The Beyond Pain Podcast

Episode 56: Where We Have Been, and Where is PT Going?

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca reflect on their journeys in physical therapy, discussing their early experiences in school, clinical rotations, and the challenges they faced transitioning into the professional world. 

They explore the evolution of physical therapy practices, the integration of fitness into rehabilitation, and the impact of virtual consultations on patient care. The conversation highlights the importance of communication, patient relationships, and the need for a more personalized approach in therapy. 

They also touch on the challenges of burnout and the value of time in the therapeutic process, concluding with a look towards future topics.

Takeaways

  • The transition from student to professional can be challenging.
  • Clinical rotations provide valuable but sometimes overwhelming experiences.
  • Communication and connection with patients are crucial for success.
  • Fast-paced environments can teach valuable skills for managing multiple patients.
  • Finding the right work environment can significantly impact job satisfaction.
  • The integration of fitness into physical therapy is becoming more common.
  • Virtual consultations are changing the landscape of patient care.
  • Time spent with patients is often more valuable than the number of visits.
  • Burnout can occur when taking on too much responsibility.
  • The definition of physical therapy is evolving to include a broader focus on wellness.

Joe Gambino (00:00)
Welcome back in to the Beyond Pain podcast. am one of your hosts, Joe Gambino, and I'm here with Joe LaVacca You can find us on Instagram at Joe Gambino DPT for myself and at strength and motion underscore PT for LaVacca over there. This podcast is on Instagram Beyond Pain podcast and on YouTube cups of Joe underscore PT. And if you would like to work with us, there's application form down in the show notes. Please feel free to reach out whenever you want.

And Joe and I, already talked about the Knicks and our devastating week one loss. We will not rehash this year because there was a lot of complaining and a lot of bitching. So we will leave it in the past and we will move forward. Welcome back, Joe, boy.

Joe LaVacca (00:31)
Can't go backwards, will not be going backwards.

man, I'm really glad you said that because I feel good about that decision. after being sick to my stomach, I actually think that's why I might have a cold. they ran down my immune system and ramped up my stress response so high that I just can't even talk about it anymore. But we are also supposed to be preparing for summer this weekend as it is the Friday before Memorial day. And it feels like anything, but in the Northeast right now.

Joe Gambino (00:49)
too much

That's Summertime.

Joe LaVacca (01:09)
because it has been about 40 degrees for the last three days and mister Gambino so wonderfully reminded me that it is seventy-five and sunny and the best time to be in North Carolina and looks like you guys are gonna have a wonderful weekend. I hope you get lots of sunshine and for us New Yorkers.

Joe Gambino (01:09)
You

Fantasy is on

the fence. So we'll be in Knoxville this weekend and there is some rain on the forecast so we're hoping that it holds off. I want to get some coffee and I want to hit the light.

Joe LaVacca (01:34)
Yeah, well, and for us New Yorkers, we're just, we're trying to dig out hoodies.

We're trying to dig out hoodies and sweatpants and rain gear and all this other stuff. So I think you still got it a little bit better than, ⁓ than we do.

Joe Gambino (01:45)
Yeah. ⁓ absolutely. Absolutely. Definitely by the way, New

York. So I think just that the bad weather's coming from, from the Knicks, Knicks tough loss, you know, that it's just bringing haze on, the city. ⁓ I did say we're going to, we're going to talk about the future today, Joe. We're to, we're not going to look in the past, but actually this whole episode is about looking back, looking back on the past. Today we're going to be diving into what our experiences were like when we first started getting into physical therapy.

Joe LaVacca (01:52)
Yeah, it could be. The whole city's just... Gloom and doom.

Yeah, actually, the whole, it's Flashback Friday.

Joe Gambino (02:13)
and then how things have changed. And we will bring ourselves back to the present and today and how things have changed and how we look at things differently. So I'll let you kick it off, Joe. You started your PT journey before me, I think probably like three or so years before I did. ⁓ So what was it like when you were in school? What was it like when you were initially employed? Everything before Perfect Stride kind of changed our lenses on things.

