EP176: "Don't Focus On Impairments!"

[00:00:05] Are you a motivated healthcare or fitness professional? Are you looking to work with more athletes, become a sports specialist, or even get a job in a sports setting so you can finally enjoy the career that you've always dreamed of? If so, you're in the right place. My name is Chris Garcia, physical therapist, business owner, entrepreneur, and residency training sports specialist. I've been fortunate to work in professional sports and travel around the world working with elite athletes throughout my career, and I've learned a lot of lessons along the way. I created this podcast to share my experiences and give you everything you need to know to help you.

[00:00:35] You've become a sports expert. Welcome to the SportsPT Academy.

[00:00:42] Welcome back to the podcast. I welcome all new listeners and welcome those who have heard my content in the past. I'm excited to talk about impairments and how they are not the holy grail of what to do with athletes. Before I go on to that podcast, let me talk about life. I got some updates for you. I have some gossip with my family. We call it cheese, man. It's the gossip.

[00:01:04] So I've been telling you about my son. He's been doing great. He's allowing me to hug him in front of his friends now. He's eight years old. But the cheese, man, the gossip is my daughter this week. She officially at the age of six told me Chris or dad, excuse me, dad, she has a crush on someone at the age of six in this classroom.

[00:01:28] And so I'm going to release this name. His name is Dylan and boy, Dylan, you got something coming. I'm going to what I know my wife is giving me a hard time because she's like, I think you're overreacting.

[00:01:38] And right off the bat, I'm already thinking like, all right, what do I need to instill with my daughter? What are we doing? You know, what's it? I'm big on checklist.

[00:01:46] So I'm like, now I'm trying to think of like, all right, what do I need to teach my daughter about? Like what boys to avoid or what not to.

[00:01:52] And my wife is obviously saying, Chris, this is, you're taking this way too far, but everybody has me thinking like, what do I want to do?

[00:01:58] What do I need to do to instill the best core values into my daughter? And so she can choose the right partner.

[00:02:04] Obviously the age of six is a little absurd and I totally get that, but it got my brain fiery because I'm here to, you know, help my daughter blossom into an amazing human being.

[00:02:16] And with that, who you surround yourself and who you emotionally connect with is so critical.

[00:02:21] So I'm working on that. I am a little fired up. Boy, Dylan, you watch out.

[00:02:28] My son, Zach, like I said, he's doing great. I love everything that's happening to him.

[00:02:32] My son, Jacob, is spending some time with me at Sports Performance.

[00:02:36] We've just been kind of navigating babysitting and a couple other things, but he's been here in the clinic and getting to connect with everybody on leadership development and leadership meetings

[00:02:45] and being entertained at the same time.

[00:02:47] So life is great. I'm back to working out. Life is fantastic.

[00:02:51] My wife, gosh, what are we talking about right now?

[00:02:54] We're currently working on what vacations we want to do with just the two of us.

[00:03:01] You know, what is the, we have to get some us time.

[00:03:05] I had a lunch meeting with a friend of mine from Boston and we were just talking about personal development, leadership,

[00:03:13] and, you know, we were talking about the super high level theoretical stuff.

[00:03:17] And, you know, we were talking about like, what's more important, like developing your marriage or developing your kids.

[00:03:24] And then we got even deeper where like, actually, it's developing yourself, then your spouse, then your kids, because it all trickles down.

[00:03:30] If you're happy, your spouse is happy. You guys work on each other.

[00:03:32] You guys are happy. Then the kids are happy.

[00:03:33] And so some people really target towards their kids.

[00:03:36] And so as you grow in your own marriage and everything that you do, you put attention to kids because that's natural, right?

[00:03:41] They're instinctual.

[00:03:42] So, you know, I think you redirect your energy and constant refocusing like what is so important,

[00:03:48] especially if you go into 2025, whenever you listen to this,

[00:03:50] this is being recorded in the later stages of December of 2024.

[00:03:54] So we're in that mindset right now.

[00:03:56] What do we need to do?

[00:03:56] So, all right, that's enough about that.

[00:03:59] Let's talk about impairments.

[00:04:00] Why am I bringing up this podcast?

[00:04:02] Well, it comes from an internal dialogue with my own team.

[00:04:05] We look at, you know, what do we do as physical therapists?

[00:04:08] We had a big meeting on, you know, how do we improve outcomes?

[00:04:12] And it came down to like before you start talking about, well, we need more training.

[00:04:16] We need more manual work, need more CU courses, those type of things.

