Tom Butler: 0:04

This is the Cycling Over 60 Podcast, season 3, episode 22,. What Happens If I Injure my Knee? And I'm your host, tom Butler. I'm excited to share that this episode is a milestone for the Cycling Over 60 podcast. This is the 100th episode. I feel like I should have had a cheer sound clip available there or something. Maybe in the future I'll figure out how to incorporate things like that.

Tom Butler: 0:38

The podcast started out as an effort to chronicle my attempt to use cycling as a way to get and stay fit. To chronicle my attempt to use cycling as a way to get and stay fit. Along the way. The podcast has allowed me to share interviews with people who inspire me, and my conversations with healthy lifestyle professionals have helped me make better decisions about riding and food choices. I'm very thankful to everyone who has joined me on this journey. I love it that the podcast has been downloaded in 85 countries. My big wish is that I could meet everyone who listens, and it's been so fun to meet the people I have who love cycling and share my interest in staying fit and healthy later on in life. I really appreciate all of you who have reached out with encouragement. It has made a difference for me on numerous occasions. I'm glad that I do get to see some of you in a way in the Strava Cycling Over 60 Club. I really do love seeing the pictures that get posted along with your rides.

Tom Butler: 1:29

I think it is likely that the podcast will continue past the end of Season 3, the current season, which is in September. I don't have any shortage of people that I'd like to bring on. I'm hoping that the podcast hosting provider that I use will add some features so that I can interact easier with listeners. I would really like to have listeners play a big role in shaping the future of the podcast. When you send me a suggestion of a guest, I follow up on it. Unfortunately, I'm not successful in getting everyone to come on. I'm not sure why that is, but I'll keep working on reaching out to anyone who you would like me to interview. One of the options to share your thoughts is the new Zoom call. It happens at 3 pm Pacific on Thursdays. You can find my email in the show notes. Please reach out for a link to the Zoom meeting. I had a great time talking with Scott this week on the Zoom call and I'm looking forward to introducing him to all of you on a future podcast. There is also a Cycling Over 60 Zwift Thursday club ride. You do need to be a member of the Zwift club to join that ride, but regardless of whether you are or not riding, I would like to have you join the live discussion happening each week.

Tom Butler: 2:38

Over the months that I've been doing the podcast, I've gotten more interested in seeing Cycling Over 60 become a local resource. The podcast I've gotten more interested in seeing Cycling Over 60 become a local resource. I feel we are making some great connections here locally to create a model of what Cycling Over 60 local groups could look like. We are quickly building support for a wide variety of resources that can help introduce people to cycling and to keep people going as they advance. I'm looking forward to sharing these components of a comprehensive support program as time goes on. I'm planning on wrapping up this season with the first Cycling Over 60 group ride. I've been telling people locally that the ride will happen September 14th, starting in Puyallup, washington. That date is still tentative as I make sure that it isn't conflicting with any other local rides Right now. I really like the plans that are coming together for the ride. The final thing that I will say about the future of Cycling Over 60 is that I'm looking to make it a co-generate project. I will soon be talking more about exactly what that means in a future episode. For now, I will just comment that I believe there is a huge need to get people from different generations working together to solve the world's problems. Visit cogenerateorg and see what they're up to. I'll put that link in the show notes To wrap up this discussion about the 100th episode.

Tom Butler: 3:52

This podcast isn't a big deal, but I certainly find the discussions I have with listeners and guests to be extremely rewarding. I have done 10 weeks of upper body workouts in a row so far. That means my habit change strategy is holding up well. I got a piece of feedback recently from a personal trainer that I should be looking to increase my weight until I'm at a level where I can only do six reps. In my mind I was saying look, just celebrate with me this success. But I know her heart was in the right place, so I'm going to do a little more digging into the concept of heavier weights and lower reps. I will say that I like what I'm seeing in the mirror from just 10 weeks and the big takeaway once again is that at 62, I'm certainly able to get stronger and build muscle, and that is very good news.

Tom Butler: 4:50

I feel fortunate that my hips, knees and ankles are all relatively healthy. I get aches and pains, for sure, but I don't have ongoing pain that interferes with riding. Of course, there is the knee bursitis that I struggle with, but I see that flaring up only when I have failed to train properly. It isn't some ongoing problem, but I still worry about some accident or some injury to my knee keeping me off the bike. Last fall I went backpacking with some friends, and one of them, dennis Ballew, has had a long career as a physical therapist. He commented on needing to take into consideration his previous knee injuries when he's backpacking. That immediately got me curious about his perspective on recovering from knee injury, so I asked him to have a conversation about the topic on the podcast. Here is that discussion. Well, I feel really fortunate because I have a friend here joining me. I've known Dennis Ballew for a long time and thank you, dennis, for coming on.

Denis Beaulieu: 5:44

Oh, it's my pleasure to be here. Thank you for asking.

