Most physical therapists will treat TMJ pain. Almost none will ever encounter a full bilateral TMJ replacement—paired with mandibular advancement and upper palate expansion. When that rare case appeared, there was no rehab playbook… so this clinician built one.
What listeners will learn:
- How TMJ replacement compares (and doesn’t) to hip and knee replacements
- Why outcomes research exists—but rehab pathways don’t
- How to apply total joint principles to a jaw joint
- What to do when surgical restrictions limit “normal” movement
- The role of nutrition, SLPs, and interdisciplinary care
- How lived experience changes clinical decision-making
Why it matters:
This episode isn’t really about TMJ—it’s about how clinicians think when evidence is thin and responsibility is high.
Guest:
Katie Berry — sports & orthopedic clinician, adjunct professor, and OMPT fellow-in-training.
00:00:03 --> 00:00:05 Most PTs will treat TMJ pain.
00:00:06 --> 00:00:08 Almost none will ever treat or even learn
00:00:08 --> 00:00:11 about a full bilateral TMJ replacement
00:00:11 --> 00:00:12 paired with mandibular advancement and
00:00:13 --> 00:00:13 upper palate expansion.
00:00:13 --> 00:00:15 That's a lot of words.
00:00:16 --> 00:00:17 Today's guest stepped directly into that
00:00:17 --> 00:00:18 void.
00:00:18 --> 00:00:20 Our guest is a sports and ortho clinician,
00:00:20 --> 00:00:22 multi-university adjunct professor,
00:00:22 --> 00:00:24 and fellow in training at the Ohio State
00:00:24 --> 00:00:25 University.
00:00:25 --> 00:00:27 Her path to fellowship wasn't straight.
00:00:28 --> 00:00:30 It was a decade of clinical growth,
00:00:30 --> 00:00:31 unexpected mentorship,
00:00:31 --> 00:00:32 accidental specialization,
00:00:33 --> 00:00:36 and cross-country reset that opened a door
00:00:36 --> 00:00:38 into advanced OMPT training.
00:00:38 --> 00:00:39 But during her fellowship,
00:00:40 --> 00:00:41 her professional world collided with her
00:00:41 --> 00:00:43 personal life when a family member
00:00:43 --> 00:00:45 underwent this rare complex surgery.
00:00:45 --> 00:00:45 Suddenly...
00:00:46 --> 00:00:48 They weren't just the clinician,
00:00:48 --> 00:00:50 they were the support system,
00:00:50 --> 00:00:52 the researcher, the problem solver,
00:00:52 --> 00:00:55 and the one building a rehab plan no
00:00:55 --> 00:00:57 textbook could offer.
00:00:57 --> 00:00:57 Today,
00:00:58 --> 00:00:59 she's bringing that lived clinical
00:00:59 --> 00:01:01 reasoning and that human experience and
00:01:01 --> 00:01:05 that emerging research to you.
00:01:05 --> 00:01:06 Say hello to clinician, educator,
00:01:07 --> 00:01:09 and researcher in progress, Katie Berry.
00:01:10 --> 00:01:11 Katie, welcome to the show.
00:01:11 --> 00:01:13 Yeah, thanks for having me.
00:01:13 --> 00:01:13 How'd I do?
00:01:13 --> 00:01:14 Did I do all right on the intro?
00:01:14 --> 00:01:16 Yeah, pretty good.
00:01:16 --> 00:01:17 I'm always nervous because we do
00:01:17 --> 00:01:18 pre-interview, obviously,
00:01:18 --> 00:01:19 because we want to get to the meat.
00:01:21 --> 00:01:22 I'd never like to show the intro to
00:01:22 --> 00:01:24 the guests because I want them to feel
00:01:24 --> 00:01:27 it at the same time that we're recording
00:01:27 --> 00:01:27 it so it's real.
00:01:28 --> 00:01:29 But that's a lot going on.
00:01:29 --> 00:01:30 We're going to dive into that.
00:01:30 --> 00:01:32 But I want to start with what usually
00:01:32 --> 00:01:33 people do at the end,
00:01:33 --> 00:01:35 which is thanks for being bold enough to
00:01:35 --> 00:01:38 tell this because this is not only work,
00:01:38 --> 00:01:39 but this is a little bit of personal
00:01:39 --> 00:01:40 involvement.
00:01:41 --> 00:01:41 Yeah.
00:01:41 --> 00:01:42 And that actually,
00:01:42 --> 00:01:43 that ended up being a really wonderful
00:01:43 --> 00:01:44 piece of this.
00:01:44 --> 00:01:45 Um,
00:01:45 --> 00:01:47 when I was thinking about the poster and
00:01:47 --> 00:01:49 obviously going through this whole
00:01:49 --> 00:01:49 process,
00:01:50 --> 00:01:53 when I reached out to other researchers or
00:01:53 --> 00:01:55 other folks who were working with TMJ,
00:01:55 --> 00:01:58 because it was something no one knew by
00:01:58 --> 00:02:00 the time we got to completion,
00:02:00 --> 00:02:03 which was wonderfully a successful rehab,
00:02:03 --> 00:02:03 um,
00:02:03 --> 00:02:06 which I'll get into the dicey bits of
00:02:06 --> 00:02:07 that later, but, um,
00:02:08 --> 00:02:11 that I had the perspective of being there
00:02:11 --> 00:02:14 at all aspects of it made it unique.
00:02:14 --> 00:02:16 And I think is what sort of set
00:02:16 --> 00:02:19 it apart as not just thinking about a
00:02:20 --> 00:02:24 new way to think about joint replacements
00:02:24 --> 00:02:26 or using an old way to think about
00:02:26 --> 00:02:27 joint replacements that we obviously know
00:02:27 --> 00:02:30 to a joint that's less known about,
00:02:30 --> 00:02:33 but also being able to integrate
00:02:33 --> 00:02:34 you know,
00:02:34 --> 00:02:36 we talked to nutritionists and speech
00:02:36 --> 00:02:38 therapists and kind of got the whole thing
00:02:38 --> 00:02:41 on board because I was there every day.
00:02:41 --> 00:02:43 So that was a unique piece to it.
00:02:43 --> 00:02:44 So I've got questions.
00:02:44 --> 00:02:45 Yeah.
00:02:45 --> 00:02:46 My job really,
00:02:46 --> 00:02:48 and any good host is to tell,
00:02:48 --> 00:02:50 help you tell the story so the audience
00:02:50 --> 00:02:52 can understand it the best.
00:02:52 --> 00:02:53 Sure.
00:02:53 --> 00:02:55 So where does this story start?
00:02:55 --> 00:02:56 We could start clinically,
00:02:56 --> 00:02:57 we can start personally,
00:02:57 --> 00:02:59 but I want to start where you think
00:02:59 --> 00:02:59 the story should start.
00:02:59 --> 00:03:00 Where should this story start?
00:03:00 --> 00:03:02 Yeah, I think, um,
00:03:04 --> 00:03:07 My first real big exposure to TMJ was
00:03:07 --> 00:03:08 actually in residency.
00:03:09 --> 00:03:11 I did the orthopedic residency at Memorial
00:03:11 --> 00:03:11 Hermann.
00:03:12 --> 00:03:15 And one of my main mentors, Caitlin Lang,
00:03:16 --> 00:03:20 we ran across a grouping of TMJ patients.
00:03:20 --> 00:03:22 And to most clinicians, right,
00:03:22 --> 00:03:24 we hear TMJ and we're like, oh,
00:03:24 --> 00:03:26 that somebody else is going to treat that,
00:03:26 --> 00:03:26 right?
00:03:27 --> 00:03:29 And I even ran into a couple of
00:03:29 --> 00:03:31 clinicians at AMT when I was talking about
00:03:31 --> 00:03:32 this,
00:03:32 --> 00:03:34 and one who works in a TMJ clinic
00:03:34 --> 00:03:36 looked at this case and was like, oh,
00:03:36 --> 00:03:38 my boss would treat that patient, not me.
00:03:39 --> 00:03:41 And so I think that perspective of like,
00:03:41 --> 00:03:43 this is complex and it's different.
00:03:44 --> 00:03:46 Caitlin was the first person who basically
00:03:46 --> 00:03:47 said the TMJ is just a joint.
00:03:48 --> 00:03:49 It is joint like any other joint.
00:03:50 --> 00:03:51 It's a synovial joint.
00:03:51 --> 00:03:53 We are going to look at the mechanics,
00:03:54 --> 00:03:55 the biomechanics behind it,
00:03:55 --> 00:03:57 and we're just going to treat these people
00:03:57 --> 00:03:58 as they are.
00:03:59 --> 00:04:00 And there's been some really wonderful
00:04:00 --> 00:04:03 research over the last couple of years
00:04:03 --> 00:04:04 from a couple of different groups.
00:04:06 --> 00:04:08 that have started to put out papers that
00:04:08 --> 00:04:10 really are, let's classify this, you know,
00:04:10 --> 00:04:12 myogenic, arthrogenic,
00:04:12 --> 00:04:14 is there a disc issue?
00:04:14 --> 00:04:16 And so I think my story started there
00:04:16 --> 00:04:18 at residency of someone just saying, hey,
00:04:18 --> 00:04:19 this is okay,
00:04:20 --> 00:04:22 we're just going to treat this and think
00:04:22 --> 00:04:23 about it with that clinical decision
00:04:23 --> 00:04:24 making,
00:04:24 --> 00:04:26 we would something else in the same way.
00:04:26 --> 00:04:26 All right.
00:04:27 --> 00:04:28 So let's jump back to something I
00:04:28 --> 00:04:30 mentioned in your intro.
00:04:30 --> 00:04:32 Your journey to fellowship wasn't linear.
00:04:32 --> 00:04:33 You worked for years,
00:04:33 --> 00:04:34 taught residents and fellows,
00:04:34 --> 00:04:36 specialized in TMJ, as we mentioned,
00:04:36 --> 00:04:37 almost by accident.
