TMD’s Podcast | Golden Nuggets: Episode 2 – John Flagg

by | Dec 8, 2020 | 0 comments

Dr. CJ DePalma, PT, and Dr. Joe Camoratto, PT from The Movement Dr. chat with John Flagg about a variety of topics! They discuss remote coaching, AT and PT, RPE training, and much more.

John Flagg is the Wellness Director at Orthopedic and Sports Physical Therapy focusing on active population rehab and transition back to activity.

He is the Head Strength Coach at 301 Strong focusing on powerlifting, weightlifting, and strongman athletes.

John is also the Owner of Rebuild Stronger, an online coaching service focused on return to competition and performance in powerlifting, weightlifting, and strongman.

The Movement Dr. is a physical therapy clinic that offers in-person and Telehealth Physical Therapy and Remote Coaching for CrossFit, Powerlifting, and more. 

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Dr. CJ DePalma, PT:

What’s up and good morning guys. Welcome back to the golden nuggets podcast. My name is Dr. CJ DePalma and I’m with my partner, Dr. Joe Camoratto. And today we have a very special guest, Mr. John Flagg. Oh, ha.

John Flagg:

Yeah.

Dr. CJ DePalma, PT:

Um, John comes to us from, uh, you know, I’ll let John introduce himself cause he’s gonna do it way better than me.

John Flagg:

Oh man. Where do I start? So, I’m the owner operator of Rebuild Stronger, a powerlifting, strongman and weightlifting coaching platform. It’s completely online. I’m also the head instructor for Clinical Athlete, powerlifting coaching certification. That is, got some pretty cool announcements for this coming year and the seminar schedule. I’m also the other head coach for the Honey Badger project, which is a health entrepreneur, coaching and mentorship service. So keep myself plenty busy and very excited to be on here talking to you guys. CJ, I’ve known you for years, Joe. We’ve done a lot of work together with the Level Up mentorship, so it’s fun to be on.

Dr. CJ DePalma, PT:

Yeah. Well, Hey, thanks for coming on. We’re super excited to, uh, to have you, you do, lots of things and a lot more than me and Joe, do we think we’re busy, but then we talked to people like you and, and it will, Joe doesn’t think he is but, I think I’m busy and then we talk to people like you and you’re like, man, we kind of suck. Um, let’s do a little more. And so, it’s definitely, always good to see, someone, especially not a clinician, which is super cool that you’re so integrated in all of this or not a physical therapist, sorry, specific with that. So integrated into the rehab world and influencing, uh, a lot of people that a lot of people believe that you can’t do without, a PT grad. I definitely am guilty of that.

Dr. CJ DePalma, PT:

So let’s, uh, just give us a little bit of background on like your athletic training and kind of how you got to where you are, why athletic training how’d you get there? Um, how did you get into this, like the rehab online space?

John Flagg:

Um, so I picked athletic training when I was, uh, just starting in undergrad. Um, there’s a lot of contention between the two professions in AT and PT, especially because really the, the base of education is very, very similar. It’s just, they end up taking two different paths. So with physical therapy, there’s the neuro component ortho component. It’s all that stuff. And with athletic training and it’s also written in our bylaws, we only really are supposed to work with the active population, which is really nebulous. It’s like one of these, what does that really, when we start talking about that legally.

John Flagg:

But, I got sucked into it because I had an athletic trainer in high school and they basically patched me together for four years and allowed me to compete at a high level. So his influence kind of influenced me to do the same thing. So went to Salisbury university. I got my degree there absolutely loved it. Working with their sports teams, managing injury, um, you know, doing a lot of lifting.

John Flagg:

I had, uh, a bunch of bunch of friends that like our schedule was basically wake up in the morning, go do morning treatments. We had 6:00 AM treatments. So we were in practically in the athletic training room every single day, doing treatments and rehab and stuff for four years, we’d do that. We’d go to class till about nine. We grab our till about noon. We’d grab a quick lunch. We’d study for a little bit. We’d go back to class by three o’clock we’re in the treatment room for pre-practice treatments to go out and stand out and practice. You come back in about six o’clock. You do post practice treatments. You practice a little bit more than you go hit the gym. You go lift and you go home and eat and go back to sleep and you do it all six days a week. So that was my, like my undergrad college career.

John Flagg:

And one of the things that solidified just really kind of, the way that I practice was my athletes at Solsbury who took better care of themselves outside of the gym seemed to not need me as much when I took that to grad school at Penn state and started working with the baseball men’s and women’s soccer team and dabbling a little bit and other teams where people needed help. I saw the same thing and I just started to build this philosophy where it was like, okay, well, if my athlete is bigger, faster and stronger than you, then they’re probably going to hurt you more than they hurt them.

John Flagg:

And my second year of grad school, I had, I was really fortunate. I worked with this kid. He was our starting forward. These are Stryker and ended up planning for years and MLS, but he was an absolute freak, like would bike 10 miles to school and then work out and then do soccer practice. And then like, you guys know what a bod pod is? No, it’s like, yeah. It’s like, it’s like an egg where you can do body fat measurements that the kid didn’t even register in the machine. Like he was just so writ and he looks at me, he’s like, you know, I’ve got like two hours in the middle of the day.

John Flagg:

What do you want to do? So what do you mean, what do you want to do? He’s like, you’re at the gym all the time. Let’s start working out together that turned into because soccer’s a spring sport or fall sport for the season. I ended up by the end of the year, having pretty much the entire team in these like middle afternoon workouts. And our injury rate went straight down. I mean, we just started playing around with stuff, running, lifting. I had two hours of basically the entire team and we just started crushing it.

John Flagg:

And that’s where I graduated from school, went to a PT clinic and that’s kind of where all the other stuff started and how I kind of inserted myself into physical therapy because I mean, I’m still a licensed healthcare provider. It’s just, I’m limited in regards to like direct access to insurance. And I can’t charge insurance. So I have to charge cash if I’m going to give services and I need a supervising physician, if I want to do certain things and that’s, that’s all well and good. But if it’s the athletic population and they’re paying the cash, then I’m in a pretty good spot.

John Flagg:

So went started working with a clinic in a high school, the after the first year we got out bid for the contract. Yeah. So every athletic trainer on staff got, let go, except for me. So I’m sitting there, I just bought a house. I had just gotten engaged and our boss came in in the middle of the summer and it’s like, yeah, we don’t have the contract anymore. So I have no way to pay any of you.

John Flagg:

So I walked up to him after the meeting and I was like, Hey man. And he goes, I know you’re in a bad spot. I was like, yeah, I’m in a shitty spot. It’s like the worst ever. I have a mortgage now, all of a sudden I don’t have rent, so it’s going to keep you on, but we’re going to have to figure something out because like, I can’t pay you to just be a fancy tech. Okay. So from that point forward, I had to like earn my, keep at a PT clinic, trying to find nontraditional ways to make myself valuable and did that for 10 years. And for the first five, it was just grinding kind of, you know, being right next to the PTs, helping with exercise prescription or whatever. Meanwhile, I’m coaching powerlifting the weightlifting and doing all this stuff that I love to do.

John Flagg:

And all that just started to spill together until clinical athlete was started with Quinn. And, you know, he’s somebody that I had always talked to quite a bit online. And this is where the power of the internet just becomes really ridiculous. Uh, we hooked up, I got into the network. It absolutely checked off every single one of my biases, but it also challenged. I was, I was still at that time and I think we’ve all been here before I got out of school. And I was like, well, I’m going to give it a try. Like, I’ll give graston a try. Not to like, if you’re a graston practitioner, I’m not, I’m not crushing you right now. But like, it was one of those things. I tried everything. And then I got demolished by Derek miles and Michael Gray and those guys in the it’s like, Oh, maybe I should think about stuff or just start trying it out.

John Flagg:

And, um, yeah. Yeah. You ask a simple question Jake Manly and I always talk about how we bonded over the fact that we both asked about body tempering in the same week on the forum and they’re two separate threads and Mike literally just like copy and pasted this super long post to both of them. And I was like, Ow, you couldn’t even like, Oh, it was rough. So yeah. And that, that that’s ended up, uh, you know, being a big catalyst for my career. And from there, it was just, okay, how do we, how do I continue to do this? I left the clinic about a year ago at this point. And I just started taking everything online.

