 Produced from the Cube Studios, this is Strong by Science. In-depth conversations about science-based training, sports performance, and all things health and wellness. Here's your host, Max Schmarzo. All right, guys, I'm here today with Dr. Teddy Wilsey, also known as strength coach therapy. For a little-known fact, Teddy and I actually go pretty decently far back in regards to the social media world. Teddy was a huge help when I first started, and I was making my page. He's been putting out some awesome material online. He's been helping athletes numerous occasions over the years, not just as a PT, but as a strength coach. He has an awesome background in regards to holistic approach. So when we're talking about a physical therapist, I think there's some connotations that come with it. At times, people only think rehab, rehab, rehab. Teddy really comes from a strong strength and conditioning background, and he has a great job of melding those two worlds. Teddy, thank you for being here, really appreciate it. Dude, happy to be on. It's gonna be fun. It's gonna be great. Teddy actually came out and visited me a month ago, and a little-known fact, Teddy pulled a massive PR on his trap bar deadlift. And I don't wanna say it was because I was around, but I'm common denominator. Yeah, yeah. No, for guys who don't know Teddy, Teddy's an awesome guy. He's a super well-versed and multiple domains. He has the ability to articulate exactly why he does things in a way that makes sense to myself. And that's one of the reasons why I really wanna have him on because he's able to express and share why he takes the approach he takes. And not necessarily why it's super unique, but why it makes sense for what he's doing. Teddy, you have really prided yourself, and this is where I think you've distinguished yourself quite a bit in the community, is in regards to bridging the gap between strength and conditioning and rehab. I kinda wanna ask you what that means for yourself, and also why did that come about, and why it's so important to you? Oh, man. I think that bridging the gap is such a challenge that we have because so many athletes are in this kind of gray area. They're in between. They have these kind of open-ended injuries or things that they're working on, whether it be a sore knee or an ACL that they tore last year, but they're not 100%. And so the issue is that we don't have somebody in place to take care of that person that's kind of in the middle. And oftentimes that would be your athletic trainer, the training staff in a collegiate or professional setting. In a high school setting, which is the majority of what I work with, the majority of athletes I work with are high school, these kids are just kind of out there floating in space. They get, let's say you're rehabbing ACL, you get discharged from PT at six months, what are you gonna do for the next six months until you are close to your 100%. We know from outcome data, from research that really athletes aren't 100% after an ACL until about three years, two to three years. And what I'm trying to do is bridge the gap in a way that I can help strength coaches to stick with what their job is and actually train their athletes and not have to kind of guess and get all fluffy with a lot of the corrective work because that's not really their job. And if they're not loading their athletes, they're not putting their best foot forward as coaches and their training and background. So I'm trying to get strength coaches kind of out of that realm and then also have physical therapists understand a little bit more about how to bring an athlete further along into the arms of the strength coach. So we're trying to kind of help everybody to do their own jobs and keep this separation while building this bridge. So it's not that I want all physical therapists to be strength coaches and it's not that I want strength coaches to know how to rehab their athletes because that's not their job. I want everybody to kind of respect each other and communicate. And that's, I mean, no matter what setting you're in, private sector, public sector, communication is the most challenging thing that we have. And I know that's what you guys are really trying to fix or to address with resilience code and your big group of professionals interdisciplinary communication under one roof. But that's my goal. And that's really where I think that I can help make a difference and speak both sides language. Yeah, that brings up a really important point that I don't know if everyone listening to this gets. So when someone gets hurt, typically they'll go see their physical therapist and we're gonna assume in this setting it's a private setting soon, not in the school. And then you go to a physical therapist and then you segment and go to a strength coach so you go back to your performance. But the communication between the two isn't always there. And Teddy, if I get it correctly, you're kind of talking about how as a physical therapist, can I think like a strength coach so I know where they need to be to actually need to be ready to perform in the weight room and on the field. And then at the same time, how can I as a strength coach think like a physical therapist so I know where they came from and I know how to properly load the athlete. Is that kind of the bridge we're talking about here? Absolutely, absolutely. And kind of you alluded to this at the beginning, we don't want to sit