00:04:38 --> 00:04:38 And we'll get to that.
00:04:38 --> 00:04:40 And then jumped back into advanced
00:04:40 --> 00:04:40 training.
00:04:41 --> 00:04:43 You went back to school after you
00:04:43 --> 00:04:45 graduated from school and also taught
00:04:45 --> 00:04:45 school.
00:04:45 --> 00:04:46 You were like, you know what I need?
00:04:47 --> 00:04:47 More school.
00:04:48 --> 00:04:49 But let's ask this.
00:04:49 --> 00:04:51 What part of that winding path, which,
00:04:51 --> 00:04:52 by the way,
00:04:52 --> 00:04:53 is always the best path who needs a
00:04:53 --> 00:04:55 straight straight lines are boring, man.
00:04:55 --> 00:04:57 But what part of that winding path shaped
00:04:57 --> 00:04:59 you the most as a clinician?
00:04:59 --> 00:05:00 Maybe I'll ask a better question.
00:05:00 --> 00:05:02 Like what a part what what parts of
00:05:02 --> 00:05:04 that winding path do you look back on
00:05:04 --> 00:05:05 and say, yeah,
00:05:05 --> 00:05:08 that twist or that turn really shaped me?
00:05:09 --> 00:05:09 Yeah,
00:05:09 --> 00:05:12 I think I get this a lot in
00:05:12 --> 00:05:15 discussions when I'm speaking with folks
00:05:15 --> 00:05:17 who are trying to decide about residencies
00:05:17 --> 00:05:19 or fellowships or other things because my
00:05:19 --> 00:05:20 path is a little bit different.
00:05:21 --> 00:05:22 My entire
00:05:23 --> 00:05:25 residency cohort were just out of PT
00:05:25 --> 00:05:25 school.
00:05:25 --> 00:05:27 So they had all just graduated,
00:05:27 --> 00:05:29 whereas I had been out for five years
00:05:29 --> 00:05:32 treating as a clinician with the mindset
00:05:32 --> 00:05:36 of personally for me that I'm someone who
00:05:36 --> 00:05:39 needs to know a little bit more about
00:05:39 --> 00:05:40 how I'm interacting with something and
00:05:40 --> 00:05:44 what I know and where maybe I could
00:05:44 --> 00:05:46 grow more and then seeking out something
00:05:46 --> 00:05:48 that will help me fill that.
00:05:49 --> 00:05:52 And so I think it sort of made
00:05:52 --> 00:05:55 that turn initially with residency because
00:05:55 --> 00:05:57 I got to go into residency as a
00:05:57 --> 00:05:58 five year experienced clinician.
00:05:59 --> 00:06:00 And so we hear all the time, right?
00:06:00 --> 00:06:03 Residency is the equivalent of three years
00:06:03 --> 00:06:03 of clinical work.
00:06:04 --> 00:06:06 You graduate and you're this expert
00:06:06 --> 00:06:06 clinician.
00:06:07 --> 00:06:09 I got to go in as a five
00:06:09 --> 00:06:12 year resident and have conversations with
00:06:12 --> 00:06:14 my mentors in residency that were just
00:06:14 --> 00:06:16 like a little bit higher.
00:06:17 --> 00:06:18 I could apply my
00:06:19 --> 00:06:22 day to day as a clinician into that
00:06:22 --> 00:06:23 advanced learning.
00:06:23 --> 00:06:26 And so I think that's sort of where
00:06:27 --> 00:06:29 my sort of winding path changed a little
00:06:29 --> 00:06:32 bit into I can utilize mentorship.
00:06:32 --> 00:06:35 I can be a mentor, share my experience.
00:06:36 --> 00:06:38 But as I was interacting with more
00:06:38 --> 00:06:41 researchers and more fellows in my day to
00:06:41 --> 00:06:42 day seeing, OK,
00:06:42 --> 00:06:44 there's there's a little bit more
00:06:45 --> 00:06:47 And there is already this wonderful
00:06:47 --> 00:06:50 established fellowship set of programs
00:06:50 --> 00:06:54 where maybe I can go and it's the
00:06:54 --> 00:06:55 next best choice for me.
00:06:55 --> 00:06:57 If I want to get into teaching a
00:06:57 --> 00:06:58 little bit more,
00:06:58 --> 00:07:01 if I want to experience research at more
00:07:01 --> 00:07:02 of a one-on-one level,
00:07:02 --> 00:07:04 there's already a platform for that,
00:07:05 --> 00:07:05 which
00:07:06 --> 00:07:08 sort of is just the next best step,
00:07:08 --> 00:07:09 I guess.
00:07:10 --> 00:07:10 Yeah.
00:07:10 --> 00:07:11 I like that phrase.
00:07:12 --> 00:07:14 A wise person named Helena Esmond always
00:07:14 --> 00:07:16 said, when you're stuck,
00:07:17 --> 00:07:18 just make the next best step.
00:07:19 --> 00:07:21 And that simple reframe is really,
00:07:23 --> 00:07:25 it's simple, not always easy,
00:07:25 --> 00:07:30 but if you become myopic on purpose and
00:07:30 --> 00:07:30 say,
00:07:30 --> 00:07:32 my only decision right here is to make
00:07:32 --> 00:07:33 the next best step,
00:07:33 --> 00:07:34 because I know from experience myself,
00:07:35 --> 00:07:35 I will think,
00:07:35 --> 00:07:37 but what about thirteen steps from now?
00:07:37 --> 00:07:38 We're not at thirteen steps from now.
00:07:39 --> 00:07:40 But I still leave you reminded of this,
00:07:40 --> 00:07:41 which is why Helena is great.
00:07:41 --> 00:07:42 She'll just say,
00:07:42 --> 00:07:43 what's the next best thing?
00:07:43 --> 00:07:44 So I think that's great that you end
00:07:44 --> 00:07:45 on that.
00:07:45 --> 00:07:46 So let's go to this.
00:07:46 --> 00:07:48 There's a game that we used to play
00:07:48 --> 00:07:50 at kids' birthday parties called Musical
00:07:50 --> 00:07:51 Chairs.
00:07:51 --> 00:07:53 And we always know who the
00:07:54 --> 00:07:56 We always go want want when the kid
00:07:56 --> 00:07:57 or the adult is left out when they
00:07:57 --> 00:07:58 got no chair, right?
00:07:58 --> 00:07:58 Yeah.
00:07:58 --> 00:08:00 You sort of ran into that situation.
00:08:00 --> 00:08:04 You encountered bilateral TMJ replacement
00:08:04 --> 00:08:05 case during fellowship.
00:08:06 --> 00:08:06 Sorry, sorry, sorry.
00:08:06 --> 00:08:09 You became a TMJ specialist when your
00:08:09 --> 00:08:10 colleague retired.
00:08:10 --> 00:08:11 Is that right?
00:08:11 --> 00:08:12 And then suddenly you were left with no
00:08:13 --> 00:08:13 chair.
00:08:13 --> 00:08:14 You were the TMJ person.
00:08:15 --> 00:08:16 Yeah,
00:08:17 --> 00:08:18 I was working at Kaiser in Northern
00:08:18 --> 00:08:20 California and I had this wonderful
00:08:20 --> 00:08:21 coworker, Frank,
00:08:22 --> 00:08:24 and he was just a wizard with TMJ.
00:08:24 --> 00:08:26 And we were I was working out of
00:08:27 --> 00:08:29 an office and he basically wanted to take
00:08:30 --> 00:08:30 a step back.
00:08:30 --> 00:08:33 He was in his path to retirement of
00:08:33 --> 00:08:35 sort of letting go of some of those.
00:08:36 --> 00:08:38 that he was doing and allowing other
00:08:38 --> 00:08:39 people to fill in.
00:08:40 --> 00:08:41 And I will be completely honest,
00:08:41 --> 00:08:44 I still don't consider myself at all a
00:08:44 --> 00:08:45 specialist in TMJ,
00:08:46 --> 00:08:49 but what it led me to was to
00:08:49 --> 00:08:50 say, again,
00:08:50 --> 00:08:52 that was an opportunity as a just out
00:08:52 --> 00:08:55 of residency clinician to gain a little
00:08:55 --> 00:09:00 bit more of a stepping stone in that
00:09:01 --> 00:09:01 medical system.
00:09:02 --> 00:09:04 And so I took it on and went
00:09:04 --> 00:09:04 and did
00:09:05 --> 00:09:08 the year-long course series of TMJ through
00:09:08 --> 00:09:09 University of St.
00:09:09 --> 00:09:09 Augustine,
00:09:10 --> 00:09:12 which was my first experience in
00:09:14 --> 00:09:16 continuing education that dove so deep.
00:09:17 --> 00:09:21 It was three full weekends of a very
00:09:21 --> 00:09:23 niche, very small.
00:09:23 --> 00:09:25 Inch wide but ten miles deep.
00:09:25 --> 00:09:25 Yes.
00:09:28 --> 00:09:30 Completed those courses.
00:09:30 --> 00:09:32 The reason I also say not a specialist
00:09:32 --> 00:09:33 is I never actually took any of the
00:09:34 --> 00:09:34 final exams.
00:09:36 --> 00:09:37 I will own up to that one.
00:09:37 --> 00:09:38 I got the content and then...
00:09:39 --> 00:09:40 Everything but the test.
00:09:41 --> 00:09:42 Everything but the test, took it and left.
00:09:46 --> 00:09:46 Classic.
00:09:48 --> 00:09:51 And so got a chance then to help
00:09:51 --> 00:09:55 redesign and teach some of the TMJ classes
00:09:55 --> 00:09:55 that
00:09:56 --> 00:09:57 Kaiser Permanente was running,
00:09:58 --> 00:09:59 and then work with some of the other
00:09:59 --> 00:10:03 sort of TMJ specialists within Kaiser to
00:10:03 --> 00:10:07 just have some amount of a TMJ caseload.