[00:04:18] It really came down to what do we do for people?

[00:04:21] And, you know, if you go by the APTA or any PT school, they're easily going to say,

[00:04:26] well, you improve the way people move, blah, blah, blah.

[00:04:28] Right.

[00:04:29] But in the real sense, and for those who don't know, I have a cash pay model.

[00:04:33] I have three clinics, 15 staff.

[00:04:37] And I'm a big believer in health.

[00:04:39] I don't think that we improve the way people move.

[00:04:40] I think it's a byproduct of the small things that we do.

[00:04:43] And so if you take the model of improve the way you move, impairments are important.

[00:04:46] If you take the model of health and overall longevity in life, impairments are just absolute crap.

[00:04:52] They mean so little on this planet.

[00:04:54] But the problem is, is that if you work in an insurance-based model where insurance dictates what you can and can't do,

[00:05:01] kind of like an authority, you're subjected to their terms, which is you got approved to me.

[00:05:06] So therefore, you have to improve an impairment.

[00:05:08] Then therefore, that impairment dictates or influences a person's pain.

[00:05:11] That pain gets down.

[00:05:12] Insurance reimburses.

[00:05:14] Happy world.

[00:05:15] In a cash pay model, out-of-network model, or even the pro-athlete model.

[00:05:18] Pro-athletes can care less about impairments.

[00:05:20] And this is why I'm talking about this.

[00:05:21] Like, if you love working with athletes, whether it's in-network, out-of-network,

[00:05:25] they really don't care about impairments.

[00:05:27] And they're like, oh my gosh, that's really cool, but I got to play.

[00:05:29] But I want to do this.

[00:05:31] They're thinking about the long-term goal.

[00:05:33] And you're so caught up in the minutia of, well, how do I improve this thing over here?

[00:05:38] And they're trying to play.

[00:05:39] There's this big gap.

[00:05:40] I want to play.

[00:05:41] And you're like, but you have knee valgus.

[00:05:44] And you're like, but how does that correlate to this?

[00:05:47] And impairments, we've been trained through PT school that, think about this,

[00:05:52] all you do is obsess about impairments, right?

[00:05:55] It's insufficient scapular upward rotation and enter humoral glide and all these other things.

[00:06:00] Okay, those are associated with tissue trauma.

[00:06:02] Got that.

[00:06:04] But you really have to understand at a super high level, where does pain come from?

[00:06:09] Let's take an atraumatic individual.

[00:06:11] Because I think we can go, we can do a contact ACL or a motor vehicle accident.

[00:06:17] That's not what I'm talking about here.

[00:06:18] I'm talking about non-traumatic pain.

[00:06:21] How does it happen?

[00:06:22] This is preventable pain.

[00:06:23] Pain is just from undue stress applied across time, right?

[00:06:29] So if I hit my knuckle so hard against the wall, that's going to just hurt, right?

[00:06:34] Just constant stress.

[00:06:36] Now, if you squat with bad form, you're going to hurt your back.

[00:06:40] You do that enough times, and that's when the pain comes through.

[00:06:42] So if we can all be on the same page that pain is caused by repeated stress over time.

[00:06:50] So once you understand that, your goal is, okay, well then we manage stress.

[00:06:55] Because if we help people get out of pain, your job is to alleviate stress.

[00:07:00] Okay, now we're agreeing.

[00:07:01] Okay, where does stress come from?

[00:07:03] Physical stress, not emotional and all those things.

[00:07:06] Those are the underlying things.

[00:07:08] But where does the physical stress come from?

[00:07:10] Well, it could be from knee valgus.

[00:07:12] It could be from them crossing their legs all day.

[00:07:15] It could be from them running too much, too hard, too soon.

[00:07:19] It could be the poor running shoes.

[00:07:21] It could be the hard pavement.

[00:07:22] It could be the surface.

[00:07:23] It could be their strengthening routine.

[00:07:26] I mean, there's so many reasons why somebody develops physical stress applied across time

[00:07:32] that then leads to pain.

[00:07:34] Okay, so the question becomes, out of all of those variables,

[00:07:37] why do we hone in on impairments as the single focus for why pain relief exists?

[00:07:45] Ironically, we can all agree, how does physical stress apply to this person?

[00:07:50] Well, physical stress is the reason why they develop pain.

[00:07:52] So let's take a wider approach on where physical stress comes from.

[00:07:57] So the easy way to break that down is three different categories.