John Flagg:

The catalyst for going online is I had a weightlifter who, the gym that I was coaching people out of, she moved down to Texas and she was like, well, what do we, what can we do? I don’t want to find somebody down there. She lives in like middle of nowhere. I was like, well, I can try coaching you online and see how that works. And from there, it’s what it is now, which is about 50 athletes and you know, people in India and Finland and I love it. It’s great. It is definitely more… Frank, Frank and I talk about this all the time. It’s definitely more strength ad conditioning based than what I think a lot of people, uh, think of like telehealth. So there’s a benefit there, but the, the digital space is exploding. So it is pretty cool to see.

Dr. Joe Camoratto, PT:

Yeah. And we’re, we’re both happy to be part of the Honey Badger, trying to at least myself, trying to figure out how to, how to go online. I know that, uh, CJ already has been online for a number of years now. And so I’m, I’m happy to be working with him as well, but it is a, those represent its own unique challenges of like, um, you know, how do you communicate well, how do you communicate your expectations over messaging? When you’re working with an athlete who you don’t usually video chat with, or you don’t go on phone calls with and how do you, uh, communicate well and build that, you know, therapeutic alliance, uh, without being a person it’s definitely been challenging.

John Flagg:

It is a challenge, but I will say this is something we, we chatted a little about, a little bit about with Natasha Welch that did our live training this past week. COVID was tough for a lot of people. What’s that?

Dr. CJ DePalma, PT:

Which we missed.

John Flagg:

Oh, recording is there. It’s great. She did an awesome job. But with, with that, COVID was tough on a lot of people, for sure. But it also made people go, well, you know, I don’t want, I don’t want physical therapy online. I don’t want coaching online. Now, all of a sudden you have, if you want anything, you have to go online. And now all of a sudden people tried it and then this is pretty, it’s a pretty cool, like I don’t have to leave my house. I still feel just as good. I get, you know, in some instances, depending on your environment, you get more feedback, more, more care, you know, there’s, there’s physical therapy mills out there where you got two people coming in every 15 minutes. Now, neither, none of us were in that environment. But if, if you’re a patient that’s used to being able to only talk to your PT for five minutes, and now all of a sudden you get 20, 25 30 you’re… You’re loving it.

Dr. CJ DePalma, PT:

Yup. Yeah. It’s, uh, it’s been a, um, I would say I’ve been kind of like, kind of like groveling at the sight of all of this, like online success people are having. Cause you know, we’ve just gotten so much flack over the years of like treating people online and not touching them and things like that. And I’m like, you know, I don’t know what to tell you. Like it’s, you know, the success rates are there and uh, I’ve always been very fortunate to have a very specific, patient demographic that like comes through my door through my, my funnel. So like my like, uh, success rates and outcomes, like I think they’re fluffed. Right. So I don’t think it’s very fair, but, but you know, even the ones that might not fit the mold, you know, we’ve had a lot of success and a lot of people, you know, are seeing those kinds of things, uh, with, with this new like tele-health, um, and I was talking to a physician the other day and she’s a, um, I dunno, maybe a GE gastroenterologists possibly. Um, I can’t remember. And, uh, she’s an athlete and minor was going to be an athlete of mine, but anyways, and she was like, I love this.

Dr. CJ DePalma, PT:

She was like, I have, you know, she sees a lot of older, older population and, and I think like, it’s the best thing you have, like to get, to get a, a, a dependent 80 year old who’s non-mobile to the hospital for a five minute checkup with their physician is insane. The amount of costs, like, you know, you have Z trip or like, you know, uh, uh, whatever, it’s like move America that has like come out, you know? And like, there’s just like whole big ordeal. And it takes them the whole day just to go see their doctor for a couple, you know, 10 minutes to read a MRI they got six months ago that they could have just read it over the phone, but now that Medicare’s, you know, and, and it’s paying, I think it’s great. I think it really, hopefully it sticks and I hope it opens up the door.

Dr. CJ DePalma, PT:

Um, it kind of segways into my, uh, my next question is like, of your online until you have 50 athletes. Like, so how many of them are rehab? How many of them are actually just purely performance? And like how long, like how long do they usually work with you? Like, what does that, what does that life span look like? Um, you know, and where do you, where do you get your athletes from?

John Flagg:

Well, it’s a great question because I am still a firm believer that that rehab training is always a spectrum. I would say,…

Dr. CJ DePalma, PT:

Don’t you go political on me.

John Flagg:

I’m not, I’m going to go to the point. Um, but it, it is always difficult to quantify that number because people float back and forth. I do have a few athletes who are, are real high octane, and it becomes one of those things where you kind of gotta like tap the screen to be like, Hey, I told you to chill out. Yep. We’re here because you wouldn’t chill out. Um, but of the 50 that I have right now, it’s, it’s a little bit more than that. Um, I’d say about 20 of them would be considered. Like, I can’t train to the absolute way that I want to, or like, uh, we always wonder, can I actually like increase performance? Can I step back performance on top of this person? They’re probably not there yet. They’re still still trying to get back to baseline.

Dr. CJ DePalma, PT:

Sure.

John Flagg:

The other 31 32 of them are, are all performance. Most of them come, I’ll tell you what my local local roots are, are pretty, pretty deep. Um, so I would say 60 to 70% of them are relatively local, at least within the DMV region. And then the rest come from either word of mouth or the Clinical Athlete podcast has been huge. Um, for me in regards to just getting, getting my message out there and people interacting with it. So that would be probably my third. That and Instagram, but that’s where they come from. And, you know, I, I thoroughly enjoy it and that’s not just not just powerlifters. I’ve got weightlifters in there. I’ve got strongman competitors in there. It’s a blast.

Dr. CJ DePalma, PT:

Can you snatch? Can you front rack a barbell?

John Flagg:

I, um, I used to, I used to, I used to have this great dream of being like a super, super spindle athlete. And then, uh, it was a couple months ago. I looked at the, when it was actually when I turned 36 and I was like, sweet. I’m a masters athlete now in USAW, like I could qualify. So I looked up the qualifying totals for the…could…. I definitely could, if I didn’t feel like arm was going to snap off. Snatch wasn’t bad. Like I felt okay with snatching. It took a lot of warm up, but man…

Dr. Joe Camoratto, PT:

You’ve spoken about in the past, how you feel that your shoulder mobility is an adaptation for your bench press.

John Flagg:

So there’s actually a study on that. Uh, that there is a, a normal decrease in shoulder flection, overhead in bench, like elite level bench pressers. So it’s a sport adaptation that they, there are actually starting to see in some of the literature. There’s not a ton of powerlifting literature. But that is one.

John Flagg:

My other one is my other favoriteone is one Quinn sent me about contextual inference where you, you play darts while you bench press in between. And it actually artificially increases your RPE. So those are my two favorite papers right now. It’s playing darts while bench pressing and that bench press is a flection reducer.

Dr. CJ DePalma, PT:

Yeah. I mean, it makes sense of like, especially if you’re like a true power focus bench presser, right. Of, uh, you know, extension moments of the triceps and abduction and squeezing the lats, et cetera, creating, I mean, that makes, that makes a lot of sense. Um, but on the flip side, if you would have been overhead squatting the entire time, he probably would be fine.

John Flagg:

Oh yeah.

Dr. Joe Camoratto, PT:

But would his bench press be as heavy?

Dr. CJ DePalma, PT:

I mean it might be,

John Flagg:

I think, yeah. I don’t know. I don’t think there’s enough there.

New Speaker:

No, definitely not.

John Flagg:

Definitely not, but I’ll tell you what if I had been overhead squatting on a regular basis, I’d probably be much better off.

Dr. CJ DePalma, PT:

Yeah. So when’s the last time the bar touched the front of your shoulders. How close does it get, where you got like four inches? Probably.

John Flagg:

If it’s just the bar…? It hasn’t in a long time.

Dr. CJ DePalma, PT:

Yeah. I can’t even touch my shoulders with just the bar. No worries.