Tom Butler: 5:55

Now I went on a hike last fall and Dennis was on the hike also, and I was really happy with my performance because it really showed the advancement I'd made in my health gains since I started cycling. So that was about a year and a few months after I started trying to get healthy with cycling and I'm really glad that that translated into being able to go on a hike. It wasn't a super long hike but it was still a bit challenging and I really enjoyed the group of people that we had together on the hike, including spending a little bit of time with you, dennis.

Denis Beaulieu: 6:30

Yes.

Tom Butler: 6:31

I noticed something on the hike and you actually talked a bit about it, and that's that you have to watch how your knees are performing when you go on a hike, and I thought that it was really interesting to talk to you about that, because you're a physical therapist and you've been in practice a long time, and so I just thought your perspective kind of on knees, which is something that I think we have to take into account as we get older and want to stay active I just thought it'd be really helpful to have your perspective on healthy knees or what to do when your knees aren't so healthy. And I'll start this way you are a physical therapist and I'm wondering what got you interested in a career in physical therapy?

Denis Beaulieu: 7:14

You know, it was really one of those weird things. When we were in high school, we all did those career searches and it just so happened that we had I was living in a boarding school and it just so happened that our assistant deans were pre-physical therapy college students, and so they were the ones that really introduced me to physical therapy. At that point, none of us had really heard of physical therapy. So we were, I would have to say. I would have to say there's probably about 30 students that went on to be physical therapists just because of those two guys. And yeah, we, we had no clue what we were doing back then. We just thought, you know, maybe we'll be teachers or physical physical education coaches. And then physical therapy came on. It's like, wait a minute, there's something medical here as well as physical. This looks interesting. So that's what got me started.

Tom Butler: 8:08

I love it. Now would you say that the field has evolved since that time and in recent years. What would you say has changed?

Denis Beaulieu: 8:20

Yeah, I mean when we started off with physical therapy back in the day there was still quite a rehab mentality hot packs, ultrasound, hot and cold treatments and stuff and I would say we've drifted away from that just because we know that you can do that at home. It doesn't take a lot of information you might say to put on a hot pack or ice pack. So we've drifted from that. When we got started, we started doing more activities that you might consider to be more chiropractic or osteopathic in nature. So we were mobilizing and manipulating the spine a bit more and that has grown. But the trends kind of come and go.

Denis Beaulieu: 9:04

Recently we're doing activities such as dry needling. I don't know if you've heard of dry needling. That's one of our newer activities, especially in this state where we use an acupuncture needle, but we're using it more like a physical therapist or you might say Western medicine would actually use a needle. We're using it as a probe to help stimulate a muscle, for muscle re-education, not trying to necessarily take over the acupuncture's jobs, but we are finding some uses for some new tools. We've done electrical stimulation for years, muscle stimulation as well as pain inhibition. So that's just one of the newer things that have been interesting in helping us with our physical therapy.

Tom Butler: 9:46

It seems like the education of physical therapists has changed a bit. I don't know. It seems like mostly what I see now are people that have doctorates in physical therapy. I don't know how it was when you started, but again it seems like the educational requirements or vigor or whatever, has changed a lot over the years.

Denis Beaulieu: 10:19

It has, taking physical therapy from a bachelor's degree kind of like. Well, the nurses would do two years of prerequisites, two years in the nursing program, and then go sit for your boards and become a registered nurse. Same thing for therapists. We started off as a registered physical therapist. Then when I went through schooling they were just advancing to a master's degree and then probably 10 years later they were really pushing for a doctorate degree, largely to help us become a little bit more independent in the medical practice but to give us again more of that specialized knowledge.

Denis Beaulieu: 10:56

I guess when you encompass all that we do, part of our activity is you might consider to be hands-on, like a chiropractor, massage therapist. A lot of our, the bulk of our information is rehab, exercise, science, and so you're combining a lot of these different elements then into what is now a doctorate degree. So, but it's the same, it's the same entry point. When we went through the master's program the knowledge was generally the same as what you're getting from the doctorate program. There's three years in the physical therapy program now, and so there's just a stronger base, I guess, from general studies, getting a bachelor's before you go through your doctorate program in physical therapy.

Tom Butler: 11:42

My thought on that is that over the years, that physical therapy has really been seen as a vital, even part of keeping people functioning well, keeping people healthy, and I think that when you think about you know a doctorate level education, it's really saying that this, the knowledge is broad, that a physical therapist has to have and so you need to put in the time to turn a lot of things, because it is playing a role in a lot of aspects in modern medical care.

Denis Beaulieu: 12:20

Correct and there's a lot of different avenues that physical therapists can take their practice. They can be in hospital rehab, they can be in neuro rehab, it can be an outpatient orthopedics. There is a broad range of general studies and then each therapist can kind of work towards a more specific avenue, whatever suits them. And yeah, there's a lot more to know. You might say.

