00:00:14: Ladies and gentlemen, boys and girls, welcome to the staying aligned podcast.

00:00:19: I am your host as usual, Alexander Eisner.

00:00:23: I am joined by the ever present and just happiest that he's joining us today, Sean Steele.

00:00:30: Sean and I are joined by our guest today, a specialist in sports orthopedics, a PI master in extremity orthopedics, and is going to give us something of a master class today.

00:00:44: We're very much looking forward to welcoming Dr.

00:00:46: Matheson to the podcast.

00:00:48: Doctor, thank you for being here.

00:00:50: Thank you for having me.

00:00:52: Before you introduce him, I dare you to pronounce his first name.

00:00:56: I think it's Welch.

00:00:58: So give it a try.

00:01:00: I think it's, I think it's Gramey.

00:01:02: Grame, Gramey.

00:01:03: No, not at all.

00:01:04: Okay, give him the authentic pronunciation doctrine.

00:01:07: I'll coach school me, Sean.

00:01:08: Tell me what it is.

00:01:10: I'm waiting to hear from the horse's mouth.

00:01:11: Yeah.

00:01:12: So

00:01:13: it's pronounced Grame.

00:01:14: It's like frame with a G.

00:01:16: Grame.

00:01:16: Grame.

00:01:17: See, now we know.

00:01:18: And is it, what's the ethnic background of the name?

00:01:21: I like to say there's a really creative ethnic background, but the story is actually my brother's preschool class.

00:01:29: or like a big hair class, there's a kid named Graeme and my mom liked the name, so she took it.

00:01:35: You know, I'm so disappointed.

00:01:36: I shouldn't have even asked that question.

00:01:38: I can totally empathize.

00:01:40: My middle name has a similarly ridiculous story, but before, by the way, we don't need to get into that.

00:01:45: Let's get into this.

00:01:46: Doctor, tell me in briefly, and again, we have a tight thirty minute ship here, so tell me briefly who you are, what's the background, what's your specialty, what kind of patients are you seeing, just tell me a little bit about yourself.

00:02:01: All right.

00:02:02: So obviously, like every orthopod or not every orthopod, but many of us, I grew up playing sports.

00:02:08: I'm from Canada originally.

00:02:09: So my sport was hockey.

00:02:11: Then I got into a lot of weightlifting, powerlifting, and then started developing more and more injuries.

00:02:17: As injuries came on, I learned how to rehabilitate a lot of the injuries and then started helping other athletes with their injuries.

00:02:25: I really loved that whole spectrum of care.

00:02:28: And then after dealing with kind of the non sort of side of treating injuries.

00:02:33: I went, well, I'd like to be able to treat absolutely everything.

00:02:35: So why not, you know, go to medical school, do surgical residency and treat athletes and patients alike.

00:02:42: So that's kind of how I got into the sports orthopedic side of things.

00:02:46: Sports, obviously, I love sports.

00:02:47: I love the athletes.

00:02:48: I understand their mentality.

00:02:50: They're wanting to get back.

00:02:51: They're wanting to get back to a hundred percent.

00:02:54: So I really appreciate that.

00:02:55: I've had my own only one surgery though so far to my right shoulder because I try to avoid it as much as possible.

00:03:00: But and that's kind of my mentality is if we get you better without surgery, let's get you better without surgery.

00:03:04: But if it comes to that, I'm your guide to help you get there.

00:03:08: And you've got this.

00:03:10: humans are meant to move philosophy.

00:03:13: I've seen that written a couple of times on some of your literature.

00:03:15: What does that mean to you?

00:03:17: How does that guide your sort of care philosophy?

00:03:20: So I've got a few different philosophies, but we'll focus on the musculoskeletal.

00:03:25: So humans are meant to move, but the audience are meant to move.

00:03:28: When we stop moving, things start falling apart.

00:03:31: There's two unavoidable truths in life when it comes to the body, at least from my side of things, is you got to do some form of cardiovascular exercise for your cardiovascular health and heart health.

00:03:42: And you have to do some form of a resistance training, strengthening exercises to maintain muscle mass, musculoskeletal health, and to avoid injuries.

