The Tactical Doc: With Dr. Brandon Bellman

EP40: The Tactical Doc

00:00:00 Dr. Bellman: Like many physical therapists, I tore my ACL. I had a wonderful PT experience. I really fell in love with the ideas of exercise science, motivating individuals, getting them back to doing what they love. Fast forward, I go to college at Otterbein University. And so as I was completing my education, I started to see that professional athletes get all this high quality care. I was like, I really want to look into the first responder or the tactical athlete. There is no off season. Every day, it's game time.

00:00:36 Dr. Bellman: Specifically the law enforcement officers, risk for injury is three times greater and their life expectancy is 21.9 years less than their counterpart in the general public. It is a lot about changing how they frame or see the problem. Am I solving their pain or letting them not have to question whether their back's gonna give out the next time they have a situation that requires them to get physical? Unfortunately in that situation, that could mean life for us.

00:01:13 Cinnamon: It's the first responder, the first to get the call, the first on scene, greeted by God knows what, pushed beyond the limits that they don't even set. Then what happens? You're listening to After the Tones Drop. We're your hosts. I'm Cinnamon, a first responder trauma therapist who founded our practice after seeing the need for specialized care following a local line of duty death. 

00:01:40 Erin: And I'm Erin. I'm a first responder integration coach. 

00:01:44 Cinnamon: We help first responders receive transformational training, therapy, and coaching. 

00:01:49 Erin: Now we come to you to explore, demystify, and destigmatize mental health and wellness for first responders. 

00:01:58 Cinnamon: Our show brings you stories from real first responders, the tools they've learned, the changes they've made, and the lives they now get to live.

00:02:16 Erin: Welcome, Brandon. We're excited to have you. 

00:02:19 Dr. Bellman: Thanks for having me, guys. 

00:02:21 Erin: Yeah. 

00:02:22 Cinnamon: Yeah, we're mixing it up. Congratulations, Brandon. You have earned the gift of me teeing you up and introducing you, which is a stray from our typical mode. So let's start with the doctor part. I'm going to try to get this right. Brandon, our guest, Brandon Bellman is a doctor. The doctorate is in physical therapy, but you have your BS. 

00:02:45 Dr. Bellman: Correct.

00:02:45 Cinnamon: In athletic training and then you have your master's degree in allied health. So you are a hyper-educated individual and you are also duly credentialed in both physical therapy as well as an athletic trainer. And we got to meet because we have a connection where you last were, which was at Otterbein College in Westerville, Ohio. So what I've learned about you both in our conversations as well as our introduction email was that you also own Bell Performance Therapy. And you really have this passion to understand and implement how the human body rehabilitates and what that performance can look like when somebody is performing at an optimal level. 

00:03:34 Cinnamon: One of your missions with Bell Performance Therapy is to serve over 10,000 first responders in the next five years. And you're currently running a 14-week wellness pilot. We get to introduce you, but many people who are in this industry in Ohio or central Ohio probably know you. But this allows you to provide some high quality services to individuals who may be outside of what maybe insurance would cover, but would be more along the lines of preventative where maybe there's not an injury yet that would justify physical therapy. And then you also do some non-traditional things after an injury. And then you also have kind of like a one-stop shop where an individual can get all of the things and I'll kind of let you talk to our listeners about what those things are. So did I miss anything, Erin, in a proper introduction? 

00:04:27 Erin: I think you did fantastic. 

00:04:28 Cinnamon: Thank you. 

00:04:28 Erin: You're hired. 

00:04:29 Cinnamon: Like a five out of five. Okay. And so now we will turn it over to Dr. Bellman and he can talk to us about his work and his passion. 

00:04:38 Dr. Bellman: Yeah, absolutely. Thank you. That was a wonderful introduction, probably the best one I've ever had. So I'll start with how I came to get here. And just like any physical therapist story, it always starts with your first injury. As a high school athlete, just like many PTs, I tore my ACL. I had a wonderful PT experience. I really fell in love with the ideas of exercise science, motivating individuals, getting them back to doing what they love. And I was unfortunate and fortunate enough to have a second injury that resulted in very poor care and took me down the medical pipeline where things got misdiagnosed, put me in positions where I could have had surgeries to get me back on track but timelines were missed and ultimately, I had a bad episode of care. 

00:05:27 Dr. Bellman: And so, this hit me on the other side of the health and wellness spectrum of, I knew what good care looked like and I knew what bad care looked like. So, fast forward, I go to college at Otterbein University to get my Bachelors in athletic training and I learn immediately what things went well in my first injury and what things went bad in my second injury and where different education styles and backgrounds could really affect how someone receives the quality of care they receive. So in this path of athletic training, you're working with college athletes, high school athletes, but I started to research, into, the tactical athlete. 

00:06:04 Dr. Bellman: And so as I was completing my education, I started to see that professional athletes get all this high quality care. And that's ultimately where athletic trainers want to end up is they're like, hey, I want to go work for a pro team. But by the end of my education, I felt I've kind of seen that, done that as far as covering football, covering soccer, baseball. I really want to look into this tactical athlete. And so, when I went through my master's also at Otterbein University, I really tailored that to learn about the business of physical therapy and the niche of the tactical athlete.

00:06:40 Dr. Bellman: And so, what I did was I went and I saw out any practitioner provider, strength and conditioning coach that worked with tactical athletes and I interviewed them for the next four years trying to understand how do you identify the needs of military, police, fire, EMS, how do you create a performance program that is tailored to their demands because if you look at a football athlete, they have an in-season and off-season. And based on those timelines, you can dictate what the training looks like. 

00:07:14 Dr. Bellman: Are we going more for strength? Are we going more for speed? We've got times to decompress, shed all the stress you've accumulated from the season. Or you look into the first responder or the tactical athlete. There is no end season. There is no off season. Every day, it's game time. And so I carried that education into my doctorate. And so in my path to get more experience with tactical athletes, I just started offering free services.

