A Patient’s Mindset and Consistent Small Habits Often Determine Long-Term Success

Layla [00:00:02]:

Welcome back to Shoulder Wise, the podcast where clarity, strength, and care come together for every shoulder journey. Today we’re tackling one of the biggest questions patients ask. Can physical therapy really fix my shoulder? Dr. Ben Szerlip is here to explain not just the medical side, but the patient stories, the mindset, and the innovations behind moderate shoulder care. Hi, Dr. Szerlip. I’m so excited to be speaking with you again today on this episode and get into physical therapy and how it can really help patients. So how are you doing today? Are you excited?

Dr. Ben Szerlip [00:00:34]:

Yeah, I’m doing wonderful, and I am excited. I would say that this is one of the most commonly asked questions or discussed topics in my office. And I think it’s very subjective, but hopefully we can kind of shed some lights and create some insight onto how to process this stuff and then to hopefully a little more ways to objectively see our progress on the therapy side, too.

Layla [00:00:59]:

Awesome. Awesome. So let’s hop in. I have some questions for you, Dr. Szerlip. So when patients first hear physical therapy for a shoulder problem, what do they usually expect with that?

Dr. Ben Szerlip [00:01:12]:

Yeah, we all have this, you know, even though we don’t think so, we have these preconceived ideas. Right. There are so many stereotypes or assumptions. My favorites are being that they’re going to be tortured with rubber bands and they’re gonna have these things to move all the time are the stretch bands. Some people see them. The other thing, they think that they’re being prescribed physical therapy because it means that they’re too weak and they’re too frail and that they need to get stronger and they need to get muscles. I think both of those conceptions are a little bit of a myth. Some of my strongest athletes can have some of the biggest deficiencies.

Dr. Ben Szerlip [00:01:51]:

And some of the past episodes we’ve talked about, there are 17 muscles attached to the shoulder BL, which are one of the primary drivers of our shoulder motion and our shoulder health and our shoulder stability. And for. To kind of. To simplify things, if you associate back pain, people think you need to strengthen your core. Right. And so that is the core of the shoulder. And so if you’re strengthening by lifting weights, then you can actually create an imbalance by strengthening some of those 17 muscles, but not all of them. So you actually almost create.

Dr. Ben Szerlip [00:02:27]:

Some of my strongest athletes have the bigger imbalance than, say, somebody who didn’t lift weights at all. Many ask the question of how many sessions do I need? Right. And I kind of tell them, like, how many piano lessons do I need? So I Can play the piano. Right. And I kind of rely, or use the Chinese proverb from Lao Tzu is if you give a man a fish, you know, you feed them for a day, but if you teach a person to fish, you feed them for a lifetime. And so I think that therapy is designed towards one just not only navigating how to align that imbalance or troubleshoot on one of the, maybe ergonomic things they’re doing throughout the day or through their sport, and more importantly, how to teach them how to maintain that longevity throughout and be self sufficient on their own.

Layla [00:03:19]:

Absolutely. Giving them those tools to be self sufficient in the long run can go so far, like you said. Absolutely. And how often do patients overestimate or underestimate the potential of physical therapy?

Dr. Ben Szerlip [00:03:35]:

Yeah, I think that we all, again, have our preconceived notions about that too. But it’s difficult to overestimate the potential value of physical therapy. It’s like me, if we undervalue the importance of getting more sleep and everybody kind of the data kind of shows that, or eating healthy. Right. If you teach yourself on how to cook a healthy meal, I think that that’s going to improve your quality of life, your social skills and your, you know, your maintenance, your, probably even your budget. Right. So learning more about how to maintain your health, how to mobilize your joints, how to strengthen your muscles and how to improve your, your core strength is probably going to pay off now and then in the future when you’re trying to prevent injury. So maintaining your activity level as we all age inevitably encounter injuries.

