Episode 63: Training Is Healthcare: Building Resilience Beyond Pain with Katie Dabrowski

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• Joe Gambino
• Joe LaVacca

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Summary:

In this episode of the Beyond Pain podcast, Joe LaVacca speaks with Katie Dabrowski, a physical therapist and director of rehab at Old Bull Florida. 

They discuss Katie's journey through pain and injury, the complexities of pain and suffering, and the importance of viewing training as healthcare. Katie shares her insights on how to help clients navigate their pain experiences, the significance of resilience, and the need for a holistic approach to rehabilitation. 

The conversation emphasizes the importance of empowering individuals to take control of their health and well-being, moving beyond just pain relief to fostering overall wellness.


Takeaways:

• Katie Dabrowski is a passionate physical therapist and educator.
• Pain is a common experience that connects us all.
• The focus should be on creating robust and resilient individuals.
• Training is an essential part of healthcare.
• Understanding the psychological aspects of pain is crucial.
• Clients often overlook the importance of strength training.
• We need to help clients find joy in their activities despite pain.
• Communication and education are key in physical therapy.
• The healthcare system needs to shift towards a more holistic approach.
• Building relationships with clients enhances their rehabilitation experience.

Transcript

Joe LaVacca (00:43)
hello everyone and welcome back to the Beyond Pain podcast. My name is Joe Lavaca and I am one of your hosts. The other host is taking the week off. Mr. Joe Gambino is away with his friends and family. We hope he's having a good time. But if you know me, I can't do anything alone. So I brought on a very special guest and co-host today for everyone, Miss Katie Dabrowski.

Katie is the director of rehab at Old Bull Athletics in Florida. And Katie, you have two offices, Pinecrest and Coral Gables. Are you in both?

KATIE DABROWSKI (01:20)
No, I see patients only in one location and we have an incredible team in the other location. Yeah.

Joe LaVacca (01:25)
All right, all right, cool.

Katie is an amazing PT educator and I have been looking forward to having her on the podcast for quite some time. So Katie, I'm gonna let you take the floor, introduce yourself, whatever you would like our listeners to know about you, please help us understand a little bit more about Katie.

KATIE DABROWSKI (01:44)
Well, thanks for having me. I'm excited. You know, it's cool. I kind of put this together. So back when I was in PT school, which was like 2016 to 2019, whole like Instagram world of PTs wasn't super big yet, but Joe's page was one of the first that I followed. yeah, so it's like this cool full circle moment where I'm like, man, like who would have thought? So just very happy to be here and thanks for having me.

Joe LaVacca (02:00)
he'll love that.

KATIE DABROWSKI (02:10)
So yes, as you mentioned, I'm a physical therapist and a strength coach. I wear a few different hats. So, I'm yeah, co-owner and director of rehab of old bowl where I treat patients and then, you know, manage the team and help us continue to grow. have just the most incredible team of coaches and rehab providers. And at old bowl, basically our mission is to change healthcare and to make people when they walk in, not really know if somebody's doing training or rehab. very movement-based, very strength-based.

And we're just trying to really empower people to be the fittest and healthiest versions of themselves along just the normalcy of life of getting pain and injury along the way and how to come out of it. A few other hats that I wear, I teach neuroscience at a university, actually where I went to undergrad, which is pretty cool. And I love that. It keeps me kind of...

in the know of what's going on in the academic side. I'm a neuroscience nerd, so I absolutely love that part of it. And then being able to bring in some clinical stuff for undergraduate students who, you know, most neuroscience majors aren't just doing it for fun. They're doing it because they want to go to med school or PT school. And so being able to bring in clinical stuff is very cool. And then I also am involved with Gifted Academics. We're a group where we create

kind of no BS exactly what you need certification prep resources for the CSCS, the CPT exams, the CISSN, the sports nutrition exam. So just very, very passionate from the education side and just like, I don't know, man, trying to make this industry better and making sure that people feel really fulfilled. think our jobs are so cool, but...

burnout and maybe not getting the best resources, all of those things are problematic. So I'm trying little by little to help combat.

Joe LaVacca (03:48)
Yeah, well, if you could share your passion with our industry, I think there'd be a lot less burnout. And I think sometimes to me, that's what's missing. You know, I meet all these people and they're just like sort of confused on their journey. I know they're younger. They'll find their path. I told them to just give themselves time, meet themselves with some grace. You did have a little flex on us there when you said you were in PT school in like 2019. So you're obviously a lot younger than me, which is awesome. But I love hearing.

KATIE DABROWSKI (04:14)
Well, I did go

to school later, so I am 33 so I did go to school later. Yeah

Joe LaVacca (04:20)
Yeah, you're a lot younger than me. You're a lot younger

than me. No, but I love how, again, like, passionate you are about the field. And that always comes through in your Instagram page. And you mentioned Old Bull and how you guys have this team. It reminds me a lot of what I always see from Ryan at Reload. That's the team over here in New York City, where you guys all genuinely seem to like each other, which is also probably helping with burnout and helping you guys have a lot of fun. So, yes.

KATIE DABROWSKI (04:37)
Yes.

Yes.

Totally. We

consider Reload and Old Bull to be kind of sister gyms. as you can imagine, there's a ton of back and forth of clients in New York and Miami. So we actually get to collaborate a ton together, which is so much fun. And it's funny you mentioned that. I remember when I visited Reload for the first time, it was the very first time I had walked into a gym where it felt how I feel when I walk into Old Bull and where I just could feel this energy and this buzz and like...

Everybody's goofy and fun, but also so good at their jobs and passionate and focused on like creating this next level experience. And I felt that immediately at Reload. Like they are just an incredible team.

Joe LaVacca (05:26)
Yeah, we'll definitely talk a little bit about the environment of rehab where I am located at Strength and Motion. We're a private training studio. So all your kettlebells, dumbbells, barbells. So when people walk in off the elevator, there's always like a double take. And I'm like, yeah, sorry, there's no white walls or candles and that, you know, nice easy listening music in the corner. I don't have a Keurig. I don't have a hot cold pack machine, but you know, here we are. We got, got, we got weight. Let's go, you know? So I think that's really, really cool.

KATIE DABROWSKI (05:37)
Yes.

right.

