Catching the Big One

Summary Join us as we explore the transformative power of point-of-care ultrasound in clinical practice with experts Steven Ramsey and John Van Eyk. Discover how ultrasound enhances diagnosis, improves patient outcomes, and expands the scope of practice for healthcare professionals. Key Topics Point-of-care ultrasound applications Blood flow restriction and DVT detection Ultrasound in emergency and outpatient care Guests Names Steven Ramsey and John Van Eyk Chapters 00:00 Introduction and Personal Updates 02:19 Upcoming Conferences and Courses 03:49 Introduction of Guest Steven Ramsey 09:17 John Van Eyk's Practice and Ultrasound Use in ED 14:51 Case Presentation: DVT Detection in the ED 18:33 Ultrasound in Diagnosing Knee Injury and Blood Clots 23:31 Implementing Ultrasound in Clinical Practice 26:17 Statistics and Sensitivity of Ultrasound for DVT 30:09 Expanding Ultrasound Skills: Cardiac and Vascular Imaging 34:31 Challenges and Opportunities in Ultrasound Education 37:02 Future Courses and Applications in Sports and Critical Care 41:29 Closing Remarks and Resources 42:33 riverside_outro__ mar 17, 2026 001_j&k.mp4 resources Point-of-Care Ultrasound Courses by Stephen Ramsey - https://owensrecoveryscience.com/diagnostic-ultrasound-courses/ Blood Flow Restriction Training Resources - https://owensrecoveryscience.com/bfr-courses/ 

https://owensrecoveryscience.com/

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SPEAKER_03 1:21

Welcome to the Owens Recovery Science Podcast, where we dive deep into all things blood flow restriction training. I'm your show host, Johnny Owens, and whether you're a clinician, researcher, or athlete, you've come to the right place. Each episode we break down the latest research, interview leading experts, and translate complex science into practical applications. We're here to bridge the gap between laboratory findings and real-world implementation. It's been a minute since we've had one of these. Kyle, how's life, man?

SPEAKER_05 2:22

It's good, man. We we got a little heat wave on the West Coast right now.

SPEAKER_03 2:26

Yeah, heat wave on the west coast. Ben was in a blizzard and couldn't get out of Minneapolis. Couldn't get home. So yeah. I don't know. He was gonna drive home in the blizzard. But anyways, he he made it back. He's he's across the hall. He's doing good, Kyle, in case you're worried.

SPEAKER_05 2:40

Oh, I was I was a little worried. Not like a lot, but like a little.

SPEAKER_03 2:44

Yeah, yeah.

SPEAKER_05 2:45

Yeah. Well, I'm mostly concerned about my March Madness bracket right now.

SPEAKER_03 2:49

Yeah. I'm concerned that Longhorns didn't freaking make it into the real deal. We're in the first four again. Yeah. Longhorn basketball is um they need Arch Manning. Arch fixes everything. But it's been a busy busy season, man. That's why I we haven't been able to do a lot of these podcasts. I feel like it's been like conferences nonstop and webinars nonstop. And you got Rencho Los Amigos tomorrow, right? Yeah.

SPEAKER_05 3:19

They're actually gonna start doing uh they're looking at doing BFR in their inpatient uh setting, which is which is neat.

SPEAKER_03 3:26

So I'm excited to go down there and talk to them and then we have NFL PFATs in two weeks in sunny Arizona, so that's gonna be a blast. So, anyways, um our guest today um is one that if you listen to our podcast, you should know. It's Stephen Ramsey, who is the pocus with the most us point of care ultrasound god guru. We were at CSM together, like, oh man, he's he's the god of of point of care ultrasound. Um and then John Van Eyck, who is a PT. Where what are where are you, John? Sorry.

SPEAKER_01 4:01

I work on the Navo Indian Reservation and up in C uh in Fort Defiance, which is uh Seoulso Medical Center.

SPEAKER_03 4:08

In in Fort Defiance is in what state?

SPEAKER_01 4:11

Oh, I'm sorry, Arizona.

SPEAKER_03 4:12

Um it's Arizona. Okay, that's what I didn't know if it's New Mexico or Arizona. Okay.

SPEAKER_01 4:15

Yeah, we're right on the line. So New Mexico is my backyard. So cool.

SPEAKER_03 4:19

Well, this is a beautiful country, man. And so John's gonna go over a very cool case um that that came up. And so we don't do enough of these like cases, and so it's it's kind of not 100% blood flow restriction related, although it it kind of tied into maybe doing that, but really this point of care ultrasound and why we think it's so important. And so I'm gonna lead off with my case from CSM. Stephen Ramsey and I are presenting together. Um, I'm just thinking I'm crushing it, right? You know, usually you get done and everyone's like, that was amazing. Your jokes were awesome, Johnny.