Dr. Ben Szerlip [00:04:26]:

So I think the biggest thing that matters to me, and I think that what we try to get across to the patients is I think that the bigger force beyond the truth question is the commonly held belief that pain is a medical problem or a symptom. Right. And in reality, our body’s way of telling us something is wrong is with this pain, Right. Think of a check engine light in your car and most of us would be somewhat concerned and try to address the issue. Right. But instead with the pain, we kind of get frustrated, we get annoyed. It’s almost like a nuisance. So if, you know, we try to treat the symptoms or turn the check engine light off with things like painkillers and inflammatories, oftentimes those don’t work and they’re not resolving the problem.

Dr. Ben Szerlip [00:05:10]:

Instead, we need to correct our movement patterns, address the mobility limitations or restrictions, and then rebuild strength in a safe and effective way. In my opinion, that is the main objective for physical Therapy is to empower us to get back and stay on track to improve our health and quality of life in the long term, not just to get rid of the temporary pain or symptoms that do annoy us and frustrate us every day.

Layla [00:05:36]:

Absolutely. And can you walk us through how strengthening certain muscles actually changes shoulder function?

Dr. Ben Szerlip [00:05:45]:

Yeah, I think that. So that is an excellent question. I think we’re going to provide a link and some, you know, some images and even some videos on this podcast, because the most important thing is the kind of the visual. It’s trying to, like, talk somebody or read about how to do a jumping jack. But I think that the key are these stabilizing muscles around the shoulder blade of the scapula, the bone found behind the shoulder. And there’s a couple kind of. There’s four main categories, and the one is the foundational activation of those muscles and then strengthening the stabilizers of the scapula. And then we focus on mobility and stretching.

Dr. Ben Szerlip [00:06:26]:

And then the fourth one is kind of wrapping it all or bringing it all together as the functional integration. Right. So the muscles we want to focus on are typically the lower trapezius and the rhomboids, but then the stratus anterior. But we don’t need to focus on the muscles. So we’ll kind of show a picture of some scapular clocks. But really all we do is we move the shoulder blades in different directions and kind of imagine your shoulder blade on a clock, and you kind of move those around in different directions. There’s also the wall slides where you kind of almost do like a snow angel, and you bring your forearm up against the wall and you’re able to retract or bring those shoulder blades back up against there and move them completely through and add resistance training as well to that with bands later. Then there’s the pushup plus exercise.

Dr. Ben Szerlip [00:07:14]:

So they’ll kind of show a picture of that. But you’re kind of doing a plank on the floor, but you’re not doing a pushup with your bending your elbows. You’re doing it by bringing your shoulder blades down and back. And I kind of think that myself and you and most of the other listeners out there, we do spend a lot of time hunched over a computer, you know, bringing our shoulder blades forward, and it affects our posture. I think the. One of the mobility stretches I love is the pectoralis minor stretch. You just find yourself in a doorway or a corner and you open up these muscles here. So strengthening the muscles in the back and opening up the muscles here because we spend all day with them pulled forward.

Dr. Ben Szerlip [00:07:51]:

Right. And then some of the functional integration, or the fourth category is overhead carries. Some you can do simple things, just nothing. Or you can do a dumbbell or a kettlebell. There are external rotation exercises or even more advanced things is with the cables. I do think that some of those advanced things we can build up to. And the key point, and we’ll kind of talk about this a little bit more, is just start easy, something that you can do and you can manage and you feel like a little bit confident that you’re just starting somewhere and somewhere we’re also not going to have an injury.

Layla [00:08:29]:

Absolutely. And speaking of speaking of injuries and all these different exercises that can help with mobility, are there ever mistakes or are there common mistakes that people make during therapy that can actually slow progress or even cause them harm or more pain at all?

Dr. Ben Szerlip [00:08:49]:

Yeah, I think that and most of my male patients kind of are in this mindset after we all watch a Rocky video. And that is we can over train, especially as we get older. I’m in my 40s now and it’s humbling. And it’s also funny about how even when I was in my 20s and 30s, you can do pretty much whatever you want and not feel like you have to recover the next day or not have an overuse injury. So try to monitor that activity level. And people will have this history of saying, hey, it only hurts when I do that. If I take a couple days off or if they’re doing something at work, but they notice they take a four day vacation, the pain goes away. Right.