here and bash physical therapists. I think that my profession has a lot of growth or a lot of room for growth in the athletic performance area. But the reality is that I think that a lot of the responsibility here falls on the rehab professionals, the ATCs, the PT's to better understand the needs of an athlete and to help prepare them and make them more resilient so that they can get back to the plane. Simply fixing pain isn't a good barometer. We need to kind of move beyond that to, second that your hamstring doesn't hurt, doesn't mean you're ready for high speed running again. We know that you need repeated exposure to high speed bouts of running. Who's gonna help them do that? Who's gonna help the athlete? I see this all the time with soft tissue injuries where you go back onto the field and you might be okay at first but that cumulative stress will break you down. And again, the bridging the gap just comes down to like you said, Max, the coach, the sport coach, the strength coach appreciating or understanding that that athlete maybe not 100% and the physical therapist also being able to communicate with them. I mean, there's nothing more frustrating than those sport coaches that they kind of have this mindset. Well, if you're not 100%, I don't want you out here. Come back when you're 100% and it's just not that simple. And they need that exposure to the competitive environment to know that they're 100%. There's no way that they'll know that until they get that repeated exposure. So I go through this time and time again, it's just really challenging. I'm always reaching out to coaches and I'm in the private industry and reaching out to different ATCs at different schools trying to create that communication. Yeah, I like how you brought up, pain is not our barometer. And I like that from a multiple standpoint too because pain is whether or not you want to talk about pain in regards to how you perceive pain because that's one thing versus actual pain, tissue disturbance. And for those listening, there's the idea that our brain associates a region of the body with pain. They kind of call that pain science adosioceptive. I'm not versed enough to dive into it, but it's the idea that our brain is telling our body it's hurt despite it not actually being hurt. And the other aspect is pain because of tissue disturbance. So there's actually something going on in the tissue itself which is causing a problem. Now, in regards to that, you said it's not just pain but it's the aggregation and the accumulation of repeated stresses that allows the tissue to be resilient, right? You're talking about, oh, you get back on the field. Well, that's great but you're gonna be running more than once on the field. So how as a physical therapist, as a strength coach do we address the situation of making sure our athlete isn't just ready from a pain standpoint but from a tissue tolerance standpoint? We address this, I use this analogy all the time whether you are learning something for the first time or you're rehabilitating, you need a periodized and methodical approach to loading. And so if somebody's coming back from a hamstring injury, let's say a hamstring tear, a really kind of aggressive injury, they're not going to just linearly come all the way back the same way that we don't linearly train anybody. They're gonna need kind of ups and downs, undulations, they're gonna need times where they overreach and times where they allow that stress on the body to decrease and really kind of realize their gains. And if this rehab process is two to three months, we have plenty of time to really kind of plan that out. And then of course kind of roll with the punches because there's always unexpected symptoms, stuff happens, you know, that's just part of the game but it's this kind of higher level approach where we approach an injury with a training mindset that I think is extremely important. And it's just, you know, physical therapists they don't talk about this stuff. They're not educated on it in school. It's not part of the board exam. And physical therapy is a huge profession. A lot of us are doing the exact opposite of what I do. They're working with people with strokes and spinal cord injuries and Parkinson's and multiple sclerosis. And it's extremely important, but we come out of school with this just gross general degree that doesn't really allow us to specialize in anything. So that's a challenge. Yeah, and I think an aspect which is unfortunate about physical therapy it's nothing to do with the individuals. It's more of a bureaucracy issue is the insurance aspect, right? Where if you're seeing a physical therapist and you're seeing them based on insurance, well, if your knees, what's hurt it's being caused by a hip and maybe a shoulder issues. I can only really treat the knee, right? I'm filing my codes and they get reimbursed for my actions to make sure you're not paying, you know, out of cash, out of pocket. I need to make sure that as a company that I am acting on the part and area that you came to me, despite the fact there might be other areas involved. And so when you work in a cash pay system, it's different because at cash pay, you have a lot more autonomy because you're treating it much more as, hey, here's my physical therapist, but I'm not gonna, you know, trust insurance to tell me what's best. I'm gonna trust you to tell me what's best and I'm gonna provide you with the money for reimbursement