It’s not very often I’ve met someone with more letters after than in their name – DPT, MS, MTC, CertMDT, CFS, CSCS, FMT, FMS, FAAOMPT. This is a testament to Dr. Erson Religioso III‘s achievements so far; his list of accomplishments with undoubtedly continue to grow. In addition to his clinical practice, he has filled his plate with a number of ventures including Edge Mobility Systems, The OMPT Channel, Physio Answers, Physio Pics, Physio Stories, and his blog The Manual Therapist. Also, connect with him on twitter via @The_OMPT & @PhysAnswers.
This was a fantastic interview filled with enough goodness to turn it into a 2-part series. I hope you enjoy it as much as I do.
Let’s start at the beginning! What initially drew you into Physical Therapy?
My parents were MDs and I was exposed to health care since I was born, being very comfortable with it. I remember kids in school saying they hated the dentist and I could never figure out why! In high school, a girl I was dating was in an MVA and she started attending PT, so I thought, what the heck, I’ll try this and if I don’t like it, I’ll just go straight to med school. After the first day of my first clinical in an acute care setting, I remember calling my parents saying, THIS is what I want to do! I was so pumped! The rest you could say is still history being written.
You’ve gone through quite an evolution as a clinician. Describe your evolution over the years.
Well, it started out having an amazing othopaedics instructor who was an officer and fellow in the AAOMPT. Waaaaaaayyyy back then, in 95, we had 10 credits of ortho, 5 of extremities and 5 of spine. Most of the other programs only had 3 credits and 1 semester back then. It was MDT and OMPT based (sound familiar?). I thought manipulation was just about the best thing since Jackie Chan (being the mid 90s). I told my parents, “I think I want to be a chiropractor.” As MDs, they said they would disown me. My current business partner, who was rehab director of a hospital where I was doing one of my last clinicals asked, “Have you ever heard of Stanley Paris?” So that’s when I entered USA’s now defunct Residency Based DPT program. I took all their courses for credit starting the day I graduated after PT school and finished them in 1 year. I took my MTC back then, and did not pass Myofascial Manipulation – the irony! I just did not have enough experience as a new clinician to answer some very basic questions that experience would have taught me. When I passed 3 months later, from better studying, not experience, I was whalopping on people and having good results. I was also doing lots of palpation for position, manipulating everyone and discarded most of my MDT training.
MDT comes strolling into town and I thought, I should probably get these credentials. I told my Part A instructor, “I’m only taking this course to get the initials, but don’t plan on using it.” So yeah, I was a young, brash, know it all jack-ass. I took all the MDT courses and passed the cert in about 7 months.
I got my start in Soft Tissue work from the IPA, and took four of their courses, enough for their half cert, but was too daunted by PNF to actually get tested. I noticed for the first time, taking time to do STM actually got me much better results that 5-10 minutes of joint mobs. However, I was still bruising people, and had good outcomes, averaging on the 10-20 visit range for most patients for the next several years.
About 8 years into practice, I attended a MDT Clinical Skills Update Course. I woke up with a “stuck facet” and just needed a manipulation. No one at the course would (or is that could) manipulate me, so for the entire day, I actually sat there, and actually really listened…. so end range you say? Let me try that. For the next several hours I did end range cervical retractions with sidebending left overpressure. It hurt like hell, but the more I did, the better I felt. By the end of the day, I estimate I had done about 500, but I was 100% pain free, in other words I did what a patient would do in 2 weeks in 1 day. No one looks at you funny at an MDT course when you’re doing this stuff btw. At that level everyone is a cert, so there is a lot of walking around, pressups, etc. So, this MDT stuff works!
For 6 years, I supplemented my salary as a peer reviewer. I really got a lot of insight into the HMOs and what a good peer reviewer is really trying to do. Not to mention, I got to see so much abuse of a system and terrible SOAP notes! My most memorable example, literally 100 hand written notes of S: No new complaints P: Continue PT – I guess that makes it a SP note.
At some point, I also took all of Butler’s first series of Explain Pain courses, which changed the way I interacted with patients, and this has of course only been reinforced by all the great blogging and research they have done along with Moseley’s group.
Since then, after reviewing literature on the near impossibility of capsular and fascial deformation, I have practiced a lighter and lighter touch, and my OMPT, including IASTM and joint manipulation are only to make the patient be able to perform their HEP, whether it’s MDT based, neurodynamics, or other. I think supplementing MDT as a system with other systems like the SFMA and MDT has been a match made in heaven and recently I have started focusing on real basics, like sleep, eating, and of course, better breathing through the use of a capnotrainer and a feedback approach.
