Joint Effort PAs
We're two orthopedic surgery physician assistants discussing PA school, life as a PA, cases and topics related to orthopedics, and much more!
Joint Effort PAs
Patellofemoral Pain Explained
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Patellofemoral Pain Syndrome: the diagnosis everyone has heard of, but nobody can seem to explain in less than 30 seconds.
This week, we're tackling one of the most frustrating conditions in orthopedics. Why does PFPS seem to affect everyone from runners to weekend warriors? Why do patients expect a quick fix when the answer is usually "it depends"? And why is it so difficult to explain that the pain is at the knee, but the problem often isn't just the knee?
Beth breaks down how she approaches patellofemoral pain in clinic, from evaluating biomechanics and movement patterns to discussing the role of the glutes, VMO, core, activity modification, and patient expectations. We also talk about why treatment can be slow, why compliance matters, and why there isn't a magic injection, brace, or surgery that solves every case.
If you've ever struggled to explain PFPS to a patient—or you've wondered why your knee hurts every time you take the stairs—this episode is for you.
Welcome to Joint Effort PAs, where two orthopedic surgery PAs get real about life in medicine. From tips and tricks to professional growth, work-life balance, and everything in between. We're here to share what we've learned and what we're still figuring out. Let's get into it.
SPEAKER_02All right, are we recording?
SPEAKER_00Yeah. Yeah, it's happening. No. Sorry. Okay. I'm here. I'm in. Mike is on. Yeah, it has been. I mean, not this whole time. So our our pre-recordings are still safe.
SPEAKER_02They're they're sacred. They're locked away somewhere. Can't be bought. Cannot be, not yet, at least. All right, Hannah, how was your week this week? It was okay.
SPEAKER_00Okay. It was it was emotionally taxing. It was like a four minus. Yeah. But you know, next week's another week. Yeah. I'll say that. Yeah. I um I will strive to be better.
SPEAKER_02Okay.
unknownYeah.
SPEAKER_02Always, always good, good goals. Mine was also mediocre. Um, I don't really know what else to say other than that. I got a couple um staff members turning over and a couple good leads on new providers, so that's good. Um, but again, just in the the sitcom of our lives, this was this was mediocre.
SPEAKER_00Yeah, mediocre, the week of the doldrums. Yeah. Yeah. Um, so yeah, something equally as mediocre.
SPEAKER_02Yeah, no, or we're gonna be mediocre as a good transition.
SPEAKER_00Yeah, we're gonna transition into something quite mediocre, but it isn't mediocre. And that's the point.
SPEAKER_02No, this is gonna be very, very, very helpful for any orthopedic PA that is new or that doesn't really have a wrap on how to talk about patelephemoral pain. So patelephemoral pain is a diagnosis we love to hate, and also the patients we love to hate. So that that's pretty accurate, right?
SPEAKER_00Yeah, yeah. It is one of those things that sees you a lot, and explaining it is so challenging. Obviously, coming up with a plan that works is very challenging and it just continues to plague you. These are the people that like, yeah, no matter what you do, they keep coming back and they're like, nothing is better. And yeah, like lose things to offer them.
SPEAKER_02Yeah, I I see this a ton. And um, I do think I do a really good job at explaining what this is, and it's always a kid or a 45-year-old female, and their parent. That's what's like so hard because the parent comes in wanting answers, like they, you know, metaphorically and literally have a notebook of like, here's what we tried. Before I even talk, you're like, I'm gonna save you some time. We've done this, we've done this, we've done this, we did this.
SPEAKER_00And you're like, wow, I've done every you've done everything. I was just about to offer you.
SPEAKER_02Yeah, and I I really do think I do a good job with this because I've like I've had, you know, a very beginner conversation. Then I've like developed that, and I really think you do a good job. But I got a two rating in the month of May. No comment, no nothing. Like it was a drive-by shooting. That's what it felt like. Yeah, I don't know who it was. Someone robbed me, and I just like, wow, where's my wallet? Like I just have to move on.
SPEAKER_00Like you can't you can't call the sheriff to know or you can't call the sheriff.
SPEAKER_02No, and I know I normally can like email the person who like looks at this stuff, and I did, and they were like, Nope, no comment. Let me know if you need anything else. I'm like, I need you to be a detective. Like closure. So I think it had to have been on a patelphemoral pain patient because those ones I think are the most dissatisfying visits for everybody.
SPEAKER_00Side note, not funny, maybe it will be funny, but like the amount of time we spend reveling in these things. What if the person just like got the thing and accidentally like hit the two on their phone and was like scrolling through things and like whoops, and you're sitting here for hours, like who said that?