SPEAKER_05 4:55

Can I get a picture?

SPEAKER_03 4:57

Instead, this old angry jerk like tears me a new one at the end of my talk, comes up and he's got like a little notepad, and I'm like, what's going on with this guy? And so I'm bringing it up because the last piece I'm gonna bring up kind of ties into to this podcast we're doing today. And so we I use this same joke all the time where we talk about the Augustus beer, his beers, um hyperemia, hyperemia. Yeah. And then 1936 in in JAMA, there was a paper where they used it and they, you know, found remarkable changes in peripheral vascular disease. And then I do this like joke of like, yeah, but when we looked at that journal, they also had cigarette ads. So I don't know if I would trust that stuff, right? And so he comes up and he's like, you know, you mentioned that in 1936 that they had cigarette ads in in the journal uh in JAMA, like that was, you know, a problem. You realize that people didn't realize cigarettes were harmful until 1944. So I'm not really sure what your point was. And I was like, to be funny, asshole. It was just to try and be funny. And then I said, you know, we have this new diabetes paper, which is gonna do a podcast with Dominic Peston, which is a badass paper. And if it's published in journal Cell Metabolism, which has an impact factor of 34. And I said, you know, just for you know, reference here, or PTJ has an impact factor of like four or whatever it is, you know? Yeah. And he got up after, and he his thing he said on that was he's never been so offended in his life that I put down our PT journal compared to cell metabolism. I was like, dude, if you were at my talk last year or I had the penis slide with the tourniquet on it, you would have been way more offended. Yeah. But lastly, and then I'm gonna shut up and let you guys cook. Um we we do the slides because I was having to do the safety thing of like, okay, we looked at in the military, does this potentially cause clots? And in all these healthy, elderly, and yada, yada, yada, acute chronic trials, we didn't see signs of clots with blood flow restriction. But I said, you know, the one thing that wasn't looked at was post-surgical. So my first randomized trial I did with the Department of Defense was we made sure that when we were doing this trial, we just were monitoring for clots. Not that I was saying we were gonna cause clots. It's just our primary aim was strength and hypertrophy. But we also, like along the way, just looked for clots. Um, and there were none. And I said, you know, we saw, you know, on duplex ultrasound scan, there were no signs of clots. And so he tore into me that I was put like putting service members in harm's way because I was trying to do a study that might potentially cause clots. So, anyways, enough of this. He obviously it still drives me crazy.

SPEAKER_04 7:56

That goes back to the PTJ impact factor of four because I homeboy doesn't understand there's inclusion in this.

SPEAKER_03 8:03

My wife was loving it because she's like, oh, you don't get enough people like that don't love you. So she was just like, I love this. But that goes into we were looking for clots, and I I'm gonna just let you guys roll into this case y'all are going to present. So, Stephen, give us a little um quick hit on on your bio and and um John as well, and then we're gonna go into your course, Stephen, why you did the course, and then let's just roll into this case.

SPEAKER_02 8:30

Well, yeah, let me let me add to that. As a uh somebody sitting on the stage, I found it very entertaining. About my talk at all. And I'm I'm talking about ultra like novel ultrasound things. He didn't say a word about you and Al are just sitting there laughing.

SPEAKER_03 8:45

I was looking like you don't have any problems with these guys? It's all me.

SPEAKER_02 8:49

All me. Yeah. Yeah. Well, yeah, so uh I'm Steven. I I practice in in Atlanta. Um I practice in the critical care environment, but I've been, you know, probably more importantly and more relevant, been doing uh pointy care ultrasound education um for now going on four years, and I've been using it clinically for a little bit longer than that. So um yeah, I think you know the biggest thing is we got connected uh for the very kind of things you're talking about. Us can we identify the presence or absence of DVT was the first question that we asked. And knowing that we can use ultrasound uh as PTs and knowing that we can see that reliably, I think that uh kind of spun into these courses that now are musculoskeletal, cardiac, pulmonary, you know, vascular. Um there's a lot of really cool um stuff there, and a lot of people that are getting a lot of benefit. So, which brings us to John. So John took one of my courses here recently, and John, introduce yourself.

SPEAKER_01 9:45

Hi again, I'm John Van Eyck. Um I am a physical therapist, and I actually practice uh solely in the emergency department. Um have a diverse background, but I've been in the ED for some time, and um in the last uh it's almost two years now, have been in fully embedded. And so, you know, we're in a rural setting, um, and uh we have about 40,000 visits per year to our hospital, uh, being a 52 uh bed hospital just to the ED, you know, 40,000 in the ED. And so we see a lot of orthopedic muscoskeletal injuries, and you know, we can't order MRIs um emergently unless it's you know, we think it's a brain bleed or something else, uh more serious. And so uh you know, it's not an option sometimes to do uh imaging uh for you know muscoskeletal injuries. And so I just wanted to be able to find a way to be more accurate in my diagnosing, saw Stephen's course and decided to take it. Um glad I did. Um and I took it actually last uh last summer, so in Melbourne.