00:03:49: If you negate any of those, you're going to end up with problems either this guy or the rest of your body in terms of, you know, extremity injuries, musculoskeletal tendon tears, that sort of stuff.

00:04:02: So the human body is meant to move.

00:04:04: You got to move it.

00:04:05: When you stop moving it, bad things happen.

00:04:08: That makes a heck of a lot of sense.

00:04:10: And I think that that probably plays into this, you know, your, your sort of baby steps in recovery.

00:04:16: I mean, when you've got somebody with a, you know, with a traumatic injury rather than something chronic

00:04:21: or,

00:04:22: or, or.

00:04:24: coming on over time, but you've got some traumatic injury.

00:04:27: You seem to sort of embrace this baby steps approach that plays out over sort of mild treatment or conservative treatment up to more interventional medicine.

00:04:39: Talk to us a little bit more about that sort of idea in your practice.

00:04:42: So the baby step mentality is basically a lot of.

00:04:45: A lot of people run into injuries or these chronic tendonitis, tendinopathies and pain.

00:04:50: And it's usually, it's not something that happens all of a sudden.

00:04:52: It's something that's been accruing over time for years and years and years.

00:04:55: A lot of people I speak to, you're going, when was the last time you actually physically exercised your body?

00:05:00: And a lot of them, it was, you know, high school when they played sports, that sort of thing.

00:05:03: When was the last time you did like any meaningful jumping type of activities, et cetera.

00:05:08: And a lot of people, it's been, you know, twenty, thirty years.

00:05:10: So I try to explain to them, you know, this is something that's been happening for a long time.

00:05:15: a long time to get there, it's going to take some time to get out of there.

00:05:17: So the whole baby steps mentality is basically with a lot of these rehab injuries that don't need surgery, even if it's partial tears, tendinopathies, you need to find your body's ability or the soft tissue's ability to tolerate load.

00:05:32: Once you find that, it's baby steps going forward.

00:05:36: So you just want to make slow, steady progress.

00:05:38: It's the old, I remember from weightlifting, you used to say, Hey, you know, you don't need to make these big, fifty pound jumps all the time.

00:05:45: say to your bench press, if you put two and a half pounds on the bar every week and you do that for a year by the end of the year, you've got a big bench press.

00:05:52: So it's kind of a similar mentality in that where you're making these small little progresses throughout, you know, daily progresses.

00:05:59: You're not looking for these big jumps when your body, the human body is extremely adaptable and it can do some absolutely amazing things, but it really doesn't like to make big changes in a short amount of time.

00:06:12: It likes to slowly adapt over time.

00:06:14: And talk to me about chiropractors role in that.

00:06:17: So I see chiropractors as playing a pretty big role in helping patients stay moving during recovery, certainly in the active care phase, rather than passive care.

00:06:29: We're talking active care.

00:06:32: How do you see chiropractors helping in furtherance of that baby steps, staying active mentality?

00:06:41: I completely agree.

00:06:42: And I think you can probably put it into different levels.

00:06:45: Chiropractors that some, even if they're just doing passive treatments, some that are doing passive and active treatment and some that are doing all active treatment, even from the passive standpoint, if you can get you moving and you don't have that big step backwards, the patient can lose.

00:06:59: start to get back to the regular activities and sometimes doesn't need any more treatment than that.

00:07:03: When you get to the passive and active, you get them so they're feeling better, so they can move better.

00:07:08: And now that they're also providing strengthening exercise therapy to also help them start making those baby steps forward.

00:07:15: And then you have some that they go, you know, I'm not going to do any of the passive.

00:07:18: Let's just get you moving on active and get you slowly adapting with strength exercises, resistance exercises, and trying to get you back to your return of function.

00:07:25: So they play a lot of different roles and all can be beneficial but usually you're going to find the most bang for your buck in that kind of passive active model where you're providing some pain relief with manual therapy adjustments but you're also getting to do some sort of strengthening active routine.

00:07:41: so you can kind of get that.

00:07:42: you know neuromuscular reeducation if you want to call it that or just increasing and building tissue tolerance.

00:07:50: Yeah and then talk to me about how.

00:07:51: what you're seeing in in chiro records I mean in sort of best case scenarios, you're seeing patients who've already been through a good amount of, and now obviously we're talking about PI.