SPEAKER_02I know, but like I feel like the people who give you a one give you a scathing remark. They just do because they've got stuff to say. The person who gave you a two was basically a fuck you. They just like slash my tires. They were like, Yeah, here, sit on that. Yeah. Anyway, um, so I think, and you know, you can you can relate in the hand world, but this is a diagnosis that I see a lot of. It's so abstract. Um, patients have pain with patellmal pain, anterior knee pain, generally not injury related. It is bilateral, but sometimes unilateral. They've seen X amount of providers, they're coming to you with hope because everyone's told them, quote, nothing's wrong. They've had all the tests, they've had an MRI, they've had an X-ray, they've tried PT, they've tried home exercises, they've invested in braces, they have the skin outbreak from all the taping. Like they already come in telling you that they're they've tried all the things that you're gonna suggest. Yeah, yeah, yeah. Um, but we see this, like, God, I wish I had the data on percentage of how much we see it a lot. We see it a lot.
SPEAKER_00So this presents as like what the typical person, like you said, female in their 30s, 40s or a kid, um, typically female.
SPEAKER_02Yeah.
SPEAKER_00Anterior knee pain. Yeah, like vague anterior knee pain. Yeah. Um, you know, this isn't like your typical because you can the other differentials you can think of this, especially with kids, like Osgood Schlauders, they're sending Larson Johansson, like not those things, not very clearly defined, just vague, um, vague achiness.
SPEAKER_02Yeah. So I mean, a lot of primary care we'll call this growing pains, and then that appeases the parents until they stop the kid stops growing.
SPEAKER_00I would argue growing pains would more be like you would say that as far as um Oscar Slaughters or something.
SPEAKER_02But growing pains, growing pains comes with like, hey, you're growing, so just live with it until you're done growing. And then when they come to us and they're done growing, they're like, Oh yeah, now what? Um, but the questions are like, why is it so simple? Like, I'll study patelephural pain, you know, like before boards or whatever, boom, done. Two seconds, interne pain, conservative treatment. Next, but why is it simple on paper, but so impossible?
SPEAKER_00I think it's because nobody's figured it out yet. So like the textbooks don't even know.
SPEAKER_02I think I think like um very difficult, like cancers, which this is a cancer in my life. Yeah, I think it is multifactorial treatment. And I say those words like there is not one thing. I don't have a packaged up pill or one answer that's gonna fix you. It's gonna be a lot of things, and we need to figure out what your formula is. Like, what is the combination of things and in what order to get you out of this syndrome? Um, but the visits are long, they're like emotionally long. Yeah. Um, I like to go in with direction because if I don't, then I'm like all over the place. And then when they don't improve, like I before I go in for the follow-up, I'm like, please be better, please be better. And they're like, no. And then I'm like, but like a little, like I'll try to like bait them, you know. Um, and then it makes me feel like I don't understand it. Yeah, you know, because there's gotta be something else. Um, and I teeter for some of them. And again, take all the pale formal pain patients, those that we operate on, are such a small amount. And again, we'll go through like contraindications and indications. I want to offer them surgery. I do, but they never get better.
SPEAKER_00Yeah.
SPEAKER_02And they want me to too. They want me to also offer that for them.
SPEAKER_00Yeah, but like I think, and I will make this akin to like ganglion cysts, my cancer. Um, you know, they they come to us after they've already had it drained, they've had it this, that bracing, whatever, and they just want it removed. And the people who get their dorsal ganglion cysts removed still complain of dorsal wrist pain after the cyst is gone. Um, and then like, oh my God. And then what about when it comes back? If it comes back, yeah. Terrible. You said I'm gonna fix it, it won't come back. Yeah. Um, I never tell them that, actually. And we can get into our spiels, but I bet it's probably similar to yours if you get to the point of surgery where you are very strong with the wording of, hey, there's a chance everything changes. Yes.
SPEAKER_02Yep. Yep. So patelephemoral pain, let's talk about the fact that it's called a pain syndrome. It's like dorsal wrist pain, it's not a fucking diagnosis. Yeah. Patelephemoral pain is like it hurts you. Yeah, yeah. It is, it hurts you in the front of the knee and like runner's knee, anterior knee pain, patelephoral pain, jumper's knee, all of those things are dumb. Yeah. It doesn't tell the patient what's wrong. My 20-minute conversation attempts to tell the patients what's wrong. But I mean, the diagnosis sucks. So again, if you have a meniscus tear, ACL tear arthritis like that, those are I can take out a model, I can show you what that looks like. I now draw pictures with patelephemoral pain. Yeah. But depending on the receiving audience, sometimes it works, sometimes it doesn't. Um, but yeah, patelephemoral pain, your knee hurts because of the way you are.