00:07:39 Dr. Bellman: While I was unlicensed, I was just doing personal training. Put on Reddit boards and Instagram, wherever I could find people that were police officers. Hey, I'll do a free 12 week program for you. Here's my background. I'd love just to get experience and get to learn more about your community. So this provided a lot of good opportunities for me to learn. So far to the point where I was working with law enforcement officers from the UK, I was introduced to a classmate’s family member who was a local officer.

00:08:09 Dr. Bellman: And one of his stories really changed the trajectory of where I wanted to take my business. And so he was in his 50s, had been in law enforcement for his entire professional career. He had a double knee replacement. And so he did a couple of weeks of PT. They kicked him to the edge once insurance ran out as far as coverage. And they never got him back to running. He was afraid, if he had to act on the job, is he going to be able to perform?

00:08:37 Dr. Bellman: He also had a fitness test coming up which had some financial repercussions as far as insurance benefits if he wasn't going to pass it. And he was like, Brandon, I don't know if I can remain a police officer if my knees aren't working. Like, I don't have confidence in this. So I worked with him for about 12 weeks. The test ended up coming three months earlier than we anticipated. But fortunately, he was able to complete all the running with spare time.

00:09:06 Dr. Bellman: In addition, some of the big things that I really took away from it was my time working with him. He lost 18 pounds, his resting heart rate dropped by 18 points. So, his resting heart rate was about 100 when I met him and by the end of the 12 weeks, it was in the 80s. And so, to me, I was like, okay, these are some high indicators that were making meaningful change in his health. And then I really took to the books of, what do these look like for other law enforcement officers or other first responders? 

00:09:41 Dr. Bellman: So when I was looking through the stats and Cinnamon, I believe I talked to you all about this. I'm, we’re on the phone. So I apologize if anyone already knows these. I'm sure they've been beaten into you. But specifically the law enforcement officers, your risk for injury is three times greater than the general public. 83% of officers are overweight. 85% of retired officers are overweight and their life expectancy is 21.9 years less than their counterpart in the general public. 

00:10:13 [Cinnamon]: Wow. 

00:10:14 Dr. Bellman: Yeah. When I saw this, I really took a step back and I said, who's out there addressing these issues? And in my research, as you start on Google, I'm looking for first responder health and wellness providers. And what I'm finding is there's apps and maybe a couple companies that are providing services but they're sequestered on, their edge of the nation. And I start reaching out to police officers that I know through friends and family and they're saying, yeah, I know my agency has these apps. I know they have these resources, but I don't know how to get involved with them or I don't really trust it. 

00:10:51 Dr. Bellman: And so, at this point, I'm still in PT school and I'm like, all right, well, I know I want to deliver high quality services, unfortunately, in the state of healthcare, specifically physical therapy. If you go work for many of the… we'll call them big box clinics. You can have an amazing PT but for insurance reimbursement purposes, you have to get them double, triple booked at times. If you have three patients in one hour, you are not delivering care. So, if you get officers who have to go through this clinic because that's just where they were referred to, you're gonna get a double knee replacement and you're gonna get them, oh hey, we got you walking and that's good enough. Insurance said, “We won't cover anymore, so see you later.” 

00:11:33 Erin: Yeah, sorry that you can't do your job anymore, but at least you're walking. 

00:11:36 Dr. Bellman: Absolutely. 

00:11:37 Cinnamon: What a bar. Like if that's our bar for measurement of what we would consider success or complete, that's a little unnerving. 

00:11:47 Dr. Bellman: Absolutely. And to try and get his perspective where he thought he was doomed to be in pain, not be able to complete work. And that's a complete identity shift for him. Like, he is the provider for his family. And so there is a ton of stress that he was dealing with that I don't have insight to completely, but knowing that if I can get him to run 300 meters in X amount of time, to him, he is fulfilling additional requirements that get him through the job, keep him a provider for his family, make him feel confident in his ability to react to a situation should he need to hoof it or get moving a little quicker on the job. 

00:12:34 Cinnamon: I have so many things that I want to say. And so Erin, are you going to still let me ask the questions because I have so many questions. I'm so excited about what you have to say. 

00:12:45 Erin: I can just sit here and listen and learn. 

00:12:47 Cinnamon: Sit still and look pretty. 

00:12:48 Erin: Really, I can. I promise. 

00:12:50 Cinnamon: Okay. Dr. Bellman, let me go all the way back up to the top of the first page of my notes. In our field, and I think in general, when we have certificates hanging on our walls, most people just say it doesn't matter what they say. If I have an office and a this and a that, then it's pretty vanilla across the board. But I find it one very interesting and also slightly scary when you said that the quality of care that any of us can receive, and you're talking specifically about PT is impacted by the education or the institution in which they received it. Can you talk a little bit more about that? 

00:13:34 Dr. Bellman: Yeah. So, I don't want to point at any one institution. And as you look across any medical profession, there's going to be different schools of thought on how you approach certain situations. And when it comes to education, there's more traditional teachings that, as we are looking at the research, do not hold up in their narratives, which may be more important than the actual intervention itself, is, why are you providing this intervention? What are you telling the patient that will do for them? 

00:14:07 Dr. Bellman: So, let's say it comes to a joint alignment and I won't tuck your ears off about the fallacies in that as well. But what a lot of people will come in is, hey, I was told I have a degenerating spine or my hips are out of alignment or something is out of whack and that creates a fear of movement. So, now they're like, I need to put myself in a bubble because even if I get this adjusted or fixed, it could pop out at any second. But in all reality, a lot of research is saying you putting yourself in a bubble is only exacerbating that, it's making you fragile. We need to get you moving. 

00:14:46 Dr. Bellman: 99% of people have asymmetries in their musculoskeletal system. Whether it is a true malalignment of a joint, it really doesn't matter. We want to get you functioning. I like to say strong is never wrong. We want to get you strong, make you robust so that any demand thrown at you, regardless of what an image or some other clinician might say, you are not afraid to act because the second you put yourself in a bubble, you are going to second guess all of your actions. It is going to change your identity as what you're capable of physically, what you can do in your job, how you can support your family and play a role in. 