Dr. Ben Szerlip [00:09:31]:

And so we should try to keep a mental journal. But most muscles, especially if you’re not a highly conditioned athlete, are not meant to be exercised daily for a high level performance. And actually giving your body rest for anywhere from 24 to 72 hours can help improve your recovery and actually help your performance and the way you build muscle too. So I think that the overuse is the biggest thing. And I think that a lot of us are self taught or have ingrained exercises that build certain aesthetic muscles in the gym, but don’t actually again contribute to that balance and alignment or that core stability that we need. So we should also try to not just focus on beach muscles in the gym.

Layla [00:10:17]:

Absolutely. Yeah. I think that that is usually where people go for when they think about that initially is the aesthetic. But definitely there’s, like you said, there’s so much more.

Dr. Ben Szerlip [00:10:27]:

Yeah, I think all of us do. And all these magazines that we see are actually how it literally Says how to get beach muscles or how to get a six pack, which is probably not important to your core function or your limitating, limiting your injuries. I think one of the perfect examples was I typically tell my patients not to bench press after 35, because if we’re focused on the movement of the scapula and how it rotates on the chest wall, the bench actually pins your shoulder blade up against that board. And so if you’re stopping your shoulder blades from moving, you’re putting all your pressure and tension across the anterior cuff. So I’ll get a ton of patients who love bench and think it’s a great exercise. Some even think it’s like a manhood thing. And they’ll stop the mobility of their shoulder blade and they’ll put all this tension on their anterior cuff and they’ll have this shoulder pain, but they just think they’re actually trying to do well or do something good by their body by exercising.

Layla [00:11:26]:

Oh, wow. That. Yeah, I would have never even thought about that. I know that that’s, like you said, a really super common exercise as well as benchmarks. So that’s definitely interesting to hear. And what types of shoulder injuries typically respond well to physical therapy?

Dr. Ben Szerlip [00:11:43]:

I would say almost every injury, there’s, there’s, you know, a few that don’t, but the big ones are the rotator cuff tendinopathies or partial rotator CU tears, most types of shoulder instability, and like I said, irregular movement of the scapula. I think those are some of the most common things that I see in the office. But any kind of, you know, knee, hip, ankle, you know, I think the. Even when people do need to get a procedure or they have an injury and have to take some time off to recover or heal or let that inflammatory process go down or let something scar in, you actually need therapy to get back. I actually see super high level athletes who are running marathons and then they take six months off to recover from a surgery and injury and they need to rehab. And then I see people who are relatively deconditioned, like myself, sitting at a desk all day to get back to certain activity levels. We need to focus on that therapy too. So post operatively or preoperatively or without surgery, I still think almost every patient, it’s like, who.

Dr. Ben Szerlip [00:12:49]:

How can you stay healthy without maintaining a proper diet?

Layla [00:12:54]:

Right, of course. Yeah. They definitely have to go hand in hand. And on the other side, conversely, what’s a red flag that tells you therapy alone might not be enough?

Dr. Ben Szerlip [00:13:07]:

Yeah, I think that we still need to focus if most things can be improved by therapy. And I do stand by that. And I know we have some phenomenal therapists and we’ll provide that to the link as well. And they are the true heroes and they’re getting our patient outcomes. So all the credit to them and the patients as well. But some of the red flags that we want to watch for in therapy, if there’s a full thickness tendon tear, that it could be a time sensitive thing or that mechanical ability to move the joint is affected, if there’s a fracture, it’s a little more obvious and apparent. So if there’s a fracture that’s displaced or the joints not aligned, that may need a surgical intervention. If a patient has too much pain to go through the physical exercises, then we try to modify or stop and then you can get additional imaging.