SPEAKER_00Yeah. You exist in a world where your knee hurts.
SPEAKER_02Yeah. So I will address the things like I understand you've been dealing with for X amount of years. I understand that you've probably been told you'll grow out of it, or um, there's nothing wrong. Um, but it is a thing. I will say, like, this is a thing. This is a really hard thing. We see a ton of this. Traditionally, the things I want to tell you, like what my textbooks tell me, aren't the right things. Yeah. You know, and I will try to talk about these nitpicky things that I've used in the past that will help. And I know the patients haven't tried it. Um, but anyway, then they're like, but let's get supplements and stuff. Yeah, yeah. So they're like, let's go over the MRI. Always 100% of the time, pull up the MRI scan, and they find something to like like um like latch. With a latch on to. So like excessive lateral pain syndrome, ooh, Hoff is fat pad impingement. They're like, Well, can't you take that out? Like, like, I mean, you can't, like, you can like you can debris that you can do a lateral release, but like if your quads and your hips and your glutes and your VMO don't work, you're gonna be right back here. You know, but they like they want something, and I'll go to another doctor to see if they'll fix that something. Um, but the MRI often says maybe chondromalacea, probably not, fat pat edema, maybe some maltracking, and the the radiologist says it in such a stupid way, like lateral uh um uh impingement of Hoffus fat pad sometimes seen in maltracking syndromes, right?
SPEAKER_00Yeah, and like great, you fucked me over putting that right now.
SPEAKER_02Or it'll say no internal derangement, or it will say no abnormal findings, or completely unremarkable MRI.
SPEAKER_00So unremarkable, it's disgusting.
SPEAKER_02But I but I will um and that's that's a good like leading point because I'll say to the patient, you know, yeah, let's talk about it. And I will go through the whole thing of all the forces that pull on the kneecap, um, how in females when you're growing the you know the cue angle down to the knee, if there's no glute can yeah, if there's no glute control, your knee's gonna hurt. Yeah. The end. Yeah. If you're a multi-sport athlete, your knee's gonna hurt. If you're a single sport athlete, your knee's gonna hurt. Yeah. And all these patients if you're not an athlete, your knee's gonna hurt. Especially if you're not an athlete. Um, but most commonly seen in females, most commonly seen in those that have some degree of underlying hypermobility, whether it's like real, like an EDS variant, yeah, or just familial and not, you know, diagnosed.
SPEAKER_00What about those EDS patients when they're like, oh, I have EDS, and like they told me, I feel like we've gone into this before, that um like I can't get into a geneticist. And you're like, well, I don't think they're gonna do anything different for you. Like they might tell you and write on a piece of paper that you can see on your chart that you have this diagnosis, but like they're not gonna, you don't have a magic fit.
SPEAKER_02I have a 45-year-old female that I saw her daughter, spoiler for patelloformal pain syndrome, and then she was like, Oh my god, you explain that so well. Like, I'm gonna transfer my records and I'm gonna see you.
SPEAKER_00And you're like, nice.
SPEAKER_02Yeah, she's like, I know, but listen, so this is this doesn't surprise you, right? I've had four surgeries on my left knee and it still hurts. No surgeries on my right knee. I'm getting my labrum and my hip repaired next week, which by the way, that probably was not torn. That's probably just mold like MDI in the hip. Um, and so I see her. She I know so what she wants. She wants MRIs, I get MRIs. The right knee or whatever she knee she had four surgeries on shows that she had four surgeries on her knee. The left knee, completely unremarkable MRI. Called her to go over the results, and she was very disappointed I was not suggesting surgery. And then I will say to the patient, What are we gonna fix?
SPEAKER_00Like, yeah, what are we gonna fix? So, side note, and I like don't like to be this person, but we'll be this person because everybody thinks this. We're gonna say it. What is the association between this, you think, and like psychological factors? Because I try so hard to like not lump these things together, like, oh, um, part of this is just like like there's a psychological component to vague anterior knee pain, just like there is vague ulnar-sided wrist pain. Yes. Um, and and I like it does exist because again, there are pathologies that cause this, there are surgical fixes and indications sometimes for these things. But there are also people that just don't get better no matter what you do. And like, is it a something we're all just completely missing? Or is it also, is there a psychological component to it? Is there like a thing with people not like intolerance to mild discomfort that in some populations people don't like know, like, oh you know, oh, I picked up my coffee mug this morning and my wrist kind of like twinged and hurt. Yeah. And like my wrist just twinged because I grabbed it weird. I don't know. And then somebody who is gonna seek an answer and like a fix to never feel that because that's abnormal.