00:15:25 Dr. Bellman: So my long-winded answer, there's no wrong school, it's just a matter of how do you approach the issues? And then it is what constraints does the healthcare system place and how well you can deliver these interventions? 

00:15:41 Cinnamon: Yeah, that, I think there is a world of knowledge that only providers get to understand when it comes to healthcare because we as consumers don't always get what's happening on the back end and what is motivating things. And we're interfacing with people, but it's not the people we're interfacing with that's always making those decisions. And that does complicate the trust in the treatment. One of the things that you talked about that taps into what we do is, as you were talking about the gentleman that you worked with, and made such an impact on his life, what does this mean for what we call the drop? 

00:16:25 Cinnamon: So Ohio and some other states have something similar where after the retirement age, I can stay involved for eight years. So we have a lot of that, but if we have a lot of that where people need office jobs, then we're losing experience on the streets or in the stations. That impacts our ability to recruit. Like you mentioned, if I am having a reduced level of confidence in my ability to do my job and feel like I'm doomed to the pain, that's going to make me hesitant and that can compound lethality on the job. Whether or not I feel like I need to go for my gun versus I can run a little bit further. 

00:17:07 Cinnamon: You also mentioned the identity shift when you're the provider in a family and Erin and I have done episode after episode that has folded in the concept of identity in these roles and how strongly our first responders tie themselves to what they do. And when issue of performance or injury or chronic pain becomes present, then now we have to look at the implications of your mental health. Right? So this isn't just about, how can we get injured or old guys more fit and able to do their job. There's also the component. 

00:17:47 Cinnamon: And I think all of us, whether we're making the podcast right now or we're listening to the podcast, know at least one person who has had negatively impacted mental health due to an injury. I want to go back and have you define for us what a tactical athlete is. 

00:18:04 Dr. Bellman: Yes. So there are several definitions. I would include a tactical athlete to be more so your first responders. So police, fire, EMS and military. And then depending on the definition, it may include combat athletes, which would be like your MMA, those sort of athletes. And newer definitions would include your prepared civilian. So someone who wants to feel like they are more of a hybrid athlete. And this may be someone who is considering going into the National Guard, going into the army, or they just find having those skills useful and it is something they enjoy. 

00:18:47 Cinnamon: I'm so glad that after you said a combat athlete, you said MMA because I was thinking like military combat, but I get where you're going now. We can see how that group is a little homogeneous. So what makes the difference in this group as far as that athleticism? I get the idea of like, I'm not necessarily a weightlifter or a marathon runner. So what happens differently for tactical athletes that would make their injuries different as well as their rehab different? 

00:19:19 Dr. Bellman: Yeah. So as far as their injuries, it's a matter of what the profession is, what stresses it is placing on them. When you look at your endurance athletes, their training, mostly endurance. If you look at a power Olympic lifter, they wanna take that power, that Olympic lifting, the time with a barbell through the roof. If you look at a field athlete, then you start looking, well, what position do they play? Is it a receiver? Is it alignment? And I can train according to what that position does. When you look to a police officer, we don't know what every situation is going to entail. So it is a very broad spectrum of we need to train a little bit of everything. We need to identify that our timeline has no constraints of in-season or off-season. 

00:20:08 Dr. Bellman: You go into work X amount of days per week and every day is game day. And with that training, knowing that we do not have our scheduled game days, you need to modify, manage stress completely different. If we're in the pre-season, we can make the workout super tough, condition you super hard, but if you also need to go to work the next morning or you have a shift later that evening, you can't go and guess. We can't train you to sail here. We can't have you just feeling jello on the job. 

00:20:41 Dr. Bellman: And so trying to consider a lot more factors of intensity, volume, taken to effect. What is that mental stress at this point? What is the family stress, financial stress? How do we modify so we are not pushing you into, over training or putting you in a position where you are not ready to perform at your job? 

00:21:04 Cinnamon: That's a fantastic explanation. I mean, I certainly got clear, Erin?

00:21:08 Erin: I never write things down. It's the one thing I wrote down with a star, tactical athlete, question mark. And also congratulations, listener, you are a tactical athlete. Who knew? We had a guest on, previously. He's like, as long as you throw the word tactical in front of it, they'll do it. They'll believe it. They'll buy it, which makes me chuckle. And they are athletes in that, as far as they need to be conditioned to be able to do, to do their job. So yes, that was an excellent explanation and thank you. 

00:21:35 Cinnamon: Yeah, you created something that I wasn't expecting in terms of similarities. I was thinking they sit and then all of a sudden they run or they stand, that kind of thing. But I love how you talked about the need for a broader spectrum of training focus. You have to be able to do well at a lot of things. And that every day is game day. And so that there is no in season or off season. 

00:22:03 Cinnamon: And I've got some people who come for therapy and they can't move. They'll have, like, a back injury. And even this week, I went and heated up a race bag and put it behind where a client was sitting on their back. And I didn't know if they're gonna be able to get out of the house. And so it's like, how is this person expected to go, work? And when I'm saying, hey, why don't you go get checked out? I will in three months, because that's what my next test is.

00:22:34 Cinnamon: I also like how you blended in the idea of those stressors. So can you talk a little bit about how you feel what we would call, like external stressors, like family stress or financial stress play into how somebody rehabs? 

00:22:51 Dr. Bellman: Yes. And so a lot of it may be where my scope of practice ends and where I need to refer out. 

00:23:05 Erin: Hey there, listener. If you could ask any question or freely talk about any challenge related to being on the job and no one would know, what would you say? We are excited to share about our confidential hotline that we created just for you. Through this confidential hotline, you can leave a message sharing a success, a struggle, or simply ask a question. We will spotlight calls and offer feedback and insight from a licensed therapist and a certified coach who work exclusively with first responders. 