Joe LaVacca (02:41)
Yeah, school, ⁓ we can start there because there's a lot of new grads entering the workforce in probably this week, next week. So congratulations to you guys. Welcome. It is not all gloom and doom, unlike the next playoff outlook and the weather here recently. And I think that you'll find that you've made an excellent career choice. When I was in school or when I think about school,

biggest things I'm reminded of were just our clinical rotations. And, you know, those were always interesting because there was only so much or kind of like I felt only so much I could do in each one. And I was more or less interested in the fields that we were, you know, assigned to. And for those that don't know who are listening in at least my PT school, Sacred Heart University, we did ⁓ orthopedic or like musculoskeletal affiliation.

Joe Gambino (03:14)
Hmm.

Joe LaVacca (03:40)
Then we had to do a neurological one or like an inpatient rehab one in the hospital. And then there were all sorts of other specialty areas like cardiovascular. ⁓ you can get into geriatrics, you can get into pediatrics, but ultimately as you were, you know, picking all the places you want to go or trying to win the lottery on some of these places, cause a lot of them were sports teams and stuff too. You were trying to refine and hone in on where you want it to be.

And it was always interesting working under someone with such a eye or magnifying glass over you because everything you did was graded. And it reminded me of being on the pit. I don't know if you watched that show on HBO, but it was funny because as you're working with people, you're getting questioned by your instructor simultaneously. And it's like, are you trying to make me look smart? Or are you trying to make me look like an idiot right now? I'm not sure which way it is. However,

I also felt like a lot of the places that allowed us the opportunity to go in there, minus, you know, a sports facility sort of thing, it was almost a little bit like slave labor. You went in, you were, you know, kind of put through the rigors, excuse me. And if you did well, your reward was to get worked as hard as possible. If you did not do well, then there was very little.

Joe Gambino (05:04)
Yes.

You

Joe LaVacca (05:09)
done for you, at least in my experiences. Now, luckily, I did do well and I had great clinical instructors in all of my rotations, but I know that wasn't the same for everyone. So did you ever feel overworked? I mean, obviously we weren't paid in these earlier things as students and how did you cope with that?

Joe Gambino (05:31)
you

Yeah, so when I was in PT school, think every, every, especially the ortho ones, ⁓ I didn't really feel overworked when I was in the hospitals. ⁓ Or when I did subacute, they weren't populations that I worked with often. There's not a high volume of people that we see. ⁓ It was definitely a different learning experience on those, was fun. ⁓ But when I did my ortho ones, ⁓

I did well on all of them. My background, I already had maybe five years of personal training experience under my belt. So when I went into each one, my bedside manner, and I think that's what really matters to, know, even when I was a clinical instructor at Perfect Stride, the thing that matters most is how you communicate with your patients and how are they buying it, right? And I can, I did that in every single one of them ⁓ and every single one of my affiliations, except for my first one, because it was my first ⁓ one, which was an interesting experience.

I was seeing 20 plus people in a day, which is a lot, know, perfect stride. We were only seeing eight people a day. So that was a huge difference. But yeah, I was just thrown in like I was a full physical therapist. I had some guidance along the way, but there wasn't too much because I I just used my personal training background and I just connected with people and I just did fine. I'll give myself a little pat on the back. I did win the clinical excellence award.

Joe LaVacca (06:58)
There you go. I was gonna...

Ooh.

Joe Gambino (07:02)
because

me and another guy in my program, Tom, pretty much they gave, I don't know if they gave out two for the people who got the highest scores through all the CIs along the journey. know, little two here. But yeah, I mean, it just came back to my background. And a lot of times when I get like students or people who are, you know, like even just asking my history, I'm like, oh, how do I have success? was like, get some coaching experience now.

Joe LaVacca (07:14)
Wow. Very good. I did not know that about Mr. Gambino.

Joe Gambino (07:30)
That's the thing that's gonna give you the most value down the line. It's not more education. It's can you connect with someone? Can you have a conversation with someone? Do they believe in what you're telling them and then move on? We've talked about this a thousand times on the podcast. But I'll leave it there. I'll let you know if you have anything to say on that or add or whatever.

Joe LaVacca (07:49)
Yeah, no. mean, I think your comment on seeing as many people as you did was sort of what set my expectation going forward. And my school was very big on professionalism and looking the part. And I think they were so wrapped up in that, that they missed a lot of opportunities, I think, to drive home therapeutic alliance, communication, the power of listening.

