Q: What is your background and what led you to a career in physical therapy (PT)? Dave: I grew up in western Montana and was always drawn to the sciences and anatomy. I thought I wanted to be a physical therapist. Then I was a college athlete and I saw guys go through some pretty devastating injuries. A really good friend of mine tore his ACL, so I watched him rehab that and he came back the next year, a better athlete. That’s when I really started getting hooked. Not only just because he came back, but because he came back better than he was before and actually was a better athlete. That was inspiring to me. I then went through undergrad, went off and got a chance to play football after college for a while, and then came back to the University of Montana and finished up. I knew that was the right choice for me from the start. Q: Can you give an overview of Rehabilitation Services here at Bone and Joint? Dave: We’ve been open as Bone and Joint Rehabilitation Services for about a year and a half. We have the location in Franklin, and we also have a location in the Tollgate Medical Plaza down in Thompson’s Station. Right now we employ seven PTs, three PTAs (Physical Therapy Assistants) and three Occupational Therapists, two of which are Certified Hand Therapists (CHT), which is an additional certification they obtain through extensive training. Only about 50 percent of people pass that exam, and it’s basically a specialization for hand therapy. On top of that, we have a great receptionist staff that we couldn’t manage our days without. They are a huge part of who we are as well. The services that we provide are head-to-toe physical therapy – we treat everything from neck and back injuries to post-operative and sports injuries. The Occupational Therapists provide rehab services from the shoulder to the fingertip, and also do a lot of specialized splinting and making orthoses and things like that. Q: What populations do you treat? Dave: We’re here for the community. The main thing that we want to do is help out people who live here. The only thing we really wouldn’t see is infants. But we treat kids very young – as young as six or eight years old, all the way up to our geriatric populations. I think it lends itself to being a pretty neat setting for us because we see all kinds of people from the community. You get a wide mix of people. It’s great to see the interplay of the ages. Sometimes some of your hardest workers could be your eighty-five year old, and it’s funny because you’ll see them motivate young kids. But then you’ll see an athlete working out in there, too, and they’re inspiring to somebody else. Then somebody will come in with similar injuries and they might have just had a total knee replacement, for example. They can look across and be like, “well, what did that guy have done?” Then a patient may share, “that was me four weeks ago.” And they’re like, “no way, I could be doing what you’re doing in four weeks.” So it’s neat to see the interplay between all the different populations in the clinic. And I think it makes it a pretty high energy fun place to be. Q: We know that sports medicine is a huge part of Bone and Joint Institute. We are involved in the local sports community. What are some of the most common sports injuries that you see here? And how do you address their injuries and get them back in the game? Dave: We see a lot of different athletic injuries here, from strains and sprains to repairs of tendons and ligaments. We definitely see a lot of knee injuries, which can include cartilage injuries, dislocations of the knee cap, and one of the most commonly known injuries, the ACL tear. Not all injuries require surgery so we always try and treat conservatively if appropriate. One thing we always try to do is tailor rehab to the individual. Every athlete’s needs for return to play are different and there is never a “cookbook” for rehabilitation. A lot of physical therapists started their journey into working in rehab due to a past injury to themselves. Several of our staff were actually high level athletes, and all of us are fairly active people, and that helps us to empathize and be an encouraging teammate who understands the physical and psychological effect of injury. With all our patients, and especially with our athletes, we collaborate with the physicians right away. We have access to specific details of the surgery, sometimes even getting a chance to meet them prior to them attending rehab. It’s important to me that they view us as a teammate through the injury and recovery process. One thing that is a great attribute of our team, is that while we follow all rehab and physician protocols, we also make sure to use evidence based practice, functional performance testing and objective information to progress our athletes. Simply moving along by a post-operative timeline is not acceptable to us as functional mobility, balance, muscular power and endurance, stability and range of motion must all be assessed before moving to a harder phase of rehabilitation. We also use something called the DorsaVi, which is a sensor based system that gives us objective data and identifies faulty movement patterns that may lead to increased risk of injury or even just decreased performance outcomes. We regularly collaborate with physicians, families, coaches, and school athletic trainers, to make sure that everyone involved is aware of any restrictions and safety concerns, but also are aware when it is time to safely crank it up and progress back to the activity they love. Q: Tell us about the sports medicine, rehab, and the relationships we have here in the community. Dave: We talked about the continuum of care and the cooperation between the doctors and our team, but there’s such a psychological issue that happens when you have a bad injury. There’s that, “gosh, am I going to do it again?” My team does a great job of providing that psychological component and being encouraging from the get-go. A big part of that is just education and saying, listen, this week’s going to be really hard, next week is going to be a little bit better. These are your goals and this is what we expect to see – but realize, this is the timeline for your injury, so what you need to do is let’s focus on the here and the now, but always remember that there’s a tomorrow. I think that helps a lot, and it helps the parents as well to understand what the goal is because I know as a father, that’s what I would want. And so I think that’s a big part of what we do – the educational component and building the confidence in moving forward. Obviously, we try to provide the best care we can, which is why we’re big into evidence-based practice and making sure that we’re not only just going for the goals that we know that they need to hit to get through the protocol, but also the goals of functionally what they want to get to. And that’s different. That’s why being good listeners and making sure that you’re incorporating the patient’s goals into the sports medicine rehab program is really important. Another thing that we really pride ourselves on is getting people to their highest level, and that means being better than you were before. That’s important to us – making sure that that you see us not just doing the minimum for you. I want them to be confident and feel just like my friend did that got me into PT, watching him go back to sporting better than he was before. The other thing that we have that’s just an absolute blessing is our partnership with Williamson Medical Center, we provide athletic training to a lot of the high schools around here. We also have athletic trainers that we communicate with, so if a high school athlete gets injured and they start transitioning away from us, we have someone who has been involved in their care, who knows them, and can take over where we left off. Q: How does Rehab Services make us a destination for orthopaedic care and provide comprehensiveness to our practice? Dave: I really think it is the team approach. I can’t even explain how many times we get together with physicians, their staff, or our team of therapists to work together to best understand the individualized nature of every patient we see. We have a rehab team full of great experience, but a great servant’s hearts and high energy. Along with that, this is a group of physicians that comes to us and wants our opinions. We have roundtable discussions with them and we go around the table and say, “where are we missing something?”, “What can we do better?” We can work with each other to collaborate and provide information and expertise. It’s really easy for doctors to get busy with patient care and their lives, but the fact that they sit down and take the time to go through things with us is huge to me. The Bone and Joint Institute is also able to assist with most any bracing needs patients require through the use of our in-house Durable Medical Equipment (DME) team. They are very helpful to Rehab Services as they ensure that any braces used after injury or surgery are not only well-fitting but maintain patient safety as their mobility and function improve during their time with us. Bone and Joint Rehab Services is striving to be the best at what we do, and provide the kind of comprehensive care that no one else can. We want to take rehabilitation to a level that no one else does – that is the ultimate goal. For more information about our Rehabilitation Services Department, visit https://bit.ly/3d5M1DY or call 615-791-2640.