SPEAKER_02So I will tell you on my team, when we we do um ACL reconstructions, we went through a time where we had everybody fill out a grit score.
SPEAKER_00Okay, like quick dash for yeah, yeah.
SPEAKER_02It was it was called a grit score. Um, I have to find it on my computer somewhere. But anyway, like when I start a project, I finish it sometimes, never, always like so that gets down to I think what you're asking, yeah, but um to answer your question, patients with patelphemoral pain often have higher rates of anxiety, depression, yeah, pain catastrophizing, fear of movement, hypervigilant to symptoms, and stress-related pain amplification. Yes, like facts.
SPEAKER_00Yeah, no, that's like I I believe those things.
SPEAKER_02Compared with asymptomatic cohorts, these factors are associated with higher pain scales, greater disability, lower quality of life life, and worse outcomes after rehab. Yeah.
SPEAKER_00Yeah, absolutely. I mean, because I think somebody could have the same, you know, patelephemoral instability issues and one person just ignore it and tolerate it and live their life just fine. Yeah. And many hurts sometimes when I do these things and it crunches a little when I walk up and downstairs, but whatever. And then the other person who has had five surgeries because of it and is hyperfixated on it. And so, like, you know that nothing is gonna make that.
SPEAKER_02So other interesting fact is that patelphurnal pain often affects high-achieving personalities, such as runners, athletes, dancers, highly active individuals who are often goal-oriented, perfectionists, and frustrated by limitations. You know exactly the patient I'm talking about. Um, where they feel it, my knee clicks, my other one doesn't. Why? Fix it. Yeah, I can't have this clicking. Well, does it cause you pain? No. But it clicks, but it feels like it will click.
SPEAKER_00Yeah, yeah.
SPEAKER_02So the uncertainty of will it, won't it, sometimes is more psychologically distressing than the pain itself. Or like the 13, 40, 15-year-old female who's in gym class and some they're asked to sprint and they feel something funny, therefore they abort, and then it results in, oh, you can't complete this. Oh, you must sit out. Like there's there's certain factors that go into that.
SPEAKER_00So interesting to me. Yeah.
SPEAKER_02Um, so are there certain psychological factors? Yes. I think these patients generally have lower pain tolerance. And when you give them an abstract diagnosis and pair it with that, it's like a recipe for disaster.
SPEAKER_00And that's a really hard thing, like you can't really get into that side of things with it. Yeah. You know, our job is to diagnose a very clear problem, and here is the injection and/or surgery and procedure that will fix it for you.
SPEAKER_02I'll tell you what, I can't inject weak quads, I can't inject tight lateral, you know, tight ileotobia band, I can't inject, you know, quad weakness. Yeah, yeah, I know.
SPEAKER_00Um you can't inject peptides. I can't.
SPEAKER_02Can I? Can I? Um But no, I will focus on these visits. I will explain to the patient there's extra stress on the joint, all of the factors pulling on your joint. If there's a little maltracking, a little bit of quad weakness, your IT band's a little bit tight, and you're pairing that with overuse, overactivity, and your skeleton is growing, like that's the perfect formula for exactly what you're feeling. Um, pair that with your abductors are wee, your glutes are we, your core is wee, you're over pronate when you walk. Like, that's crazy. Now you've chosen volleyball where you jump and you land, you know. You've also chosen to be a runner where you're excessively running up and down hills. Um, you also chose to wear your hey dudes all day. Like, you know, there's all these things. And I will go over every single one of these things. Um, but again, it's just it's so draining. I don't know. It is draining. Yeah. And here's the other thing, and again, for our for our uh athletic trainerslash um physical therapy friends, they suck at it. Like that is a blanket to state, and I will defend that. Physical therapists suck at patelphermal pain because they treat it all the same. And I think you have to know the patient, know what their psychological issues are, and slowly bring them up to speed as far as what your plan is. I will tell patients I'm gonna schedule you a six-week follow up, and we'll do a six-week follow-up after that. You may have no improvement in your symptoms over that period of time. Like you need to buckle in. This is going to be a project, yeah, more so than a, hey, you'll be cured in six weeks. Yeah, you know? Yeah. Um, so I don't know, and again, I'm I'm generalizing, I don't know that the physical therapists have that long conversation, especially when they're Medicaid and they only have six visits for the year.
