Lesson Learned: Dan Pope, DPT, OCS, CSCS

Hello everyone, I'm Dr. Darsha Shah, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined, a podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Here's a quick word about today's sponsor for this episode. Do you need access to cash at fair rates? Dr. Doc Lending believes that when debt can be avoided, it should be. They also realize, however, that sometimes borrowing is necessary to help doctors overcome short-term cash issues to improve long-term personal financial health. 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But I mean, what's up? You're using bike? I used to do treadmill. I used to do a speed walk. Yeah. Yeah, like 4 miles per hour ratio. Yeah. I'm actually considering investing in some type of, so I've got an air down bike. But it's not the greatest for zone 2, right? It's just really annoying to kind of do that. And I don't know. I don't know if I see so many. My wife is just like, do you really want to move this? We've kind of gotten so comfortable. What's going to be a pain to move in 4 miles? Yeah. You're about to move, I know. Yeah. But zone 2, I need zone 2. Anyways, I need a zone 2 in my life. Anyways, but what are we talking about today? We recently had Dan Pope. I mean, I really enjoyed our conversation with him. Dan is so knowledgeable. Such an awesome dude. So I really, really enjoyed our conversation. I'm so happy that he was able to make some time. Honestly, I had more questions than answers after our discussion. And I feel like we barely got to even scratch the surface with him. But, you know, duty had to call and he had to see a patient. So hopefully we'll get him back and kind of dive a little bit deeper into some of the topics. But can you take aways, man? Would you learn? Yeah, absolutely. So Dan Pope, talking about this pain-free fitness app, I can speak properly. You know, he kind of started off with a very similar theme as what David O'Tay, right, from our second episode was talking on terms of building rapport with your clients. The biggest thing I took away, you know, one of them was at least the connection, right? He used to give his phone number out or he still does. He still gives his phone number out to his clients, right? Because that's how you build that trust. That's how you get people to buy into what you're saying, right? And he even said he's like, sometimes he'll get clients that come from one physical therapist to him. And he'll ask, oh, why'd you leave that other physical therapist? And they'll say, oh, well, they told me, you know, XYZ. And in his mind, he's like, well, I'm also going to tell you XYZ. But the difference is I'm going to build a therapeutic relationship, right? I'm going to be vulnerable myself. And hopefully you become vulnerable and together will kind of, you know, traverse this journey and get you better. Yeah, I think the specifically thing, because it stuck with me, he said therapeutic alliance is going to affect outcomes. I love that. I'm stealing that up. I got to let him know. But yeah, I love that building reporting. And, you know, people will just start to hear this common theme. And we keep talking about this. And I love it. You know, it's because these are things that work. The other thing on that front that when he had talked about is how do you get these people to buy in? He said, you got to walk the walk, right? I mean, a lot of his clients and patients are these individuals who are power lifters and who are crossfitters and stuff. And he's educated in that front. I think he has a crossfit level one coach. He was a strong man competitor for a long time. He trains hard. He continues to do that. He puts a lot of these videos out on his social. You get to see that he's actually active. And as Simone made, one of us, one of our previous guests had talked about, you know, you got to walk the talk, as she liked to say. And I mean, this is why I think individuals, such as what's his name? Spencer Nardalsky, right? He's really big. They got really big 15, 20 years ago because I think when he first came out and his name was the doc who lifts, right? Right. And I mean, unfortunately, and I don't want to offend my physician colleagues, but I think as physicians, we weren't recognized as individuals who were exercising a lot. I think a lot of that has changed. We've gotten significantly better, and especially in our professions, we're very much tuned to exercise. But doctors didn't use to exercise a lot. We weren't well known for training hard, and definitely not with any meaningful intensity. And so I think that that was really, really important. But to me, one of the first points that really kind of resonated with me is just his journey. His inspiration to become a physical therapist was the fact that he was seeing all these individuals when he was during the conditioning coach. And as they were getting injured, they were going to physical therapists, and they're being told by the physical therapists, well, you shouldn't have been dead lifting in the first place, or you shouldn't be overhead pressing in the first place. And it's like, that's not good advice. And then unfortunately, these individuals, because they don't know any better, right? The patient, that specific patient doesn't know any better. They would tend to villainize him because he's the one who was doing the programming, and that wasn't necessarily true. It wasn't the exercise that caused a problem, right? Maybe something deeper than that. His passion for walking down that journey and getting that extra medical training was so he can continue helping those individuals rather than turning them away or sending them out. So I really love that. And that kind of resonated with me because that's the reason I went to medicine, right? So I can look at the big picture beyond that. I was just about to say that. I think that's a lot of reasons why we see a lot of career changes in medicine, right? Especially people becoming physicians, because they want to be the ones that, but they see what happens, but oftentimes as an MD or DO, you're the one making that last final choice. And I think a lot