Tom Butler: 12:54

Activity is such a key aspect of longevity and I think every year it seems like there's, you know that's emphasized even more, that you know inactivity is like the new smoking and different things like that. That really you know if you're going to be healthy longer and I'm a really specific example of that if you want to be healthy longer, you have to be active, and I'm wondering how you see the role of physical therapy in keeping someone active for life.

Denis Beaulieu: 13:28

There's a bit of a struggle with that too, because when someone comes to us with a positive attitude about recovery, getting back to activity, it's so much easier to work with that type of a person versus trying to, shall we say, push someone along into physical activity, and we've identified that as a marker for success. I mean, if you're coming to physical therapy from an injury and you're motivated to get back to your sport or get back to healthful living, even if it's hiking or, in your case, bicycling, it is so much easier to guide that process versus someone who has been inactive. It's so much harder to. I guess the saying that I use is you can't steer a parked car. It's very hard to get someone motivated if they're not already moving, so that becomes challenging. So movement, physical health, keeping active, especially for longevity's sake, is very important active, or would you see the majority of people you know being active?

Tom Butler: 14:32

I mean, we hear statistics that you know only 30% of people are really active. Would you say that that is what you see in your practice?

Denis Beaulieu: 15:19

Well, fortunately for us there's a pleasant blend. We have employed a lot of athletic trainers and so we tie into the schools a lot, so it seems like on a given day we see a lot of young athletes. We see a lot of young weekend warriors too. The other interesting aspect of our practice is we do see a lot of injured workers, so we do a lot of occupational medicine, so people trying to get back to their job and their work, but then there's a significant portion of those that are just inactive.

Denis Beaulieu: 15:51

I don't know why I started to have this pain, but I started having this pain Help me of active versus inactive adults per se, just because if you're coming to us, you're definitely going to be working on a injury or a pain that won't go away and you have sought medical attention and you figure that physical therapy is going to be the one that helps you. So it's kind of an unusual blend and of course insurance drives some of that, but for the most part there is a fair blend of those that are already active versus those that are inactive, Gotcha.

Tom Butler: 16:38

Now, in my case, I was like 59 years old. I had probably decreased my activity level for 30 years and had gained weight for 30 years. And you know, and at 59, I'm like, okay, something's got to be done here. I had some disease processes that I wanted to reverse. So, given someone not having been very active, you know, and starting out in their 60s or 50s, is there a role for physical therapy assessment before starting being active?

Denis Beaulieu: 17:16

You know, not really. I think you find most people just simply say, oh, I remember I liked walking or running or cycling, and they'll jump into that activity, which is good. That self-starter mentality is really what you're looking for is somebody who wants to get back into activity. So whether it's a court sport that you can enjoy with friends or going walking, just simply starting is probably key to that first step getting into your activity. So physical therapy doesn't necessarily start that process, but we're definitely there along the way. If injury would happen, say if somebody started a walking program and realized that they were using poor shoes and ended up with foot ankle problems or hip problems, that's when you'll see physical therapy becoming involved. We're really down the journey away, not so much as an entry, return to sport or return to activity type of industry.

Tom Butler: 18:16

The reason that I asked that is because I ended up developing bursitis. I was on a ride and it kicked in. It was the first longer ride I had done. It was actually on my 60th birthday and I really yeah, so cycling over 60 kind of that's part of what created this, and it was the longest ride I had done in a long time, and at about the 50 mile mark I started developing some knee pain. It got pretty bad by the time I hit the 60 miles and I went in and you know it felt like everything pointed toward bursitis and so so what happened with that physical therapy appointment? And you know what happens pretty much any physical therapist that would look at me, you know they'll say, like touch your toes or something like that, and then they become pretty much horrified that I have so little flexibility, you know yep and so you know I get these exercises for flexibility.

Tom Butler: 19:27

The thing is, you know, was I get these exercises for flexibility? The thing is, you know, was that something? It seems like that's something that I could have gone in to a physical therapist and said, hey, I'm getting ready to be more active than I've been in the last you know, easily 25 years, maybe 30. Could we talk about some of the things that might interfere with me being able to be active, and would they have maybe checked for flexibility at that time and said, hey, you know this is going to be an issue for you if you're not flexible. What do you think about that kind of free activity assessment later on in life?

Denis Beaulieu: 20:06

Well, tom, that would be a refreshing visit. I would so enjoy that visit with you because you know, if somebody is starting back to an activity, there is some key points you can look at Flexibility strengthening. How much load and how much progression do you do? So there's a couple of ways we could help. We could look at that flexibility, strength and kind of help you design a more comprehensive program, I suppose, than to just go back and see what 60 miles is going to feel like. But you're also kind of we're in the middle and I'll give a shout out to the athletic trainers of the world.