John Flagg:

I asked you was about this time last year. Uh, I helped Quinn out with the CWC in Tyson’s corner and he used me as the example of how to build a front rack. Cause I got my notes, the whole crowd starts laughing at me and I’m like, okay, I’m the butt of the joke. Now this is great.

Dr. Joe Camoratto, PT:

You, um, you mentioned RPE. Can I delve into a question about RP? Sure. CJ, is that all right? Alright. So, uh, I know that you, John, I know that you, um, speak with, uh, your, you’re a Precision Athlete, right? Um, precision Powerlifting systems. Yes. Yeah. Kevin coach. Um, and I know that Kev, Kevin, I don’t know him well enough to call him Kev. I know that Kevin, uh, does a lot of dynamic systems theory. Right?

John Flagg:

Yes.

Dr. Joe Camoratto, PT:

And that he’s not very big on RPE for beginners because the, um, because it is a skill and that you need to, uh, train at a certain intensity before you’re able to guess what your intensity is, um, while you’re training. Uh, and so for your clients online, your athletes online, do you use RPE for them as a start? Or do you like, how do you, how do you manage that? Um, like do you use percentages? You use rep max, you use RPE. What, what the what’s this new use?

John Flagg:

So I do use RPE cause I want them to be exposed to it as soon as I can. So using it, it being accurately used… this is probably the way to put it…

John Flagg:

It being accurately used early on is probably slim. They’re just not, they’re not going to be very good with it. However, if they don’t get exposed to it, they’re also not going to get exposures to those that, that skillset. So I like to use it early on the difficult part when it comes to coaching through that, is that I can’t tell somebody what their RPE is based off bar velocity or that sort of thing. So what I try to do is anchor it with some sort of rep rep max, and I’ll do this early on, not like first two weeks early one, because most of them are prepared for that. Like that would be a huge spike in workload and due to chronic work ratio, debates aside, I really don’t like just take somebody and like throw them straight to the moon right off the jump street.

John Flagg:

But after you know, three, four weeks where they’ve gotten a good amount of repetition in, and they’re starting to figure it out a little bit, I’ll throw in, you know, a five, six rep max and say, okay, like, I wanna, I want you to take what you said was an eight, a couple of weeks ago for a set of five. And I want to see you just do as many as you can. Some people are relatively accurate and they’ll, they’ll anchor that, that RPE relatively well. And they’ll get like six and they’re like, Oh, okay. So we’re, we’re pretty much on point. What you said was an eight was probably closer to a nine. This is what it feels like. I’ve also seen people get 19 and you’re like, okay. So when it starts what’s to burn, that’s, that’s not an eight or nine. That’s like I’m warming up.

John Flagg:

So you get people and they realize that and it’s like, Oh crap. I either have to go heavier. Or if they’re not comfortable with that, if they’re relatively ranked beginners, I’ll put in a variation with like a lot of tempo or relatively novel stimulus. So that we’ll still get that difficulty because you add about anything, it’s going to artificially increase RPE at a lower absolute intensity. You do a novel stimulus, same thing. Cause their degrees of freedom are still really low. They’re just not able to do those things. They’re like baby giraffes being born. So that’s how I manage teaching RPE. And then you still have to occasionally anchor it because you’ll get a little, you’ll get like intermediate advanced lifters that are like, it’s an eight and a half and it’s a 12 and quite are you doing alright, do this again? So it is a skill, but you know, some, some people, it takes a little bit longer for them to figure it out and that’s, it is definitely a skill I have also in certain instances. And it depends on where the athlete is coming from. If they’re a big time old school, linear periodization, where everything is percentages, all blend. So like, okay. 65 to 70% for five to six reps should be about a seven. And you know, then you make adjustments as those actual tendencies emerge over time.

Dr. Joe Camoratto, PT:

I, I should’ve, I should’ve anchored this with what RPE is.

John Flagg:

Rate of perceived exertion. How hard you think something.

Dr. Joe Camoratto, PT:

Yeah. That’s zero to 10, zero to 10 subjective, a rating on how difficult you think it is, but could also be connected to reps in reserve in that, uh, an eight out of 10 is, uh, to about two left in the tank. So to say,

John Flagg:

Yeah, the only thing that I struggle with when it comes to RPE is it almost feels like it should be a five point scale, not a 10 because nobody ever even registers anything under a 5.

Dr. CJ DePalma, PT:

Yeah. Yep.

John Flagg:

But everybody, everybody knows a 10.

Dr. CJ DePalma, PT:

I do. I read register under a five all the time, but I, but we, we work in percentages. Uh, I don’t. Um, uh, but if someone says, you know, I need a, you know, a conversational effort, I’m all, I’m all in, all in some conversational efforts.

John Flagg:

I got this what’s up guys. How’s the day?

Dr. CJ DePalma, PT:

Um, yeah. Uh, that’s funny. So I wanted to, um, you talked about some people claim it’s an eight, uh, or do a five rep claimants at eight from one week, and then they do 19. Um, do you see a gender bias with that? Um, as a male to female or, uh, obviously beginner to advance is probably more accurate, but do you ever notice that, um, women manage volume, uh, better than men or vice versa?

John Flagg:

Um, to an extent, I’ll say to an extent, um, I think women recover better, but so do light weight men. So I do have, uh, some, some lighter weight men and really a lot of it just comes down to the physiology involved in how much muscle mass they have and, and that sort of thing. I can say, I’ve definitely started to notice in particular that there’s almost like particular types of lifters. So Claire’s I, and I talk about this all the time. Claire eats volume, like she can just she’s incredible. Sets of 10 super heavyweight, you know, 85% and just keep it….Yeah. Yeah. She’s, she’s awesome. Um, I can’t do that. I’ve never been able to like survive those, those sorts of things, even when I was lighter and I was like one 90, one 95 and not, not doing what I do now, I still thrived off singles, doubles and triples.

John Flagg:

And that’s where I just it’s like my happy zone. My injury rate is super low at that point. My progress is very consistent. I’m much more compliant, but when you have me start eating volume, I just, I just, I don’t handle it well. So I train it really, really high intensities for an extended period of time. And she can train it really, really high volumes for an extended period of time. My wife is right in the middle. Like we have to do, I think there’s a gender bias, maybe because of just the fact that women are overall lighter athletes. Um, and there, there’s probably some hormonal, uh, contribution there, you know, with, with the, the, uh, recovery effects that as a gender progesterone and all those things have, they probably do tend to take more volume. But one thing I have found, I would say, and I don’t want to sound ageist here. My older clients, because of a lack of exposure to strength training tend to be much more conservative. So the 35 plus year old demographic, regardless of it’s male or female, tend to be much more conservative with those numbers than a younger demographic.

Dr. Joe Camoratto, PT:

Such an interesting topic to talk about the aging strength athlete, because the convention is that you get injured because you’re old. Um, whereas I think that people would get injured because they spike without having trained for a significant period of years, and then thinking that they can just come back in and, and do whatever they want. And so I think it’s a lack of a training adaptation rather than an inability to tolerate training at all. Yeah,

John Flagg:

No, there’s definitely risk involved with like, just jumping back into training. But, you know, there’s a prevailing mindset in that generation that, I mean, look, it was, it was like the cardio bunny, it was all run, run, run, step aerobics, you know, all these other types of physical activity and I’m not bashing any of that stuff. But using weight was looked at as detrimental to your health. It stunted kids’ growth. It made you slower. It made you immobile it, all these negative effects that, that people, you know, quantified with strength training and load, and that was pervasive in men and women. More so women just because of the societal impact and what people view as like what, what they should or shouldn’t do, which is complete bullshit too. That should be done. But I mean, I see it across the board and it’s like, Oh, this feels heavy. And it’s like, okay, you know, you got a 40 year old guy, this feels heavy. All right, cool. Let me see how many you can do 20 reps later. Alright. So let’s put more weight on and let’s try to do that.

Dr. Joe Camoratto, PT:

That’s the point it’s supposed to be heavy. Yeah.