00:08:03: You're seeing a lot of patients who have been through conservative care with a chiropractor.

00:08:08: Now they're coming to you because, you know, this injury or that injury may have resolved or is making good progress, but there's one stubborn injury that maybe isn't making as much progress as they'd like, and so now we're having to consult with an orthopedist on next steps.

00:08:22: What are you looking for in those chiropractic records?

00:08:24: What do you want to see in terms of timelines, in terms of functional limitations, in terms of the failed previous attempts at conservative caring?

00:08:32: Talk me through what you're looking for in an ideal case.

00:08:35: So in an ideal case, it would be you see a mixture of that passive active, you see improvement over time, and that's why they haven't been, you know, moved on to the next step.

00:08:46: I usually say as long as the patient's making improvements, and that kind of goes back to that conservative model, if you're making improvements with conservative treatment, keep on the conservative route, you can probably continue over that.

00:08:56: that prolonged course to conservative.

00:08:58: If you're making no improvements with conservative, again, that being a passive active model, then get them over to me to see what other things that we can be doing.

00:09:06: I might just say, hey, we got to keep continuing on that course or maybe able to offer some injection therapy that might help with their pain so they can fully participate in that active model.

00:09:17: But if they're just going to be supplying the passive because we're going to cover all gambits I'd rather them get them over to me quicker.

00:09:24: Get the imaging get them over to me so we can start offering that active Plus, you know other adjunctive modalities that we can offer.

00:09:32: and is that something you do as a as an arthropod I mean you're doing sort of I don't want to step on toes and say the word physical therapy, but you're doing some active stuff in your office as well as Injections and surgeries.

00:09:47: I do the surgeries and injections.

00:09:48: I can give them a lot of times.

00:09:50: I will write them kind of a home routine that they can get on to but I also do refer them on to physical therapy So that they can have somebody watching them do all the exercises.

00:10:00: But the home program is more.

00:10:01: if they've had barriers to care And or if we're just trying to not leave a gap something they can do in the meantime until they get to see the physical therapist who can give them a structured comprehensive program and they can be watching them as they're doing it.

00:10:17: Let me add a couple of other questions in that line.

00:10:21: Most chiropractors have had training in physical therapy and we advocate strongly active care.

00:10:28: along with passive care.

00:10:30: In fact, the passive care model is quickly disappearing.

00:10:34: And that's a good thing because I think a combination is important.

00:10:37: So we're pro chiropractic law firm.

00:10:40: We speak the language, we teach at the schools, we do the continuing education, we write the books, we write, we do the videos.

00:10:47: So what I want to really make crystal clear to our audience here, which is the chiropractors, and this will be repeated, republished to be part of our permanent, part of our... our YouTube package, is that as a pro chiropractic law firm, we only want to work with pro chiropractic MDs.

00:11:04: That's hard.

00:11:05: Many MDs are trained elsewhere.

00:11:08: They have no understanding.

00:11:09: Appreciation are actually hostile to chiropractic.

00:11:12: Sometimes an MD will actually say nefarious and nasty comments about, oh, you're seeing a chiropractor?

00:11:19: Aren't you worried about your neck?

00:11:21: So really a borderline of as an attacking mode.

00:11:26: For those doctors, I don't even bother calling them.

00:11:28: I just put them on the list.

00:11:29: We never talk to them again.

00:11:31: We never refer.

00:11:32: We never have anything to do with them.

00:11:34: And so if we get calls virtually throughout the week, hey, you know, good orthodontist community.

00:11:41: So what we're looking for is somebody that is actively interested and intrigued with why chiropractors are successful.

00:11:47: Why have they been around a hundred and twenty years?

00:11:51: And I see millions of patients a year.

00:11:54: That's going to be an interesting question from any perspective of any health care provider.

00:12:00: The other is when referrals are made to your office, it should be made by the chiropractor, not the attorney.

00:12:06: That's how it works in personal injury.

00:12:08: It looks like it's attorney directed.

00:12:09: It comes out testimony, hurts the case.

00:12:12: It looks like it's not authentic.

