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Dr. Yoni Rosenblatt: Thank you so much for tuning in to listen to this episode of True Sports Physical Therapy podcast. This conversation is gonna help you rehab Tommy John surgeries infinitely better than you have in the past. You're gonna hear a lot of clinical pearls and words of wisdom from Dr. Mike Reinold who has probably rehabbed more Tommy John surgeries than anyone else in the country. But he really goes into the nitty-gritty of how to get an outstanding outcome with the athlete that's in front of you and trying to overcome that surgery. Also look forward to hearing tidbits about Mike's career, his profession and also the way he manages and juggles everything. It's really an awesome conversation that I know I learned a lot from and hopefully you will too. We're always looking for your feedback so please share it at True Sports PT on Instagram, we're always reading your feedback and a lot of you guys requested to have Mike Reinold on so I'm so excited that he was able to join us for today's episode. Also if you're interested in joining the team or just finding out more information about True Sports Physical Therapy that's the best place to do it at True Sports PT, you can also find us on our website truesportspt.com. Without further ado, an awesome conversation with Dr. Mike Reinold.
Dr. Yoni Rosenblatt: Welcome to the True Sports Physical Therapy podcast. As always this is Yoni Rosenblatt, I'm really excited to have Dr. Mike Reinold with us. Mike, welcome to the show.
Dr. Mike Reinold: Yoni thanks so much this is awesome. I've been listening to the podcast I've been watching you guys online and I really appreciate all the stuff you guys are doing pushing the envelope a little bit with the sports PT profession. So thanks so much for having me and taking sometime to chat today.
Dr. Yoni Rosenblatt: Absolutely. I've heard and we have all heard so much about what you've published and what you've produced in the clinical side. Tell me a little bit about your path to get there, tell us the Mike Reinold professional history.
Dr. Mike Reinold: Oh man. I'm getting too old Yoni, that could take us the whole episode but... Yeah, I'll try to give you the nutshell one. But when I was in college trying to become a physical therapist I always knew I wanted to get into sports. So I started to become an athletic trainer at the same time. I knew I wanted to specialize in baseball so I thought like, Who are the best out there? Who are the experts out there? And I found ASMI, the American Sports Medicine Institute down in Birmingham, Alabama and Dr. Andrews, the surgeon to all the star athletes and Kevin Wilk, my friend and mentor now. I owe them so much for helping me to set the tone for the future of my career and not just my knowledge but also understanding what it is to become a sport physical therapist and the nature of that.
Dr. Yoni Rosenblatt: So I worked down there for a while, I got a great opportunity to come back home to Boston and work with the Boston Red Sox for a while. So you could argue I got my dream job in my late 20s so that was kind of cool. But over time things evolved and I got out of baseball for a little bit and opened up my own place up in Boston, it's called Champion PT and Performance, it's a big gym Sports Performance Center with PT and we're doing all that. Since then I've done a bunch of stuff, bunch of online stuff, and I work with the White Sox now, I help them with their medical department. But other than that, it's pretty good. And I'm the president of the American Academy Sports Physical Therapy, I should've said that. So that's a fun one too, to give back to the profession.
Dr. Yoni Rosenblatt: Well we appreciate it dearly. You've belittled a lot of those unbelievable accolades and positions, so I appreciate the humility. Tell me how you balance all of those things. You got private practice, you've got your consulting, you have your education. What's your secret to balancing all of these things?
Dr. Mike Reinold: Yeah. Most people that you think are doing a really good job probably aren't behind the scenes but... No, the secret is very easy for me. Like a long time ago, maybe about 10, 15 years ago I started to get really systems mindset where developing systems and proper processes, I'm kind of maniacal about that sort of thing. So any time you're starting a business or you're leading a department or a team, I think that's an important thing to start with. But then from there, it's all about your team. And I'm super fortunate to have amazing teams at every organization that I help run right now, because to me, without them none of this would work. So the better your teams the more they allow you to do other things. So I could do things like for example, once Champion got to an amazing point and all my team there was doing such a great job, I said, "Okay, well I have some bandwidth. I can go help the Chicago White Sox. That's great." And then once that process kinda got rolling, more bandwidth kind of opened up because again a great team's in place, I can go help the sports academy. So that's kind of how I've been doing it. I'm really looking forward to cut back a little bit so I can start working on my golf game a little bit more. But other than that though, it's been fun to have such great... [laughter] I don't know. One day.
