EP156: "3 Things To Consider Before Recommending Surgery For Athletes"

[00:00:00] Are you a motivated healthcare or fitness professional? Are you looking to work with more athletes,

[00:00:09] become a sports specialist or even get a job in a sports setting so you can finally enjoy

[00:00:13] the career that you've always dreamed of if so, you're in the right place.

[00:00:17] My name is Chris Garcia, physical therapist, business owner, entrepreneur and residency

[00:00:21] training sports specialist. I've been fortunate to work in professional sports in travel

[00:00:25] around the world working with elite athletes throughout my career and I've learned a lot

[00:00:29] of lessons along the way. I created this podcast to share my experiences and give you everything

[00:00:34] you need to know to help you become a sports expert. Welcome to the Sports PT Academy.

[00:00:45] If you want to know three things to consider before recommending surgery for athletes,

[00:00:49] you need to tune into this episode. Welcome all new listeners and welcome back to those who

[00:00:54] have heard my content in the past. I'm excited to talk about surgery

[00:00:58] and what you can recommend for your athletes. But before I do that, what is happening in life?

[00:01:04] What is new? What's the positive focus? What's happening? For those who have been long-term

[00:01:09] podcast listeners, it has been a whirlwind. You know, everything from my last episode where

[00:01:15] I mentioned, you know, my clinic, one of my clinics flooded. I recently just had a one of my

[00:01:21] teeth like I had a crown on my one of my teeth and it cracked so I am navigating that.

[00:01:27] I've had challenging, you know, patient cases. I am like including new services inside my clinic.

[00:01:34] I have a new course that's being created. There is a ton of stuff and it makes me so happy

[00:01:41] because I flourish inside the chaos. My kids are fantastic. My son, Zach, you know, he said

[00:01:48] something to me the other day. He said, Chris, dad, dad, I want to, I want to start a business

[00:01:55] and I was like, excuse me. He's like, yeah, dad, you know, I want to be like, you know, I was like,

[00:02:01] you know, son, you know, that you don't have to start a business to be like dad. You know,

[00:02:05] I really just want you to really enjoy what you do and I really had to reflect on that. You know,

[00:02:10] when I talk to when I mentor all my physical therapists and mentor individuals and private practice

[00:02:16] owners, I realize, you know, the goal is to be happy. And when I see my son and I really don't

[00:02:25] want him to follow my footsteps if that's not what he's enjoying. And to me, that was amazing

[00:02:30] to just hear his feedback and like he just wants to be like his dad and that's such an amazing,

[00:02:36] amazing feeling for those who are parents on this and you listen to this. It's like one of the

[00:02:40] most rewarding things on the planet because you live and breathe through being an example. And

[00:02:47] when you see that happening in life, it's a little teary-eyed moment, you know. So he's great.

[00:02:55] So Zach also started across this week which is fun to watch. I've never played for those

[00:02:59] cross players out there. That's a tough sport. My daughter is doing fantastic, doubling up on

[00:03:05] gymnastics and my son Jacob is trying to be like a siblings and just keep up with them. So

[00:03:11] all's good in this world. A bunch of chaos. Family is fantastic. Let's move on to this episode.

[00:03:17] So let me tell you why I'm talking about this today. I have between my my tooth

[00:03:24] cracking to mentoring PT on my team about a condition and surgery considerations

[00:03:33] to another mentor session with somebody I work with in New Jersey. All of these cases came together

[00:03:40] and they were about surgery and it's about these three considerations. I'm going to share with

[00:03:45] you. So if you've struggled to work with athletes or patients and you're like man, they really need

[00:03:50] surgery award. Is this the right recommendation? This episode is going to help you outline

[00:03:55] three things to consider anytime that you recommend something to an athlete and you're saying the

[00:04:00] word surgery. You need to use these three considerations that will help you feel confident about

[00:04:04] that and offload the responsibility off of your shoulder and onto the patient so they can make

[00:04:09] the best decision for yourself and take that pressure off of you. So if you're a PT and you find

[00:04:14] yourself in these situations, this episode is absolutely perfect for you. All right. Let's talk

[00:04:19] about them a couple of the different cases. So we had a case with a patient who has some hand

[00:04:28] issues and if you ever worked with let's say a spinal cord injury. Let's say a higher level spinal

[00:04:39] cord injury and they use kind of active insufficiency to help them with certain things.