00:10:07 --> 00:10:08 And for us, it still was pretty low.
00:10:09 --> 00:10:11 It was probably, you know,
00:10:11 --> 00:10:14 three to five patients a week tops that
00:10:14 --> 00:10:15 we were seeing,
00:10:15 --> 00:10:17 but it was much more than I'd seen
00:10:17 --> 00:10:18 before any of that.
00:10:20 --> 00:10:21 What about stepping in that role taught
00:10:21 --> 00:10:23 you confidence?
00:10:23 --> 00:10:24 Or did it give you confidence?
00:10:24 --> 00:10:25 I don't want to assume.
00:10:26 --> 00:10:27 Skill development, embracing uncertainty.
00:10:29 --> 00:10:30 With what I get to do for a
00:10:30 --> 00:10:32 job, one minute I am confident,
00:10:32 --> 00:10:33 maybe overconfident,
00:10:33 --> 00:10:35 and then ten minutes later I am wildly,
00:10:35 --> 00:10:38 wildly nervous about what is about to
00:10:38 --> 00:10:38 happen next.
00:10:38 --> 00:10:40 I'm assuming, hopefully,
00:10:40 --> 00:10:42 that I'm not alone, right?
00:10:42 --> 00:10:43 That happens a lot,
00:10:43 --> 00:10:44 even with someone with a lot of training.
00:10:45 --> 00:10:48 Yeah, I think anything new, right?
00:10:48 --> 00:10:50 We've got this like huge world that's
00:10:51 --> 00:10:54 available and we know a little bit about
00:10:54 --> 00:10:56 something and decide, hey,
00:10:56 --> 00:10:57 I'll learn a little bit more.
00:10:57 --> 00:10:58 And I think what it does or what
00:10:58 --> 00:10:59 it did for me in this instance was
00:11:00 --> 00:11:02 it sort of brought up the floor, right?
00:11:02 --> 00:11:04 So TMJ is this wildly complex tool
00:11:06 --> 00:11:08 sort of umbrella diagnoses that has so
00:11:08 --> 00:11:10 many comorbidities and so many different
00:11:10 --> 00:11:12 mechanisms that are involved in it.
00:11:12 --> 00:11:15 And so it made the like very standard
00:11:15 --> 00:11:18 TMJ care easy.
00:11:18 --> 00:11:19 Okay,
00:11:19 --> 00:11:22 I can do all of the simple stuff
00:11:22 --> 00:11:24 well and correctly and get my patients on
00:11:24 --> 00:11:25 the right path.
00:11:25 --> 00:11:27 And so for a good chunk of TMJ
00:11:27 --> 00:11:28 patients,
00:11:28 --> 00:11:29 we know that sort of takes care of
00:11:29 --> 00:11:29 it.
00:11:29 --> 00:11:32 It's education and sort of some of the
00:11:32 --> 00:11:33 basics and it can,
00:11:34 --> 00:11:36 it can really create a better scenario for
00:11:36 --> 00:11:39 them and then what it did was help
00:11:39 --> 00:11:43 me identify okay where do i put my
00:11:43 --> 00:11:46 more complex cases how do i think about
00:11:46 --> 00:11:48 what might more be going on
00:11:49 --> 00:11:50 that isn't just those basics.
00:11:50 --> 00:11:51 And so it sort of,
00:11:51 --> 00:11:52 it gave me that,
00:11:52 --> 00:11:54 to use our PT catchphrases,
00:11:54 --> 00:11:57 it gave me the toolbox to identify better
00:11:57 --> 00:11:59 what was going on with those more complex
00:11:59 --> 00:11:59 cases.
00:11:59 --> 00:12:01 New business idea, by the way,
00:12:01 --> 00:12:03 I'm going to produce my own actual
00:12:03 --> 00:12:04 toolboxes
00:12:05 --> 00:12:06 And then what you'll do is you'll prompt
00:12:07 --> 00:12:09 people to buy new grads a toolbox as
00:12:09 --> 00:12:09 a gift.
00:12:10 --> 00:12:11 And that'll be my only business model.
00:12:11 --> 00:12:14 I will sell the actual literal toolbox.
00:12:14 --> 00:12:16 Let's talk about the case that we alluded
00:12:16 --> 00:12:18 to in the intro.
00:12:18 --> 00:12:19 Where's this?
00:12:19 --> 00:12:20 Where's the start?
00:12:20 --> 00:12:22 Is this who is like paint the picture
00:12:22 --> 00:12:22 for the audience?
00:12:22 --> 00:12:23 Who this?
00:12:23 --> 00:12:24 Let's do the W's.
00:12:24 --> 00:12:25 Who are they?
00:12:25 --> 00:12:26 What happened?
00:12:27 --> 00:12:28 How were you brought in?
00:12:28 --> 00:12:29 What'd you do next?
00:12:30 --> 00:12:30 Yeah,
00:12:30 --> 00:12:32 this was also a little bit of a
00:12:32 --> 00:12:32 winding path.
00:12:33 --> 00:12:36 And I will say part of what made
00:12:36 --> 00:12:36 this case
00:12:38 --> 00:12:39 easier to write up.
00:12:39 --> 00:12:44 And obviously that's easier is still not
00:12:44 --> 00:12:46 alluding to the fact that I'm less than
00:12:46 --> 00:12:47 halfway done writing it up.
00:12:47 --> 00:12:47 Simple, not easy.
00:12:48 --> 00:12:49 Simple, not easy.
00:12:49 --> 00:12:49 Yes.
00:12:50 --> 00:12:53 Was that it wasn't a typical TMJ case.
00:12:54 --> 00:12:55 Which is what makes it so amazing and
00:12:55 --> 00:12:56 why people want to learn.
00:12:56 --> 00:12:57 You want to learn about the edges,
00:12:57 --> 00:12:59 the normal stuff we've sort of have in
00:12:59 --> 00:12:59 the bag.
00:12:59 --> 00:13:00 It's in the toolbox already.
00:13:00 --> 00:13:02 Yeah, sort of.
00:13:02 --> 00:13:06 But most folks who encounter this TMJ
00:13:06 --> 00:13:07 replacement
00:13:07 --> 00:13:12 It's juvenile rheumatoid arthritis or sort
00:13:12 --> 00:13:14 of a joint preservation procedure.
00:13:14 --> 00:13:17 So they've already been through the gamut
00:13:17 --> 00:13:18 and things aren't going well.
00:13:19 --> 00:13:20 And so they're going to replace the joint.
00:13:20 --> 00:13:22 And I think that's very typical to most
00:13:22 --> 00:13:23 joints in our body, right?
00:13:23 --> 00:13:24 We're not going to replace them until
00:13:24 --> 00:13:26 we've sort of run out of our conservative
00:13:26 --> 00:13:26 care.
00:13:27 --> 00:13:29 And then I on purpose did no research
00:13:29 --> 00:13:29 about this.
00:13:30 --> 00:13:32 Well, not none, but a little bit,
00:13:32 --> 00:13:33 but I on purpose don't go too deep
00:13:33 --> 00:13:34 because I'm going to have an expert.
00:13:35 --> 00:13:36 So paint the picture of what this
00:13:36 --> 00:13:38 replacement, if a PT is like, Hey man,
00:13:38 --> 00:13:38 I'm,
00:13:38 --> 00:13:40 I'm doing more knees and hips and ankles.
00:13:41 --> 00:13:42 What's she talking about with the TMJ
00:13:42 --> 00:13:43 replacement?
00:13:44 --> 00:13:46 What's that look like in general?
00:13:46 --> 00:13:47 And what's that look like in this
00:13:47 --> 00:13:48 particular story?
00:13:48 --> 00:13:49 Yeah.
00:13:49 --> 00:13:51 So in general, it's the same,
00:13:52 --> 00:13:53 and this is where I'll sort of use
00:13:53 --> 00:13:53 the,
00:13:53 --> 00:13:57 the comparison to most joint replacements,
00:13:57 --> 00:13:57 right?
00:13:58 --> 00:14:00 So whenever we're thinking about a knee or
00:14:00 --> 00:14:02 a hip or any of those things,
00:14:02 --> 00:14:04 what we're thinking about is the articular
00:14:04 --> 00:14:06 surfaces have broken down.
00:14:06 --> 00:14:09 And so you have a proximal and a
00:14:09 --> 00:14:10 distal end of that joint,
00:14:10 --> 00:14:12 and you're gonna excise the proximal end
00:14:13 --> 00:14:14 and replace it with a component,
00:14:14 --> 00:14:16 and you're gonna excise the distal
00:14:16 --> 00:14:16 component,
00:14:17 --> 00:14:18 and you're gonna replace it with an
00:14:18 --> 00:14:19 artificial component,
00:14:20 --> 00:14:22 and then they will articulate together as
00:14:22 --> 00:14:23 the new joint, right?
00:14:23 --> 00:14:24 Well, yeah, when you say it,
00:14:24 --> 00:14:24 it sounds easy, but...
00:14:26 --> 00:14:28 But it's exactly the same thing.
00:14:28 --> 00:14:30 And so in that TMJ, right,
00:14:30 --> 00:14:31 you have an articular fossa,
00:14:31 --> 00:14:33 and you have the mandibular condyle,
00:14:33 --> 00:14:36 and they articulate together in the native
00:14:36 --> 00:14:37 joint.
00:14:38 --> 00:14:40 It's both a roll and a glide that
00:14:40 --> 00:14:42 happens within that joint.
00:14:42 --> 00:14:45 Once they install it, it's just a ramp.
00:14:45 --> 00:14:47 And so it simply has,
00:14:47 --> 00:14:49 they replace that condyle with a ramp,
00:14:49 --> 00:14:51 or the fossa with a ramp and the
00:14:51 --> 00:14:52 condyle,
00:14:53 --> 00:14:55 again with kind of a mini condyle,
00:14:55 --> 00:14:57 but it simply articulates in one
00:14:57 --> 00:14:57 direction.