Dr. Ben Szerlip [00:14:03]:

So there’s a lot of things that we can do. But essentially, if there’s a, a structural damage issue or if another scenario would be if there’s bad, let’s say bone on bone arthritis, we’re trying to mobilize the joint, improve the capsule or ligaments or tendons. But if there’s bone on bone arthritis, or there’s a major full thickness tendon tear or there’s a bad fracture, those are some of the more common things we see and they might not be improved as much with therapy.

Layla [00:14:31]:

Yeah, that makes sense. And I, I luckily don’t have arthritis, but I’ve mentioned my grandpa on this before and his arthritis was so painful that when he tried to do physical therapy at one point, they were just like, you can’t, you can’t do this. It’s just, it’s not going to work. It’s going to be too painful.

Dr. Ben Szerlip [00:14:48]:

So, yeah, it’s absolutely. And so I think those people are actually the happiest because they see the biggest amount of relief. And so even trying the therapy, I think that they didn’t lose anything. Your grandpa actually gained something because, hey, I’m even more confident that I’m going through the surgery which has its own, you know, potential pitfalls or problems or patients feel, as we talked about in the last episode, they feel some type of fear or lack of control that they’ve done the therapy, that it, it’s not working for them. And then they will actually, I sincerely think they’re happier because they lost something and then they get it back, which is, that’s the most fun to see.

Layla [00:15:29]:

Yeah, yeah. I’m sure it’s super rewarding as well. And when people think about Non surgical options. Physical therapy isn’t the only one. Right. So can you explain how PRP stem cells or other advanced therapies fit into shoulder care?

Dr. Ben Szerlip [00:15:50]:

Yes, I think that that’s, that’s hitting on another probably one of the most common questions that I see. And patients will come in and find it and then say, hey, I know I’m, I’m gonna do therapy and I’m currently doing that. Or I’m also, they’re much more proactive. They may be wearing like a fitness tracker. Um, they also, I see a ton of people who are not diabetics. They’re wearing continuous glucose monitors. I think those are very helpful and effective on, on monitoring as far as your diet and nutrition. But the most common things for glucose by far are platelet rich plasma and stem cell treatments.

Dr. Ben Szerlip [00:16:25]:

And to just break it down into plain English, that healing after an injury involves a well orchestrated and complex series of events where proteins in the blood act as messengers to regulate a healing process. Right. And so many of those proteins involved in the healing process are recovered from small cell fragments found in blood called platelets. Right. And so when you’re injured, the platelets activate and gather the in to the injury site and release the beneficial proteins called growth factors. And those same platelets help you form a clot. Right. If you get cut and do stop bleeding.

Dr. Ben Szerlip [00:17:02]:

So this is the beginning of the healing cascade. Right. So how do we, you know, harness this and help treat patients? Well, platelet rich plasma is a concentration of the platelets and the growth factors created from blood. So we can pull up a picture, but you literally draw your own blood. You know, the blood is centrifuged down and spun down and we can show a picture of that. And to separate the platelets from other unwanted cellular components, the PRP contains an increased level of platelets and growth factors that are, you know, have the potential to improve the cell’s ability to respond to an injury. And we think that that is been significantly helpful in patients with overuse injuries. Again, tendinitis, partial thickness, rotator cuff tears, arthritis, when they’re trying to think of it like almost like a fertilizer to help a plant grow.

Dr. Ben Szerlip [00:17:56]:

And we’ve had good success with our patients and I think more and more are becoming aware of those alternative treatments.

Layla [00:18:05]:

Absolutely. That’s great that there is awareness around that now for sure. I wasn’t aware that that was something to supplement physical therapy at all.

Dr. Ben Szerlip [00:18:15]:

So yeah, I think that five and ten years ago they didn’t have, I mean, there was only the professional Athletes were getting it. I think Kobe Bryant was one of the first ones. And then they talked about other things, too. And usually it’s the professional athletes or famous movie stars or singers that kind of get to try these things, and then we get to see them. And the data is promising. It’s still limited at this point in time. And I think the other thing that, that we talk about is stem cells and the difference between, you know, there are several cells found in. In bone marrow, and that’s usually.