of what you need to do. And so when we're talking about this, there's two models and distinguishing those two models are important because in the insurance-based model, unfortunately the freedom is, it's difficult. It really is. And you don't even get a whole hour or something. It's a half hour, right? It depends how you're doing the billing. First, the cash-based model, you have much more freedom to really take care of the body holistically versus, you know, how do you get my codes in so I can get, you know, reimbursed and make sure that you don't have to pay, you know, cash or something you don't wanna pay cash with. In regards to that, and this is kind of an opinion question, how do you see someone maybe in that insurance model applying a more holistic approach? And then what's your opinion also on insurance versus the cash-based model? So I spent the first year of my career as a PT working in an insurance model. I knew the entire time I was going to go cash, it was just a matter of when. I think that in the insurance model, you have to kind of fudge the books a little bit. Sometimes you have to justify to yourself, first and foremost, if you feel as if you are acting in a moral and ethical way and putting your patient's interest first, I think that you can do other things outside of that body part. And sometimes, like you said, Max, it comes down to something silly like, can I strengthen this person's hip when they have a knee issue? Of course you can. You can pull up a million articles that show the importance of proximal strength for distal stabilization. And we see that at the hip all the time, even from an athletic standpoint to people with osteoarthritis. Strengthen hip helps the knee. The issue is when somebody comes in and they say, okay, now my left foot hurts, but you're treating their right side. That can be challenging. That can also be challenging because maybe you don't have the amount of time that you're spending together to fully address both issues. So the way that I would handle that, and I still typically do this, even though I'm in a cash-based model and I can treat anything I want, I still typically will explain to patients, look, I wanna give this one body part or this one concern of yours, the entire due diligence that it deserves. And if we have extra time or if we want to see each other a little more frequently to work on your shoulder on the other side, maybe we can, but I wanna focus on the knee first. And that kind of comes down to individuals and whether they're gonna do stuff on their own versus they need me to babysit them. And the second part of your question, kind of cash versus insurance, I think that you're gonna find that more and more physical therapists like myself are going to the cash pay model, not because we're raking in the dough, but more just because it's the only way that we can be entrepreneurs. And it's the only way that we can bring in clients on our own. If we had to certify ourselves with all of these insurances, we might have to wait six months of business ownership before any of the insurance has even paid us. So we would have to go six months into debt and physical therapists, compared what we make to like a lawyer who goes to school for the same amount of time, we're making pennies on the dollar. So it's not a profession, just like strength coaches for most of them, it's not a profession, you go in for the money, you go in for the passion. And most physical therapists, I think are pretty passionate about their job, but they're kind of held handy or held handcuff by the insurances and the bureaucracy. And that's, I mean, dude, it's a problem with healthcare across the board. It's not just physical therapy. And that's, you know, it's a problem with our country, not to get into politics, but just, you know, how much it's a big issue. It's a big political football for the elections, for all that stuff, healthcare, it costs a lot of money. And, you know, I think that one of the populations that kind of slips through the cracks are athletes, because like we said, a lot of healthcare is not the professional, the practitioners are not trained to help athletes, and athletes have a totally different set of rules and prior level function that they need to get to. And there's language in a lot of these kind of insurance guidelines and what they'll pay for, that once somebody is kind of functioning at a normal level, below their athletic level, they can't get reimbursed by insurance anymore. So there's all those things that kind of are piled against athletes, trying to get medical help in rehab. Yeah, and something that you brought up as well was the aspect that on a cash pay program is you can do things that are scientific, that might not be, you know, recognized by insurance. What I mean by that is you can use different pieces of technology. You can use 3D motion capture. You can use different force plates, whatever what you need to provide the best tools possible. And so the money side, it's also funding a facility that might be more suited to providing the best care possible. And so because you're on a cash pay and you might be making maybe more money than an insurance model, well, you can buy better equipment now to provide better services. And like you said, it's an entrepreneurial system because at the end of the day, no matter how you twist it, it's about your client and about you providing the best thing for them, otherwise