00:14:57 --> 00:14:58 It just glides.
00:14:58 --> 00:15:00 So it loses a little bit of the
00:15:00 --> 00:15:03 joint mechanics and it becomes
00:15:03 --> 00:15:04 unidirectional.
00:15:05 --> 00:15:08 So the other complex piece to our native
00:15:08 --> 00:15:10 joint is if we're looking at it head
00:15:10 --> 00:15:12 on, it also rotates so that we can,
00:15:13 --> 00:15:13 we can,
00:15:14 --> 00:15:17 you do lateral movement in our jaw so
00:15:17 --> 00:15:18 we can go left and right.
00:15:19 --> 00:15:21 And that happens at the joint as well.
00:15:22 --> 00:15:23 In the new replacement joint,
00:15:24 --> 00:15:25 it just glides.
00:15:25 --> 00:15:28 All you get is an inferior glide.
00:15:28 --> 00:15:29 You don't get any more of that lateral
00:15:29 --> 00:15:30 movement.
00:15:31 --> 00:15:34 And so it restricts the motion slightly.
00:15:35 --> 00:15:37 It takes away those degrees of freedom a
00:15:37 --> 00:15:38 little bit.
00:15:38 --> 00:15:40 But you replace a joint that's broken
00:15:40 --> 00:15:40 down.
00:15:41 --> 00:15:43 And so you have this brand new surface
00:15:45 --> 00:15:47 that is able to move without those
00:15:47 --> 00:15:49 inhibitions that the native joint had.
00:15:49 --> 00:15:49 All right.
00:15:49 --> 00:15:51 So now we understand sort of the AMP
00:15:51 --> 00:15:52 a little bit enough.
00:15:53 --> 00:15:54 Yeah.
00:15:54 --> 00:15:55 I'm not sure if I did a great
00:15:55 --> 00:15:56 job explaining that.
00:15:56 --> 00:15:57 You were doing roll and glide.
00:15:57 --> 00:15:58 Trust me.
00:15:58 --> 00:15:58 Five stars.
00:15:58 --> 00:15:59 No notes.
00:15:59 --> 00:16:00 If people are watching the video to this
00:16:00 --> 00:16:01 podcast,
00:16:01 --> 00:16:03 you can see some great articulation with
00:16:03 --> 00:16:04 that.
00:16:05 --> 00:16:07 But when you encountered this particular
00:16:07 --> 00:16:08 replacement.
00:16:08 --> 00:16:08 Yeah.
00:16:09 --> 00:16:11 You found, am I right?
00:16:11 --> 00:16:12 Like you kind of found almost nothing
00:16:12 --> 00:16:14 about what happens next.
00:16:15 --> 00:16:16 What do we,
00:16:16 --> 00:16:17 so we got to the replacement.
00:16:17 --> 00:16:19 We know how to do that.
00:16:19 --> 00:16:20 We just described in general,
00:16:20 --> 00:16:22 in big picture terms, what that replay,
00:16:22 --> 00:16:25 why we do it, what happens during it,
00:16:25 --> 00:16:25 what happens after it.
00:16:26 --> 00:16:26 Yeah.
00:16:27 --> 00:16:28 But then where's the playbook?
00:16:28 --> 00:16:29 I guess you found,
00:16:30 --> 00:16:31 what'd you find when you looked and how
00:16:31 --> 00:16:33 do we bring this person back to function?
00:16:33 --> 00:16:33 Also,
00:16:33 --> 00:16:35 what did like paint the picture for me
00:16:35 --> 00:16:35 briefly,
00:16:36 --> 00:16:38 what deficits look like when we're not
00:16:38 --> 00:16:40 rolling and gliding, we're just gliding.
00:16:40 --> 00:16:41 So paint the picture of what this person
00:16:41 --> 00:16:42 looks like afterwards.
00:16:43 --> 00:16:43 What'd you find?
00:16:44 --> 00:16:45 And when, if you didn't find anything,
00:16:45 --> 00:16:45 what'd you do about it?
00:16:46 --> 00:16:46 Yeah.
00:16:47 --> 00:16:48 So when I went, uh,
00:16:48 --> 00:16:49 obviously the first place to go,
00:16:49 --> 00:16:51 especially when you're a fellow in
00:16:51 --> 00:16:51 training,
00:16:51 --> 00:16:53 but also when you encounter something you
00:16:53 --> 00:16:54 don't know is, um,
00:16:55 --> 00:16:55 What have other people done?
00:16:57 --> 00:17:00 And so what I found was this kind
00:17:00 --> 00:17:02 of wealth of research on outcomes.
00:17:02 --> 00:17:03 So, you know,
00:17:03 --> 00:17:04 these joint replacements have been
00:17:04 --> 00:17:06 happening and they've been happening for
00:17:06 --> 00:17:09 years enough that, you know, Stryker,
00:17:09 --> 00:17:12 who's one of the companies that develops
00:17:12 --> 00:17:13 artificial joint replacements,
00:17:13 --> 00:17:16 they have a specific three D printed
00:17:16 --> 00:17:17 patient specific
00:17:18 --> 00:17:20 joint that they'll three d print for each
00:17:20 --> 00:17:22 patient right it's common enough that
00:17:22 --> 00:17:24 they've developed a system around it sure
00:17:24 --> 00:17:28 um and so i found research on outcomes
00:17:28 --> 00:17:30 which is great for the surgeons right
00:17:30 --> 00:17:32 because that is their the question they
00:17:32 --> 00:17:34 have to answer is that's their stat that's
00:17:34 --> 00:17:36 their kpi what are the outcomes right and
00:17:36 --> 00:17:38 basically all of the outcomes were six
00:17:38 --> 00:17:41 month and one year follow-ups and the
00:17:41 --> 00:17:44 outcomes are great improved quality of
00:17:44 --> 00:17:45 life decreased pain
00:17:46 --> 00:17:49 near normal range of motion and opening at
00:17:49 --> 00:17:49 a year,
00:17:50 --> 00:17:52 but nothing about how they got there.
00:17:52 --> 00:17:54 Ah, the missing piece, the path.
00:17:54 --> 00:17:54 Yeah.
00:17:55 --> 00:17:56 And even talking to the surgeon,
00:17:56 --> 00:17:58 which I was lucky enough because it was
00:17:58 --> 00:17:59 a family member to be at all of
00:17:59 --> 00:18:01 the pre-op and post-op appointments,
00:18:03 --> 00:18:05 he was first hesitant about PT in general
00:18:06 --> 00:18:07 because there's not a lot of PTs that
00:18:07 --> 00:18:10 see it and treat it and didn't really
00:18:10 --> 00:18:12 know what was being done in PT.
00:18:12 --> 00:18:16 And so his only guidelines were no force
00:18:16 --> 00:18:18 on the upper palate because it had been
00:18:18 --> 00:18:19 obviously broken and there was a surgical
00:18:19 --> 00:18:20 plate.
00:18:20 --> 00:18:23 and no lateral movement whatsoever,
00:18:23 --> 00:18:24 because obviously the joint doesn't allow
00:18:25 --> 00:18:25 that.
00:18:26 --> 00:18:29 And so I found one case study that
00:18:29 --> 00:18:30 basically was like,
00:18:30 --> 00:18:32 PT is going to be so important.
00:18:32 --> 00:18:33 There's this thing called the therabyte,
00:18:34 --> 00:18:34 use it.
00:18:34 --> 00:18:36 I was like, okay.
00:18:36 --> 00:18:37 So I looked up the therabyte.
00:18:37 --> 00:18:39 What is the therabyte?
00:18:39 --> 00:18:40 It's like a
00:18:42 --> 00:18:45 imagine like a car jack,
00:18:45 --> 00:18:46 but for your jaw.
00:18:47 --> 00:18:50 Like you crank it and it opens.
00:18:50 --> 00:18:52 And so the idea is that this patient
00:18:52 --> 00:18:53 is using,
00:18:53 --> 00:18:55 and it's used in TMJ treatment pretty
00:18:55 --> 00:18:56 frequently actually when there's an
00:18:56 --> 00:18:57 opening restriction,
00:18:58 --> 00:19:00 but that's the best sort of way I
00:19:00 --> 00:19:01 can describe it.
00:19:01 --> 00:19:03 And so it's got a lever and you
00:19:03 --> 00:19:04 put it in between your teeth and you
00:19:04 --> 00:19:05 crank it and it'll hold it open.
00:19:05 --> 00:19:07 And so you can get a passive stretch
00:19:07 --> 00:19:08 very easily.
00:19:09 --> 00:19:10 On a daily basis,
00:19:10 --> 00:19:12 frequency is important when we're working
00:19:12 --> 00:19:13 with joint motion.
00:19:13 --> 00:19:13 And so,
00:19:14 --> 00:19:16 but that was the only indication was use
00:19:16 --> 00:19:18 the therabyte, work on range of motion,
00:19:19 --> 00:19:21 period, end of sentence.
00:19:21 --> 00:19:21 That was it.
00:19:23 --> 00:19:24 And so what it led us to do
00:19:24 --> 00:19:27 was, again, I had this three sixty view,
00:19:27 --> 00:19:27 which was wonderful.
00:19:27 --> 00:19:29 And so we could talk to a nutritionist
00:19:30 --> 00:19:31 because until twelve weeks,
00:19:31 --> 00:19:33 the patient isn't allowed to have any
00:19:33 --> 00:19:34 solid foods,
00:19:34 --> 00:19:35 no pressure on the upper palate.
00:19:36 --> 00:19:37 And so we were working at a nutrition
00:19:37 --> 00:19:38 deficit.