[00:04:46] And for instance, say somebody has a condition where they can extend their wrist. They don't

[00:04:52] they can't use their extensors but they have their flexors and so when you have somebody who

[00:04:57] can use flexors, when they're in a shortened position, when their wrists are flexed or whatever it is

[00:05:03] they can grip. But the minute they put themselves into extension, their flexors just passively turn

[00:05:09] into finger flexion. Now this individual during this case had an injury or had some deformities where

[00:05:17] they're having now contractures with their finger flexors. And the consideration that surgeons

[00:05:24] have made is what if we have a tendon flexor tendon release, right? So this person has flexor

[00:05:31] tendon contractures and they want to release those. Now the consideration that we discuss and I

[00:05:39] simply ask you know, well how much extension do they have actively and it turns out that they don't

[00:05:46] have any whatsoever. Now they have extension at the break or really alas, like the meat of it

[00:05:52] but they don't have any finger extension. Also they have some other deformities, swan neck,

[00:05:57] formulas, all these other things but it came down to... All right this person's a high surgical candidate,

[00:06:06] they're having significant impairments in their life, they've been to three or four different

[00:06:11] surgeons to consider is this the right thing to do for me. And you know it's a big tough question as

[00:06:17] a provider, as a physical therapist, put yourself in a position where you're like well gosh they

[00:06:22] look for your input. Now they're going to Google, they're going to spend their time with family

[00:06:25] members are going to be asking friends are going to be doing these but your opinion weighs heavily

[00:06:29] and that puts a lot of pressure on you and so you have to kind of put this in the context. All right

[00:06:33] so how do I give this person the best case scenario? And I'm going to outline three things but I wanted

[00:06:37] to share the story. So one of the first things we considered was okay if they don't have the surgery

[00:06:44] what happens, right? So now they have finger flexion contracture they can't actively move the wrist

[00:06:50] now that is like that has to deal with feeding that has to do with quality of life opening doors

[00:06:56] opening jars and they lose their independence, they lose their mobility and that's just one aspect

[00:07:02] okay so their quality of life is impaired to an a certain extent but now if we do a flexor 10 release

[00:07:09] what happens with the flexor 10 in? So if we release the flexors so they no longer have as much

[00:07:14] active flexion. Now they're floating with less flexion now if they don't have extension

[00:07:21] near muscle control or strength what happens at hand it's kind of floppy and you don't have muscle

[00:07:26] flexors now to flex it and you don't have extensors to extend it so now it's just kind of floating

[00:07:31] in there. Now this is a unique scenario but like what would you do on this? I mean if this was your

[00:07:37] aunt, your uncle, your grandma, your grandparent what do you do on this? Basically it came down to

[00:07:41] what's the quality of life that you want? Do you want to struggle now or do you want the potential

[00:07:46] risk of I don't even know if this is going to work and as you can imagine surgeons have a high

[00:07:50] pressure at this point what do you do with this? That was one case number two was my tooth all right so

[00:07:57] my tooth I had a crown placed I don't know 15 years ago 10 years ago on one of my molars one of my

[00:08:05] teeth and I was eating pizza the other night with my kids and I took a bite and I heard a crack

[00:08:13] and I looked at the crust I was like there's no way this crust is that crispy. I was really like

[00:08:18] consider I didn't even know what was happening I couldn't I couldn't process it so I bit down

[00:08:25] and I felt a crunch. I was like that's weird I bit another one and I just heard more crumbling

[00:08:30] I'm like oh my gosh so I threw out the pizza and I find my tooth my crown had just basically just