Dr. Yoni Rosenblatt: Yeah. One day, exactly. Like all of us, one day. So you've built incredible teams. What do you look for when you're looking to add to those teams?
Dr. Mike Reinold: Yeah. That's a good question. For me, it always comes down to... A lot of what we do isn't as complicated as people wanna make it out to be especially on social media. So for me, I'm just looking for a good person first. A good human. That's step number one. It sounds easy but you gotta have a good human. And then from there you've got to have a real service-based mentality, I think that's important in our world nowadays is you have to understand that we're here to help serve our community, our clients, our patients, our athletes, whatever it is you're working with. So for me, we can train anybody to do anything we want. It's the people that have that mentality that it's not about us, it's about them, that really succeed I think in this world nowadays.
Dr. Yoni Rosenblatt: PT really isn't that high level. You can dumb this thing down really beautifully where they're tight and you stretch it or they're weak and you strengthen it. And if you can get a little simpler about that and boil that down, I've found that that goes a long way.
Dr. Mike Reinold: That's funny, right? I always tell people, if somebody spent a day with you or I, Yoni, I think they would leave and say like, "Wow, they're a lot more simple than I thought they were gonna be." To me that's the key to success is that we understand that it's not about complicating everything, it's actually about simplifying everything.
Dr. Yoni Rosenblatt: Yeah, simplifying it. And also like the patient and athlete, they have to understand it, make them the expert at what's going on. I've seen that go a really long way. So along the expertise, you are the elbow whisperer. I think I saw that on your business card. And so if you have to introduce this audience to UCL surgery and rehab, tell us about what's new and kind of educate us on this internal bracing technique.
Dr. Mike Reinold: Oh yeah, no that's good. That's actually a good topic, the internal brace. Heck, you know the last several decades we've had a gold standard for Tommy John procedures, for UCL injuries and overhead athletes, mostly baseball players. But we've had a gold standard with the reconstruction. And it's very reliable outcomes, you could argue 90 plus percent success rate especially if done in the right person and not a young kid or something like that. But it's been really good. The problem is though, if you look at the sport of baseball in general, the amount of injuries that we're seeing especially Tommy John in the elbow just continue to sky rocket. It's actually enormous and it's absurd when you actually look at some of the epidemiology of them and how they're continuing to hurt themselves. But the typical person now is becoming younger and younger every year. So when I first started 20 plus years ago, the person that would get a Tommy John injury was in their 30s, more of a wear and tear type injury, just chronic degeneration over their career. And now your listeners now, it's high school kids, it's college kids, it's sometimes even youth kids. It's just different now. So this reconstruction procedure is a big deal. Luckily, as we got better with surgical technique and the advent of some new things like this internal brace which is essentially just like a fiber tape. It's like a piece of tape we'll call it, right?
Dr. Mike Reinold: That was started to be applied in other areas like the ankle for example, like for chronic ankle sprain where you could repair a ligament with this new tape. And we've had some really, really smart physicians like Buddy down in New Orleans and Jeff Dugas in Birmingham, Alabama. They've done a really good job trying to now incorporate that into the elbow. And what we've found so far is that if you have the right type of Tommy John injury, meaning not everybody is a candidate for the internal brace, but if you don't have this crazy chronic degenerative tear, it's not torn in half, you just have some essentially like a non-functioning, it's just not stable enough type ligament, you can add this internal brace to it and actually have some pretty successful outcomes. And the benefit is the rehab's a lot faster because you don't have to have a full reconstruction and turn a tendon into a ligament, that takes time. So our return to play is a lot faster, so it's pretty exciting.
Dr. Yoni Rosenblatt: Yeah, that's awesome. So dumb it down a little bit. We talked about making things simple. So this is the ideal candidate is only an attenuated ligament without...
Dr. Mike Reinold: When you look at UCL. If you tore your ACL in your knee, it kinda just pops in half. You're skiing, you twist your knee, it pops in half. That doesn't really happen as much with the Tommy John ligament. Sure. Could you do that? Absolutely. Don't get me wrong. But what happens over time is you almost see like if this is the ligament kind of attaching into the bone, what happens is that it almost starts to just kind of like peel off a little bit on the articular side, you see that a little bit. And it's not a full-blown tear, but essentially what happens is it is essentially not functionally stable. So if you can go in there and repair that or if just one side comes off and you just wanna put it back down and then reinforce that with the internal brace, I think you have a higher chance of being successful.