00:23:38 Erin: You can access our hotline voicemail by visiting AfterTheTonesDrop.com and clicking the voicemail tab. Additionally, you can join our mailing list if you'd like or easily follow us on Facebook and Instagram for all the most recent updates. You know the drill. Telephone, tell a friend, tell a first responder.

00:24:11 Cinnamon: Erin, you have to use words now. 

00:24:13 Erin: I literally just wrote that down about, how does mental health and physical health and how do you encourage that to go hand in hand. 

00:24:20 [Cinnamon]: What? 

00:24:21 Erin: She's like pointing at a piece of paper. That. 

00:24:23 Dr. Bellman: Yeah. 

00:24:23 Cinnamon: She's writing for you, Dr. Bellman. She never writes. 

00:24:27 Erin: I don't. I don't, so. Anyway, sorry, continue. 

00:24:31 Dr. Bellman: And so, trying to ask preliminary questions for me to get insight, where are they at in that process? And when it comes to performance training, if those stressors are high, sure, we can get after it. But the accumulation of physical and mental stress are amplifiers for potential pain or injury to feel worse for them. And so, if someone is consistently rating a high external stress, this is a cue for me to say, hey, we either need to just have a conversation. Maybe today is less exercise or rehab. And if I'm not the person who can provide that assistance, let's find you some resources to do so. 

00:25:11 Dr. Bellman: And so, the realization where physical therapy and performance training do leak over into mental health, but there is a barrier as far as my license can provide and I know that we need a full spectrum of care. And so, with my business, this is something that I've been also trying to extend out. So, we have a sports psychologist. Well, he's a mental performance coach completing his doctorate in sports psychology, but knowing that the combination of these services and what we're actually looking for now as a clinical counselor, so we get the full picture, is integrating a combination of that mental performance, cognitive stress into our training, get people more prepared for that, but also integrating that clinical counselor into that group, into that community where people feel free to speak. 

00:26:01 Dr. Bellman: And then they're like, hey, I have trust immediately, into these providers. I'm going to go right to them. I don't need to push, I don't need to wait six months until I have a very awakening moment where it could be life or death. Hopefully we are getting to those situations faster. 

00:26:17 Cinnamon: Oh, we're going to talk, Dr. Bellman, after. 

00:26:20 Erin: And I'm like, I'm in Hilliard.

00:26:21 Cinnamon: Yeah, girlfriend's in and she is a certified coach, as well as a chemical dependency counselor. Okay, so you had mentioned that the life expectancy age of law enforcement officers is 21 years less. So when you're looking at your scope and you see that, what are the things that you would have went to as far as assumed causes or what the PT physical world would say would be those causes and what doing this work have you learned about things that may not have been listed in your education but working with this population you've learned?

00:27:03 Dr. Bellman: Yeah, absolutely. At the end of the day, regardless of profession, we're all people. The number one cause of death in the United States is heart disease. When you look at law enforcement, early retirement due to heart disease is 20% to 50% of cases. And so when we look back to my example of me working with the one officer, when I walked in with him day one, I was like, hey, your resting heart rate’s at 100. You are in a high stress mode all the time relative to what it could be. This gentleman was a tall glass of water. He was about 6'5", 340 when I met him. 

00:27:37 Dr. Bellman: And so, carrying that extra weight, we just know in the literature is going to put you at risk for additional comorbidities should he develop type 2 diabetes down the road, should he develop other metabolic conditions. And so, trying to address these, whether that is in the form of exercise, in my vision, we need to do the whole hearted approach where it's exercise, we get them in contact with the dietician. If it is a mental component, we get them in contact with a counselor. If it is a food relationship issue. 

00:28:14 Dr. Bellman: And so, taking into effect that sometimes it's not anything special as far as they don't have a rare heart condition that we're seeing in cops but it is heart disease and it just happens to occur more based on a combination of diet, being sedentary as a requirement of the job for a good portion of it and stress. And they have the perfect storm. 

00:28:38 Cinnamon: So right before you answered that question, I wrote down, how does their cortisol levels contribute to their, let's call it obesity or like, I hate the word overweight, cause it's like over what weight, but you know what I'm saying. 

00:28:55 Dr. Bellman: Yeah. 

00:28:55 Cinnamon: Where you're seeing the weight be a factor and we can talk about the lack of activity, but we also know that many times those big bellies that we see that are hiding the belt buckle has a relationship with stress hormones and cortisol and the like. I know you say diet and exercise and stress, but I don't think that we really truly understand what you mean when you say stress. 

00:29:21 Dr. Bellman: Yes. So getting so sympathetic versus parasympathetic hormones. So sympathetic, being your fight or flight, that norepinephrine, epinephrine, your adrenaline and your cortisol, all of these things that stimulate your body's processes to speed it up to say, hey, we have to act now. If you are a first responder, a tactical athlete, odds are you are operating in this high alert sympathetic state more often than you need to or should. And so these elevated levels will start to tank your endocrine response system, your immune response system, and you get a cascade of potential risk factors, comorbidities that will follow if these are not addressed. And we start to see that come out as heart disease and other related possible morbidities. 

00:30:15 Cinnamon: I think a lot of times we expect that there to be, like a certain line in someone's career where maybe every shift they end up in the gym and then all of a sudden like they don't. And those guys that are still in the gym, those folks that are still working out on the regular basis, how much of an impact do you think it would have on their overall health if they added a component that addressed the stress? 

00:30:39 Cinnamon: So let's say they're eating okay, they're working out regularly, maybe not with a trainer and maybe not the way that you would have them working out as an athletic trainer, but just the way that they do it in the station or agency gym. But what piece of action would you want them to take to address that stress component that you're speaking of? 

00:31:01 Dr. Bellman: Yeah. So a lot of it could be some of your basic issues. How is the recovery processes? How are you going home? On my end, a lot of education on sleep hygiene. You need that for recovery of all systems. As far as other stress training, how do you debrief yourself? Now, this is where my services end and picks up with my sports psychologists or like clinical counselors but how are you disseminating what you're experiencing? How are you addressing your insecurities, your fears? And as far as performance, that may be allowing someone to operate in a situation where simple tasks don't require as much mental bandwidth. 