they won't come back. And so the idea of having that entrepreneurial push to provide, okay, how do I provide the best service? Right, it's not, oh, I'm Ebenezer Scrooge and here's my money and I'm gonna sit in my tower, but here's my money and I'm going to now, I need to buy equipment because I can provide better motion analysis in X, Y, and Z. I don't wanna go on that rant because that's something you and I would enjoy talking about for about two hours, but I'm not sure if everyone else wants to dive into it. One of the things you did mention was the athletic population. And I know in the athletic population, returning to life is not really what they're interested in. They're returning to performance, right? Their life is performance. And so if I'm a basketball player, Teddy, thanks, you got me to walk again, but I need to jump for your attention. I gotta play three games this week. When it comes to that situation with an athlete, high school, professional, middle school, weekend warrior, whoever it is, because that mindset, again, is probably the same for all those athletes. How do you go about the, not just the design and selection of your periodization, but also the actual modalities and the exercise you put into the program to make it specific to that person? I mean, it's really, this is where the kind of the bridge to gap idea comes from. It's similar to how I was taught how in my, in 2007 at University of Pittsburgh in exercise science, one of our projects was to write a training program for, and I think I chose rugby, you know? At first, the first thing you do is you look at what are the kind of the biomechanical and range of motion demands of their sport and of their specific position? What are the energy system demands? How frequently are they going to be playing and practicing? What's their yearly schedule? And when you factor all of those things in, that's how you can create the rehab program the same way that you would create a training program. And I'm paying attention to all of those things, especially as we get closer to return to sport. You know, if I have a basketball player with an ACL, they're gonna be doing very different conditioning at the end of our sessions than a football, American football player would be for obvious reasons, the difference in energy system usage. So, you know, I think that it just comes down to taking the time to understand what that person's goals are and then working backwards to tailor fit the program to them. And same thing goes for the weekend warriors. I mean, they're usually a little bit easier in terms of their goals, but the athletes are the ones that have these very specific demands for their sport. Yeah, that makes sense. One of the things you talked about is, right, not just movements, but energy systems. And we're not just talking about, you know, oh, can I get the leg stronger? Can I get it functioning at a higher velocity and a higher output repeatedly over and over again? And so for people who maybe haven't gone through rehab, I have numerous times, unfortunately. The aspect that Teddy's kind of talking about is that gray area between strength coach between physical therapy, especially on the payment model you're in. And unfortunately, most sport coaches don't recognize a gray area. If you're on the court, you go 100% regardless of if you want to go 100% or you should go 100%. And I like the idea of taking that ownership, Teddy, and really finding that middle ground. Because I think people say, oh, let's bridge the gap. What the hell does that mean? You know, like, okay, like give me some definition. I think you put a really good definition behind it. It's that gray area where you can start to meld, you know, some of those strength conditioning practices, but into a traditional physical therapy model that allows you to really fully repair and heal tissue. With that being said, there's a bit of big push, I guess over the past five to 10 years on pre-hab, right? People are talking about pre-hab, pre-hab, pre-hab. You're obviously well versed in this area. And I wanted to get your take on pre-hab because I've seen your Instagram and for those who aren't following all seven people in this world who aren't following Teddy. Go check it out because he talks quite a bit about you need to, lifting weights is pre-hab. It's not, it's just the band and doing some ankle mobilizations. It's being strong, being robust and being resilient. And I really love that takes. I'll let you kind of take it away talking about how you define pre-hab and what it really means. Yeah, so, you know, the courses that I teach on my own and with Jacob Hardin are called pre-hab 101. And we chose that name not because we are getting people in a room to teach them corrective exercise for two days. We chose that name because it resonates with people. And like you said, it's popular. But we approach pre-hab in a different way. We think that, you know, the most important thing that you have to account for is load. Total stress is something that we can manipulate. We can affect based off of the training program, the practice schedule, et cetera. And it's something that we know more than or we understand more than almost anything else is link to injury. You know, there's not great data out there about range of motion and biomechanics and how that links people to injury. The functional movement screen has zero reliability in terms of or validity rather in