SPEAKER_00So yeah. That's tough. Yeah, if there's any PTs out there who specialize in patelephora pain. Oh my god.
SPEAKER_02And I if you don't, like I think that is a huge opening. Like if I had a patelephemoral pain guru that I can send people to, that would be amazing. Um we need the patelephemoral guru. But I think I think though, in treating these patients, you have to think outside the box. Like if you were to Google right now, like how do you treat these patients? Physical therapy, corrective shoe wear, NSAIDs, avoiding activity, return to activity to tolerance. You can tape them, you can brace them, whatever. And it's not something that keeps you out of sport. But if you see this kid has been dealing with it for three years and their parents are like, but they can't be a swimmer, you're like, I mean, you can, you just have to decide with how much you want to deal with. Um, but I will tell them there's no thing, like I can't package up a thing and give you a pill or give you a shot. Um, but again, is it their back? Look at their hips, are the hypermobile? Um, with female athletes, like maybe we do more than one sport to fix it. If you're balance things out, yeah.
SPEAKER_00These are usually like what your hamstring dominant athletes.
SPEAKER_02Yeah.
SPEAKER_00Um, yeah.
SPEAKER_02And I will have one of my key moves is I'll have the patient in the room step up on the stool and try to do like a heel tap, like a really low, what are they? They're 12-inch stools and you know, toe tap, no problem. Most of them can pop that out. But if you really try to do a heel tap, almost like you're doing a um pistol squat kind of you will see their knee completely valgus. And I'll have the mom stand behind me, and I'll be like, You see this right here? Yeah, this is what's going on. And I had a really good visit, which hopefully wasn't the two last week, where the mom was like, Oh my god, I see that. And I said, Listen, you know what that tells me? You need to work on your glutes. And she goes, Oh my God, if I had a dollar for every time one of my coaches told me that, and I was like, but that's why we're here. That's why we're here. Like, um, and God forbid you talk about their weight.
SPEAKER_00It's to touch you subject.
SPEAKER_02Like, I will say that. Like I will say, we need to, you know, optimize. I don't know if they'll say the word weight. I think we need to optimize, you know, your body habit. Oh God. Panis. Words that I hate when they hit my ears. No. Um, yeah. And I will, I will admit the shortcomings. I will say, we should have a better answer for you. There should be an injection that will fix you. I should have a physical therapist where I can package you up and send you to, but it's it's just not that easy, unfortunately.
SPEAKER_00But I think at least, like, this is my hope with these types of visits that these patients feel like you are just as frustrated as they are with the condition and the treatments and whatnot. Um and, you know, I think it's a a more in-depth visit than just looking at somebody and be like, oh, well, like the MR is negative, x-rays are negative, and said therapy, that's all we have to offer this. That's something very easy to do. Um, but if you want to get, if you want to level up, then speaking for these other things.
SPEAKER_02Speaking of leveling up, I've created a document that is core values patelephemoral pain.
SPEAKER_00The core values of patelephemoral pain.
SPEAKER_02Yeah. What are the core values? Okay. So how can this affect you in different stages of life? And again, it gives in the beginning patelephoral pain describes pain in and around the kneecap. Wow, why, right? Um how patelephoral pain can affect you at different stages of life, because I will see this teens and twenties, overuse, muscle imbalance during growth, 30s and 40s, repetitive movement, um, long hours of sitting or standing, like unfortunately, and things like Uncorrected in your teens and twenties, 50s and 60s. Now you're adding in cartilage wear. Sarcopenia. Another word that makes your ears want to bleed. Or um or previous injury. And then 70s and beyond, joint stiffness, arthritis, reduced activity tolerance. I mean, they it affects everybody. Um we what does it say? At our practice, um, cell femoral pain takes a multi-treatment approach. Healing takes time, patience, and consistency, and your feedback is essential as part of the process. Physical therapy, home exercises, power plate, vibration plate protocol. That's huge for simultaneous gluten thigh activation. Outside the box, red light therapy, laser therapy. We talk about bracing and taping, foot and ankle alignment, anti-inflammatory support, the core values of recovery, patience. This is not weeks. I'm sorry, this is not days, it's weeks to months. Consistency, regular exercise and therapy builds results, communication, share what's working and what's not working with your team, teamwork, you, your provider, your therapist, your parents, um, and progress, not perfection. Small improvements lead to lasting results.
