A Scary Fellowship Practical

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[00:01:12] Welcome to Untold Physio Stories Podcast. Your perfect commute resource with

[00:01:26] physiofaliers, successes, interests and cases, and more from the physio and rehab world.

[00:01:34] With your host Dr Andrew Rothschild and Urson Rhelyhioso.

[00:01:40] Welcome back to Untold Physio Stories Podcast.

[00:01:42] When you host Dr. E with Modern Manual Therapy, Edge Mobility System and our four-month online

[00:01:46] mentoring program, Modern Rehab Mastery, my co-host Dr. Andrew Rothschild is not with me today

[00:01:51] but I have a very special guest, Dr. Steve Goostery. Can you do a quick intro and talk to me Goose?

[00:01:58] I'm sure you get that a lot. Do you get talk to me Goose a lot?

[00:02:00] Clever person yeah like that. Yeah so Dr. Steve Goostery here just recently kind of branched out

[00:02:07] on my own after 15 years of the trenches. Been a fanboy. 15 years already.

[00:02:13] I was a PTA first so I think that counts right because I did a lot of counseling and I took

[00:02:18] my first MDT course as part of my first kind at Aburback in 2009. I think so. But always

[00:02:24] been a fanboy we met and Boston in 2012 I believe it. I was out east doing my DPP there.

[00:02:32] It was kind of a bridge program at the time but I think we outed our lab partners or something but

[00:02:36] like hey I know you're the manual therapist so I thought that was super cool.

[00:02:39] Aren't you like 8 feet tall or something? I'm like 6'4". So yeah I remember you

[00:02:44] taking a picture with you. Obviously guys are good exaggerates so I think I'm actually like 6'3

[00:02:50] but you always got to add up a plus one. So on 5'7 so I mean to me anything over 6'7 seems pretty tall.

[00:02:56] Respect. Yeah. All right yeah I mean it's great to have like known you when you were a student and now

[00:03:04] you know you're forming your own practice so but you do have a story for us right? I do it yeah

[00:03:08] I just right before I get to that it's very interesting fellowship story which I'm sure you have

[00:03:12] a bunch of horror stories from that too because that's a very challenging thing to go through but

[00:03:16] I want to give you an apology and practice this by saying I just ordered your

[00:03:21] the edge mobility tool and put it at the active what is that? Oh the actor was here. Yeah so I just

[00:03:27] and I just switched by all my baking and so there's a whole debacle there so apologies in advance

[00:03:32] for that but I'm super pumped to try out that stuff out. I've been using your edge tool for the

[00:03:37] last decade the same one so that thing is the same one. I mean I don't even know if I have one

[00:03:42] that's 10 years old. Well there you go there's a special archive somewhere but not in my practice

[00:03:47] of things like they leave the practice like chips and we used to have like I donated 5 mile business

[00:03:53] partner finally I'm like you gotta start paying for these things because people keep on like walking

[00:03:57] out with them like their points. I think I'm sure I think I'm sure that thing I'm not even sure but

[00:04:02] uh yes so let me get to this story so this was a uh remember in your fellowship and I'm pretty

[00:04:08] sure it's standard you know operating procedure now but uh it was a live exam and it was my very first

[00:04:13] one I was maybe three months into the program um shout out to Carol Courtney at Northwestern she was

[00:04:20] my still a huge mentor in my opinion but yeah so I'm getting ready my mentor at the time plus Carol

[00:04:26] Courtney were in the room or in the spa private treatment room and I was sweating bullets and I'm

[00:04:31] usually very cool con collected uh and the patient comes in I was trying to express much history take

[00:04:38] it like and you know anything that I'd manage at the time right so patient comes in 40 year old

[00:04:44] female left I think left for right lateral hip pain was her to complete so I'm like oh this is

[00:04:50] gold that it's probably already greater trochanteric you know whatever her pain syndrome so I'm

[00:04:55] like this is going to be awesome I'm gonna be a such a stud right so uh do it a very solid

[00:05:00] subjective they take me out in the hallway I got a breather if they're like what are your top five

[00:05:05] hypotheses what's going on so uh this is yeah I wasn't really thinking medically looking back on it

[00:05:10] or even pain dominance at that time because I was still pretty new um so I'm like this is either

[00:05:16] a lumper spine referral or GTPS whatever I'm like I'm gonna we're off the fine then go to this

[00:05:22] then give her a sweet loading program and look like a stud so it's long to read what got through

[00:05:28] the subjective got through the objective and I was scratching my head and I could tell the patient