00:12:14: So we encourage the chiropractors that on a high trauma case, a serious trauma case, they need a second opinion.

00:12:21: It may be very well, hey, luckily nothing's serious here, but an MRI is a pretty good idea.

00:12:26: It's cheap.

00:12:26: It's extremely reliable.

00:12:28: The technology is getting better.

00:12:30: And it's a good baseline for any patient to have is an MRI of their neck, because sooner or later they're going to have problems with their neck.

00:12:36: and spying, and so that's usually a good call.

00:12:39: But having, and then the patient, chiropractic patient presents themselves to the appropriate medical doctor, orthopod, particularly, they show them that disc they just got, and then you can read it with the patient contemporaneously.

00:12:52: It's very, very valuable.

00:12:53: The patient gets a professional point of view about what the condition of their anatomy is.

00:13:00: Then the, some of the times we get reports where, This is a horrendous mistake and I mean it causes a great problem where the the orthopod knows should know that it's a Chiropractic referral, but then in fact they'll say yeah, but the patient should see Joe blow the physical therapist while the patient is a new patient for the chiropractor and That's of course patient stealing.

00:13:24: And that's a big no-no.

00:13:26: You don't want to switch patients perfectly happy with their chiropractor.

00:13:29: They're not looking for an alternative.

00:13:31: The chiropractor told them they should get an orthopedic evaluation.

00:13:34: Instead, they're told to see a physical therapist down the street.

00:13:37: So I've had to make that call once in a while to a certain doctor say, look, this is your last and final chance.

00:13:43: But the chiropractor is fully qualified.

00:13:45: He provides you the business.

00:13:47: Don't cut his legs under and send them to another facility when that's not called.

00:13:54: So what the golden rule is, and that depends upon if you have confidence in the chiropractor, if the patient gives you good information and says, hey, this patient should get this kind of therapy.

00:14:07: This is what I recommend.

00:14:09: And more chiropractic care is recommended.

00:14:11: That's the magic words.

00:14:13: Once you say more chiropractic care is recommended, the chiropractor is going to get paid.

00:14:17: He's going to be happy.

00:14:19: Shows confidence by an outside opinion that chiropractic is good for this patient.

00:14:24: And then that report that you write up should go to the doctor.

00:14:27: the attorney gets a copy But the but the report is made out to the chiropractor because that's the referring source.

00:14:34: So those are just some of the things I wanted to mention because you come highly recommended.

00:14:38: We're excited about working with you.

00:14:40: We've heard extremely good things about you But the rudiments are that were probably the only real personal injury law firm that cares and works with and believes in chiropractic.

00:14:54: As I kind of delineated between the active passive passive only versus active only, the only times I ever send them off to physical therapy is if they've been receiving chiropractic adjustments and not being able to get the strengthening exercises, but a lot of times they will come with strengthening exercises that they've already done.

00:15:15: done that side of the treatments and then we move on to the next steps.

00:15:23: That's good and appropriate, but if you find that the patient's not getting the kind of care that you think is worthy, a call to the chiropractor is extremely highly recommended.

00:15:34: We're all busy.

00:15:35: It's tough trying to make these extra calls, but that's something that a chiropractor would remember forever and say, look, this patient's got a real particular knee problem.

00:15:43: These particular exercises would be extremely beneficial.

00:15:48: Most chiropractors know that, but it'd be nice if you told him rather than simply refer to another source

00:15:53: and give the chiropractor an opportunity.

00:15:55: That's a great point.

00:15:56: That's a great point because we see a lot in PI cases now, this collaborative medicine approach where chiropractors and orthopods or chiropractors and neurosurgeons are talking with each other in the middle of the case.

00:16:10: And it's showing up in everybody's records.

00:16:12: Oh, Dr.

00:16:13: So-and-so talked to Dr.

00:16:14: So-and-so and we collaborated for five minutes on patient care and treatment plan moving forward.

00:16:18: And you send them back to the chiropractor with instructions on specific active care you want to see over the next six to eight weeks and come back to me and see if that helps.

00:16:27: Those sorts of notes and records in patient files look fantastic from a PI standpoint.

00:16:32: I mean, when I'm in a deposition setting and I'm seeing notes like that, nothing makes a doctor look more objective and less like they're in the pocket of some PI attorney and actually being that.

