Episode 6: Healing. That Sh*t Takes Time

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• Joe Gambino
• Joe LaVacca

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Summary
In this episode, Joe LaVacca and Joe Gambino discuss the process of healing and the common questions that arise during rehabilitation. They emphasize that healing takes time and that it is important for clients to have realistic expectations. They also highlight the role of diagnosis and prognosis in creating a treatment plan. The hosts discuss the importance of setting goals and the value of guidance and coaching in the rehab process. They also touch on the role of manual therapy and the need for individualized approaches. Overall, the episode emphasizes the importance of commitment, patience, and consistency in the healing process.

Takeaways

• Healing takes time and it is important to have realistic expectations.
• Diagnosis and prognosis play a role in creating a treatment plan.
• Setting goals and committing to the rehab process is crucial.
• Guidance and coaching are valuable in the healing journey.
• Manual therapy can be diagnostic and help with desensitization.
• Commitment, patience, and consistency are key in the healing process.

Transcript

Joe LaVacca (00:00)
Hello everyone and welcome back to the Beyond Pain podcast with myself, Joe Lovaca and Joe Gambino. In today's episode number six, which we commonly refer to as number seven, we talk about healing and how this takes time. Now, Joe and I start our chat by noticing we both wear pink today. Totally not planned.

And then we dive into what we feel are four very common questions about the rehab process, including what's wrong with me. How long will this take to get better? What can I do and what can you do? So we hope you enjoyed this conversation and all future conversations we have on the Beyond Pain podcast. And if you do, please be sure to like, subscribe, comment, share all those wonderful things that we can do with social media to help the podcast.

grow. Without further ado, here is episode six, not seven.

Joe Gambino (01:47)
Welcome back into the Beyond the Pain podcast. I am your host, Joe Gambino, and your other host is here as well, Joe Lavaca, just a couple of Joes, hence why I think we're called Cups of Joes. And I've got myself a little coffee here so we can Java chat it as we're kind of going through it.

Joe LaVacca (02:08)
Yeah, I think it's good that we bring that up episode seven, you know, two Joes. That's why we're called cups of Joes. And it's OK. We're still learning. We're still learning.

Joe Gambino (02:12)
Yeah.

Yeah, yeah, this is this is a passion project right we have no rules here But you know you can reach out to us I tell everybody at the start of the episodes reach out anytime I'm a big fan of having DM conversations with people so I am Joe at joking you know DPT on Instagram Joey LaVacca here's at strength in motion underscore PT feel free to reach out to us anytime you want You can watch this show on YouTube as well

Joe LaVacca (02:21)
That's right. That's right. That's true.

Joe Gambino (02:45)
YouTube channel is cups of Joe's underscore PT As Joe mentioned last episode. I haven't even mentioned it once but we do have a YouTube Instagram account for this show. I don't even know the What is the the handle? I don't even know. There we go. Yeah beyond pain podcast And there will be an application form down in the show notes as well So if you don't want to be a much you can fill that out if you if you are interested in working with us as well so

Joe LaVacca (02:56)
We do. It's just Beyond Pain podcast.

Joe Gambino (03:14)
As we will actually before we dive into our pink matching tops today, I have to say this little countdown timer where we're recording that five, four, three, two, one, it brings a lot of anticipation and I don't want to say anxiety, but they like builds up momentum for the show for me personally. No one can see it besides us, but.

Joe LaVacca (03:17)
Yeah, this is crazy.

Well, I mean, you just yelled at me. You just yelled at me for banging on my desk. So I guess it was doing it for me too. So yeah, I will try to contain my excitement. I think any countdown is exciting. I think maybe we should actually do that in the rehab process right now. Like, welcome people in. It's like, hey, hold on, we're gonna start in three, two, one, tell me your story.

Joe Gambino (03:57)
I would love to see someone's reaction to that. Just be like, I think I need to go to the bathroom and then like never show back up again.

Joe LaVacca (04:07)
Yeah, my quote unquote clinic is just part of a bigger gym. So I'm right by the elevator. So it's a quick escape for anybody that just wants to shoot right back down to Fifth Avenue for sure. So I don't know, maybe I'll try it next week. I'll let you know how it goes. I mean, you're going to Mexico this weekend, you said, right? Where about in Mexico?

Joe Gambino (04:17)
Yeah.