[00:08:39] disassembled crumbled under pressure and so I took it out and I didn't know what the next step was

[00:08:46] so it was Friday night I called dentist everyone's clothes on Saturday so I basically didn't eat with

[00:08:51] my right side I only ate with my left so and I started like now my left muscular like cheek

[00:08:57] is now sore because I'm eating all with my left so on Monday I call a dentist I'm like hey you

[00:09:03] know I need some I need to input what do I do here? One dentist said hey you have to remove your

[00:09:08] entire tooth you have to extract it completely and then we're going to backfill with all these

[00:09:13] other things I was like well that sounds like a very invasive surgery. What do I do with this?

[00:09:18] and then I call another another dentist to say hey what do you have? Like hey these are the

[00:09:24] options we actually don't have to extract your tooth we can do something else as that sounds like

[00:09:29] a better option and both of these the case of the complex hand and my personal tooth case maybe

[00:09:36] realize and maybe think about all the other surgical candidates that I've helped before in the past

[00:09:42] basically got me understanding there's fundamental foundational questions or ways you can

[00:09:48] approach these things so that way you can appreciate how to work with people and take that pressure

[00:09:53] off of you. I want to share that after years of doing these conversations with patients and being

[00:09:58] able to help people I wanted to share what that foundation is and how I approach that and how you

[00:10:04] can do it inside your care to be able to do this. So here they are. Number one what you're going

[00:10:13] to consider is what is the goal with this procedure or surgery? Is it function or pain? There's

[00:10:21] two different things and now we compartmentalize them into one thing but the reality is this is a

[00:10:30] scenario where you have to determine are you looking for pain relief or are you looking for

[00:10:33] functional improvement because in the hand scenario pain is not the consideration it's a functional

[00:10:39] challenge and in my case with my tooth it's a functional challenge for some people it's pain

[00:10:44] management and now we have to ask yourself and work through in an algorithm is how much pain do

[00:10:49] you expect to be alleviated with this procedure? That's the question for the surgeon and then

[00:10:56] you have to qualify that patient and say how much is old enough for you to consider doing the

[00:11:02] surgery if they say hey it's going to be 50% improvement in back pain neck pain shoulder pain

[00:11:06] is that enough for you to qualify that and most people don't think like that that's not something

[00:11:10] new process they hope this is going to remove their pain completely and I think that's a very fair

[00:11:15] question you have to ask and have with them. It might not take away 100% pain and you got to be okay

[00:11:21] with that because there's going to be scar tissue there's going to be other things that we don't

[00:11:25] consider and that discussion has to come up now if they're looking for functional pain or the functional

[00:11:30] improvements what's the amount of functional improvement you're looking for what's the degree

[00:11:35] and what's enough because then that allows that patient to really have the expectations expectations

[00:11:41] for surgery is life it is everything the more someone is expecting something and they're more

[00:11:49] okay with if it doesn't go right or if it goes wrong and I'll tell you the questions I asked my

[00:11:55] dentist to be able to do this but it's the question I will ask on the front end what is it that you

[00:12:01] expect what degree of pain improvement or what degree of functional improvement are okay and would

[00:12:06] you consider where's the threshold where you wouldn't and for some people they might back out of

[00:12:12] that surgery and all you've done is prevented a potential or delayed the potential inevitable now

[00:12:17] that's okay but what's your role your roles provide people with support and feedback so they can

[00:12:22] make a better decision for yourself so number one ask what's the degree of pain or functional

[00:12:27] improvement that you would expect or want the next one you have to ask is what's the five-year

[00:12:34] outcome that you want now or expect now you might say you know I want pain relief all these other

[00:12:42] things what's the five-year prognosis because now that might change something or if they're like oh

[00:12:50] it's just gonna last you a year some patients might be like oh then why don't whatever my other

[00:12:57] options it asks if forces that patient and you to ask bigger better deeper questions to allow