terms of predicting injury. And so pre-hab in this sense, and this really it applies more to kind of like lifters and recreational athletes and people that have control over their programs. Because if you're an athlete, you don't always have control or you usually don't. But pre-hab refers to these ideas of monitoring stress, appreciating the cumulative load that has this effect on your body. And also kind of figuring out ways to check back. So one of the things that, you know, we talk about a lot is like, is what are the different markers of fatigue? And how can we use those to help dictate our training? So like an example would be, Max, some of the experimental work that you've done with kind of testing physical readiness and even if I just use like the G-Flight and tested vertical jump, and I use that as something to kind of mark my readiness for the day. That is a version of pre-hab. Anything where you are kind of forward thinking and trying to avoid rehab or stay healthy is pre-hab. And sometimes it's as simple as, okay, I've got like a peck tendon or bicep, proximal bicep tendon issue. Let's floor, let's floor press for the next three weeks. And then we'll go back to the barbell. You know, sometimes it's just these little changes that can make a big difference. And it's not always about seven different exercises to fix your biceps tendonitis, you know? And so, but that's kind of what we have to put on Instagram sometimes. And that's what gets clicks. And so that's the whole tricky line. But pre-hab man is just appreciating cumulative stress of the body, making small changes when you can. I really like that definition, because it's encompassing. And I think, you know, socially we think pre-hab and theraband and bird dog and a glute hip ridge are the first three things that come up. But really everything we do is pre-hab because we never want to go to rehab. And that's why when you look at some of the models that you present in regards to, I'm gonna, you know, lifting in general is pre-hab. It's pre-hab to avoid death even. Like it's the ultimate pre-hab exercise as medicine. And we look at the small adjustments you can make. It's the ability to work around maybe disturbances in your capacity and being intelligent. So I really liked the example you gave with, you know, the bicep tenonitis and shoulder issue and maybe we're gonna floor press versus bench press. Now in someone's mind, they might say, oh, you know, for floor pressing, you know, that's not pre-hab, that's lifting. But really it's that small adjustment and being aware of what you're dealing with at the time. That is pre-hab. And that's a model you can take and apply universally. That makes nutrition pre-hab, right? And what's so beautiful about the definition you gave Teddy and not to go on too big of a rant is that pre-hab becomes synonymous with performance. And it should be because performance avoids rehab when you're optimal. And if we're avoiding rehab, then what's the difference between pre-hab and performance? I love that definition. Yeah. And, you know, kind of going back to the bridge-to-gap conversation, that's where the stubborn strength coach that is unwilling to make small modifications based off of injury or pain kind of ends up, you know, up the creek without a paddle or whatever down the, I'm bad at phrases. But, you know, that's where they just end up in a bad position because they're not willing to modify their stubborn and they're not appreciating this kind of, this cumulative stress idea and this pre-hab idea of making small changes when it's necessary. So it could be the coach that won't let any players box squat, but you've got somebody with hip impingement and that free squat or that deeper squats just really kind of beating them up, you know? And so there's all these small modifications that we could make. And I understand that that's challenging sometimes for a coach that let's say they have, you know, 20 athletes at once and they're the only one responsible for them. It's challenging to make those modifications, but that's where kind of bridging this gap. Maybe that athlete doesn't need to not lift. Maybe they don't need to just be in the athletic training, be on the training table for an hour. You know, maybe they can do these small little things to train around injury, train through injury. And so that's a big part of what I teach and talk about in those courses and doing a couple of talks this spring at some different kind of strengthening and dishing settings. And that's a big part of my focus is how to train around injury, continue to train because if you're not training something else is going to lag behind as well. And that becomes a whole nother issue. You know, the guys that tweak their hamstrings after they come back from ACLs or you come out of a boot and then your Achilles is jacked up, you know? And so like anything that we can do to continue to challenge the organism while they're injured is important as well. And that falls into the pre-hab category. For those listeners that aren't super familiar with periodization, and this is, I promise you on topic, it's typically very rigid by tradition. In eight weeks, we will do this. It's kind of like, well, I don't even know if it's, you know, it's going to be sunny and I don't know, you know, I'm not going to be sick. There's so many things we don't know. And I think we see a lot of, this happens a lot in general popular, you