00:16:43: I mean, it's not just for show.

00:16:45: They're really trying to get this patient better as quickly and as collaboratively and as efficiently as possible.

00:16:51: I find that to be remarkably good both for a PI case and for patient outcomes.

00:16:56: Have you ever seen anything like that?

00:16:58: or are you seeing anything like that in your practice?

00:17:01: In terms of?

00:17:03: Just collaborative approaches with chiropractors and other doctors coming in and sort of working together on patient outcomes.

00:17:12: Yeah, for sure.

00:17:14: I noticed that the communication is definitely difficult to get back and forth a lot of times.

00:17:23: If we get the chiropractic notes, a lot of times we don't get the chiropractic notes, we have to go off of what the patient says.

00:17:29: But yeah, with chiropractors that send in the referral plus notes, give the contact information, then we can actually touch base with them and keep going.

00:17:38: Are you are

00:17:39: you saying I mean is?

00:17:40: it sounds like you're saying that it would be really helpful if when a chiropractor makes a referral to you that they send along their their their their chart their full chart as of this point moment.

00:17:49: so you can see not just hear a subjective you know patient history from the patient but you can also see it

00:17:54: for one hundred percent.

00:17:55: yeah and again Just going back to the physical therapy, chiropractic therapy.

00:18:02: At the end of the day, physical therapy just means strengthening exercises.

00:18:06: That's just kind of what you call it.

00:18:07: It doesn't mean it has to be done by a physical therapist.

00:18:09: It just means this is the recommendation is for strengthening therapy.

00:18:13: It's difficult to write on a note, strengthening therapy, because most people are like, what are you talking about?

00:18:18: But physical therapy, it's not a referral to a physical therapist.

00:18:22: It's a referral for physical therapy, not.

00:18:24: So whoever can whoever can take that upon themselves to give.

00:18:30: And I always write a rationale for why, which areas, which muscles, et cetera.

00:18:35: Again, that's probably more because of my background in knowing which things to kind of target to help certain conditions versus like a lot, we'll just write, you know, physical therapy right shoulder.

00:18:47: do it this long, two times a week for six weeks.

00:18:49: Whereas I specifically state the areas that I want targeted, because the amount of times that I, particularly the amount of times that I get a patient that has, you know, quote unquote, a shoulder referral, and they've got upper trapezius spasm and periscapular pain.

00:19:01: And I'm going, okay, well, this is, you know, we need to focus mainly on periscapular strengthening.

00:19:07: So I will write out exactly which areas to target, even give muscle areas to target.

00:19:11: And then they go, okay, so even if say they're like, well, I'm not really that familiar with the shoulder.

00:19:16: What sort of exercise do I give?

00:19:18: You can do like a quick Google search on physical therapy exercises to perform for, you know, targeting these muscle groups and it'll give you a good solid idea of which ones that you can form with them.

00:19:29: Yeah.

00:19:29: Yeah, I think

00:19:30: that's great.

00:19:32: I think that's exactly what, I mean, the, I think what Sean's getting at is we've seen some, some horror shows, some horror stories of, of some, you know, well-meaning chiropractor sends a great patient referral to an orthopedist and then is not getting the sort of reciprocal sending back to the chiropractor for conservative care as needed.

00:19:55: If you were to get a referral from a chiropractor who was doing active and passive care and you thought that patient needed additional active, specific active care, you would obviously send it right back to the chiropractor that sent it to you with those instructions to do that for however long and come back to you and see, I mean, that's the kind of collaboration we're talking about.

00:20:12: That's a good point and that could probably be, well, shoot.

00:20:15: It could be better delineated in the note as well, just stating that chiropractic slash physical therapy to work on versus saying physical therapy.

00:20:25: Because in my head, I just have physical therapy as strengthening and active treatments, which that's something I could do better on.

00:20:33: Well, that's not the point of this, but I'm glad we're growing together.

00:20:40: Let's talk about what you do when you're not sending them back to a chiropractor when they're when they're unfortunately gonna have to stay with you.

00:20:46: Conservative treatment didn't work.