Joe Gambino (08:06)
Mm.

Mm.

Joe LaVacca (08:18)
because really they just wanted us to make sure we were in a shirt and tie at all times. And funny story about my inpatient rehab in the hospital. I showed up in a shirt and tie one day, for day one rather, and my instructor thought it was so funny the way I was dressed that he told me if I don't come in a shirt and tie every day for the rest of my eight weeks there, he was going to fail me.

Joe Gambino (08:37)
You

You

Joe LaVacca (08:46)
I

mean, it was absolutely absurd because here I am like moving patients with bacterial infections and wounds in their bed and my tie is like just draping all over them and bedpans and everything else. And, you know, he just got a kick out of it every time he's like, you know, when somebody starts to fall, they're going to grab that deck tie yours and you're going to go right down with them. So good luck. And luckily I got through it. I only dropped one patient. ⁓

And it was a stroke patient. And I remember the response of a few of the CIs. My CI came up to me because I was pretty independent at that point. And he was like, what did you do to Mr. Lee? And I was like, I didn't do anything. He was walking, he was doing good. And the next thing I knew he was on the floor. And he was like, God, I'm gonna have to fill out so much paperwork because of you now. And then another PT came over to me and she was like, hey, Joe, I just want you to know that it happens to everybody.

And if you're not pushing your patients, they're never going to fall. And then that made me feel really good. So I told my CI that he's like, Oh, you know, I saw Rebecca come up to you. What did she say? And I said, you know, she gave me lots of word of advice that, you if I don't push my patients, you know, they're never going to fall. And he's like, no, your patients are just never going to fall. Don't ever do that shit again. So a little reality check there. But as, as I then picked, you know, orthopedics or like musculoskeletal to sort of like jump into.

⁓ seeing people every 15 minutes, which was what I was doing as a student just became the norm. That's what I thought. So again, for people who have maybe not been a part of in network physical therapy, which I think are few and far between, because I always think that people probably end up starting down that path, at least when they have pain or an injury, just because it's, you know, maybe convenient is more affordable. ⁓ there's more options in your neighborhood. So when you go in and you have a person at eight.

815, 830, 845 and nine. You're like, well, this is just what I did in as a student. start everybody on heat and ice, I guess, or a tens unit, which is like electrical stimulation. Maybe do a quick history, quick rub down massage, maybe have time for a couple of exercises. And I don't know if where you are, if you guys had AIDS, but the first job I had did everything.

probably unethical, but the one thing they really stood by was no AIDS, no AIDS, no help. You know, this is a PT office. And I'm like, yeah, great. A PT office that requires each PT to juggle five people at a time, not remember anybody's name diagnosis, maybe where they are in the recovery process. And then just keep giving them the same thing over and over until their insurance company denies them more visits. And I think that was always the most frustrating thing is that I always wanted more time with people.

And then I felt almost sort of guilty in a way where I'm giving the same thing over and over again. I'm not really sure if I'm making a difference or not, or if it was just time. And then especially dealing with so much insurance nonsense, a lot of people, when their insurance ran out and you were maybe making progress with them, they would just stop coming. So I think that's what really shaped obviously where I am now and strength and motion in the business.

Because like you said, Perfect Stride kind of probably opened our eyes to the way things could be and seeing people for an hour and giving them that time and attention. So what was your first job was Perfect Stride, right? ⁓ okay.

Joe Gambino (12:25)
Yeah,

it was. so, you know, I'll paint this little picture because I think it was different. I don't know, uh, when you were in PT school, uh, cause you, I mean, you talked about your, your story of like your first CI, like fancy car dress, nice, and this of, or it was like when you were in PT, uh, for one of your injuries. But when I started my first CI was very similar in that depiction, you know, he's like, well-dressed guy, nice car, was multiple businesses. And he would tell me.

Joe LaVacca (12:40)
⁓ yeah.