I am, yeah, I am. Right in the Tulum area, so it should be fun. Yes, yes, I am mostly looking forward to getting some golf, so.

Joe LaVacca (04:31)
very nice, very nice. I have not been to Tulum.

okay, very good. I've not been to Tulum. I've heard that it is now very built up. It's no longer the hidden gem of Mexico. Have you been before and do you agree?

Joe Gambino (04:46)
I have not been and I don't know. I have nothing to say on that topic.

Joe LaVacca (04:48)
Okay. So bad question on my part. I'm learning. I'll ask better questions in the future.

Joe Gambino (04:51)
Yes.

I sure hope so, Joe. I do hope so. But, you know, I also think the anticipation of this show was elevated because we are both wearing pink today and we did not plan that. So that was that was fun that I didn't even notice. Good. Good. You redeemed yourself for for the bad question.

Joe LaVacca (05:01)
Ugh.

Yeah, that's really wild. I did not plan that.

Yeah, yeah, I thought this was a little too early for pink. I was going to wait to bring this shirt out for Labor Day, but then I was like, you know what? I want to impress you. And then lo and behold, for anyone not watching the podcast, Joe shows up wearing a pink sweatshirt. So already like just doing this for a few weeks, man, we're already riding the same wavelength together. What a, what a.

Joe Gambino (05:28)
Yes.

Know no, wow, we are we are synced up and and ready to rumble so Joe Yeah, it has been actually it has been very good So today we're talking. What are we episode? I? Won't know until we actually yes, we're seven today. I lose track very and we're talking about healing As you like to or as you put it right this shit takes time So little one, we just start there

Joe LaVacca (05:38)
What a bonding experience this has been.

Seven.

Joe Gambino (06:02)
Why don't you just take the floor? I don't know where you even want to start this conversation because I feel like we can probably talk about this for like nine hours and have this as like a 12 episode podcast. Where do you want to open the floor with this?

Joe LaVacca (06:16)
Well, maybe we, maybe we do sort of have that expectation. Cause I do think there's a lot to say here. And I do think this is a really important part for clients to understand. And I, maybe, maybe this is what we do, Joe. I have an option here for us. Like what is healing from maybe more of an emotional or sort of like mind standpoint versus what's healing is more from like a body standpoint. But for today, why don't we keep it from like healing the body.

I think that's why most people are going to end up finding us anyway. And I have some notes here in front of me, but I think generally speaking, when people begin this process with us, and I've seen this pop up a few times and I want to know your thoughts on this. There's four main questions that typically pop up for people. What's wrong? How long will it last? Is there anything you can do? And is there anything I can do? Do you think those are four?

fair questions to start off the process when people seek us out.

Joe Gambino (07:17)
I think they are very fair questions for anybody to have. And then just a little bit back to like emotional, physical. I do think they're tied. Maybe we think of it this way for today's episode. It's like, how much time does it take to physically make changes? But we both know, right? Like if we're working with somebody, changes or at least how they're feeling happens can happen like very quickly within one session, right? So what is that difference between like the changes and what they're feeling and how does that?

Joe LaVacca (07:43)
Sure. Sure.

Joe Gambino (07:47)
compare to actual tissue adaptation, actual healing and things like that. So we'll dive a little bit deeper, but why don't we start with those four questions and then we can kind of branch in and drive from there.

Joe LaVacca (07:59)
Right, right. So I think like when it comes to that first question, right? Like what's wrong? I mean, it kind of comes down to a diagnosis and I think getting our thoughts on diagnosis might be a good way to tie in here. I think a little bit less of diagnosis these days is more maybe prognosis these days, right? Cause I feel like prognosis for me sets us up on this plan or this pathway and allows us to

like come to terms with reality. However, I think a diagnosis for our clients is a little bit more important because I think that creates their plan, right? So it's like this like balance of, you know, we're helping people with their experience. So for me, prognosis is more important. But for I think a person that internal representation of the diagnosis is maybe what they're really after. So.

If I think about it, I'm usually just trying to help people accept their reality, reassure them that they will get better. But I kind of balk sometimes at this diagnosis or labeling things really specifically. Do you try to give people a very specific diagnosis or is it more function -based or maybe even big picture?