SPEAKER_02 11:01

That's right. That's a long hike from Arizona.

SPEAKER_01 11:03

It is a long hike, it was a nice hike though.

SPEAKER_02 11:06

So yeah, a little bit about that course, you know, the structure is um you know 70 probably 75% musculoskeletal, but we do touch on some of those other things, and in keeping up with you, John, I feel like you probably more than most have implemented all aspects of that, and your practice area I think sets you up for that because you're you're operating as a primary care provider in many ways, and triaging people that are coming through the door, which is nice.

SPEAKER_01 11:33

Definitely. Even even the pulmonary side of it, I was covering on the floor up on MSU, oh, probably four weeks after I took your course. Um they had um the doc the hospitalist was doing a ultrasound of the lung, and I walked in and was like, Oh, you got a nice uh lung slide there, and he looked at me like, Why would you know? I'm like, we do uh diagnostic ultrasound. Thanks for asking. So it was kind of a nice moment.

SPEAKER_03 12:05

That's what I I really love about Steven's course is most people are just it's just MSK that PTs are getting a lot, you know, when they're looking at these ultrasound courses. But to have, you know, where we are screening the vasculature and you can look at cardiac or pulmonary, um, even if that's not your flavor, it it's really cool to know that. And then someone like you, John, that's you're like a well-rounded ultrasound user now, it sounds like. How do you say do you like uh on a typical day or week, how much do you think you're breaking out the ultrasound and doing stuff?

SPEAKER_01 12:35

I typically break it out almost every day. Um the only exception is if we're just like slammed crazy, and then you know, uh even if I was slammed and I felt like there was like a great reason to get it out, then I would do it. Um but I do two to three a day at least. Um and I and well, I see about eight to ten patients a day, so that's a pretty good percentage, actually.

SPEAKER_03 13:00

Yeah. Do you mind sharing what what system you use?

SPEAKER_01 13:05

Oh boy. That one I should have I should have grabbed the name of the um Was it like a big GE one or use it more like an iPad, small one? No, no, no. We're actually using one of the big ones. Uh portable, but it's a computer-based one. Um the oh I know shoot, I can't think of the name of it. Um we actually just got a brand new one that is just like really nice because it's got AI and everything. I still trying to learn that one. Um, I'm more comfortable actually with the older model just because that's what I'm familiar with. But I started, you know, started playing more with the with the bigger, nicer one. It's in the main. Uh, our ER is divided into fast track and primary uh or main. Uh, and you know, so the traumas come into the main and we see more of the like the urgent care uh injuries in fast track, but I I work in all settings. We also have an obs and a rapid triage assessment area, and I work in all of those, and I do ultrasounds in all of them as well.

SPEAKER_03 14:06

So very cool. Are are you billing for that?

SPEAKER_01 14:09

Not yet. Well, I I mean, yes, yes, I am in a sense. I mean, I I just build it into my um my uh eval time, uh, and that works really nicely. Um, you know, I I probably should. Uh Steve and I actually talked about this uh a couple months ago, and uh I just haven't tried to see if they'd pay it, you know. Um but um you know I know the codes now um and would be curious to see if it would get reimbursed. Um and it's just kind of a it's just gonna have to be a trial and error thing.

SPEAKER_03 14:47

Are you just billing the government primarily?

SPEAKER_01 14:50

No, actually we bill um insurance if they have it. Insurance, okay. Um you know, and then if they don't, you know, it kind of goes into you know funding through the IHS, uh, which is nice because we can treat everybody the same. So it doesn't really matter you know what your insurance is coming in.

SPEAKER_03 15:10

Because when I was in the DOD, we would bill the DOD and they're like, they don't really pay anything, it's just for fun. So I I would I would put in ever I would I'm gonna make myself look like the most productive dude in the world because I would throw everything in there. So 10 manipulations and yeah, doing all sorts of things. Diathermy. Um it was all in there.

SPEAKER_01 15:32

That's funny.

SPEAKER_03 15:34

So you guys want to talk about this case and how it how it came around?

unknown 15:38

Yeah.

SPEAKER_01 15:38

Do you want me to start, Steven, or do you want to go? You want me to go? No, yeah, please.

SPEAKER_02 15:43

Please go ahead and I'll I'll kinda I'll fill in with the like uh sensitivity specificity side of the ultrasound, but you talk about your case.

