In my opinion, Physical Therapy patients are often under exercised and do not return to prior levels of activity due to a lack of rehabilitation intensity.  What are some of your recommendations for implementing higher level exercises and strength and conditioning principles for practicing Physical Therapists?

We have a problem in the physical therapy profession where we are fearful of overloading patients in the clinic. Unfortunately many injuries to tissues happen when the demands placed on that tissue exceed what they we prepared to handle. So if we underload we won’t build tissue capacity up to a high enough level to reduce future re injuries. 

My biggest reccommendation for orthopedic clinicians wanting help implementing higher level rehab exercises is to work as a coach! I’ve learned as much in the past year from working with one gymnastics coach as I did from anyone in the actual rehab professions. For those that can’t coach, start reading and following some of the more prominent names in strength and conditioning. See what they are doing and the gaps between that and your rehab programs. Then game plan how to close that gap as much as possible. 

2.  In many athletes, a lack of joint mobility presents as a stability or motor control problem.  What are some common clinical patterns/presentations you observe in these athletes and how are you teasing the mobility vs. stability impairment out during your exam?

Before ever assuming mobility or motor control problems, I always perform both active and passive available motion in all joints making up the larger movement pattern we are working on. Skipping this step often leads athletes and clinicians to working on the wrong thing. 

3.   What role does blood flow restriction training play in your clinical practice.  Which patient populations benefit most from this intervention?

Blood flow restriction is a huge part of my practice for anyone needing improved strength and/or hypertrophy that cannot tolerate heavy loading. This may be after a surgery, acute injury, or someone just fearful of heavier movements. BFR allows us to get similar strength and hypertrophy changes at loads as low as 20-3% of their one rep max that we see lifting loads heavier than 70%. 

BFR also has some very cool hormonal benefits such as improved growth hormone release vs heavy training which can potentially help with bone healing, tendon and ligament rehab, and greater reductions in patient reported pain levels. 

4.  The Tar Heels had a great run in the tournament can we expect a repeat in 2018?

Despite being a die hard TarHeel, I’m actually not much of a basketball fan. I was fortunate enough to work with the football team for two years and tend to follow them more. Hopefully having the Number two draft pick in this year’s NFL draft will help.