Denis Beaulieu: 20:50

They're underutilized, to be honest. They're really your performance experts when you are going through a recovery like from bursitis, once you've discovered that you can, you can't just do 60 miles in a in the drop of a hat. There is some training and pre-training that you should be doing, or even cross-training you should be doing as you get back to an activity when you're restarting later on in life. But athletic trainers, they're underutilized, mostly because they're and this gets into some strategies mostly because that's cash out of your back pocket, and this gets into some strategies mostly because that's cash out of your back pocket. So you have to actually go seek out a trainer, seek out somebody who knows your sport or be familiar with your activity, and yeah, they probably don't get utilized as much. You go to the gym and you say, oh yeah, I get that one athletic trainer appointment to learn the equipment, but you can actually secure their services to help guide you through this return to exercise how much load, what should my nutrition be, what should I be doing on off days and how many days should I train? So they're really in a key position to help.

Denis Beaulieu: 22:04

I would love to do that appointment and say, oh yeah, you've got some flexibility concerns. You have some mobility concerns. You may want to look at these issues before you jump right into this sport, but I would have to say let's give a shout out to the athletic trainers of the world and give them a shot. I love it. They are the performance guys. We sometimes miss that spot. I mean, we are good at it, but we're good at bringing you from the ACL injury back to hey. I think you're ready to go hit the field and get back to football or get back to basketball. In that mix, though, we really like to use our athletic trainers. So there's a shout out for those guys.

Tom Butler: 22:49

Great, and so do you have athletic trainers on staff. Is that right?

Denis Beaulieu: 23:03

We do and we use the athletic trainers as much as we can in clinic, but a lot of our athletic training staff are also then working at the high schools and helping their athletic programs, which, with the rise of concussion awareness, that has been a big job for us as far as helping kids that have gone through concussion injuries in their recovery process. So we've become part of that process then, with the athletic trainers being a very key point of that.

Tom Butler: 23:25

Interesting so yeah. Now, what do you think about cycling as an activity to stay fit later on in life? Do you have a professional opinion about that?

Denis Beaulieu: 23:36

It's a great activity If you think of the you know load on the joints if you were to start, say running versus cycling. There's less impact with cycling, certainly more ground to cover, boy, you can get out and see some scenery More than just the three times around the block walking. So there's definitely some great aspects to cycling, but there's also things that we could talk about too, like the bursitis issue. How do I prevent things like that from happening? When you go back to a cycling activity that is very, shall we say, linear, it's a forward motion. There's not a lot of variety to cycling. Your legs and your hips, kind of, are doing that same forward, forward motion. So that's that's probably where we start to see issues like your bursitis. You may need to be cross-training a little bit, so that's that's part of the concern I guess I would say between, uh, with any one sport, that you make sure that you're actually training and cross-training and developing the whole body, as opposed to maybe a specific muscle group.

Tom Butler: 24:45

So there's also you know what I've heard a few times is, the position of cycling is something that you know, along with the, the position that we're sitting in front of a computer, kind of bent over in front of a computer, kind of that combination. Can you know, cycling does not like offset or confront or whatever, that kind of position problem.

Denis Beaulieu: 25:13

Right, because you're utilizing the same muscles that you're going to be concerned with. Let's say we're talking about a 40 year old who has been sitting in his office chair for years. Their stiffness is going to be along the same lines of muscles that you're going to be using as a cyclist. So the use is really good, because in order to stretch a muscle, you know that you have to use those muscles. So if we want to talk about hamstrings and hip flexors for what I call a sitting athlete Somebody who's going to be behind the desk working on the computer, sitting in a chair for long periods of time, versus somebody who's going to be starting cycling there are some of the same muscles that you can work on, but you still want to work on cross-training.

Denis Beaulieu: 26:00

You still want to work on some of the more lateral muscles instead of just the forward hip flexors and hamstrings. They share a similar concern and they can help, like you can use your cycling to help with your long-term sitting, but you still want to cross-train. You still want to utilize some other muscles to support that.

Tom Butler: 26:21

Now on a bicycle. You know, and it's incredible when you start crunching the numbers, but you know, like the Seattle-Portland ride, which is like a 206 mile over two days, you know when you're pedaling at 90, 95 reps per minute and you know you're doing a lot of repetitive motion over you know the two days of the stp and so it seems like if there's, you know, a little bit of alignment by the time you repeat that motion over and over again, then that misalignment is really a problem and I found a good bike fitting to be really important to me. But I'm wondering about your perspective on that. What do you think about when you think of, like the repetitive motion and getting a bike fit to you know, to the individual?

