cardiovascular training.

So that's one. With that scenario in particular, you got three other good limbs to train. You know, there's this like – I've seen a couple papers on this thing called the crossover phenomenon where essentially if you keep the rest of your body trained and you get strong, there's like some crossover effect. Like the lagging limb kind of like catches up a little bit or like without actually having to exercise it very specifically. Just if the overall organism is strong and fit, we tend to see like little jumps and attributes like strength and like faster than you would if you just detrained everything.

So we're back to that whole don't take two weeks off. But like, yeah, so you got three good limbs. Even if that sprained ankle is so bad you can't even bear weight right now, we're probably still like moving. So active retomotion is probably happening right away. So not just like – not just doing absolutely nothing. And as soon as we can weight bear, we're doing whatever we can tolerate. You know, if it's just balancing on one leg, if it's some type of squat or split squat or lunge, even to decreased range of motion and very slow tempos and just body weight, we're starting that stuff pretty much as soon as they can, one, tolerate it.

And two, this is a little subjective, but like it doesn't increase their swelling. It doesn't increase – it doesn't flare up their pain to which things get like worse more than 24 hours. And so if we do an exercise and it blows them up for the next two days and they can't do anything, well, that didn't help anything. So we're still kind of like in those acute scenarios. We've got to be careful. But pretty much as soon as we can move that limb, we're doing it. We're training the other three limbs almost like normal. So like single leg deadlifts on that other side, doing whatever squats, leg press.

You're not going to like create these crazy imbalances from a few weeks of doing unilateral stuff, but it will at least keep the whole body relatively fit. Yeah. So just stuff like that. It's just – I think we forget that like one joint injury or one muscle injury does not equate to the entire organism being laid up. Yeah. No, I totally agree. There's – I think there's a recovery period for like the structure. And then there's no point in deconditioning the rest of the organism in that sense, you know. So back on to that two weeks off type of thing, I feel like I've seen other people take the extreme when they get that recommendation.

And I'm sure there's going to be a partially psychological approach with this too. But so when they hear take two weeks off, they say, I'm not going to do that. My doc doesn't know anything. So I almost feel like currently there's like a backlash of my doc doesn't know anything. And I feel like I see it throughout forums a lot, and it's really disheartening to me because I'm sure they know something, you know. So I don't know if you have that. Oh, yeah, for sure. Pete, you know, every profession has got a stigma, you know. With physical therapists, it's like all he's going to do is just give me a yellow TheraBand and, you know, rub some ultrasound.

With athletic trainers, it's like, oh, they just know how to tape an ankle. Psychpractors, I'm just going to pop my neck and that's all they can do. Or physicians, I don't want a shot. I don't need a prescription. So what do they know? You know, so I do. I think there's stigmas. I think there's stereotypes. I think that we go back to the whole, like, if you're going to, if you had like the lesser of two evils, I would rather you take two weeks off than go the other way and like continue to just flare yourself up out of spite. You know, if we had to pick one or the other. And prove him wrong. Yeah, exactly.

But that's exactly where education comes in because – and it doesn't have to be a lecture with the client. We can say in an acute scenario, we've got to get mother – like you said, we've got to get mother nature a little time to put the pieces back together literally, right? The swelling and inflammation is actually a signal for us. It allows us to see how we're progressing through the healing process. So we don't necessarily want to artificially take that away completely. We don't want to increase it unnecessarily. But we listen to that and then we modify accordingly. What's interesting, though, is if it's a chronic issue, let's say some type of tendinopathy that's been there for a couple years or like nonspecific low back pain or these types of things, a lot of the research will say that those things don't get better with rest.

Yeah, and sometimes they sensitize even more. So like you'll see – you'll hear people say a lot maybe with like a teletenopathy, anterior knee pain. Say when you're running, jumping, lifting, squatting, something like that. They'll say, well, actually, when I rest, when I stop training, it gets worse. So I just figured I might as well keep training. If it's going to hurt either way, I might as well feel strong. And I'm kind of like, yeah, that's not wrong. So then the approach that we're going to take is trying to modify the dose in a way that it doesn't sensitize you but you still get training effects.

So that's where I completely disagree with the take two weeks off in a chronic scenario because that will do absolutely nothing for the person who's been experiencing something for six months, 12 months, a year, three years. Oh, take two weeks off. You'll be fine. No, that would have worked over the past five years. You know what I mean? So when people come to my office and they say, well, I just went to the doctor and I say – he just told me to take some time off. I say, well, at least he's not concerned because, you know, if there was something wrong, he would say, well, let's go get some imaging.

