Healthy Wealthy & Smart

The Healthy Wealthy & Smart podcast with Dr. Karen Litzy features top experts in health, wellness and business with a particular focus on physical therapy. We take evidence based medicine and break it down making it easier to understand and immediately apply to your life. At Healthy Wealthy & Smart our goal is simple: to provide you with the best information to live a healthy and pain free life!
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Oct 14, 2019

On this week’s episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Cameron Massumi on new graduate engagement within the American Physical Therapy Association. Cameron Massumi, SPT is the president of APTA's Student Assembly Board of Directors.

In this episode, we discuss:

-Cameron’s passion for new graduate engagement within APTA

-Inclusion and diversity within APTA

-How to engage in networking events

-Ways you can get involved within your professional organization

-And so much more!



Cameron Massumi Twitter                                                                Outcomes Summit: Use the code LITZY for discount    

For more information on Cameron:

My name is Cameron Massumi, and I am the President of the Student Assembly Board of Directors. I believe that APTA serves an integral role in ensuring the future of our profession through advocacy, public awareness campaigns, and the sharing of a unified vision. However, there is, unfortunately, a marked decline in membership as students graduate from PT school and become active clinicians. It is my goal to stop this from happening and hopefully bring new graduates back into the APTA. My strong background in sales and marketing as well as my leadership experiences prior to entering PT school will allow me to bring a unique skill set to the Board of Directors. I

will use these skills as well as my connections to ensure membership and engagement increase so our profession can continue to grow and become stronger. My vision is that through my leadership the student assembly can help promote awareness of the profession, increase diversity, and boost member retention. As a profession we need to collaborate, innovate, and strive for excellence. APTA is the best tool to ensure the success of our profession so that we can #MoveForward, so let’s get together and create some real change. After all, we’re #BetterTogether!


For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas ( until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website:


Read the full transcript below:

Jenna Kantor:                00:00                Hello, this is Jenna Kantor with healthy, wealthy and smart. I'm here with Cameron Massumi who is currently the APTA student assembly president, all those things, however you prefer to pronounce it. First of all, Cameron thank you so much for coming on. First of all, it is a joy to interview this gentleman before we go into our topic on new grads. Cameron is one of those rare bulls who has massive stamina where he ran twice to become part of the student assembly. And that alone just shows that if you've seen the movie Rudy where he never gives up on his dream, Cameron, you definitely exemplify that. So thank you for being a person with the stamina to run again. And very, very well represent students at large.

Cameron Massumi:       00:49                Oh, thank you for that Jenna. I have to say that I wouldn't say it's a stamina aspect more than it's just perseverance. I think you really learn from your experiences. I did run twice the first time I was unsuccessful. But I'd say that I gained a lot of knowledge from that. You know, you learn a lot about who you are. You really take the time to do some introspection and see what are the areas that you're most passionate about and you find ways to stay motivated and stay involved. I was thankful to the previous board. The students tell me they really helped me find an area in which I could contribute. And so I was a member of the professional advocacy committee and did some work on playing national advocacy centers and then did what I could to stay involved and really kind of figuring out what I would like to work on the next time around when I applied.

Jenna Kantor:                01:41                I love that. I love that. All right. Let's now jump into the new Grad stuff now. Why are we talking about new grads? Cause right now you're currently a student. I actually am a new Grad. I'm experiencing what we are going to be discussing. So why do you specifically have a passion for new grads and have some futuristic plans for that, which we will get into in a bit, but why specifically new grads?

Cameron Massumi:       02:03                Sure. I think the best way to address this is looking at friends and connections that I've made. I think APTA does a phenomenal job of first of all engaging students and finding a platform for them to have their voices heard and for them to be able to network with other individuals. You know, firsthand that we can make some great lasting friendships. But what the APTA I think struggles that a little bit is retaining some of that engagement when it comes to new grads. We have no secret that we have a decline in our member basis as people transition from students to working professionals. There's a positive in that the trend is moving forward as we are retaining more and more. I think early career started years has incentivized the ability for the association to retain members.

Cameron Massumi:       02:51                I think the fact that with our rebranding that we're currently going through as an association, we're finding what matters to its members and really utilizing that to make the association more applicable and more exciting for demonstrating value to members. For me as a person that's about to embark on my own career, transitioning from the role of student to professional it's how do I find a way to stay engaged and how do I find a way to contribute to not only association but my profession. One of the things that most of the feedback that I get from a lot of my friends having graduated is they feel that they're going from a space where they have an existing platform to, you know, share their views and their desires within the profession to one where they don't. So this is a passion project of mine and something that I'm really looking forward to contributing on. And I think APTA's done a commendable job in engaging student voice and looking for collaboration on this. Individually myself, I'm looking at utilizing my state chapter to help with this. But also really pulling students and seeing what we can get collaboratively and seeing where that goes.

Jenna Kantor:                04:17                I love that. So regarding new grads, how do they have a voice right now?

Cameron Massumi:       04:23                Ah, it's interesting question. I think that ultimately it comes down to you finding your voice. You can use social media. It's a very powerful tool. You can use open floors within APTA. We just had our house of delegates and there's plenty of opportunities for members to get involved there. You can become an active member in your delegation. You can seek leadership opportunities within your chapter, within sections, academies or even at national office. I think that there is a plethora of opportunities for people to utilize. But it ultimately, it comes down to you what level of motivation that the individual has.

Jenna Kantor:                05:02                I want to dive a little bit deeper onto the negative specifically for us as new grads and anybody who's listening, not you, you're not a new graduate currently a student. But for being a new Grad, there is definitely a dropoff. There are these opportunities but a lot of it has to do with after five years of experience, doors really do open for getting to apply for some greater leadership positions. And even that when you go, well for me, I specifically experienced this in my state, there is still a level of trust, meaning distrust for me being a new face and energetic face, a creative face, not somebody who's been around to learn the ways of how that specific area wants it to run. So would you mind speaking on that? Where is there a voice for somebody who is still waiting to be trusted?

Cameron Massumi:       05:53                Sure. Tough question. Thank you for that. I'd say a lot of that really just comes down to you as an a association, as a profession or as a whole what we are doing to uplift and support individuals. There was a good bit of discussion at house of delegates and at next about diversity, equity and inclusion and for our student assembly meeting at next conference we had a round table and we invited some key panelists as well as students to share their insight and experiences on the topics. And it's interesting because when it became apparent really quickly is how diversity was highlighted almost exclusively at equity and inclusion. I think that as we try to shine more light to that and looking at what equity really means and inclusion and equity, meaning truly leveling the playing field and supporting people and giving them all the tools they need to have equal opportunities. It's not just saying here go, we're really building up individuals and letting them get to a place where they can create change and they can make their mark. And inclusivity is just ensuring that we're doing that with everybody and we're bringing them to that point.

Jenna Kantor:                07:29                I just want to express my appreciation for this. With the diversity, equity inclusion coming up in these conversations at this conference, at the house of delegates. It's great, although we do not have a game plan at this moment, which is very clear in this conversation. It's good that it's being brought up on the national level, not just at the state level. I definitely personally represent this being a person with a personality that is out of the norm. Now, if I went to musical theater people, I'm in the norm. My personality blends in and actually Cameron, you would stand out. So I do appreciate that it's beyond just the color of your skin. So I appreciate that the equity and inclusion is also being included in this whole picture with the actual definitions to provide the opportunity that people, so desire.

Cameron Massumi:       08:23                So the quote about diversity is being asked to the party and inclusion is being asked to dance. And I think that's a pretty powerful statement if you really break it down and you know, I commend APTA for their effort in or renewed effort in ensuring that we move forward with this as a profession. But it's really interesting. You know I see a very diverse group of people that come to these conferences and in my program back at Virginia, I see a vast diversity within our student population. Inclusion is one of those ones that's a little bit harder to utilize. Because you can't really force somebody to do something. You have to elevate them and promote a way in which they can take that opportunity to really get their voice out there and heard. And, and I think that we're moving in the right direction and it's exciting times and I can't wait to see where it goes.

Jenna Kantor:                09:24                Yeah, yeah, for sure. I think I really liked that you gave that definition. It was worth the wait. It was worth it. So for me, I was just at house of delegates to share a little bit and I'm new. It was my first time at house of delegates. So as a new Grad I went there and I was not voted in as a delegate, an elected delegate. But I was an alternate delegate and with that I was able to attend and sit in the gallery, which is in the very back in order to just listen and learn, which is very valuable during the breaks I am very extroverted.

Jenna Kantor:                10:05                And where for you Cameron, I mean you are present so people want to talk to you. You have that. It's amazing for me. I want to meet people. So I did find regarding specifically inclusion, which is why I wanted to, I was like oh I thought of this. I'm like, oh this'll be a great one with Cameron cause this is where your passion lies. I found myself in the room, you know when you see two people bonding that, oh they know who I am so I'm going to stand on the side and wait until you know you're kind of like smiling awkwardly on the side, you know, so I can get in the conversation and maybe have some bonding time. I think maybe one time, the whole time was it actually successful with me standing on the side because people were so focused in on their individual conversations.

Jenna Kantor:                10:46                So I did not get any networking at all in at house of delegates, which was a shame. And, as you are saying right now about that, inclusion is hard because you can't force anybody. I think what I experienced would be a perfect example of a very, very eager beaver wanting to meet people. Cause that's the thing. You need to meet people. You need to gain that trust and you develop those relationships. And I'm not important enough. That's what I'm assuming where they would go, oh wait, Jenna's here, let's include give eye contact, equal eye contact in the conversation where you can somehow become a part of it even as the new person. So I really like how you're bringing that up, the individual. What are ways that we as the APTA team members where we could start thinking outside of the box outside of our own world to maybe pay attention to when we are actively being exclusionary because of the own world that we live in.

Cameron Massumi:       11:46                Well first I like to say I'm sorry that you were made to feel that way. The House of Delegates is definitely crazy, especially this year when we had over 70 motions to get through. So you have a shorter amount of time and always so much to really get some of those meaty discussions out of the way that can present quite a problem to be able to communicate and network, I guess.

Jenna Kantor:                12:09                Oh, for sure. But these are half hour breaks.

Cameron Massumi:       12:12                Well my suggestion, I mean this really goes down to what are you doing to engage in conversation. You know, I recommend that if it's something that you're passionate about to find alternative means of starting dialogue, you know, it's fine to use the tact where you're kind of standing by respectfully and waiting, but there are other times where it may be more appropriate to interrupt but to you know, find a way to segway into the conversation and say, you know, I was just standing by and I really heard you discussing this. You know, it's actually something that I'm really passionate about. Would you mind if I shared my input? Or you know, maybe ahead of time, reach out and say, Hey, I know I'm a member of your delegation or I am a constituent and this is a passion area of mine I'd love to be involved in discussing this.

Cameron Massumi:       13:10                There's all sorts of different ways that you can approach individuals and it's going to vary based on your personality and the personality of who you're trying to reach out to. So that's where I'd say it took to really start and just find ways to do it. I mean, I'm a very extroverted person. I have no problem really walking up and saying, hey, you know, I would love to engage in some dialogue, but there's other people that are more timid and you just have to find different ways of doing it. I don't think that it is plausible to really expect people to just notice you at all times and be like, Hey, like I see you over there, come on in. And I don't think that that is an issue with inclusivity, more so than the fact that there's just a lot of things going on. So, it's important for people to take more active roles to get involved with things that they're passionate about.

Jenna Kantor:                14:09                This is really helpful. I mean and you make a very good point here Cameron, on just like seeing the real big picture of like the barriers, even though we may be all be in the same room of just the chaos that goes on in the rooms. And this isn't just like one thing. I mean we have these annual wonderful events, CSM, NEXT, we have the national student conclave. We had these other events which are also other opportunities and then of course the local opportunities as well. So for you, what are your future plans that you want to explore with the new grads? Because I remember us talking at Graham sessions, I believe. No, Federal Advocacy Forum. We're like plugging all these places everywhere, by the way, attend all these things at the federal advocacy forum. And you were talking about your passions, some things that you might want to develop one day for new grads. Would you mind starting to go into that?

Cameron Massumi:       15:04                I'm sure I don't have any true plans at this point. All I know is that I feel that the new Grad, early career professionals population is kind of a lost area. And what I mean by that is that there's no formal engagement targeting that group. And that's unfortunate in my mind. So I'd really like to see more active participation engagements available for that demographic. And currently myself, you know, I'm looking to kind of transition from the current role that I'm in and to more of one focused on my local chapter level for a little bit as I also work to you know, further my own practicing career and then really just find a final way to increase involvement and engagement with that population. So there's a good number of early career professionals that I'm friends with that live in my home state. So I would just want to collaborate with them and see what we can get off the ground going.

Jenna Kantor:                16:13                I love that. And for those who don't know, Cameron’s a champ.  I cannot express enough how this is somebody you do want to meet. You do want to have in your life in some capacity because of just he is a person who really speaks his truth but really from the heart and has so much love for others and seeing everybody really have the ideal professional career that they so desire. And we had a great bonding moment at federal advocacy forum talking about this and though I have most definitely put you in the hot seat, but for reasons to really help identify that there is and what you just said, there is a gap on the support that's available right now. It's not the APTA is ignoring it, they see it, but it's still there. It's one thing to see it and then figure out exactly how can action be taken. That would be exactly what people need. It's definitely been discussed. So I really appreciate and I'm honestly happy and excited for people in your area to be getting your wisdom and you even just like figuring out what you can do. That's very powerful. So just honestly, thank you for that.

Cameron Massumi:       17:25                Oh, thank you Jenna. I'm just one person, you know, and I'll speak in, like you said, from the heart, and these are just my own thoughts, but I really think that that the heart of it is collaborative efforts. You know, people from various backgrounds are gonna be able to come together and really problem solve a lot. And then as far as APTA goes, I think that they do a terrific job of acknowledging areas for improvement. And they are really actively trying to pursue avenues in which they can rectify some things and improve existing methods. I don't think that they do a bad job by any means with early career professionals, but I just don't think that it's where it needs to. I don't think that where it currently is where it needs to be. But you know, everything's a learning process and as we continue to grow as a profession, things will inevitably improve.

Jenna Kantor:                18:18                Oh, for sure. I was looking at things like that as opportunities. I'm like, oh look, we have more opportunities. And I think, it is really good at looking at things as opportunities and you have to look at it in a positive light. So for anybody who might be listening and being like, ah, you know, waiting for us to say something bad. Like what is it going to, how in this particular conversation right now where we're really trying to reach out and pull in the new Grad audience, like, is it gonna do us any good to sit here and bad mouth or to actually acknowledge what the APTA is doing and how they're regularly acknowledging things. So that way it gives you a rightful reason to hope and believe in an organization that has the power to make a huge difference. They have a huge audience.

Jenna Kantor:                19:02                They have a huge following. Even if right now in June 2019 just for when this goes forward, and time passes, there's one third of the population. There's no denying. Even for nonmembers they have a huge, huge audience. So it is very important. Even if you don't currently believe are not currently a member which join if you're not currently a member, you cannot deny the outreach that they have. So what is very good news? You want to hear that they're talking about it. You want to hear that it's on their mind. You want to hear that they're seeing the opportunities and are trying their best to explore it to the right thing because you know, as soon as they take action on it, they got to stick with it to see if it works, you know, and get that feedback. Well Cameron, thank you so much for coming on here. Thank you for dedicating this time. You've been in meetings this whole time and I was able to fortunately schedule you here at NEXT 2019 and I could not appreciate it enough. Do you have any final words you would like to say? You're like Mic drop to people who are new Grad physical therapists or even soon to be.

Cameron Massumi:       20:14                Thank you Jenna for the opportunity. I think the biggest thing is just be an advocate for the profession and for yourself in whatever capacity that is. The APTA provides a lot of platforms for you to be able to get involved, for you to be able to get your voice out there and heard, support your PAC. You know, that's how we get things done legislatively. How we improve things regulatory too. As an example from a student perspective, you know, lots of lobbying has allowed for legislation to be enacted to help with student loan forgiveness. That's massive. You know, that helps not only students, but early career professionals and we're relieving a lot of their financial burden. Stuff like that is really powerful. Don't underestimate your voice. You have much more volume, your actions and your voice speak volumes and just find a way to get involved.

Jenna Kantor:                                        I love it. Thank you so much.


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Oct 7, 2019

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Michelle Collie on the show to discuss the importance of outcomes and how they can make a difference in your practice. Michelle became the owner of Performance Physical Therapy. Under Michelle’s leadership, Performance has grown to a practice with 13 locations in Rhode Island and Massachusetts and over 200 employees.  

In this episode, we discuss:

  • What is the definition of outcomes as it relates to physical therapy.
  • How to use patient outcomes and business outcomes to drive your business forward
  • Using outcomes data to increase your referrals
  • A sneak peek into Michelle’s keynote speech at The Outcomes Summit
  • And so much more!




The Outcomes Summit: Use the discount code LITZY

Performance Physical Therapy

Performance PT on Facebook

Performance PT on Twitter

Performance PT on Instagram


For More on Dr. Collie:


Born and raised on a sheep farm in New Zealand, Dr Michelle Collie spent her childhood years training pet sheep, riding motorbikes, and eating enough lamb to last a lifetime. She earned her bachelor’s degree in Physiotherapy from the University of Otago in 1994 then moved to Rhode Island due to the United States Physical Therapy shortage. In 2003 while pursuing a Master of Science and Doctorate of Physical Therapy from Massachusetts General Hospital’s Institute of Health Care Professionals, Michelle became the owner of Performance Physical Therapy. Under Michelle’s leadership, Performance has grown to a practice with 13 locations in Rhode Island and Massachusetts and over 200 employees.  

Michelle is an APTA member and serves as the chair of the private practice PR and Marketing committee. Performance Physical Therapy has received a number of awards over the years for its business success and philanthropy, the highlight being the recipient of the 2014 Jane L Snyder, Private Practice of the Year. She is a board-certified Orthopedic Clinical Specialist


Read the full transcript below:


Karen:                         00:00   Hey Michelle, welcome back to the cloud cast. I'm happy to have you back.

Michelle:                      00:04               It's great to be here. Karen, thank you for having me.

Karen:                         00:07               Of course. So today we're going to talk about outcomes, specifically outcomes within your clinic and with your patients. But I think before we get into the meat of this talk, I would love to hear from you what your definition of outcomes is.

Michelle:                      00:24               Well, um, hopefully I'm not quoted by the Webster dictionary or anyone else out there, but for me in my practice is a physical therapist. To me, outcomes of the results that are numbers and they could mean practice management outcomes such as how many patients we see visits in an episode in here. They could be outcomes related to patient satisfaction such as your net promoter score or how many Google reviews did you get. Or they could also be clinical outcomes based on such things as the specific clinical outcomes means, Mitt measures that we use, whether it's related to the Oswestry or a disability scales. So those are just examples of some of the outcomes. But I think outcomes are like the results, tangible numbers of behind them. So you can actually give some, um, objective measures behind what these outcomes are.

Karen:                         01:19               Right. And you S uh, I like that you kind of put those outcomes into different categories because when I hear outcomes I just get incredibly overwhelmed and think, well there's, there could be so many. Right? So thanks. No. So now we kind of have a defined how do we measure outcomes within our practice? And maybe you can give some examples of what you guys do, but is there, do you have any standardized ways that you are measuring these different outcomes?

Michelle:                      01:50               So again, we can classify it into different ways and I will bring out one, one methodology actually is when it comes to practice management outcomes, that's something you hear often, especially with the benchmarking program that happens through the private practice section. We start looking at outcomes and using numbers to benchmark against each other. And those are things such as, um, how many, how many visits in an episode of care or how much revenue do you gain per patient visit? So these are things that are very much financial and operational defined and how you figure out business wise how well you're doing. So that's one side I'm going to flip to the other side, which I think is much more exciting to talk about for most people and that's actually our clinical outcomes. How good a job or how well are we doing when it comes to treating our patients?

Michelle:                      02:47               And there's such a drive now to looking at our outcomes as far as our clinical outcomes and what does that truly mean? Does that mean that my practice or Misa physical therapists get someone better and less visits or at least amount of time or with more intervention or different combination when, how much better do we get someone? So the outcomes to me relate around time, which could also be actual number of visits or encounters and also is how much bitter someone gets. If I'm treating a runner and they, our goal is, Hey, I want to run a marathon in four hours, am I being sucks? Can I get them back to being able to do that? And can I do that just as well as not just the next physical therapist, but other fitness, health care provider, whoever that is. And how can these outcomes?

Michelle:                      03:42               So how do measuring outcomes help to drive your practice? So I guess this is a really, what you're counting down to was the why. Why bother doing this? And so yeah, this is getting to the why, which is the most fundamental part is by measuring our outcomes and helps us differentiate. Now when we can differentiate ourselves, it makes it easier to do marketing and that marketing can, it can impact us in different ways. We can use it to market to get more patients. We can use it to negotiate, which is marketing messaging with a payer, whether that's an insurance company or whether someone's paying cash for services that we now have outcomes, which is data to help him messaging and differentiate, here's what I can do or my practice can do. Um, so I think there's many different levels, um, that it relates to, but it's all comes back to marketing and messaging and being able to differentiate and communicate to the consumer and will the payer about what our services can provide.

Michelle:                      04:54               And can you give an example of how you, you and your practice might use your outcomes to market and you can choose if you want to market to a payer market to the general public, I'll let you choose. So we've done a whole bunch of things that our practice and hit a lot of success. Um, one is marketing and this is probably the easiest one for people to understand marketing to physicians. So with the data that we have, I can go to a physician [inaudible] physician group and say, Hey, here are end results. If you, when you refer a patient to us, we're going to get them this much theatre and here's what the national benchmarks are. So we're actually proving to you that we're going to get the results that you want and guess what? I can and we're actually gonna do it at least visits and what the national standards are.

Michelle:                      05:51               Now I can compare as cells to um, we, I compare as to practice nationally or regionally or even over time. Look, we put these new systems in place or we started try needling or using this new blood flow restrictive therapy or whatever modalities or treatment methodologies we're using and say, because of this, now we're now we have the data to show how much better we're getting patients. And then for us it's actually really helped to Provo provide actually data to referral sources and they can actually say, Oh, so we're going to seam patients to you because you're actually going to provide solutions and get our patients better. It's not just about the fact that Oh, you've got more clinics or you are open on Saturday mornings and no one else is, or you had fancy equipment. I mean these are true differentiators, not just things we can do to make ourselves look better.

Michelle:                      06:50               I think that's the big thing. I think, you know, years ago I always used to think that marketing and promoting your practice was just simply about relationships. And if people like you, they'll send you patients and patients like you, they'll come back to see you and all those. Although those things are true too a little bit when you've actually got the data behind you and really meant, helps you tell a story and say, Hey, this is why we should be treating your patients or to the general public. This is why you should be coming to physical therapy to help with your back pain or your ankle sprain or your pelvic health problem or your dizziness. You've got the numbers to show that we will get you better.