SPEAKER_01 15:50

Yeah, I I think it's interesting because you were talking about blood flow restriction, and and I don't do blood flow restriction in the ED, but this was a blood flow restriction case. Um I uh had this lady came in and she'd had an injury um about five days earlier. Um it was a car accident, a minor one, very minor one. And she came into the ED for knee pain. I had assumed uh, you know, classical step on the brake, um, you know, hit a rut and get a twist through the knee and have a meniscus injury. So I decided to do an ultrasound. Um in no way did I have any suspicion of anything but maybe uh osteochondrial type of injury or a meniscal injury. And uh she actually couldn't stand on the leg because she was in so much pain. She also had some pain that was similar to um, you know, ridicular symptoms, and she had some history of back pain, so I wasn't like again concerned about anything uh nefarious here. I thought it was gonna be a straightforward case. Try getting her out of the wheelchair and onto the table, and she's like, Look, I just can't uh I can't I can't get into that position because I was trying to get her prone. Because she was complaining of posterior knee pain, so I was thinking maybe a baker's cyst because it was posterior medial. And um just decided, okay, look, I'm used to doing everything different. I took dry needling, I don't dry needle in any of the positions they tell you to because you're in the ER, you can't. Um everything you do is different. Sometimes even manipulation are different. So I I kind of had her in a semi-reclined position over the over the table and did uh the ultrasound. Uh started, you know, where it was just easiest, which was the um posterior portion of the knee, and put it on there. And I have to give kudos to Steven on this. He taught us in the course. Always check out the neurovascular bundle, just it's right there, check it out, just make sure you always check it. And so I I stuck the um the ultrasound head on there, and boom, the neurovascular bundle you know jumped up first and was huge. And I was like, hmm. Tried to compress it, wouldn't compress. Um, had her change position, wouldn't compress, and called the doc and said, Hey, can you come in here and check out this knee? I think she's got DVT. And this is a credit to our clinicians, uh, or our you know, providers I work with, they trust, you know, trust PT, you know, very much. And instead of saying, well, let me look at it, she's like, okay, I'm gonna order uh an ultrasound scan. There's no need for me to see it. If you think there's a DVT there, there's probably a DVT there. And so she um got the DVT, uh, the ultrasound official and came back, and sure enough, she had a big old clot. And um again, her Wells criteria, I actually ran it again this morning to make sure I I figured it right. It was minus one. So there's no reason to to suspect this. Um looked like it at all. There wasn't even any swelling. Um it was just the last thing I was concerned about. Um, you know, the the only the only criteria that was a positive was the the knee pain, you know, posterior knee pain. Um and so it was uh it was pretty you know pretty benign. So she was thankful. The provider came in was very grateful. And so now when I asked for a uh ultrasound you know official, just to rule out suspicion of a DVT, no one no one argues with me on it, which is nice. So um, but it was a it was a great idea.

SPEAKER_05 20:28

Hopefully you don't have to do that too often. With that, and hopefully you don't have to do that too often.

SPEAKER_01 20:33

No, she's she's the only one I found so far. So yeah.

SPEAKER_02 20:38

So yeah, but you you talk about John, talk about how I mean you you placed the probe on and we're already suspicious. I mean, I think that the one of the things I hear most often is we have such limited time that we don't really have time to implement ultrasound in addition to all the other things we do. How fast, how quickly were you like, man, that's as far as I'm concerned?

SPEAKER_01 20:59

Oh man, I mean, I knew that there was a baker's cyst, I would see that in seconds. So baker's cysts are so easy to find, especially if they're large. And if they're really, really painful, they're usually large. So those are bam, you know, right in front of your face. Takes me, well, I gotta go get the machine, set the patient up, turn the machine on, put the ultrasound gel on, throw the probe on two minutes, you know. Um, and then you know, if we're the patient was was, you know, her her you know, her um neurovascular bundle was easy to find, so I didn't have to go searching. Sometimes if you have a more uh uh well nourished patient, it you know, it can be harder to find those things. Yeah, they're harder to find. You know, I always love it when I when I get to do an ultrasound on somebody who's slender, you know, it's like, oh, this is gonna be easy. Um uh, you know. Um, but yeah, I mean finding that literally honestly, within 30 seconds of the probe on there, I found I found the clo the DVT. So or evidence of the DVT, yeah.