00:31:45 Dr. Bellman: And so, your motor mapping, your ability, we'll say muscle memory, your ability to do things that are necessary and have low cognitive demand, create less stress on the system so that when you are evaluating a situation out in the field, you can mentally be more in tune with that rather than thinking, oh, hey, I need to go position myself in this certain place and I need to be aware of what's behind me. 

00:32:11 Cinnamon: It decreases the oh shit moments. 

00:32:14 Dr. Bellman: Yes. 

00:32:14 Cinnamon: You're less likely to go to the oh shit because you have more room in your cup to handle shit that doesn't require it to turn into an oh shit. Okay, so you hit the nail on the head with our people and our people love to say, I'm used to it. When it comes to their shitty ass sleep quality, they don't sleep. So then you're lucky maybe if you get, whether… depending on law enforcement, what your shift is, but one night out of three, there's a good chance that you will be disrupted if you have a averagely active department. 

00:32:52 Cinnamon: But then we have people who have disruptive sleep because they don't have a regular sleep schedule or they are having nightmares or dreams, whatever. Can you teach our people right now how it impacts the body and their ability to function and recover? Because we say it all day and I will even show them an organ clock and be like, this is what you're missing out on. But as a doctor, can you please maybe convince them what a big deal their lack of sleep is because they spend so much time with people who also sleep like shit that they have normalized it and they don't understand to what degree this is impacting them and how serious it is. 

00:33:40 Dr. Bellman: Yes. So I will say my doctorate is in physical therapy. So all of my focus for the past several years is how does this affect injury rates and recovery? There was a study and I'm gonna butcher the actual numbers without it in front of me. But if you were getting less than seven hours consistently, I believe your risk of injury goes up from anywhere from 70% to 100% for any musculoskeletal injury.

00:34:09 Cinnamon: What's a musculoskeletal injury? 

00:34:13 Dr. Bellman: So typically in law enforcement, you're gonna see these as your sprains, your strains, your back pain. If you look at law enforcement, 15% to 35% of individuals will go through early retirement just because they have back pain. 

00:34:28 Cinnamon: What was that percentage again? 

00:34:31 Dr. Bellman: 15% to 35%. 

00:34:33 Cinnamon: And when you say early retirement, would that be early retirement according to our retirement systems, like they haven't met 25 years or they haven't met a certain age mark and they're declaring it in early retirement. 

00:34:49 Dr. Bellman: The study was from Smith et al. health and fitness and law enforcement. I would have to go back and look at their definition, but I believe it was if you left the workforce of law enforcement before you met your planned time, that is what they dictated as early retirement. 

00:35:08 Cinnamon: So I have yet to meet someone doing these jobs that has not talked about some kind of ache or pain or injury that would fall under that musculoskeletal list. So even that lower back pain or the neck pain, all of that stuff seems to be pretty inclusive. Right? So what you're saying here is, all of the injuries that we typically see out of our tactical athletes falls under the category that if you're sleeping less than seven hours a night, you're 70% to 100% more likely to get those. 

00:35:50 Dr. Bellman: Correct. 

00:35:50 Cinnamon: That would explain it, right? From me having this kink in my neck that I can't seem to get rid of to somebody complaining about their lower back pain to jumping out of a fire truck into a pothole and spraining their ankle. All of that would be included. It sounds more not like a question, because it sounds more like a, wow, but could you confirm that I'm in the right region? 

00:36:13 Dr. Bellman: Yes. 

00:36:14 Cinnamon: Okay. 

00:36:14 Dr. Bellman: If your body is not recovering, your tissue is going to continue and continue to experience traumas. Initially, exercise, you create traumas to your body and you respond to it. If you're not giving your body a chance to adapt, build that muscle, build back that bone, build back that tendon. 

00:36:32 Cinnamon: Oh, wait, wait. That sounds a little bit different. So let me make sure I'm saying this right. So if I go to the gym and work out an hour every single day, that is going to create trauma to my tissue because I'm working it out. But then if I go home and I sleep less than seven hours and then the next day try to work out again, my body would have no time for restoration and I'm traumatizing that tissue again before it's recovered. 

00:37:02 Dr. Bellman: Yes. I would say if you are getting no sleep and you are training to failure back to back days, it's probably going to be very soon that you are going to experience a muscle strain. 

00:37:13 Cinnamon: Hey, fire boys. Listen, they're the worst, man. 

00:37:20 Dr. Bellman: Now, in a lot of training approaches, if you are working with firefighters or law enforcement, knowing that I don't want to take them to the 100% stress mark. I don't want to train them to failure because I know their sleep isn't going to be great. And so I want to manage that stress. I want to keep it where we are still providing, opportunity to adapt, to get stronger, faster, to make those tissues stronger. But I am going to plan how that looks throughout the week. 

00:37:49 Cinnamon: So what you're doing is going to take that into account because you're a professional and know what the hell you're doing. But if I am doing this on my own and trying to work out like I did when I was a high school football player or a soccer player or whatever else, and just going balls to the walls while my ACDC plays, and then I'm up all night with runs, that's where the problems come in, not what you're offering, which is it's being created in relation to the knowledge of what the sleep is, but that's because you know that stuff, where if you don't know that stuff, you're not going to take that into consideration.

00:38:27 Dr. Bellman: Absolutely. 

00:38:28 Cinnamon: Oh, geez. 

00:38:29 Erin: I know this one's gonna get sent out in an email for every client to listen to, like, here, check this out. What I was gonna say was, I'm curious about the effects that even just something as simple as their gun belt has on their bodies. Let's just say they are in really great physical health, but they carry around this heavy gun belt.

00:38:47 Cinnamon: 60 pounds, typically. 

00:38:48 Erin: Yeah. What's your experience with that alone? 