Dr. Ben Szerlip [00:18:49]:

And they, they do stem cells in. People ask like, hey, where do they get that? And it’s not from umbilical cords. That’s what people think sometimes in babies, but we get them. I think the most important or the best found factor is in the bone marrow, and that’s usually in your hip. And we have a picture of that, too. But it’s the mesenchymal stem cells, or MC MSCs. They’re also basically medicinal signaling cells. And these have the capacity to form things like osteoblasts, which recreate bone, or chondrocytes, which recreate cartilage, and myocytes, which recreate muscle.

Dr. Ben Szerlip [00:19:24]:

Right. And so the MSCs, or mesenchymal stem cells, have been found to provide signals that assist with healing to cells already present in the body. And so what that does is we were able to pull bone marrow out of a place like the hip or the pelvis, and it’s responsible for repairing and building damaged tissue. So we can use a similar machine to spin that down, and it harvests the cells into a smart volume, which we can use in your body, for like, example, a tendon or a joint, and that contains much higher amounts of platelets, um, and the MSCs, or stem cells than regular bone marrow.

Layla [00:20:05]:

Wow. And then are these therapies effective on their own, or are they best combined with rehab and additional lifestyle changes?

Dr. Ben Szerlip [00:20:14]:

Yeah, I think everybody starts to know me by now. It, it, it’s. It’s. You can’t. It’s not a shortcut, it’s not a quick fix. I think if it is, I, I kind of tell people the easiest quick analogy is just like a fertilizer, you still need the soil, you still need the plant, you need water, you need sunlight, if you’re going to stick to that analogy. So I still think that the staying active, mobilizing your joints and doing it, getting the appropriate diagnosis and going through that with your physician so you can tailor the treatment plan just for yourself. And I think that’s what patients like is now we have different Tools.

Dr. Ben Szerlip [00:20:49]:

Now we have different options and we have different modalities that we can go down an algorithm or we can try one thing and not feel completely helpless when that thing may not work right away. So I really, it’s. It’s helped a lot.

Layla [00:21:04]:

Absolutely. It’s definitely something to supplement. Yeah, sounds like 100. So when patients often struggle with patience and consistency, I think it’s super common in all people, especially if it’s something new, that consistency and patience can be a struggle. Right. So how important is mindset in a successful physical therapy journey?

Dr. Ben Szerlip [00:21:32]:

I think that that’s actually the most important mindset. I think that the. I’m going to bring up one of my favorite authors and books that I think has made a big impact in the surgical world and my life. It’s called Atomic Habits. And we can show a picture of that or even have a link. It’s by James Clear. He’s an amazing writer and a fellow Ohio guy. I believe that’s a great book.

Dr. Ben Szerlip [00:21:58]:

Yeah, yeah, it is. And so I want to kind of channel his. It’s his message and not mine, but I think it really does. It’s about habits and the Michael Jordan or professional athletes or successful entrepreneurs or CEOs. It’s not just something that we want to believe it happens overnight, but it happens over. You know, we Talked about the 10,000 hour rule, but I think that the point is it’s so easy to overestimate the importance of one defining moment and underestimate the value of making small improvements on a daily basis. So improving by 1% isn’t particularly fascinating to people. It’s not a, you know, story worthy thing, but it can be far more meaningful.

Dr. Ben Szerlip [00:22:43]:

Habits are the compound interest of self improvement. The same way that money multiplies through compound interest. The effects of your habits multiply as you repeat them. So it’s really when you’re looking back two, five, or even ten months later that you can see the value of your physical therapy paying off. And the exercise that you put in or the habits that you pick up and they become strikingly apparent, but only after the fact we’ve set up that process or that system.