Yeah. Yep. Love that.

Joe LaVacca (05:51)
I'm gonna start off with a couple of easy questions, Katie, just so we can get to know you even better. And the first one I have for you is what are you reading, listening to, or watching at the moment? You can go all three or just one, but what would you recommend to myself or the listeners out there?

KATIE DABROWSKI (06:11)
great questions. I love to read, but I find that listening to stuff is just easier with how busy we are. When I travel, I try to just pick a book to read for fun and kind of just try to relax with that. It's funny though, because a lot of the books that I pick to read for fun are not fun. Like I was reading, I can't even remember the, it's up there right now as I look up, the price we pay and it's all about the downfalls of the healthcare system and it's super depressing.

Joe LaVacca (06:35)
Cool.

Love it!

KATIE DABROWSKI (06:39)
My fiance is like, we're at a pool on vacation and you're reading about like dismantling the healthcare system. So that's just for funsies. But for, from a podcasting perspective, there's so much good stuff out here. Obviously this one. ⁓ I obviously I've been, I'm a big fan of just like, I'm such a strength and conditioning nerd. Like I love the iron culture podcast with Eric Helms. Like they're hilarious. And it's also just

Joe LaVacca (06:52)
Thank you.

Yes.

KATIE DABROWSKI (07:05)
extremely evidence-based but also just conversational. I think for PTs and for rehab folks who are trying to get more exposure to the SNC world and just like the lifting world, that's a really great one to listen to. So I'm always listening to that kind of in the background. It's a great show. Watching otherwise, I'm not really watching much right now, so I don't have anything for you there, but reading if you want to get

Joe LaVacca (07:28)
Oh, no Squid Game 3, no

bear, no nothing like that.

KATIE DABROWSKI (07:32)
I haven't watched that. No, also again, my fiance thinks I'm a serial killer because I'm not super into TV. So you're just learning a lot about our relationship right now. No, no, mean, well, sometimes I like comfort of watching the same things that make me happy. So Veep is our favorite show ever and we rewatch Veep religiously. So I guess that would be the answer. Yeah.

Joe LaVacca (07:49)
There we go. Love, Eep. All right, very good. All right,

cool, very good. What about music? What's on the turntables?

KATIE DABROWSKI (07:58)
I notoriously am known for PRing to like sad R &B so that's really what I like to listen to a lot. Frank Ocean is my favorite artist of all time so that's always kind of on in the background, you know, you just got to feel something when you hit that PR.

Joe LaVacca (08:08)
All right. All

right. yeah. You got to come down and start crying with all the hard work that you put in to get there. Yeah, I like it.

KATIE DABROWSKI (08:17)
It's so funny,

the people in the gym, actually my business partner is really similar to me, we have like mirror images of music interests, but everyone else will be like, can we put something else on? Are you okay? So, you know, just different interests in the gym.

Joe LaVacca (08:31)
Absolutely. Joe and I also have a loose kind of coffee theme on the show back when we were young and youngins. And there's actually a couple of our initial episodes on YouTube. And I think it might have been in my late 20s when we just started dabbling, recording ourselves in the back corner of a clinic and we would do it over coffee. So Katie, how do you take your coffee?

KATIE DABROWSKI (08:37)
Mm-hmm.

my gosh, I've never met caffeine I don't like. Big caffeine fan for sure. I like black coffee. I just wanted to just do the job, get straight into my bloodstream. Being in Miami, we're spoiled. We have such good coffee. So we have very, very strong, amazing coffee. I've also, I've gotten into matcha lately as well, which yeah, which has been interesting. I like it a lot too. So yeah, black coffee or some matcha and I'm happy.

Joe LaVacca (09:04)
Mmm.

Mm-hmm.

that's big at the gym too.

Yeah, I'm trying the matcha because I want to fit in with the trainers and everybody at the gym. So they do these like matcha latte runs and I'm just like, yeah, yeah, for sure. Get me one. And then there's a place called Cha Cha, which might be in Miami, too. I think they're a chain and you know, one of the trainers I bumped into him on the elevator yesterday and he was like, he has four iced matcha lattes. And I was like, how how much did that run yet? He was like, this was about $49 and 17 cents. And I was like,

KATIE DABROWSKI (09:29)
You ⁓

Mmm.

maybe.

I

Joe LaVacca (09:54)
Damn, I really wish I would have gotten in on it. He was like, I couldn't afford it. He's like, sorry, you would have been the fifth person I asked because I'm right by the elevator. He's like, I had four yeses and that's about, I carry 50 bucks on me and that's it. Now I can't eat lunch today.

KATIE DABROWSKI (09:55)
Yeah.

Hahaha

It's capped, yeah. Yeah,

it is expensive, it is expensive. Who knows if for good reason, but I bought in, it appealed to me, I'm the target market, you know, so.

Joe LaVacca (10:15)
Yeah.

Excellent. All right, Katie, thank you so much for being so open and cool so far. I'm going to switch gears for us. And aside from wondering how people take their coffee, the first question we always ask guests is what is your experience with pain and injury and how has that defined both the way you view pain now as a person and as a professional?

KATIE DABROWSKI (10:43)
That's such good question. Yeah, I mean, I find that most people who go into this industry, it's probably because they've dealt with something on their own from a pain and injury perspective and became passionate about how to help people do the same. So, you know, we've all had our shares of aches and pains and things like that. My biggest injury and probably the defining injury for me, I was a rower in high school and college and I had a pretty severe disc herniation in college that

actually stopped me from finishing my final year of rowing. And that in itself, devastating to somebody who spent their whole life in this sport to go to college for it. definitely such an emotional and psychological side of things that really stood out to me and just still something I'm really passionate about with helping people through. Looking back, it was such the

perfect storm of things coming together for an injury to be more likely to happen or symptoms to be bothersome instead of maybe not. know, rowing, it's obviously a really hard sport and a lot of stress on your low back, but beyond just the mechanical stress of it, I mean, in college rowing, you know, we are practicing 20 to 25 hours a week.

we are getting up at 4 o'clock every morning to be at the boathouse at 4.45, but we're still college students, so we're not really sleeping. And I was a lightweight rower, which comes with a weight restriction. So I was absolutely involved in disordered eating and not eating enough and lost my menstrual cycle. Like all of those things was kind of the poster child of low energy availability and reds.