[00:13:03] somebody be more successful and make a better decision for themselves so in the case of my tooth

[00:13:08] the short term is if I do one procedure that does basically a cap to put it on top and salvage it

[00:13:16] that lasts me about 10-15 years that's my prognosis before that the mechanics or the physics won't

[00:13:22] allow it to as a whole anymore now my 30-40-50 year plus prognosis with replacing it digging it

[00:13:29] and completely putting an artificial one in there is that's the best long term prognosis so now I

[00:13:34] have to make a decision on how what is my decision gonna be what type of prognosis do I want

[00:13:39] do I function improvement yes now for how long do you want like a 10 to 15 year or do you want a

[00:13:45] lifetime mmm that is a fantastic question now these are the conversations I had with my

[00:13:51] dentist this morning so those two questions are big they just now you have some tools new toolbox

[00:13:57] okay I'm considering surgery perfect are you looking at for pain relief or functional improvement

[00:14:01] and what degree would be the minimum for you to consider moving forward number two what's the five

[00:14:07] year prognosis that's a good question for the surgeon and what's the 10-15 year prognosis so

[00:14:12] they can make an informed decision and understand oh that's the path I want or I wanted better so

[00:14:18] that's number two and last but not least number three is this is a tough one and I like to ask

[00:14:25] this to all my patients and to all the physical therapists and mentor what would you do if this

[00:14:32] was your family your spouse your wife your husband your friend your family your colleague your uncle

[00:14:38] your aunt what recommendation would you make to them that's a tough question because you

[00:14:44] usually don't treat your patients that way why not it's my question that changes your approach

[00:14:51] because now you're going to take off your type a OCD PT brain who's very analytical and logical

[00:14:59] and scientific and that's fantastic but now you're teaching now you're dealing with somebody's life

[00:15:06] now you might say hey the research says I understand but would you do it and now that changes

[00:15:12] the game because now you add emotion into your decision making your very used to a logical approach

[00:15:17] if they're at 12 weeks this is a stimulus I provide this much progression this over time

[00:15:23] you're gonna go step up step down plios blah blah blah that allows you to move in a very logical

[00:15:28] fashion the difference now is you have emotion tied to it once you have emotion tied to any decision

[00:15:34] it makes it more difficult because you have subjective components to this so it's easy for you

[00:15:39] as a physical therapist to rely on research and be very very analytical however let's take the human

[00:15:45] side of you because I know it exists behind that shell you are an incredible human it's just masked by

[00:15:51] a white coat of a physical therapist who blocks your ability to make good decisions and help people

[00:15:57] genuinely because you're afraid to shut it down you're afraid to make emotional support

[00:16:02] more personal decisions right fully so it got you to this point in your career but when you talk

[00:16:07] about humans and they're now they're about to make a life decision on is this the best decision for me

[00:16:15] you have to have that element you have to have both you can't be too emotional because then you

[00:16:20] have no logic you can't be too logical because you're a robot you have to have a little bit of both

[00:16:26] so let me put this in context my dentist was offering me my decisions my options I said what would

[00:16:31] you do if I was your uncle at grandfather and he did the same thing he was like oh

[00:16:41] I said that's fair because this is exactly how it approached a patient and ultimately he said

[00:16:46] Chris I truly believe that the short-term prognosis is probably better for you given your scenario

[00:16:56] and I said you know what I trust you that's all I want to hear I'm doing that because now I take

[00:17:01] the logic side of it here's the structure here's a physics here's what would happen to

[00:17:05] my tooth and then I said you know what would you do if it was your tooth and he had to think about

[00:17:10] that and make that decision and to me those three things help you make the best informed decision

[00:17:17] that's all you can do for your patients you can do all the research in the world then when turned

[00:17:23] around what if it was you what would you do and you'd be like I wouldn't do it then why don't you

[00:17:27] relay that information that allows you your human side come out share it with them and that

[00:17:34] creates relationships and outcomes that will last a lifetime patients are looking for the logical