00:19:39 --> 00:19:41 But then also to say, OK,
00:19:41 --> 00:19:45 if this was a knee total joint
00:19:45 --> 00:19:45 replacement,
00:19:46 --> 00:19:49 We have both healing timeframes that we go
00:19:49 --> 00:19:50 across.
00:19:50 --> 00:19:53 Are those remarkably different in the jaw
00:19:54 --> 00:19:56 than the knee or the hip or anything
00:19:56 --> 00:19:56 else?
00:19:57 --> 00:19:57 No, they're not, right?
00:19:57 --> 00:19:59 So we have our tissue healing timeframes.
00:20:00 --> 00:20:04 We have our sort of must need early
00:20:04 --> 00:20:04 movement, right?
00:20:04 --> 00:20:05 We replaced a joint.
00:20:05 --> 00:20:07 We need to get that joint moving as
00:20:07 --> 00:20:08 quickly as we can.
00:20:09 --> 00:20:11 Does that still coincide with this joint?
00:20:11 --> 00:20:12 Yes, it does.
00:20:12 --> 00:20:12 Let's do that.
00:20:13 --> 00:20:15 And then beyond that,
00:20:15 --> 00:20:17 what are we preparing for?
00:20:17 --> 00:20:19 What are the milestones that we're trying
00:20:19 --> 00:20:23 to look for in a total joint replacement?
00:20:24 --> 00:20:27 First, let's get the quad active.
00:20:27 --> 00:20:29 Let's get them off their assistive
00:20:29 --> 00:20:30 devices.
00:20:30 --> 00:20:32 Let's get them walking normally.
00:20:32 --> 00:20:34 Then let's sort of expand on that.
00:20:35 --> 00:20:37 And so taking that same viewpoint for this
00:20:37 --> 00:20:39 patient, we were able to say, okay,
00:20:39 --> 00:20:40 our first is we need to get that
00:20:41 --> 00:20:41 early motion.
00:20:41 --> 00:20:42 How do we do that?
00:20:43 --> 00:20:45 with internal and external.
00:20:45 --> 00:20:48 And we chose to go with tongue depressors
00:20:48 --> 00:20:50 rather than a therabyte because we had
00:20:50 --> 00:20:53 them readily accessible in the clinic and
00:20:53 --> 00:20:54 you stack one more on top and you
00:20:54 --> 00:20:55 can measure it.
00:20:55 --> 00:20:57 And yeah, you don't use what you need.
00:20:57 --> 00:20:58 You use what you have.
00:20:58 --> 00:21:00 It was easy and it was free.
00:21:00 --> 00:21:02 So we went with that.
00:21:03 --> 00:21:05 And then as we were progressing towards,
00:21:06 --> 00:21:06 okay,
00:21:06 --> 00:21:08 we need muscular endurance because at
00:21:08 --> 00:21:09 twelve weeks,
00:21:10 --> 00:21:11 the patient's going to need to be able
00:21:11 --> 00:21:12 to chew and tolerate that.
00:21:13 --> 00:21:15 So how do we load the joint in
00:21:15 --> 00:21:17 different directions to be able to start
00:21:17 --> 00:21:18 to simulate that?
00:21:19 --> 00:21:22 And then as our like really big umbrella,
00:21:22 --> 00:21:25 any patient that has TMJ complications,
00:21:25 --> 00:21:27 there's regional interdependence.
00:21:27 --> 00:21:30 And so we need to address posture and
00:21:31 --> 00:21:34 upper cervical spine and the neck and all
00:21:34 --> 00:21:36 of our postural muscles and how this
00:21:36 --> 00:21:36 patient is
00:21:37 --> 00:21:39 moving about their day and going about
00:21:39 --> 00:21:39 that.
00:21:40 --> 00:21:42 We were able to just apply all of
00:21:42 --> 00:21:46 those same major concepts to this surgery
00:21:48 --> 00:21:49 and have a pretty good outcome.
00:21:49 --> 00:21:51 It's the next best thing.
00:21:51 --> 00:21:52 I mean, everything that you just said,
00:21:52 --> 00:21:53 I don't know if you noticed it for
00:21:53 --> 00:21:54 the last like two,
00:21:54 --> 00:21:55 three minutes when you're describing that
00:21:55 --> 00:21:57 you were talking about load range of
00:21:57 --> 00:21:58 motion and muscular endurance,
00:21:58 --> 00:22:01 where I think myself included, um,
00:22:01 --> 00:22:02 when I heard TMJ,
00:22:02 --> 00:22:04 I would look around for who I was
00:22:04 --> 00:22:05 going to pass the hot potato to.
00:22:06 --> 00:22:06 Um,
00:22:07 --> 00:22:09 but you're talking in terms that PTs use
00:22:09 --> 00:22:11 every single day and how we think.
00:22:11 --> 00:22:12 And one of the first things you said
00:22:12 --> 00:22:14 was, I believe it was your mentor said,
00:22:14 --> 00:22:15 this is a joint.
00:22:15 --> 00:22:17 It acts like any other joint.
00:22:17 --> 00:22:17 Yeah.
00:22:18 --> 00:22:18 but for some reason,
00:22:19 --> 00:22:19 and I can see it,
00:22:19 --> 00:22:21 why we might approach this or be hesitant
00:22:21 --> 00:22:22 to approach this.
00:22:23 --> 00:22:26 Since there wasn't a clear definitive CPG,
00:22:26 --> 00:22:27 it wasn't a path, right?
00:22:27 --> 00:22:29 You sort of built it while you were
00:22:29 --> 00:22:30 walking in.
00:22:30 --> 00:22:34 Were there any frameworks that you maybe
00:22:35 --> 00:22:36 stole bits from?
00:22:36 --> 00:22:38 Picasso said, good artists borrow,
00:22:38 --> 00:22:38 great artists steal.
00:22:39 --> 00:22:40 So were there things that you were sort
00:22:40 --> 00:22:41 of grabbing the best of,
00:22:41 --> 00:22:42 almost like a MacGyver?
00:22:43 --> 00:22:44 Yeah.
00:22:44 --> 00:22:45 So in general,
00:22:45 --> 00:22:49 we took a couple of different and I'll
00:22:49 --> 00:22:51 say Jake Bleacher, who is at Ohio State,
00:22:51 --> 00:22:54 was my main primary mentor working with
00:22:54 --> 00:22:55 the patient because they were also a
00:22:55 --> 00:22:56 family member.
00:22:56 --> 00:22:58 He was our primary treating PT and I
00:22:58 --> 00:23:01 was present at sessions and doing the
00:23:01 --> 00:23:01 home.
00:23:01 --> 00:23:03 PT by proxy.
00:23:03 --> 00:23:04 PT by proxy.
00:23:04 --> 00:23:04 Yes.
00:23:05 --> 00:23:07 And doing the accessory sessions at home,
00:23:07 --> 00:23:09 which was nice to have.
00:23:09 --> 00:23:10 But it's good to have a PT in
00:23:10 --> 00:23:11 the family, you know.
00:23:13 --> 00:23:14 You know,
00:23:14 --> 00:23:15 that's the Thanksgiving dinner topic.
00:23:15 --> 00:23:16 Correct.
00:23:16 --> 00:23:17 Oh, my knee hurts.
00:23:17 --> 00:23:19 My neck is feeling a little wonky.
00:23:19 --> 00:23:20 You're like, that's great.
00:23:20 --> 00:23:25 Pass the gravy.
00:23:25 --> 00:23:27 We took a look at frameworks in general,
00:23:28 --> 00:23:28 right?
00:23:28 --> 00:23:29 Again, saying this is a joint.
00:23:29 --> 00:23:32 What is the CPG?
00:23:32 --> 00:23:34 I was at Ohio State at the time.
00:23:34 --> 00:23:37 So what are our Ohio State guidelines for
00:23:37 --> 00:23:38 total joint replacements?
00:23:40 --> 00:23:42 And looking at those components helped
00:23:42 --> 00:23:45 give us that initial framework of how do
00:23:45 --> 00:23:47 we want to approach this and what do
00:23:47 --> 00:23:47 we need?
00:23:48 --> 00:23:50 What are the guidelines that we'd normally
00:23:50 --> 00:23:52 be looking for and how can we apply
00:23:52 --> 00:23:52 that to this case?
00:23:54 --> 00:23:55 The secondary piece were the surgical
00:23:55 --> 00:23:56 restrictions.
00:23:56 --> 00:23:58 So we did have the restrictions of,
00:23:59 --> 00:24:00 you know, listen to your surgeon always,
00:24:00 --> 00:24:02 the surgeon's right with kind of what
00:24:02 --> 00:24:03 they're looking for.
00:24:05 --> 00:24:07 And so we had no pressure on the
00:24:07 --> 00:24:07 upper palate,
00:24:08 --> 00:24:10 which meant that all of our distraction
00:24:10 --> 00:24:13 had to be only with pressure on the
00:24:13 --> 00:24:13 lower jaw,
00:24:13 --> 00:24:15 which is typically how we treat TMJ
00:24:15 --> 00:24:15 anyway.
00:24:17 --> 00:24:19 The guidance of no lateral movement.
00:24:19 --> 00:24:21 And then we also had the restriction of
00:24:21 --> 00:24:22 no dry needling.
00:24:22 --> 00:24:23 until three months.
00:24:23 --> 00:24:25 The surgeon wanted to be really clear of
00:24:25 --> 00:24:26 any infection.
00:24:26 --> 00:24:28 And so using those two things were sort
00:24:28 --> 00:24:31 of our bigger picture framework.
00:24:32 --> 00:24:33 But then we also dove into,
00:24:33 --> 00:24:40 there's a two article series that was done
00:24:40 --> 00:24:44 by, let's see, I have names.
00:24:44 --> 00:24:44 Okay.
00:24:48 --> 00:24:49 Stephen Schaefer,
00:24:49 --> 00:24:51 John Michael Brismee and Carol Courtney in
00:24:51 --> 00:24:52 twenty fourteen.