know, GenPop, where they go online and I love a lot of the fitness, you know, doing a good job providing information, but they might provide a workout, you know, oh, the big chest workout and the big arms workout. And they'll see it and they'll say, I have to do these exercises for these reps. But what you're saying, Teddy, is let's take that concept and let's be flexible because right now people are so concerned with longevity. That's the thing that comes up quite a bit. Oh, you know, how can I function well when I'm older? How can I, you know, be able to play baseball or basketball with my grandkids? And a lot of it I think comes down to and you hit on this very well, is let's be logical, right? Let's be flexible. And yes, obviously working out and exercising is very important. And if we know exercise is important and nutrition is important, we'll just stay on exercise for the sake. Exercise is important. And we know we need to continue to exercise and find ways to make exercising an option. So while there might be issues that come up, I think you would agree with this that a lot of the issues come up because we're almost stubborn and we fight through the warning flags. Instead of being flexible and really, you know, maybe a deep squat isn't best fit for me at this current moment. Maybe at some point in time, it will be. If we're talking about longevity and if you really want to dive into the science or the more muscle mass you have, the less percentage you are likely to die, like there's a direct relationship to all cause mortality. So all, you know, it's obviously important for function health. Okay, well, we need to find a way to exercise. And what you talked about Teddy is like, let's be flexible, let's allow us to exercise, train and have performance throughout our life because we're not being rigid. I really like that because for people who just introduced this area, they see workout, I have to follow. I don't know how many times I've gotten tenonitis from doing that, whether it's in my knees or my biceps because I've said I have to jump or squat today. Yeah, I really like that. Absolutely. You know, it's one of those things that it's not always the role of the strength coach. And I touched on that a little bit that sometimes let's say you have 20 athletes in the weight room and you're the only coach, you don't have time to spend 20 minutes one-on-one with one person experimenting with foot persistence for their squat. But that's where the gray area comes in. And can an athletic trainer help with that? Can a therapist, which there are none in college, don't even get me started on that. But can a therapist help with that? You know, and so that's where I think that kind of that bridged gap needs to happen. And you know, I talk about in some of the talks I give, I talk a lot about like the physiological benefits of training too, and what happens when we detrain. You know, things travel up pretty quickly when we detrain. You know, and so it's extremely important, even if it's like a heavy sled drag, something to get people to expose people to higher heart rates, it can really help to maintain physical fitness when you're hurt for a little bit. And you see this, especially with an athlete that like they're out for two weeks, you know, they can't just hang out for two weeks if they're gonna be right back on the field. And so it's really, it's somebody's job on that staff to get creative and figure out how to train them as much as they can. Yeah, one of the questions I have for you is in a situation where someone might have an injury and they're working with a trainer or strength coach, how do you feel about still seeing physical therapy but in conjunction with getting that workout? Because like you said, working around what you can, but maybe there's certain soft tissue work, the physical therapist can do, there's certain specific understanding of that, you know, local tissue itself that can better help the healing process than just train around. How do you see those two kind of working together? I mean, that's the ideal model, you know? Unfortunately, it just doesn't happen as much as we would like. I've spoken to people in professional organizations that don't have that sort of communication across the hallway and their medical staff doesn't let people go to the strength coaches until they feel that they're cleared because they don't trust the strength coaches, that's the only explanation for it. There are some places that I've spoken to, I have a buddy who's in college who has a really good relationship with his ATCs and they have what I would consider to be maybe like a model program in terms of their communication. So it really just comes down to the individual program and what they can kind of, you know, the kind of trust and rapport that they can build. But here's a perfect example. If somebody has a hamstring strain, once they're beyond that kind of acute inflammatory pain period, they could be pushing a heavy sled. That's primarily a quad dominant movement, especially if you march in a certain way, whereas dragging the sleds is gonna be more of a hamstring dominant movement where they dig their heel in. So there's all these little modifications. You know, if somebody has a hamstring issue, they can probably do, let's say you do like a band running in place, they, or like a, it's kind of like a high knees in place, they could do that maybe a week or two before they could.