Soft tissue work, active rehab and a five-step recovery structure

I was very insecure when it came to, like, my structure and rehab, right? So I know bits and pieces of rehab. I just never knew how to put it all together. And I kid you not, in the first month that I was there and you gave me all these, you know, Google documents of the way you were breaking down, you know, different pathologies, right? It allowed me to really see how you broke everything down. It gave me an idea of how to structure everything and not to really, you know, overcomplicate it. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery.

And now, your host, Dr. Sebastian Gonzales. Hey, everybody. Thanks for listening to the show. I'm Dr. Sebastian Gonzales, your host. If this is your first time in the show, welcome. By the way, I'm realizing that the intro is really challenging when I'm in a home studio now. I'm used to being in my element. Shit. So this podcast here is going to be about Mikey's questions, all right? If you have not been to this podcast before, then what you should expect from it is basically where clinicians gather to improve the communication and outcome. Like, it's really cool that we get to learn a lot of great things about the body, but unless the patients let us do it to them, then we're not going to get any changes.

So in the beginning, this podcast was mainly about getting patients to just understand what's going on with their body. But I think now, as you kind of see over the past 100-plus episodes, that it's molded into a little bit of kind of both. So I like to think of it kind of like we're at a bar, having a beer, or a shot of scotch, maybe some. Costco's got some great 21-year-old scotch blend. It is a, what do they call that? Peat? No. Sherry cask. It was a Sherry cask blend. It was really amazing. By the way, you can't buy Kirkland in stores. I don't know if you know. You can't buy it in bars. It's not allowed.

But anyway, somehow we all three got it, and we did a cheers, and we're just talking about what's going on with that person who is not the medical person there. We're trying to get them to the outcome that they're looking for. So that's what the podcast is all about. Please go back in the archives and listen to the archive episodes. There's some amazing things back there. And as we move forward, this one is going to be with my intern, Mike Valesko. God, I'm going to misspell your last name just like I do everybody's name. Ah, screw it. We're just going to go with Valesko. So Mikey Valesko. So Mike has a lot of questions around the office, and he's always like, hey, so what do you think about this?

Hey, what do you think about that? And they're usually not always related to each other. He's got a lot of random topics, and so I thought, you know what, Mike? Let's just do a podcast with every time you ask a good question, or if you have a question, let's write them down. Let's do a podcast on those questions. That way everyone can benefit. Could you ask really good questions? Let's do that. So he agreed to be on the podcast. It's his first time on a podcast, so give him a little bit of slack there. And he's going to be on as a serial question giver for a little bit of time every once in a while just because he poses such good questions.

So I hope this is helpful to everybody. And as we get into the show, the first part of the show, typically I share a little bit about myself via short story so everyone can get a good idea of who the host is. So hopefully you get to, you like to follow along with the learning process. I've learned a lot over the past couple years doing this podcast as well as hopefully speaking skills and apparently not, unless ums. So the story is going to come, I shouldn't even try to ad-lib stuff. So we're going to get to that short story, then we'll get right into Mikey's question series. So recently I purchased a boat.

I don't remember if I told the story or not, but either way you're going to hear it twice if I did. So I purchased a boat and the speaker system, the stereo system, didn't work on the boat. And so I decided to go and upgrade that thing because I think I like to have music on a boat. I don't know about you guys, I love to have music on a boat. So what I did was I got some five and a half inch speakers. I got to get creative where to put them because I don't want to cut holes in the fiberglass. I got some upgraded little tiny speakers that it came with, but more so I got a subwoofer and I put a box in there.

And the box had to be put in a spot that was kind of hung up on the wall so you can't see it, but it's cradled in there pretty good because this is an 18 and a half foot boat. And there's a lot of space under the helms. So I was telling Allie that, I'm like, you know what? I was laying there one night, I was like, you know what? I think we need a subwoofer in the boat. And she's like, no, no one needs a subwoofer in the boat. And I sat there and thought, you're right. But I do. I need a subwoofer in the boat. Like I won't enjoy the boat unless I have a subwoofer. So luckily I found a good $40 marine subwoofer, built a box out of scrap wood that I had, and I tested it out the other day.

