On this episode I sit down for one of my favorite conversations I have had on the podcast for a while. Dr. Gary Chimes is a medical doctor in Bellevue, WA and specializes in Sports Medicine. His practice is unique in the fact that he focused on helping people optimize their physical health and reach the next level of performance rather than focusing on catching illness or injury after it has happened.
Dr. Chimes is currently writing a book with a working title of "50 is the new 50". This is all about how to get the most out of your middle ages. He touches on some great points and tactical advice for those of you aged 40-60.
Dive into the topic of specialization and variance in physical therapy, comparing the differences between smoking and obesity, and how healthcare providers can tackle these topics without coming off as rude. Explore how physical therapists can safely teach patients to squat and progress, as well as the concept of subspecialty and the importance of allowing providers to focus on their areas of expertise.
Finally, join us as we explore athletic self-selection and skill sets, discussing the different muscle fibers and the importance of precision and excellence in endurance sports. We reflect on our athletic journeys and background. Listen in as we share our thoughts on navigating risk and middle age, exercise strategies for aging, and the importance of stress management and domain specificity in our lives.
To learn more about Dr. Chimes and his practice check him out here.
If you want to read the highlights rather than listen check out the transcripts below!
--------- EPISODE CHAPTER FULL SUMMARIES ---------
(0:00:00) - Telemedicine and Sports Medicine Practice (11 Minutes)
Dr. Gary Chimes and I discuss the differences between telemedicine and in-person visits. We explore how physicality can sometimes be lost in telemedicine and the unique challenges it presents. We talk about how Dr. Chimes has developed an algorithm for history-taking over the phone and how telemedicine has helped inform his in-person visits. We also chat about how telemedicine has enabled patients to access medical care in rural areas, as well as the importance of payment parity. Finally, we talk about our practice model, which is designed to be a backup for physical therapists and chiropractors.
(0:0:44) - Specialization and Variance in Physical Therapy (6 Minutes)
We discuss the differences between smoking and obesity and how healthcare providers can approach the topic without coming off as an 'a-hole.' We explore how physical therapists can safely teach patients to squat and how to progress them, as well as the concept of subspecialty and the importance of allowing providers to focus on their own areas of expertise. Finally, we congratulate Dr. Gary Chimes for opening up the Covington Clinic.
(0:16:58) - Specialization in Physical Therapy and Medicine (4 Minute
We explore how physical therapy can become more specialized and how the density of a population can affect this shift. We compare Korean restaurants and physical therapy subspecialists, and how Chinese restaurants on the East Coast and Pacific Northwest differ. I share my experience of choosing between medicine, math, and professional wrestling and how my interest in pro wrestling has impacted my practice of medicine.
(0:21:23) - Wrestling and Brain Injury Statistics (12 Minutes)
We discuss how I got into pro wrestling and the importance of understanding brain injury after Chris Benoit's story. We reflect on the overlap of my knowledge in brain injury, testosterone supplementation, and pro wrestling. I also share how a lecture from Randy Sussman led me to pursue a MD/PhD at Stony Brook.
(0:33:06) - Athletic Self-Selection and Skill Sets (12 Minutes)
My athletic background and journey to becoming a better Ironman triathlete are discussed. The different muscle fibers and importance of precision and excellence in endurance sports are explored. I am now training for a quarter mile and have set goals in anticipation of turning 51. My experience in pro wrestling and understanding of brain injury have helped shape my current athletic goals.
(0:45:20) - Navigating Risk and Middle Age (6 Minutes)
I share thoughts on risk aversion, comparing it to a retirement portfolio. We reflect on how my father's upbringing during the depression and World War II influenced his outlook on risk, and how his actions from that period still affect me today. We discuss the importance of taking risks in one's younger years, and how risk should be modulated as one ages. I also compare risk taking to a diversified portfolio, and how it applies to exercise, parenting, and career decisions. Finally, we consider how one's age affects the level of risk one should take in their life.
(0:50:55) - Exercise Strategies for Aging (12 Minutes)
We reflect on how the balance between high variance and low variance strategies can affect an athlete's performance. We consider the example of George St. Pierre and how his style changed over the years, as well as look at the importance of the Health and Human Services exercise guidelines. We also discuss the potential risks of relying too heavily on high intensity interval training versus moderate exercise. Finally, we contrast my father's upbringing during the depression and World War II with my own experience in terms of risk aversion.