SPEAKER_02 22:07

Yeah. And I I want to just um real quickly just talk a little bit about the kind of the statistic sensitivity and specificity of this. And this is what we talk about in the course. You know, when we hear ultrasound for DVT, there's different tiers to this, right? There's the complete duplex ultrasound. Johnny, maybe that you guys did this in your study, but this is compression from the groin to the ankle with Doppler, spectral and color Doppler. And that's what, you know, when the physicians order this, that's probably what they're ordering. But there's these kind of lower-tiered ultrasound exams that are called limited exams. And what we talk a lot about in the course is three-point compressibility and two-point compression ultrasound. So that's just compressing around the groin, the saphinophemoral junction, and around the popliteal. That's the two-point. The the interesting thing about that is you would imagine you would lose a lot of the predictive power, the diagnostic power with that, and you really don't. The sensitivity and specificity is still above 90% for both. The false negative rate is really low. The only argument is about five, maybe to seven percent of DVTs are in that mid-phemoral between the knee and the hip. And so maybe you lose out on that, but how how much time would it actually add to throw that additional compression site in? We're still talking about a two to five minute exam in total, um, just compressing those. So, just for the listeners, I mean, you're taking an ultrasound probe, putting it transverse across the vessel, pushing down until you see the vein collapse. If it doesn't collapse, then you're suspended. Just that there's a DVT. Um, so it's a really easy exam. I think that's gonna provide a lot of utility for anybody in the rehab setting going forward, post op or not, you know, for your patients. Yeah.

SPEAKER_01 23:45

Yeah. I gotta comment on that for just a second because um people ask me all the time now if you could, you know, being in the ED, what course would you recommend? I says, well, I'll recommend this course, whether or not um you're in the ED, like any, especially anywhere rural, but anywhere, the number one course I would recommend is ultrasound, diagnostic ultrasound, because it's gonna allow us to practice at the top of our scope. Um and and it gives allows so much patient education. I mean, I'm sitting there educating the patient. Sometimes I'm educating the providers on what I'm looking at.

SPEAKER_03 24:22

Very cool. It's just such a yeah, from a safety and a screen, but then also, you know, from uh tracking outcomes uh in the outpatient setting, is it's really pretty cool to see people using it for that as well. Yeah. Um that's awesome.

SPEAKER_02 24:39

I'm glad you're I'm glad you're doing that. And uh, you know, I think that we talk about across the settings. I think we talk from ED to ICU to sports. If you want one thing you can implement tomorrow for PTs. If you haven't gone to even gone to a course, you could probably find an ultrasound and put it across a vessel and and start compressing and seeing if you you catch people there from a DBT standpoint. So I think that's the big takeaway is it's super easy, really easy to learn, really easy to implement.

SPEAKER_03 25:07

And the machines are more accessible now. We we would do it in the DOD, I didn't, but you know, a lot of our clinicians did, and we had those giant GE ones that are like fifty thousand dollars. Now in the military, it's just you know with a little iPad and a little probe and AI's like kicking in. So it's it's not like it's uh such a huge burden to entry anymore.

SPEAKER_01 25:28

No, and honestly, the the neurovascular bundle looking for DVTs um is one of the easier aspects of it to learn. I mean, trying to get in and learn all the anatomy and trying to figure out you know what layer of the quad you're looking at or the um or the MCL you're looking at, it takes a little bit of time. But with the if you learn the neurovascular bundles then and be able to how to track them, um it's pretty simple.

SPEAKER_00 25:59

Yeah.

SPEAKER_01 25:59

Especially if there's something wrong.

SPEAKER_05 26:01

Yeah. That's pretty cool because you mean that's part of the skill that you could learn like that first course, right, Steven? I mean, you you just you know, a lot of times the hard thing about weekend courses is you learn all this stuff and then you go back and you're like, uh, a lot of this I can't really apply because I'm just not good at it yet for whatever reason, you know, especially if you think of like manual techniques and things like that, where everybody just ends up being a guinea pig. But with this, at least you take home that skill, that initial skill, and there's others that you can kind of keep working on through mentorship and things like that to get better at to where you know you continue to sort of level up, if you will.

SPEAKER_02 26:42

I think that's a reason why that was our first introduction as a a team with ORS is is this something that would be a reasonable thing for a therapist to do? And the answer is yes, it's really easy. I do I do want to touch on, I mean, I think it's nice to have this conversation. I also think that there would be it's important still to talk about the barriers that exist. Um I you know, again, the sensitivity and specificity is really high. As I mentioned, that you could, if you just compress the groin and the posterior knee, you could miss those in the middle of the femur, basically mid-phemoral, and you could kind of miss below knee dBTs. But if you follow any management of VT in general, not a lot of places are actually treating below knee DBTs. The risk of propagation is is lower, and the incident rate is lower. It's about 25% of all DBTs are below knee, and only about 10% of those actually propagate. Only about 2% of those turn into PEs, which is really what we're talking about trying to prevent. The DBT is not gonna kill you, right? The PE is. And if John didn't do that scan, you know, and maybe just did his manual techniques and didn't catch that, then it might have gone unnoticed and then not treated, and then you know, obviously you could have had a really bad outcome.

SPEAKER_05 27:51

So that's with doing a screen that's supposed to help you pick up.

SPEAKER_02 27:55

Yeah.

SPEAKER_05 27:55

Exactly. That's what I was gonna say. He did everything right. He did everything right, above and beyond what I think probably allowed him to do.