[00:17:40] side 100% but more than anything else they're scared they're emotional they're not thinking logically

[00:17:46] so you have you who is 100% logical robotic and doesn't want to share your feelings with patients

[00:17:52] and be genuine because that's how medicine is and he has patients who have a huge emotion has

[00:17:58] googled stuff but created more emotion they have a super logical human with a super emotional

[00:18:03] human those don't mesh you kind of have to do both present the five-year prognosis logic present

[00:18:11] functional and pain improvements and what's the middle and they would do that gives them logic

[00:18:16] and now you provide a little bit of emotional support on what would you do if this was yours your

[00:18:21] family everything else those two combined you're now a little bit of emotion with logic and now

[00:18:26] they're high emotion with a little bit of logic that combined helps people make the best decisions

[00:18:31] and you can go home sleeping about it thinking about I made the best decision possible I feel good

[00:18:37] about that and that's the problem that you have as a as a healthcare provider you take things home

[00:18:42] because all the pressures on you why is it on you because you've allowed it to this is the way

[00:18:47] you genuinely offload it into the patient and allow them to make the best decision possible so

[00:18:52] you can sleep good at night and feel good about the decisions you make ultimately we're all trying

[00:18:56] to do the same thing we want them to create amazing outcome in people's lives sometimes we're

[00:19:01] presented with tricky situations like a flexor tendon release that maybe is not ideal maybe it's

[00:19:07] going to help but you go through those three scenarios maybe you run into a friend or somebody who's

[00:19:11] cracked a tooth and they don't know and there's two different options which one would you do you ask

[00:19:16] those three questions functional or pain improvement what's the minimum that you would do ultimately

[00:19:22] what's a five ten year prognosis what would you do and what are those options and number three

[00:19:27] what would you do if this was your friend or your family between those three those are the only

[00:19:31] three things that you really need to consider now you do all your googling your youtube being all

[00:19:35] those things that allow you to make the best decision possible but ultimately you have to be

[00:19:40] you have to be a good human a good healthcare provider and be genuine about that and that allows you

[00:19:45] to sleep better at night and really feel good about the prognosis and everything you're going to do

[00:19:50] and when you see them afterwards you're like do you feel like you made the best decision and they'll

[00:19:54] happily tell you be honest and be like but you knew everything going in you knew the risks and you

[00:19:59] can't be unhappy about that you made that decision it just it allows people to make the best informed

[00:20:06] decision whether that takes them a year or five years it's the number one thing that has helped me

[00:20:11] the most to improve my outcomes believe or not because if i'm seeing somebody pre-op and i've laid

[00:20:16] out this this outline they knew that going in so now their expectations were met or exceeded

[00:20:22] or whatever it is and so now my rehab matches what we delivered and now we know what you know if I

[00:20:28] don't know i'm only going to get 70 percent improvement but we knew that going in now I look like a

[00:20:34] great provider I look like a person who's done my job and that I will always get somebody who's

[00:20:40] like they're going to refer their friends or family their mom the grandmother sister because that's

[00:20:44] all they're looking for think about anybody if you had a crack tooth what would you do you go

[00:20:48] all the resources figure it out but you still come down to shoot what decision do I make and that's

[00:20:55] the human element that's the question that you no one can overcome but you or that patient

[00:21:01] and all you're doing is giving people the tools to make that decision a little easier a little bit

[00:21:06] more effective and it allows them to just ensure that they're in the right place at the right time

[00:21:14] I've probably been presented with thousands of posterical complex cases and this week

[00:21:23] today actually I was put in a position what would you do and so i am going to move with the

[00:21:30] shorter term prognosis on my teeth wish me luck but i feel good about the scenario i feel

[00:21:36] good about my decision based on the scenarios that i've done and it's very healthy to go through

[00:21:41] these scenarios and be the patient on this side so it's been fun and allows me to really see it as a