It sounds banging. So I want you to know that if you hear a bass bump in the lake scaring all your fish away, that's going to be the boat right there, okay? Everyone needs a subwoofer in their boat. Needs. You basically lose half the music. There's no point. There's no point in even listening to music. Like old school 90s rap, there's no point in listening to any of that if you don't have the bass. It's all about the bass. I don't know who made that song, but they probably stole my line. That was probably my line. It's about the bass. Go ahead. More bass. Let's get into the show. So I'm actually really interested in – I myself love soft tissue.

And I knew you were very big when you first started your career. You were all about MRT. I kind of want to know the background story behind you, kind of like the whole transition of you becoming – being so MRT-based to – I mean, you very – you use it very like – I don't say you use it very much. I guess so – yeah, I'll answer that. I think – so does everyone – I think I mentioned it probably – I will in the intro that this section is called Mikey Ask. So it's just a bunch of serial questions that Mike likes to ask in the clinic, and so we're just going to make them dual purpose here. So Mike can ask anything he wants.

This might be an ongoing series. Yeah, with MRT – so I was in a clinic where we did a bunch of like soft tissue work. Like it was like when people called, it was like, yeah, like I want to get this done. The guy was like, yeah, I'm going to do that. And so like it worked. Everyone liked it, you know. But as I went back to that clinic later, like I visited him after practice, after I graduated, and I was out for a handful of years, and I just looked at his schedule. It was like the same people. Like it was the exact same – like I knew everybody on the schedule. So things weren't really changing too much long-term, in my opinion.

But especially when I had – you read the book. Do you read my book? No? So the book – Did you copy? There's an audio version too. But basically – so me and Cody were sitting around having a beer one day, and so I was having issues with – like he would explain like the cases he was having issues with, and I would explain that – it was kind of like brainstorming. And I was like – I typically had a back case. And so like I had too many beers, and so he's like probably 250. I'm like 150, and so he drinks quickly, and I don't drink slowly. But we had some mongos. They were like 8 percenters. So I was getting pretty drunk.

I'm like, you know what? How much do you think you know that I don't know about back pain? He's like – he's like – basically he said you only know 25 percent of what I know, kind of. And so I was like, hmm, what is that? And so I went back later the next day after kind of remembering that, and then I looked at PubMed. PubMed went on to McGill. McGill went on to some McKenzie's, and then went on to Dan John and things like that. So it was kind of like just a spiral of things that, wow, if that worked for that case or for a low back, why would this not work for all the other cases? Like if you're talking about like the concept of like co-contraction and like I know DNS talked about joint centration and blah, blah, blah, right?

And so it's like if you're stabilizing that movement segment that is kind of irritated and then building supports with the ball and sockets around it, why can't you do that to the other spots like the neck and the shoulder and the – and so – and then we started to get down the realm of referred pain. When I had my first case that IT band cleared up without doing IT band massage to, it was just like mind-blowing. It was like, holy shit, I didn't have to do any of that, you know? So that was kind of like the reason. And I found more and more cases that just don't – they don't need it as much as I thought they did.

Okay. So, I mean, that's a great explanation. Well, how would you say – when would you choose to use it? Because I do see using it sometimes, but – Yeah. I mean, when would you use it? So there's – without saying like patients' names, because I know you'll probably know their names. If you – if there's a case – is there a case particular you're thinking about? Not really. I just kind of want to kind of understand your rationale behind when to use, you know, ART and when not to use it. I mean, just to kind of – Yeah. There's patients that have been around for a long time. Like they've been in and out of my office for various things.

And like some people – I know this one lady. She just – she just loves tissue work. Like she just loves it, you know? And so like she comes – she comes around like once every couple months, something like that, when she has a flare-up in some case. But, you know, I – like I even told her about like since we're – now we're in the coronavirus times. I told her, look, you can't come in. We got to do virtual. And she's like, no, no, no. I need tissue work. I'm like, no, no, no. You know, let's – I've been telling her – I've been telling quite a few people for a long time. I said, can you – are you willing to try this?

And so they're – not all of them are willing to try. Or there's cases that are like chronic cases. Like imagine like you've had low back pain chronically for 10 years and you have that main syndrome type of, you know, like muscular and fascial adaptation. Like that's a lot. Like – but those new cases, it's like there has been no time for scar tissue or adhesions or any of that stuff really to build up in my opinion. So what are we treating, you know, other than just making people feel better, which is okay, but you kind of got to stabilize it after or do something which is supportive after. So I don't know.