Karen:                         07:31               Yeah, and I think it's great to use numbers because these are our facts, right? You're not fudging these numbers. This is the actual data that is coming out of your clinic. So I think it's great to be able to then instead of just have the data and say, Oh great, look what we did. But you want to use those outcomes in order to market your clinic.

Michelle:                      07:56               Exactly. And I think the other nice side about it as when you're using the data to market, it actually changes the culture within your clinic and within your practice.

Karen:                         08:07               That was literally my next question was how did outcomes affect that people working day to day in your practice?

Michelle:                      08:13               Yeah, well I think it's really helped to make us practice and every visit make all of our clinicians and their patient care coordinators and our assistance and our exercise specialists realize, yes, we're very concerned about customer service and giving, um, you know, having beautiful clinics and all of these other aspects. But at the end of the day, we need to make sure that every moment we're spending with patients is designed to get them back to be doing the things they want to do in this got a show in the data. Yeah. And I think it's helped to really drive our clinic and the kind of care that we're providing. So it's not just about, Oh, I'll collect the data and now I'm going to get paid more by an insurance company. Or now people are going to come and see us or doctors or refer. It actually drives the culture within a clinic to ensure that you, I always feel like we've got rid of complacency which can sometimes creep and practices. Yeah. And how do,

Karen:                         09:14               how do you use this, the outcomes data to kind of align with your vision or the or the mission of your practice? What would you say to other clinicians when it comes to aligning the data with the mission and vision?

Michelle:                      09:30               Well, I think that's really a great point you bring up because people often say, well how do you know what to measure and why are you doing this? And I think it always starts with your strategic plan and figuring out, first of all, what is your purpose? Which is like your greater good. Why do you, why you in practice and what's it all about? And then thinking, okay, well then what's their, what's their mission, what are EMV values? And once you figured those things out, then you can challenge yourself and say, well how am I going to prove it and how am I going to measure it? So that when someone says to me, Oh, your purpose is about having a healthy, fulfilling the film happy community, and you're helping your community to be in that way, how are you going to truly measure that?

Michelle:                      10:13               That's what you're doing? So I think you have to start with that strategic over powering, look at your vision, your mission, your values and names going on. How am I going to measure that and not the other way round. Mmm. We see like, yes, we're going to look after our community and then we're going to use innovative results given here and now it's like, well, how are we going to prove that? I'm like, the only way you can prove that you're getting results driven, innovative care is by showing the data because otherwise it's just talk [inaudible].

Karen:                         10:48               Yeah, yeah. No, that's great. As you're saying this, I'm thinking about my mission for my company and like, Hmm, yeah, okay,

Michelle:                      10:59               how am I going to measure this now? And it's not, you're not going to come up with it overnight and there's no perfect way to do it because this is quite a new area for physical therapists or we're only just part of this evolving healthcare environment where payments changing and with payment changes the messaging of how we're promoting what we do, but it is turning into much more a shift away from fee for service and much more to say like we're paying for the outcomes or the experience, not how many visits or how many units of charge per visit or how many visits and an episodic here we should be advocating improving our stamps for our outcomes. Neat. Good. The only way we can do that as some health, pulling out what clinical outcomes and how we're gonna measure those and basic jet.

Karen:                         11:50               Yeah. And how do your outcomes from clinic aligned with

Michelle:                      11:54               your vision and your mission? Like what is the mission of your clinic and how do you, how do your outcomes revolve around that? The way our mission is about providing innovative, results-driven, physical therapy services for a community. And the way that we measure the outcomes is that our goal is to get, use the hashtag better, faster. So we're all about getting people better, more better, and doing it in the least number of visits we possibly can. Now it's interesting because there's many practices out there, and I'm often challenged by this and this is where I butt heads with media, other people in private practice and like, but we get paid per visit. Why would you want to see people enlist visits? And I've had some really fun heated debates with some colleagues and peers over this Mike. But if we can do it and least visits, isn't that the right thing to do?

Michelle:                      12:45               And then doesn't then allow us to advocate and, and, and prove ourselves and our value. And they're like, what? How can you afford to do that? Because you're basically sacrificing money because you're going to do it and least visits. So it's been a fun debate to have because we've had it now for many years. And I think the ties of changing, because I've been now in a position to actually go to payers and insurance companies and actually hit the data and say, look, we are doing at least visits. So let's talk about how we do some cost sharings. Let's talk about different ways to reimburse because we're doing it and at least visits and uncles to go to the outcomes to show that we're getting people just as bitter or more. That's really poor English with that. So I came up here. Yeah, that's okay. We get the gist of it.

Michelle:                      13:35               So one of your outcome measures might be how many visits are in an episode of care? So we had the keys that we use, we use visits in an episode of care and the other one we use is the clinical more clinical um, change. So traditionally we've used photo focused on therapeutic outcomes of your system. Um, which has been great because that will, that will differentiate patients based on payer, um, diagnosis, body part, all of these things. So we can say, Hey, for a bag spine or all the Pedic on Euro or upper extremity, here's how, here's the change that we're getting in function and we can actually beat back and compare ourselves to other practices both in our region and nationally as well. You can do, it's an interesting time because now with MIPS and again I realized the assaults and people out there who don't know if MIPS are going to happen and we still don't have a lot of final rules, but again, we're still in with Mets. We're still using different, um, standardized clinical outcome tools that we're all very familiar with and I'm looking at opportunities to benchmark not just against it within their own practices, but between each other's practices as well.

Karen:                         14:54               Yeah, I think that's great. I love looking at it that way of, of figuring out your mission and then how are you going to measure it and then taking those measurements and using it for a whole bunch of different things.

Michelle:                      15:07               Well, I think that to me that's been the most interesting thing in our practice. It's, we've got this mission and a vision, which is what you have to start with. And your purpose. We've created the tools to measure it well. We've figured out what tools and how to measure it and it's, it's really helped evolve the culture of that practice. It's helped us with how we onboard our staff. It's helped us with how we recruit new people. It's helped us when we take on students. So it's had a big impact on every part of their practice. And, um, rather than just, you know, how just rather than just how we treat a patient, an everything embodied bodied, everything.

Karen:                         15:47               That's awesome. And now you had mentioned photo and coming up in October, October 23rd to the 25th, and Knoxville, Tennessee is the outcomes summit. Uh, and you are one of the keynote speakers. So can you give us just a little sneak peek, a little taste of what your keynote speech is going to be about?

Michelle:                      16:07               Well, so the keynote speak is all about on marketing with outcomes data, helping people understand the value, um, for outcomes data. When marketing your practice, I'll use my personal story because I think it helps to show that I'm, you know, really at the end of the day, just a little farm girl from a very remote part of the world. And um, so if, if I can use data to Mark it with anybody can, and I also like to talk a lot about the fear because I think there's a lot of fear out there. PTs are often scared. One of my deck data doesn't show what I want it to show.

Karen:                         16:44               Right? Then what happens

Michelle:                      16:46               then what happens? So yeah, that's like the million dollar question. And then what happens is people run away from fear and then they don't do it and so they're not moving forward. So I definitely had plenty of fears when I first started put up though the date and say what a for not as good as we think we are. Well, I find it interesting that it's really abandoned teach and if you're following what your purpose and your mission is and the results are going to happen because this changes all of the messaging and it impacts your entire culture. But I think it's a journey of how to address the fear of what if my data isn't as good as what I think it can be. Because when it comes to marketing, yeah, I can have beautiful brushers and amazing weird site. I can be open all different hours and think those things are going to differentiate me and they will a little bit.

Michelle:                      17:37               But at the end of the day, I do think it comes back to data is the real differentiator and if you want to get serious about marketing and messaging what your practice does, and I think this goes, now I'm going to get on a, and this goes for our app proficiency as a whole and list were privy. At least we're proving that we really are the base caregivers for muscular skeletal and your a muscular disorders and diseases. Then we, you know, we're still lists, we're just not doing a good job, but at the moment like how do we differentiate ourselves from the other healthcare providers and fitness people out there who also say we'll take care of someone's back pain or help them get trained for a five K. so again, we have to, as a profession, as a whole, use that data and be comfortable using it to prove proven value.

Karen:                         18:31               I love it and it sounds like it's going to be a great talk. So all of the people who are going to the outcomes, the clinical outcomes summit are in for real treat. Um, so that's awesome. Now, uh, before we, and here I have a one more question and that's what advice would you give to yourself as a new graduate? Fresh out of PT school. So that farm girl from New Zealand, she just graduated from PT school. What advice, knowing where you are now in your life and career, would you give yourself back then?

Michelle:                      19:11               Oh my God, it's so much advice I would give. I think it would be about the key advice I would say is that your, we all have fear. We're all nervous of things. Whether it's, Oh, I'm going to make a mistake when I treat a patient or I'm going to have a practice that's not successful, or I'm going to open my mouth and sound like an idiot, but we're all gonna do it in. That's fine. And the only way to conquer those fears is just push through it and just keep, keep moving forward. So I think it would just be letting myself know at that shy Tinder age in my early twenties that, um, all the challenges that I had, just the same of everyone else's. And so yeah, just put on your big girl panties. They would say base the fears and move forward. Sorry.

Karen:                         19:57               Great advice. And now where can people find you, whether it be on social media and or your clinic?

Michelle:                      20:04               Um, so we have a multi clinic practice based out of Rhode Island with some clinics in Massachusetts as well. So performance is our website and all their social media handles all reflect their performance. P So, um, feel free to check out her website and we are you on Instagram, Facebook, Twitter, all of those, all of those places.

Karen:                         20:30               Awesome. Well, Michelle, thank you so much for coming back onto the podcast. I appreciate it. You gave me a lot to think about, so thanks so much. Thanks very much, Karen and everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.


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Sep 30, 2019

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Stephanie Gray on the show to discuss bone health.  Dr. Stephanie Gray, DNP, MS, ARNP, ANP-C, GNP-C, ABAAHP, FAARFM, is a functional medicine provider who helps men and women build sustainable and optimal health and longevity so that they can focus on what matters most to them. She is co-founder of Your Longevity Blueprint nutraceuticals with her husband, Eric. They own the Integrative Health and Hormone Clinic in Hiawatha, Iowa.

In this episode, we discuss:

-What is functional medicine and integrative medicine?

-Hormones that impact your bone density as you age and how to find your deficiencies

-The difference between natural and synthetic hormones

-Your Longevity Blueprint: a guide to mastering each of your body systems

-And so much more!



Integrative Health and Hormone Clinic Website

Your Longevity Blueprint Free gift: 10% off using code healthy10

Stephanie Gray Facebook

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Stephanie Gray Instagram

Your Longevity Blueprint Instagram

Stephanie Gray Twitter

Your Longevity Blueprint Youtube


For more information on Dr. Gray

Stephanie Gray, DNP, MS, ARNP, ANP-C, GNP-C, ABAAHP, FAARFM, is a functional medicine provider who helps men and women build sustainable and optimal health and longevity so that they can focus on what matters most to them! She has been working as a nurse practitioner since 2009. She completed her doctorate focusing on estrogen metabolism from the University of Iowa in 2011. Additionally, she has a Masters in Metabolic Nutritional Medicine from the University of South Florida’s Medical School. Her expertise lies within integrative, anti-aging, and functional medicine. She is arguably one of the midwest's’ most credentialed female healthcare providers combining many certifications and trainings. She completed an Advanced fellowship in Anti-Aging Regenerative and Functional medicine in 2013. She became the first BioTe certified provider in Iowa to administer hormone pellets also in 2013. She is the author of the FNP Mastery App and an Amazon best-selling author of her book Your Longevity Blueprint. She is co-founder of Your Longevity Blueprint nutraceuticals with her husband, Eric. They own the Integrative Health and Hormone Clinic in Hiawatha, Iowa.


Read the full transcript below:

Karen Litzy:                   00:01                Hi, Dr. Stephanie Gray. Welcome to the podcast. I'm happy to finally have you on. This is taken forever between the two of our schedules.

Stephanie Gray:            00:09                Thank you for having me on. I'm excited to speak with you today.

Karen Litzy:                   00:12                Yeah, I'm very excited. And we had met, Gosh, last year, maybe

Stephanie Gray:            00:17                October.

Karen Litzy:                   00:18                Yeah, October of last year. Holy Cow. Yes. Well, I'm very excited to have you on because when we met at unfair advantage and I remember hearing your story and hearing you speak and I thought I need to talk to this woman because I think she's doing some really great work, so I'm happy to have you on and share all about what you're doing. We'll talk about your book, the longevity blueprint in a little bit, but first, can you let the audience know a little bit about your journey from your BS to your MS in nursing to doctorate to all these certifications and how that happened in the why behind it?

Stephanie Gray:            00:58                Sure. Well, maybe the short version is that I was born and raised in the Midwest and I grew up in a very healthy family and I wasn't quite sure what I wanted to do with my life as many people are I’m sure. My parents always took us to see a chiropractor, not a regular doctor. They were self employed, had a really high deductible. So they wanted to keep us healthy and growing up, I wanted to get into medicine. I kind of grew up wanting to be a doctor. I'd play with my doctor Kit, but I didn't necessarily want to prescribe drugs. And so I thought, well maybe I'll go into nursing. Right? So I went through the nursing program at University of Iowa and I love nurses, man, they're so important. We have a shortage, we need more nurses. But I thought I wanted to have more autonomy and more independence and I wanted to still be able to diagnose and treat patients.

Stephanie Gray:            01:43                And so I did continue on to become a nurse practitioner and I ended up going through the master's and then the doctorate program. And I still was a little unsatisfied. I felt like, man, there's gotta be more to life than prescribing medications. Right? Nursing is a more holistic approach in general. And that's why I'm biased to nurse practitioners as primary care providers because I think they do provide a more holistic approach. I wanted some additional trainings so that I could incorporate nutrition, that I would have some credentials behind recommending things other than drugs. So I did also then pursue a master's in metabolic nutritional medicine, which taught me a lot about, you know, using supplements and herbs and whatnot, which I heavily applied in my practice. And then I also did complete the advanced fellowship in anti-aging, regenerative and functional medicine which helped me tremendously. I learned a lot about use of bioidentical hormones as well. And I really just became on fire for integrative and functional medicine and thought, this is it. This is what, especially my community in Iowa needs, because there weren't a lot of providers offering this sort of care. So that's, I guess that's kind of my story.

Karen Litzy:                   02:50                Well, that's a great story. I love it. Now you mentioned functional medicine and Integrative Medicine. Can you kind of help us out and talk about what those branches of medicine are?

Stephanie Gray:            03:01                Sure. So integrative medicine combines or integrates conventional medicine with natural, uneven, complimentary forms of medicine. It's not, I'll say functional medicine also really more works to get to the root cause of the problem. That's kind of more of the definition of functional medicine. And I use both in my practice. I use functional medicine to kind of discover the why, but I also use integrative medicine because there is a time and place for medication use. Sometimes patients do need antibiotics or surgery. I've had to partake in them myself. But I want to provide my patients with the best of all worlds combined. So do I think chiropractic is important? Yes. Acupuncture? Yes. Use of supplements. Yes. Medications, all of the above. I think the major difference in the analogy I use with my patients that I did not create a colleague, Patrick, he mentions conventional medicine as being more of the fire department approach. Right? We need conventional medicine. If you have a big bad ugly tumor or whatnot, you need the fire department to put that out to remove it. But conventional medicines tools are drugs and surgery. Functional medicine is a little different. We described that in my practice as being more of like a carpenter approach and that's what I describe in my book. Really helping to repair and rebuild the body, figure out why the fire happened in the first place and try to get to that root cause of the problem, not just provide a bandaid approach.

Karen Litzy:                   04:16                Right. And that's a great analogy. Thank you for that. That’s definitely clear. It makes functional and integrative medicine a little bit clearer for everyone. Hopefully. So now I mentioned the book longevity blueprint and again we'll talk about that a little bit later, but there's a chapter in the book, Chapter Four where you discuss the importance of fixing nutritional deficiencies and specifically when it comes to our bones. So as mainly women, we all know as we get older and as we go through menopause, our hormones change and bone density can change along with that. So what nutrients I guess are specifically important for our bones?

Stephanie Gray:            05:09                So I'll discuss several nutrients. So many women think calcium is a number one most important nutrient for their bones. And the truth is that your bones need a lot more than calcium. So vitamin D, magnesium, vitamin K2 and strontium are all nutrients that I recommend to my patients. I mentioned vitamin D in several different chapters of my book and that as many people know, helps your body absorb calcium and phosphorus from the foods you eat. And it helps with bone remodeling. Maybe I don't know how deep we should get into that. Maybe you shouldn't, but without enough magnesium though calcium can also collect in the wrong places in soft tissues and cause arthritis. And so magnesium is just as important as calcium. There have been several studies of women with Osteopenia or osteoporosis showing they're actually not deficient in calcium deficient, they’re deficient in magnesium yet.

Stephanie Gray:            05:58                What's the number one most prescribed supplement? Menopausal woman. Again, it's calcium. I personally have had a kidney stone and they are not fun. So calcium can not only gain weight, it can cause bone spurs, but it can cause kidney stones. It can calcify our arteries. We don't want it getting absorbed in to the wrong places of our body. And that's where vitamin K2 comes in also. So vitaminK is really overlooked nutrient. It's one of the four fat soluble nutrients. So it really helps prevent calcium from accumulating in our vessels. And it can even, some people believe can help remove dangerous calcifications too. We know that low levels of k2 can directly be related to poor bone mineral density. So I like analogy.

Stephanie Gray:            06:45                So here's another analogy on what vitamin K2 really does, and vitamin D. So vitamin D is the doorman that opens the door for calcium to enter the bloodstream. But once it's in the bloodstream, it could go anywhere. So I think if K2 is being that usher that's going to direct the calcium from the lobby, if we think of a hotel or whatnot, directing him to the appropriate seat in our bone matrix. So do we need vitamin D? Yes. Do we need magnesium? Yes. We also need vitaminK2. So there are different sort or different types of vitamin K. So vitaminK is broken down to K1 and K2. So if you are purchasing a supplement, if it just says vitaminK , you don't necessarily know what you're getting.

Stephanie Gray:            07:26                You want to make sure that the label is really differentiating if specifying what is in that product. So vitamin K1 isn't as much needed to be supplemented. It's the deficiency is pretty rare. It's found in leafy Greens. Hopefully you're all getting your leafy Greens. But vitamin K2 comes from very specific foods and also bacterial synthesis. So think of it. Think of yourself as you know, if you don't have a healthy gut, unfortunately your body's not going to be able to convert. K1 to K2 in the gut if you've taken antibiotics, whatnot, if you have a lot of food sensitivities and gut inflammation. And so you really want to think about consuming foods with K2 and possibly supplementing in that as well. So vitamin K2 comes from fermented soybeans, which many of us probably are not consuming and also from the fat milk and organs of grass fed animals.

Stephanie Gray:            08:16                So things like egg yolk, butter, and even liver with why we're coming, we're becoming more vitamin K deficient is that you are where you're what you eat, eat. So if you've heard of what Michael Poland has said, and I think that's really true with K2. So when we removed animals from the pasture, right? If we don't eat animals that are eating greens, they're not getting the K2 themselves and then we're not getting it from our products. So you want to make sure you are eating grass fed animals and think of wild game. Wild game is really what's can usually consuming the ingredients. So try to consume more pheasant, duck rabbit, venison, elk, or wild Turkey. I mean these are things that we don't all have access to, but that would actually help increase our K2 levels. So if you can't get some of those foods into your diet, then you could consider supplementing that.

Stephanie Gray:            09:06                It could literally again consume the fermented soy beans. But MK7 has a pretty long half life, longer than MK4. So I recommend my patients take MK7, MK4 is actually extracted from a tobacco plant, which I don't like either, sometimes will come from fermented soybeans, geranium or chickpea. And the source that we use for our production is chickpea. It has a longer half life, so a single daily dose can provide longer protection. So many of my patients, we're putting on 45 90 or even 180 micrograms of MK7 per day. It's great to incorporate foods that have, you know, consumed grass Greens. You hit the chlorophyll to get the vitamin K and to have a great healthy gut that convert can indicate too, but if you can't, and supplementing with MK7 is what I recommend.

Karen Litzy:                   09:56                Yeah. And, just so people know, are you doing blood tests on people to find these levels? I just want to point that out so that people listening are like, well, I'm just going to go buy all this stuff, but you have to go and be evaluated first.

Stephanie Gray:            10:15                Yeah. So in my book in chapter four I talk about, well, every chapter of the book discusses a functional medicine testing option that's available. And chapter four is all about examining micronutrient deficiencies. Which even my patients who eat organic, who grow their own food in their backyard are still nutritionally deficient because our food sources are just not as nutrient dense as they used to be. I mean, the magnesium content in our foods has been on a decline since the 1950s. It keeps going down and down and down, which is very sad. But because of that, we can see that evidenced on a test that we run on our patients. So one of the first tests for my patients with osteoporosis or Penia that we would run is this nutritional analysis, which is looking at vitamin, mineral, amino acid, antioxidant, and even Omega levels. And if you have the access to a functional medicine practitioner, definitely I would recommend getting this test because then you don't have to guess how much magnesium, how much do I need? It's better to really get the test to see what you need.

Karen Litzy:                   11:12                Right. Yeah, no, that makes a lot of sense. And I just wanted to point that out to people so that they know. I guess also, are there any dangers of taking these vitamins if you don't need them?

Stephanie Gray:            11:28                So vitaminK to a high dose just can cause blood thinning. So if patients are taking anticoagulants, if they're on medications like Warfarin, you know, Coumadin, then this could potentiate those effects at really high dosages. So if you're listening to this and you want to take some K2, you probably need it. But talk to your doctor or nurse just so that they know so that they can monitor your levels. So that would the biggest, biggest side effects.

Stephanie Gray:            12:04                The last nutrient for bone mineral density that I recommend to my patients is strontium. This was one of the first minerals that I really learned about for bone density. So I heavily used it initially even before I learned about the importance of K2. There have been randomized double blind placebo controlled clinical trials showing that strontium in a dose of about one gram per day could be equally as effective as a lot of the bisphosphonate medications without getting those nasty side effects. But I have seen this be effective in my patients too. Granted, I'm recommending they take minerals, optimize their hormones, reduce their stress, exercise, right? So all of those interventions are going to have an additive effect for improving bone density. But strontium can be very, very helpful for bone density as well.

Karen Litzy:                   12:48                Nice. All right, so we have vitamin D, vitaminK2, strontium and magnesium.

Stephanie Gray:            12:56                And then calcium of course calcium. I don't put calcium on the top of the list, but yes.

Karen Litzy:                   13:01                But it's there. Okay. All right. Now you mentioned hormones for a quick second there, but is there value in optimizing hormones for bone density?