[00:05:34] was noticing that I was getting a bit flustered and I was looking over at Carol and whoever else

[00:05:39] the other mentor was at the time and they're actually holding on I have a quick question are these

[00:05:43] actual patients or mocked patients that are acting these are actual patients that got placed

[00:05:51] on my schedule by the scheduling team so I okay okay see we only had mock we didn't have like

[00:05:56] an actual real thing that we had to figure out no we don't know Carol Carol Carol's a mess around so

[00:06:03] um so yeah so I had no clue that's why I was even googling this person and I'm like I saw their name

[00:06:08] maybe you know that morning and within an hour they showed up so that was you know number one

[00:06:13] checker here that's three the mentor here let's go so I thought it was doing a solid job and

[00:06:18] yeah there are John got a ton of notes I'm trying to make casual eye contact with their

[00:06:24] stone-cold poker face right so then I'm like I'm this is automatic fail and whatever I'm accepting

[00:06:31] that so did my objective have not been fine and he concorded sign whatsoever so I was getting

[00:06:38] frustrated I can tell the patient was so whatever so to manual therapy fellowship right so

[00:06:43] you want to find it or who concorded sign test retest do a manual intervention test retest so

[00:06:48] I did just a general long-axis distraction traction whatever you want to call

[00:06:55] gradient mold from all again perp time we can make length uh

[00:06:59] constantly our one R2P1 we all that good stuff uh no no effect no changes but her functional

[00:07:06] baseline was it just a over it like that's a made deep squat so I you know okay cool I got that

[00:07:12] got her off the table no effect did it uh do it like on did a thrust traction in it let's

[00:07:18] remake your squat nothing so I'm literally I'm ready to quit right so then she's like oh maybe

[00:07:27] I should have shared this with you when you were asking me all those questions but I have a mass

[00:07:34] and my jaw dropped and I looked at Carol and I think other mentor dropped her pen

[00:07:39] so I'm just like well that would have been a little helpful when I was asking you all those questions

[00:07:45] that's right there was a you know there's a message to my madness you know so there's that so

[00:07:50] well I'm sure you're sure I remember this patient because she made fun of my khakis I'm

[00:07:54] 64 and I had some really baggy khakis on it she told me I looked godly or gawky or something

[00:08:00] so that one's the definitely sticks out of my brain that's funny well yeah I mean

[00:08:06] this is one of those things where I always where I learned to ask is there anything else you want

[00:08:13] to tell me that I didn't ask or anything that you think is not relevant but there's anything else

[00:08:18] going on medically either now we're in the past because people are like yeah I had some of us

[00:08:23] very similar hip pain and they're like oh yeah you know what I remembered like two visits in

[00:08:28] whereas you're not getting better I remember like falling down the stairs and landing on that hip

[00:08:33] right you know and that's where if I could do it over again I would have done a little bit more

[00:08:37] of a deep dive like that's a good chance of excellent hip right yeah well yeah that's pretty scary

[00:08:44] did you pass though or did you fail so I passed I think we all high five each other once the patient

[00:08:49] left the clinic and she came back I treated her maybe eight visits over two months period because

[00:08:54] that's my MO I'm not going to see you six we don't ever visit for six weeks that's that's shameful

[00:08:59] it's not going but the sides of case yeah so she was like a lifelong patient I haven't heard from her

[00:09:04] in a while but that's just maybe I'll reach out to her now I'll see you awesome awesome yeah that's

[00:09:10] great yeah and another hip patient who also was like only intermittently better and every once

[00:09:16] a while they were just like every morning they were worse but throughout the day they were just

[00:09:19] overall better with the like side glides and the lateral and posterior change stuff I was giving them

[00:09:24] and they're like you know when I figured out that like my garage door always sticks open and every

[00:09:28] time I like a garage like physical door not like the the corridor but like the the door you go

[00:09:33] in and out of this person but now it like always sticks open because the frame is warped so every

[00:09:39] morning when I'm going to work I slam it shut with my hips which is like like a verse reverse

[00:09:45] thrust of the side glides that were making her better so I was like okay I want you to kick it now

[00:09:51] instead once she was kicking it then it just everything else like clicked in the place because

[00:09:58] that was the thing that made her worse in the morning that's super cool and from your experience

[00:10:02] you know we've both done the MDB training um you and pain as an a one so this is just a random

[00:10:07] question for you to remind me of the big experience but do you think you know when it's a

[00:10:11] you ruled out the spine or maybe it is a spine arrangement um you think gliding toward or away is

[00:10:17] more effective or it just happens I'm sorry well I mean I would say the majority time is going to