Joe Gambino (09:15)
So I agree with you. I think probably the especially people who have like chronic pain and they like I feel like not having an answer is one of the hardest thing for people to process because it's like why do I have so much pain when every MRI every scan every doctor I've says says there's nothing you know physically or anatomically wrong. So you know I think it is a definitely a fair statement that I think.

Patients or whenever anyone has pain they want to know Why it's happening. I don't ever really give like like I mean in our world rather there's like a medical diagnosis and there's a Movement diagnosis, I guess we can call it right like we don't give medical diagnosis, right? I mean we can we can probably get a pretty decent hint on like what kind of tissue is irritated but I would say is I always try to bring it to

Joe LaVacca (09:59)
Yeah, sure.

Joe Gambino (10:11)
the movement assessment, the findings that are happening and what is, you know, why do I feel like from a movement perspective, from a stress perspective, everything that's kind of going on with their history and how they're physically moving and presenting and what things cause their pain. And I use that as the backboard, like, you know, okay, well, it's more so, and I'm just going to make something up here where like, you know, back pain being flexion, maybe flexion intolerant, bending forward causes pain, but maybe not at rest, but maybe when,

They're picking up a box, right? So there's like a stress component to it, right? And now how does that tie into what we're seeing in the movement assessment? How is that tying into how long it's been going on for? Is it episodic? Is it chronic? Has it been getting worse? Has it been getting better? There's a whole lot of like contextual things. And then how can I synthesize that to somebody and say like, well, all this stuff is happening. This is from a movement perspective. This is kind of what's all contributing to it. And now we need to stay focused on.

Well, I want to know all their goals, right? I want to know where they're starting from, where their goals, how is it impacting their life? And now just kind of laying out that framework and kind of like how you are the prognosis, the plan of care. These are the steps forward that's going to slowly chip us away to have to kind of work there.

Joe LaVacca (11:23)
Yeah. And I think that's really well said. And then that kind of brings us then to the next question, which is kind of how long is this going to take to get better? And I think there's a nice saying here, probably that I think I've stolen from Louie Gifford is like, before we do anything, right. And get you to help yourself. I want you to know two things. This does get better and it can take a while, which is kind of, I think, the theme of the episode. The reason why.

at Strength and Motion in the clinic, I have decided on kind of putting together clinical pathways for people that last about eight weeks is because for the most part, I think pain ebbs and flows along that kind of spectrum, right? Where if you think of a wave, it'll kind of come up and crest and then kind of fall down. And I think these like eight to maybe even 10 or 12 week cycles is pretty realistic.

even when people are maybe even in a flare. Hopefully their flares don't last that long, but according to some of my clients, it absolutely can. So I think that when I look at strength and conditioning, when we look at just the ebbs and flows of pain, or when we even look at healing processes, the reason why I settled in on eight weeks is because I want people to commit to that process. And I can almost assure them that by the end of the eight weeks, they will be in a better place. And this kind of goes into this big idea of, well,

Even if your pain is the same, if you've committed to a program, you're probably moving at least a little further or a little better. If you've committed to a strength program and there's no sort of abnormal tissue involvement or maybe trauma or something along those lines, you should have been able to add more sets or reps or strength or poundage, right? So you will be better from a strength perspective. And then by just working together and interacting and me sharing my ideas with you,

you'll even be more knowledgeable, right? Where you maybe have this different perception or framework of pain. So no matter what, I think you're going to be in a better spot in this eight or 10 weeks. So when we're thinking about prognosis, and I know it's not linear and another sort of like little saying I like is that recovery kind of Toblerone's, which is also just a delicious chocolate bar if never, never once ever had it or seen it, but they're little triangular blocks, right? So if I,

Joe Gambino (13:39)
Hehehe.

Joe LaVacca (13:46)
If I map out people's recovery, I don't usually do the squiggles and the upside down and the turn because that curve never made sense to me because it's a time curve. You cannot go backwards in time. So I hate that curve, to be honest with you. So I draw this Toblerone or this up and down wave more like a heartbeat, but it's always moving forward. So when you think about your prognosis and stuff, what do you do to...

Joe Gambino (13:50)
Mm.

Joe LaVacca (14:12)
coach people with their prognosis? Is that something that you spend time on or is that just sort of like emergent, you know, person to person?