of people would like to have that because they've seen that, hey, with their previous jobs or something, they weren't able to influence in that way. So yeah, it was really cool to see him wanting to personally develop self-improvement and get better and become a master at scrap. For sure. And I think I love their complete model. I don't think he said that. He did a loot to the fact that they're cash-based, a champion PT, and they're very special in that regard in terms of the clients and populations, again, the relationships they have with physicians. But what I love is they call themselves performance-based therapy, right? That's what the model is. They built a gym at the facility, and then they built a physical therapy around it. They didn't do it the other way around. And that was very intentional, you know, according to what Mike always talks about on his podcast, Mike Reynolds is kind of one of the co-founders and a champion up there. And they don't say that necessarily do physical therapy, because there are a lot of individuals. Like he says, they walk that line between sports medicine and performance and rehab, and, you know, I would like to be one of those individuals down the road for myself. I kind of consider, you know, and this isn't a plug for myself, or trying to do it on the floor, but I think it's extremely important to understand for patients and for colleagues when you're referring out, that you're sending to somebody who truly understands what the issue is, right? And for patients, example, I don't know how close you follow CrossFit, but Matt Frazier, you heard of him? Yeah. Right? I mean, only the fittest man, five times, it's insane. The guy's an absolute nut job, right? But I think his story he talks about is there was a point where he was going through a back injury and could only deadlift like 200 pounds or something, and he went to go see the physician, and physicians was like, well, deadlift 200 pounds, like you shouldn't be doing more than that. And he, like, now this is a 500 pound deadlifter whose below 50% has normal capacity and it's like, what are you talking about? But to the physician who necessarily didn't work out, or it seems like a lot doesn't understand the deadlift, the exercise and all that stuff, doesn't see that, that that's a disability. Like our profession, that's what we do, right? I think most individuals, when they think of disability, they see an individual in a wheelchair, or they see a kid with some type of congeneral abnormality. But disability comes in all shapes and sizes. And it doesn't discriminate, right? It's any type of impairment and the quality of life, whatever we're talking about. As Dr. Art previously said, performance is function. And your function, if it's impaired, whether it's lifting, not being able to lift 500 pounds, or not being able to get this, can a soup from the, from the cupboard up top, whatever that means, like, we got to be there to help them individuals, right? Get over that. And so that's my little spiel of what Payment Arts all about, I guess. Yeah, no, I love that, right? And it transitions to my next point, very nicely, where I ask Dan about movement, right? Because in medicine, we know back in the day, it's not even too long ago, when people had injuries, we would say, oh, bed rest, right? Like, you got to rest, whatever's injured, don't move, let it heal, and then you can get back into what you're doing. And now we've obviously flipped the script on that, and we're saying, hey, movement's actually what's going to keep this pain away, right? Not obviously going 10-10 intensity, but getting some movement and getting that blood flow, we know that there's advantages to moving, even when you get that back injury, right? And what Dan says is, you know, movement can be the medicine, or it can also be the poison, right? And he talks about, like, taking an aspirin for a headache or something, where you can take a couple, and that might help your headache, but you can take the whole bottle, and you might be dead. So, you know, it's not an aspirin, that's the issue, it's the dosing of it. So I just thought that was a super cool analogy. We know that exercise is medicine. There's no disputing that. How does it work? Well, it's a complex phenomenon in terms of its therapeutic benefits, and it's probably the, like, out of the scope of this discussion, and to get the complex physiology of how it's helping. But he touched on the concept of unloading when athletes do come to him, when they're injured and training through injury. And I think he had mentioned that he didn't necessarily like that. I would suggest the term de-loading instead, right? When you're basically, whatever the component of this causing you stress, unwanted stress, negative stress, and you take load off of that, but you put it on in a different way. For instance, if somebody has issues deadlifting, right? I think you have a history of this when somebody was like, don't deadlift and you're like, this doesn't really make sense, right? We know that deadlifting causes somewhat of a shearing force on the spine, and that isn't necessarily always good. But the spine, the axial spine, is really good, does a good job for the most part to take compressive forces, right? So if maybe somebody can't tolerate deadlifting because of their back, but maybe they can do a back squat, okay? Maybe if they're bending forward too much, then it's still going to cause a shearing force, maybe they can do a front squat. If the front squat doesn't work, maybe they can do a goblet squat. There's a ton of variations. That's called switching up exercise. That's exercise selection. But he talked about, I think specifically when you asked him, hey, how do you manipulate the variables? There are so many of them. We have frequency exercise selection. I just touched on. You can modify intensity. You can modify volume. Some of them combine becomes load. And his response, it's like art. And forget exactly what he said, but it was really funny, even though he's not an art fan. But I think specifically he was talking to coaches and trainers and physical therapists. He said, we