Dr. Yoni Rosenblatt: Okay. And then walk me through how that rehab differs from our original UCL approach.
Dr. Mike Reinold: Yeah, so with the original UCL approach, there's a bunch of things you're concerned about. Obviously, the tendon has to turn to a ligament, so that takes time. That takes weeks before that even happens. So the structure of the ligament, it has to heal over time. That's important. But there's also big bony tunnels that the physician puts into the elbow. Both proximal and distal, there's some big bony tunnels. And if you go too fast with that, you certainly don't wanna fracture one of those or crack one of those. That would be really bad.
Dr. Mike Reinold: For us, the procedure there is more complicated, it's a bigger surgical procedure. With the brace, because we're not reconstructing anything, we're just repairing it and then reinforcing it, theoretically it's stronger sooner so you can go a lot faster. So I still am... I don't wanna say anxious 'cause that's not quite the right word. But when we look at the protocol and we start bringing people through the process, where I was like, Gosh this is really fast. How are they tolerating this? But they do. And when you have a new surgical procedure and you have to write a rehab protocol for it, you have to base it on your understanding of the basic science and physiology and that sort of thing, and you have to do your best guess with that. And essentially what we've done is we have people that can start throwing no later than three months a lot of times. And with the Tommy John procedure, they're starting to throw give or take at probably closer to the five month mark.
Dr. Mike Reinold: So we have people that are two months faster just with that, but then the throwing progression is so much faster too, it's about half the time it could be. So people are back six, seven, eight months instead of 12 to 15. That's a pretty big deal.
Dr. Yoni Rosenblatt: That's a really big deal, especially if that's how you earn your living, being on the bump.
Dr. Mike Reinold: Correct, yeah.
Dr. Yoni Rosenblatt: That's definitely a big deal. Talk to me about ranges of motion and how much time you spend hands-on in both options. 'cause I don't think that this internal brace has taken the country by storm yet, I think there are definitely places where they just don't know it yet. So if you could break that down into two categories, tell me how you're allocating your time early on.
Dr. Mike Reinold: Yeah. For sure. The first phase of either of these procedures is almost like the damage control phase, where you have a lot of pain, inflammation. They have to cut through muscle mass and stuff to get into the elbow, there's a lot of secondary healing that needs to occur. So range of motion is important. You don't wanna lose motion. Typically in these athletes and really anybody in general, but if you avoid elbow extension for too long at a time, you can lose it. The elbow joint is very congruent. If you were to look at a picture of the elbow joint just on Wikipedia and you look at it, there's no empty space, there's no big joint capsule, it's a very congruent joint. So it can get tight very easily and you can lose extension. And that would be bad especially if you're a younger person. So we do a lot of frequent range of motion right away, first week we're doing range of motion, flexion and extension. I will say as a little tidbit for those that don't do a ton of Tommy John's, careful with forcing flexion because that puts some tension on the graft that they just had, but with extension, I don't wanna say we're forcing it but we're certainly trying to get it back within the first few weeks after surgery.
Dr. Mike Reinold: So I'm a little bit more... I wanna make sure we get that extension. If flexion is struggling a little bit, I don't mind as much. But it's all about being consistent and just gradually progressing each week to make sure that they're making little gains. And the motion will come back. We don't struggle with restoring range of motion in these surgeries unless you just flat out don't do it for too long, like you wait two or three weeks to start therapy or you aren't focusing on range of motion. If you just focus on it pretty early, it should come back in these procedures.
Dr. Yoni Rosenblatt: And that's for both of them, right? You would say that for...
Dr. Mike Reinold: For sure.
Dr. Yoni Rosenblatt: By the way, in doing a lot of these interviews and podcasts and just talking to PTs across the country, that sounds so similar to what I hear about the ACL. And I think it's like a massive mistake we make as clinicians, of being super leery to know where that joint needs to be, and to know what we're pushing through to get there. So it's a force a knee into terminal extension and to educate appropriately to get them to terminal extension. You're not stressing that ACL. It sounds like it is the same thing here with the elbow, appropriately, to just get to that terminal extension. And once you know that own that, relay it to the patient. A lot of that stuff like you say kind of falls away. They're gonna get that extension. Let me ask you this. How do you know how hard to push into flexion extension? How do you gauge how hard you're pushing?