In the exams, I found that it's more enlightening to the patient to not do tissue work or manual therapy on them first and then take them out to a rehab setting and they feel significantly better by doing a rehab exercise. And then they're not as willing or wanting to – needing to go back into the manual therapy setting. But there's a time and place for all of it. Nice, nice, nice. What's your opinion on like the whole thing because I've heard it many times from different clinicians of, you know, touch is such an important part of what we do because it builds some sort of connection. Yeah. Well, so that's – I think we're talking about interpersonal relationship now, you know, and obviously you got to do what you got to do to get the person to do what they got to do or, you know.

But like they ever tell you like in the sales game, like you're supposed to like walk up and like you put your hand on their shoulder and you're like, hey, here's the car that you need, you know. And so like the initial touch part is like it's important for getting the end result to happen, I think what you want. But I think in regards to just actually touching, building the trust, I think that's definitely a part. I don't know, there's people that are pen pals and they feel like they know each other. People on social media feel like they know each other without having to touch each other. And like I know there is a – there's a value of manual therapy.

I think there's a strong value of it when – but I think it's overly utilized is all. And I think there's – I think there was a – wasn't there an article that came out recently that said we basically know nothing that we know about manual therapy that we thought we knew? Was there something like that that came out? I believe so, but I haven't got around to reading it. Yeah. I'd have to look back and see. But I think if I recall it, it was basically this works, it makes people feel better, but we have no idea why, you know. Yeah. I see what you mean. I know I'm jumping all over the place just because I want to get the explanation from your part.

But again, I'm just asking questions. This is why the segment is called Mikey Ask. So, another question is how did you come up with the five-step process that you have that you now practice under? It was first a four-step process. And before that, it was just random phases. And it was – I don't remember, actually. I have no – I don't really remember. I remember that I did bring a sheet of paper into the bar one night and I had like, you know, phase one, we're doing spinal stabilization. Phase two, we're doing unilateral loading. Phase three, we're doing anti-rotational. And so, I put down like measurement tools of like how you would exit that phase or how you knew you were complete with that phase, I guess.

I think probably the spinal endurance one was based upon McGill endurance testing, you know, like being able to do a side plank for like roughly 90 seconds, you know. Things like that. And I know you see up on – you see up on the wall at the office, there's those three things that it's like if you can't do those, then it's like there's no – like there's a – you'd think there's like an outlier. There is – I know in that – on the stuff on the wall, which is really old, that's probably – that's probably like three, four years old now. There was the third phase, which was strength, I think is what it was at the time.

And so, it was like – imagine someone comes in and they're like, hey, so I can do like 50 pull-ups. And you're like, well, how much can you squat? And they're like, 10 pounds. And you're like, that doesn't make any sense. It doesn't make sense. Yeah, so there's like – there's outliers. So, I put down like five things like you should be able to, you know, deadlift your own body weight a handful of times, you know. And at least like the parameters of like, well, I weigh 300 pounds, it's not fair. Well, it's like, okay, one outlier is that it's the weight, right? Like your weight is the outlier. It's not the weight that you're moving.

I think squat and deadlift I made pretty close. There was a carry. There was hanging from a bar for like I think 45 seconds or something like that. So, there was a bunch of those things in there, plank hold for 30 seconds. So, I don't know when it became the five steps other than when I realized that the fifth step was movement – I think movement variability. And there was something beyond the gym. So, I think – I guess I don't know if the listeners realize, but there's other podcasts that talk about the five steps. First is diagnosis, working diagnosis – or sorry, history, exam, and working diagnosis.

Step two is first aid as well as safety net, kind of like a slash. Number three is it's buttressing, corrective or corrective movement or breaking systems. Four is strength, five is playfulness. It's kind of like a pyramid that goes up. Yeah, I've honestly seen very – I like the whole structure of it just because if we can give a good breakdown to the patient, I feel like they understand that we have a structure to their care. And they're more likely to be – you know, stick to their program. Yeah. So, I mean, overall, I feel like it's been very effective. Well, you know what I like with – at least when you have someone who's come – say they came in for like a shoulder and then they came in for a hip, you know, different things.