(1:02:53) - Exercise, Aging, and Performance (6 Minutes)
We explore the technology behind hearing aids and how they can be paired to a phone and fitness band. We also discuss how to individualize physical therapy for each patient's needs and how to create a safe space for those with aesthetic goals. We reflect on performance and health, exploring how Ben Bruno and other high-level trainers have discussed the difference between the two. Finally, we consider the balance between high variance and low variance strategies to achieve athletic performance and reflect on how my father's upbringing during the Great Depression and World War II affected his risk aversion.
(1:08:51) - Stress Management and Domain Specificity (8 Minutes)
We explore the differences between fear and relaxation and how being able to stay calm in the face of adversity can help us to go further. I use examples from my own life, such as customer service phone calls and a medical procedure I was in the middle of, to illustrate how stress management can be domain specific. We also talk about how helping patients navigate something outside their domain of expertise is a big part of my job.
(1:16:31) - YouTube Channel for Medical Topics (1 Minutes)
I chat with Dr. Gary Chimes about the content on his YouTube channel. We take a look at videos covering topics like lip of gems, frozen shoulder, calcific barbitage, and why people should not use non-steroidal anti-inflammatory drugs. We also discuss the possibility of scheduling a follow-up conversation.
--------- HIGHLIGHTS ---------
0:01:14 - Telemedicine and Learning New Exam Techniques (104 Seconds)
0:19:40 - Specialization in Sports Medicine (51 Seconds)
0:31:11 - The Importance of Clinical Testing (91 Seconds)
0:36:48 - Building Endurance and Exploding Speed (56 Seconds)
0:40:37 - Success and Living Your Best Life (79 Seconds)
0:56:57 - Exercise and Injury Prevention (77 Seconds)
1:00:44 - Preventing Injuries in One Sport Athletes (89 Seconds)
1:05:23 - Fitness and Performance Goals (66 Seconds)
1:07:55 - The Toll of Combat Sports (65 Seconds)
1:14:32 - Learning New Skills in a Career (68 Seconds)
--------- HIGHLIGHTS WITH TRANSCRIPT ---------
* Telemedicine and Learning New Exam Techniques | 0:01:14 - 0:02:58 (104 Seconds)
You kind of brought up telemedicine and and that's kind of like. I think you know, around the time that we started meeting with you Was like after COVID it already started because we didn't start a belbiclay until like 2021. Yeah, what's it been like doing the telemedicine? are you still doing a lot of that?
0:01:29 Dr. Chimes
Yeah, i probably do it about 50 50 telemedicine and in person. So I think I was unusually situated well to do telemedicine, being a mid-career physician. Just the nature of my personality is that I've often been people that you know people call and wanted second opinions, like my friend. You know I'm from the East Coast, so you know if I had a friend from New Jersey who something happened to their calf, i was just in the habit for you know decades of learning how to do a history over the phone and Being able to have them simulate an exam. You know, trying to explain how to do Thessaly's maneuver over the phone, i was concerned by meniscus injury, and so I've already developed this kind of algorithm that worked well for not having the person in person with me, and so when we pivoted to telemedicine, it wasn't that challenging and I actually have learned some stuff through telemedicine that I Have now translated to when I see people in clinic. So, for example, for a shoulder labor injury, you know Some of the classic maneuvers you might use, like an O'Brien's test, and I can do that virtually. You know zoom and that's fine. But I started doing a test called the back fist test, where you basically have your elbow, your shoulder, abducted 90 degrees, rele, rele with 90 degrees, and then imagining that you're trying to back, fist somebody behind you and it's basically Simulating the late cocking phase or throwing motion. I've actually found that to be a more sensitive test for liberal injury than a lot of the other stuff I was doing in person.
* Specialization in Sports Medicine | 0:19:40 - 0:20:31 (51 Seconds)
And then, like, when I think about that, i'm like, well, i don't know if I personally would want the person who only repairs five Achilles a year versus the guy who's doing, you know, 150 a year, which is kind of an interesting thought, But yeah, I think it doesn't need to get pared down as much as like at least in PT, where it's like Tony is specific to ACL but he also just loves knee and lower extremity in general. That's a pretty good niche in general for PT.
0:20:04 Dr. Chimes
Yeah, i mean, i think it's just probably the way like just human interest is in that, like most people have multiple things that they're interested in And hopefully, like you know, just like as a quirky thing, for example, like I'm you know one point I was debating about whether I was going to be a physician, a math professor or a professional wrestler And I still have like this great love of pro wrestling and like WWE pro wrestling.
