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Episode 9: Sports PT Residency - A Deep Dive Into The Experience


Nate Reynolds 0:05

Welcome to this week's episode, I am talking with James Zotto. He currently is a physical therapist in North Dakota. He is a orthopedic clinical specialist and a sports clinical specialists. So welcome.

James Zotto 0:40

Thanks, Nate lucky to be on podcast and looking forward to it.

Nate Reynolds 0:44

So tell me a little bit more about where you grew up, where you went to undergrad, grad school and kind of how you ended up in North Dakota.

James Zotto 0:52

Alright, so I grew up in Libertyville, Illinois, which is a northern suburb of Chicago played all three sports there football, basketball, baseball. I was lucky enough to get a scholarship to go play football at Wofford College in Spartanburg, South Carolina. So I went there for undergrad got my biology degree and ended up. I was thinking about going to either med school or PT school, I ended up choosing PT school. And my wife and I both went to grad school in Charleston, South Carolina. So I ended up at the Medical University of South Carolina for my doctorate in physical therapy. And going into PT school, I knew that I want to work in sports, physical, physical therapy and work with athletes. So I was lucky enough to get accepted to the University of North Dakota's sports, physical therapy residency, and that was a one year program after school. So all through 2017, the summer of 2018. I was there. And after that, I was able to go down to Columbia, South Carolina to work at Apex performance, which is a hospital based force Performance Center. I was there for about a year and a half and just with family reasons went back up to North Dakota now I'm currently in outpatient ortho clinic working for a private practice.

Nate Reynolds 2:11

That sounds like kind of a whirlwind. You know, like you start up in the Midwest, and you end up in the south and you go, I mean, is North Dakota even considered the Midwest or is that like the North North Midwest?

James Zotto 2:23

So it depends on who you talk to people North Dakota called the Midwest, coming from the Chicagoland area. It is no nothing like the Midwest in terms of weather. It is way colder way windier, a lot more snow. So it's almost like southern Canada. But now there's great people up in North Dakota. I really like all the guys that I work with. And all my patients. It's just a little bit of a different culture shock. It was a culture shock coming from Chicago to South Carolina. And then it was even a bigger culture shock moving from South Carolina to North Dakota in terms of weather and just how things are done here.

Nate Reynolds 3:00

Yeah, I mean, that's how I felt when I went from New York down to South Carolina for that short time. And just for the listeners out there, James and I overlapped by what a week or two down in Clemson. And we were Yeah, we're both doing a neuro rotation. And we both ended up leaving South Carolina after but it was a fun. It was a fun time.

James Zotto 3:24

While we were there. Yeah. It was a very interesting experience. Very interesting clinic with interesting people. But I was glad that there was another person there with me experiencing it. I wasn't the only one there.

Nate Reynolds 3:36

Yeah, you know, it was great. It was great. Betsy was great. And so the next thing is, you know, you had an interest in sports. You know, what was the sports residency process like, looking at schools, trying to apply to them? Just tell me a little more about that process?

James Zotto 3:53

Yeah, it was a really intense process going through all the different sports residency is I think there's almost 50 accredited programs now. And I know I applied to apply more than half of them because I knew that's what I wanted to do. So I applied to a whole bunch of them didn't really matter the location, I looked up the different programs and what they were about. And I base it off of that, but I applied to a good deal of them. And I was lucky enough to get probably six or seven different interviews, which at this point are the most intense interviews I've ever been on. They were one to two day for interviews, talking about research, talking about your past clinical experiences, talking about your future plans, putting you in different patient scenarios, doing mock clinical interviews and not clinical exam. So it was super intense and it was pretty intimidating with some of the hot names in PT depending on where you are going. So like I said, I was super lucky to get that experienced and it's probably the most intense interview that I'll ever have unless I go into like a big pro sports clinic or something like that?

Nate Reynolds 5:04

Yeah, I mean, it sounds intense, because I know now being three years out, just having someone watch me do a clinical exam, you know, you still get a little nervous. But you know, you're talking about doing that as a new grad, and not really having much exposure to what or even figuring out like what your treatment style is. And like you're trying to impress these, you know, hot shots in the physical therapy realm. I think my knees would be shaking a little bit.

James Zotto 5:31

Yeah, yeah, it was definitely intimidating. But it made me a better person, a lot better interviewer, getting comfortable. Getting asked uncomfortable questions and trying to come up with things off the top of your head, you prepare as much as you can, but sometimes they just have to do some different stuff that you're not even prepared for.