Wait, what, are there other interview questions?
Ha! We just getting started! Tell us more about your Fellowship experience. Why did you decide to take on this challenge? And with which organization?
Well, I got lucky. Since there was no difference at the time in requirements between fellowship and residency (before 2005), my residency hours along with my DPT through the University of St. Augustine counted as fellowship hours, so I was grandfathered in, having met the requirements of the time. My fellowship required 10 article reviews, 10 publishable case reports, and way more hours than the current requirement, so it’s not like I did not put in the time… I did! It was under the mentorship of Dr. Ron Schenk, who started their fellowship, and the MDT fellowship, and it was a great experience. I learned not only MDT, but neurodynamics, some Greenman based MDT, got my first Rocabado type experience, and more, which really helped form the clinician I am today.
You serve as an adjunct faculty at D’Youville College, Daemen College, and SUNY at Buffalo Doctor of Physical Therapy programs. How did you get involved and what motivates you to devote your time to academia?
I owe almost all my opportunities I had early on in my career to my aforementioned mentor, Dr. Schenk. After fellowship, I had no job, and he was leaving DYC, and suggested I apply for that job. So only 1 year after graduating, I became full time PT faculty, and ended up teaching a lot of the kids I used to hang out with. I did say in an interview I would not hesitate to fail a friend because the lack of knowledge or performance could mean someone’s health or worse. Dr. Schenk left for a few years and came back and started teaching at Daemen, and recruited me to teach Neurodynamics for the fellowship program, plus some an in clinic course called Clinical Exposure, where students come in and observe once every other week for a semester prior to their clinicals. Really makes them more comfortable so they’re not deer in headlights on their first day of actual clinical. For UB, a student visit by the ACCE was enough to have me start teaching ortho labs there for about 6 years.
I can say now that I have really scaled back on my adjunct work, and no longer teach at UB or Daemen. I just did not have the time once I started having my own practice, blogging, and the (inter)national teaching tours. I still love having students in the clinic and they keep me on my toes! I still teach at DYC (my alma mater) 3 times a year in their Advanced Ortho Program, a kind of mini certificate for students interested in more than what their ortho class offers.
Congratulations on everything you’ve accomplished so far! How do you balance career aspirations and family life?
After starting my travelling, I cut back on my clinical hours. My family are the most important thing to me, so I only work 3 days in the clinic now. It’s enough to still see a wide variety of patients, but I get to hang out with my girls and wife a lot and really help around the house. My wife is very supportive of my teaching and told me 5 years ago, someday I think you’ll be teaching all over the country! Even though when I called her from the Buffalo airport to tell her I was boarding for my first tour, she said “I miss you already, how long do you plan on doing this?” Lol! I couldn’t do it without her support.
Another way I balance is to take off a significant amount of time from the practice when I have a new child. This time around I’m off until the second week of May. If this is my last child, I want to make this time with my family count! I am still seeing concierge clients on a cash basis intermittently as sleep allows.
How can Physical Therapists avoid professional burnout? What has kept (and will keep) your fire blazing?
I had the unique opportunity of being a clinician, PT faculty, and peer reviewer. Now that I am onto private practice owner, international lecturer, and online mentor, I just try to keep it varied. I’d say to avoid burnout, you need to take courses that really light your fire. Take something totally different and not just more of the same. For me, learning about different ways to help others is what keeps me going. There are always different ways to look at things and what works for some does not work for others. It’s why I’m against the odd trend of Advanced Clinical Reasoning vs. Toolbag arguments we see online. Why can’t it be both? You also want to select your patients if you can. Gone are the days for me that I see worker’s comp patients who do not respond more than 2-3 visits, that helps!
Favorite books and/or authors that impacted you the most, both personally and professionally?
Professional: David Butler/Lorimer Moseley – really changed the way I interacted with patients, what words I chose, etc…
Personally: I used to love Michael Crichton years ago but feel that his last 2-3 books prior to his passing were written with movie adaptation in mind. I love RA Salvatore and his Forgotten Realms characters. During my last clinical, one of my best friends and fellowship mentee years later introduced me to his books. I read about 10 years of his books on one clinical!
I just finished Guillermo Del Toro’s The Strain Trilogy, amazing read! It’s about vampires viewed as a disease and how fast it can spread like a pandemic. Btw, vampires are for killing, not loving! After that, I started The Martian, kind of like Gravity on Mars… it’s one of the most gripping books I’ve read in a long time… highly recommend all four of these!
Find me on twitter: @Cinema_Air