Joe LaVacca (11:58)
Okay.

KATIE DABROWSKI (12:18)
I was a neuroscience major and set on getting a neuroscience PhD. So I was doing research and running into labs and trying to get publications. And I was again, also a college student. So the one day a week that we could go out, I'm going hard and I'm drinking all night on a Saturday. And it's just that cycle. it was, it's so obvious knowing what we know about the complexities of pain and how all of this stuff is linked. But at the time it was very much just seen as this mechanical injury.

And I remember I've always been quite strong. I've been training strength training now for 20 years. And by the time I was getting into college, like it had been something I had done for a long time. And when I was doing the physical therapy for my back, I could like do everything they were asking me to do because I was strong enough. But it hurt and it was really painful and it was really depressing. And I still felt I was debilitated all day. So it was this weird thing of like, how can I be so strong but then still have this pain?

Joe LaVacca (13:00)
Right.

KATIE DABROWSKI (13:15)
And I don't know if I even recognized it at the time, but now I do. And it just shows you how there isn't one answer for why somebody's experiencing pain and everything isn't based on some mechanical injury only. And everything isn't just an answer of like, well, you're just weak. So we have to get you stronger. So all of that stuff just really kind of like culminated. And I'm extremely passionate about helping people navigate those situations for themselves.

really being open and vulnerable about my own experiences to make people realize like there is a light at the end. mean, I don't think most people, if they look at my Instagram and see what I'm doing in training, I don't think most people would think that I've ever had a disc herniation that stopped me from my sport or that I couldn't tolerate deadlifting for a while. But I think it's a really great example of it's just made me a lot more resilient and a lot more psychologically understanding of how

Joe LaVacca (13:55)
Right.

KATIE DABROWSKI (14:09)
awful an injury is from a mental health perspective. Like looking back, it's so evident that I was just wildly depressed when it was happening and I didn't know at the time. So I think all of that, like I think these things shape our experiences so much and that's always been something that I hold very special to have been able to go through and then kind of help people when they're going through their own journey as well.

Joe LaVacca (14:11)
Sure.

Yeah, that story is amazing. And it's so common with a lot of the people that we bring on. feel like a lot of our clients are our patients. They look at us like you were saying on Instagram and they're like, well, Joe's never had pain. Katie's never had pain. know, Joe doesn't know what it's like to feel depressed or anxious. Katie's never had anything bad happen. And then you're like, well, hold on. I'm a, I'm a human being, right? I I'm just like you. Chances are we have experienced a lot of the same thing. And as you point out, you know, this devastation and the depression and

KATIE DABROWSKI (14:53)
Mm-hmm.

Joe LaVacca (15:02)
You know, obviously your neuroscience background wanting to help maybe some of the mind and body side of things. How often do you jump in and share your story or maybe when do you share your story with clients? Because I imagine discs and back pain, something you guys are seeing a ton of, working with athletes, reds is probably coming up all the time. So where do you kind of jump in and share your story? Where do you feel like that's valuable for people in the rehab process?

KATIE DABROWSKI (15:30)
one of those things where you definitely have to read the room because we don't want to make it about us. Like that's always the fine line, right? You know, I often, I like to discuss some of these things as a relationship starts to develop more from a personal standpoint because I definitely, I want to make as much as possible like this is about them and their story and that's a huge part of it for sure, but

I would say in most instances at some point throughout the duration of working with people, people will straight up ask too if I've ever experienced anything, or I will pepper in and share some of my own experiences, especially when there's things that are so personal that I can deeply understand, like a back injury. You know, I think unless somebody's experienced true back pain and like nerve pain, it's really hard to conceptualize just how debilitating it is, and it's one of those things.

Then this is to be said for any musculoskeletal injury, but I think back pain is something that's even more emotional than other things. And on the outside, you look fine. Nobody knows that really anything is wrong. And I just remember vividly, like, you know, I was a college kid, so still trying to go out and live my life. But like, I couldn't even be engaged in the situations that were happening because I was just standing there in so much pain. And that part of it is so difficult for people of like, well, how do I even have a normal life anymore?

Joe LaVacca (16:34)
Yeah.

KATIE DABROWSKI (16:45)
So I definitely share those things. And then additionally, like on the side of reds and like low energy availability and things that I talk with women very personally a lot about because the struggles of balancing training and nutrition and workload and not under eating and all of that, it's such a difficult concept for most people, especially women. And I like to be very honest that I've experienced the same struggles. Again, similarly, they might see me and be like, well, like,

you have all this muscle, you're fine, you've never had an issue, and it's like, no, no, I used to really struggle with this too, and it's things that I'm so excited to be on the other side of because I want to help people. So it's always probably weaving in at some point, it's just reading the room of when the appropriate time is.

Joe LaVacca (17:26)
Yeah, I've found that when people share their stories, they do feel so alone. And most of the time to just start that whole connection process, I'll just remind them, Hey, this is something I hear all day long. So what you're feeling, what you're going through is completely normal. And sometimes people are surprised by that. And right.

KATIE DABROWSKI (17:45)
Yes.

Yes, it's so validating. It's so important.

Joe LaVacca (17:51)
And I'll just kind of ask for permission sometimes. I'll just say, look, when you're ready, if you would like me to share some stories that others have gone through or myself has gone through, I'm more than willing to talk to you about that. However, like you said, I want to make this about you today. So let's figure out more things about you and your life. And I think this is a perfect segue because you're a college student. You have this pain. You're working hard. You're trying to be in your 20s and

set yourself up for the rest of your life, but then also compete as a rower and pain as you so wonderfully put it on a recent podcast as you're on, right? It's this connector. We all have pain at some point in our life. A lot of clients that I work with, and I'm sure this is the same for you, come in and they say, look, I have a high pain threshold. I can tolerate pain, but there's always a limit. And your story there just reminded me of that difference between

pain and suffering and pain being so complex. Yeah, I want you to focus on volume and load management and tissue reconditioning. I want you to focus on your sleep and your nutrition. and by the way, I want you to go out with your friends and I want you to, you know, manage your relationships with your fiance and I want you to be intimate and I want you to be social and I want you to be all these things. And you're like, how do I do that when I'm with pain? So

In your opinion, are we kind of focusing maybe too much on pain relief and not helping people with suffering? And how do we maybe go about distinguishing that?