Nate Reynolds 5:48

So you actually got the job at North Dakota? What was it like on a day to day basis being a sports resident?

James Zotto 5:58

Yeah, it was an awesome experience. I think my experience was a lot different than a lot of people. And that's one of the reasons why I chose North Dakota. So it was great because you are actually employed by the Sports Medicine Department. So at the University of North Dakota, they have two pts working full time in their PT clinic and their PT clinic is right next to their athletic training room. So there's one big sports medicine building its PT athletic training room, there's an old basketball gym, that separates the PT clinic and athletic training room, from the football weight room. So you have access to all those different spaces, the gym, the football weight room. And on top of that you're collaborating with all the athletic training students, athletic trainers, the strength coaches, so you're just around so many sports, medicine professionals, and it was such a laid back environment to so you're in the PT clankers athletes coming in and out just talking to you being able to work with them, if they come in from lifting and say, hey, my back hurts, can you take a look at it, it's just so easy to get access to him instead of that formal process of an outpatient clinic where someone has to go through their insurance and they have to get pre approved for all that. It's just a smooth environment that I don't think most places have.

Nate Reynolds 7:20

So you're saying that you work pretty closely with atcs what was like one thing or a few things that you notice about working with ATC? Is that maybe is like a misperception on our end. And like what what they know and what they're capable.

James Zotto 7:35

Yeah. So I mean, I helped teach in some of the athletic training program and I spent a lot of time with athletic training students and their program, they go through all the musculoskeletal system. So like our first year of PT school is all musculoskeletal, like upper extremity, lower extremity spine, and they go through the same exact course. So they were doing all the special tests, all the manual muscle testing, just like you do in PT school. So they know a great deal of stuff. And then they also are super good at the acute management, so concussions, acute ankle sprains, screening for fractures, so that they are a very, I think, underappreciated medical professional. And then there's a lot of them a lot of certified athletic trainers that work for football, and hockey. They're all straight certified strength conditioning coaches. So I think one of the best jobs that you can think of is the University of North Dakota hockey team is number one in the country right now, their athletic trainer is also their strength coach. So that just makes it so smooth, because he can alter workouts for people that are dinged up or injured, and you can just kind of bounce back and forth between those roles.

Nate Reynolds 8:50

Yeah, I think that's a great point that you kind of bring up about that. Because I think if you think about like, what is the ultimate rehab professional, it's someone that can handle the acute care injuries, know how to rehab it, and then know how to get them into that strength and conditioning into that performance aspect. And so then it's just one continuum. And I feel like in physical therapy, and like the traditional sense, we, we have a tendency to underload a lot of our patients and we really struggle going from that rehab setting to that performance, that wellness fitness area. And so that's something I think we need to work on. I think there's a lot of things out there that are helping us get there in Con Ed, but I think it's not really addressed in physical therapy school all that well. At least that's my opinion from my experience at Stony Brook. Maybe it was different me I see.

James Zotto 9:42

I mean, I agree our ther-ex course was doing like many band exercises laying on a Swiss ball or physio ball. We had a I don't even know an election course with that pretty much prep you for the CSCs But I think there was only one or two people that actually did the whole thing and took the CSCs. Based off that course, I definitely think it's becoming more common for pts to seek out that extra strength conditioning knowledge and even pts that workout and train themselves they get a good understanding what it feels like to be under a heavy barbell and actually experience that RP of seven or more. So having a good training program yourself and just being exposed to different types of training is something that pts need to branch out and get better at.

Nate Reynolds 10:33

One thing that I think I hope we kind of transition away from his theraband like, I hope we actually start using weights and because in the real world, your grandma lifting her purse or laundry, you know, she needs to lift, you know, 15-20 pounds, you know, the theraband isn't training for that environment, hoping fingers crossed that we make that transition.

James Zotto 10:56

For sure.

Nate Reynolds 10:58

And so you kind of were talking about the day to day, were there any like cool experiences that you got to do? I know when I was talking to someone that did this force residency at the University of Rochester where I live right now, you know, they did like to build a training camp in the summer. Do you have any like cool experiences like that working with specific teams? on a day to day or or even for a short period of time?