Stephanie Gray:            13:13                You Bet. So about 25 well, I think it's 27% of women over 50 can have osteoporosis, right? Like a fourth of those patients of that population, which is pretty scary. Yeah. And I'll go 40% have osteopenia. There's also, I'm referencing women over 50 so what's the other common dominator for women over 50 usually you're going through menopause around that declining and this, the danger here is that this can increase risk for fractures. Of course, Osteoporosis Foundation says at 24% of those with hip fractures die within a year. That's, that's terrible. Very cool. So absolutely, I run a hormone clinic and I strongly believe that improving estrogen, progesterone, and even testosterone levels in women can help with bone density. And I can talk a little, I can go into depth with each of those hormones.

Karen Litzy:                   14:06                Yeah, I think I would like a little bit more in depth conversation on that and also the difference between synthetic and natural hormones.

Stephanie Gray:            14:15                Sure, sure. So maybe first we'll talk a little bit about estrogen. So estrogen literally helps with a proper bone remodeling process. Progesterone helps promote osteoblastic activity. So osteoblast help build your bones while osteoclast break it down, right? So progesterone is going to help with the bone builders and testosterone has been proven to actually stimulate new bone growth and inhibit or block the osteoclastic that breaking down activity. Progesterone, I've even been heard called one time I heard it called a bone trophic hormone. Like it literally seems to promote bone formation, which is wonderful. So it's one of the first hormones I'll start my patients on even before their menopausal many peri-menopausal or younger are taking progesterone. And when I mentioned testosterone for women, some women kind of look at me sideways like, well I don't want to grow a beard or I don't think I need to.

Stephanie Gray:            15:12                But actually it's extremely important if you even think of how testosterone helps with muscle mass, it can help strengthen the patient also, right? To improve balance, to minimize falls. Testosterone is great for many reasons. In my book I actually mentioned a study. I feel so strongly about how important testosterone can help really because of the study, because I've seen this, testosterone has shown an 8.3% improvement in bone mineral density, which is like unheard of. It's just dramatic. I've had patients who have received hormone replacement therapy, not overnight, but over a year, go from having osteoporosis, Osteopenia to even having normal bone density because after a year, their bones are improving and that is amazing. But conventional medicine, many times putting patients on drugs, we're just hoping that they don't have a decline. We're just hoping that they stabilize, not that they actually build bone density and hormones can really help do that.

Stephanie Gray:            16:08                But in reference to your other question, anytime we talk about hormones, the cancer word is going to come up. So that's where I can differentiate between the synthetics and the naturals. And in my book in chapter six actually show the molecular structure of synthetic hormones like I synthetic progestin and natural progesterone aesthetic is faster on molecule and natural testosterone cause the hormones really need to fit like a key fitting in a key hole, right? And that's what the molecular structure of natural or bioidentical hormones are. I mean, they should fit like a key fitting in and thus caused your side effects. So most of the studies that showed hormones cause cancer were studies like the women's health initiative study, which was done on a lot of women, but they use synthetic horse urine and they use Premarin.

Stephanie Gray:            16:54                That's literally what Premarin stands for, pregnant Mare's urine. So naturally I try to not replicate what was done in that study with my patients. I don't want to use synthetic hormones. I don't want to use oral estrogen either. That means estrogen taken by mouth in a pill form, right? Which is going to have to be cleared through the gut and the liver. So who was trained through, I should say in addition to the fellowship program that I went through was bio t, they're a hormone pellet company. They're the biggest hormone pellet company in the nation who very well trained their providers and their practitioners and they keep us up to date on all the current research and what's happening in Europe as well with hormones. And so they strongly believe that hormone is given an appellate version, which is an actual subcutaneous little implant that we put under the fatty tissue, kind of in the lower back.

Stephanie Gray:            17:44                Upper bottom area is by far the safest. And that's what we're going for with our patients, right? We want to improve on density. We want them feeling better. We want to give them the safest version of the safest dosage. And so pellet therapy specifically is what can improve bone density the most. But again, we're using natural hormones that are plant-based, not synthetic. They should bind to your hormone receptors appropriately. And therefore the risks of, you know, what were shown in the women's health initiative study just can't be compared to what practitioners like myself use. Cause we're using natural hormones, not the synthetics and not by mouth.

Karen Litzy:                   18:19                And so what are the side effects or the downside of using these natural hormones versus a synthetic?

Stephanie Gray:            18:26                Sure. So all of us are already making, well we should be making hormones, right? Which when we grow up we go through adolescence, our hormones peak and then in our twenties and thirties and forties and 50s we start seeing this decline. So really if hormones are dosed appropriately, patients shouldn't have side effects. However, if you think of younger women when they're cycling, sometimes before bleeding they may have some fluid retention or a little bit of breast tenderness or whatnot. And sometimes those symptoms can reoccur as we give patients hormones. The goal is that those would be very short lived. They wouldn't last once we refined the dose. But too much of estrogen can definitely cause fluid retention, breast tenderness, potentially some weight gain. Too much testosterone could cause acne, oily skin, hair growth. Too much. Progesterone can make you feel a little tired. Most menopausal women need help sleeping. So they like that effect, kind of calms them down. Or if women are real PMSing they need or have anxiety, they need some progesterone to calm them down. But we don't want to overdose patients. Right? We don't want to get them to high levels of the hormones, but we want to give them high enough levels that will protect their bones, that will help them sleep. Right. That will provide benefit.

Karen Litzy:                   19:34                Are there instances of cancer with the natural hormones?

Stephanie Gray:            19:41                So there are always instances of cancer? I can't say definitively that. No, I've never seen it. I'd never had a patient ever have cancer. But from my experience, they're very rare. And Bio T are great to have as a resource because they track all of that. I mean, they're tracking all these hundreds and hundreds of thousands of patients with pellets and they're tracking the rights and if they confidently say the rates are extremely low.

Karen Litzy:                   20:07                Well, you know, cause we wanna give the listeners sort of like a balanced view of everything. So we want to give the, you know, as you know, and I'm sure this is the exact questions that your patients probably ask you.

Stephanie Gray:            20:23                Yes.

Karen Litzy:                   20:25                Or hopefully that's what they ask you. Let's put it that way, So now talking about these hormones, how would one know if they are low on these hormones?

Stephanie Gray:            20:37                Good question. Really get tested. Does every postmenopause woman with osteoporosis need testosterone? No, I can't say that I'm speaking to what has helped my patients. But the beauty of functional integrated medicine is that we personalize treatment, right? We test hormone levels to see what our patients need and we test them at the beginning of therapy and through the therapy and annually, right. To make sure we're not under or overdosing our patients. So, I recommend that women, even young women, and I should say men too, but we're kind of speaking to women today, get their hormone levels tested in their twenties, thirties, forties. Right? So they can get a baseline. They can track changes. So they start to feel different, start to feel something has gone awry, we can compare to see where their hormones were before. I think that's really important. But basic blood tests can tell you where your hormone levels are.

Stephanie Gray:            21:27                And now that's for postmenopausal women and for men. Now if you're younger, another test that I utilize in my practice is saliva hormone testing. So for younger women whose hormones fluctuate, whose hormones fluctuate on a daily basis, many times I'll have them spit into a tube every couple of days over the course of a month so we can really see what's happening. Maybe they're getting headaches for population or maybe they're getting headaches before bleeding or having pms or whatnot. If we can correlate their labs with their symptoms, then we know exactly what's happening, which hormones fluctuation is triggering that, and then we can intervene appropriately. So that's the beauty of testing and not guessing. Really being able to examine on paper what's happening and match it with what the patient's plan.

Karen Litzy:                   22:09                And with osteoporosis or Osteopenia, let's say you are getting tested when you're younger to find out, you know, what are you deficient in vitamin or mineral wise and where are your hormones levels at? Can you through this process help to let's say ward off osteoporosis or Osteopenia even if it's a genetic thing within your family.

Stephanie Gray:            22:40                I guess the easy answer there would be sure. That would be the goal of course. So we want to ward off all chronic disease.

Karen Litzy:                   22:47                Yeah, exactly.

Stephanie Gray:            22:49                I'm sure there could be some rare genetic disorder. I'm not aware of that. Maybe, you know, we couldn't influence, but yes, that would absolutely be the goal is intervene soon. Absolutely.

Karen Litzy:                   23:03                Got It. And is there anything else when you're seeing patients coming to you with Osteopenia, osteoporosis, anything else that you're looking at or any other treatments that you may suggest? So that if anyone is listening to this, and let's say they are concerned that maybe they have osteoporosis or Osteopenia or they are post-menopausal or reaching that post-menopausal phase and they want to go to their doctor and they want to ask them about these tests, is there anything else aside from what we've already talked about that you would suggest?

Stephanie Gray:            23:37                Oh, all kinds of things. So I'm back to the micronutrient deficiency possibility. Well, especially if that occurs, we're going to be looking at diet with the patient, right? I had a young woman my age who was drinking like six or seven cups of coffee per day. And I said, you know, that's just basically leaching minerals from your bones, right? It's a diuretic. It's essentially robbing you of all important nutrients, even nutrients you're supplementing with. So you still need to examine diet with all of our patients and make sure that we're eating well. Right? And not just drinking tons of carbonated beverages or caffeine or whatnot. So definitely looking at diet is important. Sometimes we do look at heavy metal toxicity with our patients, with these patients specifically. I don't want to say it's rare, but it's much more common and more easy to treat the patients, you know, by fixing the nutritional deficiencies and the hormones.

Stephanie Gray:            24:32                But there are times where it is really important to look at heavy metals as well. And then I definitely always ask my patients about their stress, right? So if they have low hormone levels, that's part of that's natural, right? Your hormones are going to decline as you age, but you're super stressed out. Stress is your body's biggest hormone, hijacker stresses not helping your situation or your bombs. So we do need to think about lifestyle and really getting stressed under control, deep breathing, Yoga, meditation, and then examine if they're doing weight bearing activity as well. Yeah, of course. Needs to start really young, right? You build your phone mineral density in your 20s. So know that needs to start at a very young age. But I do want to make sure my patients are exercising as well.

Karen Litzy:                   25:20                Awesome. Well, I think that gives us a really nice holistic view of kind of looking at Osteopenia and osteoporosis from sort of bridging the gap really between that functional medicine and traditional medicine. As a physical therapist, I often get patients referred to me for osteoporosis to do those exactly what you said, those weight bearing exercises, stress reduction, things like that. And so it's good to know that as a physical therapist that we can team up with other healthcare professionals with our patient's wellbeing at the center.

Stephanie Gray:            25:54                Absolutely, I would say that that's also a belief for functional medicine, that we need interdisciplinary care for our patients. You know, I don't have time during my visits to teach patients exercise for strength and balance. We have our own strengths, but we can work together as a team and really have a multidisciplinary approach for our patients, which is going to provide them with better outcomes.

Karen Litzy:                   26:17                Yeah, no question. I agree 100%. And now we had mentioned the book a little bit, it's called the longevity blueprint, can you tell the listeners a little bit more about the book and where they can find it?

Stephanie Gray:            26:30                Maybe I'll go off on a little tangent here and just say why I wrote the book first. I think sometimes patients or consumers may think, oh, so-and-so just wrote a book, but she doesn't know because she hasn't experienced such and such or whatnot. And I'm definitely a provider who has gone through my own health challenges, unfortunately. But fortunately I've used them to my advantage to write this book. So I personally, I've struggled with a lot of things. The most challenging really was fast heart rate or a tachnocardic episodes, which, landed me at Mayo Clinic actually, well, firstly to be in the emergency room, but I eventually landed me at Mayo and conventional medicine's approach to my issue was to take a medication to control my heart rate. And although that could have worked and could have helped, I thought I need to figure out what's happening to me.

Stephanie Gray:            27:25                I needed to figure out why my body's gonna ride, right, why my heart is racing like this. And so around the same time, my husband is actually our office manager at our clinic. We have integrated health clinic in Iowa and he said, you know, you should really use this to try to streamline the process as far as what we recommend to our patients. Can you outline all of what we offer? Because sometimes patients would come see a functional medicine practitioner who only offered gut health or only offered hormone health or detoxing or whatnot. And we really offered the whole Shebang. And so he said, why don't we try to create some sort of analogy to outline all of what we can offer patients really to provide them hope. And so I created this blueprint outlining a functional medicine and all the different principles of what we can offer patients with every organ system of the body.

Stephanie Gray:            28:14                And then I kind of laced through my personal story as well as far as what I had to utilize to regain back my health. And so what I'm doing with the book is I'm trying to at least create this analogy between how we maintain our homes and the compare that to our body, right? So with our home, we have, well I have hair in my drain, right? I don't want hair clogging my drain. You probably mow your lawn. If you have a lawn, you probably change the furnace filters on your home right there. Just things you'd have, you know, you have to do to maintain your home. But we don't always know how to maintain our body. We don't know how to rebuild our body if we're sick or build that health period. And so I'm taking a room in each of our homes, right?

Stephanie Gray:            28:55                And I'm comparing that to an organ system in the body. So chapter one is all about gut health because I believe that gut is the most important piece of our health, most important organ system that we have. And I'm comparing that to the foundation of the home. You have to have the strong foundation upon which to build good health. So then I go chapter by chapter. I'm comparing, you know, organ system. So we were talking a lot about chapter four today and chapter six, chapter six I'm comparing the heating and cooling in your home, right? And you don't want to be too cold, you want to be too hot, you have to have a good thermostat there. But I'm comparing that to the endocrine system in the body. And so I try to help patients rebuild their body, rebuild every organ system using functional medicine principles. So I talk about the tests that are important. I talk about the nutrients that are important and offer patients resources as well.

Karen Litzy:                   29:42                That's awesome and that's really great for patients. And just so everyone knows, we'll have a link to the book in the show notes over at So if you're interested and you can go over, click a link and it'll take you right to Stephanie's books, you can read more about it and see if it's for you. And now, Stephanie, I ask everyone this question at the end of the podcast and that is knowing where you are now in your life and in your business, what advice would you give to yourself and in your case, since you have a plethora of degrees, let's say right after your bachelor degree, after you graduated with that bachelor's in nursing.

Stephanie Gray:            30:26                Okay, so that's tough. I think what part of what I've learned through my health situation, I had to change my diet and nutrition and what not, but I also had to reduce stress big time. And so I think one I really recommend to all, well everyone but including the youth, I wish I would have as happy I as I am to be where I am and to have the knowledge I have so that I can ultimately help others. My health suffered along the way and so I could have, you know, done this over a longer period of time and instead of jamming it into fewer years, I think the advice to myself would be to physically set time in my calendar to deep breathe. Deep breathing has been extremely important to me to calm my nervous system. I'm obviously a fast talker and I needed to set aside time for my body to just mend and relax, rest and digest. So I think that's what my advice would be to take time for myself. As hard as it would've been, it probably would've been very difficult for me to do yoga. I probably couldn't have sat still, but I needed it. Yeah. That's probably the advice to just slow down, breathe slowly, take time.

Karen Litzy:                   31:39                Yeah. And that's great advice and it's advice that I give to a good majority of my patients as well. And so now is there anything else, I know that you had mentioned that you have an offer for listeners. Do you want to share that now?

Stephanie Gray:            31:54                Sure. So if you're hearing about functional medicine for the first time today, I'd highly recommend you check out my book just because I think that it could provide you hope or hope for a loved one. I think many patients are just so dissatisfied, they keep going to the doctor, they keep being told that everything's normal and they know they don't feel normal and they know there are answers out there and there's a good potential that a functional medicine provider could help you. So I would definitely recommend grab a copy of my book, which is loaded with resources but also look for a functional medicine practitioner in your area. So the code on our website that can be used to purchase the book, although it's available at Barnes and noble and Amazon and everywhere books are sold is So if you use the code healthy10, you can get 10% off order on the book or any of the supplements like vitamin K2 or anything you feel like you need. But after, you know, when you think of a home being built, there's always a contractor overseeing that process. And, that's what the last chapter of my book is about. Finding your contractor to help you personally as a community build your health. The book can help, but you do need a guide. You need a contractor.

Karen Litzy:                   33:01                Well thank you so much. This was great. I love learning different ways to kind of keep myself healthy and as I get older and I start, I mean I think I have a little while left, but kind of entering the phase of my life where a lot of this stuff is going to be very pertinent to me. So I thank you for sharing it all.

Stephanie Gray:            33:25                Well, thank you for having me on. I hope this helps many of your viewers

Karen Litzy:                   33:28                And I think it will. Thank you so much Stephanie and everyone out there listening. Thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.


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Sep 19, 2019

LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Alex Hutchinson on the show to discuss sports journalism.  Alex Hutchinson is National Magazine Award-winning journalist who writes about the science of endurance for Runner’s World and Outside, and frequently contributes to other publications such as the New York Times and the New Yorker. A former long-distance runner for the Canadian national team, he holds a master’s in journalism from Columbia and a Ph.D. in physics from Cambridge, and he did his post-doctoral research with the National Security Agency.

In this episode, we discuss:

-How to disseminate findings from complex research studies to a layman audience

-Attention grabbing headlines that commit to a point of view

-Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance

-What Alex is looking forward to from the Third World Congress of Sports Physical Therapy

-And so much more!


Third World Congress of Sports Physical Therapy

Alex Hutchinson Twitter



Alex Hutchinson Website


For more information on Alex:

I’m an author and journalist in Toronto. My primary focus these days is the science of endurance and fitness, which I cover for Outside (where I’m a contributing editor and write the Sweat Science column), The Globe and Mail (where I write the Jockology column), and Canadian Running magazine. I’ve also covered technology for Popular Mechanics (where I earned a National Magazine Award for my energy reporting) and adventure travel for the New York Times, and was a Runner’s World columnist from 2012 to 2017.

My latest book, published in February 2018, is an exploration of the science (and mysteries) of endurance. It’s called ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance. Before that, I wrote a practical guide to the science of fitness, called Which Comes First, Cardio or Weights? Fitness Myths, Training Truths, and Other Surprising Discoveries from the Science of Exercise, which was published in 2011. I also wrote Big Ideas: 100 Modern Inventions That Have Transformed Our World, in 2009.

I actually started out as a physicist, with a Ph.D. from the University of Cambridge then a few years as a postdoctoral researcher with the U.S. National Security Agency, working on quantum computing and nanomechanics. During that time, I competed as a middle- and long-distance runner for the Canadian national team, mostly as a miler but also dabbling in cross-country and even a bit of mountain running. I still run most days, enjoy the rigors of hard training, and occasionally race. But I hate to think how I’d do on an undergraduate physics exam.


Read the full transcript below:

Karen Litzy:                   00:00                Hey everybody. Welcome to the Third World Congress of sports physical therapy Facebook page. And I am your host, Karen Litzy. And we have been doing several of these interviews over the past couple of months in support of the Third World Congress of sports physical therapy. And today we have writer, journalist, author, athlete, Alex Hutchinson who is part of the Third World Congress. He's going to be a part of an informal Q and A and also doing a talk with Greg Lehman, who's already been on. So Alex, welcome to Facebook live.

Alex Hutchinson:           00:37                Thanks very much, Karen. It's great to be here.

Karen Litzy:                   00:39                All right, so for those people who maybe aren't as familiar with you, can you tell us a little bit more about yourself?

Alex Hutchinson:           00:46                Yeah, I mean, I guess when people ask what I do, I say I'm a freelance journalist, but if you kind of drill down a little bit, my subspecialty is like, I'm a sports science journalist or even an endurance sports science journalist, which isn't really a job, but it's effectively what I do. So I write for, for outside magazine and a few other places. There's Canadian running magazine and a newspaper in Canada called the globe and Mail, but mainly outside magazine about the science of Endurance sports, sports more generally, adventure, fitness, health, all those sorts of things. A fairly, fairly broad stuff that interests me, I try and look at the science angle of it. And so that means talking to a lot of athletes and sometimes I talk to coaches, but mostly I talk to researchers who are trying to use, you know, research studies, peer reviewed, you know, placebo-controlled, blinded studies to answer questions that a lot of us have when we exercise, you know, what workout should I do or how should I refuel or these sorts of things.

Karen Litzy:                   01:48                Alright, so you're taking, which I think is great. You're taking the research and you're able to disseminate that out into, if you will, the layman's audience.

Alex Hutchinson:           01:57                Yeah, that's the goal. Yeah. And, it's interesting cause I come from a running background. I was a competitive runner. And I was a, a guy interested in science, but there wasn't no, when I was competing in the sort of nineties and early two thousands, it to me at least, it seemed, it wasn't very easy, I didn't even know that there were, you know, thousands of researchers around the world trying to answer these sorts of questions. And I think for me it was in the middle two thousands I started seeing some columns in the New York Times from Gina Kolata. And then from Gretchen Reynolds.  Gina Kolata had a column called personal best where she was like looking into the myth that lactic acid causes fatigue. And this was maybe around 2005 and I was like, Holy Mackerel.

Alex Hutchinson:           02:37                And she was interviewing scientists who are asking these questions. And I thought there are scientists who care about lactic acid so that kind of started me on the path of thinking that, realizing there's a body of research out there that wasn't reaching interested lay people like myself. So I started pursuing that. And I think today there's a lot more. Like there were a lot of avenues through which exercise science reaches the lay people. I feel like I'm one of those channels, but it's definitely, there's a lot more options for people now, including directly from scientists themselves in places like Twitter.

Karen Litzy:                   03:13                Exactly. And I think that's where I, you know, in the late nineties, mid two thousands, social media certainly wasn't as robust as it is now. And now you have scientists and researchers being encouraged to get onto these platforms and disseminate some of their information, whether it be through tweets or infographics, podcasts, Facebook lives, things like this. So I think the leap from relatively nothing, you know, meaning researchers kind of doing their research but not having perhaps the means to get it out to a wider audience outside of a journal that not every lay person who reads, you know, having such great avenues to disseminate this information. Do you feel like it's made a difference in the general public?

Alex Hutchinson:           04:00                I think it has. It's hard to really evaluate this stuff, but my sense is there's a higher level of literacy or sort of awareness of issues, you know, things like how to fuel that's maybe not just drawn from, I heard it from a guy at the gym or I heard it from my coach who heard it from his coach who is taught by, you know, some guy in 1830 that this is how it works. I mean, I would almost say that we've gone from a place of scarcity to a place of excess that now it's not like you can't find information. Now there's these fire hoses of information just drenching you with 20 different theories. All of which seemed to be supported by scientists about how you should eat, how you should exercise, how you should move, and all these sorts of things.

Alex Hutchinson:           04:45                So I started writing about sports science, let's say 15 years ago or a little less than that. And at that point it was like, let's get the information out there. People don't realize that there's information now. It's like there's all this information, let's curate the information. Let's try and provide people with some judgements about what's reliable and what's not. Why we think that some sources of information are better than others. How each person can evaluate for themselves, whether this is trustworthy. You know, and this is obviously not an easy or there's not like one answer to this study's right and this study's wrong, but, yeah, I feel like my role has shifted a little bit from get the information out there to, okay, maybe I can be a trustworthy source of curation where I'm giving people the information, not necessarily telling them what to think, but saying, here's the evidence. Now you may choose to think this evidence isn't convincing enough for you to switch to the, you know, the Aldana Diet or you may not, but here's, here's what the evidence says it exists.