Joe Gambino (12:56)
that, you know, he would see, he would see people every 15 minutes. was very, very fast paced. was in Whitestone in New York. Great guy, funny guy. But like, I mean, he was telling me like, with like reimbursements, like they were making, you know, $500 in a sitting, three to 500, like in network. And they were just like, he was just seeing as many people as he could. And he had another business with,

like I was almost like an ortho group, like a surgical center in a sense. he did very, very well for himself. But that was like very fast paced. My first one, I didn't really get to treat many people. He let me do a little bit of manual and like some, because he knew my background was in personal training. He let me do the exercises with people and stuff like that. But they were in and out. But everyone loved him in there and that's what really mattered. You know, like everybody that came in there.

They loved having like a conversation with them. all laughed and then they, they, and they pieced out. and it was similar each one that I will kind of went through, you know, see people say the same thing, you know, 15 minutes at a time, 30 minutes, maybe you got, ⁓ stuff like that. it interesting for you, know, you came up to the determination on yourself, like, I'm not sure if I'm making an impact. You know, I want to have more time. I want to get more education. Like when I started, I already had years of personal training under my belt. I was already spending one hour.

getting to do whatever I wanted from a fitness perspective to help people reach their goals. And then I come into this environment and I have to see people for 15 minutes and pass them off and have to start on hidden eyes. Like that's the process of these places. And as a student, you can't change that. Right. Um, and I didn't like it because I liked spending the time with people. liked to get to know them. A lot of these people, when I was doing personal training and I was still doing while I was in school, which was, which was nice. Um, I saw these people more than they saw their friends. I mean, like.

Like we would go out to the bar, like on the corner after a night session and have a drink and hang out for a couple hours. Like, you know, that's how close I was able to get to these people. And in that other environment, you can't really do that, right?

Um, so there's, there's a part of it, this fast-paced environment. I felt like I needed to give more, you know, I came from doing an hour of stuff. 15 minutes is definitely not enough. And some of those places, the people are in there for an hour and half because they just keep adding exercises, the same exercise as everybody gets. And then all of sudden that person is in there for an hour and a half, but you only see them for 15 minutes. So I didn't like that, that component of things. Um, and I almost wanted to not go into physical therapy. And then I met this, uh, strapping young lad at a, at a course that we had to take.

⁓ It was like a professional requirement when you're in physical therapy. So we had to do a physical therapy chapter talk. And in middle of that talk, there was a course on taping and none other than Joel LaVacca was there teaching that course. And it was the first time in the physical therapy world where I heard you talk about people that I followed in the strength world. Mike Boyle, Gressy.

Sam John, I was like, wow, there is actually something different going on here that I have not seen in any of these others. So I reached out to you, I ended up shadowing you and that turned out to me getting the job at Perfect Stride. And then that was more of an environment that I was used to. It's one-on-one. I get a whole hour with you. get to just talk to you, educate you, connect with you, get to know you. And that's what kind of kept me going down this pathway. I think I've even talked about on the podcast, the initial transition from

personal training to physical therapy. took me almost three years to call myself a physical therapist because I never really, I just identified so much as a strength coach and a personal trainer that, and I just had a bad taste in my mouth, the physical therapy for a very, very long time, even before I got into it, that I didn't really want to identify. And then I found my own path and then I was able to identify as a physical therapist. ⁓ I fast forward today. mean, most of what I do isn't really

deemed physical therapy, I do mostly fitness at this point and kind of guide the process. So it's very, very different with what I'm doing today as what I did when I started. So it's a pretty big evolution.

Joe LaVacca (17:07)
Yeah. And, ⁓ God, I, I remember the course that you're talking about, but it's funny. I forgot that you shadowed before. And now because you said that I remember us actually taking a picture together, like by the treadmill and the logo. ⁓ and either, you know, one of us posted it on Instagram and both of us did, I think, but that was the first picture we ever took together. And wow, that was cool. That was a little, yeah, that's definitely a flashback Friday. Cause I totally forgot that you shadowed there for a day or two. ⁓

Joe Gambino (17:15)
Yeah.

Mm-hmm.

.

Joe LaVacca (17:35)
Well, you I think the important theme that's emerging on both of our ends is that there was a lot of good to take from the negative experiences because it helped us realize what we wanted or what we could do to help people. And there was still, and you mentioned that maybe a lot of what we do now, traditionally 10, 15 years ago,

Joe Gambino (17:49)
Mm-hmm. Yeah.