00:24:52 --> 00:24:54 And that was one of the first papers
00:24:54 --> 00:24:55 that really was like,
00:24:55 --> 00:24:57 let's break this down for the PT.
00:24:57 --> 00:25:00 How how do we conservatively treat the
00:25:00 --> 00:25:01 TMJ?
00:25:02 --> 00:25:04 And then there's a million articles that
00:25:04 --> 00:25:06 go back with Roccobato and de las Peñas.
00:25:06 --> 00:25:07 Right.
00:25:07 --> 00:25:08 And sort of these more.
00:25:09 --> 00:25:12 contemporary TMJ physical therapy,
00:25:12 --> 00:25:14 really specialists and specialist
00:25:14 --> 00:25:15 researchers.
00:25:15 --> 00:25:16 And to say,
00:25:16 --> 00:25:18 if it was a conservative issue,
00:25:19 --> 00:25:21 how would we treat the muscles?
00:25:21 --> 00:25:23 How would we treat the joint restriction?
00:25:23 --> 00:25:25 And how would we treat the spine and
00:25:25 --> 00:25:26 the accessory to that?
00:25:27 --> 00:25:29 And so basically just combining it is a
00:25:29 --> 00:25:29 post-op.
00:25:30 --> 00:25:32 How would we take those conservative
00:25:32 --> 00:25:34 measures and those post-op milestones and
00:25:34 --> 00:25:37 guidelines and meld them so that we can
00:25:37 --> 00:25:38 make sure that
00:25:38 --> 00:25:42 we are engaging everything that we need to
00:25:42 --> 00:25:44 to give the best potential outcome.
00:25:45 --> 00:25:46 All right.
00:25:46 --> 00:25:47 So if we're making a movie out of
00:25:47 --> 00:25:48 this,
00:25:49 --> 00:25:50 we understand the problem where this
00:25:51 --> 00:25:51 started.
00:25:52 --> 00:25:52 And what was the initial injury?
00:25:53 --> 00:25:53 Did we skip that?
00:25:53 --> 00:25:55 What was the initial... We did skip it.
00:25:55 --> 00:25:57 So again,
00:25:57 --> 00:25:59 this was a little bit avant-garde in sort
00:25:59 --> 00:26:00 of how we got here.
00:26:01 --> 00:26:04 Instead of an actual TMJ injury,
00:26:04 --> 00:26:06 this was actually an airway preservation
00:26:06 --> 00:26:06 procedure.
00:26:06 --> 00:26:07 So...
00:26:08 --> 00:26:10 The family's got a history of sleep apnea
00:26:10 --> 00:26:13 and cardiovascular disease that comes with
00:26:13 --> 00:26:13 that.
00:26:14 --> 00:26:16 And so this family member was able to
00:26:16 --> 00:26:16 say,
00:26:16 --> 00:26:20 based on kind of sleep apnea testing and
00:26:20 --> 00:26:23 joint facial proportions,
00:26:23 --> 00:26:25 that they were already in a sleep apnea
00:26:25 --> 00:26:27 phase at a young age and that that
00:26:27 --> 00:26:30 would lead to- How old?
00:26:30 --> 00:26:31 Thirty-three.
00:26:31 --> 00:26:31 Okay.
00:26:31 --> 00:26:31 Yeah.
00:26:31 --> 00:26:33 So younger than I assumed when you were
00:26:33 --> 00:26:34 painting this picture.
00:26:34 --> 00:26:35 So that's a bad podcast host.
00:26:35 --> 00:26:37 I should have brought that up earlier.
00:26:37 --> 00:26:38 That's right.
00:26:38 --> 00:26:38 Yeah.
00:26:38 --> 00:26:40 And so this is sort of where we
00:26:40 --> 00:26:41 we ended up with a patient who had
00:26:41 --> 00:26:43 no TMJ complications to begin with,
00:26:44 --> 00:26:47 which led to, in my opinion,
00:26:47 --> 00:26:49 a much more clear cut recovery.
00:26:50 --> 00:26:53 Because there weren't that there wasn't
00:26:53 --> 00:26:56 that list of I've already gone through all
00:26:56 --> 00:26:56 of this.
00:26:57 --> 00:26:57 Instead,
00:26:57 --> 00:27:01 what we got was from an airway that
00:27:01 --> 00:27:01 was
00:27:02 --> 00:27:05 nine cubic centimeters of volume to twenty
00:27:05 --> 00:27:06 cubic centimeters of volume.
00:27:07 --> 00:27:10 That was the intent for surgery.
00:27:10 --> 00:27:13 But the same surgery is done for those
00:27:13 --> 00:27:14 joint preservation procedures.
00:27:15 --> 00:27:17 And so the other benefit for this is
00:27:17 --> 00:27:19 we had kind of a clear cut case
00:27:20 --> 00:27:21 quotes there, certainly.
00:27:21 --> 00:27:21 Right.
00:27:23 --> 00:27:26 And so in talking with other research or
00:27:26 --> 00:27:27 with other clinicians right now who have
00:27:27 --> 00:27:29 more complex cases,
00:27:29 --> 00:27:30 we have a little bit of groundwork.
00:27:32 --> 00:27:34 that we were able to develop on something
00:27:34 --> 00:27:35 that wasn't complicated.
00:27:36 --> 00:27:38 And so that path now is what are
00:27:38 --> 00:27:41 those complications with the more complex
00:27:41 --> 00:27:43 cases and how do we make this a
00:27:43 --> 00:27:44 deeper,
00:27:44 --> 00:27:48 more extensive journey towards a CPG or
00:27:48 --> 00:27:50 something like that with those patients
00:27:50 --> 00:27:53 that have a more typical sort of
00:27:53 --> 00:27:54 presentation.
00:27:55 --> 00:27:56 We need the moment then, Katie,
00:27:57 --> 00:27:58 if this is a movie and that's what
00:27:58 --> 00:28:00 a case report should be.
00:28:00 --> 00:28:00 It should be a snapshot.
00:28:01 --> 00:28:02 Everybody's on bated breath.
00:28:03 --> 00:28:04 How'd this turn out?
00:28:04 --> 00:28:05 Great.
00:28:05 --> 00:28:08 So we were able to, from, again,
00:28:09 --> 00:28:12 the main improvement was that airway
00:28:12 --> 00:28:13 preservation,
00:28:13 --> 00:28:13 so a
00:28:15 --> 00:28:17 to and change fold increase in airway,
00:28:17 --> 00:28:19 but opening over forty millimeters,
00:28:20 --> 00:28:22 no restriction in food, no pain,
00:28:22 --> 00:28:23 a return to full activity.
00:28:23 --> 00:28:26 So weightlifting, lots of aerobics.
00:28:26 --> 00:28:28 The patient can sleep on their back now,
00:28:29 --> 00:28:30 which is impossible before,
00:28:30 --> 00:28:32 impossible before because they stop
00:28:32 --> 00:28:35 breathing and just full return.
00:28:35 --> 00:28:36 The biggest hurdle.
00:28:36 --> 00:28:37 So we're
00:28:38 --> 00:28:39 it was August of last year.
00:28:39 --> 00:28:41 So we're a year and a half out
00:28:42 --> 00:28:44 a little over, um, has been salad.
00:28:44 --> 00:28:44 Okay.
00:28:44 --> 00:28:47 I don't understand.
00:28:47 --> 00:28:50 So you lose some of that lateral movement
00:28:50 --> 00:28:50 with the joint.
00:28:51 --> 00:28:54 And so chomping salad straight up and down
00:28:54 --> 00:28:55 has been a little bit more of a
00:28:55 --> 00:28:59 difficult, um, eating experience.
00:28:59 --> 00:28:59 Um,
00:29:01 --> 00:29:02 Who do you go to?
00:29:02 --> 00:29:04 You go to your speech pathologist and say,
00:29:04 --> 00:29:05 hey, how do we fix this?
00:29:06 --> 00:29:08 This is great interprofessional
00:29:08 --> 00:29:09 collaboration.
00:29:09 --> 00:29:09 Yeah.
00:29:09 --> 00:29:11 So we had an incredible set of
00:29:11 --> 00:29:13 myofunctional exercises for tongue
00:29:13 --> 00:29:14 dexterity,
00:29:14 --> 00:29:17 for stretching the muscles as they were
00:29:17 --> 00:29:17 recovering.
00:29:17 --> 00:29:20 I know some of these as a professional
00:29:20 --> 00:29:20 podcast host.
00:29:20 --> 00:29:22 I do need to increase my tongue dexterity.
00:29:22 --> 00:29:27 Honestly, we think as PTs,
00:29:27 --> 00:29:28 we have fun toys.
00:29:29 --> 00:29:30 I want to spend a little bit more
00:29:30 --> 00:29:32 time with SLPs,
00:29:32 --> 00:29:35 like very fun toys that we can- I
00:29:35 --> 00:29:36 call them cousins.
00:29:37 --> 00:29:40 PT, OT, speech, athletic trainers,
00:29:40 --> 00:29:42 chiropractors, right?
00:29:42 --> 00:29:44 We're all sort of in the same mess.
00:29:44 --> 00:29:46 I had a chance to work as a
00:29:46 --> 00:29:47 pediatric physical therapist in a clinic
00:29:48 --> 00:29:50 that was more OTs than PTs.
00:29:50 --> 00:29:51 And I sat back-
00:29:52 --> 00:29:56 And they were behavior magicians like it.
00:29:56 --> 00:29:57 I was like,
00:29:57 --> 00:29:58 I have no idea what you just did.
00:29:58 --> 00:30:00 I watched it in plain sight.
00:30:00 --> 00:30:01 I saw the trick.
00:30:01 --> 00:30:03 I'm still baffled how you did it.
00:30:03 --> 00:30:05 So this is a great example of bringing
00:30:05 --> 00:30:07 in our SLP friends that could make some
00:30:07 --> 00:30:08 amazing results together.