Dr. CJ DePalma, PT:

So, yeah, I think there’s, um, uh, or they do, you know, a perceptual input there. So obviously

Dr. CJ DePalma, PT:

I work with, uh, I would say obviously everyone listening, um, uh, maybe, maybe people don’t know me. I work with CrossFit athletes primarily, um, uh, in a couple of weightlifters and, uh, they’re female weightlifters. Uh, the ones that, uh, that I would say they’re CrossFit athletes, but they’re exceptional weightlifters. And, uh, all of them just eat volume, all of that. But again, I think there’s like this like, um, adaptation. So I I’ve seen, I don’t remember who it was, maybe Scotty or someone else posted something of, um, due to, um, almost like a muscle fiber design, uh, genetically women manage volume better. They manage close to one RMs much better than most males do. Uh, and, and it’s like the athletes that are just slightly less explosive. Like, I’m, I like, I personally am a great example of that. Like my one RM is horrendous, but I will take 85% for an hour without question.

Dr. CJ DePalma, PT:

And, like I’ve, I’ve done 80, like a real 80, 84% for 2012 reps, like a true 84%, like a, like a new, new, heavy one RM. And it’s like, um, same thing with, uh, my weightlifting, fatigued, weightlifting. I’m very comfortable, well, over 90%, uh, right at hundred percent. Like, no matter how fresh I am, how strong I’m feeling like it’s like, obviously like a one in a million shot, but it’s like, there’s like, it’s, it’s really interesting. But I’m like definitely more of like the volume athlete. Like I’m not super explosive. Um, uh, and I don’t have that like intensity focus. Like I really struggled to, uh, like just purely weightlift at like a high percentage, but like, I’ll manage like early phases, fifteens, twelves at 70 and 75%. I feel the best. And that’s like, where I have like the most success from. But when we get like, towards the end of the phase where it’s like a testing, almost always like creep up like a tendinopathy or something like that, or like an ache that I can’t break.

Dr. Joe Camoratto, PT:

How many times did you train this week?

Dr. CJ DePalma, PT:

I didn’t train yesterday. So three I’m doing fine. I don’t, I don’t train that I don’t train that often. I just train really hard.

Dr. Joe Camoratto, PT:

I mean, usually, uh, I’ll text Caesar in the days I got a training number two, training, number three today,

Dr. CJ DePalma, PT:

It’s different. I’m not lifting every session. And sometimes my second session is bodybuilding. I’m in this garage and, you know, I’m like, pretend there’s a mirror there and I’m staring at myself, so it’s fine.

Dr. Joe Camoratto, PT:

Just take your shirt off. So the neighbors can see.

Dr. CJ DePalma, PT:

My training is much different, you know, like I, half of it’s conditioning…half of it? 80% of it’s conditioning. And now the CrossFit season is… we don’t even know. So my coach was like, let’s go to a weightlifting cycle. And I’m like, Oh, great. I’m so excited to just the next four.

Dr. Joe Camoratto, PT:

So I wanted to ask another thing about dynamic systems theory. Because I just, I mean, is that, is that similar to like a constraints led approach to training? Are those two things like together?

John Flagg:

I would say they’re together. The general kind of overview of, of dynamic systems theory is, is being able to manipulate those constraints.

Dr. Joe Camoratto, PT:

Right.

John Flagg:

And, you know, as coaches, this is, this is a pretty big portion of, you know, the, the clinical athlete coaching course as coaches, we can only control so many of those constraints. If you look at dynamic system theory, you have individual constraints. We can’t really do a whole lot with that internal stress, how well they’re sleeping, how well they’re eating the mindset that they come into the gym, those are all constraints that the athlete puts on themselves. We can, we can give them mindset training. We can get them referred to, you know, sports psychologist or whatever, but they still have to take ownership over that stuff. Environmental constraints of the next one, how hot it is in the gym, uh, how loud, the music is playing.

John Flagg:

Like, there’s, there’s again, certain things that we can control, but really, you know, how much, how much can you really control when you get central air brought in and you turn the music down or, or whatever. Um, but there’s still, there’s still limited control that you have, then there’s task constraints. That’s what we can control. We can control the task constraint, and we can, we can sit there and manipulate a pin squat as opposed to a competition squat to get a particular effect.

John Flagg:

I always look at this from traditional soccer coaching. So you have fulfilled soccer where you got a lot of space. You can see the ball coming to you. You can see defenders coming to you. You can see the field. One of the things that soccer coaches have done for years is short field or small box soccer training to get a better first touch on the ball for their players, for them to play with their eyes up instead of staring down so that they respond and react faster.

John Flagg:

All they’ve done is take the task and constrain it into a smaller area to get a particular effect. And they’re not sitting there going, okay, you gotta… They’re not cueing their athletes to like, be faster, be quicker on the ball. No, I’m just going to make it so that the defenders two feet away from you instead of 10 feet away from you, and you’re going to figure it out. It’s the same thing with dynamics, that dynamic system theory with task constraints in powerlifting. If I see that you suck coming into the hole, or you can’t create or maintain tension through there, then I’m going to constrain that task to make it so that you have to figure that out. One of my favorites for that is a pin squat. If you come down and you crash pins, you’re, you’re done. It’s error corrections. Your brain is going to go well, that didn’t work. And you’re going to have to figure out how to be successful. There you do a block of that and they come back and all of a sudden they have, they learned how to create tension in the hole and they’re squatting better. So it is, it’s the same thing. Uh, I think the constraints, led approach just sounds way sexier. Uh, and it, it definitely is like, easier to understand that statement than when you’re like economical dynamical systems. People are like, what is that?

Dr. Joe Camoratto, PT:

So do you find that there’s like, cause I’m trying to think of a, um, specificity right. Of, of strength. And so I’m trying to figure out when I think of the, the small field in soccer, I think of it like straying away from the task that you need to be specific for, which I guess would be a full field soccer. Um, I guess where’s the difference between trying to just be as specific as possible for the tasks that you’re trying to do, and like how far away can you stray with the constraints before you’re not being productive towards the task at hand. The overall tasks that you’re trying to get to the goal.

John Flagg:

Exactly. My thought on that is it first off, I’ve asked that question from a lot of people and nobody really knows because so small field soccer, you’re still playing soccer. It’s not line drills. It’s not, you’re not breaking portions of the game apart, and working on how to pass or anything. You’re still playing soccer. In a pin squat, if I set them to powerlifting depth, they’re still squatting to the standard that’s required probably in the stance, it is a competition stance. I’ve just added a constraint to the task to get a particular effect and change that portion of it. We don’t stray away from it for so long that they regress in the actual main movement. But the other thing that I found as long as you’re able to meet the standards of the sport with something that’s powerlifting, when the squat is probably the most difficult one to meet their standard with, and you can do it with any type of foot width, you can do it with any type of hand grip width on the bar, as long as the bars on your back and you can squat below parallel. You’re pretty good.

John Flagg:

So why stands high bar squat is, is viable there. A low bar, narrow stance squat is viable there. So they’re still squatting. They’re still doing the actual task, especially from a performance standard. So if they’re a performance athlete and I’m having them do pin squats or wide stands, high bar squats or whatever, it may be as long as they can still meet the standard as the athlete that would pass in competition. I don’t know. It’s still specific to the actual task. The only time that changes is into like a rehab where I’m taking the pins and putting them right at a range of motion threshold, or, you know, then obviously you’re not going to meet standard. Cause you’ve got patellar tendinopathy that we have to work around, or, you know, you have to sit to a box to, I mean, you’re not gonna have a box in a powerlifting meet to sit to. So like, those obviously are different, but you can still use it to, to change the competition task and watch that get better.

Dr. Joe Camoratto, PT:

All right, cool.

John Flagg:

That was a long answer.

Dr. Joe Camoratto, PT:

No, no. I mean, I’m still trying to still try and take information about different because I see such a wide array of coaching styles and theories and different systems. And so it’s good to hear this kind of stuff.

John Flagg:

Well, the big thing for me, it does, it does seem like a large dichotomy. You have individuals who it’s squat bench, deadlift in your competition stance ad nauseum. Sure. And I’m not disagreeing with that in any way, shape or form that is going to work with particular athletes. There are other athletes that’s not necessarily going to work for Andy when it comes to like, look at, look at West side compared to linear periodization. They all had really successful athletes. Some of them self-select to those particular methodologies because it just works for them. Um, conjugate worked for me for a good amount of time, then it didn’t like, okay. So I moved on to something else, Kevin and I are very flexible. It’s one of the reasons why I’ve had people be like, why? Like, why is Kevin Kane, your coach? Kevin’s my coach. Cause he, we respect each other and he allows me a lot of free reign over what I do, but still holds my feet to the fire. So I mean, that’s what I need.