Joe Gambino (14:17)
Yeah, it's a well I always Lay out the plan for people You know, I mean as far as how long it takes for for someone's pain to come down and how many ups and downs will there be along that their journey Usually I tell people you know at some point you're gonna start feeling better and you're gonna start to push your body a little bit more and then there will be a flare -up and that's usually a really great sign But I'm a little different as far as like when I'm working with somebody

90 % of the time the the the commitment level that we're signing up for is at least four months long And there's a number of reasons right because I look at things when we look at movement Long -term and strength and whatever however, we want to look at it It takes time for tissues to adapt. So yeah, we talked about earlier pain can come down relatively quickly We can get someone feeling better. We can get them back into it's a graded movement, but tissue adaptation is gonna take time

We see with strength like strength training, everybody knows four to six week window, 48 week window, right? Those strength adaptations are actually going to happen. Anything before that is going to be neurological in nature. It's not going to be, it's not going to stick, right? Same thing we can kind of look at here. So as we're trying to create adaptations in mobility, as we're trying to create adaptations in strength, and as we're trying to change the body, right? Like we're looking at it in these four week blocks of trying to create change.

And each one builds over the last with the goal of trying to create like long -term change and habits and things like that. Or like over four months, like you can have a very, very different outlook on the way that you move, the way you feel your confidence in getting back to golf training, running, whatever it is. Right. So, but I lay that all out. Like the, this is the step, this is the path. This is what we're going to be working on now. And when we take these like,

key things that we're starting to attack. You should sort of feel better. We should see this happen. And then we take that whatever the next domino is and then the next domino. And I always try to let them know because I feel like when they know what the focus on what the plan is and they are more aware of what's going on with their body and they're educated, they're part of the process, right? They're not just like going through the motions. They understand this is what's, this is what's happening. This is how I can be in at the end of the four months of us working together.

They will then have two choices. One, they should be knowledgeable enough and have a good understanding where they can take things on their own and feel like they can be independent in their own care. Or if they just like what we're doing and they like the guidance and the accountability and all the stuff, all right, we can continue our journey together. But I do want to, I like, I always want to make sure I'm never going to be working with somebody for the rest of their life. So I want to make sure that they're going to be ready at whatever that point is that where they can go take care of themselves as well.

Joe LaVacca (16:42)
you

Yeah, that's cool. So I like that three month thing because I've actually been or essentially said four months. I've been actually toying with the idea of increasing it 12, 12 weeks or three months myself because I just think that I'm almost throwing at times too much then at people and expect a little bit too much of them in that eight week window to be able to, hey, start a program, be successful, follow through with your strength, you know, understand a little bit more about pain. And it's like,

Do I want to give like this really brief masterclass or do I want to have people sign up for like a semester? Right. And I think that when we think of even the way we learn and I think healing and learning or rehab and learning and healing are all sort of synonymous and interconnected for me. In school, it was a whole semester of a subject that you just kind of got gradually and gradually exposed to. Those semesters did go for three to four months. And even then it was just the tip of the iceberg in most cases, right? You'd have.

chem 101 or, and then you go to 201 and then you go to 301 and wow, okay. Four years later, you have a degree and that's still not enough for some people. So you get a graduate level and that's still not enough for some people and they go for their doctorate or a PhD. I mean, so it just kind of keeps building, right? So I think what I've tried to do is even kind of slow myself down a little bit more with my verbiage with this prognosis stuff and say, Hey, look, you know, these eight weeks that I'm laying out for you are just the first.

eight weeks of your big process. And it doesn't mean, and I think this is where you were going at the end there, right? It doesn't mean we have to work together once a week, once every other week, once a month for the rest of your life. But I do want to work with you for as long as possible. I want to work with you for years, which I've been working with some of my clients virtually, you know, training and programming for them. I've been doing this for three years with some of them now.

And I love it. And I don't want them to ever go unless, and this is what I tell them, unless your goals change. If someone messages me and is like, Hey, I want to start taking up golf. And I'm like, well, hey, look, I know Joe Gambino. He loves golf. He's, he's going to, he's going to train you for golf. He's going to, he's going to teach you all that stuff. I, I can't do that. I have no idea. I wouldn't even never know where to start. But if I think about like people running a marathon, I'm not going to run a marathon. I'm probably not going to be your guy.

So why don't we transition you to somebody else? But as long as your goals match the skills or services I can give you, then hey, I want you to be part of strength and motion forever, right? But I think that maybe deviates us into the time, do you ever get into just like timelines of healing with people, like inflammation and repair and remodeling? Or again, is that context dependent, you know, maybe on the person in front of you.