[00:08:00] In their ADLs, in their work habits, and then in their fitness routine.

[00:08:04] Those three things cover most things that people do on their planet and everything else.

[00:08:09] So sleeping.

[00:08:10] Sleeping would cause to be like in their ADL.

[00:08:12] So if they have neck pain from sleeping, that's physical stress across time.

[00:08:16] So then you would then work on a pillow, work on ergonomics.

[00:08:19] But you can't tell me that lack of cervical rotation one direction is the primary reason

[00:08:24] that they develop pain.

[00:08:25] It's a secondary or incidental finding where basically, yeah, you found it,

[00:08:32] but it's probably not the cause.

[00:08:33] It's associated with it.

[00:08:34] But yet you hold everything on an impairment.

[00:08:37] So instead of going impairment based, well, they have an anterior human position.

[00:08:41] I understand that, but they had that for years.

[00:08:44] What was the trigger that made them happen?

[00:08:46] Well, it was anterior positioning with more repetitive stress at work,

[00:08:49] with more repetitive stress in the gym.

[00:08:51] Great.

[00:08:51] So solve those things instead of the superficial incidental finding of the impairment.

[00:08:56] Solve the weight routine.

[00:08:57] Solve the posture.

[00:08:59] Solve the work ergonomics.

[00:09:00] Solve the work.

[00:09:01] Those things all contribute to that.

[00:09:02] The problem is most of you think like, well, that's easy.

[00:09:06] Yeah, but do it with every single patient, every single athlete,

[00:09:09] because if you can take this comprehensive approach to why pain exists,

[00:09:13] you get rid of impairments.

[00:09:14] That's what everyone tries to figure out.

[00:09:17] So if I give you a case study right now on paper and I say, you know, shoulder pain,

[00:09:21] we have a 30-year-old with shoulder pain, crossfitter, anterior shoulder pain

[00:09:25] with no previous history of pain, what is their pain coming from?

[00:09:30] Well, you'd be like, well, let me see their posture.

[00:09:32] Let me see their antihumor.

[00:09:33] No.

[00:09:33] Great.

[00:09:34] What is their weight routine?

[00:09:35] What do they do in the gym?

[00:09:37] What was their training volume before?

[00:09:39] What did they do for work?

[00:09:40] What do they do at home?

[00:09:41] Those are more important than the impairment itself.

[00:09:45] Now, this is mind-blowing for most people.

[00:09:47] You depend on having to see people.

[00:09:49] I need to touch it.

[00:09:50] I need to feel it.

[00:09:50] I need to do anything.

[00:09:51] Why?

[00:09:51] Why?

[00:09:52] It laser focuses you on the wrong thing, on the small minutia of this small repetitive

[00:09:57] stress.

[00:09:58] What about the big repetitive stress?

[00:10:00] What if they were brand new to running and they just went out and did a marathon?

[00:10:04] You really, that knee valgus caused anterior shin pain or anterior knee pain?

[00:10:08] No.

[00:10:08] It was a total stress applied across time.

[00:10:11] So instead of just looking at impairments, now what I'm telling you is here, there's different

[00:10:15] ways that you can apply this.

[00:10:16] But when you're looking at athletes, you can't take this model.

[00:10:18] If you work with orthopedic, inactive, boring patients, great.

[00:10:22] That model works.

[00:10:23] I think that's like the AAA of all.

[00:10:26] That's like if you had AAA, AA, single A, and pro sports, that is a AAA.

[00:10:30] If you work in orthopedic practice, inactive, boring people, you're in like the minors.

[00:10:35] You don't really understand and you don't appreciate how hard and how difficult this can be.

[00:10:40] And your goal is to get there.

[00:10:41] Now, here's where you start.

[00:10:42] Stop looking at impairments and start looking at their training.

[00:10:45] Meaning, what did you do over these last three months?

[00:10:47] This is the time where you say, okay, great.

[00:10:50] Tell me what you do for a living.

[00:10:51] Tell me what you're doing throughout your day.

[00:10:52] Tell me what your weight routine was.

[00:10:54] Perfect.

[00:10:54] Before I look at you, I need to understand that because I can understand your total stress.

[00:10:59] Then I can start to zoom in on your impairments.

[00:11:01] Because if I can just figure this out from with, you know, without even looking at you,

[00:11:05] I've done half my job already.

[00:11:07] Now, the other half is to create the plan.

[00:11:10] But most people rely so heavily on these impairments.

[00:11:13] I think that's why movement and motion, we've all been like brainwashed by the APTA and your PT school.