00:38:51 Dr. Bellman: Yeah. So if we wanna break a lot of injury down to its simplest form, it is typically you are putting too much stress too soon or creating a demand higher than what your body can handle. And so, even though you're super fit, if you are at an increased volume, so you are getting 40 plus hours a week with external 60 pounds on your body, that is going to wear you down. And if we look back to the recovery practices, if you are not optimizing your recovery and potentially if you are not training to get your body more adapted to tolerate those stresses, then there's going to be failures in the system. It's not guaranteed. Maybe there's some people who maybe aren't in the greatest shape and they can tolerate it but I would say that's a rare few. 

00:39:43 Cinnamon: I'm so glad Erin asked you that because I definitely had that thought earlier, not even doing anything but just wearing the gun belt, that I may not be completely accurate, but I'm pretty sure it weighs in at about 60 pounds, depending on what your role is. That's a lot of weight. We're not even asking anybody to run or jump or even get out of a chair yet. Just having that drag all the time, which again, makes sense why people are retiring early because there's not enough seats to be sat in to take people off of the road or off of a truck. 

00:40:21 Cinnamon: Oh my gosh. I will say, Brandon, this is our first episode of this kind, and I don't know why. Now that we're hearing from you and we're learning all of this, and clearly we're learning as our clients are learning and our listeners are learning, because this is stuff that we didn't necessarily know. You could hear the shock in our voice. But this is such a key issue. 

00:40:45 Erin: It is. And I do want to say, I just looked it up, because 60 pounds seems like a lot. That's like a third grader. Wrapped around on, waist. So it says here, when fully equipped, these belts hold all of an officer's tools and weapons and typically weigh approximately 15.4 to 17.6 pounds. 

00:41:03 Cinnamon: So instead of 60, maybe what I heard was 16. 

00:41:06 Erin: 16, yeah. 

00:41:08 Cinnamon: I'm so glad you checked that. And so I don't look like an idiot. 

00:41:10 Erin: Because I was like, 60 pounds? And God, that's like having my daughter [in that moment]. 

00:41:12 Cinnamon: You know I have no concept of measurement. You ask me to walk 100 yards or 100 feet, I'm probably gonna roughly land in the same place. 

00:41:19 Erin: But that's still a lot of weight.

00:41:21 Dr. Bellman: Yeah, so when you're looking at law enforcement that load carriage, like Erin said, is probably closer to 15 pounds on the belt, then you add in plates or soft armor depending on what you're wearing and if you are in SWAT and you're wearing a little bit more gear depending on the situation at hand, that weight just continues to go up but it is still an external load that you need to train to tolerate which at times means we apply additional external load with exercise. But that also means, hey, you've accumulated a lot of, we'll call it mechanical stress, tissue stress. We need to get you out of weight and maybe unload things that'll allow you to recover.

00:42:06 Erin: Hey, there, to all you fearless folks who've been tuning in to After the Tones Drop. You know, we've been dishing out some real deal mental health wisdom for our first responders and we need your help to keep it rolling. So here's the deal. Take a minute and do us a favor by leaving a rating and review on your favorite podcast platform. And listen, we're not expecting a novel here. Just a few lines about what you're appreciating about the show. Whether it's our interviews, perhaps the educational aspect, or just our goofy humor and metaphors. And your feedback, it's like the gasoline in our engine, fueling us to bring you more of the good stuff. So let's keep that siren wailing and those reviews pouring in. Thanks, we appreciate you.

00:42:58 Cinnamon: Brandon, when we talk about, in terms of our starting point or our focus being mental health, we hear all the time, exercise is so good for your mental health. But when can exercise not be good for your mental health? I don't want people to just assume that any kind of exercise is good and it's not informed. And I think you've touched on this before, but I really want to hone in on that where it's not just like this blanket statement of exercise is good for you, but what are some of the key components that an individual who hasn't accessed you or someone like you, what do they need to make sure that they're doing as well as not doing to actually benefit from exercise, physically and mentally? 

00:43:47 Dr. Bellman: Yeah, so I would say where it typically becomes counterproductive is when you are taking it to the extremes. And so situations where you're chasing being sore, you want to work out the failure. And whether you think you're doing it for your fitness or you are punishing yourself and that is your outlet, those situations that put you in a place to experience an injury or are not providing actual beneficial results are what we'd want to educate out of. I will also say most forms of exercise are good. And when you look at most first responders, depending on their background, many don't exercise regularly. 

00:44:27 Dr. Bellman: And so when we look at general exercise, maybe a SWAT guy, we have them in the weight room and we're doing pretty hard workouts. But for some guys who maybe haven't worked out since they played high school football, maybe we just start on some light aerobic stuff. And when we go back to talking about just pain in general, there are studies that look at chronic back pain, which is riddling most tactical athletes. And just a few days a week of moderate intensity aerobic exercise. You go hop on the stationary bike, maybe do a 30 minute, just break a sweat, nothing too strenuous. That has been shown to reduce chronic pain significantly. 

00:45:09 Dr. Bellman: Now that might not mean, hey, I live my life at a 7 out of 10 pain and that's going to take it to zero. But people who are active and they desensitize their body to movement because usually if you have back pain, certain movements hurt. They get down to maybe a three to five out of 10 pain baseline. And so any movement I'm going to recommend and not everyone wants to be in the gym getting after it. 

00:45:32 Dr. Bellman: One of the local commanders, he is a marathon guy. So when he wants to work out, I'm not going to make him be a powerlifter every time we hang out. He's got goals outside of his job where he wants to go do crazy stuff, like run ridiculous distances–

00:45:47 Cinnamon: 24 hour straight.

00:45:47 Dr. Bellman: And go be, triathlons. 

00:45:49 Cinnamon: [Till the dark].

00:45:49 Dr. Bellman: Yeah.

00:45:50 Cinnamon: I would not want to hang out with you anymore. You're like, when we're hanging out, I'm like, yeah, that would make me not wanna hang out. So I'm gonna go all the way back because I think we're getting close to wrapping up. I'm running out of questions and the questions I do have left we're gonna have to go off stage for. But you had talked about how, because of the nature of the healthcare system, most big box PT physical therapists may double or triple book. 