I'm going to refer you to this specialist. We're going to consult this. We're going to do this test, this type of image, et cetera. Well, I'll just take two weeks off. You'll be fine. I was like, all right. You know, the physician's job is to keep you alive and if it's an orthopedic specialist job is to keep the hinge on the door. So if he's just telling you to take two weeks off, at least he doesn't think it's anything serious, right? Yeah, that's good. Yeah, and so now you can start to fill in the gap a little bit because they're not going to be satisfied with that recommendation, especially when they've already tried that in the past with chronic scenarios and it hasn't helped.

So we're filling in the gap as to why maybe it doesn't help. And then in an acute scenario, we're saying, well, it's a conservative recommendation. It's not wrong to protect Mother Nature's natural hearing response. We're going to do that for sure. The difference is we're just not going to take the entire body off. That's the difference. And so you can kind of spin it. It doesn't have to be negative of the other practitioner. You're just, you know, kind of like adding to the recommendation. Yeah. Well, I got a question. This is going back to acute and chronic. So if someone's had a repeating, say, knee injury over the course of five years, every couple years.

So how do they decide then if rest is proper or not? Is it chronic, subacute, acute? That's a good question. It's because it gets hairy, right? If it's recurring, it's like, okay, this is an acute bout of a chronic issue. And so it gets complicated. And that's what you actually see with the tendinopathy literature is they have terms for this. So if it's painful, if it's acutely painful, it's termed reactive. And if it's a chronic issue, but this is like a flare-up of this chronic issue, like what you're describing, it's called degenerative, reactive on degenerative. So it's like flared up, but it's always already kind of a little bit jacked out for like over the last few years.

So I think that – I think there's not necessarily a right or wrong. It's kind of like specific on the context. And so if it is – if it's truly an acute bout, they haven't felt this pain. Yeah, you know, it's off and on for the last five years, but I haven't felt it over the past year. I still consider that an acute bout because they've been sensitized or desensitized for a long time. They haven't experienced this thing. And so even though it's something that they have in the past, it's still a new response, you know, based on their relative past. So we'll still kind of treat it like maybe hopefully Mother Nature will just desensitize it naturally.

But if you get the people who are just like always a little bit flared up or whatever the issue is, but it's always kind of there or maybe it goes away. Yeah, but it goes – or it goes away maybe for like a week here and there, but it's always there. So in that case, time off wouldn't really help because it's – they've been doing that. You know, it's – there's no – it's been going on for so long off and off. There's no acute inflammatory response to be taken away. All you're going to do at that point is, again, become deconditioned. And so in those scenarios, it's more – it becomes harder to manage.

There's more ups and downs, which you should tell the person. Expect that. It's not going to be a linear thing. But it still comes to like workload. So you just got to find their triggers. What movements, what positions, when you do them a lot, seem to be contributing factors? What type of training do you do? Is it an intensity-driven training or a volume-driven training? And you try to find their triggers based on that stuff, and that's where you can make recommendations, you know, try to modify those things. So are these – so we're getting pretty in-depth here, and I realize we're – Sorry. No, it's okay.

It's okay. I thought about retitling this podcast, Reactive Tendinopathies. There you go. But – so then let me retract a little bit back into the, like, modernization of healthcare idea. Do you have this conversation with patients, and do you educate them this long? Yes. Okay. Absolutely, 100%. Because it sounds like – because I'm sure some of the listeners are like, I've never had this type of rapport nor education from my doc. Well, it's – so it's hard with the systems that are in place, especially in physician practices. This is not a knock on physicians. This is just kind of the way the system is.

They've got, like, 70 people on their list. And maybe I'm exaggerating, but there are probably physicians who have, like, 70 names on their list for that day. And, you know, half of those people are going to see, like, the PA and not actually the doctor. So the point is their time is very limited. I think the average interaction time between a patient and the medical doctor is, like, five minutes maybe, something like that. It's not very much. And so that is part of the problem is the way the system is set up, which is why I've – when I decided to kind of do my own thing was to go the out-of-network route so that I could have longer sessions because I know that I'm verbose.