John Flagg:

But, that dichotomy, I just don’t think it exists in true practice. So it’s, it’s tough. And the part of the biggest problem with that is like, if you look back at it, I have a book. Um, uh, I don’t have it in front of you right now, but I think it’s the Secrets of Culver City, Westside barbell, which is actually up in Ohio. Uh, I think it’s up a little higher, but it’s not the actual Westside barbell. It’s not Louie. Um, it’s Vince, Ella and all those guys, man, they did a ton of weird stuff. Like made up exercises. They tripped and fell over some really cool methods that like now we’re going, Oh yeah, that works. And they did some stuff that just didn’t work. And you look at their experimentation. If it was now, they would only post the cool shit on Instagram.

Dr. Joe Camoratto, PT:

Sure.

John Flagg:

So that’s the other thing it’s like, well, I do it this way. Okay. Did you, so you’re telling you never changed that person’s before you’ve never used a variation.

Dr. Joe Camoratto, PT:

Did that book come with a flame beanie for you to squat in?

John Flagg:

No. No, no. That was a Chuck. Chuck was way after that book.

John Flagg:

Yeah. Yeah. It’s not, it’s not an actual Westside barbell book.

Dr. Joe Camoratto, PT:

Oh, okay. I just, I watched the, the, was it the Amazon or Netflix documentary recently? And I was just like, Holy crap.

John Flagg:

West side versus the world?

Dr. Joe Camoratto, PT:

West Side versus the world.

Dr. CJ DePalma, PT:

Whole another world. Yeah. A whole nother world.

John Flagg:

Dave Tate does a couple of table talks that are awesome with stories about those guys. Oh man. Okay.

Dr. CJ DePalma, PT:

Dude. Talk about a, uh, interesting character. Dave is a whole nother level. All those guys, just the whole comparable, another cloth.

Dr. Joe Camoratto, PT:

And you really have to be dedicated to get like American flag sleeve tattoos on your forearms, you know. I was going to ask, uh, John, when talking about tattoo, dedication, when are you going to get rebuild stronger on the neck?

John Flagg:

Oh my neck?

Dr. Joe Camoratto, PT:

On your neck.

John Flagg:

I don’t think I’m going to get it on my neck. I still have a whole sleeve. I need to finish. I’m not going to do anything on my neck. And uh, I feel like I have a life that is phenomenal and incredibly supportive. The reason my beard is as long as it is, is because she doesn’t want me to ever trim it. So, but neck and face tattoos, I think are a deal breaker for her. I think that’s it. I’m not going to go there,

Dr. CJ DePalma, PT:

You know, we’re talking about this, like this like dichotomy of, of, you know, specific to, you know, you guys are talking about powerlifting, but I think it very much reins with weightlifting, CrossFit, gymnastics. There’s like, I mean, there’s so many successful directions of training that all of these sports have, have found. And I think it’s not, you know, we talk about rehab the same way, right? It’s like, you know, Oh, someone has back pain. Well, this, these exercises have worked for me every time. And this, this clinician, including myself, you know, resonates with these exercises at first. And then usually it probably works. Right. And you know, for, for these, that, but the ones that it doesn’t, you know, you have to stay flexible, but I mean, CrossFit and weightlifting are very much the same.

Dr. CJ DePalma, PT:

Right. There’s, you know, there’s lots of people who, you know, in weight lifting, don’t train the full lifts for long, long, long periods of time. Right. And then there’s other schools of thought that you snatch clean and jerk and back squat every day until your knees bleed. And you know, they might be taking, you know, they might be getting some help, but it is what it is, you know, and then CrossFit, you have athletes that, that they just, they aren’t sport specific all year long. They just condition and they just get strong and they just, they, they create single modality approaches to a, a multimodality sport, um, until a couple of weeks before competition. And, and they’re very successful. IE Matt Frazier like that guy just beats himself into the ground with like assault bikes and rowing. And no one knows what he does, but I’m pretty sure that’s exactly what he does.

Dr. CJ DePalma, PT:

And that’s why he’s so much better. And he just happens to be really fucking strong, you know? I mean, the guy doesn’t jerk heavy for years, and then he jerks, you know, like 190 kilos from the blocks. Uh, like before the games last year, it was just like, Oh, alright, okay, sure. Why not? And then you have other athletes, uh, that do like, I mean, massive CrossFit volume every day, five days a week. And, and they’re successful too. And it’s just, it’s really interesting to see this performance side of, of, um, all these different approaches to create the same result, uh, and same with rehab. And I think it shows that that it’s really not us it’s it has so much more to do with the genetic makeup of the person in front of you and how they’re just how they respond to what you’re saying and what you’re giving them, uh, is probably so much more or less to do with you as the clinician or the coach and more to do with their inherent design.

John Flagg:

Well, and I want to touch on that as well. The other portion of this, I think there, there are genetic kind of types that, that people self select into. The other thing to think about too here is the belief that that athlete comes in with. So for me, in particular, when it comes to my clientelle, variation is a favorite modality of mine. No. Why is it a favorite modality of mine? Because I have people that are coming to me going, something’s not working. I’m either in pain or not seeing performance increases. Something’s not working. So a lot of the times if I’ve bring a novel stimulus in, I can spark growth. Does that mean that I am highly variable with every single one of my athletes? No, I’m just not. I have, I have programs and I have, I have individuals right now that are only doing the competition lifts even, even with nationals being canceled and everything like that.

John Flagg:

It just depends on what that person is in front of you, where their beliefs and where they’re, where you can create, buy in. And then you create things around that. It’s, it’s still all athlete, client centered. And a lot of those things emerge over time. Uh, CJ’s talking about people who can, that he’s like really good at that 85%. I watched my wife the other day, take 275, which is 90% of her one rep max, for multiple sets of six on Sumo deadlift. And then it’s like, okay, three weeks earlier, let’s go for a new one rep max. And it was like, Ugh, terrible. Just hated it. It’s like 90% for sets of six across the board. Just crushing them. Why? I don’t know. Could we do that for a few months? Just doing those for sets of six, five, six, seven, and then test again, probably would it have gone up a ton? Probably not. But it’s weird.

Dr. CJ DePalma, PT:

It is strange. I want to, I want to interject and ask you a question. Um, uh, do you feel the deadlift, uh, kind of breaks the mold of like working percentages compared to like the back squat? Right. It’s so strange. You’re just like, it’s like once you’re going 95%, so many people. And I, and I think this is for all, in my opinion, I think for just about everyone, obviously there’s like, it varies, but if you break it off the ground, once most of the time you’re getting less, unless you’re like, well over like a one RM, like a true one, RM it’s going for multiple reps. Right. I think someone who really showed the craziness of it was down at, at, you know, at hybrid, like you’d watch Stephie, like she’d pull, like she’d get 500 going and then it just like, wouldn’t stop.

Dr. CJ DePalma, PT:

And it was just like the first one would take, it would be like a seven second rep. Right. And then the next one would be like a three second rep, same thing with like Hayden, see that guy, that guy can grind out anything in the world, but he’s, he’s weird. I’ve watched him. I wa I, I was at Soul when they were there and I watched them squat 600 and I watched him go down and elevate descend in the same squad because he was grinding so hard and still make it, I mean like inches, not like, not like a pause and like a sticking point. Like this guy was shaking, the weights were clanging. And he was like, and then just came back up. And I was like, I quit. I think I squatted like 300 next to him that day. And I was like, you know what, I’m just going to, I’m going to say, let’s stick with CrossFit.

Dr. Joe Camoratto, PT:

Kilos? Wow, man.

Dr. CJ DePalma, PT:

Uh, but yeah, the deadlift, I think it’s, you know, how have you seen that? It’s, it’s really strange. Like, what have you seen with, with that as far as like programming percentages, is that, or RP, does that change? Like how does that change, uh, based on the lift itself and why do you think it is?