Dr. Mike Reinold: Yeah, I think the first thing comes back to time. So meaning, let's say for example it's early, that's when you have to have a little intuition. But let's say if it's late, it's eight weeks, nine weeks, ten weeks and they're still scuffling with some range of emotion. I know I can push because I know on the inside it's healed enough that I can get more aggressive. So time's number one. But most often it's early on and people are pretty sore. I'll say this. I think you have to move them. If they're super flared up from the surgical procedure and they're just having a really crazy inflammatory response, the elbow's hot, swollen, that type of thing. Moving it is key and frequent gentle motion is phenomenal for them. So they need to do it at home quite a bit. If you crank on that a little bit too much, you're gonna get a bit of a bounce back and it could kind of backfire. You'll get a loss to range of motion. That's not what we're shooting for. That's not good. But for me, that's why the protocols is there, so you know like, Hey, I wanna get about five to 10 degrees of range of motion each week. So it's almost like a pace car, making sure that you're doing that. Is there gonna be a little discomfort?
Dr. Mike Reinold: Sure. But man, with very fairly gentle range of motion that you're performing as a therapist, you're not putting that much stress on the healing tissue, you're not twerking the crap out of it. So for me, I think you'll have that intuition that it's... Get to that little bit of pain. If somebody's having a really bad time and it's really sore, we'll just do passive range of motion for longer. I might just move somebody back and forth for 15 minutes straight and just talking to him about, what are they watching on Netflix, what's going on? Did they see the game last night? And what happens over time as you get into that edge of that threshold of where they are and that window slowly opens up as they get more comfortable. So you have to understand the healing constraints, you have to understand that any guarding or spasticity is probably something you don't wanna push through, that's gonna... It's probably gonna backfire on you. But some general discomfort, I think they just gotta gain a little confidence in the limb and just gentle working it through is gonna be better than just cranking on it.
Dr. Yoni Rosenblatt: Yeah. How do you set that patient up? I really value the Macrina mobilization where he works on that knee into flexion over edge of bed. That's like the biggest thing that I learned from 15 years ago, from Lenny, right? But how do set that up for success around the elbow?
Dr. Mike Reinold: Yeah, I mean, similar thing. I think we do most of our range of motion just supine with, put a little towel roll under their elbow. And again, it's a very comfortable position. You can relax your thorax, you can relax your scab, your shoulder joint, and just allow us to do the motion. So for me, I think that's a pretty simple way to do it. That it's about getting them to relax, right? And I think the seated position for the knee is a good example. It's about just getting them to relax and just allowing the motion to happen.
Dr. Yoni Rosenblatt: How do you feel about me calling that the Macrina mobilization versus the Mike mobilization?
Dr. Mike Reinold: I think that's good. Well, I mean, we both got it from Kevin Wilkin. I'm sure he got it from somebody else. So there's a long line of that. But I appreciate it. Lenny's the man. So for sure, Lenny's... He's got a lot that I've learned from him over the years too.
Dr. Yoni Rosenblatt: I love it. How much pronation supination are you biasing, are you worried about?
Dr. Mike Reinold: Yeah, we work pronation supination right away. No limitations, meaning you can do that to full pretty early in the process, but absolutely you want to work on that. And one thing, we didn't talk about it with the other range of motion conversation we just had. But just remember a few weeks ago, this kid was injured, right? This kid... Something was going on with him and he had an injury. So maybe his flexor pronator mass was really tight two weeks ago before surgery too. So it's not just do we do their range of motion, but we may have some things we have to clean up that was there for months. So yeah, pronation supination doesn't really put a lot of strain on the graft so it's something that we do pretty easily at the beginning. And yeah, you rarely have trouble with it.
Dr. Yoni Rosenblatt: That mindset that you just highlighted is so imperative to an outstanding sports PT, which is something led to this issue. Maybe it's elbow related. It's probably... Maybe it's shoulder related. You said something awesome on your webinar last night about the percent of velocity that comes from everything but the upper extremity. Which was what number?
Dr. Mike Reinold: Right. Yeah. 86% comes from the trunk and core and lower half.
Dr. Yoni Rosenblatt: And so this is going to tie into my next question, but we're trying to figure out what got the patient to this and let's see if we can fix that while they can't pick up a baseball. I think that's an awesome piece to look at. So going down that rabbit hole, when do you start strengthening and when do you start really full body conditioning?