But, like, you know, seriously speaking, like, education to me is so, so, so important. I want – I need the time to be able to discuss these things. It's also why I send out those questionnaires and try to get this information as much as I can in the door so that we don't have to pry in the session. We can just kind of, like, jump right in. So, yeah, I think part of it is the system, these high-volume systems that don't give the practitioner enough time with the patient. And it's also a skill that I'm still developing every day to try to be able to articulate these types of things without it just – without you losing the patient, going right over their head or demeaning the things that they've tried to do or demeaning other clinicians' recommendations in the past.

And so it's – yeah, it's a learning curve for sure and it's a skill. But I just think education is so important. I think it's – I think there's research to back it that our words are very, very powerful and that they can spin – they can make the person believe certain things. So if somebody comes in with knee pain and I say, you know what, like I have this, like, really worried tone and it's like, oh, gosh, you know, we're going to need to do something about this or you're going to have knee pain for the rest of your life. Or if I look at our MRI and I say, oh, my goodness, you're 29 but you've got the back of an 80-year-old.

God, what's wrong with you? Or, you know, we could talk about how some of these quote-unquote pathologies are actually normal in the asymptomatic population and maybe just a normal part of being a human. And you're probably in some amount of discomfort because your training programming was a little bit past your ability. And so we'll talk about that instead of, like, all the things that are wrong with you structurally. So it's all about how you word things. I think it's very, very important. Okay. So then with – I heard you say on another podcast, I think it was something to the effect of those people that only come three times, it's really hard to make a dent in their condition.

I thought it was something to the effect of that you didn't have enough time to educate nor change ADLs or their pain triggers. Does that sound familiar or am I making this up in my head? So, no, you're not – I'm sure we've had that conversation. I've had that conversation many times. So it's the – so let's say in my model, the frequency is very low because they are out of network. People tend not to come back for, you know – I'm not going to get the type of person who's going to come to pay three times a week for the next six weeks. That's just a lot of money. So what we try to do is – that's why education is so important because I need to give them tools.

If they're only going to see me three times a week, I think it came back to actually where we're probably talking about some type of passive modality or something like that where that's why education takes precedent over something like a feel-good type of treatment that may have like a short-term effect. But once they walk out the door and those short-term effects wear away, what tools have they been given to manage their case themselves? Which at some point they're going to have to do anyway no matter if you're an insurance-based clinician or not. So if they're only coming to see me for one to three sessions, my hope and goal is not to quote-unquote fix them but it's to give them as many tools as possible to be able to manage their own case.

Yeah. And if they come back to me every month or so, they've managed successfully and were able to maybe jump a level as far as like the next step. Yeah. Well, what kind of tools are you talking about? Because people might be thinking hammers. Oh, yeah. Okay. So tools as the proverbial tools, how to modify their lifestyle or training load to manage their own symptoms. So we'll talk about their overall training workload, how they can modify overall volume of work. So first of all, we have to help them identify what their triggers are. It's like, oh, my knee hurts when I squat, you know, 80% of my one rep max but it feels okay, you know, anything less than that.

And I say, well, that's easy. So let's just not squat 80% right now because that's obviously beyond your tolerable workload. So we'll talk about squatting is not off the table but what we're going to have to do is go lighter, we're going to have to maybe go slower, decrease the overall number of sets that you're doing, you know, so we'll look at their program. But when I say tools, it's educating them on not just does it hurt or does it not but actually being able to listen to their body and manage variables, you know, on the fly, on their own. So they're almost kind of their own practitioner.

And then also when is it important to listen to your symptoms and when can you like push through a little bit? And that's a thing that's kind of case by case. And in some like chronic tendon issues, sometimes you actually have to recreate a little discomfort in order to make the tendon stronger. So we'll talk about that, you know, how much pain is too much. And let's say if you're doing this like slow squat exercise to strengthen your quads and your patellar tendon, it's okay if it flares up for a little bit for the next 24 hours but then it should die down, you know, before you does it again.

So just little things like that to give them expectations, not to be afraid of their symptoms and then how to like manage variables to – yeah. And that's what I mean by – and that's what I mean by tools. It's typically nothing physical unless it's a weighted implement, you know, literally. But it's things that give them the autonomy. It gives them the power. And then I'm just – again, I'm kind of a consultant and a guide. It's like, okay, now we're ready for this progression of movements or whatever. Yeah, it sounds like a lot of patient empowering, which I think is great. I know that I've struggled a little bit on my end with some people – I mean, people have different learning types.