Joe Gambino (19:47)
It is context dependent for sure. I think it would kind of like probably the where I do most is during like acute phases of like flare -ups right like You know if there's someone who has like more like nerve type issues Well, I let them know like you know like this flare -up period is going to take longer than if it was something else right like usually nerve tissue stuff right like from what I've seen from my own body right like I

That seven to 10 day window, right? As things are gonna probably start to calm down or if it's any other tissue, right? Like you have this acute phase and maybe within that like three first three to five days things should start to come back down. Right? So like they're that probably stuff I talk with people more because you know, when someone's like super acute, especially like I don't like to poke the bear too much. So I usually like to see how things trend and start to come back down and then start to, you know, work through things.

So that's where I set a lot of those expectations. What about for you?

Joe LaVacca (20:45)
Yeah, again, I think people come in with more of the buzzwords of inflammation and then even try to, I think, label a lot of the reason why they have pain or maybe they're not seeing progress. And I do get into it or I try to get into it a little bit more, just, you know, maybe again, from like a bigger picture standpoint, like, hey, look, if we agree that this looks like a tendon issue, acts like a tendon issue, then it probably is a tendon issue.

this could take months to years to fully heal. And I tell them, don't be alarmed by that. That doesn't mean that you won't be able to get back to function. It just means that if we were gonna continually scan or ultrasound or look at your tendon, we should continue. And I mean, this happens naturally anyway, but we'll continue to see turnover and healing and repair for months to years potentially. That is nothing you can do about that, right? And there's nothing to be alarmed about.

Joe Gambino (21:12)
Mm -hmm.

Joe LaVacca (21:40)
So there's a lot of those sayings now that popped up, especially with tissue stuff, you know, maybe treating the donut, not the whole, hey, we want to think about you as a system or as an organism. I want to make you as efficient as possible, right? Because with the inflammation, and that's sort of the guideline I give to people, for two or three days, this is going to ramp up, right? So this is why if you do have a flare or you have an acute injury, right, for two or three days, you're like, this is never going to end. Because that inflammatory cycle is ramping.

Joe Gambino (21:46)
Mm -hmm.

Joe LaVacca (22:08)
then it sort of gradually tapers down. And this is why you can breathe and then settle yourself out probably in about 10 or 14 days. But every time that cycle starts, we are kickstarting more repair. So repair maybe starts by week, you know, two to three, maybe a little bit sooner, but that repair process of any tissue could take up to a year. The remodeling and molding, like if I kind of liken it, if we were sculptors.

We have like this big block of material in front of us and we can mold it into something, right? And I can make it look like a tree or a person. It's not gonna look very good if I just do it with my hands, but what would happen if I take a scalpel and I take my time and I fine tune it? Well, now I can make it look like you. I can make it look like something else. I can make it look like a more specific tree, right? So where do we need to go? Do we need to get you back to?

a fine tuned piece of artwork or sculpture? Or do you just need to get back to your day to day life? You know, do you need to get back to just living and walking and dressing, going up and downstairs, playing with your kids or grandkids? Not everyone, I think, has these really big athletic goals, at least initially. And I think maybe one of these other things that people are seeing now on Instagram is training everyone like an athlete. Well, life is a sport, right? So there's I think there's so much variation to do.

with people, you know, so many people will come in and like, Hey, look, I can't jump and I can't hop and I can't sprint. I'm like, Okay, you don't have to you get to you're a human being, you can adapt, you get to do those things if you want to again. But if not, guess what, we can picture any other type of rehab program or strength conditioning program for you. So I mean, we can get into different tissues and stuff like that. But I think if we go back to those initial three questions, or four questions, rather,

The next one that kind of pops up that I wanted to talk to you about, well, is like, there's people always saying to me, well, you know, I want to know what I can do, right? In that process. And I usually ask them like, well, what are your goals for today or this week? And they're like, I want to learn a little bit more. Right. And I'm imagining that they say that, or I hope that they're saying that to other providers that they've seen. But there's always a disconnect, right? Like,

Joe Gambino (24:10)
Mm -hmm.