SPEAKER_03 28:02

That lady, poo, if she would have been in my hands, I would have been like, come on, let's bend. And then 10 minutes later, yeah. I got a I got a bill for this.

SPEAKER_02 28:15

So let's say, you know, let's let's let's propose the scenario that you did that and didn't see a DVT. So I think, you know, especially for the low to intermediate risk, the kind of conventional wisdom would be if I'm a clinician and I screen it, I think there's low risk to intermediate risk. The what the research says is actually we should repeat that every five to seven days. So that's just for the clinician out there that's saying, well, I you know, I thought this patient was you know low to moderate uh risk. I didn't see a DBT or I wasn't confident. There's no harm in repeating that kind of longitudinally over the course of a week or two, too, is just to rule it out. That's another part to implement.

SPEAKER_03 28:52

Cool. John, are you using it also like to look for any any bone abnormality, fracture, things like that, tendon?

SPEAKER_01 29:03

Oh yeah, yeah. I mean, if there's two two circumstances, well, I use an A chance I get. You don't have to give me a big excuse to use it. But um, like if I can't figure out what's wrong with the knee, I'm looking at going, I just have no idea. I'm gonna get that ultrasound out and try and figure it out. If I really believe I know what's wrong, I want to show the patient what's wrong, I want to show the doctor what's wrong, I get it out. I mean, I had I've had two cases with fractures that were really interesting. One was a couple weeks ago, um was a growth plate issue, and uh the we suspected it, um, but the for whatever reason the x-ray wasn't dropping, and so we were just not getting you know the pictures down. Um, and so I was like, let me just grab the the ultrasound. And so I'm in there, called the doc in, and I was like, hey, check check this out. And we were able to see before the x-ray that there was a large fracture at the growth plate, um the right at the um, you know, the tibial tuberosity, it had popped up, and so it you know was sitting up like this. And what was really amazing about this is you could see the gap was just really wide, and you know, just a lot of um anechoic signal coming out of that fracture. And what was also interesting about it is I couldn't get I could find the patellar tendon, but it was on it was on slack, and I couldn't get it to contract because as it pulled up because it lifted up the patellar tendon and slack. That was an extremely cool case, and yeah, um you know it was neat to see it and then get the x-ray and go, well, yeah, that just matches what we saw in the ultrasound. And it was neat that the doc was standing there beside me to be able to see it as well. I mean, I found it, then she saw it, and then we confirmed it. It was just it was a neat case. And then Ortho, this gets cooler. Ortho came down. Um, he actually came back in and uh he was off, and uh he had not seen the ultrasound, so I was able to pull the ultrasounds up to show him, and he he was pretty amazed too because he'd not ever seen it used uh diagnostically like that. So he's a great orthopedic doc. He just doesn't use ultrasound.

SPEAKER_03 31:24

A lot less radiation as well. Skip that x-ray.

SPEAKER_01 31:27

Yeah, he's interested now though. I'll give him a take your course.

SPEAKER_03 31:31

I bet. Imagine. Yeah.

SPEAKER_02 31:34

John, John, I got a I got a question for you. John, uh, you know, I I know you're you were well respected prior to using ultrasound. Do you feel like using ultrasound has changed your credibility amongst the interdisciplinary team?

SPEAKER_01 31:46

Yeah, yeah. I mean, they um they in fact, you know, when I grab the ultrasound, if they have time sometimes, they'll come in with me. But yeah, they they do. And then it's neat too, because we just have a new employee. She just started, she's a doc, was at Loma Linda, I believe. Um anyway, her her uh residency was in ultrasound, and so I'm starting to get to work with her a little bit, and that's exciting. So the two of us on board together um really make us a strong team in the ED because she ultrasounds just about everything. But um, I do a little more musculoskeletal than she does.

SPEAKER_03 32:26

So and you're like a lot of people I've talked to who do it, or the ones who do it and really find it interesting and start picking up things, they do it a lot. You know, in talking with Steven, and it's like you you you need to really practice a lot with this to get good at it. You know, that's why there's mentorship things and and stuff like that. So you're kind of like the perfect PT where you're like, I love this thing, and I I mean that's that's what I want to start being able to do is is mess with this a whole lot and and just measure everything because I think it's really cool. And like I said, it's it's just a few minutes, it's like no big deal. And the patients probably think it's cool.