Some are visual, some are auditory. And like some people just flat out say that they just don't have time, which I don't know. I probably sound like an asshole when I say this, but I'm like, I'm not going to care about your injury more than you do. You have to learn it. And, I mean, I feel like you probably have tools right on your site. You got a bunch of good stuff on there. Is there certain things that you would give like – say someone that had like a back injury on your site. You're like, read this, watch this, or is it all face-to-face? Good question. I do – I mean, I have at this point lots of videos and tutorials, and we're developing like guideline plans, like actual handouts to give people based on specific cases.

But it's – I think that always at least that conversation to be had is very easy because it puts things into context. The problem with a video is let's say that, okay, a little back pain, there's a couple exercises. There's no way to know if they don't have a background in the context of pain or their injury. Now all they know is there's two exercises for back pain, for all different types of back pain. Like what if those two exercises don't work well for them? So I get a lot of – you get a lot of questions on social media and through email. Hey, just a quick – I don't want to take up too much of your time, but just a quick tip on how to manage this complex case I've had for a long time.

And do you have any recommendations? Do you have a go-to exercise? And I've – I always come back with it's very difficult because what if that exercise doesn't work for you? And then now it's kind of like – now there's a negative connotation to either that exercise or my recommendations in particular. So I always like to have the face-to-face contact. And then during the session, it's kind of trial and error. Can we recreate your pain with certain positions? What positions feel a little bit better? How does that relate to the movements that you feel the pain in real life? It's just easier to do that face-to-face, yeah.

So you probably can't get to everybody, though. I'm sure you get people – you get emails from all over the place. And is that part of the reason for the clinical athlete development? That's one of the big reasons. And I figure that's kind of where you're going. And like – so clinical athlete is this network of healthcare providers. It's essentially a map for the public to go on and just find a provider in their area, hopefully. And it's – these are providers who are – work with the athletic population. They're either athletes themselves. That's just – that's kind of their niche. And so a little bit more vetted than just doing a Google search and going to the next sports med clinic and hoping that they actually have a clue.

So that's a big reason is being able to refer. If somebody comes from – emailing me from Florida, I didn't have any – I don't know, man. Gosh. You know, here's – yeah, it's like you said. Here's a video, but just know that I don't know if it's going to be appropriate for you. And I'd recommend going to see somebody in person, but I don't really know anybody down there. But now it's been so much more helpful to have that network to fall back on because I can just, bam, shoot in the link to that clinician's clinical athlete profile page. And it's been great. And then – or I have patients that move away, you know, and then they're looking for practitioners.

And now me and the other provider can have a dialogue because he and I are – or she and I are already part of this network together. And so we're already familiar with each other. It's very, very cool. So it's helped a ton. Is that people only with – is that only PT or do you have strength coaches, orthos, all that stuff? It's on the directory itself. It's open to any healthcare provider. So there are PTs, chiropractors, medical doctors, dieticians, athletic – licensed athletic trainers, these types of things. In the forum, we have a private forum as well where we're basically just education and discussion.

Strength and conditioning coaches and students are a part of that, so healthcare students. So we can all kind of discuss and learn. But on the public directory itself, it's healthcare providers. Just to decrease confusion, you know, I think the whole – we're working on the coach thing. It's just harder to vet. So we try to keep it to healthcare providers. But there's a process to it. You know, there's an application. There's a forum initiation. So before the clinician gets put on the map, they have to go into the private forum and actually, you know, discuss an idea or two. So it's kind of a natural filter.

So any clinician who just kind of wants their face on the map and is like, I don't want to discuss with my colleagues or have this type of connection, then they don't go through the process. So it's been a nice – just a nice, like, natural process to filter that out. That's cool. Yeah. How did you come up with the – did you just wake up one day? You're like, I'm going to provide – I'm going to make a network. No, I had – well, I kind of. I had the idea in physical therapy school, which is not that long ago, you know, maybe first, second year of PT school, which would be like six, seven years ago.

I thought it would be cool having this same discussion that we are now. Oh, gosh, I wish there were more healthcare professionals who kind of, like, understood the whole spectrum of rehab to performance, this type of thing. And I was like, that would be really cool to have a map. I want to do that. And then I didn't have the resources or the know-how to put something like that together. And then fast forward four or five years later, beginning of 2015, I moved to California. But it was kind of like, you know, I have a network now, just a general network of providers all over that I've been lucky enough to have touch with.