But then you gave them – like you examined them, which is completely different. You did a first aid, which say like it's the shoulder, like you wanted to – you gave them a sling. It's completely different. And then you gave them some corrective exercises and some were on the ground. And it's like, hey, these look familiar, but we're cuing them a different way. And then when you get them into resistance training, it's like, oh, these are the same things. So, that's why I was thinking pyramid style where we just all have slightly different starting points with the problem. You only need like 20 different corrective exercises that really are going to be useful.

And then you'll need five basic movements, like the Dan John push, pull, carry, squat, hinge, which is you're going to be here. And then the top is – I guess it should be like an hourglass because there's infinite number of playfulnesses. So, have you been playing with that with your patients? With the five-step, yes, absolutely. That's the way I go ahead. And so, so far, I don't know, at sports med, I have more time to play with my – you know, to be able to be with the patients. So, I could spend from like an hour to an hour and a half with them and it would be okay. And versus like at Cal State Northridge, where I'm at, I have about like a 30-an-hour window, even though it still takes about an hour even if it's a follow-up.

So, I need to get better with my time management in that setting. But I mean, at the sports med clinic, I'm able to, you know, give them like when I first saw them for the first time, a shoulder patient, I was able to give them a safety net. You know, find a – like truly find a – get the history, which is your first step, your diagnosis. And then your second step would be my safety net, which I found – I pretty much found a position of comfort that would pretty much reproduce your pain at least 30%. I mean, not reproduce, decrease your pain from 30%. So, I was able to find them in that position.

And then after that, I was able to do some corrective exercises. I especially – I really enjoy doing like a lot of the DNS stuff that we've been doing lately. So, a lot of the scapular stabilization, DNS is like pretty much a three-month period, you know, movements that we've been learning, you know, in clinic with you. Nice. And then eventually, you know, I didn't really have them in that phase for too long. I was able to throw them over to the strength and conditioning with Dan John, and I was able to get them out in about – get them better about like maybe six visits, I would say. So, it was like a – it's been very effective, but it just allows me to see it on paper like where my patient's at.

You get what I'm saying? Because if not, I'd be all over the place. Now, I want to share with you guys a break. We're going to do a break, and I want to share with you guys a webinar series that I put together. I'm extremely proud of it, and I'm going to continue to promote this thing to death because I think it would be a huge mistake to have made it such as I did. I did put 15 hours into it of recorded content, and then nobody finds it. So, if I was talking to my five – not five-year-old self, I guess myself that was in practice for five years or even a couple years ago, I would say, if you do not get this, it's a complete waste of your money to go to any other CEU unless it's on my CEU list that I listed in the workshop.

So, I believe in it that strongly. It will help guide you into what CEUs are going to be useful and ways to organize the content that you guys get at some of the CEUs. How do things like FRC plug into here? How do things like DNS plug into here? How do things like Dan Johns plug into here? I cover all this stuff. I don't go through all of the parts, the nuances of those, but I'll tell you where they plug in for sure, and I'll show you the steps that I take to make people feel better with hips and shoulders and low backs and cervical spines and referred symptoms, IT bands, hip FAIs, things of that nature.

And so, I'm going to share with you one of the testimonials or at least part of an email that I got from one of my students that was in there. And so, I won't spare you. I won't go through the entire thing, but basically, they were working with someone with hip, and they didn't feel comfortable with hip people until we did the hip course. And so, this was just the next week after we did the hip course. And so, they said they missed a few steps in the exam and treatment, but they felt way better and more comfortable than ever dealing with a hip complaint. I can't wait to master this and mess around with more.

And so, they had a really good experience in it. I guess that's not the best testimonial, but I don't want to reveal all too many of the details that they said because it might get too much into personal stuff. Either way, they felt comfortable mastering or dealing with hips. And so, if you're having trouble dealing with hips, I encourage you to go through the first course I have, which is one of six, which is on the p2sportscare.com slash products page. It's one of six hip complaints. Go through there. It's the best money you'll ever spend. Again, I don't make money on the podcast, but if you want to know what I really think about how to treat people, it's in there.