KATIE DABROWSKI (19:28)
love this question so much. Yeah, I mean, I think, and I also love what you said about it being a connector because it's always, it still surprises me because again, we're just in this bubble and we talk about these things all the time, but the average person still really does not understand that pain is normal and that pain is to be expected. Pain is something that people are going to have.

throughout their life. It's part of the human condition. And the absence of it isn't the only way that you are healthy. And I think most people still really think that. And if we can shift that of thinking it as a connector and it being something that we know everybody is going to experience in one way or another, and our goal is to help people be as resilient and robust as possible psychologically and physiologically to be able to handle the inevitabilities of life, I think that's a really important mindset shift, and I like that.

concept so much. And in terms of, yeah, like how much we focus on pain versus the suffering side of things and just being able to like manage your life in spite of pain, I think that's very important. I think even over the past couple of years at Old Bull, we've really shifted a lot of our messaging even to pain-free training and come see us to get out of pain and are you dealing with pain? Let's fix it.

because I don't think our main job is to fix people's pain. I think our main job is to create a human and help create a human who is so, so mentally and physically strong and robust and resilient that regardless of what life throws at them, they can tolerate it. And to help create a game plan for when these things do happen and how do we manage all aspects of your life? How do we still find joy in life? How do we still...

Not think that pain is what defines us. That's really hard. It's a big, it's a tall order compared to just, you know, saying, well, I can kind of rub your shoulder and do some of these movements and your pain's gonna go away. I'm very clear on that messaging now where, you know, when somebody comes in to see us, a lot of, of course, their thought immediately is just about their pain. And I'm always explaining to people, like, we do things a little bit differently. I don't want you to be in pain and I'm sorry that you're experiencing it and I know it's not fun.

A big goal that we have is to restore and improve your function and make your quality of life better and help you see progress even if pain isn't decreasing every single day. Part of our goal is to help you recognize what progress is and show you how amazing your progress has been even if there's some pain day to day sometimes. again, that's a great opportunity for me to share my own pain experiences too. I don't train 100 % pain free. Stuff bothers me and that's okay.

So I agree with you. I think it's very important in our industry to shift a little bit from like a fix it approach and just like curing pain and more to helping people cope and develop skills to handle flare ups if and when they happen and to see them as data points instead of setbacks, to see them as information for the process and information to help us better guide what our program might look like to be able to handle things.

It's not perfect and it's not easy to get somebody to buy into that immediately. Something I talk about a lot and I've talked about from learning this with Craig Liebenson, who's a mentor of mine and somebody that I teach very frequently with. Instead of trying to change people's minds about things, we can create scenarios in rehab and training where we're violating their expectations of maybe the...

fear they have around exercise or the thought that pain means they can't do things and we can create an environment that's so positive and warm and welcoming that their mind might change without us having to tell them. I think we have lot of areas of opportunity in our industry to be better at that.

Joe LaVacca (23:04)
Yeah, I love so many things that you said there. I think that kind of like, and I think you and Craig both say this, like that kind of guiding by the side, right, negotiating people through their journey, and not making it just about pain relief. And the more I read about pain, and particularly chronic pain, one of the things I remind clients of it's not just your knee, you know, when we're talking about persistent or problematic pain, the longer it stays,

KATIE DABROWSKI (23:14)
Mm-hmm.

Joe LaVacca (23:33)
the longer it affects you as a person. And we know that the brain rewires and there are actual changes in the way we think and the way we behave. Some of those things might not be reversible. So rather than trying to eliminate a part of you, why don't we better understand it? And then why don't we grow you to this robust person who can handle everything and

KATIE DABROWSKI (23:57)
Yes.

Joe LaVacca (23:58)
know the right coping strategies when a flare happens or something doesn't go our way. And it could be smooth R and B, right? Maybe it's going for that walk, right? But you always have a plan to kind of move forward. And I think that's where a lot of the neuroscience stuff has helped me. And I would love your sort of input on this, because when we talk a lot about suffering with clients that I work with, one of the things I always want to know too is, well,

KATIE DABROWSKI (24:06)
You

Joe LaVacca (24:27)
Hey, going out, and we'll just use you an example, if that's okay. know, going out is clearly important to you. You're 20, you're in college, you're with your friends. You have though, this like really bad disc pain and back pain. What makes going out special to you? And if it's just being with your friends, well, hey, maybe you can't go out every Friday, but could you have friends over on then Saturday morning for like a game recovery morning and

tea and breakfast and coffee and you're still going to get the same thing, right? That friendship or that bond and you don't have to go and torture yourself at a place like a bar and dance and you know, hop around and then pay for it the next day if that's all you're looking for. So when we think about graded exposure in that sense, have you ever talked about people like that with like social elements on like breaking it down or going out for 10 minutes one night and then going out for 20 minutes the next night? I mean,

Do strength and conditioning principles sort of play across the board, even when we're thinking about a lot of the psychosocial elements of our care?

KATIE DABROWSKI (25:31)
I love that, absolutely, because I think most people when they come in to see a physical therapist or a rehab provider, a lot of times when they have pain, the expectation is just, and because it happens a lot, they're just gonna be told to stop doing that thing. Like, okay, well just don't do that. Like, okay, well that doesn't really help me very much at all. ⁓

Joe LaVacca (25:48)
Yeah. Right. How much do owe you?

KATIE DABROWSKI (25:51)
Yeah, yeah, you're like, okay, great. And they just feel very limited by what they're able to do. The amount of people, and I know you can relate to this, who come in and just have almost like a laundry list of the things that they were told they're not allowed to do anymore. And we have to unpack that. That totally happens from a social perspective too of like, I think when people start to really open their eyes to understanding how much more of the psychosocial side of things are impacting their pain experience too, that's where those conversations of, yeah, like.

graded exposure and progressive overload of social activities are important too. It's not just that we have an RPE cap on our movement and we're decreasing the range of motion so you can tolerate it. It's like, well yeah, what's the maximum tolerable dose of the social activity that you want to do? I think that's very important too. I think those are the concepts that are gonna continually set providers apart from maybe more traditional models or more models that are focused on

taking things away from you instead of finding ways to work with what you can do. And I think that's incredibly important for people. I most people, would argue, when it comes to pain, the more difficult parts of it beyond the physical sensations are feeling out of control in your own body and then also just feeling like your life is completely taken away from you and you are kind of a victim just to what your pain is going to allow you to do that day.