00:20:49: Even the active care, strengthening the muscles, we did these things.

00:20:52: They were still having issues, shoulder, knee, issues, wrist, ankle.

00:20:58: Talk to me about step one.

00:21:02: In in interventional medicine if and I imagine that's somewhere some some sort of injectable And then and then step two and what are your and I?

00:21:10: obviously this change is based on the specifics of the injury But talk me through it.

00:21:14: general step one and then general step two.

00:21:16: Yeah, there's

00:21:16: there's a lot of.

00:21:18: there's a lot of debate out there versus whether or not these biologic therapies can be done in isolation or in conjunction.

00:21:25: I always say that I like to have it done in conjunction.

00:21:28: I find I remember one orthopod who's big into regenerative medicine arguing with me that he said, well, I wouldn't say that doesn't work in isolation.

00:21:36: But, you know, if PRP, say, for example, plus physical therapy, it's a one plus one equals ten.

00:21:44: And I go, well, Why would you ever just leave it as a one?

00:21:48: So that's where I go in my head, just continuing the strengthening exercise therapy and I always do them in conjunction together because PRP in my opinion and in my experience works a lot better in conjunction with and then once you fail the say the PRP plus therapy.

00:22:04: I'm not going to go backwards and go to the cortisone.

00:22:06: I find cortisone is basically just an older version of PRP with its inherent risks and where you're just basically trying to cut out the inflammatory response versus trying to create a anti-inflammatory slash healing environment for the stuff tissues.

00:22:23: And then also I get into more specific injections.

00:22:25: A lot of times patients have had, already had PRP injections say into the glenohumeral joint.

00:22:30: And then in my world, as a shoulder specialist and knee specialist, more specifically, the shoulder joint has four different areas that you can specifically inject.

00:22:41: And if you inject one, you're not gonna hit the other three.

00:22:44: So one injection is not equal to the other.

00:22:46: So that's why it's a very meticulous physical examination symptoms and then you determine in which area needs the injection.

00:22:53: So, for example, the shoulder joints, the glenohumeral joint for where you can inject.

00:22:58: The glenohumeral joint, the acromioclavicular, so the ac joint, the subacromial space, and then you have the long-headed biceps tendon.

00:23:05: So all of these are specific pain generators, and you can get injections into those specific areas.

00:23:10: And if you have one saying to the glenohumeral joint, it's not really, you know, there's a communication between the two, but you're asking a lot for that.

00:23:17: solution or those healing factors to get into the long-term biceps tendon sheath.

00:23:21: So all of those are different injection for me.

00:23:24: So some people that don't respond to a glenohumor joint still have that long-term biceps pain.

00:23:28: I put it right into the long-term biceps tendon sheath, and they tend to do a lot better.

00:23:32: I'm thrilled to hear that cortisones are considered sort of passe and that PRP has taken over in that field.

00:23:41: And I was asked an interesting question.

00:23:44: I saw a knee doctor.

00:23:47: And torrents and so I'm getting my PRPs both knees, you know, that's just I got not a trauma, but it's.

00:23:54: it's a wearing out issue and it seems to be helpful and use logically it makes sense fresh blood into the areas where there's not a lot of blood Circulating in the first place.

00:24:05: But you know, what is it?

00:24:08: Yeah, I don't sense that you get immediate relief, but it just seems like the right thing to do.

00:24:12: How do you what?

00:24:13: what's your experience with PRPs on trauma patients?

00:24:16: On trauma patients, again, unfortunately, it's always a more complicated answer, isn't it?

00:24:24: So not one, not all PRPs the same.

00:24:26: It depends on how you harvest it, the techniques you use, the amount of blood draw you use.

00:24:30: At the end of the day, the bigger the blood draw, the more platelets you're going to get.

00:24:34: There's lots of good studies showing that it's about the total volume or number of platelets that you get.

00:24:41: So that makes a big difference.

00:24:42: Whereas, you know, before it'd be like, well, let's do four injections, see how you do.

00:24:46: And they look at that compared to one injection with the equivalent amount of platelets in that one injection to the four.

00:24:52: And, you know, they kind of do better with the one injection with the higher platelet volume.