* The Importance of Clinical Testing | 0:31:11 - 0:32:42 (91 Seconds)
Yeah, well, i think that's a great like topic too, cause, like I mean two different things there. It's like that's easy as PT too, like we get into these pattern recognition where it's like, oh, pain sitting, pain bending forward, pain going down your leg, it's probably a disc, but then it's like we're just gonna go down that path and instead of like, like you said, like let's do some things to like test and rule out And that's why I've liked your guys approach and it really just physiatry in general, which is like we'll take imaging but we'll also do clinical testing, cause like I feel like sometimes in orthopedics the clinical testing is kind of lacking now where, like, for example, i had this patient she had a knee injury during soccer, had had a meniscus tear and then got it repaired and then had some sort of instance of hyperextension and kind of re-caused the same similar pain. She's got pain with like passive extension. She's got a few different other symptoms interarticular swelling, some other things, got MRI. Mri is clean. Orthopedist says it's not inside your knee, the MRI is clean. But it's like well, like there's a lot of other clinical signs that point to like it being like something interarticular, and then another doctor kind of worked it up and spent maybe an hour or 15, like looking at it And was just like no, this is something interarticular. And then we started to go down that path. But it's interesting cause I think there's just such a like reliance now on imaging purely, but not like necessarily, like subjective information.
* Building Endurance and Exploding Speed | 0:36:48 - 0:37:45 (56 Seconds)
0:36:48 Dr. Chimes
So I had no idea how fast I could run a quarter mile And so I'm now doing it at about a six minute 45 second pace. You know my goal is to get it down to a six minute mile pace, but like it was really like striking as like crap, i have like no two. I have two muscle fibers anymore, Like I'm just like a big slogging, you know soleus muscle, and like I need to like be able to explode, you know, and so it was really striking to like just go all out you know, you know just what does that even feel like?
Yeah, it's interesting how that goes away, cause like I sprinted for so many years of my life. I mean I started training like very intensely at probably 13 years old where I was like with a club coach and that's all I did. It's funny cause, like I went the other way, where now I'm trying to build my endurance systems because I at one point in my career I could not jog a lap around the track without cramping up, but I could run at full speed and I'd be relatively fine.
* Success and Living Your Best Life | 0:40:37 - 0:41:56 (79 Seconds)
0:40:37 Dr. Chimes
I'd say the one thing where you know, just my wife and I met in our 40s and so it's a late start. So I'd say, like that's probably the area where you know I'm not in the 99th percentile. Well, let's say I'm 85th percentile, but um, you know, I think about, like my father, for example. My father, you know, was born in 1934, grew up in the Bronx, but mostly in Brooklyn, was a really smart guy. He was, like you know, one of the top students at Stuyvesant High School, which is a magnet school, and then he just for a series of reasons, he became extraordinarily risk averse. So for a person of his aptitude, you know, even being at one of the best high schools in the country, he it didn't translate well, you know, and I'm really appreciative of everything my dad did. But I think there's a lot of people like that and And I think this kind of gets into some of that ceiling floor stuff we were talking about before I Think there are people who are successful but are still not living their best lives And I think that that's something that's just it's super important to me where, like, just because you're doing okay Doesn't mean you're doing what you want to be doing, and that's the niche I'm really trying to hit, you know, and not that I'm against remediation, not that I'm against like trying to be the social safety net for people who are at the bottom. It's just not what my skill set is like.
* Exercise and Injury Prevention | 0:56:57 - 0:58:14 (77 Seconds)
it's like well, I hate the word forever, but you know it's like this should be part of your routine because of, just like you know, age related changes, Just like I don't do the same exercises that I was doing, Like you said, when I was 16 or 18 or 20, when I was training for collegiate track. It's very like high risk, high reward type exercise, A lot of Olympic lifting, a lot of like overhead. So you know it's like a lot of power based movement, a ton of ply metrics. Now I've like started to go like lower impact, like more healthy stuff that I can move, but I've also had to incorporate, like you have, a lot more mobility and especially spine stuff. And then like, as you accumulate injuries, unfortunately, like you said with your heart, like you have an opportunity, if you hurt your knee, to repair that tissue. But it's like the sad fact of like accumulating injuries is like the number one predictor And Tony always says this, maybe you got it from you The number one predictor of future injury is past injury.
0:57:52 Dr. Chimes
Yeah, I mean, I definitely said that to him. He probably got it from me, but you know Tony's, you know again he's had. you know, it's been 10 years since we worked together And, by the way, he's doing an Ironman next month. Oh, that's awesome Yeah.
He's in the midst of training. He's in like the last, like the really bad, heavy weeks, and then he's, i think he starts tapering, maybe in like two weeks.