Dr. Mike Reinold: Yeah. And great thought behind that too, because that's the benefit of this long rehab process is we get to reconstruct the person like kind of top to bottom. And that's why a lot of people say sometimes they come back throwing harder. Like if you look at statistical studies that look at like, let's say velocity before and after a Tommy John at a professional level, right, they don't go up in velocity. They may go down in velocity. They certainly don't go up. What happens in the youth though is that they're a mess and we clean them up for a year and then they come back throwing harder, but it's just because they weren't optimized. So most people aren't optimized. I will say this is my biggest... Fear is the wrong word. I'm not really afraid. But like my biggest fear of the internal brace procedure is that it's so fast that I don't have enough time to clean the kid up before he starts throwing. Right?
Dr. Mike Reinold: I mean if his mechanics are terrible, if he has terrible rotator cuff strength, he's never worked out his core or his lower half in his life and he hurts his Tommy John because he throws with terrible mechanics, then me rushing to have him start a throwing program eight to 10 weeks after surgery, he's going to look even worse. Right? So for me, I think we need to really be smart about that. I think we can do a better job. We start strengthening right away technically, right? We'll do isometrics around the elbow joint right away and the shoulder joint.
Dr. Mike Reinold: We do that right away. We'll start doing an isotonic program and controlled ranges for the shoulder and elbow like week three, by week four the latest and start to progress. And then if you just think like even just adding a pound a week for a couple of months, that gets him to a really good spot. And then when you get to about week 12 for a traditional reconstruction, around week 12 is when we would start integrating some more loaded movement pattern. So away from the isolated strengthening of a muscle and more towards loading a movement pattern like a push and a pull, for example. So we'll do that around week 12. Everything will be about a month earlier with the internal brace procedure.
Dr. Yoni Rosenblatt: And then how about the rest of the athlete? Lower body, trunk, you comfortable with that right away?
Dr. Mike Reinold: Yeah. So we actually have a lot of our athletes. So if you're a pro athlete, right, you're like a high level athlete, you're going to be doing stuff right away, right? You have another arm. You have your legs. Assuming you didn't take a gracilis graft, you have your legs, there's plenty to do. So our pro athletes certainly aren't sitting around. If it's a traditional reconstruction, I won't necessarily rush them back into the gym, but I'd say by about the fourth week or one month out, they're getting back in the gym. It makes them feel better mentally and it just makes them feel like they're moving their body a little bit. It's just a win-win for a lot of reasons. So yeah, I mean, I think that's an important part of the rehab for sure.
Dr. Yoni Rosenblatt: Yeah, and I think early on from what I've seen is getting them moving early is going to help with some of that other stuff that you talked about, which is their physiologic response to the surgery, right? How quickly can we get swelling? How much can we help them between the ears, things like that. And also when you get towards that blood restriction, look at the entire systemic hormonal response to whatever you're loading, whether it be legs, how much is that helping the rehab program?
Dr. Mike Reinold: Absolutely. Yeah, I agree.
Dr. Yoni Rosenblatt: I think is totally worthwhile. So you mentioned throws. Tell me when Mike Reinold thinks an athlete is ready to pick up a baseball.
Dr. Mike Reinold: Oh, I like that. Well, I mean, we'll talk again essentially, we'll talk reconstruction first, right? So with reconstruction, the first thing that you have to do to pass the criteria to throw is it needs to be what we use is 20 weeks. So time is one, because you need to have the ability to heal. That doesn't mean you're ready at 20 weeks, but most of you tend to be ready. The way we built our protocol though in the rehab program for this person is each week and each step and each activity they do, you could argue is a return to sport test, right? So meaning like you can't start throwing until you do one hand plyometrics. You can't start one hand plyometrics until you do two hand plyometrics. You can't start two hand plyometrics until you have a good baseline strength and dynamic stability of the cuffs and scab.
Dr. Mike Reinold: Oh, that's the right thing, right? You can't do that until you have like good baseline range of motion and mobility of the elbow, right? So for us, that is how we sequence it. When we get to the point where we're ready to throw, if you've done everything we've asked you to do, I know you're ready. Right? Because you're going to literally pick up a ball and play light catch at like 30, 45 feet. That is very anticlimactic compared to what we've been doing in rehab.
Dr. Yoni Rosenblatt: Yeah. I smile because you make it sound so simple, but that's your point is that if you're planning a program and you really boil this thing down, it ain't rocket science, right?