SPEAKER_01 33:02

No, they do, and you know, if I have time, I can go in to longer studies so I can just show the patient everything. Yeah. Um gives me a chance to check the entire knee. But if I have a limited time, I just go after what, you know, the area of complaint. Um I still always you know try and get behind the knee um just to check it. Um uh just to make sure everything's you know good back there. But uh it's really a handy tool. And um, you know, I I I use it on the shoulder, getting better with the ankle. The ankle's hard. Um getting better on the ankle. I um using it on the wrist now. This is a funny story. Um my daughter, I can tell this, she gave me permission. Um she um has EDS, and but she is an artistic person, so she's always sculpting, painting, or doing something. And she started getting wrist pain, and so her uh EDS doc ordered an ultrasound, uh diagnostic ultrasound. Well, there's nobody in our area that does them. I I tried getting here one, and so I had to I sit down with the doc. Look, I got this moral dilemma. I can't ethical dilemma, not really moral, but ethical dilemma. I have a um my daughter, and I shouldn't be doing her ultrasound, but there's nobody else. And so doc came in and we did the ultrasound, and uh there was not a ganglion cyst as um as was suspected, which is nice. She actually turned out to have intersection uh syndrome and had inflamed tendons in that uh in that section. So I was able to diagnose her correctly, and the doc uh did the write-up without my name on it.

SPEAKER_03 34:51

Anonymous anonymous ultrasonar.

SPEAKER_02 34:54

Yeah. John, you gotta brush off your your cardiac for her just to keep screening her valves, you know.

SPEAKER_01 35:00

Oh, yeah, that's a good idea. Yeah. That's actually a really good idea. Because that's one area that I just want to be able to uh I'm hoping with um our new doc they'll be able to practice that more because that's something I would like to learn. You know, I mean I learned it, but I'd like to become proficient with it, you know, if I feel confident with it.

SPEAKER_02 35:20

Yeah. In our two-day course, it's impossible to feel great with cardiac. I mean, that's a that's a three-month study in and of itself.

SPEAKER_01 35:28

So Yeah.

SPEAKER_02 35:29

Yeah.

SPEAKER_03 35:30

Is that is that the tip of the iceberg of of ultrasound hard hard things to do?

SPEAKER_02 35:38

For me, you know, I think so. I think because we're talking about, you know, with MSK, obviously there's angle dependence and pro placement it's like has to be pretty specific. But for the heart you have that in addition to really need a lot of quantifiable data, and so using the ultrasound to measure velocities and volumes to be able to actually get to the diagnosis is important from a cardiac standpoint. Not only do I have to put it in the right place, I have to know how to manipulate the ultrasound and then know what kind of know what to look for and what's artifact versus real. I think cardiac makes it a little bit more challenging, but I just had this conversation uh earlier today with a uh a teacher out at uh Seton Hill. You know, the reality is where we're saying we should start as PTs is if I'm suspicious that somebody has a cardiac disease, could I put the probe on their chest and just visually assess is their heart dilated? Is the squeeze function normal? And that's kind of what we go over in the course. Some more of the qualitative side, the visual assessment. And you can actually get pretty good at that in a few weeks at practice. Um, so yeah.

SPEAKER_03 36:46

John, go ahead. You're a lifesaver, brother.

SPEAKER_01 36:50

Well, I uh I'm just glad I went to the course. Honestly, um from a professional standpoint, again, be able to help me practice at the top of what I can do. Probably the most important course I've taken as a PT, honestly. I mean, there's other courses you can kind of just read about, learn. I do functional giant needling, that really changed my life as a as a therapist. But um it didn't give me the ability to you know look in into somebody's, you know, joint, you know, around somebody's joint uh and and make an early diagnosis. Um and so I just really really think it was like so worthy my time. In fact, it was worthy enough of my time that I decided I want to try and go for my RMSK, so we'll see. Um it's a good career path as well. There's not many PTs out there that have done it, so um, you know, it gives you some opportunities after you even retire if you want. So it's awesome.

SPEAKER_05 37:52

And it's an important thing to be able to get. I mean, it's it's unique that physical therapists are able to get the RMSK, right? Because basically APTA you know negotiated on our behalf to allow us to get the same certification that physicians get.

SPEAKER_02 38:09

Yeah. Oh, it's and it's it's huge because I mean it's not just uh I mean it's a credibility thing. Physicians and excuse me, therapists are taking and passing this exam alongside their physician colleagues. And and I would argue, and I think I'm preaching to the choir here, I would argue that we're uniquely positioned to have the RMSK. Now the the next barrier is the RDCS, the cardiac version of that, that I'm gonna try to volunteer to sit for on our profession's behalf. And and probably fail, but I'm gonna still sit for I didn't even know that.

SPEAKER_03 38:43

That's badass.

SPEAKER_01 38:44

That's pretty cool.

SPEAKER_03 38:47

That was awesome. Good conversation, John. Yeah, John, appreciate you. Keep doing what you do, man. Um I love that you're also helping helping out the folks in that part of the country that that really deserve it. And sounds like your your hospital's really booming, but you guys are doing good stuff there.

SPEAKER_01 39:03

So yeah, great place to work. So I love what I do. Feel blessed because I'm uh you know in the ER. I love it. And uh it gives you a chance to see patients at their worst and make them better. That's a whole nother conversation, but uh um yeah, it's it's a good one.