James Zotto 11:23

Yeah, yeah, it was awesome. So they let me kind of tailor it to whatever I wanted to experience. So I play college football and football is kind of my sport. So I started in July 1, and a couple weeks after is when football like summer camp fall camp started. So all the football guys were on campus. And I pretty much worked with them. The entire season, I went to every single like morning practice and in the summer, every morning practice before school actually started. And once their school schedule or weather, practice schedule, got switched afternoon, I was able to do that. But I pretty much spent the whole preseason with the football team, working with them helping athletic trainers tape in the morning, do all their rehab or prehab stuff prior to practice during the rehab and recovery stuff after practice. So that was really my main team and in the fall season. They let me travel with the team for one away game. So that was pretty cool experience to be able to see what the guys in the athletic training staff deals with on the road trying to make a make shift athletic training room in a big conference room with tables and Norma Tech's whatever they have. So I would say that was probably the highlight just being able to work with the football team. The hockey team is top notch. I mean, I tell people, their hockey team is pretty much like the Alabama comparable the alabama football so they were a little bit more closed off. I went to every single home game spent time in the locker room before and during intermission. But I wasn't able to travel there a little bit more closed off.

Nate Reynolds 12:59

Hey, that's pretty. That's pretty sweet. They you know, you got to be I feel like it's great to always be around people that are like the top of their field. And so just watching how those guys probably trained and approach their craft their top five, do you want hockey? That's that's a pretty big deal.

James Zotto 13:18

Oh, yeah. They have they have their goals there. A lot of them are already signed, they've top picks by the NHL, or in the NHL draft at high school. And now they're just getting better every year in college and just waiting to go to the NHL.

Nate Reynolds 13:33

Yeah, that's crazy. It's crazy how much different that is compared to other sports is kind of like in a baseball player, you know, getting drafted out of high school and then playing three years and then like, okay, like, I'm going to the Red Sox or Yankees or, you know, if you're a Cubs fan and the Cubs, if you're a White Sox fan. I was gonna say if you're a White Sox fan, that's unfortunate.

James Zotto 13:55

No White Sox for me. All cubs.

Nate Reynolds 13:58

So what unique value do you think doing a residency provide where you wouldn't have gotten that elsewhere? from like a clinical standpoint?

James Zotto 14:06

Yeah, so that's the reason why I wanted to do a residency is get that direct mentorship. And one thing that was so great about the residency in North Dakota was you are it's the volume isn't as high as a normal clinic. But you don't have that normal schedule, like one person every 30 minutes or every hour. It can be someone coming in from shift from practice. So you're with two pts all the time. And if I had a question with the patient, I can just say, Hey, can you come over here and watch this, let's take a look at this together. So it was so easy to get that mentoring, terms of assessment and treatment, that it was constant, you have to have so many mentoring hours throughout the residency, but there was so many mentoring hours, we couldn't even track all them just because there was so much collaboration between me and then the two PTs and then just a different treatment approach. So going to school in South Carolina. There's a lot different Treatment aspects down there versus what they're taught up here. And one of the PTS, his name is Jake Thompson. He's one of the best manual therapists I've ever seen. So he recently went through a fellowship program, spinal manipulation Institute. And he really introduced me to dry needling and got me comfortable with that took a CT, or got certified in both the courses. And then spinal manipulation. So we would be able to practice on the athletic training students. So I would just say, hey, come over here, let me practice on you that I'd be able to incorporate that into my treatment with athletes. So just getting just easy access with mentoring. And I there was a lot of things that I didn't even know I didn't know for just being exposed to a whole different treatment mentalities and progressions and regressions and things like that.

Nate Reynolds 15:50

I think the most important thing as like a new grad, whether you do a residency or not, it's just finding good mentorship. And I think one thing you have to be wary of is that you want to be in a comfortable environment where you can ask questions, I think there's a lot of times where you're the new guy, so you want to prove that you have the knowledge and the experience to treat people well. And I think it makes people are hesitant to ask questions. But if you can find an older PT that just understands what it was like to be a new grad, that kind of empathizes, then I'm always willing to show different techniques, or do try something else, and learn from other people. Because I know that I don't know everything, especially with hands on, like, like, he talks about the manual techniques, they really require a lot of practice to actually do them well. And to make sure that, especially if it's a manipulation, that when you're doing it safe in to that, you know, you are getting all your leverage, correct, and so that you can, you know, get that quick thrust, and it pretty, pretty well. And so they get that relief, cuz there's nothing worse than, you know, being like, Oh, this is the this is gonna work great. You get unloaded off, and then you do it. And you're like, nothing.

James Zotto 17:00

Yeah, that that'll really break your confidence. And it's not comfortable for the person you're working on. So that's why you practice on your family and friends before you bring to the clinic.

Nate Reynolds 17:11

Yeah, especially spinal manipulations, or like driving like, Yeah, something, something that could tweak someone a little bit. Definitely do friends and family first. So what other opportunities do you think that it provided you after you're done with a residency?