Karen Litzy:                   05:45                Yeah, and that's a great lead into my next question is when we look at quote unquote fake news and we can categorize that as misinformation or disinformation. So misinformation being like you're putting something out there and you think it's good, but you just don't know that the information is bad versus disinformation, which is, I guess we can categorize more as propaganda. So you know, the information's not correct, but you're pushing it out there anyway. So I think it's important to me. Both of those are fake news, but it's important to make that distinction. So as a journalist, how do you navigate this and how important is it for you to get that right?

Alex Hutchinson:           06:27                Yeah, yeah, yeah. Well, getting it right is important to me and I'm glad you made that distinction because I think that's an important one because you know, fake news in the politicized sense is another way of saying propaganda. And I think that's mostly not what we're dealing with in the exercise or the health space. I mean there, there is actually, I mean, you know, let me take that back a little bit there. There are people who are just selling things to make money who are just, they don't really care whether it's true. They're putting steroids into their stimulants, into their strength supplements because they just want people to feel a boost and they're just flat out lying so those people are bad and they're also not that hard to spot if truth be told, if you're critical, what's tougher is the, you know, what you call misinformation rather than disinformation, which is people honestly believe this.

Alex Hutchinson:           07:20                Like, I tried this diet, it works for me, and therefore everyone should be doing it. And I read this study that shows that people who do this diet, you know, increase their levels of some inflammatory marker and that proves, that confirms my belief. And therefore I'm going to become an evangelist for this. And I'm going to say that everyone who disagrees with me has been paid off by big industry and blah, blah, blah. And sometimes it's not quite that. I mean, I'm caricaturing it, but people don't have strong beliefs that don't have as strong beliefs about, you know, controversies in particle physics cause we don't have personal experience in particle physics when you're talking about health and exercise and eating and things like that. We all have our, we have our experiences. And so we map that on top of whatever evidence we're experiencing, and I include myself in this, you know, my experiences play into what science, scientific research finds plausible.

Alex Hutchinson:           08:12                So that creates a different dynamic. So to answer your actual question, how do I navigate this? Imperfectly like every other human, but my goal in what I write, what I try and do is if I'm writing about a study, this article from my perspective as the one in which I'm able to serve, take the key graph from that study, cut and paste it into my article and then describe what the study was. Here's what they did, here's what they found.

Alex Hutchinson:           08:46                I'll take it a step further than that because my role is to interpret. I'll say, here's what I think this means, but I want to make sure I can give enough information to someone who doesn't think that's what it means is also can also see, well that's what the evidence was. And it's like, well no, I don't agree that that should change my behavior or whatever, but I'm giving them, I want to give people enough information so they understand what the study did and what it found. And then the meaning, if I've given people enough information, they don't have to rely on me telling them that this is what it means even though I am going to tell them what I think it means.

Karen Litzy:                   09:16                If you were to give tips to let's say the layman person, say it's like my mom or you know, your friend who knows nothing about science, he doesn't have a phd in physics, and we'll get back to that with you in a second. But what tips can you give to the lay person on how to spot this misinformation, because the thing is when you look at a lot of articles, they're always citing this study, that study, this study.

Alex Hutchinson:           09:47                Yeah. It used to be like, show me the peer reviewed evidence. But yeah, I've slowly realized, you know, and understood that there is a peer reviewed study for everything. And you know, 10 years ago I used to get, I'd see a study saying, you know, hey the, you know, the fruit of this plant, if you take it's going to increase your endurance by 2%. It's like, well if they have a placebo controlled, double blinded study published in a peer reviewed journal, it must be true. I'll write about it. And then, you know, I never did hear about that extractive of such and such a plant. Again, like no one, it never turned out to be a thing. And I sort of finally understand, you know, started to understood the bigger systemic problems, which is that if you have, you know, thousands of Grad students across the country looking for a master's thesis that can be done in six months or an experiment, they can be done in six months.

Alex Hutchinson:           10:33                They're testing all sorts of things. And if it's not interesting, they don't publish it. And if it happens by chance to produce a positive result, then they publish it in a journal. So we get this sort of, there's always public positive studies about everything. What I was saying, which is that just the mere presence of a study isn't enough. So there is no simple template. But I would say there are some guidelines like follow the money. If someone's trying to sell you something, it’s obvious, but it's surprising what a good rule of thumb that is. And it's why we see so much information about pills and technology.

Alex Hutchinson:           11:20                And so little information about, you know, another study showing that sleep is good for you, getting some exercise is good for you because it's very hard to monetize that. And so there's lessons. I don't mean to sound like a patsy or like someone who's, you know, pump promoting my own way of seeing things. But I think there are some sources that are more sort of authoritative than others. And frankly, the mainstream media still does a pretty good job relative to the average blog. Now there are some great blogs out there and you know, and I will say, I started out in this, I set up my own blog on wordpress and I blogged there for five years, just analyzing studies. And then runner's world asked me to bring the blog onto their site and then it got moved outside.

Alex Hutchinson:           12:08                So it's not that there aren't good blogs and you can maybe get a sense of what people's agendas are and what their backgrounds are. But, you know, if I knew that, I know in this highly politicized world, I know that this may be a controversial thing to say, but if I see something in New York Times, I'm more likely to believe it than if I see it on, you know, Joe's whole health blog and I read the New York Times and I get frustrated frequently and I say that now they're getting this wrong. And this is not a full picture of this. Nobody's perfect. But I think that people with credentials and getting through some of those gatekeepers is one way of filtering out some of the absolute crap that you see out there.

Karen Litzy:                   12:53                Perfect. Yeah, I think those are very easy tips that people can kind of follow. So sort of follow the money, see who's commissioned said RCT, systematic review. And, oftentimes, especially on blogs, it can be a little tricky because some of them may write a blog and be like, oh, this is really good. But then when you look down, it's like the blog is sponsored by so-and-so,

Alex Hutchinson:           13:18                And that's the reputable people who are acknowledging who's sponsoring them. Then there's the people who are getting free gear, free product or money straight up, but they're not, you know, like there's levels of influence and the people who are disclosing that at least they're disclosing it. But nonetheless, it's, you know, one of the things that I think people often kind of misjudge is when, when someone says that follow, you know, follow the money and the financial influences, finances can influence someone. That doesn't mean that the people who are passing on this message or corrupted or that it's disinformation as you would say that they're deliberately, yeah. I mean, lots of researchers who I really highly respect do excellent research funded by industry. And I think that there's any important information that comes from that research, but I also think that the questions that get asked in industry funded research are different than the questions that you might ask if you just had you know, a free pot of money that wasn't tied to any strings.

Alex Hutchinson:           14:16                If you want to, you know, not to pick on anybody, but if you want to know which proteins are best for building strength and if the dairy industry is going to fund a whole bunch of studies on dairy protein, then you're going to have this excellent body of research that shows that dairy protein is good for building muscle. That doesn't mean it's wrong, it just means that we haven't studied what, you know, vegetable proteins or other forms of meat. There's been less emphasis on those proteins so you get a distorted view of what's good or bad without anybody doing anything wrong. It's just that money does influence the way we ask questions and the answers we get.

Karen Litzy:                   14:53                Great. Thank you. Now I had just mentioned about having a phd in physics. That is obviously not me. How did you end up doing your phd in physics and how does this help you when it comes to writing your articles or writing these reviews of RCTs or systematic reviews?

Alex Hutchinson:           15:14                Well, I should first say that if anyone's interested in becoming a science journalist, I wouldn't necessarily recommend doing a phd in physics. It's not the linear path or you know, the path of least resistance. I honestly didn't know what I wanted to do when I grew up. Some advice I got, which I think was good advice to some extent was, you know, if you don't know what you want to do, do something hard because at least you'll prove to people that you can, you know, solve problems and there'll be some transferability of that training. And I think that was true to some extent. And I, you know, so I did physics in Undergrad. I still didn't know what the heck I wanted to do. And I had an opportunity to go do a phd in England, which seemed like a big adventure.

Alex Hutchinson:           15:50                So I went and did a phd there, PhDs there are actually a lot shorter than they are in North America. It's just over three years for my phd. So it wasn't, it wasn't like this sort of, you know, spent my entire twenties on this. Physics was fun, but it just, I could see that the other people in my lab were more passionate about it than I was, that they were, they were just interested. They were passionate about it. And I thought, man, I want to, I want to find something that I'm passionate about. So I ended up in my late twenties saying, okay, well it's been a slice, but I'm going to try something else. And, you know, fortunately I guessed right. And journalism turned out to be fun. Fun for me. I don't write, you know, especially these days if I'm writing about exercise and it's not like I need to know Newton's laws or anything like that or you know, apply the principle of general relativity to exercise.

Alex Hutchinson:           16:35                So there's not a lot of like direct pay off. But I would say that having a scientific training has helped me be willing to speak to scientists and not be intimidated by paper. You know, Journal articles that look very complex and you know, I have the confidence to know that, okay, I don't have a clue what this journal article is saying, but I know if I slow down, if I read it a few times and if I call it the scientist and say, can you explain this to me? I'm not worried. Well, I mean, I don't like looking stupid, but I'm over the idea is like, it's okay. I can call up the scientist. I know enough about scientific papers to know that probably the guy in the office next door to whoever wrote this paper doesn't understand this paper. You know, science is very specialized and so it's okay to just say, explain to me, explain it to me again. Okay. This time, pretend I'm, you know, your 90 year old grandfather and explain it again. And so that allows me, or has helped me write about areas even when I'm not familiar with them and not be intimidated by numbers and graphs and things like that.

Karen Litzy:                   17:36                All right. And I would also imagine that going through Phd training yourself, you understand how articles are written, you kind of can look at the design, and you can look at the methods and have a little bit more, I guess confidence in how this study was maybe put together. Versus no training at all.

Alex Hutchinson:           18:03                You've seen how the sausage is made and so you understand the compromise that get made. I will say that it was surprising to me how different the physics processes to the sort of the sports science world in terms of just the factors that are there that are relevant in physics. You’re never dealing with people. And with the sample recruitment and things like that. An Electron is an electron, you know, for the most part. You know, and this is an important to understand is physics aside by looking a lot of studies, I started to see the patterns and started to understand what the functions were, started to understand how to read a paper relatively quickly. How did you know it? For me to find stories, I ended up looking at a lot of journal articles and I can't read every one of them in depth in order to find the ones I wanna write about.

Alex Hutchinson:           18:52                So I have to find ways of, you know, everyone knows you. Yeah, you can read the abstract, but you're not going to get the full picture. You know, you start to learn just by experience, by doing it. That, okay, if I read the introduction, that's where the first three paragraphs are where they're going to give me the context. Because often a study seems very specific and you're like, I don't know what you're talking about. And then they'll give two paragraphs where they're just like, since the 1950s, scientists have been wondering about x, Y, and zed. And then you can go to the conclusions and then, you know, depending on how deep you want to get, you understand where, which part of every paper is written with a specific format and you can figure out where to go with a little experience. And it doesn't require a physics phd or it requires just getting, getting familiar with that particular, you know, subject area.

Karen Litzy:                   19:35                Nice. And now, you know, we talked earlier about how, you know, information from researchers went from like a little drip to a fire hose and as far as getting information out to the general public, so because there is so much information available, how do you approach designing your article titles and headlines to ensure you grab attention for the reader. So I think that's a great question directed at the researchers who are maybe thinking of doing a press release or things like that to help promote their article.

Alex Hutchinson:           20:10                Yeah. This is a really interesting question. This isn't one where my thinking has shifted over the last, let's say, decade. So I started out, you know, in print journalism, writing for newspapers and magazines. I still do that, but one of the things in from when you're writing for a newspaper magazine is you don't have control over your headlines. You write the article, the editor writes the headline. And so my experience in that world was always one of frustration being like, I wrote this very carefully nuanced, balanced article. And then the headline is, you know, do this and you'll live till you're a hundred or whatever. It's like, no, that's not what I was saying. It's terrible. And so I got into this sort of reflects of habit you know, just apologizing for the headlines. Like, Oh, you know, when I talked to researchers, I'm so sorry about the headline.

Alex Hutchinson:           20:59                You know, I'm very sophisticated, but you know, that this silly editor wrote the headline and a couple of things help to sort of shift my views a little bit on that. One is the shift to online meant that newspapers and journalists now have a very, very clear idea of who clicks on what. So you understand what it is that gets people's attention. And the second thing is that, you know, when I started my own blog, and then even now, when I blog, I don't have full control of my headlines, but when I was on wordpress, I wrote my own headlines. And when I now as a blogger, I suggest headlines. And so I don't have control, but I am given more input than I used to be on how this article should be conveyed.

Alex Hutchinson:           21:40                And one thing that's really clear is that, what people say they want and what people will do is different. And so I remember looking at when the global mail is the Big News newspaper in Canada. I remember when it first started showing its top 10 most clicked articles. You know, in the transition to digital on its website. And of course, everyone says, I hate clickbait. I want to have sophisticated, nuanced conversations. And then the top 10 articles clicked would all be something to do with Brittany Spears or whatever. You know, this was 10 years ago. And it's like, so people click on, people do respond to clickbait and click bait it's bad. But you know, I sometimes I want like sometimes give talks to scientists about science communication and I'll give some contrast between here's the journal article, you know, here's my headline and the journal article will be something that's so careful that you're not even, it definitely doesn't tell you what the article's going to say.

Alex Hutchinson:           22:36                You're not even entirely sure what the subject is. You know, like an investigation of factors contributing to potentially mitigating the effects of certain exercise modalities. And you're like, I don't know. I don't know what that's about. No one clicks on it. And so it's like that sort of, if a tree falls in the forest, if you write a perfectly balanced nuanced article and nobody reads it, have you actually contributed to science communication? And so one of the things that I found in with headlines that I'd complain about is I would complain about a headline that someone had written for my article and then, and I try to think why am I complaining about this? And it's like, well it's sort of coming out and saying what I was hinting at, I was hinting at, I didn't want to come out and say, you know, overweight people should exercise more or whatever.

Alex Hutchinson:           23:22                Cause that's horrible. No one would say that. But if you sort of read what the evidence that I was shaping my article to be, it'd be like, if you're not getting results from your exercise, maybe you're just not exercising hard enough. I was like, well maybe I need to own the messages. You know, if the headlines to me seems objectionable, maybe it's my article is objectionable and I've tiptoed around it, but I need to think carefully. And if someone reads my article, you know, an intelligent person reads my article and says this in sum it up in seven words, this is what it is, then I need to maybe be comfortable with having that as the headline, even if it's an oversimplification, because the headline is never going to convey everything, all the nuances. There's always caveats, there's always subtleties.

Alex Hutchinson:           24:04                You can't convey those in seven words. That's what the article is for. So I've become much more of a defender, not of clickbait, not of like leading people in with misleading things. But if ultimately the bottom line of your article is whether it's a academic article or a press article is, you know, this kind of weight workout doesn't work and you should be okay with a headline that says that. And yes, people will say, but you forgot this. And then you can say, well, no, that's in the article, but I can't convey all the caveats in the headline. So anyway, that's my, that's my sort of halfhearted defense of attention grabbing headlines in a way.

Karen Litzy:                   24:37                Yeah. And if you don't have the attention grabbing headline, like you said, then people aren't going to want to dive into the article. So I was, you know, looking up some of the headlines from and the first one that pops up is how heat therapy could boost your performance. And you read that and you're like I would want to find out what that means.

Alex Hutchinson:           25:02                And they put some weasel words in there. It's not like heat therapy will change your life. It's how it could boost your performance. And so, and I'm there, it's interesting, I've got conversations with my editor and they, you know, they don't like question headlines. They don't want to be as like, is this the next, you know, a miracle drugs? And then it turns out the answer is no. It's like they feel that's deceptive to the reader. They want declarative headlines that say something. It’s an interesting balance but outside has been, they've had some headlines which were a little, you know, there was one a while ago about trail maintenance and it was like the headline was trail runners are lazy parasites or something like that. And that was basically, that was what the article said. It was an opinion piece by a mountain biker. They got a ton of flack for that and they got a bunch of people who are very, very, you know, I'm never gonna read outside again. It's like, dude, relax. But I understand, but I understand, you know, cause it is a balance there. They want to be noticed and I want my articles to be noticed, but I don't want to do it in a deceptive way.

Karen Litzy:                   26:07                Yeah. And I think that headline, how heat therapy could boost. It's the could.

Alex Hutchinson:           26:12                Exactly the weasel word that it's like, it's, I'm not saying it will, but there's certainly some evidence that I described in the article, but it's possible this is something that people are paying or researching and that athletes are trying, so it's, you know, check it out if you're interested.

Karen Litzy:                   26:25                Yeah, I mean, I think it's hard to write those attention grabbing headlines because like you said, you can have the best article giving great information, but if it's not enough in the headline for the average person to say, hmm, Nah, Nah, nevermind, or Ooh, I really want to read this now the, I think when you're talking about an online publication, like you said, you now have a very good idea as to who is reading by going into the analytics of your website. So I think that must make it a little bit easier, particularly on things that they're going to catch attention.

Alex Hutchinson:           26:59                And so since I'm working for outside, I don't have access to their analytics though. I can ask them what my top articles were or whatever. And I actually am careful not to ask too much because I think there's a risk of you start writing to the algorithm. I start with, you know, you're like, oh, so if people like clicking on this, I'm going to write another article that has a very similar headlines. So, when I had my wordpress site, I had much more direct access to the analytics and it's a bit of a path to, it forces you to start asking yourself, what am I writing for? Am I writing to try and get the most clicks possible or to do the best article possible? So I actually tell him when I talked to my editor, I'm like I don't want too much information.

Alex Hutchinson:           27:43                I want to know. Sometimes I kind of want to get a sense of what people are reacting to and what aren't. And I can see it on Twitter, which things get more response. But I don't want that to be foremost in my mind because otherwise you end up writing you know, if not clickbait headlines, you write clickbait stories, you know, cause you do get the most attention. Yeah. So I try not to follow it too much and let someone else do that worrying for me.

Karen Litzy:                   28:09                Yeah. So instead, I think that's a great tip for anyone who is putting out content and who's disseminating content, whether it be a blog or a podcast, that you want to kind of stay true to the story and not try and manipulate the story. Whether that be consciously or maybe sometimes subconsciously manipulating the story to fit who you think the person who's going to be digesting that information wants.

Alex Hutchinson:           28:34                Yeah. And I know that happens to me subconsciously. You know, it's unavoidable. You're thinking, well, if I write it this way, I bet more people are going to be interested, it happens a little bit, but you want to be aware of it. And especially, I guess if you're, let's say you're someone who's, you know, starting a blog or starting some form of podcast or whatever it is, clicks aren't the only relevant metric and you can get a lot of people to click on something, but if they're left feeling that it wasn't all that great, then you're not gonna, you know, it's better to have half as many people all read something and think that was really substantive and thoughtful and useful than to get a bunch of clicks. But no one had any particular desire to come back to your site.

Karen Litzy:                   29:15                Like you don't want to leave people feeling unfulfilled. Yeah, yeah, yeah. Not Good. Well great information for both the researchers and for clinicians who are maybe trying to get some of that research out there. So great tips. Now, we talked a little bit about this before we went on air, but in 2018 you've published your book, endure mind body and the curiously elastic limits of human performance. So talk a little bit about the book, if you will, and what inspired you to write it?

Alex Hutchinson:           29:50                Sure. The book is basically, it tries to answer the question, what defines our limits. Like when you push as hard as you can, whether you know you're on the treadmill or out for a run or in, in other contexts, what defines that moment when you're like, ah, I can't maintain, I have to slow down. I have to stop. I have reached my absolute limit. And it's a direct, you know, it's easy to understand where the book came from. I was a runner and so every race I ran, I was like, why didn't I run faster? Like I'm still alive. I crossed the finish line. I've got energy left. Why didn't I, why surely I could have run a little bit faster. And so basically I, you know, I started out with an understanding of a basic understanding of exercise physiology.

Alex Hutchinson:           30:32                And, you know, 15 years ago I thought if I can learn more about VO2 Max and lactate threshold and all these sorts of things, I'll understand the nature of limits and maybe what I could have done to push them back. And about 10 years ago, I started to realize that there was this whole bunch of research on the brain's role in limits. And there've been a whole bunch of different theories and actually some very vigorous arguments about this idea. But this idea that when you reach your limits is not that your legs can't go anymore. It's that in a sense, your brain thinks you shouldn't go anymore than that. Your limits are self-protective rather than reflecting that you're actually out of gas, like a car runs out of gas. And so then I thought I was gonna write a book about how your brain limits you.

Alex Hutchinson:           31:12                And in the end, as you can probably guess, it ended up being a sort of combination of these sorts of things. Like there's the brain, there's the body, they interact in different ways, in different contexts. So I ended up exploring like, you know, we were talking about this before, what is it that limits you when you're free diving? If you're trying to hold your breath for as long as possible, is it that you run out of oxygen after a minute and then how come some people hold their breaths for 11 minutes? And how does that translate to mountain climbing or to running or to riding a bike or to being in a really hot environment or all these sorts of things. So that is what the book is about is, is where are your limits? And the final simple answer is, man, it's complicated and you have to read the whole book.

Karen Litzy:                   31:51                Yeah. And we were talking beforehand and I said, I listened to the book as I was, you know, commuting around New York City, which one it would got me really motivated and to want to learn more. And then it also, I'm like, man, I am lazy. There are so many different parts of the book from the breath holding, like we were talking about. And things that I was always interested me are altitude trainings and the how that makes a difference, whether you're training up in the mountains or sea level or in those kind of altitude chambers. Which is wild stuff. And is that, I don't know, is that why people break more records now versus where they were before? Is it a result of the training? Is it, and then, like you said, the brain is involved and so are you just by pushing the limits of yourself physically, but then does the brain adapt to that and say, okay, well we did this, so I'm pretty sure, and we lived, so can we do it again?

Alex Hutchinson:           33:08                And that's actually a pretty good segway to the World Congress of sports therapy. Because the session that I'm talking about it that I'm talking with Greg Leyman is on pain. And, one of the things that I find a topic that I find really interesting is pain tolerance. Do we learn to tolerate more. And so, you know, one of the classic questions that people argue about on long runs is like who suffers more during a marathon, you know, a two and a half hour marathoner or a three and a half hour marathoner. It's like, one school of thought is like, well, it's a three and a half hour marathoner is out there pushing to the same degree as the two and a half hour marathoner, but is out there for longer for almost 50% longer so that that person is suffering longer.

Alex Hutchinson:           33:56                And the counter point, which sounds a little bit maybe elitist or something to say on average, the two and a half marathoner has learned two and half hour marathoner has learned to suffer more as his learning to push closer to his or her limits. Now that's a total generalization because it's not really about how fast you are. It's about how well you've trained, how long you've trained. So there are four marathoners who are pushing absolutely as hard as any two and half hour marathoner. And there are some very lucky two and a half hour marathoners who aren't pushing particularly hard because they were capable of doing it, you know, at two 20 marathon or something. But the general point that I would make and that I think that the reason that I think the research makes is that one of the things that happens when you train, so we all know that you go for that first run and it feels terrible, Eh, you feel like you're gonna die when you keep training, all sorts of changes happen.