SPEAKER_03 39:22

Well, anytime you get cases, send them our way. We'd like to even just write up a blog on it, you know, maybe not even for publication, but I think something like this could could easily be a case study that we send in to GOSBT or something.

SPEAKER_01 39:34

Yeah, I still I still want to do that on the case we just went over.

SPEAKER_03 39:39

So cool. Cool. Well, congrats, man. Thanks for coming on. And um I I think this course is super valuable. We don't we only would do blood flow restriction. That was that was like our line in the sand, and then talking with some colleagues and then talking with Steven, and and it was like, man, this this makes perfect sense. And this would this is the only other course we would ever have um that's not blood flow restrictions. So um we have um Steven's courses hosted. Stephen, I think you're gonna have even you know um other other sites that'll have courses listed. You want to plug anything right now?

SPEAKER_02 40:16

Or yeah, you know, I think the biggest thing we're working on, you know, John came to a general course, and I think those are really nice if you're looking to start out with ultrasound because it gives you a little bit of everything. We've got two new course types coming up, which will be uh ultrasound for the elite athlete, so geared more towards kind of the highest level athletic population uh for ATs and PTs, and then there's one in the critical care space, which I'm particularly passionate about. It's where I work. So we'll have a course geared for the critical care PT or OT or you know any other discipline in that space. So those are some things coming out uh here hopefully this year that'll be nice to see.

SPEAKER_03 40:53

Well, when I was at the NFL Combine meeting, I mean uh NBA Combine meetings last year, um the two hottest topics were Achilles injuries and DVTs. And so lines up perfect, man. So if if you're working with with basketball players or any elite athletes, there's there's a lot of cool stuff. I know you and I talked about Steven, so yeah, I'm excited to see what that one holds.

unknown 41:15

Yeah.

SPEAKER_01 41:15

Yeah, and I I'm gonna you know do a spot uh little spot here for Steven. He hasn't asked me to, and nor am I getting paid to do this. But uh, you know, I've been to two ultrasound courses now because I am interested in getting my RMSK. And I will tell you that Steven's course, especially for a first course, uh was just superior. Um, you know, really good pace. It was a smaller class so that you could learn. The class I went to was like 30 or 40 students. We didn't even get to put the probe on patients, you know, in each other for certain, you know, uh, you know, like I didn't get to look at the hip, which is the one I wanted to look at, because I was the patient, and then you know, and then we ran out of time uh because there just wasn't there wasn't enough probes, there wasn't enough time. Um when I went to Steven's course, excellent amount of time, excellent instruction. Um and uh I learned a lot. So I mean I think it's a great course to go to.

SPEAKER_03 42:16

Yeah. At the NFL meetings last year, a couple of the NFL teams couldn't stop just talking about how great Steven is. You know, old men don't yell at him after his talks, but but no, they were saying the same thing, John. They were like, man, this course was so valuable and glad they did it. You know, and and they were in a different spot because they're like our doctors, you know, our team doc does a lot of this, but then you know, following up with them, they're they're really trying to do like you, John, and and start implying it a lot more. Even like just baseline, looking at some baseline characteristics and their athletes so they have some tracking data if they need to look at, you know, put injuries and how they want to get back to baseline. So it's pretty cool. All right, man. I guess the love fest is over for Steven. Um We can keep it going if we need to. I mean, it's good, brother. Your head's almost bigger than the screen right now. So um, anyways, check out um our courses at OrangeGravyScience.com. We have BFR, we have Steven's courses. Um we don't ever say this, but if you like the podcast, um subscribe and and give us a rating. If you don't like us, don't do that. Um don't hurt us if you don't like us. Don't hurt us. But we have a lot of courses coming. We have a lot more podcasting content coming and a BFR app that should be rolling out here pretty soon as well. So um I guess I'm I'm free to say that now because we're so close. Yeah. Maybe Kyle.

SPEAKER_05 43:41

It's only about six months late. I know. Gen 3 is out and rolling.

SPEAKER_03 43:46

Gen 3 is out. Throwing system is making a lot of noise right now. Just had some media group somehow got a picture of an MLB picture with it on throwing. So um lots of things. All right, John. Thanks so much, brother. Steven, you too. Good to see you again. See you guys. Thank you, John. Thanks, guys. All right. All right, later. Thanks for tuning in to the Owens Recovery Science Podcast. Before we go, a quick reminder that the information discussed on this show is for educational purposes only and is not intended as medical advice. Always consult with your healthcare provider before making any changes to your treatment or training regimen. For show notes and additional resources, be sure to check out Owens Recovery Science.com. And don't forget to like the show and subscribe for more evidence-based insights. Until next time, earn your deep flags.