[00:21:48] provider and as a patient and improve my quality of care so I hope that helps wherever you are in

[00:21:54] your career whether you're new grad or student or a 20 year veteran you've always been perplexed

[00:21:58] with these type of scenarios in your life whether that's your own surgeries your own injuries

[00:22:03] and now you're putting in context just to make that a little simpler so

[00:22:07] I hope your life is as amazing people have been asking me hey Chris what's your next course

[00:22:12] i haven't released yet there's been a lot of things going on

[00:22:17] so for those who are interested in attending i've had two people already sign up

[00:22:20] I released it under the radar apologize but people have been asking so there's a couple of

[00:22:26] upgrades to what we're doing last year i did my accelerator

[00:22:30] and this year i'm actually hosting my strength conditioning summit first there's a lot

[00:22:35] a lot behind that but basically the interest was higher to be able to do my strength conditioning

[00:22:41] summit so if you've never been to my summit before you can go to dr. Chris Garcia

[00:22:47] excuse me dr. Chris Garcia.com-forward-slash-submit

[00:22:51] this is a strength conditioning summit to give you a framework on how to improve your skills

[00:22:57] and confidence with strength conditioning for the first year ever whenever you're listening

[00:23:02] to this this is a February of 2024 whenever you're listening to this this is the first time i'm

[00:23:08] opening it to all health care and fitness professionals so this is going to be a mixture my vision

[00:23:13] and dream is to have education that helps align and get gain a bigger collaboration between athletic

[00:23:22] trainers physical therapists massage therapists chiropractors physicians p.a.s i've worked in professional

[00:23:29] sports so i've seen what that team can do and they can do significant damage and the best way possible

[00:23:34] and i want to bring that to communities i want to being bring a central source of

[00:23:39] education that helps align everyone so strength conditioning is a big one this one helps align

[00:23:44] athletic trainers who have athletes going back to sport maybe you're the physical therapist

[00:23:49] who collaborate with them and they're going back to sport you want to communicate with them

[00:23:52] or you work with personal trainers or strength coaches and you're sending them back to the gym or

[00:23:56] they're in the gym and they're hurt or you're a fitness professional and you want to be able to work

[00:24:00] with more physical therapists or you want to help with you know rehab or prehab inside your programs

[00:24:05] i'm here to align everyone and so i'm including for the first year all health care and fitness

[00:24:10] professionals i've got a little twist that will be released in the near future i'm just

[00:24:15] locking some things down but it'll be in sandy agle there will be a virtual option

[00:24:20] so for those who are attending virtually you have access to the modules afterwards

[00:24:25] this year we're adding force plates and in force plate data to help you understand

[00:24:29] how metrics and force production can help simplify your strength conditioning program how to say

[00:24:35] you i've never done it before but if i just did some testing it'll tell you if somebody's very

[00:24:39] springy and needs strength or somebody is strong but not springy and they need a lot of

[00:24:44] plyometrics so you don't waste your time it'll make it more efficient for you so there's a lot of

[00:24:48] good things inside this strength conditioning summit so if you want to be able to collaborate with

[00:24:51] other providers your fitness professional want more foundation in that you're a health care provider

[00:24:56] want more background than that or you're between the two and you want to just lock it in and improve

[00:25:00] your ability to connect with people or you're just literally looking for more pearls on how to

[00:25:06] improve your strength conditioning this course is perfect for you so i'm excited to see you inside

[00:25:11] the course that'll be May 18th and 19th 2024 Saturday and Sunday in San Diego now if we have

[00:25:19] too many registrants there's two options i might open it up to more virtual or if you really

[00:25:25] twist my arm we will open up to a bigger venue i don't have that planned but i'm already seeing

[00:25:31] with two people registering before we even launched the course it kind of gets me excited it's

[00:25:37] scared so if that's for you i'm excited to see you there it's at drcriscrocia.com forward slash

[00:25:43] summit other than that i will see you guys on the next episode take care thanks for tuning in to

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