Layla [00:23:16]:

Absolutely. And I think definitely, like you said, mind mindset is such an important part of physical therapy and the journey overall. But what advice beyond that do you give patients about setting realistic expectations for timelines and for outcomes as well?

Dr. Ben Szerlip [00:23:36]:

Yeah, and this is where I have to, you know, identify as one of the world’s least patient people. I think if you see a surgeon, they’re seldom Unsure and they’re never, never really patient. And my wife will also attest to that. But I think that the best way is having that kind of changing expectations. So we are not perceiving things as success or failure, right? And I go back to the atomic habits thing and we could stay on this forever. But the most fascinating thing is that success and failure, the people who are successful and the people who fail often have the same goals, right? And so it’s achieving a goal is only a momentary change, whereas having a process. So with my patients, and even when my own rehab and I mentioned an injury I had, I began to realize that it had very little to do with the goals that I set and nearly everything to do with the systems that we put in into place to follow that within that structure that gives us the freedom to follow different things. Goals are about the results you want to achieve, but systems are about the process that leads to those results.

Dr. Ben Szerlip [00:24:54]:

So when problems arise and you spend too much time thinking about your goals and not enough time designing your systems, and so I will kind of examples of that is, you know, the goal is not to read a book and then stop. The goal is to become a reader. The goal is to not run a marathon, which I am guilty of. I ran one marathon and then couldn’t walk for three days. But the goal is to become a runner, right? Or to learn an instrument. No, the goal is to become a musician. So I think that that’s. What if we set our goals to like, hey, I’m going to get to X or I’m going to get to Y and it doesn’t happen.

Dr. Ben Szerlip [00:25:34]:

Those people are frustrated and they’re much quicker to drop that habit that we all know that we, we probably will benefit us in, in life.

Layla [00:25:43]:

Yeah, no, that, I mean, that makes complete sense. And this realm and in life overall, like you said, they can have the same goal, but the process in achieving that goal can vary so much. So consistency and repetition and that mindset shift that we talked about and certain lifestyle changes are really what contributes to helping actually reach that goal. And it’s like we spoke about a lifestyle change when really being able to have that mobility back and feel better will be what really shifts your whole perspective and your future and how you’re able to continue about your day to day. And you’ve referenced this in other episodes where someone’s goal can be wanting to lift their kid up or, you know, throw a baseball. So those little changes that help to reach your goal will really change your future and not only get you back to your goals, but also just change your life overall. So I think that like you said, I know you said you’re not that patient. I’m not the most patient myself, so I can completely relate.

Layla [00:26:50]:

But when it’s something that is this important for your future and your life, and even you’re just everyday tasks and things like that, it’s super important to try to be as patient and consistent as possible.

Dr. Ben Szerlip [00:27:03]:

I don’t think that anybody who says they’re a patient person is probably stretching the truth or not realistic with themselves, especially in this day and age. But I do think that. And then I fail all the time. Some people think that it’s about having more willpower. It’s not. It’s about just having a system and it doesn’t have to be. And you’ll notice in three months is not a special date. But a lot of people in three months from now, which is January, are gonna have these resolutions and they’re gonna say, I’m gonna work out for two hours every day and it’s gonna be amazing.

Dr. Ben Szerlip [00:27:35]:

I’m only gonna eat salads. I’m never gonna have a glass of wine. And so if we set these huge, massive goals, as opposed to, hey, I’m gonna run a mile, I’m gonna lace up my shoes and I’m gonna walk half a mile, right? Or if I don’t have time, I’m going to spend five minutes or 10 minutes doing some kind of stretch or exercise routine that’ll get my heart rate up and mobilize my joints. Right. So if you do that and then you can stick with that. So it’s not like a, necessarily a 90 day time period, but just kind of starting with those realistic things and that success will become contagious, Right?

Layla [00:28:12]:

Those small steps towards the bigger goal. I think, like, it’s so common for us to say, like, for example, I want to be a runner or I’m just gonna eat salad, I’m gonna work out for two hours a day and just jump to that goal, which is not obtainable, especially if you haven’t been doing anything like this leading up to it. So. And it’s new. So those little things, just taking that and breaking it down.