Denis Beaulieu: 27:12

Yeah, there was. I know I recall there was some coursework that came through for physical therapists on how to help with this exact problem as we look at various sports in our area. You know that was one of the things that came up. It's like we should be helping this bicycling community with bike fit, and maybe you could help me know more about that too, because I would assume that some of the bicycle shops that are selling you their equipment would also have some expertise in that as well. Do you find that to be true? Is there a bike?

Tom Butler: 27:46

fit. I think there's a couple different things that go on. I think that bike shops understand if people are comfortable when they're riding, they're going to be happier with that purchase, be happier with that purchase. And so I think there's a layer of bike fitting that goes on, that like gets you to the point where you feel good on the bike. But then there's a totally different layer of bike fitting and I think many of the people at that in that place are physical therapists, where they're, you know it's really a science and they'll use laser guides and everything. And there's, you know, like a different level, and a lot of times there's a price difference between those levels. But you know that to me that top level is so valuable that it's, you know, if you're planning to spend much time at all on a bicycle, then it's good to you know to be at that level.

Denis Beaulieu: 28:49

Correct yeah.

Denis Beaulieu: 28:50

And I think that's where I was just going to say. I think that's where some of the added emphasis could lie. For physical therapists in general, it's a specialized market. For many years I tracked down the specialized market for golf. There's a lot of things that we can do for golf, fitness and helping to improve the one tool that most people can change, which is their body. You can be fitted for clubs, you can be fitted for grips, but one of the hardest things to actually change is the physical body. So physical therapists have done quite a bit of studies there. It would behoove us, I guess, to spend a little bit more time for the cycling community to actually take on the training for the bike fit. I know that's available to us, but I would say only a few samples of people that I know have actually gone through the training. So it would probably suit us to help your community of cycling well into the 60s to be able to do that performance assessment for you.

Tom Butler: 29:56

Yeah, I think it's an interesting observation, you know, because I do think there's people that you know like spend their time as professional cyclists and then get done with that and go, you know, do physical therapy, training, and then they become a really natural kind of from a marketing perspective. They have that advantage to, you know, pull that in, as they're talking about what they do, about what they do. But you know, I would like to see cycling become so massive in the United States that you know there's more and more need.

Tom Butler: 30:30

And so you know every physical therapy clinic would want to be able to offer that, so we'll see how that goes.

Denis Beaulieu: 30:38

Yeah, I mean again making our community more aware of the cycling needs, of how to better stay in the game, if you will, of cycling on your community. If we were to spend a little bit more time making sure we knew a few specialized assessment tools that would help your you stay on the bike for years to come, if you will yeah, nice.

Tom Butler: 31:10

Now it seems, as I get older, like I have more aches and pains, you know it's like just the. It's just normal to step out of bed with some some kind of ache, and so I am wondering you know what would differentiate like normal muscle soreness after a ride versus a potential injury? I don't know if that question makes sense, but how do you, how do you make that decision that, okay, this isn't normal? This is something that I need to go seek some attention for.

Denis Beaulieu: 31:46

Yeah, I think most people come to that naturally. Basically, if a pain doesn't go away like it did last time, or if it doesn't go away in a reasonable amount of time with reasonable efforts of conservative care ice, heat, medication over the counter and those types of things then you're seeking help. It's like this is going on way too long and that's where we see a lot of people come into therapy for an assessment. It's like I have this pain. I started getting back into my sport and now I feel like this is stopping me from my sport. Help me. So, yeah, it's, it's those. It's kind of intuitive, I guess. If a pain persists and doesn't get better with your conservative methods, we're there for you. Yeah, we'll see you in therapy. Yeah.

Tom Butler: 32:37

Okay.

Denis Beaulieu: 32:38

But there's no magic. There's no magic to it. You know. You know you're going to be sore after cycling, I know I'm going to be sore after playing racquetball or pickleball. And so you monitor it, you play through it, you strengthen through it and, yeah, if it doesn't get better, you consult your doctor, they send you to physical therapy and we hook up we hook up.

Tom Butler: 33:05

So you know, I mentioned earlier one of the things that I always consider is I am very thankful that my knees are in good shape. I do have to be careful. I can get bursitis, but you know I don't have knee problems. But that's not really the case for you, right Like you have some knee problems, and so I wonder if you could talk a bit about that.

Denis Beaulieu: 33:25

So, yeah, I wish I had a great story for my injury, but it was a long shortcut. I was trying to cut across a field and it required going down a steep slope and I twisted and turned and basically tore my ACL and meniscus as I was falling. That was several years ago and I rehabbed the knee. I felt I came back to 100% really well and then, just over time sports applications I was able to injure it again.

Denis Beaulieu: 34:00

So's, it's been an interesting process then for me to stay active in sports, because I do, like everybody else, uh, working out, exercising is not nearly as fun as being out playing, cycling, uh, playing a sport. So I, uh I train now or do my own exercise routine so I can stay out on the court, and that process comes and goes. There's, you know, again, the monitoring of injury and swelling and how the arthritis is advancing. So I have to be a little more vigilant with what I do with my knee again to keep me happy, going backpacking like we did, and or staying on the court to be active and stay healthy. So it's an interesting process then, when you're dealing with that persisting arthritis from past injury.