have to learn how to do stress. That's exactly what you said in other words. But that was something that I really like. And one of his principles in learning how to do stress is he wants to mimic as a physical therapist. He wants to mimic, especially when he's singing an athlete who's injured and maybe is out of season. So he wants to mimic their sport or whatever activity they might be doing. And for us, if we're not seeing athletes, I mean, I'm going to be going to sports medicine. Hopefully you're going to follow me down that path. I'd love to have you. But you know, for individuals who aren't necessarily quote unquote athletes, I always say not to sound like a punk here. But people are still training for the sport of life. You have to train for it, right? So whatever that activity is, you need to do, right? So that really, really kind of struck a chord with me as well. Because this is something that boggles my mind when individuals say, okay, well, you're hurt just not, you know, don't train. Don't exercise. I think specifically the example they use for back, it's a little bit more complex. Core muscle injuries training around them is very, very challenging. You definitely need an expert like Dan, or the race, my coach, or somebody like that to be able to do it who really understands how to dose these, these variables, how to, how to dose stress. But when people don't train because they hurt their ankle, or they hurt their hand, or shoulder, or an extremity, and there's a million ways to do that, I mean, you're really doing your athletes an individual's a disservice because of the effect you're going to get from deconditioning and they're going to come back to that activity and be much more susceptible to injury. It drives me insane. Exactly, so it's funny. I was actually in the sauna the other day, and this guy comes in and he's like, oh, are you training for anything? I see you doing pull ups, you got a good form, what do you do? Are you training for something? I stopped. Take a deep breath. I look at him. I'm training for life. Pretty sure he's the long-term actor. Yeah, he hates you so this guy is it. I was like, great, this sauna all to myself. It's a perfect response for if you want to be left alone in the sauna. I don't think anyone just say you're training for life. Yeah, people just kind of look at you. What the hell are you talking about? Yeah, I mean, you know, at the sake of not being a prick, but it's true, man. It's so, so true because as we get older, how often does it happen that stories you hear? You're like, oh, man, I threw my back out. I was picking up my child or my grandson and stuff and that happened. It's like, you know, if your tissues aren't resilient, if you don't have the tissue capacity to do X, Y, and C, I mean, you're going to get injured. That's just the nature of the game. Exactly. No, I like to think of it in terms of what David Goggins trains and how Peter or Tia trains and fusing the two together, where David Goggins is literally training for life. Like, that dude is just a bad mofo, right? Like, he will train because he wants nothing in his way, right, whenever there's hardship. And I look at that same way, right? You build a mindset around pain, around chronic injury, all these things, and you look at what Peter or Tia says and he says, you know, you also train for life. In the sense that when you're 80 or you're 90, you want to be able to reach above, you know, the fridge or whatever, if you have a microwave up top, whatever, if you need to bend over and pick your great-grandkids, hopefully, you know, if we be able to live that long and stuff. But like, you know, fusing those two mindsets, I think, is what motivates me to go to the gym almost every day and put the work in. Yeah, I love that. I mean, for his centering in Olympics, he talks, I mean, I'm like, it's like 20 activities or something. I know a perfect goblet squat is important because you've got to be able to pick up your, I don't know, I mean, it's got to be, it's what's his model that he talks about. You're unconsciously, no, unconsciously unconscious, unconsciously conscious or something. Like, he has like four criteria about basically going from basic to master, right? It's, man, I don't know, I'll have to look it up and to talk about that. But, but basically to kind of the unconsciously conscious or whatever it is to drop into goblet squat and pick up your grandchild. I mean, yeah, that takes a lot of reps. You got to do a lot of perfect goblet squats to be able to get there. And if you don't train and if you're missing out on time when you're getting injured to not practice with goblet squats or practice body weight form or something else, then it's going to be hard. It's going to be hard for you to become unconscious and just become second nature or the principle of automaticity is what we another way to describe it. Absolutely. You know, another thing that I love and it's not something new because David Otay's talked about it before. Basically, the communication between different disciplines. How it's just absolute key, man. And I'm actually longing for the opportunity. I'm starting my sports medicine rotation next that I'm going to talk to these athletes and communicate more with the physical therapist and pick up the phone. And I'm just salivating next week that it's going to seem athletes and then be like, oh, yeah, this happened. I'm going to get the number for the coach. I'm going to call the coach. I'll call the hopefully not trying not to violate any barriers, but obviously get the permission from the athlete and set up that rapport. Set up that communication between disciplines. You know, so we as healthcare professionals, we have to take initiative to do that at physicians. We have to check our ego at the door that said before and we have to be okay calling that personal trainer. Because it's about the patient. And if we don't maybe convey, if the trainer doesn't call us to ask about, hey, is it cool for me six weeks after we do this or because they don't know, right? I mean, maybe you do a procedure or maybe you do a surgery or something like that. And