See you on the other side. Now, back into the show. Well, that's good. You got a nice flow there. And you kind of know, you have a good idea, like, where you're going, right? Yeah. And eventually, like, I really want to know exactly what, like, their end result is. You know, what is their goal? What is it that they're, you know, in the playing for? So, I mean, you know, eventually that's what's going to allow us to really get them to that fifth and final step. Yeah, I have a hard time with sometimes when they're stuck in one and two and it's just like a tinker, like, you're just tinkering, tinkering, tinkering.

Like, you see them, like, three times and, like, you're like, God, like, we haven't found anything sustainable that's keeping them out of pain. Or we did and they're doing the opposite at home and, you know, just not knowing it. So, I always find that those sessions take longer than I ever typically expect them because usually spending 45 minutes to an hour in the beginning and then 45 minutes a second session is always nice. But after that, it's just kind of like you should, we should be kind of into a little bit of loading and corrective. Like, they should know a lot of things at that point.

But when there's tinkering, it's like, you keep, I find, like, I keep giving them different things to do and they're just kind of like, they don't know where they're at, you know, other than if I show them, like, a little pyramid thing. Yeah, I understand. What about when, like, when you're troubleshooting? I see you, you know, obviously you're really trying to find a position of comfort. Like, what's your rationale behind everything? I know it's case dependent, but at least how is it in your mind that you're, like, trying to troubleshoot, you know, the patient? Yeah. How do you go about it? I'll usually go...

And that's a very broad question, very vague, but... Yeah. Well, let's just say with, let's just say we're talking about, like, like a hip, right? Like, say you take them, say you take them through the exam in history and, like, through the exam, like, there's nothing really wrong with the hip. Like, like, scourge is negative, Faberge is negative, Fadirge is negative, circunduction negative, axial compression, anvil, like, all that's negative, right? And they continue to have pain there, but a lot of their maybe low back is positive or maybe nothing's positive on the exam. And then we find that it's just true with transitional movements.

So, like, I usually go, like, off of, like, collecting information or data point type of theory and I'll, like, plug in, like, hmm, well, I don't see anything really wrong with the hip. Maybe, I mean, sure, it might be painful there. Maybe there is something going on there, but it's circumstantial. So, it's not a local inflammatory thing. It's an ebb and flow. It's not like it's a hot fire there. So, how do we decrease the amount of symptom-generating movement on it, you know? Or how do we clean it up? So, I know they'll keep going back in. A lot of them will keep going back into, like, well, like, well, my hip.

Like, is there anything wrong with my hip? No. Reasonably, there's nothing wrong with your hip. Like, we looked at the data points with it. I don't see anything making me think there's really wrong with the hip. What, do you think I should get an MRI of the hip? No, there's nothing positive on your hip. But we have all these other possibilities because you landed all these cluster points, data points in different plots. You hear me okay again? I've been hearing you just fine. Okay, this thing keeps cutting out. Now I know what Allie's talking about. So, yeah, when they're, when we're observing of what they're doing, I think there's a lot of information to be gathered that way.

So, I don't really want to muddy it with everything else you said. I kind of just want to see it in its natural environment. And I don't even want to coach them too much of how to do things other than just maybe feet together. I want to see what their normal things are. And that's why with the squat, I'll say, do the best squat that you, that you can do. And then I might look at it a different way and ask them to do a certain thing because I want to see what they're going to do too, you know. I don't think they, I think Dan John has a good saying. It's where you're at right now, you didn't get that way because of, you got that way because of what you've done in the past.

Like, sure, we can add things, like we can add more things, but you're basically a sum of your habits of whether that be eating or movement wise. So, a lot of these people, I think if we just see what they've been doing, we'll get more insight of, we can just subtract things if we want to. You don't even need to add more things. You just subtract away and then we might actually get some more too. Yeah, pretty much those are the questions that I have. Now, a really quick break from the show. And just as we've mentioned in the last couple of weeks, there's probably not going to be as many workshops in person, just like every other convention in the world.

A lot of these workshops have been canceled because of not gathering in certain areas. So, Mike actually had this idea. He's like, hey, why don't you do an online workshop? And so, I said, Mike, okay, let's do that. So, your job is to promote an online workshop. We're only going to do a couple hours, make it affordable to everybody. And so, your project in school, so he's the intern, your project in school is to promote one single thing and try to sell it, try to get people to buy something. So, he's been working for a couple weeks and trying to get people to buy something. And he believes in the product, or he believes in the workshop because he knows what he's learned at the clinic.