Joe LaVacca (26:47)
Yeah. ⁓

KATIE DABROWSKI (27:11)
So if we can create a strategy and understanding, like just like we're kind of slow dosing what we're doing in training, you can do that in your personal life too. I think that's a huge and very probably overlooked component of our conversations with people.

Joe LaVacca (27:23)
Yeah, as a as an as we kind of segue into that idea of training and strength and conditioning and you know, one of the principles that you talked about so much, which I see is kind of gaining momentum in our field, at least in some corners, depending on the people you follow is training is healthcare, right? And when you were opening up and you were introducing old bull and your mentality now, it's, you know, so much bigger than pain. It's

building people to become healthier. It's building people to become more robust. Yet when we meet people, I feel like they're always looking for that magic bullet. Well, what back exercise do you have and what quad exercise do you have? and I saw you doing a weighted pull up the other day like that. Like what, what exercise is going to help me do that with my shoulder pain? So when people are coming in with this idea that they need something specific for them,

KATIE DABROWSKI (28:02)
is in.

Joe LaVacca (28:18)
but we're trying to navigate this bigger picture. What does that discussion look like? How are you creating buy-in in those first initial sessions to say like, hey, look, we'll get to those things, but training is healthcare and elaborate on that for us so that way we can think a little bit outside the box.

KATIE DABROWSKI (28:38)
Yeah, absolutely. I think the first thing is I'm very clear immediately with a new patient, just kind of like how, what the goals of our facility and what our ideologies are that, you know, I like to ask if people have had physical therapy before and kind of what their experience was. And then I'll often say something kind of like, we do things a little bit differently here. The biggest focus that we have is making sure that you have a way to get a great training stimulus and be healthy and improve.

your general fitness in a way that is we can still manage your symptoms and and really finding all of the things that you can do without discomfort or pain. That's going to be a big goal of our first session. I kind of want to have like a list at the end of this session of here's all the things that we found that you can continue to do without pain because of how important it is for generally just your health being better. So having more muscle mass, having a better aerobic capacity, having good metabolic health.

having fun things that you enjoy. Those systemic effects physiologically and psychologically can move the needle way more than me just zooming in on one body part. Zooming in on one body part doesn't really allow us to take advantage of hormonally how amazing it is to have more muscle mass and better aerobic fitness to help support you for what you want to do in life. And we try to use almost pain as an on-ramp for the reason you came to see us was for pain, but

The reason I want you to stay with us and the takeaway I want you to have is we're here to help you make a health, be a healthier human. And I think if we're really clear with that expectation upfront, it helps because a lot of people, the questions I get a lot of like, what do do if somebody's just like coming in for a diagnosis? And if you start your session by discussing that and what your goals are, that starts to lessen the need for it. I'm also very clear because ultimately,

A lot of people associate a diagnosis with meaning that's now how I know what to do, or that's the only way that we're safe. And I'm always also very clear in saying, you know, my number one job as a physical therapist is to keep you safe and rule out red flags or things that would be dangerous and warrant the need for different medical intervention. I'm doing that today on our first session and I'm doing it every single time we meet. When I rule that stuff out,

we're very, very safe to be able to move forward with what I just talked about, with really prioritizing doing all the things that feel good and don't give you symptoms and finding entry points for the stuff that's hard right now. So I'm always doing that to keep you very safe and I will always tell you if something comes up where we need to reroute our strategy. So I think if you can be very clear with what you do and how you do it and then also that you are keeping them safe and that you are not.

flippantly not caring about a diagnosis to make a point that you are doing it because in the absence of trauma and red flags we quite frankly don't need it. That is really a goal that I have and that's a hopefully a way to help with buy-in.

Joe LaVacca (31:30)
I love that. When you're building these lists and all the things that they do well and setting expectations, how do you explain to them or how much do you let them work into discomfort?

KATIE DABROWSKI (31:43)
Yeah, that's the famous answer always is it depends. It's always going to depend on course, of course on the individual and what their tolerance is and what their injury history is. And for that, you know, sometimes what tissue is involved because we know if you piss a nerve off, it's going to stay angry a lot longer than maybe a muscle might. So knowing that stuff from a clinician standpoint, of course, is important. So all of that goes into consideration. But

A lot of it, I mean, I think most people just have a really hard time with understanding what is tolerable to push through versus not. I sometimes like, use the verbage is so different depending on the person, but a lot of times I'll kind of describe it as like, we're going to knock on the door of discomfort, but not open it. And I think that is an easy way for a lot of people because it's not a zero to 10 scale because what the hell does that mean to anybody? It's not like the...

you know, what is the green, red, yellow, red lights? It's like that's helpful, but again, not for everybody. So I try to find ways that make sense to people. I also will ask them like, does that feel like, you know, when we're doing squats and your legs are burning, like that type of discomfort, or does it feel more like it's making you change your facial expression? It's making you nervous. It's making you anxious. all of that stuff. Part of our job is to help people understand that not all pain equals harm and discomfort is intolerable discomfort.

Joe LaVacca (32:46)
All right.

Alright.

KATIE DABROWSKI (32:59)
is very different from sharp shooting alarm bells pain. So that's a challenge always. I'm purposefully pretty hands off when it comes to when I'm getting people to move around and explore movement because immediately most people are looking at me. They'll do like one quarter of a rep and be like, was that right? And I'm like, I don't know. So I purposefully like, I keep my language very vague about form. I keep my language very vague about

Joe LaVacca (33:16)
You

KATIE DABROWSKI (33:26)
where you're supposed to feel this, because I want people to just explore, and then I take their feedback and we can kind of get into the nitty-gritty from there if we need to. And that goes for pain too, like if you feel discomfort on your first rep, okay, well does it decrease when you continue? Is there a way that we can move your knee a little differently so it feels better? Like I need the data points of the person exploring movement before I jump in and tell them what they should feel.