Denis Beaulieu: 34:53

That's probably an area where physical therapy can really help the injured athlete, the injured adult who wants to stay in their sport. How do you strategize through some of that? What do I do? Now? It's really kind of the big question we hear. I think that's where you can see physical therapy really help you with the strategy. A lot of people are afraid to exercise because they have arthritis. They have this diagnosis now of arthritis. Well, one of the best things is getting education. What does that really mean for your knee or for your hip or for your shoulder? It doesn't mean you stop all activity and unfortunately, a lot of people do believe they stop activity. So we're the proponents that would help you get back to the activity, learn what arthritis really does for your body and how you can support that so you can stay active.

Tom Butler: 35:43

I think it's more fascinating that you did this injury just in some like mundane active. You know average activity, I mean I think it says something about how we can get injured. It's not you know, if you're not being active, you know you can just as easily maybe not just as easily, but you can injure something in a mundane way.

Denis Beaulieu: 36:13

Oh for sure, I mean home injuries. Home accidents, that is really. We see a lot of those types of injuries. It's not all car accidents in sports, some of it's just the silly stuff we do. I went out and stepped out onto my back porch and slipped on the ice and now I have an injury, so it can be just as pedestrian as that. Not every story comes with the great sports injury where I was going up for that winning shot and got hurt. So most of us do get hurt in so many boring ways. So now, that's that's where we find everybody. That's where we find, uh, you know, the, the avid cyclists such as yourself. Uh, might, it might be a different injury that you incurred.

Tom Butler: 37:01

Yeah, when you look back at it, do you think there's some things that you could have been or should have been doing that would have prevented that stress from leading to damage? Or is it just that things?

Denis Beaulieu: 37:19

like that can just happen. No, for me it was just something uh, it's something that could happen. Um, maybe I should not have taken the shortcut, but I did. I mean, I'm young, healthy guy, I can go through this field. Injuries and accidents, they happen, uh, to all of us. Really. There's no way to prevent that, maybe being a little bit smarter. But I think we all come to that point where it's like, well, I thought I could actually do that activity and I guess now I can't. It can be as simple as walking out on your front porch or I was out line dancing with my friends and twisting an ankle. Well, there's no way to prevent that. So we're, all you know, victims of gravity, I suppose.

Tom Butler: 38:05

That's a very good point. Victims of gravity, you know, until we have those full body airbags that just inflate, you know, whenever you start going down or something I don't know. Whenever you start going down or something I don't know, when you had your injury, I'm wondering what thoughts went through your mind. Did you feel like you knew what to do? Did you feel like you learned a lot about rehabbing something in that process of dealing with it yourself?

Denis Beaulieu: 38:38

What's your perspective there? Well, what's really interesting is that I was actually diagnosing my injury as I fell. My foot went into a hole and it started twisting as I fell forward. I'm like, oh no, I just tore my acl and meniscus, you know it was. It was kind of surreal, I suppose. On you know it's like is this happening? Happening? Yes, it happened. And then, of course, I go to my buddy and I'm like, all right, test my knee. I know I tore my ACL and so my buddies would test my knee and I'm like, oh, I guess it's not so bad Initially, I just tore it. And then, five weeks later in my rehabilitation, I forgot that my knee was injured. We had done so well at rehabbing my knee and five weeks later I jumped off of a it was a little partition wall at Multnomah Falls. I jumped off of the wall back onto the trail and completely finished rupturing my ACL.

Denis Beaulieu: 39:37

So, insult to injury. And yeah, that was the amazing process. I'm like, oh man, I did it. I forgot my own injury and I injured it again. So, yeah, even as smart as we are in the rehab industry, we're all stupid when it comes to injuries. I suppose, uh, but you know, self-diagnosed. My family was like, oh, oh, no, we need to take you to the hospital. And I was like, well, I tore my meniscus and my acl. I finished rupturing that. So let's just put me down here at the bottom of the hill. You guys finish your hike, enjoy multnomah falls. I'll see my doctor on monday. So I guess that's the added expertise that I had.

Denis Beaulieu: 40:18

I got to self-diagnose but, um, you know, I still had to go through the rehab. Once I finally got the surgery to, decided to have a surgery to re uh, to repair the ACL, I still had to go through the rehab. I still needed guys to help me. So I couldn't do it. I couldn't move my leg. So I had a really good crew and kind of knew what to do. But, to be honest, even when you're a client or a patient, you still need that help. Even if you know all the information, you can't do it all by yourself. So that is where physical therapy does shine. That's where we come in.