00:30:08 --> 00:30:09 Yeah.
00:30:09 --> 00:30:09 Yeah.
00:30:09 --> 00:30:10 It was really neat.
00:30:10 --> 00:30:11 There was a lot of,
00:30:11 --> 00:30:13 we had our one complication that we had
00:30:13 --> 00:30:14 was sort of a middle ground.
00:30:15 --> 00:30:17 We were getting really great range
00:30:17 --> 00:30:17 improvement.
00:30:18 --> 00:30:20 It was kind of just before in that
00:30:20 --> 00:30:21 sort of eight to twelve weeks.
00:30:22 --> 00:30:24 But one of the typical complications,
00:30:24 --> 00:30:26 which was written up in all of the
00:30:26 --> 00:30:27 results papers as well,
00:30:27 --> 00:30:31 that seems to resolve is a facial palsy.
00:30:31 --> 00:30:33 Because when you go to replace the joint,
00:30:33 --> 00:30:34 you're going right next to the facial
00:30:34 --> 00:30:37 nerve that's right in front of that
00:30:37 --> 00:30:38 temporomandibular joint.
00:30:39 --> 00:30:41 And so there was some facial droop,
00:30:41 --> 00:30:43 which meant if you can only have liquid
00:30:43 --> 00:30:46 foods or soft foods and you're slurping
00:30:46 --> 00:30:48 and it's coming out of that side of
00:30:48 --> 00:30:49 your mouth, right,
00:30:49 --> 00:30:50 you're losing your nutrition.
00:30:50 --> 00:30:50 Um,
00:30:52 --> 00:30:54 and so that was really uncomfortable and
00:30:54 --> 00:30:58 it's annoying and all the real drooling
00:30:58 --> 00:30:59 rule.
00:30:59 --> 00:31:01 Um, and so, yeah,
00:31:01 --> 00:31:03 a really wonderful set of exercises to
00:31:03 --> 00:31:06 help, um, sort of regain that facial.
00:31:07 --> 00:31:09 tone to be able to control those muscles
00:31:09 --> 00:31:11 in a way that was really incredible.
00:31:11 --> 00:31:12 All right.
00:31:12 --> 00:31:14 Well, now we need a question for you.
00:31:15 --> 00:31:18 You were both clinician and family member.
00:31:19 --> 00:31:19 Of course,
00:31:19 --> 00:31:21 you kept your professional objectivity,
00:31:21 --> 00:31:22 but you're still invested.
00:31:23 --> 00:31:25 How'd that dual role change the way you
00:31:25 --> 00:31:28 thought about pain, healing,
00:31:28 --> 00:31:29 communication, drooling,
00:31:30 --> 00:31:32 the emotional side of this?
00:31:32 --> 00:31:32 Yeah.
00:31:34 --> 00:31:34 Tell you what,
00:31:34 --> 00:31:37 living with someone who is having trouble
00:31:37 --> 00:31:38 getting enough nutrition,
00:31:39 --> 00:31:40 like hangry to a new level.
00:31:41 --> 00:31:42 And I say that with great love in
00:31:42 --> 00:31:43 my heart.
00:31:43 --> 00:31:46 But that was a component.
00:31:47 --> 00:31:47 You know,
00:31:47 --> 00:31:49 I've I've thought about that nutritional
00:31:49 --> 00:31:50 component before when we're talking.
00:31:50 --> 00:31:53 I don't think I would have.
00:31:53 --> 00:31:55 But it like it really was.
00:31:55 --> 00:31:56 It made a difference.
00:31:56 --> 00:31:57 Right.
00:31:57 --> 00:31:59 Pain was was worse.
00:31:59 --> 00:32:01 compliance with exercises was worse.
00:32:02 --> 00:32:03 You know,
00:32:03 --> 00:32:07 all of this sort of wove around this
00:32:08 --> 00:32:11 continual, just like hunger, right?
00:32:11 --> 00:32:13 Like always hungry.
00:32:14 --> 00:32:15 And I don't think that I would have
00:32:15 --> 00:32:17 put those things together.
00:32:17 --> 00:32:19 I think I, you know,
00:32:19 --> 00:32:20 we did the pain neuroscience education,
00:32:21 --> 00:32:22 which is important with any of this.
00:32:23 --> 00:32:24 We did the,
00:32:25 --> 00:32:26 frequency education,
00:32:26 --> 00:32:29 we did all of the normal kind of
00:32:29 --> 00:32:30 PT line of things,
00:32:30 --> 00:32:32 but seeing it from that other side and
00:32:32 --> 00:32:34 recognizing it was coming from a different
00:32:34 --> 00:32:36 place was also,
00:32:37 --> 00:32:38 I don't think I would have asked those
00:32:38 --> 00:32:39 questions in the same way.
00:32:41 --> 00:32:41 Yeah.
00:32:41 --> 00:32:44 Asking those extra layer of questions of
00:32:44 --> 00:32:47 like, how, how is it going for you?
00:32:47 --> 00:32:49 And we, we sometimes ask that,
00:32:49 --> 00:32:50 but maybe not as open-ended.
00:32:51 --> 00:32:53 And so with something like that, right?
00:32:53 --> 00:32:53 Like,
00:32:54 --> 00:32:55 How are you actually feeling?
00:32:55 --> 00:32:57 Like, yes, you've got a little pain.
00:32:57 --> 00:32:58 Great, let's talk about that.
00:32:58 --> 00:33:01 Yes, things are coming along,
00:33:01 --> 00:33:04 but what are your biggest struggles right
00:33:04 --> 00:33:04 now?
00:33:04 --> 00:33:06 And for this patient, it was, I'm hungry.
00:33:06 --> 00:33:08 And that's making everything miserable.
00:33:10 --> 00:33:10 I am.
00:33:10 --> 00:33:11 And this is going to sound like a
00:33:11 --> 00:33:12 crazy aside,
00:33:12 --> 00:33:14 but maybe for some of the audience who
00:33:14 --> 00:33:16 knows I was a radio broadcaster and I
00:33:16 --> 00:33:17 was actually interviewing someone,
00:33:17 --> 00:33:20 a rock star who had some substance abuse
00:33:20 --> 00:33:20 issues.
00:33:21 --> 00:33:23 And it wasn't the first question I asked.
00:33:23 --> 00:33:25 It was probably six or seven in.
00:33:25 --> 00:33:26 But I asked.
00:33:27 --> 00:33:27 How are you doing?
00:33:28 --> 00:33:29 And I left it super open-ended.
00:33:30 --> 00:33:30 This was public.
00:33:30 --> 00:33:32 This was very, very public knowledge.
00:33:32 --> 00:33:35 And the entire tone of the conversation
00:33:35 --> 00:33:35 changed.
00:33:36 --> 00:33:38 And we got to something that I opened
00:33:38 --> 00:33:42 the door for, for the musician who wanted,
00:33:42 --> 00:33:42 he didn't have to walk through.
00:33:42 --> 00:33:43 He could have said, I'm doing great.
00:33:44 --> 00:33:45 We went down that road.
00:33:45 --> 00:33:47 I think I warmed him up enough.
00:33:48 --> 00:33:48 to do that,
00:33:48 --> 00:33:52 but that's not in your EMR.
00:33:52 --> 00:33:54 That's not a thing to ask.
00:33:54 --> 00:33:56 But I think the reason I'm telling both,
00:33:56 --> 00:33:57 you were telling both these stories is
00:33:57 --> 00:33:58 it's a thing to ask.
00:33:58 --> 00:34:00 And you're getting great information.
00:34:01 --> 00:34:02 That was one that was,
00:34:03 --> 00:34:05 we had already sort of consulted the
00:34:05 --> 00:34:05 nutritionist,
00:34:05 --> 00:34:07 but it took a whole different tone.
00:34:07 --> 00:34:08 Totally different tone.
00:34:08 --> 00:34:09 How can we
00:34:10 --> 00:34:13 you're having to drink all day,
00:34:13 --> 00:34:14 basically nutrition,
00:34:14 --> 00:34:15 how can we supplement that?
00:34:15 --> 00:34:17 And some of it was protein powder,
00:34:17 --> 00:34:18 but some of it was,
00:34:19 --> 00:34:22 there are really nutrient rich foods that
00:34:22 --> 00:34:23 you can blend pretty easily.
00:34:24 --> 00:34:24 And the patient-
00:34:25 --> 00:34:26 Yeah, it was like, you know,
00:34:26 --> 00:34:28 we weren't going to blend pizza or
00:34:28 --> 00:34:28 anything like that.
00:34:29 --> 00:34:31 But Indian food ended up being one of
00:34:31 --> 00:34:33 the main things because lots of chickpeas,
00:34:33 --> 00:34:36 lots of paneer, lots of tofu,
00:34:36 --> 00:34:38 Thai food as well.
00:34:39 --> 00:34:41 And those were things that the patient
00:34:41 --> 00:34:42 felt comfortable blending up,
00:34:42 --> 00:34:44 but all of a sudden had a wealth
00:34:44 --> 00:34:47 more nutrition than a fruit smoothie with
00:34:47 --> 00:34:48 protein powder in it.
00:34:48 --> 00:34:51 I did not have Thai food on my
00:34:51 --> 00:34:53 bingo card of things we would talk about
00:34:53 --> 00:34:54 in this episode,
00:34:54 --> 00:34:57 but it makes logical sense.
00:34:57 --> 00:35:00 So two more questions for Katie.
00:35:00 --> 00:35:04 What's one mindset shift clinicians need
00:35:04 --> 00:35:07 when facing a condition like TMJ
00:35:07 --> 00:35:08 replacement or just something where the
00:35:08 --> 00:35:11 research really is thin and the playbook
00:35:11 --> 00:35:12 doesn't exist yet?
00:35:12 --> 00:35:13 What would you say to them?