And it's like, you know, we can start to make this thing happen. And then over the course of the summer of 2015, started getting some ideas about just putting together a website and basically spent the entire summer of 2015 doing conference calls with clinicians I knew and talking to them about this idea. And then we launched in September of 2015. And the map was on there. And the forum has grown. And for me, selfishly, it's been a great mentor, like a natural mentorship, because I think that's one of the disadvantages of being in private practice is you don't have anybody there to call you or to question you or to discuss things with you.

It almost becomes an echo chamber. You're like, oh, you know, I'm seeing what Quinn's seeing, what Quinn wants to see. And this is a great exercise that Quinn prescribed, and then Quinn gets to pat himself off the back at the end of the day. And, yeah, I'm doing really well. I know I've really got this PT thing or this rehab thing down. But the forum has been awesome because it requires me to support, you know, what I think and what I know, not just from my own experience. It almost makes me think that it's like you're putting your thoughts down in there, so you have to validate them. But it's almost like your own diary in a way, I imagine.

Yeah, absolutely. It's been very therapeutic for me in that way. And it's very helpful for patients, too. You know, we've gotten some great, great feedback about going, you know, several clinicians in the past who didn't necessarily know how to manage their performance goals, like rehab, you know, to their training. And then they go to a clinical athlete provider, and they have some great feedback for us. So it's been really good. What are you going to do with it next? I know that it's – I haven't looked at it. Actually, I looked at it today, but I was looking at the videos. I've actually been on the forum before.

I don't know if you remember the thread that I had. Yeah. I couldn't sleep at night thinking about, like, I've got to answer these people. Dude, it's crazy. Like, it's like, all right, I'm going to set aside my Wednesday to, like, the responses are crazy, yeah. But it's just been great. But lots of plans, you know. So we're – I don't know when this is going to come out, but we are launching a brand-new website very, very soon that's going to be – it's literally two years in the making. And it's going to be kind of a social media-esque thing. So the general public will be able to make, like, a profile page.

They'll have a news feed, and they will be able to follow clinicians for, like, just education and content. So the clinical athlete providers will have profile pages. It's going to run like a Facebook except without all the ads and clutter. It's just going to be sports performance and rehab and sports med. So, like, you just – you log on to clinical athlete, and you'll just be scrolling your news feed with all this awesomeness. It kind of reminds me of, like, with – I'm not on Reddit that much, but I've been on there, and I started understanding, like, how it worked. And it was just – the most popular ones just – they popped to the top, right?

And, like, you – So is it kind of like – I saw you were on Reddit, but is it kind of like – how are you going to shuffle out the people who have the worst information versus the best? Good question. So the clinical athlete providers are going to be the only ones that can post to the news feed. So they're already been through our vetting process. And that's always going to be, like, what – that question is a good one. It's kind of always going to be a part of the deal is, like, monitoring things. You know, because we don't – we're not – clinical athlete is – it's not a – it's not a system. It's not a set of beliefs.

You know, we want to stay unbiased, but if we're questioning a specific idea based on the literature and then a clinician is, like, posting the exact opposite, well, there's going to be a dialogue there, and that's kind of how we've been doing it. But the general public will just be following the clinicians who have already been vetted. So they'll – so the – hopefully the content is somewhat already filtered just from the process of being a clinical athlete provider. Okay. So I'll brainstorm with you on this just because we were talking about it earlier. How are you going to make it so people don't use medical jargon so the patients can understand?

Well, most – so if you're going to a website to get all of your information, there's an issue with that in general. So, like, our audience is not just the general public. A big part of our audience is our clinicians and coaches, too. So I'm not necessarily too worried about if the information is going to be over the top because if it's too technical for the general public audience, it's probably going to be great for the coaches and the clinicians. So we're not necessarily going to try to filter any of that. It's going to be more of, you know, if we post something, just letting them know, you know, this is – this is target audiences, the athletes, you know, clinical athlete audiences, the athletes, our clinical athlete audiences are the clinicians who are – who follow our page.

So I don't necessarily think that's going to be a problem because the point, if you're going to our website because you've got an issue, well, go to the directory and go see somebody. That's the whole point of the website is to connect you with somebody in person. So I actually see the content that we put out as at least as much education for professionals as it is going to be for the general public. I think it's a good idea. Actually, earlier this year, way earlier, I was all burnt on that I started posting on a forum. It wasn't yours. It was a different one. I won't even name it. So I gave advice to somebody, like, as much advice we can possibly give because we're not supposed to, you know, give real advice.