James Zotto 17:27

So I think it looks really good on a resume going through a sports residency and getting a year worth of work with athletes, especially as a new grad, like when you're out of PT school, so that allowed me to get that job in South Carolina, it was a brand new sports Performance Center. And all other doctors, they work for the University of South Carolina, South Carolina State, Newbury college, so some of the smaller schools in that region. So they see high volumes of surgery. And they see high volumes of athletes, though, like ACL, shoulder reconstructions, hip play room, repairs, all that stuff. So that I, I'm guessing the sports residency allowed me to be a candidate for that job. And one thing that was pretty cool about that job is in the mornings, we'd see our normal caseload. But in the afternoons, myself, and another sports PT would work in like, I guess you'd call like an ACL like bridge program. So kids out were anywhere between four and five months out of surgery, they, they graduated from their standard or normal PT, and then they were brought in for performance training. So it's pretty much a strength conditioning program, taking them through all their strength work. plyometrics jump training, agility, change of direction trending. So that was an amazing experience, getting my hands on being able to pretty much coach all these mostly High School, some college kids daily, just seeing the high volumes, got my reps in, and I think that was a great experience.

Nate Reynolds 18:57

Yeah, my last job, we had like a bridge program. It was like an ATC string coach that did that. But nothing like you're talking about where it was like multiple people. I mean, I think that you kind of hope that's where things are going with PT is that you can help in that strength and conditioning realm. I think you're experienced definitely want your skill set to that. What do you think the hardest part because I feel like I haven't seen enough high level athletes to really be as dialed in. We're like that plyometric strength training post up. What are some of the things that you think you wish you kind of knew when you're training like an ACL patient at the end of their rehab going into that return to sport?

James Zotto 19:43

So I think it all goes to the point of looking back and see you Okay, where does the athlete need to be? So what is optimal performance for their sport, so starting with the end in mind, so breaking it down, okay, this is a football wide receiver, they need to be able to run This fast this is where their squat was, this is where the Queen was, this is where the vertical jump was. They need to be able to change direction, decelerate, accelerate. So finding all those things, knowing what they have to do for their sport. And working backwards from there, I think is one of the things that really helped me during my residency and able to take that to when I was working in South Carolina. So understanding what they have to be able to do and breaking it down from there, in terms of all the strength training, plyometric progression, and change the direction and Jody, seeing it and experiencing it, and college weight room myself personally, through going through it, watching all the strength coaches at the University of North Dakota and working with them, lots of reading. So there's so many good articles on ACL return to sport and different frameworks there. And then just diving into the strength conditioning principles, reading the CSCS. I can't remember the name of the book, but national strength conditioning Association essentials of strength training, I think that's what's the name of it is just diving into strength conditioning research is is definitely key in terms of performance training, and return to play return to performance training with ACLs in particular.

Nate Reynolds 21:18

The next course, I'm actually taking is actually a strength and conditioning course, I think. Sometimes we have to look outside the PT realm to learn in and kind of grow our scope of practice, because I think we're such we're so narrowly focused on the rehab aspect that, you know, like we kind of talked about earlier about how we kind of missed those strength and conditioning principles and how to apply them into rehab and kind of regress those higher athletes. And you had a an Instagram post today, they just produced that you're talking about what was it called?

James Zotto 21:57

Sure how to pronounce it. TinDeK.

Nate Reynolds 22:01

Yes, indeed, yeah. tindek progresser. Yeah, I looked up our conversation before this, and autocorrect hinted Tinder progressor. A very different conversation.

James Zotto 22:14

Yeah, yeah, for sure.

Nate Reynolds 22:16

How do you use something that's meant for climbing to kind of give yourself some objective measures in the rehab setting?

James Zotto 22:25

Yeah, so I've I saw this, it was posted by Scott Morrison. If you're not familiar with Scott Morrison, he's, I think he's the chair of the sports section of the APTA. And for anyone listening, if you're interested in sports, physical therapy, definitely join the sports section of the APTA they've been putting out so many good posts and articles, and videos and webinars like this, they do it weekly. That's just great information for sports, Beatty, and it's all free, you just have to sign up for the sports section and pay maybe like 60 bucks a year. So first off, if you're a sports between you're not doing that, definitely do that. But there's so much research, I was one of those guys that Oh, a leg extension that's not functional testing quad strength that's not functional. But as I dive more into the research and started listening to all these high level researchers, pts ACL specialists, it's all about the quads. So having some type of functional way to measure quad strength is so key. So my clinic, we don't have access to the isokinetic dynamometer. And we don't have a handheld dynamometer, those run 800 to 1000 bucks. So I saw this post by Scott Morrison. And this technique was made for mountain climbers, it tests grip strength and endurance. And he was able to set it up with a leg extension. So you're able to set it in line with any type of leg extension or leg curl machine, and measure peak force and rate of force development for knee extension and knee flexion. So I've been using that with all my ACLs every month I test quad strain, knee flexion strain just to see where we're at where we need to go and how we can progress their training.