Joe LaVacca (33:41)
Right.

Right. I use that term all the time. I need more data to help you. We need more trends. I need more than one workout. I need more than one rep. And I love that sort of collaboration with people. let them do a rep. Let them figure it out. Let them do a few. And I love being hands off. And what I tell them, like you said, my job is to keep you safe. If I don't think you're safe or if I think, you know,

KATIE DABROWSKI (33:55)
Yeah. Yeah. Yeah.

Joe LaVacca (34:15)
Something is going to harm you in the gym. Something's going to fall on you. I'm going to stop you. Right. If you don't hear from me, just keep going. And then we'll talk about it. And I always want to know what they felt first. Right. What did you notice through those 10 reps? Was it better? Same worse. Were you able to take the pain away in one or two of those reps? And then when they give me their feedback, then I sort of like try to confirm or just ask.

KATIE DABROWSKI (34:20)
Yeah, yeah.

Fud on, yeah.

Yes.

Joe LaVacca (34:44)
couple more questions like, well, yeah, it was interesting. You mentioned rep four and five because it looked like to me, you were just shifting your weight back or forward or this way or that way. And that seemingly when you had a little bit less pain. So why don't you try that tactic? Do it again, but now do it that way. And then to your point, Oh, that's not how I'm supposed to do it though. What are you talking about? I don't give a shit. Like you were squatting. It was less painful. I don't like we'll work on the other stuff that's going on the list.

KATIE DABROWSKI (35:05)
I don't care. Yeah. Yeah.

cares. Yeah.

Joe LaVacca (35:12)
Squatting with your weight shifting backwards, right? So, you

KATIE DABROWSKI (35:12)
Yeah. Yeah.

Joe LaVacca (35:15)
the things I use with the tolerable stuff because I love all my answers in New York City Well, I can tolerate anything if I know it's not gonna hurt me and I'm like, yeah, okay I guess so but I don't really think then you probably have had a nine out of ten pain or a ten out of ten pain But that's another conversation for another day. So I do use the breathing. I definitely use the facial expressions I always tell them that you know, I want them to clown up and slow down

KATIE DABROWSKI (35:21)
Yeah, of course.

rights.

you

Joe LaVacca (35:41)
During their reps if it's tough, right? So, you know, they're making the funny faces the rep gets slow I was like, but if you're grimacing in pain, we probably want to say is this worth it or not and Then and I don't know if you do this as well if you find value of this But I just sort of started saying like let's see how you feel 612 and 24 hours later Do you think that those are also like good runways for people to reassess? You know either programming is there a

KATIE DABROWSKI (36:01)
Mm-hmm.

Joe LaVacca (36:09)
better number that you usually give to your athletes or clients to sort of really like maybe look out for to know if they're in that right ballpark of volume movement load.

KATIE DABROWSKI (36:19)
That's actually precisely what I say usually too. You know, I, or even just simply like, let's see how you feel the rest of the day and to tomorrow. But yeah, absolutely. I think I love all of those strategies. Yeah, I think making people a little bit more of an active participant in their pain experience and their rehab experience is huge. Because ultimately I think most people are coming to us with this expectation that we're going to, there's a right or a wrong way to do everything. And we're going to tell them the right way to bring it.

Back to neuroscience, like the way motor learning occurs is by trying a bunch of stuff and seeing what the most optimal way to do it for your goal is so you have the most success. I'm taking away somebody's ability to have motor learning, which is taking something that somebody is moving, somebody is learning from a movement capacity and bringing it to their cortex so it stays there and creates context and is now part of their frontal lobe real estate.

That's what is so important with this stuff because we're taking it away from more temporary learning and we're turning it into something in their cortex that stays. So if I take away that by telling a person immediately what I want them to feel, showing them really specifically their form, stopping them every five seconds, having a clipboard and giving them a checklist of all the things they need to do, I'm taking away their brain's ability to learn and create context. And that's extremely important for

being an efficient mover and helping to like, how do I utilize the strategy that's best for this task, like things that are really important. So I think that's huge. think the more I kind of joke about it where I'll give somebody a movement and they might even say like, well, how do you want me to do it? I'm like, let's see what happens. I don't know. And I purposely act a little bit like kind of standoffish and joke about it because I want them to know that it's not that serious. If it was that serious, I wouldn't act that way about it. But

Joe LaVacca (37:59)
Yeah.

KATIE DABROWSKI (38:10)
Like nothing that we're doing is so life or death that if they move their knee in this direction, their movement's wrong and they're gonna explode. So I think that is another way of like how we act when we're coaching people. It's very important. If somebody does a rep and they say they feel it and we're like, okay, well, next, we're gonna move here, we're gonna change this. Like we've just now terrified them and they're now scared of that movement and they're gonna add that movement into their associations of things that are bad or wrong. So the more calm we can be like,

Joe LaVacca (38:27)
Yeah. Yeah.

KATIE DABROWSKI (38:37)
Even if you flare somebody up, we're all gonna do it. The more calm we can be, the more calm they can be and we can start to hopefully unravel these associations of like, ex-movement is bad. This pain means I did it wrong. That's the stuff that matters so much in rehab.

Joe LaVacca (38:54)
Yeah, I would love to reference a movie here, but I know you're not going to get it. Inception with Leonardo DiCaprio. Have you at least seen that one or?

KATIE DABROWSKI (39:02)
I actually have seen that one. ⁓ Yeah, so thank you very much. That was one of those movies that I think when I told my fiance that I hadn't seen it, he was like, what is, we're putting it on right now, what do you mean? So yes, yes, I have seen it.

Joe LaVacca (39:03)
Alright!

Game changer, yeah, game changer. So yeah, I always think about that. Like I

want to plant a seed so that they come up with an idea or a thought process. And it's like they came up with it on their own and it wasn't just me giving it to them. And I think really that's the art of coaching. And I'm so happy that you mentioned the reactions of us. And I can recall multiple times where

KATIE DABROWSKI (39:25)
Yes.

Yes.