00:24:56: And then you can get into the specifics where you're going, are you going to do leukocyte rich or leukocyte poor?

00:25:02: One creates inflammatory response.

00:25:04: The other one, to try to stimulate the healing, the other one does not.

00:25:08: So one, you do use more in the degenerative conditions.

00:25:10: The other one, you'd use more kind of your acute conditions because you're trying to stimulate more healing.

00:25:15: And then you're getting into kind of degenerative conditions like arthritis versus, you know, partial thickness tears or tendonitis.

00:25:21: So there's a whole gamut of things out there.

00:25:24: But in terms of the response, some people feel great right after, and some people, it just takes a bit of time.

00:25:31: And there's no real rhyme or reason, but I do notice more.

00:25:35: the longer chronic conditions take a lot more time.

00:25:40: And it's, again, more of that graded approach because the longer it's been happening, again, going back to that conservative model, the longer they haven't been loading those tissues.

00:25:47: So it takes a longer time to get them back to me.

00:25:50: to be able to tolerate that tissue load and increase in the tissue load.

00:25:55: So those tend to take a lot longer versus somebody that kind of has an acute.

00:25:59: And that's where you get into that, hey, you could maybe do a one and done and you don't really need that much physical therapy.

00:26:04: because right after they get injured, they get that pain relief, they get the information reduction and there's able to kind of get back into, say, fifty percent activity, which looks a lot different than going down to, like, a ten percent activity.

00:26:16: Like, a lot of athletes and fighters and different stuff like that, they tend to do a lot better with that one and then slowly get back into your regular routine versus, you know, the regular kind of, we'll call them average Joe, will take a little bit longer and needs a little more guidance in terms of the exercise therapy to get back.

00:26:34: So we're going to run out of time.

00:26:37: I apologize, Alex.

00:26:38: I got to throw one more in.

00:26:40: that's going to really challenge your farewell comments, because we're pretty rigid about this.

00:26:45: Your thoughts, do you ever use small molecular peptides in your practice?

00:26:50: What do you mean?

00:26:51: Like the hyaluronic acid?

00:26:54: Yes.

00:26:55: It's for muscle mass.

00:26:59: Oh, you're talking about more of the peptide therapies.

00:27:02: That's

00:27:02: right.

00:27:03: Amino acids and peptides, right?

00:27:05: Yeah, so the BP- one five seven TB four hundred that sort of stuff.

00:27:10: It can have its place.

00:27:11: I don't use it that often I do find.

00:27:14: all in all PRP tends to be more effective.

00:27:18: and Again, it's.

00:27:20: it's it's part of Helping the environment and it's not kind of a one-stop shop.

00:27:25: It's it's kind of like if you think about solving a problem You want to cover the big three Which usually gets you ninety percent of the way and then you have all the other things that get you from ninety to a hundred percent Where you kind of many start adding in the peptide therapies, but like big three being you know proper nutrition proper exercise therapy proper Um, slow return to function, um, and, and sleep, obviously, cause that's going to help with the healing process.

00:27:49: It's a huge one that's often overlooked.

00:27:51: It's just sleeping itself.

00:27:53: And then for the ninety to a hundred, then you're talking about injectable therapies or talking about pet pet therapies and stuff like that.

00:27:58: Alex, take it away.

00:28:00: Uh, let's, let's point out where the doc, how, how we get a whole of doc Ram.

00:28:04: And

00:28:04: I have one more.

00:28:05: I want to, I want to end on a really.

00:28:07: On a really high note and it'll segue into our seminar we're going to do here next month or in November.

00:28:15: You

00:28:15: mean the world famous advanced seminar of a master class with outstanding speakers next to Disneyland?

00:28:21: That's the one.

00:28:22: I'm going to plug it in a second, but I had this whole parlay into the plug and I was going to use Dr.

00:28:28: Matheson against his will to help us plug it with this strategically placed question.

00:28:35: where I was going to ask him about sort of the future of your profession.

00:28:39: I want to know what you sort of are looking at on the horizon in terms of, you know, that's exciting, biologic, robotics, minimally invasive, rehab integration.

00:28:48: I mean, what sort of things are you looking, you know, ten years into the future and going, this is going to be cool, but what comes next?