Dr. Ben Szerlip [00:28:36]:

And when we fall off the wagon and it’ll happen, we’ll get back on. It’s. It’s okay. It happens to everybody.

Layla [00:28:42]:

Absolutely. And speaking of, you know, these timelines and outcomes and setting realistic expectations for your patients, can you tell us about a patient who completely changed your perspective on therapy and someone who’s come back. You still think about even today.

Dr. Ben Szerlip [00:29:03]:

I think that that’s one of the most fun things about our practice and being 10 years out from fellowship now we have a ton of stories, but a couple come to mind and they’re situational patients who have an injury and they think they’re going to get fixed and they probably need to get fixed, but they become pregnant. Right. And then as we know, nine months later we have to find a way to non operatively treat this and maintain it. And we’ve had several patients to prove that that situation got them so much better and they didn’t need a surgery. And they came way beyond what they thought that they thought they could and that we thought that as physicians that they could. So, or there’s let’s say a patient with a really difficult problem and they weren’t medically, they were too high risk. You know, they were, they had a heart problem that didn’t allow them to get the surgery and for a while they felt really down. But six months later they were doing phenomenally because they picked up, you know, they, where they left off and they continued to work hard with therapy and they had a little Faith and that 1% compounded and they, they did phenomenal.

Dr. Ben Szerlip [00:30:19]:

And I think that they, we all were, you know, really got a victory out of that and a positive feeling to see those patients where they’re not eligible candidates or they, we all thought they might need something to help them, but they did it on their own. And in spite of some of those challenges, there’s another patient who had bone on bone arthritis. They ended up with a shoulder replacement and they still got their pro bodybuilding card and were successfully doing bodybuilding competitions. So I think that it’s really neat to see those people even get a procedure and. But the therapy allows them to get back to really what they love. Several pro athletes doing their respective things. So that those are really cool.

Layla [00:31:06]:

Yeah, that’s, that’s very impressive and inspirational too to become a bodybuilder and to do all of that afterwards after an injury, even without an injury, that’s impressive. So having to go through that after physical therapy and really having to start restart in a way and to make it that far is definitely something memorable. Absolutely.

Dr. Ben Szerlip [00:31:28]:

Yeah.

Layla [00:31:29]:

And speaking about, you know, that growth from certain patients that stick with you on the flip side of that, have you ever seen a case where therapy wasn’t actually enough and how did you guide that patient towards the next step without losing trust?

Dr. Ben Szerlip [00:31:48]:

Yeah, I think that it’s the similar process as how we got a patient who does or does not need surgery. I think we present the diagnosis, we present different treatment options. And I think as we mentioned a little bit in previous podcasts, we create an algorithm and more medical information to empower that patient to make their decisions on what they feel. Again, does it bother me every day? Does it stop me from doing the things that I want to do or I enjoy doing and have the other non operative modalities that we discussed, are they helping at all? And patients, you don’t need a medical degree, you can answer those patient those questions pretty quickly. Any patient can. And so when we present that data, unless it’s a time sensitive thing, and sometimes they are, but most of the time it’s not, we present that and then say this is based on these factors and the evidence that this diagnosis would respond really well to this procedure and you’d have a very high success rate or a likelihood that you gain back function. You’d relieve your pain or you’d stop any further damage. I think that you allow as long as you present that data the same way, the patient is able to make their decision on their own.

Dr. Ben Szerlip [00:33:05]:

And each one of us do that in our own time, right? We all decide on whether to pick up a resolution or a habit or anything else like that on our own time. And it’s funny when somebody asks like, hey, what made you do that? And it’s sometimes smaller, subtle things and other times it’s more motivational and other times we don’t know.