SPEAKER_00This is like, you know, perfecting your position in a sport. This is like, you know, making some sort of one rep max gain. Yeah. It's not a this is the issue, take it out, do this and fix it. It is a let me build myself differently.
SPEAKER_02Yeah.
unknownYeah.
SPEAKER_02And it takes years. But that's really hard for the teenage population to hear. The parents kind of are like, wow, it's never been explained to me that way, and I kind of get it now. Yeah. But then taking your 15-year-old and you're like, hey, so when you tell me that you don't want to go to therapy because you want to go hang out with your friends, like, then I don't want to hear that your knee hurts. Um, yeah. But anyway.
SPEAKER_00And I think like, you know, depending on the parent too, you may have a very different type of conversation. There's some parents that are like, no, like if this is the issue, I agree with you. Yeah. We need to be consistent with it. Like, if you want to feel better, you have to do your therapy. And then there's some parents that are like, Why aren't you fixing them?
SPEAKER_02Like you're doing nothing. But take home and why this is so goddamn frustrating is that patelph pain is less about fixing a knee and more about managing the patient. Yes. Managing their expectations. It's really hard.
SPEAKER_00There's a lot of things like this. I think these there's a multitude of conditions that are akin to Beth's cancer of the knee, um, where you don't have like a black and white quick fix answer for them.
SPEAKER_02But I'll tell you what, early, early, early, early arthritis, not patelfermal, but otherwise in the knee, that that falls in this category. Um patients that have posture-related shoulder impingement, that falls in this category. Yep. Patients that have not really diagnostic cervical pathology, but have shitty ass posture, that falls in this category.
SPEAKER_00Yeah, like with all that vague upper jack pain, medial scapular pain. Yeah, medial scapular border pain and like scapular dyskinesis.
SPEAKER_02Yes, yeah.
SPEAKER_00Ulnar sided wrist pain.
SPEAKER_02Ulnar sided wrist pain.
SPEAKER_00Dorsal ganglion cis. Dorsal ganglion cis, yeah. Um, I can't, I don't know anything about feet and ankles, so I don't know what the cancer of the ankle is.
SPEAKER_02I think metatarsalgia, that's another one. That's all like a mechanical thing. Okay. Um, yeah, that's it.
SPEAKER_00Yeah.
SPEAKER_02Anyway.
SPEAKER_00So I think take home is get good at personalizing treatment plants for it and have a good explanation for why you do what you do for these things. Because otherwise, I think early on in your career you go into these conversations, like having the basics, the black and white answer. And then when the person looks at you and is like, but I tried that, what next? Well, now you you're deer in headlights, yes. So that's but that's also the worst.
SPEAKER_02So, like, you know, if if textbook says or experience says, or your mentor doctor says physical therapy, like ask a physical therapist, are you drying needle in your IT band? Are you doing blood flow restriction? Have you looked at their glutes? Are you doing anything with their feet? You know, like I mean, stuff like that. Force plate them, see exactly what about their running, jumping, landing is the problem. Um, yeah. So I think um as a provider, you have to be a little bit more curious and a little bit more dedicated to figuring this out for each patient. It is frustrating. There's a lot of this is normal, this is normal. Their physical exam is generally pretty normal.
SPEAKER_00Go more in depth and level up because I'll tell you, like from a PA perspective, this is typically, these all lump into the category of typically non-surgical problems. So you need to be the one that's best at managing these things. Your doc, your surgeon doesn't want to see this shit on the schedule. They don't want to deal with that. Like they shouldn't be dealing with that. Yeah. You are gonna be the ringleader of these difficult problems. Like that is your specialty.
SPEAKER_02And I think a key though is also don't tell them, hey, if it doesn't get better, come back and see me because you also are then telling them you're you're dismissing them. I always schedule these people follow-ups of like, hey, let's have an appointment of six weeks and let's see what's worked and what hasn't worked, and we'll go from there. Yeah. Um, I think once they feel like you're bought in, then they're bought in. But if it's kind of like, all right, peer and follow-up, like you know, that's not great. So you just you gotta own it, you gotta do a better job. Um, the patient population's tough. They're gonna look at you and question you, but it's part of what we do.
SPEAKER_00It's about leveling up. Yeah. Yep. This is about getting back.
SPEAKER_01Thanks for tuning in to Joint Effort PAs. If you enjoyed this episode, be sure to subscribe, leave a review, and share it with a fellow PA or med minded friend. You can also follow us on Instagram at Joint EffortPAs for updates and extra content. See you next time.