But they, in so many words, said, you need to respond as a peer. This was the moderator. And I'm like, well, what do you mean? I have a background in X, Y, and Z. You don't want me to, like, say anything about that? They're like, no, you have to respond as a peer. And I'm like, what use are these forums if no one's actually giving real information because they have to hide their degree? So I think your idea is great because you've already screened them, and you know they're going to be quality responses. Yeah, yeah. And it's, yeah, I mean, playing moderator is always fun. But you're going to, it's like a fine line between trying to filter somebody like that scenario seems odd.

And then an idea that we had in the forum was, like, nobody gets titles. This was long ago. I was like, nobody has titles. Everybody's on the same level playing field. But then we were like, well, like, it's going to make a difference if we're talking to, if we're discussing something with a coach or a student versus a colleague, you know. So, like, it's not about drawing lines, but it's, you want to make connections, I think, understanding who you're talking to. Yeah. And, like, and the other way, too, like, if I, understanding who you're listening to, I think makes a big difference. So, you know, yeah, it's not like saying, you know, you speak to that person as they are a peer, and then on your side, it's like, oh, you're being, you know, you're being a jerk.

You're talking over them, but not at all. You know, you're just kind of making that, there are levels. Yeah. You know, so we'll try to, yeah. I'm glad this is on video now. Right. Yeah, exactly. I'm going to be called names. Yeah, yeah. So, we're about to close up here pretty soon, but I know that you, I know that you have a book. Tell me about the book. The book is called Weightlifting Assessment and Movement Optimization. It's super fancy. It's for, it's specifically for the sport of weightlifting, which is the snatch and clean and jerk. However, so it's looking at movement for the overhead squat, the squat pattern in general, the deadlift, and overhead, overhead lifting.

So, the snatch and clean and jerk encompasses all of that stuff. So, for any athlete who trains any variation of those movements, do you squat, do you deadlift, do you overhead press, do you do those things fast? You know, you don't have to just do the snatch and the clean and jerk. We break down those positions and kind of offer real quick little screens to see if you've got, you know, the requisite range of motion. And then what's more important are the progressions to become comfortable and tolerant to those positions under load. And so, we offer just tons of drills and variations and techniques and cues all throughout the book to build those positions from bottom to top, top to bottom.

Nice. Do you have a whole stack of them back there behind you? I do. Yeah, I got a box of them. Do you really? I got several boxes of them. So, the publisher, I don't ship them out. Those are mine to take to like seminars and stuff. The publisher is a company called Catalyst Athletics. They publish it. They did all the pictures. They did the layout and put it together and just basically built the thing. I did, I mean, I did the easy work, which is just write it. And they took care of everything else and they take care of everything now. It's on Amazon. I have no clue how any of that works. Like, sometimes I'll go on Amazon and it's marked down for five bucks.

I'm like, oh, my book's on sale. Like, you know, I don't have any say in that stuff. So, but the process was a lot of fun. I learned a lot from it and it took me, I had like seven drafts because I kept changing things or like new evidence would come out or like, I was like, oh gosh, you know, my opinions kind of changed on this over the past several months and like I rewrite the book and eventually I just had to like push it away and say, you know what, it's done. And that's the challenge of a book. It's like once it's out there, it's almost like you can't change your mind because it's in your book.

Yeah, you can forward it, I think, and say recent studies might have changed. Totally. Or second edition. Yeah. Second edition, that's a great upsell. Yeah. Did they approach you on it or you just thought like, I'm going to do it? They approached me. Actually, this was three years ago, more than three and a half years ago. They were like, hey, you know, do you ever think about doing an e-book? And I was like, no, but it sounds like an awesome idea. And then it turned into, why don't we make this an actual book, you know, a physical book that can be a reference. And that's what it is. It's a reference.

People tell me that they read it from cover to cover. And I'm like, oh, man, I'm sorry. It's like, it's not really, I mean, it's meant for that there is narrative there. And I try to make it as flowing as possible. But it's a reference book, you know. It's like, oh, I want to get more tolerant and comfortable with my overhead position. Or I want my knees and my hips to be more tolerant to squatting. Let me, you know, flip to nine and see what's going on here. So, yeah, I hope they can just be like on the shelf of any gym that utilizes strength training as a nice point for them to come back to when they need it.