Layla [00:33:27]:

So absolutely. And it’s, I’m sure, hard from your perspective to recommend these things and try and go through all of this with a patient and then still feel like it might not be enough for this particular reason and having to continue to guide them through next steps. So it’s good that you’re able to navigate that as well and do that without losing a patient’s trust and continue to work with them and have that trust with each other and have them have that trust in you. So that’s definitely something that I think is, is hard to navigate. But definitely, you’re obviously in a lead position. So you have figured out how to, how to navigate that with your patients.

Dr. Ben Szerlip [00:34:13]:

It’s still, it’s very humbling. I learned something new every day. But I do think that, yeah, you’re right. The key is that we’re in it together. The doctors and the patients are in it together. And I know that doctors, you know, got into the medical field because they want to help people and it’s not in the short term, it’s not in the long run. So that’s really nice. We’re aligned and having those relationships, having those patients that we see over five to 10 years or I’ve treated parents and then they’ve.

Dr. Ben Szerlip [00:34:43]:

They’ve brought their kids in or they bring their uncle in. And so that’s really. It’s kind of neat to see that long term relationship flourish.

Layla [00:34:53]:

Absolutely. And that speaks to you as. As a doctor, because for them to not only just refer someone or a friend, but to actually make sure that you’re who they want to help their family, especially different family members, over the course of who knows how long that could potentially be. I’m sure it’s over a long course of time for them to still remember that experience that they had with you and refer you to relatives and friends, that goes a long way. That has to be super rewarding. But also just shows that your relationship was so good with them. You gave them such a good experience and obviously help them feel better and helped them really heal to be able to have that trust and faith in you to refer them to some of their probably closest loved ones. So that’s definitely amazing to see.

Layla [00:35:49]:

For sure.

Dr. Ben Szerlip [00:35:50]:

It is. It’s one of the most fun parts, I promise. We had the. The short version is. And it makes me almost tear up thinking about it, but our. Our oldest, Maddie, is nine years old, and. And one of my patients, she knit Maddie a blanket. And then now we have three kids and Wyatt’s six and Chloe’s three.

Dr. Ben Szerlip [00:36:11]:

And that patient, through family members, has seen us. And then she found out we had more kids based on pictures on the wall. And then they got blankets. So it was like. It so touched my heart. And it was really. Even my wife was like, you know, just so flattered and thankful. But so.

Dr. Ben Szerlip [00:36:32]:

Yes, I totally agree. And so that’s why I think that we are in it all together in the long run. And it’s so much more satisfying than convincing a patient that they need something as opposed to being with them when we all decide that that’s the right thing.

Layla [00:36:47]:

Absolutely. That is so sweet.

Dr. Ben Szerlip [00:36:49]:

Yeah.

Layla [00:36:52]:

That is so sweet. Even just for one child, it’s so sweet. But then to continue it, I thought that you were gonna say she gave you this and then now your other kids, you was like, hand me down to your younger children. But no, now she made them for all of them. I think that is the sweetest story.

Dr. Ben Szerlip [00:37:08]:

It totally is. Yeah. Yeah. Because our kids, of course would if they only had one to share they would probably fight over it too.

Layla [00:37:17]:

Of course. Of course. What? Thank you so much, Dr. Szerlip. I think this was such a informative episode and definitely shed a lot of light on physical therapy and alternatives to surgery. So thank you so much. And that’s, that’s it for today’s episode of Shoulder Wise where we really explore the real power of physical therapy and what it takes to get your shoulder back on track. Dr.

Layla [00:37:42]:

Dr. Szerlip reminded us that whether through targeted exercises, advanced treatments or a combination, better movement starts with better understanding. So subscribe, subscribe to our channel. Subscribe to this podcast so you don’t miss the next episode and share this with anyone you love who could benefit from stronger, healthier shoulders. Thank you so much, Dr. Szerlip.

Dr. Ben Szerlip [00:38:03]:

Thank you. It’s been amazing.

Layla [00:38:06]:

Awesome. We will be back with the next episode of Shoulder Wise and I cannot wait to talk to you again soon.