Alex Hutchinson:           34:52                Your heart gets stronger. You build new Capillaries, your muscles get stronger. Of course, that's super important. It's dominant. But I think another factor that's on pretend times under appreciated is you learned to tolerate discomfort. You learn to suffer. You learn that feeling when your lungs are bursting and you're panting and your legs are burning, that doesn't mean you're gonna die. It just means you can't sustain that forever, but you can sustain it for a little bit longer. You can choose to keep holding your finger in that candle flame for a little longer. And there's actually quite a bit of evidence showing that as training progresses, you learn not just in the context of whatever exercise you're doing, but in the context of totally unrelated pain challenges like dipping your hand in an ice bucket or having a blood pressure cuff squeezed around your arm.

Alex Hutchinson:           35:35                You learn to tolerate more pain by going through the process of training. And I think it's an interesting area of, I think it tells us something interesting about physical limits cause it tells us that part of the process of pushing back physical limits is pushing back mental limits. But it also tells us something about how we cope with pain and why. For example, why exercise training might be helpful for people dealing with chronic pain, for example, that it's not just endorphins block the pain, it's that you learn psychological coping strategies for reframing the pain and for dealing with it.

Karen Litzy:                   36:10                Yeah. As a quick example, two and a half weeks ago, I tore my calf muscle the medial gastric tear, nothing crazy. It was a small tear and it happens to middle age people. Normally the ultimate insult or worse, at any rate, you know, very painful. I was on crutches for a week. I had to use a cane for a little while, but I was being so protective around it. And then I read, I got a great email from NOI group from David Butler and they were talking about kind of babying your injury and trying to take a step back and looking at it, looking at the bigger picture. And I thought to myself, well, this was the perfect time to actually get this email because I was like afraid to put my heel down. I was afraid to kind of go into Dorsiflexion and once I saw that, I was like, oh, for God's sakes. And that moment I was able to kind of put the heel down to do a little stretching. And, so it wasn't that all of a sudden my physicality changed so much, but it was, I felt from a brain perspective, from a mental perspective that I could push my limits more than I was without injuring.

Alex Hutchinson:           37:35                Absolutely. And it's all a question of how we have the mistaken assumption that pain is some objective thing that there's, you know, you have it damaged somewhere and that's giving you a seven out of 10 pain. But it's all about how you frame it and if you were interpreting that pain as a sign that you weren't fully healed and therefore you're going to delay your recovery, if you're feeling that pain, then you're going to shy away from it. And if you're just interpreting it, if you read that email and it reframes it as this pain is a part of healing, it's a part of the process of, and it's like, oh well I can tolerate that. If it's not doing damage, then I don't mind the pain and all of a sudden it's become something that's a signal rather than a sort of terrible, it's just information.

Karen Litzy:                   38:15                Yeah. Information versus danger, danger, danger. I just reflected on that and thought, yeah, this is pain. It's being protected at the moment. It doesn't mean I'm going to go run a marathon given my injury but it certainly means I can put my heel down and start equalizing my gait pattern and things like that. And so it's been a real learning experience to say the least. And the other thing I wanted to touch on was that idea of pain and suffering. And I know this can probably be out for debate, but that because you have pain, does it mean you're suffering? So if you have a two hour 30 versus a three hour 30 or whatever, the person who runs it in six hours, right? Because you have pain, are you suffering through it or are you just moving through the pain without the suffering attached to it? And I don't know the answer to that, but I think it opens up to an interesting, to a wider discussion on does pain equals suffering?

Alex Hutchinson:           39:20                Now we're getting philosophical, but I think it's an interesting one cause I mean I've heard a number of sports scientists make the argument that one of the sort of underappreciated keys for success in endurance sports is basically benign masochism that on some level you kind of enjoy pushing yourself into discomfort. And I think there's some truth to that. And I think it's an entirely open question. Like are people just born, some people just born liking to hurt or is it something in their upbringing? Moving outside of a competitive context and just talking about health, it's like what a gift it is to enjoy going out and pushing your body in some way because that makes it easy to exercise. And so I think one, you know, this is changing topic a little bit, but one of the big challenges in the sort of health information space is that a large fraction of the people who write about it are people like me who come from a sports background that on some level enjoy, I go out and do interval workouts.

Alex Hutchinson:           40:16                Not because I'm worried about my insulin, but because I like it. I like pushing, finding out where my limits are on being on that red line. And so when I'm like, come on, just go out and do the workout, then others and some people find it very, very, very unpleasant to be near that line. And so I think we have to be respectful of differences in outlook. But I also think that’s what the evidence shows is you can learn to, you know, like fine line or whatever. You can learn to appreciate some of what seems bitter initially. And if you can then it totally changes then that pain is no longer suffering. Then it’s the pain of like eating an old cheese or whatever. It's like oh that's a rich flavor of pain I'm getting today in my workout as opposed to this sucks and I want to stop.

Karen Litzy:                   41:06                Yeah. So again, I guess it goes back to is there danger, is there not danger? And if he can reach that point of feeling pain or discomfort or whatever within your workouts and then you make it through the workout and you're like, I can't believe I did that. And all of a sudden next time it's easier. You pushed the bar. Yeah. You've pushed them further to the peak a little bit. So I think it's fun when that happens.

Alex Hutchinson:           41:35                And I think it's important what you said, a understanding the difference between pain as a danger signal. Cause I mean as an endurance athlete I may glorify the pushing through the pain. Well that's stupid if you have Shin splints or you know, if you have Achilles tendon problems or whatever. Yeah. You have to understand that some pain really is a signal to stop or at least to understand where that pain is coming from and to do something to address it. There are different contexts in which it's appropriate or inappropriate to push through pain.

Karen Litzy:                   42:03                Yeah. And I would assume for everyone watching or listening, if you go to the Third World Congress of sports physical therapy, there will be discussion on those topics. Given the list of people there, there will be discussions on those topics. There are panels on those topics.

Alex Hutchinson:           42:22                Yeah, I was gonna say, like Greg and I are talking about pain, but looking at the list of speakers, there's a bunch of people who have expertise in this understanding of the different forms of pain, trying to find that line, understanding the brain's role in creating what feels like physical pain. So I think there's gonna be a ton of great discussion on that.

Karen Litzy:                   42:39                Yeah. All right, so we're going to start wrapping things up. So if you could recommend one must read book or article aside from your own which would it be?

Alex Hutchinson:           42:50                I'll go with my present bias, which is so, you know, casting my mind all the way back over the past like two months or whatever. The book that I've been most interested in lately is a book called range. I think the subtitle is why generalists triumphant a specialist world by David Epstein. So David Epstein, his previous book was like six years ago, he wrote the sports gene, which I consider basically the best sports spine science book that I've read. And so it was kind of what I modeled my book endure on, but his most recent book just came out a couple months ago at the end of May. And it's a broader look at this whole role of expertise and practice, a sort of counterpoint to the idea that you need 10,000 hours of practice if you want to be any good at anything.

Alex Hutchinson:           43:33                So as soon as you're out of the crib, you should be practicing your jump shot or whatever it is. And instead, marshaling the arguments that actually having breadth of experience, is good for a variety of reasons, including that you have a better chance of finding a good match for your talents. So for someone like me had, I just had too much quote unquote grit and decided that I needed to stick with physics cause that's what I started with. And I'm not a quitter. I’d be a physicist and I might be an okay physicist, but I'm positive that I wouldn't be as happy as I am now having been willing to sort of switch career tracks. And so it has a lot of sort of relevance for personal development, for parenting and for understanding expertise also in a sports realm as well. So range by David epstein is my pick on that front.

Karen Litzy:                   44:22                Great. And we already spoke about what you're going to be talking about at the Sports congress, but are there any things that you're particularly looking forward to?

Alex Hutchinson:           44:29                Yeah, there's a whole bunch of speakers, but I guess the one that caught my eye that I would definitely not sleep through is, I saw that Keith Barr is speaking on a panel and that over the last three, four years, maybe, maybe more than that, I've just been really blown away by the work that he's been doing on understanding the differences between what it takes to train for, you know, your strength, your muscles or your heart versus what it takes to train tendons and ligaments. And so I'm really looking forward to seeing what the latest updates are from his lab and from his results.

Karen Litzy:                   45:04                Yeah. He gave the opening talk at Sports Congress, not 2019 but 2018. And he was just so good. I mean, I was just trying to live tweet and take some notes. I'm really looking forward to that as well. I feel great. Yeah, absolutely. All right, so is there anything that we missed? Anything that you want the viewers or listeners to know? Oh wait, where can they get your book from?

Alex Hutchinson:           45:35                Fine booksellers everywhere. I mean include Amazon but it's definitely put it in a plug for your local independent bookstore. It should be, it should be available anywhere. And if you can find my latest stuff on Twitter @sweatscience, all one word and there might be a link to the book that there, but yeah, really, if you Google Hutchinson and endure for any bookseller, they should be able to get a copy of it.

Karen Litzy:                   45:59                Perfect. And anything we missed? Anything that we want to hit on that maybe we didn't get to? I feel like we got a good amount.

Alex Hutchinson:           46:06                I think we covered some good basis. I guess the only thing is, you know, for anyone listening, I hope I'll see you in Vancouver and cause I think there's all of these things are ongoing discussions and there's lots more to learn. So I'm looking forward to the conference

Karen Litzy:                   46:20                As am I. Everyone. Thanks so much for tuning in. Thanks so much for listening again, the third world congress of sports physical therapy will take place in Vancouver, Canada, British Columbia, October 4th through the fifth of 2019 and so we hope to see you all there.


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Sep 16, 2019

On this week’s episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Lynn Rivers on Robert’s Rules. Dr. Rivers is currently the Speaker of the Assembly for the New York Physical Therapy Association (NYPTA) and sits on the Board of Directors for the NYPTA. She strives to facilitate the active engagement of the students in becoming advocates for the patients/clients they will serve and their profession.

In this episode, we discuss:

-What are Robert’s Rules and how debate is conducted at the House of Delegates

-Different ways to collect votes from the delegates

-Point of Order, Point of Inquiry and Point of Information

-Can a guest speak during a meeting?

-And so much more!



Robert's Rules for Dummies

For more information on Lynn:

Dr. Lynn Rivers has 25 years experience as a clinician and 20 years as an educator in higher education. Her clinical experience has focused on adults with neurological disorders and traumatic injuries such as head injury and spinal cord injury while working in a Level I Trauma Center. Before becoming chairperson of the department in 2001, Dr. Rivers was Director of Clinical Education for the physical therapy program. Dr. Rivers is currently the Speaker of the Assembly for the New York Physical Therapy Association (NYPTA)and sits on the Board of Directors for the NYPTA. She strives to facilitate the active engagement of the students in becoming advocates for the patients/clients they will serve and their profession.

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas ( until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website:


Read the full transcript below:

Jenna Kantor:                00:00                Hello and good morning. This is Jenna Kantor. I'm here with healthy, wealthy and smart and I get to interview Lynn Rivers who knows so much about Roberts rules. Okay. Robert's rules. You know I'm going to actually hand over the mic because I can already imagine me describing it and Lynn going, well not exactly. So would you mind first just defining what Robert's rules is and where it is in applied within the APTA?

Lynn Rivers:                  00:26                Sure. Well Good Morning Jen. Thanks for the opportunity. Thank you for the opportunity to be able to share just about 28 years that I have sort of gotten myself involved and love Robert's rules of order. So what is Robert's rules of order? It goes back hundreds and hundreds of years. It is the philosophy and the construct of how do organizations, any organization, whether it's a small church board or it's Congress or its parliament in England, how does a civil society with lots of divergent opinions, how do we conduct our business so that there are two principles that are met and the two principles are that the will of the majority will rule, but we must protect the rights of the minority. So it is for the voices of everyone in whatever society, whatever group, whatever meeting that every opinion gets heard and heard with respect. And that there is civility so that when very strong, strong opinions can equally be heard, both sides of the debate can be heard.

Lynn Rivers:                  01:41                But there is civility and respect. And then when the decision is reached that the minority will agree that the will of the majority will rule. So that those are the two principles. So then the rules, holy smokes, there's, you know,  I'm sure if people have looked into it, the 11th edition is 800 pages long and there are so many minutia rules. But the bottom line is that the rules guide how people make decisions about what gets heard and how we make choices. So there are just the word motions is a tenant of Robert's rules of orders. So what is a motion? A motion is just an ask. It is an idea that someone has, that they want the society, the group, the organization to do. I want to ask that we pursue buying a piece of property or I want my APTA to look into this or work on this legislation, create a document for us to help us write.

Lynn Rivers:                  02:56                It's an ask and then there's a way to make the ask. And so they give guidelines on how you make the ask. And then there are rules of then how do people debate. So you have to write out your ask. It becomes a motion. And then it's agreed during the meeting. It will be, they call it lay it on the table, but it just means say it right. Make the ask for the whole body to hear. And then there is the leader of the meeting who is neutral and just trying to facilitate the discussion and they have different titles. Then everyone respectfully just raises their hand or makes a motion. They have to be recognized to speak. And then when you speak to the motion there are just rules of civility meeting respect that you aren't shouting that you are just speaking to the facilitator of the meeting and you are making your case but you tend not to speak only about the motion, not who made the motion and don't speak ill of any other opinion. You just state your own opinion and the debate goes back and forth and then there's a vote.

Jenna Kantor:                04:16                Actually could we go on this a little bit more with the ask, cause there's some things in this that I think is so fantastic with the civility that you are discussing and you guys, anybody listening, all you new grads, anybody who hasn't done house of delegates or been to any of these type of meetings before. You know how easy it is for things to get heated when it should, when it's a touchy subject. And of course within physical therapy we're extremely passionate about what we do. So those issues can get personal very easily. So would you mind going into the process of who is actually getting the eye contact, when you are standing up to speak about something and say it might be something you are quite passionate about, you have a written out exactly what you want to say. Who do you make eye contact with? And how do you address or refer to somebody who may have spoken before? Would you mind giving an example of that so people can get a better idea of how important and valuable it is to keep this going?

Lynn Rivers:                  05:18                Be Glad to Jenna. So I'm just going to think back to the most recent house. The American Physical Therapy Association taking a stance against firearm violence. And there are some very passionate opinions in the room. So what will happen is in order to not hurt feelings or offend anyone, what happens is that the individual who wants to now speak passionately against the APTA taking any kind of social stance, they make direct eye contact, the room is full of 400 people, face forward. You're looking directly at the speaker of the house, which is the title of the individual who's standing up in the front, who has recognized you to speak and you say, Madam Speaker, I would like to speak vehemently against this. I respectfully disagree with the previous speaker from Oregon who made this claim.

Lynn Rivers:                  06:22                And I disagree with that. So you don't say, I think Henry is an idiot. You say, I respectfully disagree and you speak about people in the third person and it's amazing how that sort of takes the emotion out. You can be emotional, you can feel passionate about your stance and you could be angry about the thought of an action being taken, but you are looking at the neutral speaker of the assembly and you are referring only in the third person to previous speakers or to a speaker from another state. And it is amazing how that can really deescalate the emotion.

Jenna Kantor:                07:08                And then for such a very important debate and which I'd like to say that, you know, it's nice that there's an opportunity for every single motion to be debated on. So whether or not you think it's important, it still doesn't obliterate the opportunity for other people to debate on that, which I think is wonderful as well. But of course these things can go on forever. So how is it handled to end, you know, as a group cause you have a group of 400 people you know, for us at the house of delegates. So how is it handled, you know, to rightfully decide when it's appropriate to stop the discussion and move on to a vote?

Lynn Rivers:                  07:48                Yes. So again, what happens is, you know, people have raised their hand or we do it electronically now in the house of delegates with a blackberry, you can put yourself what they call in the queue. So you're in line to speak. And so the speaker will monitor and you must indicate to the speaker whether you're speaking for or against it. So they try to balance debate. And at times after a bit of discussion, the speaker will say, at this time there appears to be no one who is in line or in the queue to speak. Are you ready for the vote? Other times, the speaker that we do have an opportunity and in Robert's rules there is a motion it to what is called call the previous question. And all that means is that person has put a motion to say, I think I've heard enough.

Lynn Rivers:                  08:38                I have heard both sides of the debate. I am ready to vote. And so then if the speaker of the house, the leader of the meeting, observes that there are many people who think it's time to vote, then he or she will ask the body, that group at the meeting, are you ready for the vote? And if there's no objection, then you move to the vote. So it can either be everyone has stopped talking or there has been a lot of balanced debate hearing both sides of the story and enough people have spoken that the group feels they can make a vote.

Jenna Kantor:                09:16                I also saw in the meeting, and we're not gonna hit all 800 pages of the book, but I'm just pointing out some interesting things. Sometimes the voting switched between standing between saying Aye and then also the electronic vote via the device. So how does, in this case, the speaker of the house who was running the meeting, how does the speaker of the house decide which way to do the vote?

Lynn Rivers:                  09:43                Yeah, so certainly, what happens is each organization has also something that's called the standing rules. So we use set rules at the beginning of the meeting. And one of the key rules you decide is how much agreement does there have to be in order to pass that motion to say it's going to go. So for normal business, the actions of the house, we agree in the house of delegates, a simple majority, so just over 50%, 51% of the group. So the default or easiest for 404 was our voting strength yesterday, that the speaker starts with a voice vote. All those in favor say Aye. So she listens to the volume of the ayes compared to the volume of the no’s. And many times it's very clear if 300 people say Aye and 100 say no, then it's pretty clear by voice.

Lynn Rivers:                  10:42                And that's the simplest and quickest. If it's still a vote for simple majority and she couldn't tell by the voices, then we have to use the electronic voting. Within that everybody has their clicker and they vote Yay or nay and it comes up. The standing vote is typically done when there is a vote that is more precious than just a normal business action. It's any vote that is going to hurt the rights of members. And I'll give the example then if you need to know, if two thirds of the people agree, many times the speaker will do a standing vote because that is much easier to see two thirds clear by standing. And that is when there is an objection to calling the question, meaning stopping debate. And because that is a right of the minority to continue to be heard, that is when the speaker calls for a standing vote. And then there was one time, even in the standing vote, she was not 100% sure it was two thirds. So she had us sit back down and do the clickers.

Jenna Kantor:                12:05                This is great. So, you know, it's so funny, earlier you mentioned the word Henry and now I'm thinking of the Henry Bar, the candy. And I'm like, oh my gosh, what do these conferences do to me? I'm like, I need sugar all the time to like stay awake. Can we get into some of the language, just the intro that people say when they say parliamentary inquiry, like why do we say that instead of something else? Does it make it more efficient?

Lynn Rivers:                  12:35                So again, there is a protocol to how one introduces a motion. And one of the first again for civility is whenever you are recognized to speak, you start by introducing yourself so speakers know who you are. We also ask them to state what component they are from, component or state. So I'm Lynn Rivers from New York would be how I would start. And you must be recognized in order to speak. There are three instances, and someone can shout out and not wait to be recognized. Point of order, point of inquiry and point of information, point of order. They there is shouted out and you are allowed to shout it out if you believe what is happening right now is not following Robert's rules of order. We are not doing it correctly and we believe that we have to ask the speaker that.

Lynn Rivers:                  13:45                So if someone shouts out point of order, all debate stops immediately and the speaker says state your point and that person comes up to the mic and says speaker, I believe it is not in order for this motion to be heard. And there is a reason why we did not have due notice before this motion came. I don't think it's right that we are hearing it and then they would confer and decide whether that member is correct or the speaker rules. No, I do believe it's in order point and I'm sorry I misspoke. Point of inquiry or point of information are very similar. There is no real difference between that. A point of inquiry is sometimes said because people are really wanting data and facts, point of information. People tend to say they just have a question. They don't really understand why the makers of the motion wrote it this way. They don't really understand the intent of the motion. So they are asking a question to better understand the motion point of is just a little more precise if they want to. If someone wants to ask someone else other than the maker of the motions, they understand the motion but their point of inquiry is we'd like to hear from legal counsel is what the maker of the motion asking us to do. Is that legal in all 50 states? So then the speaker will say, is there an objection? Does anyone object to legal counsel addressing the body and answering this person's inquiry?

Jenna Kantor:                15:16                Yes. That honestly makes more sense for me. Now listening to that because there was a motion on creating a virtual historical museum and there was a lot of point of inquiries to the board to find out how much work would this be putting on them. Would this be possible for them to take on? And also what would the game plan, where would the financial resources come from? What would we be taking away from? So that makes even more sense. And it's also respectful way to be like, it's just clarification. It's not going to be an attack. We just have a question to like know what this means. And of course, it's pointed in a very professional way of just saying, we really just need to know to get the full picture on if this is a good thing to vote on. So, I'm getting some massive light bulbs here right now. And then I think I want to finish with one more or the Lord knows we could go on forever with Robert's rules. And, honestly, if I really do recommend, yes, it's an 800 page book, but if you're interested in it, read it. Why not?

Lynn Rivers:                  16:30                Well, and I'm going to say the caveat. Please don't start with that book because you will run away screaming, but please know, and you can just Google it. Robert's rules for dummies is one version. There are about four levels of books. There's Robert's rules simplified, right? So Google Robert's rules and look at the different books and start with the first one and then move up to the next one. That gets a little deeper into it. If you really think you want to fully understand it, you want to join be a member of the national parliamentarian society. That's when you buy the 11th edition of Robert's rules. Nearly revised. Yes.

Jenna Kantor:                17:17                Awesome. Thank you so much. And See, this is a perfect example. Why bring the expert on to help? Correct me as I'm going, why don't we just do this? You're like, Whoa, whoa, Whoa, whoa, Whoa, whoa. Well, thank you for helping prevent people from walking away and pulling their hair out. Trying to read it going, oh, I give up. So that's good. I love those dummy books. Those are amazing,

Lynn Rivers:                  17:36                I guess. But I just want to say the dummy books are not always helpful. Right. But I can assure you for Roberts rules, that book is a great start. If you just want to be able to be a voice at a meeting, not necessarily run one yet. You know, you just want, you want to write a motion, you want to get up and state your opinion and don't want to look foolish. Start with Robert's rules of order for dummies.

Jenna Kantor:                18:03                Love it. Love it. Oh, I've been forgetting what my last, Oh yes. So for those who don't know, so at the house of delegates, I'm not sure if this is elsewhere, so you can definitely clarify this, Lynn. So at that house, all the people who are elected delegates sit in, I want to say an organized clump with their states and everything. But then there can be guests attending the event and they are sitting in the gallery in the back. And these are, it's separated in the back of the room. Is it true that they can come up and say point of order or speak to a motion or ask a question and so on and following Robert's rules and when or how, if that is appropriate? Is it appropriate?