Tom Butler: 40:54

You talked about surgery. It doesn't sound like in that case there's a decision to be made when you totally tear it. There's not really a decision made about whether or not to do surgery. Is that correct?

Denis Beaulieu: 41:08

Well, not really actually. In fact, the doctors in my town who had been sending me their ACL reconstruction clients had been sending me their ACL reconstruction clients. All three doctors that I went to were telling me to not do the surgery because we're deciding that we're just going to let people get strong and we'll see you later down the road. Anyway, for me, I was still in my 20s, still felt I had a lot of sport and game to play and didn't want to stop there, and I knew what a non-surgical ruptured ACL looked like 30 years, 40 years later, because I had been treating those clients too. So I actually had to go outside of my health network and find a doctor that would treat my knee and do the surgery. Now it was the most bizarre moment of the whole thing for me as a rehab specialist that my doctors did not want to do rehab or didn't want to do the surgery on my knee. So I guess I really wanted the surgery because I knew that I wanted the performance out of my knee later on in life and I would say I made the right decision for me.

Denis Beaulieu: 42:22

There may be something different in the decision process for somebody who well, let's talk about bicyclists Do you necessarily need an ACL for cycling? And I would say not really. If you're youth over 50 and you don't want to go through the surgery of getting an ACL reconstruction, you could probably do quite well if cycling was your primary sport, because then you can work on stability and control of the leg in the absence of an ACL. So there are some options for people and you still have to make that decision with your doctors, sometimes with second and third opinions with the doctors, but there there is still that opportunity to go through and repair something that has been broken a broken bone, a broken ligament, muscle that gets ruptured. Each one of those, in each one of those cases, has their own unique features and and you have to then take that case by case, person by person, and really consider whether that surgery is important or not for you.

Denis Beaulieu: 43:29

So that's a big decision. That's usually one that you're really involving your doctor. Of course, everybody asks their friends did you get the surgery? Yeah, I got the surgery, or no, I wouldn't do that, I would never do that. So you have to weigh all this information. Now, as somebody who's seeking medical attention, what do I do? So? But I think the medical field is good at helping you process through that, and the rumor mill is good too. You can ask your friends, you can ask your buddy hey, you went through that surgery. Should I do it? And that's not the best advice, but it is still the advice we seek, isn't it so? Well, it's, it's, it's probably not.

Tom Butler: 44:12

It's probably not bad advice. Taking in an aggregate of a lot of different advices, it's like, okay, what did you go through, how did you experience that? And you add that to maybe some internet research and to some medical advice. That's taking into account your personal situation, so you know as a you know, again as a piece, but maybe not the only source.

Denis Beaulieu: 44:39

Yes, correct, correct, yeah, and physical therapy actually becomes part of that process. Can we conservatively treat this injury and not do heroic surgery? Can we let the body heal if we support it with proper activity? So we do see a fair number of cases in that category where, okay, you might have strained or torn part of the rotator cuff. Do you really need surgery? Well, let's explore that so we become a really interesting part of that process for you when you're considering your injury and considering your rehabilitation. Will I be complete or will I be to the position I need to be to continue doing what I want to do in life? So it's a really nice avenue for what we do in physical therapy.

Tom Butler: 45:28

So you are again staying active. You have knee pain and yet you're throwing a backpack on and going hiking. Can you talk about that process in your mind? Because, again, you know more kind of what's potentially going on than maybe the average person. And so what's that thought process in your mind about staying active and about pain and being active and the different layers of decisions that go on for you to be active?

Denis Beaulieu: 46:05

Yeah, fortunately I can speak well to it because I did what everybody else did in life. I had my ACL injury early in life, went through the rehab. I had an interesting perspective one day when I went to do an activity and realized that maybe I wasn't at 100% anymore. I went to climb a telephone pole at one of those adventure parks where you are climbing and doing the high ropes adventures, walking across the cable bridges and things like that. So one of the last events was climbing a telephone pole and standing on top of the telephone pole and I realized I couldn't take that steep step with my right knee and so that was a little bit of a shock to discover that I wasn't as bulletproof and maybe not at 100% like I thought I was, that I wasn't as bulletproof and maybe not at 100% like I thought I was. So that processing then kind of learning through life, that my sedentary moments kind of took me on my own little journey with my knee and my knee did not do well if I was sedentary. As soon as I got back into activity, went through strengthening, conditioning, participated in my sports, I was able to actually feel better. My knee would respond better to day-to-day activities as well as the sport activities. So it's been a really interesting learning process for me to enjoy exercise and to enjoy training and getting my knee back into a satisfactory position, a satisfactory condition to help me stay active and stay healthy. So it's been quite a journey.