Nate Reynolds 24:04

And so what weight do you put on, like the cable column?

James Zotto 24:09

Yeah. So on that post, your width, the technique, you're measuring max volitional, isometric contraction, so you need to set it up to something that doesn't move. So I had that leg press machine set up to like, whatever it is, I think it's like 200 250 pounds. So I put 250 pounds on there. So the person that's pressing into the, the calf, the leg calf doesn't move it. So they're just sitting there, and it's easiest at 90 degrees of knee flexion. Because it's just easier to measure that way. And they're sitting at 90 degrees knee flexion is kicking in that thing as hard as they can. And that technique is in line with their force. So it's just able to measure it on that progress rate. It gives you an app on your phone that can track the peak load and rate of force development.

Nate Reynolds 24:56

Then you also mentioned that you use it for shoulders. How do you set that up?

James Zotto 25:00

So we have, we don't have anything that's kind of in line with the shoulders in terms of the cable machine, we can adjust it. So we have some, like metal bars that are bolted into the wall. So I just take, like a little ankle cuff that I can wrap it around the bars on the wall. Okay, carabiner to the from the ankle weight to the tindek. And then just use like a hand strap into use that from your arm to the attendee, and just measuring internal extra rotation at zero degrees and then 9090. And I'll put a post of that eventually, when I start talking shoulders, but yeah, it's super easy to set up.

Nate Reynolds 25:43

Yeah, I mean, I think that's one thing that we're all kind of looking for, is financially, you know, as soon as somebody says medical it skyrockets the price. And so kind of ways like this, that you can use something that may not be necessary a medical device, but has everything you're looking for, it can definitely help out your your clinical practice. And I think that's one thing we need is we need to have more objective measures that we can show our insurance companies that we're making progress, because there's times where the high level athlete, you know, you know, you can do the why balance, you know, FMS, even though most people are, I think are switching away from that now. But like you also demonstrate, like the hop test, you know, those are pretty, you know, you're kind of limited with how many tests you have, that are higher level. So I think this is a great way that you can kind of objectify the full rehab, not just the end.

James Zotto 26:39

Yeah, it's way better than a manual muscle test, because you're not going to be able to break a high school or higher, higher level athletes. So getting numbers to it, athletes, like numbers, athletes, like goals to be able to achieve. So having those numbers and getting within those certain percentages is definitely something that will help any active person or athlete that you're working with.

Nate Reynolds 27:00

So one of my last questions is, do you think you need to do a sports residency program to get into professional sports?

James Zotto 27:09

Yeah, so that's a tough one. So I've never worked in professional sports. But I think that there's a couple, there's a couple things that are important there, I think having the athletic training background definitely helps. Because those are the main position. So the athletic trainers are the head of sports, medicine, and these big, pro sports teams, football, basketball, baseball. So having an athletic training background always helps because you're able to do a cube coverage on the field. And you're comfortable with all the taping and things like that. So having that having a sports residency definitely looks good. It shows that you've had that experience and the mentoring, of being in a high level sports performance team or setting. But I think the biggest thing is just getting to know people, knowing the right people, knowing the people that are hiring and working for these teams and having them be comfortable bringing you on, because you're with them all day, every day, especially during the season. you're traveling with the team, you're with the team 24 seven, pretty much. So having that great experience in a sports residency I think definitely helps. But I think being an athletic trainer and having good connections and having good experiences with the right people, I think is a little bit more important.

Nate Reynolds 28:29

Do you think that, you know, you we kind of talked about like the sports community and physical therapy. Did you get connected with other sports residents while you're at North Dakota was there kind of kind of like a collaboration with other sports residents at all?