But if you see a promotion for a workshop for a hip or a back or a shoulder or something like that, this is Mike, okay? And I'm trying to give him a little nudge along the way because I do think that once we get those first workshops going, I'm going to record them. I think everybody's going to get some good benefit from them, and they're going to be extremely affordable. So, if you're looking to participate in those workshops, just reach out to me. That's performancehb at Instagram. By the way, you can ask any question you'd like to on there. Or you can reach out to Mikey as well, who, again, it is his school project.

I'm trying to teach him the challenge of trying to sell something because we can all, as clinicians, we can all help people. Selling something to somebody to get them to help you is the hardest thing. So, help Mikey with his project. So, his Instagram is future underscore DC underscore Mike V. There's no at, so, sorry. Future underscore DC underscore Mike V. So, now back into the show. Okay, I hear you again. God. All right, Saba, I'm pretty much done asking all the questions that I have. Do you have any questions for me? Yeah, I got some questions, okay? Oh, boy. Yeah, okay. So, what do you think you need to get better at when working with patients so far?

I would say just better with just, yes, I'm very good at, like, what I do in regards to, like, you know, cueing and doing exercise. But I want to get better to be more personable and being, getting to know the patient, understanding the patient, you know. If they have any triggers or if they have any, you know, just anything that might be hindering their rehabilitation and their, you know, motivation to get better. Just so I can get them, you know, we can be at one unit and, you know, move forward. I feel like that's one thing I got to get better at. As well as really understanding concepts and being able to use those, like, creative analogies that you come up with.

They're on the fly. I don't know if you're going to. Those are on the fly. I mean, I'm trying to write down as many as possible. So, how are you going to accomplish that then? I think it's just more being in the moment. I feel I'm very hyperactive. So, it's really hard for me to lose, you know, focus. I think I just need to really be present and really just, you know, instead of thinking of what next question to ask, just be in the moment and listen to, like, whatever the answer was to my first question. And understand it, really, you know, be in the moment and be able to, you know, carry that conversation.

I feel like that's where I lack on. That's, like, my, you know, my everyday life, though. Not just in clinic. Yeah. Just being more in the moment. Yeah, the, that's a very good idea. Yeah, your first three questions were very spread. Right? That's what I'm talking about. Yeah. The, the, I've noticed that, like, on, on good interviews, there was, I've been, I've been listening to some people doing interviews to see if my interviewing stock can improve. And so I took a gamble on one of them that was, it was on, uh, uh, Dr. Perry and the, the, uh, the don't chase pain guy. And so, uh, someone made a suggestion of, why don't you try, like, the, you know, get deeper question, just follow him where it goes.

And so I did, and, and someone was like, wow, that was the best interview that I've heard of him. It's really nice to hear what, you know, who the presenter is versus all the stuff they have to say. So I think you get more out of that second and third level questions out of most people, but it's so easy just to get to, you know, like, well, you know, what, what do you need to get better at type of question. Exactly. So can you give me some examples of like about getting deeper, like what are some second and third, you know, level questions just, if you can just like, we can role play here, you know, you can ask me.

Oh, we're doing some role play. I'm so I'm not good at this either. I mean, we're getting, we're going to get better at it. That's why I've only done one, one good interview ever. Um, okay. So then why don't we go with, uh, tell me about, um, I don't know if I want to, I was going to say, tell me about the schooling experience. Tell me about your internship experience. Um, well, coming in, um, the reason why I, I pursue, I persuaded, uh, a PPR, uh, rotation with you. I was, uh, I was very, um, insecure when it came to like my structure and rehab, right? So I know bits and pieces of rehab. I just never knew how to put it all together.

And I kid you not in the first month that I was there, I re and you, and you gave me all these, you know, Google documents of the way you were breaking down, you know, different pathologies, right? Um, it allowed me to really see how you broke everything down. You get me, gave me an idea of how to structure everything and not to really, you know, overcomplicate it. Okay. So, I mean, overall, I feel like create, getting the structure that I've always wanted, I was able to get it with, within that first month. And now I'm just, you know, honing down everything and learning, you know, DNS learning, you know, um, you know, Michael shot clock's work, knowing McGill, knowing, you know, Cody, Ben Ramos, everybody like it's, you're just expanding my world.