Dr. Mike Reinold: Right. Right. And with Dr. Andrews, we used... Oh, sorry. I think we had a little lag there. Sorry. I was going to say with Dr. Andrews, we have... We would do a lot of rechecks back in the day where maybe people would come and see him for surgery, but they wouldn't be rehabbing with us because they lived really far away. But he'd want to come and have them cleared before they begin throwing. So they'd come at week 16, give or take, and let's say, are we ready to start throwing? And they may pass all the tests, right? Your motion is good, your strength is good, everything looks great. And they'll say, great. Have you done the one-hand plyo yet? And they're like, "Oh, no, no, no. We haven't done it yet." We are like, "Okay. You're going to start throwing in two weeks, right? You're going to have to do all those, right?" So I think it's important that you stick to your guns with some of those things.
Dr. Yoni Rosenblatt: I love that. That sounds like a lot of the ACL stuff we see, which is this idea of return to run. Like, what are the boxes you've checked in order to get there, right? Like, can you do a single leg stance? Can you do a plyo? Can you... All those things. And obviously moving bilateral to unilateral, it sounds like the same thing here, upper extremity.
Dr. Mike Reinold: Yep. Don't cut corners just because it's week X, right? Just because you think like, oh, it's week X. Or even worse, that the doctor blindly cleared them because it's week X. We always say like, oh, that's fantastic. Oh, the doc cleared you to start running or throwing. Fantastic. Great. Yeah. I think a couple more weeks, we'll get our goals too and you'll be ready to throw. Congrats. Right? Like, we don't make it an issue, but that's how you phrase it to them. And then they seem to get it.
Dr. Yoni Rosenblatt: Yeah. I love that. Tell me the biggest mistake you see PTs making in Tommy John rehab?
Dr. Mike Reinold: Oh, in Tommy John rehab, the biggest mistake they make. I mean, I do think that sometimes we don't get their shoulders strong enough. Right? So maybe what we're doing is we're limiting their weights. Maybe we're not getting the dumbbells as high as we can. We're not doing a lot of manual dynamic stabilization things. I think sometimes we under load people. I think that would be common early on. Secondarily, when you're in the middle of a deep throwing program, sometimes we overload where we just layer on too much stuff. So for example, if it's like month six, month seven, you're trying to set a PR and your deadlift and you're doing a bunch of gripping exercises in the gym and we're trying to progress in a long toss, that's a lot of stress on your forearm muscles and your grip, right? So you have to be careful how you layer in those different things early on. So I think most people are probably guilty of under loading at the beginning and overloading towards the end.
Dr. Yoni Rosenblatt: That's a great way to look at it. Tell me about a mistake you see that MDs make during this rehab process.
Dr. Mike Reinold: Well, I mean, I don't know if we can state this publicly here, but no. I mean, some of the potential complications, I would say... [chuckle] Right, no physicians are probably... There's I would say two things that we see for surgical complications a little bit. One is I wish more physicians move the ulnar nerve, right? And I was just having a conversation with Dr. Jeff Dugas about this down in Birmingham with the internal brace, but depending on your technique, you don't have to move the nerve. So Dr. Andrews and the modified Jobe technique, which is the most common one for reconstruction, that you have to move the nerve. It's just part of the process because it's in the way. But if you do a different technique called a docking technique, you don't have to move the nerve.
Dr. Mike Reinold: But I can't tell you how many times you've seen the nerve cause complications down the road. And if you're eight, nine, 10 months after Tommy John surgery and you start to have some ulnar symptoms that require like a second surgery, that's fairly devastating to them mentally. Not physically. We'll get over it. It's not a big deal. But man, that puts them back time-wise and mentally. I just sometimes I wish they just moved the nerve to begin with. So still my preference to move the nerve. I would say that's probably the big one that I'd like to see docs do more, but I don't think they agree with me. So that's probably not going to happen. But we see more of them after surgery than they do.
[laughter]
Dr. Yoni Rosenblatt: There you go. Exactly. What are the complications of moving the nerve? Is there a downside?
Dr. Mike Reinold: Yeah. I mean, it's more surgical time. Yeah. Anytime you have to touch the nerve, you could have some issues with it. So again, I think if you actually look at complication rates of moving the nerve, they're very similar to complications of not moving the nerve. But to me is like when you have one, like the complication of moving the nerve, not as big a deal as not moving the nerve. Does that make sense? I know that sounded challenging, but you know what I mean.