* Preventing Injuries in One Sport Athletes | 1:00:44 - 1:02:13 (89 Seconds)
That's actually a really smart way to solve one of the problems that I've been having, which is, like I get a lot of let's say, the tennis player is probably the most avid person that I get where it's like they're playing three hours of tennis five to six days a week, all year round, and I talk to them all the time about, like think about professional tennis players. There's some built in off season.
1:01:05 Dr. Chimes
There's a time like we're like they're not playing six days a week also, And high, like high level, like you go back to like an impact sport, like football.
It's like their sport goes on like three months, four months of the year And then, like most of the time, they're not spent tackling each other And they're not spent like beating themselves up because they know like that season. But it's an interesting thing that happens with like weekend warriors and people who are doing like basically becoming a one sport athlete but like forever They do start to accumulate injuries. Really hard to talk to people and like avid exerciser like this, maybe this is actually a great, that's a great suggestion that I'm gonna use now too And I haven't really thought about it too much. But trying to get people more into other stuff, maybe like use those quarterly activities as like something as a goal, but like related to what they're actually interested in, cause I get that a lot with our, with our just like avid exercisers at the gyms that we treat out of, where it's just like they work out five days a week and they've been working out five days a week for the last 20 years And they've been pushing and like it's a performance based gym or it's CrossFit, so it's like of course you're right.
* Fitness and Performance Goals | 1:05:23 - 1:06:30 (66 Seconds)
Yeah, cause like like that that may would make a lot of sense, cause the instance that I can think of is like if someone's saying they're working out really hard to just like be in shape and lose weight and not have to worry about, like changing the way they eat, for example, you could recommend that like, hey, you should do elliptical for this month, you should do swimming, you should do treadmill, like you should rotate, because your goal is not to be the best runner, it's to be really fit. So you can do that in a lot of different ways that would help you not accumulate. It's just a little harder when someone's like my goal is to be like a really good competitive tennis player And that's kind of an interesting conversation too, Cause we just hosted a rehab to perform. They do a really good course. That's a PT clinic out of like the East coast. And they did a course at our, at our gym, and they were talking about in, like you know, ben Bruno, some some other trainer, like high level trainers have talked about It's like performance is not health. You know, it's like if you're trying to be really good in performance, it's not necessarily healthy for you, you know.
1:06:22 Dr. Chimes
So that's, that's an interesting. Can I explore that for a second? Yeah, so I remember, you know, one of the last national meetings I went to, i think it was at, i think it was at the American College of Sports Medicine.
* The Toll of Combat Sports | 1:07:55 - 1:09:00 (65 Seconds)
Yeah, and it goes back to like to round full circle, to like MMA and being a mixed martial arts fan, i mean, you look at most the guys in the UFC that are like even like combat sports in general, that are been at the highest level, like Giza Ben-Askrin really good wrestler. I think he has bilateral hip replacements. Yeah, he's like 39 or 40 years old, so it's like it's like that's like the most extreme example of performance, really not being great for your body.
1:08:23 Dr. Chimes
Yeah, it's not, yeah, i am. So, like you know, the most valuable relationship I ever had in medicine was with a guy named Jim McClain who was my best friend in residency and fellowship And he unfortunately died in a snowboarding accident when he was 34. So my son, james, is named after him, and Jim was a great guy. He was a. He was a academic, all American wrestler at Rutgers and you know very good wrestler And I remember talking to Jim about it. He said, like wrestling is something that benefits from hip mobility but does not promote hip mobility, And I thought that was like very telling.
* Learning New Skills in a Career | 1:14:32 - 1:15:40 (68 Seconds)
Yeah, because how you do one thing is how you do everything essentially Yeah. Well, i mean, there's certainly translations of skill sets.
1:14:38 Dr. Chimes
But but I'll say, like in my career, you know, like you know, i was an anonymous, you know, i just think take anatomy, my PhD is an anatomy, ok, and so I was really good at dissecting, you know. And then I then learned electromyography, you know. So that's like doing nerve studies. So I'm having to learn about the nerves and muscles in another way And my PhD anatomy helped, but I had to relearn a lot of anatomy And then I started doing spine injections and I had to start learning in a different way. And then I started doing musculoskeletal ultrasound. I had to learn anatomy in different ways, you know, in terms of, you know, studying biomechanics, i have to learn in different ways. So my knowledge in one of these domains helps. But you know, just going back to my PhD, the anatomists, and knowing what the extensor, curpy radios breathes is, that doesn't inherently allow me to know what to look, what it looks like an ultrasound. I have to learn new things. Yeah, yeah, yeah.
And then you can just apply that same skill of learning, the original skill, right To to you know like, where learning is just a skill in itself. But yeah it's interesting.