John Flagg:

I have seen that I’ve seen it across the board. Uh, one of my favorite variations on deadlift to teach just maintaining position is, uh, like a one plus one or a one plus two, where you do a full lift. You come down almost to the ground and you come back up with it. So it’s, it’s one plus partials. And you’ll see. I mean, I can, I can handle at one plus two at like 95% of my one rep max, as long as, as long as I get the first one, I just off the ground, like maybe an inch off the ground. And yeah, it’s, it’s, it’s spicy as hell. Um, especially if you actually have people do multiple reps of that, like I’ll have to start with three by one plus two. And they’re just like, why am I doing deadlift cardio? You’re going to get in a better position.

John Flagg:

Um, so I think I’ve definitely seen that happen. Um, especially when you, you see those, those grinder first reps, and then all of a sudden it’s like two, three, four, five get knocked down right after it. I think a lot of it has to do with two particular things. A) there’s no benefit to the stretch reflex in the initial pull. Um, we have experimented, uh, with like small jumps prior to it, uh, that have I’ve seen with conventional deadlift in a few of my athletes. Give them a little bit more pop off the ground. Do I think that’s from the jump or do I think it’s a thought interruption where they don’t second guess what they’re about to do? I don’t know. I can’t, I can’t tell you. Cause I, I think the other thing is confidence. I think once that thing is moving, it’s like, okay, well I got it now. I’m just going to keep going. There’s something about a deadlift. When a bar is on your back or in your hands are over your head, it can kill you. You can bail at any point in time on a Deadlift, just let it go. So you always have an out too. Now you grind out a squat cause if you don’t, you better have somebody come get this. Yeah.

John Flagg:

Man, this is getting hard. I’m just going to put it down. So there’s, I think there’s a lot of, a lot of psychological constraints to it, but also that lack of stretch reflex that lack of in the system prior to being able to pull it off. And then how often I’m a big fan of like a full reset at the bottom where you come down, you actually like not fully relaxed, but you let the bar settle… If you come down and you’ve got bumper plates on it, you slam it to the ground and start pulling again like, I mean, in, like in powerlifting and powerlifting, I can’t have that happen with CrossFit athletes. Absolutely. It’s touching girl instead of the standard of their sport, it has to touch you get a rep. If it touches, touch it, throw it on the ground. Bang. I don’t care if they’re gonna let you do it, do it. Strongman it’s the same way you can take a strong man axle and literally bounce that thing off the ground and keep going in a deadlift suit. It’s the craziest thing in the world. Uh, but for powerlifting, I like it to settle and it also gets rid of that. Just that little bit of stretch reflex and it gets really hard.

Dr. CJ DePalma, PT:

Yup. Agreed. I think that’s a really good point. I think you kind of, uh, you know, I never like to create a physiological answer a hundred percent to, to anything, but that’s gotta be pretty close. Right. I think that’s gotta be definitely, there’s like a priming of the system, a stretch reflex of like, you know, like really getting the muscle spindles in GTOs like firing and, and, and primed going down for that second rep. That’s really cool. I like the, I like the pluses. Um, uh, I think that’s a, um, something that I might implement. Um, one of my athletes struggle with any, any type of deadlift volume. They all get really sore, but they’ll clean, like, you know, like 30 pounds, less than that for, for reps. And I’m like, I don’t understand you guys. It’s just like, it’s just the movement. It’s just like, it’s, it’s strange. Um, but, uh, cool. That’s really, that’s, that’s interesting. I like that. Uh, I like that reasoning and I really liked that, uh, um, that exercise selection. Yeah.

John Flagg:

And, uh, how much do you guys listen to like Chris Duffin?

Dr. CJ DePalma, PT:

Yeah, I mean, in the day, one of my good friends is a good friend of his, um, he’s a strength coach, uh, for the, um, special forces. Now he’s a performance guy for special forces now. But, um, outside of like when he sends me stuff that Chris, that guy’s a psychopath he’s nuts.

John Flagg:

He is, he is mega crazy is mega crazy. He says wild stuff. There’s one thing he says about the deadlift that is 100% true. Is if you slow people down when they’re centric, they find better stuff.

Dr. CJ DePalma, PT:

Oh yeah. Yeah.

John Flagg:

Know what I mean? Like it just, it works now. He has also said some absolutely wild stuff. I think everybody has said something to value at some point, but you know, that that’s, I always attributed to him when I do, you know, slower eccentric deadlift stuff, because, you know, he’s the one that touts that so much is a, is slowly centric to get a better start position or maintain better positions. And a lot of the times when we start talking about positional work, it’s just it’s time you spend there to get a benefit.

Dr. CJ DePalma, PT:

Yeah. That’s what I, one of the things that I’ve, I’ve moved to, uh, as far as like training with everyone, right. Almost everyone goes from a to B really pretty effectively, right. Creating force is usually never, especially in weightlifting. Right. It’s like getting the bar to move vertical is usually not a problem for most people. Right. It’s having a good, A, having a good B and then being really, really, really strong in those positions. And I’ve noticed that from a longevity and managing volume and intensity, when you, when you add pauses and time under tensions at the beginning, at the end of reps, uh, you know, the joints respond a lot better. Uh, you know, soreness responds a lot better and then they, obviously they just get a lot better, right? Like catching a snatch is not an easy thing.

Dr. CJ DePalma, PT:

And, uh, um, you know, or front rack, uh, but, uh, you can call the bar, gotta get on my shoulders. Um, uh, but when you spend time there and you just really, really hone in on those positions, they just naturally get better. Um, uh, by the time when your tension. And that’s one thing that I’ve implemented in all of my, especially my rehab athletes, uh, as like a primary portion of training, it’s just like, you know, people have pain, you know, pressing from, to overhead. It’s like, well, let’s just be overhead until this pain starts to just absolve on its own. And then, then all of a sudden their overhead positions just fantastic. Right. Anyways.

John Flagg:

Well, and then they also sit there and they can feel like they’re actually training it. It’s, that’s the big thing. You know, people, people make fun of like our biases when it comes to like, I want people to look like they’re training, but one of the reasons I wanted to look like their training is because they come in, they have this expectation when they meet a clinician that we’re just going to shut them down and be like, okay, well here’s a band and your shoulder hurts. So you’re just going to do these extra rotations until like your face turns blue and the band disintegrates. And then maybe, maybe you’ll touch a barbell again. No, I want you let’s use a barbell if we can get it overhead comfortably and explore some positions that are tolerable for you. Not even, pain-free just tolerable. And we start something that looks like training mentally, the mindset, there is so much better for the athlete then, you know, ticky tack exercises, the not going to do.

Dr. CJ DePalma, PT:

Right. Agreed. So I want that kind of opens up another question that I had this whole, like how to define the difference between an AT and PT besides the degree itself. So you work with athletes that are injured. Um, like what is the, you know, where, where do you live? What state are you in?

John Flagg:

Maryland.

Dr. CJ DePalma, PT:

Okay. Where do you live? Where do you, where do you live?

John Flagg:

Southern Maryland. South of DC.

Dr. CJ DePalma, PT:

Oh, okay. Um, I go to, uh, North, uh, North Baltimore a lot actually. Um, anyways, uh, uh,

Dr. Joe Camoratto, PT:

Oh my God. Can we hold the lift together? I’ll drive over.

Dr. CJ DePalma, PT:

Yeah, for sure. If I’m in Baltimore. Yeah. I’ll probably be in Baltimore in the fall anyways. Um, what was I saying? Oh, so how do you, you know, like, so my, my rudimentary knowledge is like an athletic trainer, you know, needs a, uh, a, a licensed physician to oversee, like, how do you evolve? How do you treat people? You know, does the cash influence have a lot to do with like what you’re allowed to do? Or, um, the gray line, what’s your, uh, what does Frank call it, your risk profile. Yeah, that was my favorite thing. And I was like, I was like, I’m gambling, baby. We, gambling always.

Dr. Joe Camoratto, PT:

Cj’s guy that flips the cops off as he drives by.