00:46:16 Cinnamon: And I know I was going to PT for my migraines and stuff. And one of the things that I noticed is I would often be given a task and then they would say, I'll be right back. And so even though I was told what to do, I still wasn't, like hyper comfortable because I haven't worked out like that since I was in my early 20s. So have you seen a difference in satisfaction with one's care, depending on whether or not the trainer stays with them the whole time? 

00:46:47 Dr. Bellman: Yes, there's big differences in quality of life outcomes. So one of my eye-opening moments when I was in PT school, I went out on a clinical out West and I would see maybe 35 patients a day. PT is typically depending on the situation, some people book 30 minutes to an hour. But in that situation, I would see the patient for maybe five to 10 minutes and I'd pass them off to an aid who was an undergraduate student. That wasn't sure if they wanted to go into PT school. Within what was allowed and to keep the clinic afloat, we had to bill as many hours as we can. And so, I don't get that full one-on-one with the patient in that situation. 

00:47:28 Dr. Bellman: And so, where I took Bell Performance Therapy was I wanted to integrate PTs and providers into the agency where they could provide services on site, where it was one-on-one for the whole hour, eyes on. You get your PT's cell phone number. So you get early access. If you got a question, hey, I'm gonna send you a video of how my workout went earlier in the week. Hey, let's break it down real quick. Getting that personalized one-on-one attention, one, lets the patient know, hey, I'm being valued. I'm getting the attention I deserve. 

00:48:02 Dr. Bellman: Two, for the physical therapist, I know I can break out all the tools in my toolbox and make sure you are getting everything I can provide you within my scope of practice versus if I have to say, hey, I'll be right back and jump between patients, I'm probably gonna grab the wrong leg if you got a bum knee and be like, oh yeah, I was just checking this one. Let's do it on the hurt one. I'm gonna be scatterbrained and I'm not gonna be able to give you the best care I can provide. 

00:48:31 Cinnamon: I could imagine just even our version of therapy. Like if I had to run in between three different mental health clients, I could not keep their story straight. Let alone what intervention I was trying to do, that would be utter chaos. And yet somehow we've normalized that for all of you. So if an individual maybe has some coverage for some PT sessions, and then they get that level of care quality, and then they decide to go to you, that's going to screw up the trajectory of their recovery from jump. Right. 

00:49:09 Cinnamon: Whereas if they start with you and they get that high quality, personalized intensive care, that's going to potentially improve their outcomes. Knowing our population, do you have an idea of financially how that would affect them if they opt out of the insurance recommended PT versus if they start privately with someone like you? 

00:49:38 Dr. Bellman: Yeah, a lot of it is going to depend where they add on their deductible. And depending on the policy, there are written policies that include out of network services. So let's just say someone came straight to me, I can still provide them, medical receipt called a super bill where they can go get reimbursed on the back end like a rebate. Insurance is sometimes greedy and they don't always respect that. But ultimately, you look at the timeline. If they are getting care that is not to the quality they need, you are now going to prolong the injury process, potentially set them up for chronic pains that could have been addressed versus if you get early access. 

00:50:17 Dr. Bellman: So ideally with Bell Performance Therapy, we're trying to be on site at the firehouse's departments where maybe an officer rolled his ankle whether it was on duty or he's playing pickup basketball. He's like, hey, Brandon, can I see you tomorrow morning? I can meet him that next morning within 24 hours, start the rehab process, potentially speed that process up. Less visits. I usually don't need to see patients three times a week because I'm not concerned about billing insurance to keep my clinic afloat. I want to see you maybe once a week a couple times and then we will space it out where we only check in every once in a while because I give you all the tools right away. As long as you're motivated, I can make sure you are on the right track without having to spend all of the session dollars. 

00:51:05 Cinnamon: Thank you. That's amazing. So it's like you increase the quality on the front end, you shorten the time on the back end. 

00:51:12 Erin: And I want to add something real quick about this story, about investment into our personal health. Because what I find is that people will not come see us if we don't take their insurance. They'll sacrifice their mental health and their wellbeing because of financial concerns or stories about finances. And for me, it's like, if this was your child that was injured, you would go get five jobs to make sure that your child got the best care. You would be researching all over the country, especially if it was something tragic like cancer, you're going to find that person and do whatever it takes. 

00:51:45 Erin: But when it comes to what I've seen is when it's me, I'll self sacrifice to a detriment, even if it means that it might make me lose my career because they're thinking right now, not long game. So I am often working with people like what is the quality of your life worth? And are you willing to make that investment into yourself? It's like untraining this concept or what I like to call scarcity around money and saying, how much is your life worth to you? And are you willing to do whatever it takes to get the best for you? 

00:52:16 Dr. Bellman: Yes, and to piggyback off of that, it is a lot about changing how they frame or see the problem. Am I solving their back pain or am I letting them not have to question whether their back's going to give out the next time they have a situation that requires them to get physical. And unfortunately, in that situation, that could mean life or death. So I wouldn't say I'm saving a life by addressing someone's back pain. But reframing it where investing into higher quality health services are going to give you that peace of mind. It is not that immediate in front of your face issue that you're addressing.

00:52:59 Dr.  Bellman: One of the things if it was a Gen Pop person is if I'm addressing someone's, we'll say a grandpa's back pain, I'm not fixing his back pain. I'm making sure he can pick up his grandchildren. Reframe those issues to something that actually is something that matters to them. His back pain alone, no one cares about. And with that, you mentioned access. Financially, medical services are expensive.

00:53:23 Dr. Bellman: And so one thing we've been trying to do with Bell Performance Therapy is get our contracts with agencies, take a load of the financial burden off the individual so that they can get that early access care to get started. And when you look into just corporate wellness, so one of these studies necessarily didn't look specifically at law enforcement, but it was just corporate wellness. For every $1 invested into wellness services, they found, if the services, which we'll go by definition, if they were quality services, that you would get a return on investment from $1.50 to $5 in medical spending and lost time. So that's a 1.5 to five times turn on investment for high quality care. 