Joe LaVacca (39:40)
You know, having difficult conversations with clients about anxiety and depression actually sparks some tough, you know, debate. And the more you react without realizing, you know, maybe where a person's coming from, or the more you react to someone, you know, putting a weight down and grabbing their low back, which has happened to me a few times. Again, you're going to think about, you know, reinforcing that idea of like, no, like now I hurt my back or I'm feeling this. my God, Joe's reacting.

KATIE DABROWSKI (39:59)
Mm-hmm.

Joe LaVacca (40:08)
this must be even worse. And oftentimes I've sort of like just tried to come to this idea of like, just don't react to anything, even when a person PRs. I'm just going to be like, I want to see what they do first, right? Cause inside I'm like, Oh, I want to hug you. I want to fist pump you. And I want to high five you. But I was like, do you realize what you just did? And sometimes people like that, they drop the weight and then they walk away from it. I'm like, what are you doing? That was awesome. Like, that's amazing. Like there was like a 300 pound squat. What are you doing? And they're like, yeah, that felt pretty good. I was like, what do you mean it pretty good?

KATIE DABROWSKI (40:16)
Yeah. Yep.

Yeah.

Right.

Yeah.

Joe LaVacca (40:38)
Same exact thing. It's like, you know, I got back pain in the squad. It's like, you know, okay, well, let's talk about it. Okay, you know, let's go from there. So I am really happy that you brought those things up. And I'm really happy that you've seen Inception. I think all the viewers too, and people listening can also collectively exhale. So as we're talking about clients, you know, starting their journey, or maybe getting some buy in, I'm sure also the other side of this coin is we meet people who tried

KATIE DABROWSKI (40:42)
Okay. Yeah.

Hahaha!

I'm so glad.

Joe LaVacca (41:05)
You know, they're, hitting their activity guidelines, you know, they're following, you know, to some degree, you know, a nutrition program, they're sleeping well yet, you know, they still have pain. I really think your background here is probably so valuable with the neuroscience, with your own experience, with all the things that you've like now sort of like collectively been building with old bill, old bull, sorry.

KATIE DABROWSKI (41:06)
Mm-hmm.

Joe LaVacca (41:33)
How do you negotiate? okay. This is my New York accent. can't talk. So how do you help those people identify opportunities or just renew their faith in the process again?

KATIE DABROWSKI (41:34)
My phone always auto-corrects to old Bill, so that's hilarious.

Yeah, yeah.

that's a great question. I find often when we get people who come in feeling that they've tried everything, the one thing they actually have not tried was trying to maintain their fitness with what they can do, find all the things that they can train without symptoms, find an entry point for what currently gives them symptoms, and then finding things to still give them joy. I find when most people come in and they say they've tried everything, they've tried...

acupuncture and they've seen this guru and they've tried this corrective and they've done bird dogs for four hours a day and they've done dry needling and they've done e-stim and they've done all of these things. It's always so surprising to me when I hear people say like, man I have tried everything. I had somebody with a, like a, just a nerve impingement, no red flags, nothing like that, but he had experienced weakness in his arm.

and he had been dealing with it for a long time on and off and he comes into me for the first time and says he's tried everything. Well I ask him what that is. His main symptom being that his arm feels weaker. Well he's tried chiropractic and this is not a knock against chiropractic but he's tried more like hands-on stuff. He's tried acupuncture needles, medications, all of that stuff and I said well that's interesting because the thing that you say that you're having a struggle with is you feel like your arms gotten weaker. Have you tried strengthening? He said no.

Joe LaVacca (42:48)
Mm-hmm. Sure.

KATIE DABROWSKI (43:01)
So I think a lot of times I think we forget how people still are so unfamiliar with what the body actually needs when there's pain or injury. And they try a lot of other things instead of actually the stuff that doesn't really sound as sexy. Like it's just like getting it a little bit stronger. Like you've poked and prodded and you've shoved needles in it and you've done all these different things, but you haven't actually done the thing to address the symptom that you came to me with.

So I think having that conversation of like, well, what have you tried versus the things that we do that are might be a little bit different and trying to create that window of hope there of like, hey, we have a lot more that we can work with. We have a lot of strategies. You haven't closed the door on every possible option that you have. In fact, you came to the perfect place because we have different strategies that I feel very confident are gonna help you. I think that's a big part of it, like showing.

Joe LaVacca (43:47)
Right.

KATIE DABROWSKI (43:53)
our confidence that we can help people with these tools because we trust physiology. Like we know this works. We know if we create a stimulus that is great enough of a challenge, we're going to get an adaptation. We know that.

We know we're gonna get that in your tissues and I know I'm gonna get that in your brain too because I'm slow dripping this movement that you're scared of that yes, I'm trying to get your tissues more tolerant of but I'm trying to make your psychology and your brain more tolerant of it too. So I think if we can honestly make people excited over like, no, you haven't tried everything. You haven't tried something that I'm so confident about. I think that's helpful.

Joe LaVacca (44:29)
Yeah.

Yeah, I love that. I love that. Thank you for sharing that. And I think that's so important. And that's the definitely the common theme that I find here in New York as well as I've gone through all of these passive modalities. Yes, I'm doing a lot of things right. But maybe we haven't capitalized on the biggest pieces. And I often will compare it to like a roulette wheel. I'm like, if you and me were going to Vegas, and you're not taking care of just general fitness, the things you love doing, you know, the things that bring you happiness.

Those are the biggest pieces on the roulette wheel. I'm gonna keep betting on them every single time. again, nothing that knocking anything else but the acupuncture, the dry needling to this, they're so small. Yeah, we can get lucky and it can land on that space, but it's way more likely if we keep betting on these big pieces, we'll probably get the results that we're looking for. So thank you for sharing that.

KATIE DABROWSKI (45:20)
That's what I always,

yeah, I love that analogy and I always try to talk with people about that of like, you know, I want to find the things that move the needle the most and all of the physiological and psychological things I just mentioned, that moves the needle the most. The other stuff is nice to do. Is it need to do? Probably not. If it makes you feel better, I am never going to tell somebody to do something that doesn't temporarily decrease their pain. Like we love temporary pain decreases. That's important. But if we want to focus on the things that

Joe LaVacca (45:40)
Exactly.

KATIE DABROWSKI (45:47)
are going to be like the most opportunity for change, because ultimately that's what I want to spend time on because that's what you're paying me for, we're gonna do that and we're gonna use this hour and get the most out of it that we possibly can that will move the needle and that's why we're doing what we're doing.