James Zotto 28:46

So I'm trying to think back there wasn't really I know some programs do like a swap. So their residency will go to another residency program for a week or two. We don't really have that we're kind of we're up in North Dakota and there's nothing really close by so that makes a little bit more. But I did go down to Fargo which is about 90 miles south of where I am in Grand Forks. So they have a really good sports Performance Center. in Fargo there. It's called the Sanford power center and they just built a new facility in California where all these high level NFL guys are training. So there's one in Fargo, there's one in Sioux Falls, there's one in Bismarck, and I would go down there one to two times a month and hang out with those with those guys. They're all sports, pts orthopedic certified specialist sports certified specialists. And they had an ortho ortho residency going on there. So whenever I go down there, sometimes their residents would be there shadowing or working a little bit, but there was nothing formal to where I got connected with other residents. I think there's there's a lot of stuff on Twitter Instagram right now where all these sports residences are getting connected and all these guys are talking on Twitter, and Things like that. But I wasn't really connected with that couple years ago when I was doing it.

Nate Reynolds 30:05

Yeah, I think they're, it's funny. I don't really use Twitter much. But I remember back when I was in PT school a lot of people were talking about like, yeah, like you got to follow him on Twitter. I was like who's still using Twitter?

James Zotto 30:17

There's a lot of good information on Twitter. I don't post anything on Twitter, really besides sports stuff, but like Lenny macrina, dan Moran's like vinyl, they're posting a lot of good articles. That's where I get a lot of my article ideas. I just see what they post in it. They're posting it reading it. I'm definitely reading it. So

Nate Reynolds 30:34

after this podcast, I'll probably credit a Twitter.

James Zotto 30:37

Yeah, look, get a get on a sports, orthopedic, Twitter. It's, there's a lot of good stuff on there.

Nate Reynolds 30:43

Yeah, I definitely well. So the last segment of this is gonna be kind of a rapid fire heartache segment. I'm just gonna ask you, so quick questions. And whatever comes to the top of your mind and just gonna fire it off, and kind of see what your answers are. So the first question, what's one tip you give to a new grad,

James Zotto 31:07

Find a mentor, either online with social media, get in a group or find a clinic where there's everyone smarter than you don't be the smartest person in the room. So find a mentor, learn from them and get good fast with that person.

Nate Reynolds 31:23

Question to name one course you'd recommend taking.

James Zotto 31:27

So it depends on what you're looking for. If you're looking for assessment, I would say the SFMA from functional movement systems. If you're looking for manual therapy, either the Institute of athletic regeneration or spinal manipulation Institute with James gunning, or if you're looking for BFR Owens recovery, those are my favorite courses that I've taken and can't go wrong with those.

Nate Reynolds 31:51

Question three, one person dead or alive? You'd have dinner with

James Zotto 31:57

Michael Jordan, Michael Jordan. That last, that last dance documentary was amazing. So just brought back memories from living in Chicago is a little kid.

Nate Reynolds 32:09

Do you think you'd pay for dinner? Or do you think you'd have to pay for him?

James Zotto 32:13

No, he'd pay.

Nate Reynolds 32:15

Sure. I feel like he's a little stingy.

James Zotto 32:19

He probably compete with me somehow we'd have some type of card game going on or something? I don't know.

Nate Reynolds 32:25

Yeah, I feel like there'll be a bet.

And then last question, what is your favorite podcast?

James Zotto 32:41

Well, I need to start listening to more of yours. So yours gonna be up there. All ones recovery science, PT, entrepreneur, entrepreneur podcast with Danny Mata. Informed performance podcast pacing performance podcast, and the just by performance podcast, a lot of strength conditioning in there with a little bit of business and PT.

Nate Reynolds 33:01

Yeah, that I think that's how we kind of got reconnected was. Well, we both took the Institute of Clinical Excellence, we're talking about advanced advanced course for fitness athlete. And that's what I was like, James zato was like, I don't know him. And then I think you're also in like, the same Danny matej group. With the PTA entrepreneurs. There's like, wow, yeah. I was like, we're,

James Zotto 33:25

We're kind of on the same track here.

Nate Reynolds 33:27

Yeah, except for this first residency. You know, it's just kind of funny that overlaps down in South Carolina. But you know, our careers have kind of taken a similar interests. You know, you went out to North Dakota. I went up to New York, but they definitely have some similarities. James, thanks so much for coming on to the podcast is great learning about sports residencies from you. I think people will definitely appreciate that information. Because I know when I was considering it, there's just so much information out there. And like you said, it's kind of an intimidating process when you look at all the schools and you know, everyone that is coming out as a new grad is considering it. So it's great just talking with someone that's been through it. So thank you.

James Zotto 34:10

Yeah, I appreciate you having me on and we'll have to do a part two eventually.

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