You're going to know it gets good use when there's just chalk all over the covers. I hope you made a black cover. Perfect. Yeah. Yes, absolutely. One last question is, if you were to go fishing and you can catch any fish you haven't caught before, what would you want to catch? I want to catch a swordfish. Do you really? Wait, sword or sail? I thought they were marlin, sword or sail. Ooh, a marlin. That's good. Any sailfish. Marlin would be great. Anything. I just want to see that guy. I've never caught a sailfish where they're breaching the water and they're just coming out like that. And I guess swordfish, they're big.

The marlins get big, too. Any one of those guys. They caught them out of here a couple years ago. I think the warm water came up from Mexico. Oh, yeah. But I want them to be small enough. I don't want a blue fin tuna where they're so big, you're not even reeling anymore. You're just like, you've got gloves on and you're literally pulling the line with your hands. I don't want that. I want to be set up in the chair, but I want to still like the feel of the pull up and reel down and like, I want that. You want one of those, what do they call those belts that just like sit right into your groin you want to create that high internal pressure for?

One of those guys. Grab me in the chair. Yeah. Well, nice. How can everyone contact you? And anything else you'd like to say? Gosh. Contact is, social media is great for me. You can just type in my name. Quinn Hennick is the kind of like, the cool thing about having a weird name is that you can just type that into Facebook or Instagram or whatever. I'll probably be the first one that pops up. You can message me on social media. I respond to everyone. I try to. It may not be the answer that you want or within the time frame that you want, but I try to get to everyone. An email is easy. Just info at clinicalathlete.com.

And yeah, I mean, I think that's a great start. And as far as other stuff, I think you asked some great questions and I'll just, we'll babble any longer on that stuff. I know you got a lot more material, but I really want to hit things that I don't think you've spoken about yet. I'm sure all the other podcasts will be a good compilation for this one. So, well, cool. Then, um, so then everyone, I'll include, I'll include all those, uh, stuff on the show notes. I don't think there's any of the references we had other than that. Do you have that, uh, that, uh, cross patterning study by chance? I can dig it up.

I can try. Yeah. I can, I can attempt to dig it up. What's the, what's the rule on sharing non-abstracts, full studies? That's kind of like copyright, right? It is, but some of them are open access. Yeah. So if, if they're already open access, then you can share all you want. But otherwise, yeah, it's researchers don't like that either. If it's behind a paywall, they're like, yo, that's like selling my book on a black market for free. Yeah. I just like giving it away. Yeah. Um, well, cool. Then, uh, I'll link to that in the show notes and I'll close up here and I'll be right back. Okay. Cool. All right.

There it is. The interview with Dr. Quinn Henich. So guys, don't forget to reach out to him on Instagram at clinical athlete, as well as his personal one, at Quinn dot Henich, Pete or DPT. And don't forget to go to his website, clinicalathlete.com. Again, we has a, he has a directory there that's beginning to enlarge. I know it's already there at the time of this podcast. It's trying to get bigger. He's trying to make it bigger. So he has screened some, uh, clinicians to be athletic clinicians. So he can understand or so they can understand what you're going through as an athlete, because it's the thing.

It's important that they know what you're going through, what your goals are and so on. So he actually has a book as well, which I will link to on the show notes. The show notes are P2 sportscare.com slash 88. That's two H's in a row. We're almost to a hundred, aren't we? I don't know what we're going to do for a hundred. It's got to be a good, it's got to be a good interview at a hundred. So, um, lastly, if you've not gone to my website, I encourage you always to do so because although we're doing this podcast version, this is audio. If you don't care about audio, go to video. We do a podcast every single day of 2018.

So if there's concepts that you want to see demonstrated, they're right there. They're right there, man. They're always there. So my goal at the end of the year is for everyone to have said, man, I really learned a lot this year from your content, your podcast, your videos, your articles, your articles were long, comprehensive, and open-minded. That's what I'm hoping to find. So direct all your patients there. I'm not going to steal them. We live in different places. So send them there, have them look at it, ptsupportscare.com, uh, and just go into the patient area. Clinicians go through and check out all the patient education tools under I'm a provider.

And that's all I got for you this week, really. So take care, be good to each other. Talk to you next week.