00:28:56: So I think we're going to continue to try to improve the biologic environment.

00:28:59: That's going to be in terms of stem cells.

00:29:01: You can talk about mu stem cells, but also about surgical, uh, implanting, kind of biologic membranes that have increased growth factors that are going to help improve the environment.

00:29:11: Uh, cause that's the one thing that, you know, especially in the older population where the biology starts to get worse and worse, you need to try to create that healing environment.

00:29:20: The problem right now is that it's, uh, the things that you put in there now are kind of short lived and washed.

00:29:25: away.

00:29:25: but it's kind of more of those sustained prolonged released type of biologic growth factors that are going to help particularly with angiogenesis or blood flow growth into the area.

00:29:35: I think robotics is going to continue to take off with kind of the AI enhancements and kind of guide the surgeries more and more because that will allow you to do more minimally invasive surgeries that you couldn't do with more accuracy and precision because a lot of times even I remember trying to do all those tiny mini incision approaches that like for total knees and things like that that just didn't go over very well in the past because it would affect your ability to get the proper alignment.

00:30:00: but now with robotics and having that you know assisted templating and things like that, you can still get all that perfect alignment, but now you can also do it through a smaller incision.

00:30:11: So I think the minimally invasive will continue to take off, like even look at spine surgery, they're doing endoscopic spine surgeries and things like that, which the less soft tissue that you have to disrupt, the quicker the recovery and the better outcomes tend to be.

00:30:25: Because at the end of the day, you want to maintain the tissues as much as possible to the original state and just fix what needs to be fixed.

00:30:32: and not create a whole bunch of scar tissue.

00:30:34: You could imagine the standard approach, which still needs to be done most of the time for spine.

00:30:39: You're cutting through all these different muscle layers that you would rather leave intact because you have proprioceptive factors coming from that.

00:30:46: You've got all sorts of things.

00:30:48: So even the endoscopic spines where you can perform those is absolutely amazing.

00:30:52: I'm just trying to figure out how they're going to do the bone grafting techniques for fusions through those minimally invasive or through when you're doing it in water.

00:31:01: Looking out for that.

00:31:02: It's Spine Guy's amaze me.

00:31:04: I know you guys are going to do some crazy things.

00:31:06: That's a fantastic answer.

00:31:08: I appreciate it.

00:31:09: There was a lot of really interesting stuff in there, and I would love another hour with you to sit down and dive into what all that means.

00:31:15: And let me, speaking of the future of trauma, our advanced PI seminar is coming up, like Sean said.

00:31:21: It's November eight.

00:31:23: If you haven't gotten your tickets yet, I highly advise you to do it before the prices go up.

00:31:27: Steelizner.com slash events, you can go down there.

00:31:30: See all the great speakers, eight hours of continuing education.

00:31:32: It is on the future of trauma, so a lot of doctors are gonna be speaking about the future of their specialty.

00:31:39: Sean and I will also be speaking about PI and the future there.

00:31:42: So if you haven't got your tickets there, I highly recommend you do so.

00:31:47: And then Dr.

00:31:48: Matheson, I just want to thank you again for taking half hour of your day, your clinic hours.

00:31:53: it sounds like, doing some PI work already today to sit down with us and talk to us about this stuff, because I think it's fascinating and I think that you're doing a great job.

00:32:01: Can you tell us if a chiropractor who's listening or watching wants to get a hold of you or send you a referral how they would do that?

00:32:08: Yeah, so the easiest way is just right from the email.

00:32:12: We've got locations in Rancho, Long Beach are two main and then working on one in Burbank.

00:32:17: We also have an office out in Corona.

00:32:19: But the easiest way is just to hit us up on our email.

00:32:22: It's with my admin assistant, Nastasha.

00:32:25: So it's N-A-S-T-A-S-S-I-A at MatthewsonOrtho.com.

00:32:30: Awesome.

00:32:31: Dr.

00:32:31: Matheson, thanks so much for being here.

00:32:33: I really appreciate it.

00:32:34: Thank you very much for having me.

00:32:35: I appreciate it.

00:32:36: All

00:32:36: right.

00:32:36: Take care, man.

00:32:37: Okay, take care.