Lynn Rivers:                  18:49                Yeah, no, that's a good question. And the short answer is no. A guest in the gallery does not have the right to state point of order. Point of inquiry, they cannot shut out. But with the permission of the group permission has to be asked, can a guest speak? So guests can be invited to speak. A guest in the gallery can ask a member of the group to request permission for them to speak. So, so there's two things. There may be a member in the audience that knows there's a lawyer in the audience or in the gallery and they may initiate the request, but the lawyer may be sitting there antsy thinking, I have something to contribute. There are guests in the gallery. They are allowed to walk up to a member and say, would you ask the speaker of the House to request permission for me to speak? Because I have something to say. And almost always the body would say yes. If someone really wants to speak. I've never seen a guest be denied, but there must be permission given.

Jenna Kantor:                20:07                Thank you. That's very helpful. Well, me as a performer first I see this mic sitting in front of us that's clearly not pointing to the people. You know, anybody sitting in amongst the delegates. And I remember staring and going, I mean, do they want us to sing? What is this opportunity? This mic Beholdeth on us? So no, they give them one for clarifying. But thank you Lynn, thank you so much for coming on and clarifying. Just even giving people a little glimpse of what Robert's rules is and just really learning how valuable it is. I think this will be such a good thing for so many, even experienced physical therapists to really know more of and understand what goes on behind the scenes and why we are following such rules. I'm new to this, but honestly, I really do believe in them because it is not easy to have these hard discussions in a nice manner.

Jenna Kantor:                21:01                You don't want to leave pissed off. You want to leave like, okay, that was fair. That was a discussion. I can see why we might be moving a little slowly on this matter or why we might move quickly on this matter. It was eye opening in a very positive way. So I was wondering, Lynn, if people wanted to reach out to you or find you to learn more or maybe even get more guidance if they start finding themselves passionate about getting much more involved in this whole parliamentary process, how could they find you?

Lynn Rivers:                  21:31                Thanks Jenna. Well, I'm in Buffalo, New York at D’Youville College and I am happy to share my email. It is

Jenna Kantor:                21:48                Thank you so much for coming on.



Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Sep 12, 2019

LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Emma Stokes on the show to discuss leadership.  Dr. Emma Stokes BSc (Physio), MSc (research), MSc Mgmt, Phd is the president of World Confederation of Physical Therapy.

In this episode, we discuss:

-Dr. Stokes’ journey to becoming the President of the WCPT

-Takeaways from the World Confederation for Physical Therapy Congress

-Constructive feedback and the 360 review

-How to grow your professional network and the two up, two down and two sideways rule

-And so much more!


Third World Congress of Sports Physical Therapy

Emma Stokes Twitter

World Confederation for Physical Therapy Website

WCPT Facebook

WCPT Twitter

WCPT Instagram

For more information on Emma:

Emma is the head of the newly established Department of Physiotherapy & Rehabilitation Science at Qatar University. She has worked in education for almost 25 years and is on leave from Trinity College Dublin where she is an associate professor and Fellow. Her research and teaching focus on professional practice issues for the profession. She has taught and lectured in over 40 countries around the world. In 2015, she was elected to serve as President of the World Confederation for Physical Therapy. She was re-elected for a further four years in 2019. She has experience as a member and chair of boards in Ireland and internationally in a diversity of settings including education, health, research and regulation.


Read the full transcript below:

Karen Litzy:                   00:01                Hey everybody, welcome to another interview for the Third World Congress on sports physical therapy, which is happening in Vancouver October 4th and fifth of 2019 and we've been interviewing a lot of the speakers and today we're really excited and honored to have Dr. Emma Stokes who will be in Vancouver with us. So Dr. Stokes, thank you so much for coming on.

Emma Stokes:               00:29                Oh, thank you so much for the opportunity to chat with you again, Karen. It's always a pleasure.

Karen Litzy:                   00:34                I know, I know I just saw you in Switzerland and we'll talk about that in a little bit, but before we get into all of that, just in case, there are some people who are maybe not familiar with you, which may be, there are, I don't know, but can you tell us a little bit more about yourself?

Emma Stokes:               00:55                Yes, of course. Well, I'm an Irish physiotherapist and I'm sitting in Trinity College in Dublin, where I have the privilege of spending a lot of my professional life. So I qualified as a physiotherapist in 1990 and let's just fast forward to eight years after I qualified, I went to my first international meeting and you know, I tell this story wherever I go in the world, which is, you know, I went to that meeting and I came home. And in that moment, in those days I really recognized that I wanted to be part of the international physiotherapy community. You know, a lot of people ask me that question. They say, well, you know, how do we become part of that? And you know, honestly then I didn't know what that meant or looked like or felt like or anything like that. But as I tell the story and we can come back to this later on, you know, I decided I was going to make myself indispensable.

Emma Stokes:               01:45                So I volunteered for every conceivable opportunity that arose, including within the ISCP, which is the Irish side of charter physiotherapists. And in 2015 I was elected to serve as the president of WCPT the world confederation for physical therapy, the global physiotherapy organization of which the IFSPT, which is the International Federation of Sports Physical Therapy, is a subgroup of which the Canadian physiotherapy association is a member organization. And of course of which sports physiotherapy at Canada is a division of the CPA. So we're all connected in this big family and I got to serve as the president for four years. And then last year I decided that I would seek a second term as the president of WCPT. And there was an election in May and I was reelected, here I am, I'm very, very happy to am honored to be serving a second term as president of WCPT. And it's been a long journey and I'm happy to answer any specific questions about that as I always am. Because you know, I think not because I want to talk about myself, but because I think sometimes people look at you and they say, how'd you get there? And I'm happy to share that journey because I think that's a really important question. When you see someone in a position that you want to be in, then you need ask them how do they get there?

Karen Litzy:                   03:01                Yeah. So let's talk about that. So you volunteered for everything and anything you could get your hands on it sounds like, and I'm sure that helped get your foot in the door and, open things, a crack here and there. So when did you first decide to be an elected official?

Emma Stokes:               03:23                I think physiotherapists are nervous about the volunteering thing and the idea that, oh gosh, it would be terrible to volunteer if you had an end game and you know, 30 odd years ago to be 30 years since I graduated next year as a PT, you know, I don't think we had the whole, I don't know the word networking even existed in the way it does now, but I loved getting involved and things. So I was very involved with the Harriers and athletics club here and lives in trinity and I reckon I spent more time with them than I did and my physiotherapy program. I just loved getting involved and you know, when you're a junior physiotherapist or in your, the early stages of your career in the day job, you know, and you'd know this Karen, right?

Emma Stokes:               04:08                You don't always have the opportunity to do the things that you want to do because you're maybe limited sometimes in the organization that you're working in. And in fairness, I worked in St James's Hospital in Dublin and there were no limitations placed on me when I started to get momentum, but it took me a few years to get some momentum. So I became a member of the Irish society and I went to a meeting. They needed a member on a committee and that's where it started. And you know, I was on a committee and then I was on another committee and then in 1996 when I was working in trinity, one of my friends whose office was across the Carto said to me, we're stuck for someone on the international affairs committee. Would you volunteer? And I think I suggest more because I was sort of trying to help her out.

Emma Stokes:               04:51                Than I wanted to necessarily do international affairs. And then, you know, it started, I just, I knew then the global physiotherapy was where my, I think maybe I was struggling to find my place in the Irish physiotherapy world or maybe the clinical physiotherapy world rather than the Irish. You see that everywhere, the clinical physiotherapy world. And so when I started to do some international work, so I got involved with my first international research consortium and I started to volunteer and so the first international meeting that I went to was 20 years ago. In 1999 and no one paid me to get there. I paid for myself to get there. I was presenting some of my phd research and I had gotten to know, Brenda Meyers, I'd met her once or twice and I emailed her, I said to her, look, I'm here.

Emma Stokes:               05:42                Do you need to volunteer? And I was a teller at the general meeting of WCPT I helped count votes. Now you might not think that that's super important which it is. In the governance meeting of WCPT, I counted the votes in 1999 and then clearly I could count and I stayed involved with European level. And in 2003 the meeting was in Barcelona and I asked you about some time, the Irish societies delegation. But I was there with some of my phd students at that stage and some of my own research. And I went to the general meeting and Brenda said to me, well you would you like to be the chair of the credentialing committee? And that's what I did. So in that, that was the time when you presented your credentials in within paper, you brought your paperwork to the meeting and there was something really elegant about that process. And now we do it electronically and it's a little different. And plus I got to meet the presidents of every member organization and WCPT at that meeting. And then I finally got elected to actually the board of WCPT in 2006 and that was a chance I didn't expect to get elected. I was only running to signal my interest for four years later. But I got elected and I guess the rest is history.

Karen Litzy:                   07:01                Great. And I think the big moral of the story here is that no one's an overnight success. It's not like you one day said, I'm going to run for president of WCPT and got elected, you have to put the time in and pound the pavement, if you will, in order to kind of work your way up. And I think in the days now of social media and everything happening, having to happen immediately. Yeah, it's hard. So what advice would you give to someone who maybe doesn't have the patience these days to put the work in?

Emma Stokes:               07:35                Yeah. So first of all, I think you have to enjoy the journey. So, you know, I never knew it was a journey in many ways. I guess at some point I knew it was a journey. And I think one of the things, because I've done a lot of reading around leadership and, I think what I've been fascinated about is this notion that just because you try once for perhaps an elected position and you're not elected doesn't mean that you walk away. So that in 2006 now, I don't know would I have walked away. I don't know that I did because I actually think I would've because I think what happened was in 2006 I had no expectation of being elected. But my plan then was to say, look, I'm interested. I know that's going to be another four years before I'm elected.

Emma Stokes:               08:26                Or I could be elected. And I don't mind if I'm not elected this time. So I was elected and that was pretty amazing. And interestingly in 2011 and it was suggested to me by a number of people that I should run for president. And I decided not to because I wasn't ready now cause that's another conversation which is about when are we ever ready. But I think I'm very objective about my abilities. And so I had sort of decided that I didn't feel ready in 2011 to be elected as the president but by 2015 given what I had done between 2011 and 2015 I knew that I had the experience, I had the capabilities to be a very effective president from the point of view, I think at least I felt I had given the organization the best shot in terms of the experience that I had gathered.

Emma Stokes:               09:33                So I had done a graduate business degree. I had done a lot of governance courses. I had been the chair of the board of charity and I just felt, I suppose I felt from a self efficacy perspective and we talked about this, about our patients all the time. I felt confident going in that not withstanding what needed to be done, I was confident that I was able to definitely demonstrate that I had the experience to be the chair of the board of a charity based in the United Kingdom, which is what WCPT is from a governance perspective. But also that I felt that I had enough experience to at least give a fairly good shot of being the president of the global organization. And there are two quite distinct parts of the road.

Karen Litzy:                   10:21                Well, and that leads me to my next question is as president of WCPT and for maybe the people listening, if maybe one day that's on their list, can you give a quick rundown of the roles and responsibilities of that position?

Emma Stokes:               10:35                Yes. And Look, you know, I think let's just use the sort of a nice kind of balanced scorecard approach to this. So to me, when I ran, when I sought to be elected as president in 2015, I said I would look in, I would look out, I will look to the future. And then I had a little small part of the balance scorecard, which is you know, that quadrant system which was about inspiring. And in a way they map onto the two I think quite distinct aspects of the presidency, which is that you are the chair of the board of an organization and a company that's based in the United Kingdom and that brings governance, legal, fiduciary responsibilities. But you were also the president of a global organization. You are the leader in some ways the first among equals. But nevertheless you are in a leadership role.

Emma Stokes:               11:21                And my perspective on that is my job is to bring people together in the global community and that's whether it's the physiotherapy part of the global community or the wider collaborative part of the global health rehabilitation community. So looking in was about ensuring that the organization with working with the board and staff and our volunteers was its best version of itself. Looking out was to start looking at who we working with internationally and what are the international organizations that we're working with. Looking into the future is about leadership. It's about creating the next generation of leaders in physiotherapy. And then the other space was about inspiring. And I suppose for me in the four years, I'm sharing something with you that I have probably not shared with very many people. So in my narrative and the work that I do with an amazing coach is around how do you walk with the dreamers and I've given a few talks that talk about what with dreamers, but it's about that idea of how do you inspire people to do something different, to get involved, to be involved in a different way, to just grow.

Emma Stokes:               12:30                I guess just to enable us to sort of amplify everything that we do. And I suppose for me that's very, very, it's an intangible, right? It's that sense of how do you measure that when it's very hard to measure it? Right? And you know, now in the next four years, that hasn't changed. So we're still looking. So I believe we need to still look in, we need to still look out. We just need to look out in a bigger, better way. We need to look to the future. And I feel that commitment from me over the next few years is really important in terms of what are we talking about in terms of sustainability, the next generation of leaders, the future of organizations that are just in their beginning part of the journey. And My blog, which just was posted yesterday, is about, I suppose that other quadrant, now I'm talking about the moon landing projects.

Emma Stokes:               13:21                So it's 50 years since, you know, since the first Americans landed on the moon. But I think that 1961 speech that JFK gave about this idea of what, asking ourselves the question about what we should be doing, not because it's easy, but because it's hard to me, you know I’ve got four years, you know, I'll be president for four years and then I go on and I just do a different part of my life. So if I had one thing that I want to do, it's about, we could be asking ourselves the question as an organization and as a community. What should we do because it's hard. What should we do, because it's right. And, we have to ask ourselves the hard questions. And those things are nuanced and they're just this dissonance in them and they're not easy and they're not going to be done in the four years.

Emma Stokes:               14:14                So what are the big projects, what does that decade going to look like? And if you look at who they have two big projects that are focused on 2020, 30, which is, you know, it's almost a decade away. And I think we as a global community and as a global organization needs to be thinking about what are we doing to help answer those questions. So I guess, yeah, does that answer the question?

Karen Litzy:                   14:52                That's the role and responsibilities in a very large nutshell, a balanced score card and nice framework. Cool. Yeah. No, that's great. Thank you for sharing all of that. And you know, I did feel that sense of global community and working together and learning and open-mindedness, I guess would be a good way to describe the WCPT meeting in Geneva, which was a couple of months ago.  I definitely did feel that global community. And I think, you know, social media has its pros and cons and we can talk about that forever. But one of the pros is that it does certainly bring people together from all parts of the globe. And so I really felt, a lot of comradery and felt like I quote unquote, Knew people even who live in Africa or they're in Nepal or Europe or even just across the United States. I really enjoyed WCPT. I thought that there were some, I mean obviously I didn't go to every session cause it's impossible. Well I went to some really great sessions that did bring up some uncomfortable questions and kind of pushed my boundaries a little bit. So I really enjoyed that. But what were your biggest takeaways? Obviously, again, not that you could be in everything everywhere all the time, but what were a couple of maybe maybe two of your biggest takeaways if you can whittle it down?

Emma Stokes:               16:34                Oh Gosh. Two really, okay. But let's, let's start with the opening ceremony. So you know, it, the opening ceremony to the board. So we work with the board and the staff work really closely together around that type of event. So the board does not get involved in, you know, what color is the curtain, but we do make a decision about the venue because the venue has a cost implication. So, you know, so do we go for a big room where everyone is together or do we go for a smaller room where there's some breakout sessions? And I think what was really interesting was we had a series of conversations around that and we finally resolved in them, I guess April, of the year before the congress. So April, 2018 but the decision was, nope, we are going into a big space where everyone is together on it. And it meant that, and you will recall this, it meant that everyone had to walk.

Emma Stokes:               17:29                It was a short walk from the venue of the opening ceremony to the welcome reception and not happening. It wasn't raining so, and so I don't know that anyone ever understood the amount of forwards and backwards and trade offs on cost and logistics and the walk and everything like that. But, when we made that decision, the decision was, we are a global organization and our strategic imperative is that we are a community where every physiotherapist feels connected to the engaged. Therefore, when we have an opening ceremony, everyone is in the room. And to me that probably has been one of the most powerful memories of my WCPT life is that moment when everyone is in the room and I have experienced it in the audience, but boy experiencing it on the stage, looking out that audience is, you know, I'm never gonna forget that, that that's a memory that I'm gonna have for the rest of my life was that I never imagined, I forgot.

Emma Stokes:               18:31                I didn't think that it would in my mind, you know, we're all gonna walk along. It's gonna be 15 minutes. I dunno if you remember this, but it was that snake of people. And it was perfect because you had international physiotherapists rambling on, and they had to walk slowly, right? Because it was enforced because we weren't going anywhere in a hurry when there was, you know, 4,000 as we wove our way along to the opening center to the welcome reception. And to me, I think it was a visual and a physical and representation of who we are, which is that community of people that are connected better because we are connected. So that to me was, it can only go downhill from there.

Emma Stokes:               19:29                Right. Cause I was just like, it was fabulous. So in terms of specific content, and I completely love the diversity and inclusion session, and I think that was, you know, that was a focused symposium. It was peer reviewed. It was submitted. It was an amazing team of fabulous physiotherapists from all over the world and a stellar audience. And to me that was, you know, that was both literally and symbolically immensely powerful in terms of what it is that we're doing as a community. And in the closing ceremony I said, you know, I felt that the three themes that came together were diversity, inclusion and humanity. And that's not to take away from the content, the science, the practice content, the clinical content. I'm not taking away from that, but I think what we've started to do is bring us up.

Emma Stokes:               20:20                We have started to lift our eyes as a global community. And now more than ever, we need to do that because of the stuff that is happening in all worlds. So, you know, we just need to raise the level of our conversation. Of course everyone needs science and they need evidence informed clinical practice, we need humanity in our conversations. And if we're not doing it as a global community, then I don't know who else should be doing this. And to me, the diversity and inclusion session was babied us. We had an amazing session on education talking about the education framework policy piece. But you know what I think really emerged from the congress was on a big shout out to anyone in education is we need to revive our educators network. We need a global community of educators that are having conversations with one another.

Emma Stokes:               21:21                We need to do it. Whatever we can do. I think the other session that that I loved was the advanced practice one because that's a big conversation and it's a big conversation that spans not just high income countries but low, low middle income countries. It's it, you know, if we look to ensuring that we'd have universal health coverage, then you know, the World Health Organization is talking about this billion level of health workforce shortage and we are a solution. We're a solution in so many ways and we need to start having those conversations around how are we the solution. And one of the ways that we are solution is around advanced practice. And then I guess the other one that I just loved, and I'm really sorry that so many people were actually turned away from the door with us doing this. And we went on, we would talk about this was the one that starts to take that editorial from editorial to action.

Emma Stokes:               22:13                Then you know, the stellar mines that were involved in that. You know, so Peter O'Sullivan and Jeremy Lewis spoke the editorial, you know, Karim, who was the editor was going to facilitate that session but couldn't because he had other commitments. But he was at Congress, which was amazing. So what we had was we had to have the insurance. We had the physicians, we have physiotherapists from the low middle income countries in that room. And I think what's brilliant is, but you know, there's a, you know, I wouldn't, I'd love to suggest that I was writing it, but I'm not, I'm just, you know, I'm sort of sitting you know, I'm there in the background saying, Hey, look, the bread lines are out there.

Emma Stokes:               23:01                You do your work. So we're going to have a nice, I hope, a nice publication around that. But, this is one of the moon landing projects, right? If we want to have this paradigm shift, what does WCPT need to be doing in terms of what does the global community need to be doing? But what can we facilitate around this? This is another moon landing project. What does that look like? You know, how do we change the way and we ensure that the delivery of rehabilitation and physiotherapy is the best version of itself.

Karen Litzy:                   23:46                It was a definitely a very popular session. Peter O'Sullivan was like, I'm sorry, I didn't know it was going to be that many people there. But it looked really great. I was watching from, I was going to another session, to see my friend, Christina present her research, but it was good to follow along with all of the tweets in the social media from there. And I was interacting and after Boris was like, so what did you think? Did you like the session? I was like, I wasn't in it. And he was like, what? But I thought you were there cause you were tweeting. I'm like, well I can keep up.

Emma Stokes:               24:20                Yeah, yeah. And you know, I think one of the things that, so we are, we are a learning journey, you know, and there was a tradeoff, right? So, yeah, I think Peter and Jeremy were really keen to get a very, very interactive session because there was data that needed to be developed from this, you know, so the data being gathered as a result within this session, which is a very interactive, you know, session. And I think that's really important. You go for a smaller room with very interactive session of course, or you go for a big space with 500 people in it and close, you lose a granularity in terms of detail. Plus the editorial was only published in June, you know, less than a year before the meeting.

Emma Stokes:               25:18                The other thing, right, you're not planning for years cause I mean it wasn't four years. And so that's where you're trying to do the responsiveness piece, which is, you know, a hot editorial, which was big on big ideas, you know, so, you know, the conversation then well it's of course that's the choice of the editorial, which is big ideas. Now let's just talk about enactment. What does that look like in term, well, A, can it work beyond high income countries, but B, what does it look like in terms of the next steps? So it is, so, you know, I acknowledge that was a big challenge and there was a lot of people who were very disappointed, but it wasn't a keynote session. It was around from editorial to acting what needed to be a granular session. We should talk about, you know, how do we keep that conversation going? And that's where I think things at the meeting that the conference in Vancouver a year later then congress the year after that starts to allow us to start a plan for those conversations to move forward.

Karen Litzy:                   26:20                Yeah. Yeah. And I think that's a good thing to hopefully bring to, Vancouver and allow people to see, well, what did come out of that WCPT and then how can we expand on that. Excellent. Good. Okay. So let's shift gears quickly. And you kind of alluded to your research earlier and that you were started your research in the 90s. And I know that a lot of your research centers around leadership. So can you talk a little bit about your research, number one and then number two, how does that research kind of guide you in your day to day function within your job?

Emma Stokes:               27:24                Yeah, initially my research was very clinically based research. And then in 2010 I made a decision. So first one, let's put it out there I'm not a researcher, right? So I'm not going to be anyone ever with a high heat index. That does not give me joy in my life. My joy is around amplifying other people's research, which is why, you know, my joy is around saying that editorial was amazing. Now let's see how we can get it to the next steps. But nevertheless, I am an academic and therefore it's really important that my research informs my teaching. You know, we are resected at institutions both here in Trinity, but also where I'm working now at counter university. And so it's really important that when we teach, we

Emma Stokes:               27:56                are teaching, our research informs our teaching. So in 2010 I had an amazing opportunity to take a sabbatical. I finished my graduate business degree. I'd suddenly discovered that you can actually learn about leadership. And I had suddenly thought, hey, you know what? Let's look the what's happening in physiotherapy research and leadership. Answer nothing at all. And, you know, then you ask yourself the question, well that's fine. You know, do we need to be doing research in leadership physiotherapy? And the answer is actually, interestingly we do because we know obviously more and more about leadership is that leadership is context specific. So it's very contextually informed. It's also very contingent around, you know, what you do on a day to day basis. But increasingly the conversation around leadership and healthcare is leadership is not a role.