Dr. CJ DePalma, PT:

I was so excited when he said that I was like, I resonated with so much early on in that course of like, you know, like the practice act and like what it can and can’t do and how great it is anyways. Um, so talk to us about that. And I think that’ll kind of close this out of like, you know, like, how does that influence your practice? Like, what does that, what does that look like? Like, are you, you know, obviously you’re doing identical things that me and Joe are, right. I mean, like, it’s not, you know, we’re not going to try and sugar coat and say, you’re not. Cause you are like, how does that, how does that work in legalities standpoint, man, that’s a big old lost in my garage.

Dr. Joe Camoratto, PT:

We’ll follow up at the end of that question too.

John Flagg:

I was like, what is CJ staring at? It looks like, someone is trying to kill him all of a sudden… It’s a wasp.

Dr. CJ DePalma, PT:

So sorry.

John Flagg:

Oh no, it’s fine. So it is a very complex question. I still have a supervising physician. I still have a certain things written in my eval and treat that are very specific to what I do. The big issue when it comes to the online space. And we start talking about your risk profile is I’m not, I don’t put hands on people. I don’t do any type of manual treatment. I don’t do any real diagnosis. I it’s typically just counseling. So we’re on the phone. We talk a little bit, we modify training and then they move forward. Even in a rehab setting, I’m not taking post-op ACLRs, I’m not, I’m not doing any of this really complex stuff that may have a protocol attached to it, or a diagnostic portion attached to it. Most of the time, it’s just troubleshooting training for people, which a lot of the times just looks like strength and conditioning and performance.

John Flagg:

There are times where if I’m going okay, and this is, this is where that risk profile comes in. There are times where I’m like, alright, modifying training is no longer viable here. We’re not able to do the things that we need to be able to do. We’re going to punt. And I find them a local practitioner that they can actually go and physically see. So, uh, down in North Carolina, I’ve got a couple athletes. They all go see Zach. So Zach will, you know, see my athlete. I get an email from him. I get a message from them. And basically Zach says, okay, this is what we’re going to do. This is what we’re looking at, training wise. And we kind of coordinate that whole thing together. And then once they start feeling better, I take the ball and run with it again, unless something else comes up.

John Flagg:

That method for me has been incredibly effective because there are times where atypical responses to training or intervention creep up. And I’m like this, well, this is not right. This doesn’t make any sense. And I refer to a GP or I refer to, you know, a physician or an ortho. And you find out that this athlete has cirrhotic arthritis and there’s nothing we would have been able to do anyway. So I punt more often than not to keep my self safe, because if you were to look at what I do, yes, like I have it. I have individuals who are injured, who are going through pain and that sort of thing, but it’s still being handled in a strength and conditioning type lens. I just have a background that’s very specific towards that stipend of management, if there’s any a time where I’m like, this person needs a step up outside of just like talking to someone and figuring out training. That’s when I want them to see somebody actually like physically in person. And I just become the referral hub for that sort of thing.

Dr. Joe Camoratto, PT:

How do you prime your athletes before sending them to a, another clinician, if at all, how do I prime them? Yeah. Like a, you know, take what they’re saying with a grain of salt or, you know, imaging is X, Y, and Z with symptoms, or is there any sort of like a pre speech that you give them or you just send them in and see what happens?

John Flagg:

Oh man, that’s a, that’s a great question. Most of the time we’ve already had those conversations. You know, if I have an individual, that’s been struggling with a particular, uh, ailments or, or, or we have to continue to modify for, for training. Um, those are typically conversations. We’ve already had the complexity of pain, you know, MRI reporting imaging. You get that a lot. You have an athlete that, uh, has knee pain going up or down the steps for a couple of weeks. And they’re there, you’re modifying training a little bit. The first thing that they want to do is I want to go to the doctor and see what’s wrong. Well, yeah. In reality, like you guys have been through this plenty of times, how many times is that MRI gonna come back and tell you what’s actually going on?

Dr. Joe Camoratto, PT:

Yeah, sure. It shows that you’re a biological organism. Yeah. And so

John Flagg:

That conversation typically has already happened where I prime them when it comes to especially seeing like a physician or another practitioner is I prime them to be advocates for their own health. Whether they’re ask questions, be involved in the process. In some instances, if they have to be a little aggressive and come across and say, look, this is what I want to do. And if somebody looks at you and says, well, maybe you should stop, go somewhere else. And they’re like, you know, from, from certain cases, I’ve got athletes in Texas that live in the middle of nowhere. We find the best that we can down there. I mean, there’s a couple of times where there’s been like you do, what, why would you do that?

Dr. Joe Camoratto, PT:

Yeah. It’s just such a, it’s such a fine line to walk between trying to save face with the medical world and not create like a mistrust with physicians, but also being like, Hey, you know, a lot of them say things that might not be accurate. And all three of us know that, you know, you can’t unring the bell and you can’t stuff the toothpaste back in the tube. And so we, uh, I’ve always had a little bit of difficulty trying to walk that, that line between being like, yeah, don’t listen to anything that they say. And also they probably know a lot more than we give them credit for and I’m a lot more than that than, than we do on certain things. And so it’s always a fine line to walk when I, when I have people go to different providers. So

John Flagg:

Have you gotten it or explored any into motivational interviewing?

Dr. Joe Camoratto, PT:

Uh, yeah. I have a general gist of it. You know, kind of a, I don’t, I don’t have a, a specific definition for it, but I meet them where they’re at sort of thing.

John Flagg:

There’s a motivational interviewing for nutrition and fitness, a counseling book. I’ll send you guys the, like a screenshot of it or something. But one of the things that I’ve found really effective lately, uh, is when you talk about ringing that bell and one of the hardest things, and I absolutely hate it. You have an athlete, go see a physician or go see another provider and they come back and there’s conflicting information, what I’ve said and what this person has said. And what it does is it creates ambivalence it’s okay. So I have hip pain and you know, we look at it and not a lack of range of motion. You’re able to hit standard. It’s probably just a training effect. That’s probably something normal. You also haven’t been sleeping or having your nutrition’s off or all these other things. They go and see a physician. Their physician tells them that there’s something wrong with their hips.

John Flagg:

You know, this there’s they’re, they’re alive.

Dr. Joe Camoratto, PT:

Bone on bone.

John Flagg:

Oh yeah. Whatever it is that you want to say. So my strategy when it comes to that is taking a, a page out of motivational interviewing and being like, okay, so the physician told you that just structurally your hips are misaligned and not in the right places. If that’s the case, why now? So all I do is highlight that ambivalence and be like, okay, we’ve trained for two years. You’ve been kicking ass for two years. You used to be a competitive athlete. Why now, if, if they were, if there was something structurally wrong with them, like that you’re 30 something years old. Like why now? Why not in your twenties? Why not when you were 16 and in high school playing three different sports. Why now? And then they’re like, Oh, I don’t know. Probably, you know, do you, do you feel as though, you know, your body better than anybody else, do you feel as though you’re just not adapting? Well, because you know, the body’s highly adaptable or do you think this is just some specter that’s been waiting to jump on your back for 30 years and then they’re like, oh…

Dr. Joe Camoratto, PT:

Yeah. Helping, helping them to the answer that they think is appropriate.

John Flagg:

Yeah.

Dr. Joe Camoratto, PT:

Um, I have one last question before we wrap this up. Uh, cool?

John Flagg:

I got plenty of time. I son’t know about CJ, he wants to work. He wants to kill that wasp, that’s what he wants to do.

Dr. CJ DePalma, PT:

It’s gone. I can’t find it I’m, I’m super nervous. My anxiety is through the roof right now.

Dr. Joe Camoratto, PT:

I just, uh, I hope we find it while we’re watching your own video. Um, so as a, as an AT and as a, an advocate for the profession, what are your thoughts on the, uh, possible advancement to a Doctorate of Athletic Training, uh, in the career field? So I’ll preface this by saying a lot of people think that physical therapists shouldn’t have gone to DPT based on the debt, uh, occur, uh, incurred is incurred the debt incurred. Um, just, just because people are like, yeah, they’re doctors now, so we can charge them for a seven year degree or a six year degree, um, with information that, I mean, we, we probably don’t use almost any of it except for anatomy and physiology. Um, and, uh, what are your thoughts on the, the athletic training cause I know that the occupational therapy career field has already started the, uh, the Doctorate program. Cause I’ve, I’ve worked with one in the past.