Joe LaVacca (46:03)
Katie, I wanna be respectful of your time. got one more question if that's okay. And I'm actually gonna let you choose how you wanna answer it. What do you wish either more patients knew or more physical therapists knew? You can pick either one that would enhance their understanding of care and the outcomes that we really are looking for.

KATIE DABROWSKI (46:22)
I offer one on each side. Okay cool. Okay good. So I feel like it kind of centers on a lot of what we were just talking about for patients. I wish patients understood a bit more of what I think our job as physical therapists actually can be beyond just fixing their pain or providing like a feel-good session. I think that with the right training

Joe LaVacca (46:24)
That was my hope.

KATIE DABROWSKI (46:44)
with the right focus on communication and education. I think we're so much more equipped to help people have just like a healthier human as a whole and zoom out on the really specific stuff that we learned in school, zoom out from the special tests and the poking and the prodding and the things that give us this like hyper specific answer and care much more about what we can do to make them a healthier human mentally and physically. I wish more people understood that that's what we can do.

We have such a rare opportunity to have the time that we have with patients, even in a busier clinic. Like, I know we're fortunate that we have an hour with people, sometimes more. Even in a busier clinic, if you're seeing two patients an hour, that's still way more time, mostly one-on-one, than they're ever going to have with any other medical provider that they see.

So I think that's, I wish people knew that because of that time and the relationship development we get to do and what our general understanding of the human body is that we can do a lot more than just care about like zooming in on their tissue. And then conversely, I think it's kind of similar for physical therapists. I think we...

I think one thing that is really lacking in our industry is knowledge of strength and conditioning principles and how to really appropriately challenge people. think PTs are often very good at taking away pain and the bad stuff, but then the person is left with not really knowing how to ever challenge themselves again or knowing that they don't have to have all these limitations. Your pain can decrease if you just stop doing stuff and stressing your body, but

I think we need to be taking people so many steps beyond that. We need to help people reintegrate into their lives. We need to help people understand the importance of muscle mass and their aerobic system and their metabolic health for overall musculoskeletal health. mean, there's tissue changes in people who have poor metabolic health that looks the exact same as tendinopathy. So if we can help people just be healthier humans and maybe not only think that our job is to

Joe LaVacca (48:40)
Yeah.

KATIE DABROWSKI (48:45)
temporarily reduce their pain or give them limitations, I think that's very important.

Joe LaVacca (48:50)
Well, Katie, amen. Um, I think, uh, I can say very confidently, um, I've gotten better because of this conversation. I hope our listeners have gotten better. And with that last answer, I am very proud to have people like yourself leading our field. So thank you for all you do. I'm going to throw one last game at you. It's just for fun. Okay. There, there is no, there's no writer. It's called this or that. Right. You probably, you know, have played it before.

KATIE DABROWSKI (48:53)
Yeah

nervous.

Joe LaVacca (49:19)
We're not looking for answers or rationale. It's just this or that you pick. You don't have to explain yourself. There's no judgments. Okay. All right. I'm going to start you off with an easy one. Dogs or cats, isometrics or plyometrics, quads or glutes, calves or abs.

KATIE DABROWSKI (49:27)
Okay, I'm scared.

bugs.

plyometrics.

Clutes.

tabs.

Joe LaVacca (49:42)
Pizza or tacos.

KATIE DABROWSKI (49:43)
my god, what? This is the first time I've really had an issue. ⁓ Pizza? Yeah, yeah, yeah, I love that the easy questions are first.

Joe LaVacca (49:48)
That's why we ease into that one.

Yeah,

it's like yeah, what do I think about my like whole life training? Yeah easy. Pizza or tacos? What? I know you only listen to soft R &B, but Kendrick or Drake? Yeah, Tom Cruise or Brad Pitt? And we have come to the conclusion. Katie, thank you so much for your time today. I greatly appreciate it. For those who want to work with you, get in touch with you,

KATIE DABROWSKI (49:57)
Yeah. It's like, you're a monster.

Kendrick.

Joe LaVacca (50:20)
learn from you all the stuff, where can they find you and tell us a little bit about your upcoming course in New York City.

KATIE DABROWSKI (50:26)
Yes, awesome. Now this has been so much fun, except for the devastating question of pizza versus tacos, but we'll overlook that. Instagram is always the best way. My Instagram, KT Dobrowski, or our Old Bull Athletics page. Great resources on both of those, or if people have questions, you can always slide in the old DMs. And otherwise, some things that are coming up. Yes, I am teaching my Training as Healthcare course, which is my favorite thing that I get to teach. I have a part one and a part two now.

Part one is focused on the lower body. Part two is focused on the upper body. Essentially, a lot of things that we talked about in here, finding entry points for people, finding safe starting points for people, regardless of pain or injury, and regardless of being a coach, trainer, or rehab provider. So finding all the things that are within all of our scopes of practice, which is movement, and how do we rule out red flags to ensure that we are appropriately dealing with these things.

The main kind of thesis and premise of training as healthcare is that diagnosis matters a lot less unless there is trauma or red flags. When we rule that out, us as rehab providers, coaches, trainers, we have a lot more of an even playing field of how we can help people and there's so much more we can do for people in pain before we ever have to refer them elsewhere. I'll be in New York City. Actually, I'll be in Newport Beach in California the weekend of September 20th for part two.

Part one in New York City will be October 18th and 19th at Perfect Stride PT in the city. And I'll be back there again January 24th and 25th for part two. We still have some spots, it's super limited. So if you wanna get some of those remaining spots, highly recommend looking into doing it.

Joe LaVacca (52:01)
Yeah, unfortunately in October I will be in Tokyo, but this is a course where I looked at, was like, I reschedule Tokyo so I can get to this course? So ⁓ clinicians, if you guys are out there in New York City during those dates, please go check out Katie. Katie, thank you again. We greatly appreciate it. We'll have to have you on again. I probably have about another 14 questions that I just wrote down for us. So we appreciate your time. Thank you so much. And we hope to have you back on soon.

KATIE DABROWSKI (52:09)
You

Thank you.

Perfect.

Yes, thank you.