Joe LaVacca (18:00)
People would come in and shadow us or watch us do our thing now and be like, this isn't physical therapy. You're just training people. like, well, that's also where a lot of the research is heading to get people active, to focus on wellness, that there is a bigger picture emerging on weight gain, a high blood pressure, cholesterol, sleep, relationships, you know, and this stuff may be, it was just, you know, gathering a little bit steam of 10, 15 years ago. And now it seems like it's full speed ahead.

You know, to the point where, yeah, I look at some of the things I write for people or how some of our sessions go and I'm like, geez, ⁓ I didn't stretch them. didn't mobilize them. I didn't do this. I didn't do that. my God. We didn't even stand up from that session because we were just talking so much. ⁓ and it's like, yeah, physical therapy, the definition I think is really emerged and you know, maybe it's, it's sort of time for a rebrand on, ⁓ our, our, our, ⁓ our organizations and our career parts, right?

However, though, still always thought that if I didn't have those experiences, even with rock tape, you know, and that's how we met where you could take something in the field as common as taping, but then add context and add layers to it. And that was something again, that wasn't probably a part of my profession or my career early on. was, Hey, you know what you did? ⁓ know, he didn't, did ice or both.

⁓ with some stimulation when you first came in, that was like your first five, 10, 15 minutes of your appointment. If I was running behind, guess what happened? Hey, is that stim feeling pretty good? I'm going to bump you up a couple minutes just so can give myself another, ⁓ you know, two, three minutes to use the bathroom, organize my thoughts, go in between some patients, do more manual therapy on someone. And then once those people came off their heat or ice or STEM, then it was more touching. It was more of that like quick massage. Hey, five, 10 minutes. Let me move this around.

Joe Gambino (19:56)
Mm-hmm.

Joe LaVacca (20:00)
Before, you know, one job I did have AIDS, one job I didn't, and it was, you know, guiding people one by one, but not losing track of anyone. That was the toughest thing in New York. you, you've seen it even with Perfect Stride, I'm sure your clients, there's subway delays, there's traffic. Um, people wake up late. So my eight o'clock would be coming in at 8 15 with 8 15, who was on time and the 8 30 who was early.

And you have like three people staring at you like, Hey, ⁓ let's get going. And you're like, this isn't the way it's supposed to be. ⁓ but again, I am very thankful for those experiences because. And really because of Dan and Vakash and perfect stride and you know, our evolution together, I realized that, Hey, we can give a lot more to people. And now I wish I had more than an hour. And when I, when I do have that time in my schedule, I'll just let the schedule ride. And I'll even say like,

maybe five minutes before the hour, I'm like, Hey, look, if you want to keep talking or working or moving or bringing up anything, I have time. And whenever I have that gift, I always try to give it to people, um, especially when they're in need. But, know, I think it really has also prevented burnout. And I don't know if you've ever felt that, uh, throughout your time, you know, either with training or with PT, it was like you said, I mean, you had those negative experiences pretty early on and then.

Joe Gambino (21:02)
Hmm.

Mm.

Joe LaVacca (21:24)
You were fortunate enough to kind of hitch on to perfect stride and then kind of build that from there. But there were definitely moments where I went through burnout. So I was wondering if you ever did too.

Joe Gambino (21:31)
Yeah,

I have. But that's always because I've always put a lot on my plate. You even a perfect stride, know, like a side business and things like that. Right. So there's ⁓ there's always things, you know, I was always adding more if I had time for it, then I would do it right. And that at times could definitely it's a burnout. But you said a couple of good things that I wanted to highlight, you know, and I think, you know, on your point of it, like teaching you, think that fast paced environment does teach you.

If you can do something in 15 minutes and create a connection and talk to somebody and manage a bunch of people coming in, it really gives you some skills that when things slow down, it just makes things easier. I do think that, obviously some people can't afford to go out of network or go to a cash-based practice. And honestly, some people do get help from being in these clinics. You don't need to go see somebody out of network. ⁓

And that's, I'm learning that more and more. always thought when I started, even when I was at Perfect Try, was like, ah, like we do something super special. And I think we do have our own unique thing. And I think that is because PT looks more like training and it's, I'll get there in a second. But I'm learning more and more that sometimes you don't really need too much or something too special to make some progress, but some people do need a little bit more.