00:54:07 Cinnamon: And that's just the dollars. That's not–

00:54:10 Dr. Bellman: Yes.

00:54:10 Cinnamon: All the other ways that we ideally, if we were really thinking about it in terms of our best interest, that's only one of many ways to consider the value for sure. 

00:54:24 Dr. Bellman: And to stay on the dollars for a quick second, because presenting money solutions tends to move problems along when it comes to bigger entities like agencies and municipalities and cities. If you look at the cost a department or a city might incur for a in-service heart attack, that could be anywhere from $400,000 to $700,000 a minute [inaudible]. If you bring in some wellness professionals to your agency and you avoid that and everyone's quality of life gets better, you are saving a significant amount in just healthcare spending. You are probably increasing the quality of life of your law enforcement officers, which, that is, our mission number one. 

00:55:03 Dr. Bellman: I don't care how much money we're saving the city. I want to improve, quality of life and longevity. And those officers, those firefighters, they are going to know that they're being valued. And so when we're experiencing an issue where officers don't feel valued at their current situation, they're making lateral moves or people are just not going into first responder jobs anymore. And so we're seeing a shortage. 

00:55:28 Erin: Yeah. 

00:55:29 Cinnamon: Oh my gosh. Thinking about the idea of what bringing a program like yours into the department or agency would cost compared to one heart attack on the job, on duty. It's not even a discussion. So I have two more questions. One is for our listeners who are like, hell yeah, Dr. Bellman, we want him in. We're gonna petition and all this to get him into our agency. How would they do that? How would they contact you to inquire about bringing you in and getting your services? And the second question is, because I just want you to roll straight into it. What have we not asked you that you want us to tell, that you want to tell us? 

00:56:16 Dr. Bellman: Yeah. To get in contact with me, the best way would be going to my website which would be bellpt, B-E-L-L, pt.com. Going through the contact us, letting us know whether you're an individual, an agency or department if you have any questions and just get the conversation started that way. Things you have not asked me. So, you mentioned my mission is to serve 10,000 first responders in the next five years and knowing that trying to sift through the BS of what is wellness. I am currently working on a free ebook that is going to be authored by several providers. 

00:56:56 Dr. Bellman: I'm working on the name, but right now I'm on the ultimate guide to health and wellness for the tactical athlete. This will be the law enforcement edition. We'll do a fire edition in, military. It will cover fitness, injury prevention, rehabilitation. That will be authored by me. Our sports psychologist, Gino, will do a mental performance chapter. Our dietician will do a nutrition and dietetics chapter. We have brought in a guest author for mental health, Amy Bach. She is here in Westerville. And then to tickle the tactical stuff, we brought in Matt Little, who is a former law enforcement and special operations in the army to write a firearms training chapter. And so hopefully in the next couple of weeks, we will have this all rolled out and it will be completely free to all first responders. 

00:57:49 Cinnamon: That's incredible. 

00:57:49 Erin: That is fantastic. I know, I'm like, oh my gosh. And I already was planning on adding you to our resources page. So it's an easy click. If for some reason they don't know how to type bellpt.com, they can just go to our page. I will add all of your information into the show notes so that it's again, an easy click away. Obviously you are in Columbus, Ohio, which doesn't make it as easy for people even in Indiana. But oh, what were you going to say? 

00:58:18 Dr. Bellman: So my education's in PT and I'm really bad at business marketing. So I get found a lot in California, Texas, and Indiana. Cinnamon had mentioned a pilot program that we had previously run. So we ran a 14 week pilot program in Ontario, California, where I partnered up with a chiropractor, a personal trainer. And we implemented all these services to four officers from three different agencies, just to establish a proof of concept down there. It is within our plans to find clinicians across all 50 states where we can have satellite locations that integrate into law enforcement, fire, EMS. 

00:59:03 Erin: I got an idea. 

00:59:04 Cinnamon: Yay. 

00:59:05 Erin: I know I'm like, let's just say goodbye so we can talk about other stuff. 

00:59:07 Cinnamon: Right. I'm like, good enough for all of you listeners. We got some, yeah. This is incredible. I would have loved to have shared this information earlier in the year because–

00:59:21 Erin: Yeah, me, too.

00:59:22 Cinnamon: I don't think that we could ever get this information to our listeners sooner. I could expect this to be an episode that gets not only listened to a lot, but shared a lot. There's a lot of information that isn't Erin and I just saying the same things over again or cracky corny dad jokes. And there's so much value in what you offer. And there's such a desperate need to attack from every direction the quality of life piece. 

00:59:53 Cinnamon: We talk about mental health, we talk about cancer exposure, we talk about obesity and heart disease and all of that. And I feel like what you are offering is truly a one-stop shop and hits all of those components and even listening to you list off the sections of your free ebook. I'm like, damn, what has hit all the points? 

01:00:19 Cinnamon: So thank you so much for coming and hanging out with us today and sharing all of your knowledge. And you couldn't even do that if you didn't have the love you have for our people and the desire to work with them specifically. And so let's all head out to the outside. 

01:00:36 Erin: To the other side.

01:00:37 Cinnamon: And start [planning] our takeover of the world. 

01:00:41 Dr. Bellman: Yes. 

01:00:42 Erin: All right. Thank you.

01:00:48 Erin: Thank you for joining us for today's episode of After the Tones Drop. Today's show has been brought to you by Whole House Counseling. As a note, After the Tones Drop is for informational purposes only and does not constitute for medical or psychological advice. It is not a substitute for professional healthcare advice, diagnosis, or treatment. Please contact a local mental health professional in your area if you are in need of any assistance. You can also visit AfterTheTonesDrop.com and click on our resources tab for an abundance of helpful information. And we would like to give a very special thank you and shout out to Vens Adams, Yeti, and Sanda for our show's music.