Emma Stokes:               28:45                It's a mindset, right? You lead from the edges. A loy about transformational leadership? It's moving from the transactional nature to the transformational. And so that's what I was doing. If you think about it, my practice in Physiotherapy was around, you know, working with organizations in either leadership roles or being part of other people who were leading projects and you know, being in the followership role or the participant road. And so I made probably, what's a career changing decision, which is that I actually stopped doing physical research. I said, okay, my research was around professional practice issues. I will research what I practice and my practices is physiotherapy. So I worked on that year with Tracy Barry around direct access and we did it globally. We're now looking at sort of processing the results of, you know, a really interesting survey around advanced practice and the building survey around that.

Emma Stokes:               29:38                And you know, so now I'm not that, I'm not the doer, I'm the person that’s part of a team and the next generation of fantastic researchers are doing the research. So I want to give a big shout out to Andrews Tollway is doing amazing work on the advanced practice survey and also Emer Maganon, who was done, you know, she was my phd student on my post-talk and she's done a huge amount of research around leadership. And I've had the privilege of being along for the ride, which is fabulous. And that's what you get to do as a phd supervisors. So that's wonderful. And so the research has been around leadership, physiotherapy. We've worked around with the global community around some of the research that's happening and there's very little in physiotherapy and that's a shame. But actually what's interesting is there's more and more and that's good. And there's a huge Canon of research around leadership in nursing and for doctors, their providence is different. And so I don't think we should underestimate doing a lot of really good research around understanding the physiotherapy perspective and understanding and enacting leadership because I think that helps us start to understand where we might have some weaknesses or some behaviors where we're reluctant to get involved. And I suppose that for me is around how do we have those conversations, both from a research perspective but also from a day to day practice perspective.

Karen Litzy:                   30:59                Right. And then you kind of answered the question of how does it affect your day to day leadership abilities. And I think you just answered that because you're finding your weaknesses as a whole within the profession and I'm sure that can make you a little more introspective to see if you're either contributing to those or hoping to overcome them.

Emma Stokes:               31:18                Yeah, absolutely. You know, I think you're absolutely right. I did a really interesting thing of just before I finished my first term as president, and I don't know if that, if you've done this or if anyone has, but I did it at 360.

Emma Stokes:               31:32                So I had 11 people do the leadership practices inventory. So I did this and then 11 observers did this and then four people did in depth interviews. Oh, let me tell ya, so first of all, I'm indebted to the 11 people who participated and who gave up their time to do the Leadership Practices inventory about me, but also the four people who did in-depth interviews and they were, you know, so there were people within and external to the global physiotherapy community and Oh gee, that was interesting. You know, that was a, I learned a lot about myself, you know, and you know, and interesting I’ve done a reflection beforehand, sort of predicting what they might say and there were no surprises. There was a lot of reinforcements and you know, so I obviously, you know, you do the thing right, the 80 20 thing, which is they focused on the 20% of stuff that you're not best at.

Emma Stokes:               32:27                And of course I had focused on that. So there was no surprises. But nevertheless it is saluatory to hear people say it about you and you know, and so on a cross, you know, so this wasn't, or three people, this was 11 people saying similar things about me and I've just spent two weeks with my family, Eh, like way more time with my family that I'm spending a long time. And I'm like, Oh yeah, I see where that comes from. Oh, how interesting. So I've done a 360 with my colleagues and I've spent two weeks with my family and yeah. Yeah, you know, I get it a lot of your niece that is seven and nine. They're saying, I think we should buy a to do list notebook. And I'm like, what do you think? I need one.

Emma Stokes:               33:09                Oh, yeah, you definitely need to do this, that book. I'm like, okay. All right. So there's seven and nine and they're seeing that list already, you know? So it's fascinating. So I think you get, I think for me it's about where did the data points come from? I'm ensuring that you get them from people who will tell you the truth in a trusting, positive way. And so I do the research and then I do the granular stuff, which is hard, but yeah. But you have to do it if you are committed to being the best version of yourself in the service of the role that you're in.

Karen Litzy:                   33:47                Yeah, yeah. And in the service of others.

Emma Stokes:               33:50                Yeah. Am I going to get any better? I'm not sure. Am I any more patient? Am I better at listening? Am I going to be any better as I'm pressing the pause button? I don't know, but I'm going to try. Maybe try anyway.

Karen Litzy:                   34:08                You know, I think the good thing is that you're now aware of some of these and I don't think they're faults. But you're aware of that side of your personality.

Emma Stokes:               34:22                Yeah. And I think maybe it's not that I wasn't aware of it, it's more that it was reinforced about the impact that it has on people. If you'd ask me, honestly, did I find out anything with the 360 that I didn't know about myself? The answer is no. But has it made me face up to it and acknowledge its impact on others? Yes. And am I taking responsibility for trying to be a better version of myself. Yeah, sure I am. Cause you don't do this without taking it on to the next phase of the journey. Right?

Karen Litzy:                   34:54                Yeah. You don't just read it and say, okay. Yup. Nope. Yeah. Great. Cool. Well thank you for that. I'm going to look into that. So, you know, we're talking about WCPT and all of these international organizations and you do a lot of traveling and meeting all the different people. So you have a very wide network. So what are your top tips for physio therapists who are trying to build their professional network?

Emma Stokes:               35:28                Two Up, two down, two sideways. And we've talked about this before, I think, which this is not my rule. I got it from, and a really good friend of mine who got it from someone else, a colleague of his, and the idea that networking is really natural to some people. Like they just, they're good at, right? Yes. But for a lot of people it's not. So, so I think the first thing is that you do two up two down two sideways route. And I think what's really interesting is when you say it out loud, you can start to use it. And in that way. So, and two up, two down, two sideways is, and so you're at a meeting and you want to be two people who are ahead of you in their journey.

Emma Stokes:               36:09                So, you get ready, you identify them in advance or you don't, you just happened to meet them. But, for a lot of people it's about working and saying, okay, these are two people that I want to meet. And you're prepared and you don't randomly want to bump into them, but you have an ask of them maybe or not. Maybe you just want to connect with them because you admire the work that they'd done. And two sideways is two people that you want to connect with who are your peers, right? So two people that you've met on Twitter that you say, okay, I want to meet that person in person, I want to see that person. And then two down or two people who are ahead of you, the behind you in the journey. So students and you know, phd student, you know, so if you're a little ahead of them in the journey, who are they?

Emma Stokes:               36:53                You know, and you know, who can you help along the way? So it's really interesting is I think it's a great rule. So you're at a meeting, who are your two up, two down, two sideways. I love it. And really interesting is if you know the rule and the person you're talking to knows the rule, it's great fun. So I was at a meeting where a physiotherapist came up to me and said, have you done your two down? So I had talked about this in the next year, a few months before rounds, and he'd come up and he said, have you done your two down yet? I'm like, sorry. He said, have you done your two down? I said, no, I haven't. He said, can I be one of them? Oh, that's so cool. And I said sure you can how can I help you? And so we ended up having a conversation and I was able to do some stuff for him that was fantastic.

Emma Stokes:               37:38                And I thought, hey, you know, that's great. So, I think it's fantastic. So plan for your two up two down two sideways or be ready for your two up two down two sideways. And you know, I still do that. I mean I still think about hooking you. Who are the two people in the world that are going to be helpful for WCPT, who do I need to interact with, you know, and I don't necessarily always know who they are now, but it's in that moment I'm like, okay, I've got my card ready, let me tell you who I am. Do you think I could connect with you about this conversation or this presentation that you made? And so the other thing then is about looking around the room. And I think this is both as someone who wants to network, but also someone who's potentially in a situation where you could open circle.

Emma Stokes:               38:24                So it's about physically looking through was a great piece of advice that I got. When circles are closed. So if it's me and one of the person I'm wearing a huddle, that's very hard for someone to come into. And sometimes that's okay because sometimes you are having a meeting and you don't necessarily, you need to have a conversation. But also sometimes it's about how do we keep that circle open to welcome someone in or if you see someone on the periphery to bring them in. Yep. So, so it's about the physicality of the space so that, you know, so sometimes it's about being polite and saying, look, oh, are you having a meeting? Or if sometimes people are having meetings, right? They are genuinely saying, look, we're actually having a conversation. But sometimes it's about looking around the room where you see the open spaces and coming in and saying, oh, hello, I'm so and so knowing that that that circle is open to have someone come in. Yeah. But also I think as people who are in spaces, recognizing if you see someone out of the corner of your eye might be hovering, have the generosity

Emma Stokes:               39:29                to bring them in and say, oh, hey, did you want to join us? Well, and sometimes, so for me, a lot of the time what I do is I bring someone in because I know they want to connect with someone and I say, okay, you guys are connected. I'm going to go and I'm going to move on.

Karen Litzy:                   39:44                Yeah. I feel like Karim Khan is the king of that, by the way. Oh yeah, absolutely. Absolutely. Yeah. Oh, did you want me to come with me? This is exactly, yeah, exactly. Absolutely. He is the king of connecting people like that at different conferences. He's done that for me so many times and I don't know how. I'm always like, what can I do for this man? Because I feel like he's done so much and he's so good. And I love the two up, two down, two sideways. I'm going to remember that when I go to Vancouver. It's a great room. You know, and maybe we need to produce a little card to up to that, like a dance card. Oh that's a good idea. Maybe we can do that for sports congress. Oh I'm definitely doing that. Oh that's such a good idea.

Emma Stokes:               40:37                And then maybe one of the sponsors or one of the, you know, cause they could have a little piece of the sponsorship piece at the back.

Karen Litzy:                                           Yeah, absolutely. Well I know that, you know, Chris is listening in on this, so I'm trying to shout out to a sponsor. And then if you really want people to kind of get into it, you can kind of fill it out with the person's name and then handed in and win a prize at the end. And I love the bringing someone in and when we were in Switzerland, Christina Lee that I was with and you know, we had met in Copenhagen at Sports Congress and decided that it all stayed together at WCPT and you know, you're just walking around and she gave me a compliment that no one's ever given me before, but it's might've been one of the best compliments I've ever received.

Karen Litzy:                   41:52                And she's like, you know, you are so good at making sure people are involved in conversations. Like you're so good at bringing people in and you're so good if someone's not saying anything of, you know, making sure there's space for them. She's like, that is, she's like I'm learning from that.

Emma Stokes:               42:10                That's fantastic. And it is a great gift of yours because you are so present in the moment when we're having conversations. So you're very sensitized I think to the people in the room or the space that we're in. So you do connect people in a way that is fantastic and it's a huge gift. And I think the fact that you don't even know is that you're doing it means that's a great gift for you. Yeah, I think sometimes, and that's, you know, that is wonderful. So you have, you know, you've internalized that it's probably just a natural part of who you are. And I think for other people it might not be intuitive, but it's a great thing to remember. The other thing to remember is the 20 second rule or the two minute rule, but we have the rule, which is, you know, we meet people all over the world. Some people meet people around the world. You're never necessarily going to remember everyone's name. So I have a rule, which is if I'm standing chatting to someone and the person I'm with who knows me, we haven't been introduced within 30 seconds. The cue is introduce yourself because either A I’ve forgotten cause I'm so taken up in the conversation. It's not beyond the bounds belief, you know, happens very regularly. Or secondly, I've had that moment where I'm suddenly thinking,

Emma Stokes:               43:28                I don't know that I remember this person's name or I'm not sure enough that I remember their full name.

Emma Stokes:               43:35                So just introduce yourself, so if you're with me and we're in a conversation, you would always do it right. You'll say, Oh hey, I'm Karen, she's introduced me. That's fine. But, but it's also, it's a very polite way of getting over that moment of she's forgotten.  She's taken up with a conversation or she hasn't done it because she's only thinking I'm having a panic. I remember exactly where I met the person. Yeah. I remember their name. And you know, sometimes I put my hand on them. But I can usually remember exactly where I've met the person.

Karen Litzy:                   44:11                Yeah. I'm good at faces. And sometimes like if I'm with some, like a friend of mine and I see someone, I'm like, oh my gosh, I know this person, I know this about them, this about them. But I don't know their names. So when we go up, we'll start chatting and then I want you to introduce and then I want you to introduce yourself. So I'll prep this, the person I'm with, I'm like, I might know their backstory, I've read them know, but I can't think of their name.

Emma Stokes:               44:32                So you know, do the 30 second rule, which is when you're with a friend who hasn't introduced, you just introduce yourself.

Karen Litzy:                   44:38                Perfect. All right, so let's talk about Third World Congress. What are you going to be speaking on?

Emma Stokes:               44:45                Well there you go, on leadership and you know, you know, how fabulous is that? I'm so excited about being there, you know, I'm just, I'm so honored to be invited because I was invited a couple of years ago and, you know, I wasn't necessarily going to be the president of WCPT again. Right. So, and I said to them, you know, what's really nice that you've invited me but you know what, it's great. We just invite you anyway because we want you to talk about leadership. And he would have been the president and that's great. So, I'm thrilled that I was invited to be that. I'm super excited about that. I'm back as the president of the world physiotherapy and, you know, I just, I guess, you know, I love the sports physiotherapy world.

Emma Stokes:               45:27                You know, I've never practiced as a sports physiotherapist and it's not my field of expertise, but I have learned so much simply by sitting in the rooms of amazing congresses. And I've learned so much that just simply by Osmosis, that every now and then I say something and I think I sound like I know what I'm talking about. Actually. I'm fairly confident that I do, but how do I know? And then I realize, okay, what I've sat through five keynotes lectures from the stellar people in the field. And it's not that I'm an expert, but I can actually at least point people to the references. So, you know, I think there is so much to be gained from a global community of practice and knowledge coming together and you know, the sports physiotherapy world is incredible and I am so excited and Vancouver is beautiful and the Canadian physiotherapy is fabulous, So bring it on.

Karen Litzy:                   46:26                Awesome. Well I know, I am excited to go in to learn and you know, there's breakout sessions. I don't know which one to go to because they all sound really great. I don't know what you think, but I think they all sound like it's an amazing program.

Emma Stokes:               46:40                Absolutely. It's fantastic. And I think, you know, you know, I get the joy. So I suppose my joy is my privilege and my joy is that I get to dip in and out of so many sessions. And because you know, in a way I am taking different lessons away from Congress. It's like this. So I'm taking away the thought leadership lessons I watched, you know, I want to sit in on the leadership stuff, I want to sit on the policy stuff. But you know, if you're practicing day to day working with people in the sports world, there the richness of the programming is like, where do you start to choose, you know, how do you decide what you're going to go to, to take away, to inform your day to day practice?

Karen Litzy:                   47:18                Agreed. I think it's going to be great. And again, just for people listening, you're obviously on the Facebook page, so hopefully you can see the banner on top that says October 4th and in Vancouver the Third World Congress of sports physical therapy. But I guess this is going to be on my podcast as well. So Emma, where can people find out more about you?

Emma Stokes:               47:40                Oh, so, well, like they want to find any more out, more about us I think actually look at, so is our websites. Have a look at the website because we are going through a major both rebranding, you know, redesign of the website. So it's going to look super different. I think we're going to have some interesting information about our rebranding by October and about the rebranding of the product. You know, the kind of, the idea of what do we call ourselves as a global community and started to merge the space. I'm committing to blogging once a month, which I've failed dismally at, but I am now committing, so just put the first blog out there and yeah, so follow us on social media, like Facebook, Twitter, Instagram, and then look at our webpage but also look at our subgroups obviously because, the world sports congress is being co hosted by the Canadian Division of sports PT and the International Federation sports physical therapy and that's the WCPT subgroups. So all joined up. So yeah, look at the website and I see the early bird is opened on until the end of August for Congress in Vancouver in October.

Karen Litzy:                   48:55                Yes. Awesome. Well, thank you so much for taking the time out and coming onto as a pleasure.

Emma Stokes:               49:00                It's my pleasure as always, and thank you for the opportunity and I will see you in Vancouver.

Karen Litzy:                   49:04                I will see you then. Thanks everybody. Have a great day.



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Sep 9, 2019

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dan White on the show to discuss evidence-based practice.  Daniel K. White is an assistant professor at the University of Delaware in the Department of Physical Therapy.  Dr. White’s research focuses on physical activity and physical functioning in older adults, people with knee osteoarthritis, and people after Total Joint Replacement. 

In this episode, we discuss:

-What is implementation science?

-Evidence Based Practice and how to use Clinical Practice Guidelines

-The latest research findings from the Physical Activity Lab at the University of Delaware

-Limitations of physical therapy branding and how we can step into the physical activity space

-And so much more!




Academy of Orthopedic Physical Therapy

University of Delaware Physical Activity Lab

Published CPGs


For more information on Dan:

Dr. Daniel K. White is an assistant professor at the University of Delaware in the Department of Physical Therapy. Dr. White received his Bachelor’s degree in Health Sciences, M.S. in Physical Therapy, and Sc.D. in Rehabilitation Sciences, all from Boston University.  He completed a post-doctoral fellow at the Boston University School of Public Health and earned a Masters in Science in Epidemiology from the BU School of Public Health 2013.

Dr. White’s research focuses on physical activity and physical functioning in older adults, people with knee osteoarthritis, and people after Total Joint Replacement.  Dr. White is an Associate Editor for Arthritis Care and Research, and an active member in the American Physical Therapy Association.  His research is funded by the National Institutes of Health, and the Rheumatology Research Foundation.  Dr. White can be reached at

Daniel K. White is an assistant professor at the University of Delaware in the Department of Physical Therapy. Dan’s research focuses on physical activity and physical functioning in older adults, people with knee osteoarthritis, and people after joint replacement.  His research uses large existing datasets to answer questions related to physical functioning and physical activity.  As well, he is also conducting clinical trials to lead ways to better promote and increase physical activity in people with knee osteoarthritis and after joint replacement.  Dan is an Associate Editor for Arthritis Care and Research, and an active member in the American Physical Therapy Association, the American College of Rheumatology, and OARSI. 


Read the full transcript below:

Karen Litzy:                   00:01                Hey Dan, welcome to the podcast. I'm happy to have you on.

Dan White:                   00:05                Thanks. Great to be here.

Karen Litzy:                   00:07                And now today we're going to be talking amongst other things, implementation science. So before we go any further, can you give a definition of what implementation science is?

Dan White:                   00:19                Absolutely. So implementation science, that definition is the scientific study of methods to promote the systematic uptake of research findings and other evidence based practice into routine practice and hence to improve the quality and effectiveness of health services. So essentially it is bridging the gap between science and practice, and it is taking things that we find in laboratories and in clinical studies and literally implementing them into real world, clinics where most physical therapists work.

Karen Litzy:                   01:00                Right. So then my other question was why should the average PT care, which I think you just explained that, so we need to care about implementation science because this is how we're getting what researchers do in the lab to our real world situations and our real patients.

Dan White:                   01:16                Yeah. I think practicing as a physical therapist, you know, you can look around and a lot of people do a lot of different things and a lot of things seem to work. Snd I think, if we want a game changer in our practice, that is going to come from a systematically studying people and understanding what are the underlying critical ingredients of our practice that really work and the best thing we have made up today to answer that sort of question of, you know, what is it that really works our clinical practice guidelines that is the, essentially the best body of evidence that has been reviewed by a panel and vetted and made to be digested by the everyday clinician. And implementing these clinical practice guidelines are really the key element that is going to lead to a game changing opportunity for us as a profession.

Karen Litzy:                   02:34                And when you talk about clinical practice guidelines, I know sometimes people think that you're doing sort of it's cookie cutter and what do I need to follow a cookie cutter recipe for because all of my patients are different. So can you speak to that?

Dan White:                   02:52                Yeah, no that is a great point. So on the one hand, there is definitely an art to physical therapy and the clinical practice guidelines and evidence based practice is by no means trying to take that away. It's evidenced based practice in general is not cookbook medicine. It is combining the three things and one is what the evidence says, but two it also combines what the therapist's experiences are and then finally it's what patient's preferences and what their feelings are on the whole thing. And it's a combination of all three. It is literally the definition of evidence based practice and these clinical practice guidelines are definitely consistent with that EBP models. So they are not directions or they're not instructions, they're guidelines. They're ways of helping people make informed decisions. And at a minimum, if you consider yourself an expert clinician and knowing what the clinical practice guidelines are, is a big leg up. And definitely key to helping our profession. It doesn't necessarily mean you ascribe them to every single patient. No, that's not what evidence based practices, but being aware of them is by definition, in my opinion, being a good clinician.

Karen Litzy:                   08:02                So can you give us an example of one of these clinical practice guidelines?

Dan White:                   08:21                Sure, absolutely. So one of the common patient populations that people treat is low back pain. And Tony Toledo and his colleagues at the University of Pittsburgh and elsewhere developed a clinical practice guidelines for low back pain, and published this and JOSPT in 2012, their paper described that the purposes of these CPGs, our first to what EBP is for a physical therapy practice. And then also to classify and define common musculoskeletal conditions from this classification criteria specific interventions are devised. So for an example, so I don't treat low back pain. This is not my area. So just forgive me for giving a guess here.

Dan White:                   09:32                One example, is a lumbosacral segmental somatic dysfunction. And this is associated with the ICF diagnosis of acute low back pain with mobility deficits. And, Tony goes on to saying that there's, certain clinical findings with this, including acute low back pain, a buttock or thigh pain restricted lumbar range of motion and lower back pain and lower extremity related symptoms with provocation. And then from that, there are specific interventions that I'm not going to get into that is unique from a different classification. So a different classification, a low back pain is sub acute, low back pain with mobility deficits, which is basically not acute but subacute patient and the symptoms are produced with ingrained spinal motions and there's a presence of a thoracic lumbar pelvic girdle mobility deficits.

Dan White:                   10:41                And then he goes on and there's these different classification criteria from which there are very specific interventions you're supposed to do. So it's classification and then intervention based on that. And essentially, that is in an ideal world of what a CPG should do. However you’re always gonna have the patient that really doesn't fit into one or the other. Let's have somebody who is not quite acute, but they're not quite subacute. So what do you do? And I think being able to first even make that distinction, you have to be aware of the clinical practice guidelines. So knowing that, okay maybe it's going to be a combination of these two interventions because of this person doesn't fit into either one, but see how that approach is already a leg up from not knowing what CPGs are to begin with and what our common classifications is. Does that make sense?

Karen Litzy:                   11:38                Yeah, that makes a lot of sense. Thanks so much for using that as a really great example for people. And when you're talking about different CPGs, I know that the Academy of Orthopedics, which used to be the orthopedic section of the American physical therapy association, they have all these different names now. It's just made it all so, so much more confusing. But now obviously big proponents of the clinical practice guidelines, but if I wanted to find the average clinician and I want to find some of these guidelines, where do I go? How do I find them?

Dan White:                   12:14                Sure. So all the published clinical practice guidelines for orthopedics are on the Academy of Orthopedic Physical Therapy’s main webpage, which is There's a banner that says CPGs and you just click on that and you can get right to all the published CPGs.

Karen Litzy:                   12:41                Awesome. And we'll have a link to that in the show notes at under this episode so that if people need it one click and we'll take you right there. So there's no excuse to not know these CPGs after listening to this podcast then because we're going to make it really easy for you. And now you just gave us a good example of how CPGs can work in clinical practice. Are there times where maybe they don't work so well or is there a downside I guess is what I'm trying to say?