[00:11:21] So get away from this.

[00:11:23] And I really think that you have to understand what people's habits are, what they do on a daily basis.

[00:11:27] Fix the habits and people's pain goes down.

[00:11:30] Now, this is why I'm not a big proponent on impairments because then you just give exercises to fix those impairments.

[00:11:36] When the solution is, if they have problems with their ADLs, their fitness and their work routine,

[00:11:41] fix those habits and daily routine that will reduce the stress probably 16 hours a day because they work eight hours

[00:11:49] and they go to the gym a couple hours and they sleep.

[00:11:51] If you fix those big things, you're getting 16 hours of rehab versus if you just fix impairments,

[00:11:59] you're only probably getting two to three hours a week because of compliance.

[00:12:03] So the reason why you can't get someone better, an athlete better,

[00:12:06] is because you're looking at how do I, what's the small impairment I can fix?

[00:12:10] And then hopefully these 27 rehab exercises fixes small impairment.

[00:12:14] When in reality, now you're looking at their total day and week.

[00:12:17] You're like, oh my gosh, I'm missing all of this.

[00:12:18] So the next time that you see an athlete, you walk in and they're excited to see you and that's fantastic.

[00:12:25] And they have knee pain, you're like, oh my gosh, I know the special test I'm going to do.

[00:12:28] I know the impairments I'm going to look for.

[00:12:30] No, no, no, no, stop.

[00:12:32] Let me understand who you are and what you do first.

[00:12:35] Let me see how much total physical stress you take on in a week, in a month, in a quarter.

[00:12:41] That's where you start with athletes.

[00:12:43] You don't have to go to impairments until after you've done five to 10 minutes of screening.

[00:12:47] Meaning if your intake form doesn't have it, have your own personal intake form.

[00:12:51] Whether it's your clinic, somebody else's clinic, who cares?

[00:12:53] Create your own little mini subjective.

[00:12:56] Great.

[00:12:56] What do you do for workouts?

[00:12:58] How often do you work out?

[00:12:59] What intensity?

[00:12:59] Great.

[00:13:00] And basically this is the principle.

[00:13:02] Frequency, intensity, time, and type.

[00:13:04] How often do you work out?

[00:13:05] What's your frequency?

[00:13:06] Great.

[00:13:06] What do you do for work?

[00:13:07] What type of labor is involved?

[00:13:08] Great.

[00:13:08] And then what do you do for your daily activities?

[00:13:10] How often do you sleep?

[00:13:11] What does your recovery look like?

[00:13:13] Ask those first.

[00:13:14] And that tells you, oh my goodness, your physical stress is off the charts.

[00:13:19] Perfect.

[00:13:19] What is this impairment going to do?

[00:13:21] I got to fix that.

[00:13:22] That is where most recovery and pain relief lies.

[00:13:25] Fix the total physical stress.

[00:13:27] Because we said at the beginning of this, pain is a result of physical stress repeated over and over leading to trauma or pain.

[00:13:37] This is a traumatic pain.

[00:13:38] This is probably most of what you see.

[00:13:41] If you do that, figure out the physical stress, adapt and fix the physical stress.

[00:13:47] And then from there, you'll see pain relief go down.

[00:13:50] And then you fine tune with impairments and a few exercises.

[00:13:54] Because the exercises are less important than the total adjustments in what they do and how do they do it.

[00:14:00] Why?

[00:14:01] Because it's just a work ratio.

[00:14:03] How much stress is being applied outside the clinic for hours on end on a week?

[00:14:07] Or your one to two minutiae exercises that are hopefully going to fix the impairment, but the impairment is so small relative to their big problem.

[00:14:13] That is how you get pain really fast.

[00:14:15] This is literally, okay, so people have asked me.

[00:14:18] I was actually talking to a team member yesterday.

[00:14:20] They said, how did you come up with this?

[00:14:21] I said, honestly, it's working in pro sports and working with an athlete.

[00:14:24] So I used to work at the United States Olympic Committee.

[00:14:26] And I used to work with athletes seven days a week.

[00:14:29] Like they lived on campus in a dorm.

[00:14:31] So it's like a college setting.

[00:14:32] And I was tired.

[00:14:33] My hands were tired.

[00:14:34] I felt, I realized what a physical therapist is.

[00:14:37] We are just band-aids for pain.

[00:14:40] Meaning insurance says, you're hurt.

[00:14:42] Go see this person.