And I, and I love it. Okay. So it's, it's hard to ask the second question cause you already dumped all the beans on some of that stuff, but so, so then, so since you have like a, since you, since you learned more than, uh, or since you learned a bunch already, then what, what do you think, how does it, how does that make you feel? Like, how does it, like, do you feel like still lagging in certain spots or? I mean, I mean, I have a humble mentality, so I'm not going to be here and be like, I know it all. Um, I do, I am getting familiar with everything, but that's the key word. It's I'm familiar with it.

You know, I haven't mastered it yet. And that's where I want to be at once I, you know, I finished that 10th term up with you. Yeah. But I mean, I feel like right now I'm getting familiar with everything. I'm learning a ton of stuff and I just want to be able to really understand everything and really understand when to use, you know, pull it out of my tool bag and use it. Well, when do you think you're going to master everything? My goal is to, I mean, I don't, I mean, hopefully by 10th term, but I don't even think that's possible. I think it's going to be an everyday thing as I even when I become, you know, when I get my license.

So, I mean, I'm going to continue to learn, but I think the best way to master something that's like what you're doing, you're, you're, you know, you're passing it on to me, you're teaching me. And I feel like once you start teaching it to others, you start to teach it, teach it, teach it. I mean, you eventually, you know, really start to grasp it a lot more than what you did in the beginning. Yeah. Okay. So that was three questions. I don't know if I got deep enough on it. That was good. So your turn. All right. So, uh, I mean, how do you like me? And let's ask this, um, how have you liked me being there with you and how I have, uh, um, I mean, if you have any feedback for me, I mean, you can give it to me.

I'll let it, I can tell everybody that's listening at this moment. Oh, Mikey. I'm doing so far. I really like that you have the nickname Mikey because all the patients really tend to like, they're like, Hmm, Mikey, huh? You should, they think they said a bunch of things about it already. Um, no, I think, I think you're doing good. You, you, you're picking stuff up really quickly. Um, and there is like, I think, I think creating like the syllabus, the only, I guess, feedback that I actually don't, I wrote that syllabus. I don't even know if we'd done it or not yet. I think they knocked out a lot of it to be quite honest.

I just looked at it the other day. Okay. So, uh, I, so I guess that, yeah, patient with patient care, you're doing pretty good. I know you're in business. You want to jump in there. Um, but I think that there, and we talked about this one time where there was, where there was a couple of people where it was still a level one, level two. And so there was tinkering, usually I'll, I'll have interns jump in with step three and four. Um, and so mainly because I still got to develop the trust with the patient and I got to know what's going on still. Um, not that I don't think you can figure it out either.

It's just, um, business to business gotta, gotta, I don't want to, I don't want to mess up. So, uh, I know you jumped in quickly a couple of times and I had to say, Hey, let's, uh, let's not do that one. Let's, let's go to the other ones. Right. Um, but everything else be good. Uh, you, you got a couple of people to, to comply with care, which is the hardest thing. And, um, you like to offer people a lot of water. That's right. I mean, it's hospitality, right? That's the first thing in the interview that we, when you've interviewed me, you're like, we, you know, we want to create a, uh, you know, warming, you know, environment.

That's what I'm trying to bring to the table. I mean, some other questions that I have, uh, let's ask this, uh, go ahead. I'm gonna get deeper. And it's, and it's, and it's, and it's, you know, something that, you know, I'm jumping from one thing from another, but I want to ask, I want to ask how have you and your significant other have been able to work together to, you know, We, we could talk about that, but you didn't go deeper into the conversation we just had. Shit. You see, this is my problem. You could, you could have asked, you could have asked, um, you know, in what circ, like in, in what circumstances or what type of cases, maybe, you know, would you feel comfortable with that?

Why don't you want me jumping in with phase one and two? You know, like all those kinds of things. You know, that, yeah, that's, that's a really good, really good point. But if you're, you're running the show, so we can. No, no, no. You know what? Let's ask, let's ask that. When would you like, I understand you said not one and two, you said, and it's business, you know, right. Due to, um, you know, you don't really want to make sure that, and I, and like you also told me it can be overwhelming for a patient. If two people over here jumping and trying to tinker with one person. I mean, so, um, what are some other reasons, um, you feel like it's, it's not appropriate for me to jump in between phases one and two.