Joe LaVacca (24:23)
where it's like, okay, well, tell me what you've done in the past. It's like, well, I have a really hard time following programs and I have a really hard time doing this and I'm really busy and I can't go to the gym and I can't do that and I can't do this. Or they just simply weren't told what they could do. Right? So I kind of have taken on this process of focus on the journey, right? Not your, not your goal, right? Because if we're getting stuck on the goal of like eliminating pain, getting back to squatting or deadlifting or running or going up and downstairs or whatever else is important, you swing in a golf club.

Joe Gambino (24:32)
Mm -hmm.

Joe LaVacca (24:54)
we're going to lose track of the process or the steps to get there. So the thing I need from you is to show up every day, commit to the things you feel like you can commit to. And there's processes that I go through to determine that. And that's what I really need you to do is to take care of yourself and meet yourself with some compassion and patience in this process. Right. And that for me is like, like step one. And then obviously we can, we can build it from there, but.

Are there specific expectations that you set for people at the beginning of the rehab process?

Joe Gambino (25:27)
Yeah. Yeah. So I think we talked about paying guidelines before and like episode. I don't remember what episode it was. Yeah, I don't know. But we've probably talked to him. Maybe they've we've kind of come into him and talked about him twice so far. And this is just like the theme of, you know, how I'm always kind of going about educating the stuff and letting people know what they what they can do. Right. So someone comes and asked me, like, how was all time? I like.

Joe LaVacca (25:39)
We've done so many, how could you keep track?

Joe Gambino (25:55)
Can I play golf? Can I go play? I had somebody who I'm working with who wants to play tennis or I actually, I don't know how I have a couple surfers that I'm working with. And the question is, is like, can I go do it? Yes, right. That's my answer. You know, it's the response, right? That happens from a pain perspective that tells me, should you not do it? Should you do more? Or do we have a decent volume where you just kind of have to stay here and try not to add to it?

Joe LaVacca (26:11)
Of course.

Joe Gambino (26:24)
So when someone's like, what can I do? Well, if it's if it's in general, well, what do you want to do? And then what if it's specific it's we'll go try it Because then we'll know based on the response Sure, you can do this, but maybe we need to tone back the volume or intensity Sure, you can do this based on the response. Don't add volume. Don't add intensity You actually have a really good sweet spot. We need to let the tissues it at that before we add more

And if there's nothing, well, there's no rules like keep going, do whatever the hell you want because there's there's nothing from a pain perspective that's stopping you. It's not going to make things worse if it's not an irritating factor. You know, and we look at that window, it's not just during, right, but it's a 48 hour window after. So it lets us know if the things are accumulating and stress is building up and causing an issue. So that's kind of how I look at it overall, how I educated and more often than I just tell them, let's do it unless it's like.

very very very clear that it will be an irritating fact.

Joe LaVacca (27:27)
Yeah, I like that. And then so then, so then the next question, or maybe the last one is, well, and this is what clients ask me to is, well, you know, what can you do for this process? Because I think that, again, their their idea is that I'm going to do some, you know, magic mobilization, manipulation, massage, that's going to fix their issue. And what I sort of try to explain is that,

My view on manual therapy has evolved to this point of where I think it is purely more diagnostic for me and helps me put load into your tissues because you're too sensitive to do them yourself, right? Or maybe you're too fearful to do it yourself. That's about it. That's kind of where I stop. And people are kind of looking at me like, well, what about like,

the tightness and the stiffness and what about the scar tissue and about this. And I sort of just pause and I say, I don't think I can provide you enough input manually to create those changes. But what I can do with my hands is know a little bit more about your willingness to move, where your body feels completely safe. And then we can sort of infer that those areas might be okay to load. And then simultaneously, if you're too scared to move, well, I can get you.

close to these positions with my hands or my body, and we can start isometrics. I can start graded exposure. The power of touch and the safety of touch from someone you trust can be therapeutic in and of itself and turn your pain down. But I always tell people that the goal there is to get kind of away from me or that sort of response as quickly as possible. We're using sort of like the manual therapy.

in that lens rather than I'm kind of a fixing you sort of mentality. So for me, manual therapies to assess, maybe desensitize people or get them to feel a little bit more comfortable with implementing force or movement to their body. But then the other thing I tell them is just reassurance and sort of the ability to always come up with a plan for us should we need to deviate. So that's my responsibility. I give you a plan.