Denis Beaulieu: 47:48

We'll often tell our clients things like you know, for your arthritis, motion is lotion. So we have all these little sayings. But it really is about how the body responds. If you maintain an active, healthy lifestyle, your body will have the tendency to heal better. It'll have the tendency to recover, shall we say, faster, or recover at least to a better position if you're active. If you're inactive, there's so many more problems that we have to deal with just in rehabbing, let's say, your knee. There's more that we have to consider Now. We have to look at your ankle and your hip and your back and everything else that goes along with that.

Denis Beaulieu: 48:29

So I think the real driving point of this discussion is activity is so important for longevity, muscle mass is important. Longevity is so important for longevity, muscle mass is important. So you need to be engaged in activities that will improve your muscle mass for longevity. One of the research pieces that I came across recently was one of the best predictors of longevity was actually muscle mass. That was kind of a shock, really, because you would think that there would be other health benefits that would go along with that, like maybe heart rate or blood pressure, blood sugars and all those. But one of the better predictors of longevity is muscle mass. So that takes us right back to activity. How do we stay active, how do we engage in this so that we can continue our sport, our recreation, the real stuff that brings us joy in our life? Should we say so?

Denis Beaulieu: 49:32

It's been an interesting journey for my own personal need that I can actually then share with my clients, because you know they're struggling, they're thinking I'm never going to get back to work again, or I'm never going to get back to hiking again. Work again, or I'm never going to get back to hiking again. It's like, well, let's try it and see, because you don't know what this process will be. Let me share my experience and let's help take you through your experience to see what you can get back, and I think that's really been.

Denis Beaulieu: 49:52

Some of the joy in physical therapy is seeing people recover from what they might have thought to be a sport ending or a event ending injury. There was one client in particular who was halfway through training for a marathon and they injured their body and thought, oh, I'm never going to get to that marathon that I'd signed up for. And we were actually able to get them through that process quicker than they thought, back into the training circuit and able to go to that marathon. So it was really kind of a neat process seeing someone go through that higher competitive level of training, have a breakdown, get them back to their training level before the event. So that was probably one of the most rewarding events ever and you know how marathons are really tough on the body, so that was very satisfying to see this client go through that process. So I think there's some of that for everybody.

Tom Butler: 50:56

I love that story and I love what it says about the power of the body to heal, right, right. If you look at structuring a program that works with the body's ability to heal, there's amazing things that you can do, and I think the really important news for someone like me is keep going, find a way Even if there's an injury. You know it might slow you down a bit, but figure out how to keep moving, keep being active and connect with someone like yourself who has professional experience with that, and then comply with what you say.

Denis Beaulieu: 51:42

Well, right, that's the other corner of that little piece of the puzzle. Compliance is tough. I don't want to do this exercise. I wasn't doing it before and I was fine Helping people see that some level of activity whether you were inactive before or highly motivated before, there is a dosage of activity that helps you rehab and helps you get better, helps you improve, helps you recover from an injury, and that's where it really does take a professional. It takes somebody who knows or has maybe seen a few of these before, to help you through that process of recovering from your bursitis or aches and pains that just don't seem to go away and they're hindering my sport. We've seen it before. We can help you through this process. So that is the pitch for physical therapy. When it comes to cycling over 60, I guess is let us help you where we can and maybe see beyond the hedge that's in front of you and help you break through some of those ideas and concepts that may be preventing you from wanting to continue cycling or whatever sport you choose.

Tom Butler: 52:49

Yeah, I like that Well. Dennis, thank you so much for taking the time. I really appreciate you bringing your perspective, both as a professional and then as someone who has his own journey as far as being active, and I just think that it's valuable to get the combination of that perspective. And thanks again for coming on.

Denis Beaulieu: 53:11

Oh, it's been my pleasure, and you've actually kind of sparked some interest in my mind as well about how do we help these cyclists in their pursuits, so I appreciate that as well.

Tom Butler: 53:22

Nice, all right, talk to you later.

Denis Beaulieu: 53:25

All right, goodbye.

Tom Butler: 53:26

Bye now. Here's the biggest takeaway from that discussion for me. I think I can worry less about a knee injury taking me off the bike for an extended period of time. Sounds like many people recover well enough to keep going in a reasonable time. But once again I heard a familiar message from Dennis. I need to think about cross-training. I'm really not attracted to the concept of cross-training Plus. I'm doing some cross-training already in the upper body workouts I do. I do think maybe I need to specifically seek out some activities that can generate more lateral movement than what I get from the pedaling motion.

Tom Butler: 54:07

So off I go again on another journey. This one discovered cross-training. That isn't boring. I would love to hear if you found a form of cross-training that you enjoy. You can find my email in the show notes or, for a quick way to message me, click the send me a text message link at the top of the episode description. I'm getting excited that warmer days are coming to my part of the world. I will welcome a day to get out in short sleeves and shorts. I hope, wherever you are, you will have some great weather to ride in as soon as possible. And remember, age is just a gear change.