Yeah. It's just, I mean, cause I know this will sound bad, but your people pay a lot of money to come and I think they expect, you know, to see me, um, and not that, not that I want to be the only one seen. Cause I know that, you know, Dawne Costantino's there now too. So it's, it's going to be a little challenging to get even people who have seen, like say people listen to the podcast. It's like, I want to see Sebastian and it's, it's not good business for me to be the only person, uh, to be seen, but they perhaps asking that upfront, it's like, you know, who would you like to see? Oh, I don't care. I can see anybody in that case.

They don't even know who the heck you're seeing and they might be okay with seeing you, but without asking that it's, we're just making the assumption. So, um, like I've, I've suggested someone, uh, uh, see, see Dawne Costantino, you know, and they're like, nope, I want to go to you. And I'm like, well, like I made myself more, even more scarce. I was like, I was like, I'm not even going to be until next week. They're like, well, I'll wait, you know? And so I think the, the expectations of what the patient has is one thing, although I don't, I don't always ask it, uh, but, but two, like, I don't think patients are fragile necessarily, but, um, I want to see that you have developed competency in case recognition before we actually like jump you in as that, you know what I mean?

That makes sense. So you just don't have enough reps. It's, uh, um, there was a lady that came in and she talked about, uh, she was talking about computer systems or like a shipping software. And so she's the, she's the business owner. And so she hired someone to do the shipping software. And so the person's having a problem with it. So she jumps over, she's like, oh, let's, uh, it's new to both of them. And so she starts tinkering it and figuring it out. And the other person's like, how did you, how'd you figure that out? And she's like, these are all kind of like, I've seen enough of these programs where I get, I get the gist of it.

You haven't seen enough programs, so it's, it's not fair to the patient. Yeah, I completely understand. Um, and you feel like I have been getting better though, right? Not jumping in and. Oh yeah. No, you're, no, you're, you're, you're ahead of a lot of people. Yeah. All right. Yeah. Um, the third question, huh? Yeah. I'm just trying to think of more questions. This is like that awkward first date where like, shit, you should like, not get it. I've had a, I've had a lot of those. Um, but in regards to, uh, what'd I say? Like, uh, yeah, I need to get better at like, uh, this is pretty much like carrying a conversation.

I feel overall. Cause it's just like, I mean, I don't know if this whole like podcasting makes me nervous and not being in the moment, but it's just like, I just need to be better at, you know, carrying conversations. And yeah, I feel like I'm not that well at it. It's a, it's a learning curve. I'm sure you'll, you'll, everyone get better over time. Yeah. Um, well, I think that's, uh, I mean, did you have any more questions we can, or we can end the session of, of Mikey ask. I think, you know, this is good enough for the first one. I feel like I'm going to prepare better next time and, uh, and have less awkward moments and moments of silence and not bounce all over the place.

And you have so many questions at work. So I know I'm going to write them down though. I'm going to write them, I'm going to continue to write them down and I'm going to next, the second, the next segment, you'll see the, the big improvement. Oh, good. And we're going to improve your interview style. Yes. We can always play the ring ring game if you want. No, no, no, no. I mean, it's enough for today. We'll play next time. We can play next time for sure. We can actually start off this segment with ring ring. Yeah. That was always fun. Okay. So, um, I will let you go and we'll talk soon. All right, Sebastian.

Take care of yourself. Later, man. Later. Mike, thanks for being on. And, uh, everybody, I apologize. There were some cutouts here with some technical difficulties, but I did my very best to patch them together. And that was, uh, uh, we're going to, we're going to have to continue to have Mike on. Uh, different points in time too. So I hope that was helpful to everybody there and that you continue to stay safe and grow your practice and help out patients and be part of the movement. I, I think as part of the movement, if you have not heard the pits already is the, the movement, the idea is that you are a healthcare provider that believes that patients can help themselves, that they are, that we empower our patients, that they can feel better quicker than ever thought possible and that they don't need us to do the, all the work.

They're part of the solution. We're just on a team. So that is the idea of the movement. So if you're part of the movement, please share this with another doc or another student or another clinician who you think can take value in this. And the only way this podcast continues to grow is if you share it. All right. I won't share it. You must share it. So please be part of the movement and share with a friend. I'll talk to you guys next week.