I don't know how you're going to react. And I'm very upfront about this with people now. I don't know if the hip circles or the isometrics or the stretch or the this or the squat is going to be the right dose, the right position, the right load, because I only had a very small sample size here. You did 10 squats for me. You did a 30 second hold. You did a one minute stretch. You seem to do okay. I don't know how you're going to do with rep two or set two, right?

So I want to get to this point of understanding how quickly we can fail, right? Or how quickly can we have an adverse response? So I know immediately to do the exact opposite. So I feel like that's more of the things I can provide, right? This guidance, this reassurance, this sort of constant coaching or tweaking of a plan, but then my quote unquote manual skills become assessment and preparation based rather than fixing or healing based. So what do you think?

that you can do for clients or what do you tell people you can offer them when they come see you.

Joe Gambino (30:41)
Yeah. Sure. So I mean, I know, you know, I don't know if everyone else knows, but I'm 100 % virtual these days, right? So I don't have the ability to put my hands on people anymore, just because I mean, I can put my hands on the screen, right? But it's not going to do anything from a manual perspective. But in essence, and I tell this people on every kind of if someone's interested in working with me, having a call, I tell everyone this, right? Like,

In today's day and age, you can get a good program anywhere. You can go on YouTube. You can get a membership. You can get exercises at your will. Right. But that doesn't mean too much. Right. Where I think the majority of the benefit or how I help people is with the with coaching. Right. So 90 percent of I think kind of like anything perceived is right. Like.

the assessment, knowing exactly where you are starting from, knowing your exact goals, knowing what I know, I can make sure that you're spending your time efficiently so that you're just doing the things that you need to do to knock those blocks. So you don't need to spend 30 minutes warming up or hours doing corrective work, right? We know like, if you do this, right, these changes should start to fall. And sometimes I'm off and we have to reassess and, you know, kind of get us back on track, but.

we're able to save in the long run, like your time investment as far as movement goes, getting back into training and all that stuff, right? The other thing is that guidance of returning to activity, the guidance and the comfort of knowing, well, what happens when flare -ups happen? Because we know it's gonna happen. What happens on the backend and how I can help you gather your mind about all these things and help you build confidence in your body and kind of go things. And when something does go south,

How can I be that soundboard to say, well, feel what you need to feel? We talked about this in previous episodes, right? Like you need to feel what's kind of going on, but how do we start to then reframe your look and how do we start to get that entry point better? Do we need to change it? Do we need to reduce it? So what is that proper now entry point? How can we continue to take steps forward and not let the fear of things getting worse?

or not sure what you're doing be the thing that's gonna make you stop doing what you're doing and almost then now start to move even further backwards from your goals. So I think that's kind of really where the value comes from, right? It's the experience of that saving time and just being that backboard for like how do we continue to progress things? I'm in a very, very systematic fashion, so it's not random. It's all very, again, right? Like.

We all have time limitations, right? So if you want to train, you want to play golf, you want to have to fixture, you know, feel better. How do you do all this stuff in one? And I think that's where I feel, you know, the majority of the value I offer is.

Joe LaVacca (33:28)
Yeah, that's great. And I think that's maybe something to kind of cap on. And I think if I'm kind of putting some of the thoughts that we shared together is that, well, the title of the episode, right? This takes time. You know, I think we're sort of in agreement that it's a minimum of a 10 or 12 week process. I like the idea that you're offering people like, hey, look, we start this process.

But now there's maybe an element of even behavior change and more consistency and you want to ride that wave while you're feeling good and then make it a part of your everyday life. So I really, really do think that that's a good message to take home if you are still in pain. And I have these conversations with people, I mean, daily. I just had one this morning actually where someone called and said, I've been going to PT for eight weeks. I didn't see the results. I want it. And when I always,

hear that my next question is, well, tell me what a typical session is like. What was your eight week experience like? And it always, and then it kind of revolves around this idea of, well, you know, I was, you know, mix and match between providers. there's a really busy clinic. I really didn't know or do much on my own. There was a lot of like heat and ice and manual therapy and a little bit of loading, but things usually hurt. So then, you know, they told me to stay away from it. so yeah, physical therapy didn't work. And I, and I,

politely interject and say, no, no, no, it's not that you failed physical therapy. You didn't start physical therapy. You didn't start a process. So therefore you can't fail something that you did not start, right? Cause you don't have an outcome. You don't have anything to sort of like hold your expectations or goals against. So knowing that,

we can be guides and I love the fact that you're all virtual now. I don't think I fully, fully realize that. But that's where I think my hope is too. And I'm always reminded the one reason I have Facebook for a couple of reasons. One of them is to just see the memories of my life. Right. And then cringe, cringe every day where like I'm almost thankful cancel culture did not exist back in like 2008 and 2010 and 2011.