Dr. Yoni Rosenblatt: I mean, I think that makes a lot of sense. It also starts to weed out the physician that is listening to a Mike Reinold or... Like they should care, you would think, about these outcomes. Because that's all you're preaching about is, Hey, we see all these people in the lab. This works better than it doesn't. You start to learn who are the physicians that give a damn or by the way, say, Mike, here's why I don't do that. It means that they're listening. You know?
Dr. Mike Reinold: Right. I agree.
Dr. Yoni Rosenblatt: So I think it's definitely worthwhile finding those, trying to find those physicians that will at least listen.
Dr. Mike Reinold: Yeah. To be part of it.
Dr. Yoni Rosenblatt: What about this? Yeah. To be part of it. You are one of certainly the most, the more active clinicians on social media. Tell me about your take on social media, both its positives and negatives that it's had on our profession.
Dr. Mike Reinold: Oof. That's a good one. It's funny. I'm on social media because you kind of have to be on social media, but I was on social media at the beginning too. So you could argue the key to my success was I was just lucky that I was one of the first. It's not that I'm better than anybody else. I just was lucky. But yeah, I think social media is, it's challenging, right? I think I've said to a couple of people lately, like Twitter, like on Twitter you're either a bully or getting bullied, it seems like. It's like one of the two, right? So Twitter's turned into a tough crowd. Instagram, I think it's fine, but the problem, the issues with Instagram is that people are using that as a place that they go to learn. I think that's hilarious, right? Like, it's so hard to learn out of context with a 30-second video, what that fits and what that does.
Dr. Mike Reinold: I just think it's not... It's entertainment, right? I'm on Instagram looking at golf swings. I'm looking at like fun pictures from my friends and stuff like that.
Dr. Yoni Rosenblatt: What else apart from golf swings? What else?
Dr. Mike Reinold: I'm mostly looking at golf swings. It's mostly golf swing. I'll be totally honest. I have better golf swing chats than anything else on Instagram. But like, I am not out there going like, oh, I'm looking for the latest and greatest exercise. Right? Like, I think the problem is everybody's looking for that quick jolt of information. And like without context, it makes no sense, right? So it's very challenging. People make some crazy statements like the nevers and always, right, that are always on Instagram. And man, trust me, we look at them and we talk about them at work with the students.
Dr. Mike Reinold: We show like, hey, did you guys see this little buzz that's happening on Twitter right now? And we're like, here's why you should never say that. Right? Like to try to help them a little bit. But yeah, so I don't know. I mean, it's a love-hate relationship with social media. I think you just have to take it as entertainment and realize that you have to dig into the research. You have to go learn from experts that are publishing, that are researching, that are educating. You have to do that. And then Instagram is just fun on top of that.
Dr. Yoni Rosenblatt: Gotcha. You have made that very clear to kind of go to the people that are publishing, researching, but also treating. And that's one of the things that I really value about following you and learning from you is that you still get your hands on athletes. You're still there working because you love it. And that's super valuable to my audience. I made the mistake of going to graduate school and being taught by a lot of clinicians that were no longer clinicians and were simply professors. I think dancing back and forth creates an outstanding environment to learn. I'm going to bring it to a close with this give me five drill, which I picked up on someone's podcast, where I just really want your quick answers to the following questions. But Mike, just try to keep it concise. Ready?
Dr. Mike Reinold: Let's do it.
Dr. Yoni Rosenblatt: Okay. What have you changed your mind on in the last five years concerning UCL rehab?
Dr. Mike Reinold: With UCL rehabs, we're going to be specific to UCL. I think it probably goes back to that flexion range of motion thing. I think over the last several years that we've had more and more surgeons performing Tommy John surgery. And some of them may put the graft in a little tight, right, than a more experienced person. That's not necessarily bad in the long run. But when that happens and you have a limitation in flexion in the elbow, you just have to be careful cranking on it. So that's one thing I changed my mind on is that I'm probably a little less aggressive on trying to get flexion back on somebody that's struggling with it.
Dr. Yoni Rosenblatt: What is the biggest failure of your career?
Dr. Mike Reinold: Oof. The biggest failure of my career? I would say probably the biggest thing that I would say a failure. That's interesting. You define failure. I like how you said that. What I would say is I think earlier on in my career, I think we all... You see an evolution of people over time. I think I was so hard into the science, I was so hard into research and publications and doing that sort of thing that I thought that I found the answers to some specific questions. I thought I found the answers. But the more that you have experience with things, you realize that there's more than one answer to most problems. So you don't want to go in there thinking that there's only one answer and being really stubborn with your approach because then what happens, and you see this on social media all the time, you spend all your time kind of defending your bias and defending your belief instead of keeping an open mind. So if I had said there's one thing that I failed earlier in my career with, was that I went in there thinking there was a right way and a wrong way to do certain things. But that's good because that failure leads you realizing that that's not true and then you grow.