the tissue quality was really poor. And they might not be able to handle load or something like that. But if you don't communicate that, then ultimately the patient's the one who's going to suffer. And I think that that's, it's just tragic. To give you a classic example of, we do this on the inpatient side all the time. You're less than, you're a couple of months away where you're going to be taking care of these individuals after a stroke, spinal cord injury stuff. And inpatient rehab is beautiful situation because physical therapists are right there. And so when you're sometimes arounding, I'm not sure how harsh she does it, but sometimes we around and they're already in therapy. And I use every single one of those opportunities if I around or in a patient while they're in therapy to communicate with the physical therapist. It's just because I get sometimes more information from the physical therapist than I do. Because like at some point it's like, these patients as stable as possible, right? If they've been you waiting for two weeks, asking them a review systems about chest pain, fever, like abdominal pain, that's, that's no need. That's fine. You asked them if they had diarrhea yesterday, they didn't, they'll let you know if they have diarrhea. But asking a physical therapist who is with them for an hour, hey, how are they getting up? Are they getting better, getting out of a chair? Are you seeing progress there? Are they getting better, combing their hair, brushing their teeth, doing adios and stuff like that? Rather than the abbreviated physical exam, I do when they're in the bed. I'm not getting any information out of that. Nothing valuable at least. So I think that that's something that's really important. Yeah, 100% agree with you, man. I think, you know, it's awesome. You're going to have the opportunity to do that. The best that I can really do, man, here right now my intern year is asking the overnight nurses what's going on and then putting in consults and hoping I don't get yelled at, right? But no, I completely agree. And, you know, Ronald Epstein talks about this in his book, Attending, which is all about being in the present moment with your patients. And I think a lot of times, like the barriers to why we don't do this in medicine is one, we think that there's more work involved, right? Now I have to make a phone call what if there's more paperwork, right? And we already know medicine already has so much of that. Number two, checking our ego at the door. Maybe that individual, that doctor thinks they have all the answers and that they don't need the help of another discipline. But what I've come to realize is if I put in those extra 30 minutes to an hour up front in terms of getting a more detailed history in terms of talking to the right people, I'm actually saving more time in the end in the long run. That patient can get out maybe two, three days earlier. That patient sees a quicker recovery and everyone's on the same page if there's less guess work. And I think in the end, like you said, it's about the patient and I think the patient you will see the overall difference. I mean, it's a lot about burnout. That's how we end burnout. When we see those great cases where we actually see our patients getting better and not necessarily coming back into the hospital. So I think all that is great care. Absolutely, man. And to your point about spending the extra a couple of minutes getting that history and stuff and also reminds me something that Alex King had talked about when his patients come in he spends the extra time talking to them because just the conversation and building the rapport and what specific treatment is going to work and also sets up the treatment to be more successful. Because there's no, again, no disputing that there is a psychological component to these treatments working. The placebo effect is very, very powerful and I don't care if that's the reason something works. As long as the patient is not suffering. We previously talked about the difference between pain and suffering and how you can quantify pain but it's hard to quantify suffering and it's also important to kind of ask that question. So yeah, I mean, I think that that's key as well. So good to remember. Very cool. Anything else you want to add in there? No, man. I think just the last thing that I'll say is I mean, huge fan of him. I mean, that's one of the reasons I was super stoked to get him on here. Just because of the education that he's been providing for the last couple of years whether it's over at Champion with Mike Reinold and they've got an awesome podcast every week they released some really cool episodes and not just Dan but a couple of his colleagues are all amazing. Dan, what he's doing with fitness pain free is really phenomenal. It's one of my go-to sources and I can't recommend it highly enough. And I mean, and not only that, I'll say that I'm putting my money where my mouth is. So I'm not really sure when we're going to end up releasing this but I'm going up to see him for a consult to kind of get a good thorough assessment and kind of help me with some of the issues with in terms of biomechanically and see how I can optimize my own training regimen and be healthier in long term. Because so, you know, I hope people continue to follow him and definitely learn from him because he's good dude. Yeah, as I was, you kind of just stole the words out of mouth. I was going to recommend everyone kind of checking out his website, fitness pain free on Instagram. This guy's putting out amazing content. I'm learning something new every time he's posting and it's definitely motivating me to check my ego at the door when I go to, when I go to the gym, you know, and look at life from a different perspective in terms of, sure, I want to get being strong and all that but I also want to limit the pain, right? So I think I think it's sage advice he's given out there. Cool. All right, brother. See you next time. All right, sounds good. All right, everyone. I really hope you enjoyed our takeaways and please feel free to share whatever you take away as well. Thank you. Thank you.