Joe Gambino (35:22)
Yeah.

Joe LaVacca (35:37)
But one post always strikes me and it was in 2016 or 2015. And I said the future, I don't know what made me say this, but the future of healthcare is going to be in telehealth and telemedicine. And I wish I could know what was going through my mind that day, but every time that post comes up, I'm like, yeah, that's kind of what I'm doing right now. I only see people a maximum of once a week typically. Most of the time people are opting to come in once every two weeks.

There's no difference in results, I tell people. The more frequently you come in or the less frequently you come in, because really most of the work we're gonna do is when you're not here, right? And that's kind of the coolest part for me to kind of think about with physical therapy and rehab now, that most of it occurs, or 99 % of it occurs when we are not together. How crazy is that?

Joe Gambino (36:11)
Yeah.

Yeah, it's why I like this, the virtual environment. And I tell people, it's like, you have access to me Monday through Friday. I mean, like if you're in clinic with somebody and like all you do is see somebody two or three times a week, you could only ask them questions when you're there for that hour. Right. So, you know, this it's one of the more enjoyable things where like I can actually like build a connection with people on in this environment and help them. And.

Joe LaVacca (36:35)
Mm -hmm.

Joe Gambino (36:48)
I guess there's what kind of like one last thing I kind of wanted to chat about on the on the point that you're talking about it, you know, and I think there's part of the problem with like the insurance based model. It's like, well, this place takes my insurance and they're conveniently located and, you know, proximity to work in proximity to my house. I mean, in New York City, they're everywhere, but I work with a lot of people in rural areas as well where they don't have access to PT and like, you know, like, I have to drive, you know, 45 minutes just to get to whatever place it is. And.

Joe LaVacca (37:13)
Yeah.

Joe Gambino (37:18)
I think that, you know, people listening, right? You need to treat your physical therapist or finding one the same way you would if you were buying a car, the same way you would be if you were getting a new phone or a new laptop. You spend all this time researching, figure out what exactly that you want, and you should have conversations with your physios to figure out, you know, is this the person, right, for me to help me, is this the atmosphere?

are they capable of taking me and bringing me to my goals? And the more questions you can ask them, probably the easier it is going to be to find out if they're full of shit because if they can't give you solid answers, right, then they probably not going to have the skill set to help you. So I would say just be the consumer, right? Like figure out, I think social media is good for that reason. I think people end up finding the people that they want. And obviously with virtual care being more and more popular since COVID.

It's easier and easier for people to reach out to like the people that like their message jobs with them even more and I always say that's kind of the case in which you'd want to be right like you want to be able to find the people you you feel very very confident that can help you and not just like this is the most convenient option for me because then there are cases like you just said where You know, it's just not a good environment It's not the right fit and now the person feels like they failed when it really was the model that in place that they were that just didn't match You know what they needed at that point in time?

Joe LaVacca (38:43)
Right, right. Yeah. Absolutely. Any other thoughts on this topic, Joe, before we wrap up today?

Joe Gambino (38:45)
I do not. I'll let you take us home, Joe.

I will.

Joe LaVacca (38:52)
All right, all right. Well, you have a wonderful time in Mexico. As Joe always says to everyone that made it this far, thank you. We appreciate you tuning into the podcast. We hope you've enjoyed this episode and all previous episodes. Don't forget to stay in touch with us. As Joe mentioned, we have Instagram handles. That is joe Gambino at DPT. Did I get that correct? All right. And mine is at strength in motion underscore PT.

Joe Gambino (39:10)
It did.

Joe LaVacca (39:18)
We'll have application forms for you guys to fill out if you're interested in working with either one of us. Please leave reviews, comments, what you want us to hear talk about in future episodes. And until then, I love you, Joe Gambino.

Joe Gambino (39:27)
I love you, Joe LaVaca, and if you made it this far, extra love for you.

Joe LaVacca (39:34)
We love you too! Have a good one guys!