Dr. Yoni Rosenblatt: That is sage, Mike. Don't date yourself. That's a great way to look at it. I think that's really awesome. If you were to construct a billboard that a sports PT drove by every day of their life, what would you put on that billboard?
Dr. Mike Reinold: Oof, that's a good... All right, so sport PT. We're here to serve. I think that's it. That's it. We're here to serve. Have a servant mindset, right? Especially nowadays too. We're graduating...
Dr. Yoni Rosenblatt: ...pulling up to a church.
[laughter]
Dr. Mike Reinold: All right, so maybe I'm not the best marketer. I don't know. But have a servant mindset because to me, what it comes down to is just very simple, is... You see students come through your facility all the time, right? Some students want to show their patience and the people around them how smart they are, and some want to show them like that, look, I'm here to help you in any way. If you go and have a servant-based mindset, I think you're set. A lot of people get upset if you're like, hey, I recommend you stop running, you take a week off from running, right? And then the next visit they come back like, yeah, I went for a jog this weekend. I couldn't help it. Some people would take that personal and they would... You just gotta realize, look, we're just here. We're here to guide. We're here to help them achieve their goals. So have a servant mindset, I think, is the best approach.
Dr. Yoni Rosenblatt: Yeah, that's an awesome way to go about it. That humility is so imperative. Let me close on this. Tell me the last time you were starstruck.
Dr. Mike Reinold: Starstruck? It's funny. It's not during sports, right? Because I've gotten way past that in sports. So it's actually like it's weird...
Dr. Yoni Rosenblatt: It's not during this podcast, so tell me when it is.
[laughter]
Dr. Mike Reinold: So I'm a music fan. So I would say like musicians still starstruck me when I get to meet some musicians and stuff. That's fun. But even back in the day, it's funny, you work with all these people, hall of famer, Cy Youngs, MVP, all these great people. And then Triple H from the WWE walk in the clinic and you're like, all right, that's crazy. That guy's awesome. Exactly, right? So trust me, it's not athletes. You walk into a clubhouse and you see some people that expect you to think like, oh, wow, like, surprise, they're not there. No, for me, I think it's more musicians than anything right now for me. That was a good question.
Dr. Yoni Rosenblatt: Thanks, man. I did some research on this. Okay, Mike, tell me how people can find you. Tell me what you're excited about. Tell us just how we can keep soaking in this knowledge coming out of the Mike Reinold brain.
Dr. Mike Reinold: Well, I'm easy to follow. Just mikereinold.com, my website, and that's kind of the hub for everything. But man, at this point, we got a little bit of everything, right? We're on all social channels, got a couple podcasts out there, just started a new webinar series, so we're doing a bunch of stuff. But a couple big things is our Champion Performance specialist, which is like our big epic course now where we kind of teach our system of how we do performance therapy and training.
Dr. Mike Reinold: It's got two cohorts a year that we open it up to, one's about to open up in a little bit of time here. So you should check that out at mikereinold.com/cps. That's a big one. And then I'm actually working behind the scenes. If you listen to this episode, you probably like baseball. We're working on a baseball rehabilitation specialist course, which is probably about 20 years overdue for me. But I don't know why I've never built this, but it's time. So we're going to get that out hopefully sometime in the first half of this year.
Dr. Yoni Rosenblatt: That sounds awesome. And I'd love to reconnect and really like dive into what that means and what you're pushing that way. I love everything you're doing, I have for years. Can't thank you enough for joining us. You're really a wealth of knowledge, both in terms of the academia, but also how to relate and how to interact and how to make meaningful decisions when that athlete's in front of you. So Mike, thanks for doing what you're doing and thanks for joining us on the True Sports PT Pod.
Dr. Mike Reinold: Thanks. That's awesome, Yoni. I really appreciate it and appreciate the kind words and you taking time out to do this and really giving back to the community yourself. It takes a lot of work to do these sorts of things. So I hope your listeners know that this is a big endeavor on your part. So thanks for taking the time out to share and help us all grow. I look forward to learning from you guys in the future too.
Dr. Yoni Rosenblatt: Thanks Mike.
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