So I think there's a lot of the things that you can learn from those environments. And I do think that people can get a lot of help from them. And if they're not getting help from them, then maybe they need to take another step to get deeper care, right? And come see someone that's out of network or cash based like you and I. But you mentioned PT looks a lot like training. And I think that's the biggest change from when I started, you know, and there was like in school, everything was down the table.

You give them some higher level drills. kind of do them off on their own. ⁓ now PT and training, they're almost kind like that, the same thing, right? And even at Perfect Stride, because my background was training, I didn't have a whole lot of physical therapy experience. Everything I did was kind of, I just gave them personal training exercises. Like, you have knee pain, we're going to squat. You have back pain, we're going to deadlift, right? And there was...

It was just kind of taking personal training and just adapting in the environment. It was helpful, right? But I was definitely missing the piece. And it's kind of evolved a little bit where, you know, training now on PT, they kind of go hand in hand. And I think what a lot of people are missing in their rehab and where I see people struggle is they don't have the higher level loading happen and it's guided. They go through physical therapy and they do their workouts. And then what ends up happening to all these people who really struggle is when they start to load heavier and heavier.

their pain comes back. And it has nothing to do with the rehab that they've done being wrong, but they haven't had guidance through the fitness, the loading, the higher level activities, and they haven't made their tissues adapt to that to make that jump yet. And that's where I think a lot of...

Joe LaVacca (24:10)
Mm-hmm.

Joe Gambino (24:27)
what we do is becomes very, very valuable, right? Like obviously, sure, we can help someone get out of that initial pain. We can move them to get them to a point where they feel confident again, but we can also take them over that hump and get them back to a performance where they feel really, really comfortable. And that's that guidance there is the difference. And I think with where I was at Perfect Stride and where I'm now, it's, instead of just going like, it was almost like a top down approach. ⁓ when I was originally at Perfect Stride, was like, you have pain.

We're just gonna do the exercises, the fitness-y looking stuff. And now it's more of a bottom up approach. I break down the movements. What can't you do? How do we start to mobilize those things, get them moving? How do we load those tissues and then take it back to the higher level movements? So it's a little bit more nuanced now, kind of how I'm approaching it and more, okay, well now I know how to rehab injuries. So we can kind of do this process, but we can still do this training around it.

And I think when we have that approach, the people who are very, very active that are struggling to get back, once you have that kind of nuanced approach, it makes the world of endurance. Cause sometimes they just need to move and do the exercises. So when I was talking to not a client yet, but she was telling me, you she's looking for a physical therapist. She's seen physical therapists and she's doing a lot better, but every time she lifts, she, she's in pain. was like, in my mind, we haven't talked about this.

You just need some guidance in the fitness world, right? Like you don't need another physical therapist to give you more PT exercises. You need what happens when we're deadlifting and you get to a hundred pounds in your back hurts. Like how do we build the volume? How do we build the intensity? How do we build maybe a little bit more capacity around the spine? However, that may need to look so that you can tolerate those stresses better. And that's really more what this person needs, not a PT program.

Joe LaVacca (25:53)
Right. ⁓

Right. Right.

Yeah, I know. I completely agree. And, you know, maybe one of the last things that you made me realize just now was the biggest difference to other than how PT looks or sounds or feels, or the appointments being spaced out. A lot of the best results I get have been virtually with people. And, you know, that wasn't even, I don't even

I think that was in the landscape 10, 15 years ago when we came out of school. I was never thinking about a virtual physical therapy appointment. How could that ever be? I need to touch you. need to do mobilizations. I need to put heat and ice on you. I need to stim you. I mean, I can't do that virtually. And then I don't remember the first actual virtual consultation I had, but I was like, wow, that was, that was awesome. And it was quiet and silent. And we just focused on each other and

I didn't have to get distracted by music and clanging weights and people screaming. And I was just able to ask this person what they wanted. And they told me and it was amazing. And it was like, wow, that should be more of the recipe I chase. What can I do to help the person in front of me? Because they are seeking services. If their guidance thus far has sort of been incorrect or lackluster, then yeah, exactly what you're saying.