00:35:17 --> 00:35:20 I think where I went and the advice
00:35:20 --> 00:35:21 that I got and the advice that I've
00:35:21 --> 00:35:23 gotten from many mentors in the past is
00:35:25 --> 00:35:28 identify sort of your primary issue.
00:35:29 --> 00:35:30 What is it that you're treating?
00:35:30 --> 00:35:31 How did you get here?
00:35:32 --> 00:35:33 Get your baseline of what it is.
00:35:34 --> 00:35:35 Look for what does exist.
00:35:37 --> 00:35:38 Researchers have come before us and
00:35:38 --> 00:35:40 they've done a wonderful job to outline
00:35:40 --> 00:35:40 those things.
00:35:42 --> 00:35:43 especially when it's sparse,
00:35:43 --> 00:35:46 a case report or not necessarily looking,
00:35:46 --> 00:35:48 it doesn't have to be a systematic review
00:35:48 --> 00:35:49 always.
00:35:50 --> 00:35:51 I got a chance to work with Todd
00:35:51 --> 00:35:56 Davenport writing up some case studies in
00:35:56 --> 00:35:58 the Kaiser residency and his perspective
00:35:58 --> 00:36:01 was every case can be a case study.
00:36:01 --> 00:36:01 It's
00:36:02 --> 00:36:04 the viewpoint of what you did and how
00:36:04 --> 00:36:07 you did it that's impactful and so when
00:36:07 --> 00:36:08 there's a sparsity of research sometimes
00:36:08 --> 00:36:11 those case studies can give you at least
00:36:11 --> 00:36:14 a leg up of how someone thought about
00:36:14 --> 00:36:18 an idea but beyond that using the things
00:36:18 --> 00:36:20 that we already know we are
00:36:20 --> 00:36:22 musculoskeletal experts right on
00:36:22 --> 00:36:25 graduation and only increasingly so as we
00:36:25 --> 00:36:28 have career and hopefully advanced
00:36:28 --> 00:36:29 mentorship
00:36:29 --> 00:36:30 A big plug for that.
00:36:31 --> 00:36:33 But using the things that we know and
00:36:33 --> 00:36:36 breaking things down to the simplest
00:36:36 --> 00:36:39 blocks and then making sure that we're
00:36:39 --> 00:36:41 engaging our patient in those things so
00:36:41 --> 00:36:42 that we have our sort of research centric,
00:36:43 --> 00:36:45 our clinical decision making hat and then
00:36:45 --> 00:36:46 our patient and putting those things
00:36:46 --> 00:36:48 together to have the best outcome for the
00:36:48 --> 00:36:49 patient.
00:36:49 --> 00:36:49 Right.
00:36:49 --> 00:36:51 Which may not always be our best outcome,
00:36:52 --> 00:36:54 but combining those things in that way.
00:36:54 --> 00:36:54 All right,
00:36:54 --> 00:36:55 so that was a sort of an open,
00:36:55 --> 00:36:56 wide open question.
00:36:57 --> 00:36:58 The last question we'll ask here,
00:36:58 --> 00:37:00 we'll make it very specific to this
00:37:00 --> 00:37:01 episode in this case.
00:37:02 --> 00:37:03 What's only one thing,
00:37:03 --> 00:37:05 what's one thing you hope every clinician
00:37:05 --> 00:37:09 does differently the next time a TMJ
00:37:09 --> 00:37:12 patient walks into their clinic?
00:37:12 --> 00:37:14 What's a thing that you hope every
00:37:14 --> 00:37:16 clinician hearing this does?
00:37:16 --> 00:37:19 Yeah, I guess a couple of fold.
00:37:19 --> 00:37:21 First, I hope they take that patient,
00:37:21 --> 00:37:21 right?
00:37:21 --> 00:37:22 Don't pass it off.
00:37:23 --> 00:37:24 Take the patient.
00:37:25 --> 00:37:29 and give a baseline at least in our
00:37:29 --> 00:37:31 own clinical experience of having treated
00:37:31 --> 00:37:35 that patient or being the point on that
00:37:35 --> 00:37:37 patient, right?
00:37:37 --> 00:37:38 The second would be involve other
00:37:39 --> 00:37:39 clinicians.
00:37:40 --> 00:37:42 The reason we love working in clinics with
00:37:42 --> 00:37:44 other people, right, or at least I do,
00:37:45 --> 00:37:48 is that there are other people there who
00:37:48 --> 00:37:50 have seen things and treated things
00:37:50 --> 00:37:51 differently or that approach problems in
00:37:51 --> 00:37:52 different ways.
00:37:53 --> 00:37:55 And so using the knowledge of others is
00:37:55 --> 00:37:57 absolutely one of the strengths of our
00:37:57 --> 00:37:58 professions.
00:37:59 --> 00:38:01 And then the third would be to say,
00:38:01 --> 00:38:02 you know,
00:38:02 --> 00:38:05 there are these great breakdowns.
00:38:05 --> 00:38:06 There's a couple of those articles from
00:38:09 --> 00:38:12 that go through and start the breakdown of
00:38:13 --> 00:38:17 here is what muscle, what joint,
00:38:17 --> 00:38:18 and what disc looks like in those
00:38:18 --> 00:38:19 patients.
00:38:19 --> 00:38:22 And here's how we can at least baseline
00:38:22 --> 00:38:22 treat them.
00:38:23 --> 00:38:24 Those things exist.
00:38:24 --> 00:38:26 I don't think we see them as often
00:38:26 --> 00:38:28 as we see ACL and the rest of
00:38:28 --> 00:38:29 that in the literature.
00:38:30 --> 00:38:32 they are there as at least your like
00:38:33 --> 00:38:34 initial blueprint printed out,
00:38:35 --> 00:38:36 read it right before you see that patient
00:38:37 --> 00:38:39 and then come in with a little bit
00:38:39 --> 00:38:40 of a toolbox and then an area to
00:38:40 --> 00:38:41 grow.
00:38:41 --> 00:38:42 Perfect.
00:38:43 --> 00:38:44 Katie, before we started recording,
00:38:44 --> 00:38:45 we said we hope we made this a
00:38:45 --> 00:38:46 conversation.
00:38:46 --> 00:38:47 We hope it was useful.
00:38:47 --> 00:38:49 The audience decides if it was useful.
00:38:50 --> 00:38:51 How did we do on conversation, though?
00:38:52 --> 00:38:53 I think pretty good.
00:38:54 --> 00:38:55 Yeah,
00:38:55 --> 00:38:57 I've definitely enjoyed sort of nerding
00:38:57 --> 00:38:59 out a little bit on this.
00:38:59 --> 00:39:00 Obviously, it's something I dove into.
00:39:00 --> 00:39:03 So I appreciate the open-ended and direct
00:39:04 --> 00:39:04 questions.
00:39:04 --> 00:39:04 Good.
00:39:05 --> 00:39:05 Well,
00:39:05 --> 00:39:07 that's the idea is PT is super narrow
00:39:07 --> 00:39:09 and then all these little nerddoms that
00:39:09 --> 00:39:10 exist in those.
00:39:10 --> 00:39:12 And I think now in twenty twenty five,
00:39:12 --> 00:39:12 twenty twenty six,
00:39:13 --> 00:39:15 I don't think nerd is the term.
00:39:15 --> 00:39:17 I don't think it has the sting of
00:39:17 --> 00:39:17 what it used to.
00:39:18 --> 00:39:19 Now it's like people embrace the nerddom.
00:39:20 --> 00:39:22 And I think especially in our profession,
00:39:23 --> 00:39:25 we all benefit from that.
00:39:25 --> 00:39:27 And when you can get these like minded
00:39:27 --> 00:39:29 or opposite minded people together and
00:39:29 --> 00:39:30 learn from each other,
00:39:31 --> 00:39:32 an episode like this might not make sense
00:39:32 --> 00:39:34 for someone who typically only sees knees
00:39:34 --> 00:39:35 and hips,
00:39:35 --> 00:39:39 except it does in case or the mindset
00:39:39 --> 00:39:41 shift of the things that Katie did or
00:39:41 --> 00:39:41 learned.
00:39:42 --> 00:39:44 You had a lot of different things that
00:39:44 --> 00:39:46 aren't necessarily standard in this
00:39:46 --> 00:39:47 particular situation.
00:39:47 --> 00:39:49 So on behalf of AMS, thanks for sharing.
00:39:50 --> 00:39:52 yeah thanks for having me i'm glad to
00:39:53 --> 00:39:55 again the hope with this really is just
00:39:55 --> 00:39:58 to start a conversation because these
00:39:58 --> 00:39:59 surgeries are out there people are
00:39:59 --> 00:40:01 treating them i'm working with a few
00:40:01 --> 00:40:03 clinicians right now and we're it's the
00:40:03 --> 00:40:06 first real wonderful discourse that i've
00:40:06 --> 00:40:07 been able to have in a way like
00:40:07 --> 00:40:09 this so hopefully it just builds so that
00:40:10 --> 00:40:13 when it does come across you or me
00:40:13 --> 00:40:16 again that there's there's something
00:40:16 --> 00:40:18 that conversation has been started and we
00:40:18 --> 00:40:19 can go from there.
00:40:19 --> 00:40:20 And if people feel stuck,
00:40:20 --> 00:40:21 what they'll do is they'll go,
00:40:21 --> 00:40:22 I heard this on a podcast.
00:40:22 --> 00:40:23 Let me find that episode.
00:40:23 --> 00:40:24 I'll send it to you.
00:40:24 --> 00:40:27 And now Katie's the resource.
00:40:27 --> 00:40:28 Yeah.
00:40:28 --> 00:40:29 Uh, Katie, thanks for your time.
00:40:29 --> 00:40:30 We appreciate it.
00:40:30 --> 00:40:31 Thanks for coming on this podcast.
00:40:32 --> 00:40:32 Yeah, I appreciate it.
00:40:32 --> 00:40:33 Thanks so much.