John Flagg:

So nobody likes my answer in my, my field. Nobody likes my answer, which is, I think it makes the most practical sense, but nobody likes it. Um, uh, so little, little background, athletic training and physical therapy have been fighting each other since the golden age of all things, since AT started, PT has been been fighting, whether it’s coming to licensure or the ability to charge insurance with athletic training still can’t do, uh, and limiting each other’s scope as much as possible. I understand that contention a hundred percent, I understand athletic trainers would pose a threat, especially if, uh, before, when an MPT was required, you guys shifted to the DPT. All we still needed was a bachelor’s degree. So especially like the neuro components and the physical therapy has a much more extensive focused education towards general physical therapy, athletic trainers are all, all ortho, right?

John Flagg:

It’s all worth though. And it’s mostly athletic ortho, I think, Oh boy, here it comes. I think athletic training should be a specialty within physical therapy education. I think it should be the last year of your DPT program. If you want to be an AT, that should be the sports med track in physical therapy. And the reason that is, is because if you look at the profession of athletic training, it’s getting choked out. It’s confusing to the consumer because people have a really hard time telling the difference between an athletic trainer, physical therapist, just as the consumer. Like we, we can argue about it all the time. The confusion comes from actual consumers. We haven’t done enough as a profession to differentiate ourselves from personal trainers because we still have this 20 year long figure out what our name is campaign because athletic trainers people are like, well, what is that? Are you a, do you work at a gym? Do you work where you work? No, we work with athletes after injury and concussion and all that stuff.

John Flagg:

Athletic training as a profession is insanely valuable. It’s one of, I think, especially for high school athletes and younger athletes, one of the most valuable exposures to healthcare they’ll ever have because it’s so accessible. The problem is, is that people don’t know what it is. They, the education for it, I think is subpar. And at this point in the marketplace, and this is the last portion of this, we’re all hired by PTs. Anyway, if you work in a hospital, your supervisor’s a physical therapist, if you work in a clinic and you’re an outpatient, or you, you, you do, uh, outreach to schools. You’re typically hired by a PT firm unless you’re in a college in a university setting, most of them are not supervised by other athletic trainers. So…

Dr. CJ DePalma, PT:

But, but then, so, so in my, uh, question is, uh, for the pro in college, the highest level. So you have your power five and your pros aren’t most of them PT, ATs, like almost all of them are because they can pay them less. And they, they fill two, they fill two voids, it fell to me. And so that’s like, one of my friends was like, yeah, I want to do, I want to do PT for a Pro Team. I’m like, you’re not you, you can’t like, you’re not an AC. They won’t like you, you won’t get hired. Cause then they need to, you don’t, unless you, unless you go and you get the concussion, like search, right. And like the on-field management, which is literally at least a full year of, of continuing ed. Right. Cause like we don’t get any on-field training. Um, we don’t get any, uh, um, acute care management as far as like true acute care management as far as injury. And so there’s this big disconnect and it’s like, okay, well, this PT is in, in this, in this role, in this pro in sports scene, but he can’t do 40% of what we need him to do, which is like on-field management. Um, so you have this dual, dual profession now.

Dr. Joe Camoratto, PT:

My, um, my university had a, you could either do a six year PT degree or if you do a seven year AT/PT degree, do you think that that’s a good mix?

John Flagg:

I mean, I don’t know if it necessarily needs to be that long.

Dr. Joe Camoratto, PT:

Well, yeah, yeah. I’ll say this so that the undergrad was separate from the grad school and this, and so I think the undergrad, um, was not, so it wasn’t like, yeah. Um,

John Flagg:

I see no problem with like at Solsbury your first year in the school, you did prerequisites and you had to apply within the program within the school. So I mean that, that made it pretty selective in and of itself, but I see no problem with it being like one year of just general undergrad work, three years of focused undergraduate work, where you come out with your AT, right. Or actually three in two and a half years. And you start before your actual graduation and PT specific courses where you also have to apply again and get out in six years with a DPT/ AT.

Dr. CJ DePalma, PT:

I agree. I think that’s, I think that’s a, I think that’s appropriate.

John Flagg:

Well, and then the other thing, too, there’s so many advanced specializations, you guys have OCS, you have these, the SES, you have all these other things. Why not just have a T not even just coming out as a DPT/ AT, but like that’s your sports specialist and you actually have, like, you’re talking about a debt incurred. Well, let’s make it valuable. Let’s make it valuable.

Dr. Joe Camoratto, PT:

But so you heard it here first, dissolve the athletic training career field. Thank you.

John Flagg:

Absorb, absorb, absorb, not dissolve.AIt’s not popular because people want, they, they continue to want AT and PT separate. And I just don’t think as a, as a market, it just doesn’t, I don’t see the efficacy.

Dr. CJ DePalma, PT:

At least the ortho field, I think in the ortho field. It doesn’t, it doesn’t really make a lot of sense. Obviously, I think you said the neuro specialties and things like that. I think it can still have its separate paths, but if you want to be ortho, um, even not athletic, like, like just ortho in general, I think it would be, it would behoove you to have this like dual training of like acute management. Um, and that’s like where the biggest differences that I’ve found is like this on-field the on-field management, uh, and the, like the, um, the higher level athlete, uh, management, cause you know, uh, me and Joe were obviously peak physical athletes, but we, um, um, but, but our, our, what our schooling has taught us, didn’t teach us how to manage very, very athletic people like that. We’d go through any of that. You want to know what my exercise was at school? Legit, my cardio or no, my pulmonary teacher who did all my geriatrics, she was, uh, GCs taught us some like calf raises at the kitchen sink and some like legit quarter squats. That was it. That was the extent of like actual exercises learned in school. And I remember the class too. And I was like, wow, was, was great. This is eye-opening.

Dr. Joe Camoratto, PT:

Will you go back and get your doctorate?

John Flagg:

I’ve played with it, no.

Dr. CJ DePalma, PT:

No, no, no way. You’re six. No way that would be debt incrud.

John Flagg:

Gosh. Well, I had plenty of people actually yell at me. This is a funny story. You actually mentioned that I, uh, before I got out of clinic and was like, I’m going to scale up, Rebuild Stronger. I thought to myself, well, maybe I should just go back and get my DPT. Like maybe I, maybe I should just really just go like do it for this same exact conversation. Cause it’s massively uncomfortable to be the only AT in the room. And I am always the only AT in the room for sure. Like Clinical Athlete people are like, wait, you have an AT on the podcast. Yes. Apparently it’s this guy. It’s a meathead.

Dr. CJ DePalma, PT:

That’s all right. It’s cool. Hey, you stand out.

John Flagg:

I remember calling Quinn calling Jake Manley and both of them being like the fuck is the matter with both of them were like, no, why would you do that? No, don’t no, that’s ridiculous. Don’t do that. Okay.

Dr. CJ DePalma, PT:

Yeah. Yeah, exactly. Exactly.

John Flagg:

Yeah. All right. I don’t know. Don’t go pay $120,000 to get a degree.

Dr. CJ DePalma, PT:

On the low end.

John Flagg:

I don’t know that. It’s always, that always goes back to your risk profile. Where are you? What are you willing to do? And for me, most of it’s strength conditioning, so I’m sticking to it.

Dr. CJ DePalma, PT:

All right guys. Well, um, I think that’s our time for today. Uh, uh, thanks for hopping on, um, John, where can we, uh, where can we find all of your, your stuff at give us your Instagram and things.

John Flagg:

I’m most active on Instagram? So that’s rebuild online, uh, on my Instagram. You can email me at any time. If you have questions, I’m pretty much an open book as obvious from this. So rebuildstrongeronline@gmail.com, Uh, is a great place. And then you can always find me on the clinical athlete, forum, trolling people.

Dr. CJ DePalma, PT:

That’s where I would prefer to find you. Um, awesome. Thank you for listening. This was John flag and we are signing off on episode 1 of the Golden Nuggets Podcast.

John Flagg:

Love it.

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