[00:10:24] be towards just because most people are going away and as a novel stimulus it's more it's more

[00:10:30] novel to load rather than unload because most people feel tightness or perception of tightness on

[00:10:35] the involved side then you go to various practitioners whether it's a standard manual therapist or

[00:10:40] massage therapist everyone says your tight and all they ever do is gap and stretch the average person

[00:10:44] according to McKenzie stats already unloads their spine thousands of times a day then they go to

[00:10:50] like unloaded even more once they get stretched so it seems like I mean even when I got certified in 2004

[00:10:56] McKenzie had said he had never seen an anterior derangement even though he knew the existed as a

[00:10:59] concept that was some of this out some of his faculty did but that's why it's that's why it's

[00:11:04] more rare because on average people just flex all day and they don't they very rarely extend or

[00:11:11] they very rarely load they're always loading they're always unloading but they don't load too often

[00:11:16] and you know I've seen that's seen several anterior derangements but they're still like

[00:11:20] they're still way more rare than posterior derangements absolutely and that's one of my favorite

[00:11:26] you know if it's even a you know no receptive nocy plastic you wouldn't prefer a full nor

[00:11:32] passive you name it I love seeing that chronic persistent person human with you know neck or

[00:11:39] even any spinal complaints but they've been told by you know a variety of providers that

[00:11:44] oh you need your your left upper trap is like you got a stretch away stretch away and then just

[00:11:49] the simple retractor then then you go toward and it's just like magic right yeah and they're like

[00:11:54] what did I mean why didn't anyone else tell me this it's like it's so it's like keep it simple

[00:11:58] Steve the kiss method like it's so simple I know I don't know you know for those of you who listen

[00:12:04] frequently near haven't you've ever taken my courses or just standard McKenzie courses

[00:12:08] I always want to ask every time I see someone in social media and they're talking about like

[00:12:12] how difficult a case is or just any case in general I'm like what do you do when you don't do

[00:12:18] repeated end range loading I mean you know they're like oh you got a temper expectations and

[00:12:23] you know you look at all these clinical practice guidelines like this always takes like four to

[00:12:27] six months and this takes six months so this takes eight months and I'm like not if you're doing it right

[00:12:32] right I feel like that that needs to be part of all entry-level DPT residency and fellowship trainings

[00:12:39] how simple is that you do a repeated movement exam with your pivons pavons neurodynamics etc right

[00:12:45] well it's also reliable I mean there's like you cannot off-research MDT that's just a proven fact

[00:12:51] especially for the lumbar spine right for sure for sure hey you know what though are we

[00:12:56] specifically talking about MDT in this podcast no we're talking about not in the print we're talking

[00:13:02] about a particular method that is very reliable and it might improve your outcomes dramatically

[00:13:07] that's correct we're calling it a reset gear between you and I for sure for sure

[00:13:11] end range and range loading resets right no no directional preference that according to the

[00:13:16] directional preference all right no no T.M. yeah hey hey goose where can people find you

[00:13:23] yeah so Brad knew I'm used to be that guy that posted on my personal Instagram once a year

[00:13:29] so this has been you know definitely a behavior change but yeah you could find the on Instagram

[00:13:34] at dr. Stephen Goostery same as you want to email me dr. Stephen Goostery at gmail.com or my website

[00:13:43] dr. Stephen Goostery at www.simplesteep.com yes that is a simple brand and it's Gooth with no E

[00:13:50] after the S there are two E's but it's after it's after it's it's part of the tree

[00:13:57] correct when I was a kid I remember asking my dad I'm like hey can I just start adding a C

[00:14:02] after this because it was typing just such a common type when I'm like absolutely not be proud

[00:14:06] of that name and I am here we are yeah you should be you should I used to want to change my

[00:14:11] first name to Scott because they weren't going to cut my name wrong and I like the name Scott

[00:14:15] I feel like Scott now wicked bro though yeah Scott really also doesn't sound right no that's

[00:14:21] that's the top of the story um sorry dr. E sounds does sound better in dr. S

[00:14:27] yeah that's why dr. Goose sounds dr. Goose sounds kind of cool I think it does it does yeah yeah

[00:14:34] all right well it's great reconnecting and I'm pretty sure you'll be on again

[00:14:38] because I know you have a couple more stories so hey if you like dr. Goostery's story or you

[00:14:42] have any similar stories have any comments or questions make sure you reach out on social media

[00:14:47] to either one of us make sure you hit that subscribe button wherever you listen to podcast

[00:14:51] apple spotify google and as always you guys have a great day thanks for sitting