[00:14:43] You're like, don't worry.

[00:14:44] I'm a pain specialist and I'll improve the way you move.

[00:14:46] And then you send them off in the wild.

[00:14:48] But you actually never make a long-term permanent change in their habits, in their life.

[00:14:53] Because you're so focused on impairments, you have to prove that to insurance.

[00:14:56] So you improve those impairments.

[00:14:57] But you know it takes 10,000 reps and six to eight weeks minimum to improve neuromuscular control.

[00:15:02] So those people go back in the wild and they get hurt again.

[00:15:05] Talk to their physician, send them back to PT.

[00:15:07] So you're just this one washing machine of band-aid pain relief.

[00:15:10] And I got tired of that.

[00:15:11] My hands were hurting.

[00:15:12] My body was hurting.

[00:15:13] And I was treating so many athletes.

[00:15:15] And I finally figured out, if I just figured out what their main challenges were that were

[00:15:19] having too much stress across the season, I can find that out.

[00:15:23] So I did injury prevention screenings.

[00:15:24] I figured out where movement and their challenges lie.

[00:15:27] Then I went to the weight room, figured out what to control their volume and intensity,

[00:15:31] see what their problems were, whether it was mechanics.

[00:15:33] Then I went out to the track or their events.

[00:15:35] And I just figured out, okay, great.

[00:15:36] Let me see what you do for more.

[00:15:37] Let me see what your training is.

[00:15:38] Let me see how much total time you set.

[00:15:39] And then I just did math.

[00:15:40] I was like, in a week, they're doing 30 hours of work.

[00:15:43] There's some reason why people get in pain.

[00:15:45] Because they went from 30, which is fine if that's your base.

[00:15:47] They went from 30 to 40 to 50.

[00:15:50] And if you look at acute to chronic workload ratio, you should only be doing about 10%

[00:15:54] increments weekly.

[00:15:55] So if I saw these huge surges, no matter what impairments they had, I knew they were going

[00:16:00] to be in pain because it was just a volume game.

[00:16:03] If I know how much physical stress is applied, I can reduce that over time.

[00:16:07] So now you can do the same.

[00:16:09] Stop looking at impairments.

[00:16:10] Look at what their weekly, monthly, or quarterly workload is, and then start to work from there.

[00:16:16] And then you get to look at impairments.

[00:16:17] I'm not saying don't use them.

[00:16:20] Don't put everything, all your eggs in one basket.

[00:16:23] And it's not your fault.

[00:16:24] It's only because that's what you've been taught.

[00:16:26] So if you're looking for a way to refresh your brain, look at something different, stop

[00:16:31] looking at impairments because they're absolute bullshit.

[00:16:34] And it's the least of the problems that this person needs to conquer.

[00:16:38] It just takes you seeing things a little differently.

[00:16:41] And if you are excited about this, passionate about it, you need to register for my eight-week

[00:16:46] online sports PT mentorship course.

[00:16:48] It's my sports PT Kickstarter.

[00:16:50] I'm here because I'm passionate about this.

[00:16:53] And I want every sports PT to utilize this because what it'll do is just complement everything

[00:16:58] you're doing.

[00:16:59] It's not going to take over.

[00:17:00] This is not like to overhaul your whole process.

[00:17:02] You just need a different view, a different lens of how you work with athletes to give

[00:17:07] you something refreshing to take a bigger look at how you can maximize outcomes without having

[00:17:12] to depend on the thing you've been doing for the last three years, five years, 10 years,

[00:17:16] 20 years, whatever that is.

[00:17:17] So if you're interested in a refresher and something very, very special that will help

[00:17:21] your clients without having to do a ton of work, you just ask better questions, look

[00:17:25] at the framework a little bit better, and then you can still apply all your impairments,

[00:17:29] your fancy modalities, your fancy hands, your exercises.

[00:17:32] Fantastic.

[00:17:32] Fantastic.

[00:17:33] I'm excited to see you in the eight week online course.

[00:17:36] It really is a way to reframe what you do, how you do it, and really how to approach

[00:17:41] athletes to give you the best possible outcomes and become that clinical expert that you've

[00:17:46] always wanted to.

[00:17:47] So if you're interested in that, you can go to drchrisgarcia.com forward slash Kickstarter.

[00:17:52] Otherwise, I will see you on the next episode.

[00:17:55] Take care, everyone.

[00:17:57] Thanks for tuning in to the Sports PT Academy podcast.

[00:18:00] It means the absolute world to me.

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