It doesn't seem like you need more of manual therapy, more of stretching, more of this. You need a progressive program. That's the thing that's missing. And through that virtual experience, I think that's running true every single time. And then that's what's sort of pushed me into, you know, getting a strength coach certification, understanding more about programming and conditioning and helping people that way, because that has led to more empowerment.

and people breaking through some of those barriers of being stuck, you know, more than anything else. And I know maybe people listening are a little bit averse to virtual training, virtual consultations and stuff like that. But Joe, if your current experience is any indication, if your company's growth is any indication, if my experience is any indication, ⁓ I would say that your aversion is probably false. Give it a try.

work with somebody that can guide you, that can progressively overload you, that can teach you the fundamentals about getting back into a gym, your home, your basement, whatever you have, bands, dumbbells, but get under that load and keep pushing it forward a little bit more. And that's definitely not something I would have thought 10, 15 years ago.

Joe Gambino (28:59)
Yeah, no, that's a, I think that's a good point. think a lot of people, um, if there's any take home for people who've been going through things for a while is, you know, at some point, like everything you've done from a PT over and over again, it's not making a major change. Then maybe focusing more on the, on the fitness component and finding someone who has an understanding. Um, there are a lot of good trainers out there that are starting to that understanding. then we have PTs like us who, you know, have the understanding of the fitness world. So the worlds are getting smaller, right? They're coming, coming closer together.

need to do some research and find the person that can have the tools for you. But sometimes you need to look outside the box if what's not working continues to not work. Because there's a lot of people I talk to who have seen a lot of different physical therapists and the results are always the same. And sometimes you need to find somebody who can move into that fitness world and blend that a little bit better. It may not be the easiest thing to find, ⁓ but I think with

podcasts, know, and Instagram and things like that. It's easier to find somebody who you can kind of jive with their philosophy and not just have to go to the place down the street because your insurance exception. So it becomes easier, I think today more than ever, or maybe it's harder because there's a lot of stuff that's out there. You can go both ways. ⁓

Joe LaVacca (30:09)
Yeah, yeah, it's that paralysis by analysis, you

know, and I think financially that's what probably turns people off too, like you were saying. And I challenge that notion all the time because I think people don't value or understand that their time is money. And if you're going to a clinic three, three days a week, even if you're paying 50 bucks, okay, that's $150 a week. And you still have not had as much time with your physical therapist.

that you or I can give you in a single session. So I always tell people that reflect how much is your time worth? Do you want to see someone and maximize that time for one visit a week or one hour a week? Or do you want to spend four to five visits somewhere else spending the same amount of money over the course of two, three weeks or more?

And would you get out of it? All right. You just lost more and more time. So I think that's always the biggest thing that people realize. Your time is valuable. Treat it as such.

Joe Gambino (31:15)
Yeah, and I think that's a great point. These environments where we're working, don't see people.

multiple times a week for weeks on end, We do as much as we feel the person needs, right? We're able to create a prognosis and kind of guide that process and let you know, this is what we feel. Sometimes it needs to be more, sometimes it needs to be less. It really just depends on where the person is. But is there anything else around this ⁓ concept of where we were to where we are today that you'd like to kind of bring up in here?

Joe LaVacca (31:25)
Right. Right.

No, I think ⁓ we can always add a little bit more. think the thing we didn't touch on this episode was the advancement of technology and apps and all these cool new devices that are out there now, which ones are worth it, which ones aren't. So maybe we could pick up that conversation next episode and talk a little bit more about that.

Joe Gambino (31:57)
Mm-hmm.

Yeah, I like that. think we can definitely do a few episodes on that. have a couple different ideas. So let's throw that around. But otherwise, let's take it home.

Joe LaVacca (32:17)
All right. Well,

exciting foreshadowing everyone. Thank you for joining us. We love you, Joe. love you. Have a wonderful weekend, everyone be safe. Happy Memorial Day and we will see you next week on another exciting episode of the Beyond Pain.

Joe Gambino (32:21)
Thank

You mean we hope you have a happy Memorial Day because this will be out right after Memorial Day. ⁓

Joe LaVacca (32:37)
we already hope you did. That's right. Good catch, Joe. Good catch.