Dan White:                   13:16                Yeah. I mean, again, going back to your original question of, you know, is this cookie cutter medicine and it's not and again, since EBP is a combination of patient preference, the provider know how, and what the evidence is. I mean, there's going to be situations where, you know, a situation's weighted much more towards a patient's preference. Like they don't want you to do manipulation or maybe they want something specific and you're like, well, that's really not called for in this case. And so you don't do the intervention that's prescribed or that the CPG recommends. And that's okay. We're not here to tell people, to command them what to do. They're coming to us for help. And, patient preference is a large part of evidence based practice. I think that’s the best example I can think of.

Karen Litzy:                   14:16                Yeah. And, and I think another, if you're looking at your clinical experience as one of the legs of that stool, if you will, and the patient doesn't have a preference yet, you're sensing as a clinician that there's some trepidation on the patient's part. There's some fear if you were to, like you said, we'll take a manipulation as an example, then using your provider know how you would say, you know, this is not the right time or place for this. And so I think you've got all of that in. So the CPGs is not a cookie cutter oath just because A B C is present you have to do treatment B or treatment a or B. But instead it's giving you a way to maybe differentially diagnose and a way to, you know, be able to maybe give your patient an explanation as to what's going on and then use your judgment, use the patient preference and the evidence to then guide your treatment.

Dan White:                   15:21                Yeah, exactly. It's just like, you know, when you just meet somebody, you try to figure out who they are, right. And you try to figure out what kind of personality they are. And there's some sort of structure or rubric people use. Like let's say there's introverts and extroverts, is this person an introvert or extrovert in the CPG the first thing that it does is provide you a framework of saying, well, what kind of types of people are there with this type of pathology? How are they a type of person that has, I don't know, this type of this type of disorder or this type or another type of disorder. And from that diagnosis of providing a classification, you can, there are clear treatments associated, with that so back to the party analogy, you know, if you're dealing with an introvert, you know, you, you know that they're not going to be super bubbly and all over.

Dan White:                   16:10                You have to kind of bring things out of them and maybe take it easy and you know, take it on the slow road. Versus if someone's an extrovert, maybe are going to be doing all the talking. And, you can just be an active listener and be very interested in what they're saying, because they're the extrovert and perhaps, you know, that that's Kinda how it goes. And the CPGs is essentially just it is in the party analogy, a way of just navigating through our clinical practice, to provide best care. And, you know, I think another, medical example that really, stays fresh in my mind is a sort of lifesaving approaches to acute MIs. And, it wasn't the sort of protocol for or clinical practice guidelines for myocardial infarction, weren't developed, when necessarily, right after science discovered that, you know, look, if you do x, Y and z can actually save someone's life.

Dan White:                   17:20                It kinda came much, much later. And it wasn't until, the university hospital in Chicago, implemented these sort of CPGs for lifesaving approaches to MI that the death rate for acute MI’s went way down. And all the medical residents followed, this CPG for treating acute MIs. And, that systematic approach is what made care better. Obviously in physical therapy we're not talking about life or death, but these CPGs have been vetted and are an approach that is systematically used, will produce a better outcomes. So yes, it's, you know, EBP, I'm not changing my story here. EBP is obviously patient preference, provider experience as well as the evidence, but when applied systematically, which means you'd be at minimum aware of what the CPGs are, they should produce better outcomes system wide.

Karen Litzy:                   18:27                Yeah. And thank you. I love the party analogy and comparing it to that medical example really kind of makes the CPGs a little bit clearer and hopefully people will now not look at them as some sort of cookie cutter program, but instead, as a way to help inform you of your practice, which I think is, yeah, I think it's great. And now, all right, so let's move on from CPGs. Let's talk about, I'm kind of interested in what you're doing next. So you are the director of the physical activity lab at the University of Delaware. So let us in on some of the things that you guys are working on. If you can, you know, I understand you can't say everything, but what are some things that you're working on that you feel like will be part of future implementation science for the average physical therapists treating patients like myself?

Dan White:                   19:23                Yeah. Thank you for the opportunity. You know my whole goal is just to get patients better. And, I worked in inpatient, acute, acute Rehab for several years. And I always wondered, you know, after I got people independent with bed mobility, transfers and ambulation, you know, would they actually take those, you know, new found independence, and actually resume their daily activities and be active in the home. And that led me to really thinking a lot about this notion of physical activity or, you know, how much do people do. And so, in the area I study, it's osteoarthritis and osteoarthritis is a serious disease that is associated with higher rates of mortality.

Dan White:                   20:21                And only definitive treatment for osteoarthritis is a total knee replacement. Now, after total knee replacement, people do great with improving their pain, and increasing their function. But there's many systematic studies that show in terms of physical activity, people aren't doing more, they're doing just as little as they did before. And I think that's a real missed opportunity for physical therapists. And I think there's a great opportunity to talk about, you know, being more active and helping patients and it really doesn't take that much. It's just a, hey, so, you know, how much are you doing every day? With smart phones and the use of fitbits, counting steps per day is actually an  incredibly effective, a way to increase or one to see where people are at in terms of physical activity and to increase how much activity people are doing.

Dan White:                   21:19                So just like if you're trying to, you know, lose weight, you usually have a scale and you want to see how much you know, where you're at and what progress you've made. Using a pedometer or using a fitbit monitor to count your steps is an analogy and analogous way of doing the exact same thing. So at the University of Delaware, we are studying what are the best ways, physical therapists and practical ways physical therapists can increase activity in people with knee replacement. And what we've done is we recently published a study that basically found that, it's very feasible to talk about physical activity and do a really quick intervention for people after knee replacement by simply giving them a fitbit monitor. And seeing how many steps per day they're walking, and then increasing that number of steps today.

Dan White:                   22:19                Our target goal of 6,000 steps per day in a study we did several years ago, we found people with knee osteoarthritis who want at least 6,000 steps per day we're much less likely to develop financial limitation than people who walked less than 6,000. So that's where we use the 6,000 steps per day. That's where we have the goal set up. And, since there is a health outcome associated with 6,000 steps that's our goal. And we see where people are walking and then we start to increase their steps by five to 10% per week. So if you're walking 2000 steps, we increase it by 100 to 200 steps per day more.

Dan White:                   23:25                And then the next week we see where they're at and we increase it again by another five to 10%. And what we found, doing this intervention and physical therapy is that a one year after discharge from physical therapy. So they've had no physical therapy and no intervention. People pretty much maintain the gains they made in physical activity and their gains are pretty substantial. There was a high percentage of people that met the 6,000 steps per day goal, and maintain that one year out in a preliminary study. And we are currently collecting more data to look at a larger sample to have a little more robust results. In talking with the theme of Implementation Science, what our next step is to do is to implement this intervention in real world physical therapy clinics.

Dan White:                   24:24                We recognize, you know, at the University of Delaware, we have a fantastic physical therapy clinic. But you know, our clinicians, and the type of people, patients that come here don't represent a cross section of the entire country. We want to see whether this intervention will work in real world clinics. And we've partnered, with a clinic in Lancaster, PA called hearts physical therapy. And we're looking at developing a implementation of our intervention at that clinic, to see, you know, what's the uptake with clinicians, what are the barriers, what are the uptake with patients, where the barriers and how can we make this evidence based practice approach actually work.

Karen Litzy:                   25:13                Yeah. And you know, as you're saying that I'm thinking, well, hmm, does it matter like these people know that they're in a study. So is that their incentive to, you know, continue on with getting these 6,000 plus steps in a day because you know, we all want to show the teacher that we're good at what we do. Yeah. Right. And then the question is that enough? Like you said, you followed them for a year to really make that a lifestyle change and maybe after a year it is.

Dan White:                   25:43                Yup. No, those are good questions. So in terms of sort of in terms of like a Hawthorne effect or where you were, you know, you're just doing this because you know you're in this study. First we do have a control group that wears the Monitor. And they did not have the intervention, but we are monitoring their physical activity and know it and the intervention group, in our previously published study, in arthritis care and research, that the intervention group still is walking almost double of what the control group does a one year out. So that's, you know, that's notable.

Karen Litzy:                   26:36                Oh, one year is a long time and at that point, do you feel like it has shifted to a lifestyle change?

Dan White:                   26:47                Yes and that's the encouraging part. Like one year out that's a pretty good outcome, for not having any contact with, you know, well not having your original physical therapy for you. And, that's incredibly encouraging for a longterm outcome and actually thinking that there might be large behavioral change. Another interesting thing with our preliminary studies that we looked at adherence or the fidelity of a treatment in the physical therapy clinic. And what that means is how often did physical therapists tell the patient about, you know, ask them about their step goals and ask them about you know, how they're doing. And it actually wasn't that great. It was around 50%. So, it wasn't that this intervention was, you know, so well taken, in my mind, it was more that the patients really grabbed onto this and saw that, you know, look, this monitor tells me exactly where I'm at. And in qualitative studies we've done, or interviews we've done after the intervention, the patients, by and large, they say, look, I know where I'm at, that this monitor tells me, and I know when I have a good day and I know I have a bad day and what I need to do to make a difference between the two.

Karen Litzy:                   28:05                That's great. And if you can get that from the monitor or the fitbit or the pedometer or whatever it is that you're using, then I think that's a huge win, not just for mobility, which obviously we know we need as we get older and especially after knee replacements, but for a whole host of other health reasons as well.

Dan White:                   28:27                Yup. Yup. Exactly that. I was just lecturing yesterday to newly-minted rheumatology fellows at u Penn in Philly. And talking about physical activity first, it was interesting to know that none of them knew what the physical activity guidelines are, which maybe, you know, most people don't know what they are, but it's a 150 minutes of moderate intensity activity per week or 75 minutes a week of vigorous intensity. And the reason why these guidelines are so important is that the benefits of health of being physically active are far reaching. They range from not only improved strength and flexibility, but you also have cardiovascular benefits. You have a mental health benefits. There's less the chance of depression, there's less chance of weight gain.

Dan White:                   29:28                There are a lot of far reaching effects even so that the American College of Sports Medicine Jokes that if you could put the benefits of exercise into a pill, you'd have a blockbuster pill. I mean, it’s definitely a huge benefit to be active. And then the second thing is that, you know, for physical therapists, you know, is that something we should address? I mean, that could be something that, yes, typically, yeah. Typically therapists you think with a patient comes in, you know, they have their complaints and, you know, let's talk about, you know, reducing your pain and increasing your range and then getting you back to, you know, where you were at. But our recently published study in physical therapy actually surveyed patients and said, you know, what do you feel physical therapists should talk about?

Dan White:                   30:24                And they were asked a range of things including weight and Diet and physical activity. And by and large, it was 90 plus percent of patients said, I want my physical therapist to talk about this collectivity. That is what they're there for. You know, that that is a major reason I am here and I want them to ask me about it and to counsel me on it. So I think that's something we should, you know, to embrace and understand, you know, what our guidelines are this 150 minutes a week, understand that. And understand, you know, what our steps per day, what are sort of major benchmarks for steps today. You know, we oftentimes say 10,000, but you know, we found earlier that 6,000 for people, you know, osteoarthritis is a meaningful benchmark.

Dan White:                   31:15                And then, the last thing I'll say about the physical activity thing is that, American College of sports medicine and the physical activity guidelines from the Department of Health and Human Services, you know, their major recommendation and before the timeline is that it's the saying that some is good but more, it's better that there is a dose response relationship between how much activity people do and their health benefits. So even getting somebody who is completely sedentary to doing at least walking for five to 10 minutes a day, can have a huge change in their health outlook and risk for future poor health outcomes. So, that is a major thing that, you know, PTs need to keep in mind is if I can get this person who I know is sedentary just to do something in adopt that I think is huge win for this patient.

Karen Litzy:                   32:12                Yeah. And, I think that the physical therapy profession needs to really step up and be the people to step into this space. I mean, this is what we do. This is our space. You know, we should be grabbing those patients who maybe have knee OA, but don't need a knee replacement yet. We should be stepping in. That's our jobs. That's what we should be doing. We should be working with obese or sedentary people of any age before they have to come and see us for an injury.

Dan White:                   32:46                Yup. Yup. Exactly. My doctoral student Meredith Christianson who worked with Gillian Hawker at the University of Toronto to do this qualitative study on primary care physicians. And essentially the question was why don't primary care physicians recommend exercise and physical activity to patients with knee osteoarthritis. Although despite the fact that every single clinical practice guideline recommends, you know, exercise by and large, the primary care physicians or that we're saying, well, we don't know what to recommend. We're not the experts. And, they would like to refer their patients to PT, but it's not reimbursed up in Canada. So, you know, I think this further underscores the notion that as physical therapists, we should own the physical activity sphere. We should be the ones that people think of, like, you know, well, I want to be active but I have some problems. What do I do? Go see a physical therapist. You are highly educated individuals who know more about biomechanics, more about kinesiology than anybody else in the clinical sphere. And we are the best place to make exercise and physical activity recommendations to people of all types, more so than any other health provider.

Karen Litzy:                   34:13                Yes. I couldn't agree more. I could not agree more with that. And, in my opinion, and my hope is that physical therapy really starts to move toward that in the very, very near future because boy could we make a big impact in the lives of people around the world if we're that sort of first line of defense, if you will. And isn't it amazing that like, I love that you brought up this not covered by insurance, but people will go and pay for a trainer or a massage therapist, not knocking any of those professions at all because I think they're all very valuable. But people will pay for that and not say, well, can you turn it into my insurance? And then when it comes to physical therapy where, you know we know all this stuff, we have the guidelines, we have the clinical prediction rules. We have the education and it's just not something that people are willing to put money down for.

Dan White:                   35:27                Yeah, I think there's two things. One I think people will pay if they see value in it. And yes, I think that it's not that we don't have value, but I don't think we're marketing ourselves well as specifically to the larger community. Going back to the implementation science, Workshop Implementation Science Conference and workshop in Providence, Rhode Island this past march and the president of the APTA came and spoke there and he said that, you know, for us as physical therapists, we're really lacking in the sales and marketing sphere. And one of the reasons why is because, well, one of the things is we all call ourselves physical therapists. But what that means is very different depending on where you work.

Dan White:                   36:33                So for instance, you know, a patient is going to have an eye, a view of what a physical therapist is. In this context. So if they see a physical therapist working in a school, well they'll think all PTs work in a school, and in acute care after a major MI then they think they only worked at acute care, but you know, marketing that we actually are versed in many areas is a challenge we have. And I don't know if that means we start to call ourselves a sports specialist or you know, cardiac specialists or what, but, you know, something along the lines of marketing our idea or marketing our expertise better is a key area of need. And then the second thing is, you know, I think it's okay to ask people to pay for things.

Dan White:                   37:24                In knee osteoarthritis as people will pay five to $10,000 for stem cells or PRP injections, and, you know, the evidence behind that is, well, let's say it politely, much lower than what the evidence is for exercise is. And, it's just incredible that, you know, if someone's gonna lay down that sort of cash, you know, I think there is a definite market out there for services that are viewed as valuable and having a physical activity or exercise prescription that's tailored to, you know, individual needs, you know, is a clear area of opportunity for our profession, for people with chronic diseases. And, you know, I think a space that we should definitely pick up.

Karen Litzy:                   38:16                Yeah, there's no question I could not have said it better myself. And I think I'm going to make nice quote on that because you're absolutely right. And now before we wrap things up here, it's the same question I ask everyone, and that is knowing where you are now in your life and in your career, what advice would you give to yourself fresh out of school?

Dan White:                   38:54                Yeah, that's a good question. The advice I'd give myself is, just do your best to make your patients better. I think that's all it is. And you know, at the University of Delaware, we have people here that work in very different outputs. So we have our clinical faculty that are working, doing a bulk of the teaching for the students. And then we have research faculty or tenure track that teach the PT students, but all have our own research lines. And then we have clinicians that are working in the clinic so very different outputs. But our goal is all unified and that is just to help patients get better. That, you know, and from the clinical side, we are focused on excellence in research or excellence in teaching students the best and latest up to date things and the most effective ways to teaching them.

Dan White:                   40:05                So they remember not only to pass the test, but to have successful careers. And then from a research perspective, we're trying to look for, you know, what are game changing discoveries to help treat people and help them get better. And then the clinicians are implementing that on a daily basis at the University of Delaware. And you know, again, what makes us, I think, what I think of as a prideful point is that we're all aligned in our goals with trying to get people better. And so that's something that I guess, you know, I've always ascribed to as both a therapist, as a doctoral student and now as a clinical scientist is trying to, you know, my major goal is just to help people get better.

Karen Litzy:                   40:54                That's a wonderful answer. Thank you so much. And where can people get in touch with you if they have questions?

Dan White:                   40:59                My email address is Feel free to email me anytime.

Karen Litzy:                   41:16                Awesome. Well, thank you so much. Thanks for breaking down the clinical practice guidelines and implementation science, and I love the stuff you're doing in your lab, so thanks for sharing.

Dan White:                   41:25                Great. Thanks so much for having me

Karen Litzy:                   41:27                And everyone else, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Sep 5, 2019

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Kathy Mairella on how to get elected to the House of Delegates and other APTA positions. Dr. Mairella is Assistant Professor and Director of Clinical Education at Rutgers University.  Dr. Mairella has served in a number of leadership positions, including service on the American Physical Therapy Association Board of Directors, and terms as president and chief delegate of the American Physical Therapy Association of New Jersey.

In this episode, we discuss:

-How to make yourself known to the Nominating Committee as a potential candidate

-Referencing the candidate’s manual and seeking guidance from your campaign manager

-Candidate interviews and Kathy’s experience with election day

-The continual pursuit for leadership experience

-And so much more!



APTA Engage Website

Kathy Mairella Twitter


For more information on Kathy:

Kathleen K Mairella, PT DPT MA, received a Baccalaureate degree in Physical Therapy from Boston University, and a Master of Arts in Motor Learning from Columbia University. She received a Doctor of Physical Therapy degree from the MGH Institute. Dr. Mairella is Assistant Professor and Director of Clinical Education. She teaches Professional Development I, and Health Care Delivery I and II. Her professional interests include health policy, professional leadership, and clinical education. She has presented on these topics on the national and state level. Dr. Mairella has served in a number of leadership positions, including service on the American Physical Therapy Association Board of Directors, and terms as president and chief delegate of the American Physical Therapy Association of New Jersey.

For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas ( until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website:


Read the full transcript below:

Jenna Kantor:                00:00                Hello, this is Jenna Kantor with healthy, wealthy and smart. And I'm here with Kathy Mairella and we are at the house of delegates and going to talk about the process, the election process for people who are running for positions within the APTA. And I know nothing. So first of all, Kathy, thank you so much for coming on.

Kathy Mairella:                                     Thanks. This is fun. I'm looking for to talking about this.

Jenna Kantor:                                        So for those who haven't listened to any of the interviews that I've done before that were kind of similar, I am totally beginner and I'm just going to be asking step-by-step and learning with you the listener about this process. So let's start from the very beginning. And honestly, I don't even know what that is. So Kathy, would you start, how does it just even start in the first place? Is it a piece of paper you signed? Do you raise your hand in a meeting? Like how do you get the opportunity to run for a position within the APTA?

Kathy Mairella:             00:49                So that's a great question. So many, many of the leaders who run for positions at the APTA level started the component level and they often, it means state component mainstay or it can be an academy section as well. Those are also components. So every state has a chapter and then your sections are also considered components. So most candidates who run at the national level have had some level of leadership experience at the component level. And so you start there simply by showing up and getting involved in different activities. Usually if you have a leadership interest, somebody will notice and give you some direction and it helps to get that direction if you ask for it. If you're doing some work on a committee level or a task force level, you can ask the people who are more engaged.

Kathy Mairella:             01:55                How did you do this? How did you get started? I started as a New Jersey component leader. I started as a secretary and moved through vice president and president and then to chief delegate. And so I got to know people on the national level through my work as a chapter president and as a chief delegate because that's where you come to a national meeting and you start to connect with people beyond your component. You start to meet people who are either other delegates or serving on the national level. And you develop connections, you develop relationships. When I went to my first delegates, I looked at the candidates who ran and I thought I would never in a million years do that, but I was a delegate and I watched and then people came to me and said, we think you have some leadership, would you be in check?

Kathy Mairella:             03:00                And I was totally floored. I did not expect that at all. In fact, I was a member of APTA's nominating committee. So nominating committee members are elected to slate the candidates who run and they start years ahead of time identifying those who are interested. And so I was approached and I thought, not really, no, I don't think I really want to do that, but it gave me the idea of perhaps in the future serving at a national level.

Jenna Kantor:                                        I want to pause you just very briefly. Would you mind saying what a delegate is for those who don't know what that means?

Kathy Mairella:                                     Sure, absolutely. So each state chapter elect delegates who go to the house of delegates to vote on motions which are ideas, ideas for action. Really the house of delegates is considered a representative body, just like Congress as a representative body. So you are elected by your state or there are also section delegates, but you're elected to represent them in the house of delegates.

Kathy Mairella:             04:21                And the house of delegates has about 402 delegates. And so the states with larger membership have more delegates, states with smaller memberships have at least two. They will never have fewer than two. So they call that apportionment.

Jenna Kantor:                                        So you're bringing up the delegates cause they're the people who vote for you. So it’s important to be introduced to them because it can help your candidacy if you should run.

Kathy Mairella:                                     Correct. And when you decide you want to run, it's important to get a sense from people. Is this a good idea? You don't want to put in all the work and then not be successful. So you really do start to observe people who have been elected or people who are doing work within the association that inspires you, that interests you and you know, you can observe them, you can ask them questions.

Kathy Mairella:             05:24                You can start to connect with people. And then running for offices really a matter of experience. But it's also a matter of timing. We all have work life integration and we figure out the timing that works best for us. And in my case, I had three growing children. I knew I wanted to serve at a point where they were a little bit more independent. So that determined my time frame. So again, I had been a chapter president, a chief delegate, and then at the end of the time I was a chief delegate. My youngest child was graduating from high school and I thought, okay, this is the time for me to start pursuing that. So, I would observe then you need to know what the positions are. You need to know.

Jenna Kantor:                                        So just to run for say, secretary or President or director, you need to know what it means that you would need to know what to do.

Kathy Mairella:             06:29                Correct. So, the board of directors at the APTA level is 15 members. You have nine directors and then you have house officers, speaker and vice speakers. So those are two board positions that actually run the house of delegates. And then you have president, vice president, secretary and treasurer. So you would need to know, you know, kind of the roles and responsibilities of each of those. And you can also run for the nominating committee, which I mentioned earlier. So those are the people who are elected by the delegates to determine who the candidates are each year. So, you know, you run through a process that starts immediately after each house of delegates. So we literally just finished the house of delegates today on June 12th, and the next cycle starts for the 2020 election today. And it starts by forms that are available on the APTA website that any member can complete.

Kathy Mairella:             07:34                They don't need to be done. You don't need to be a delegate. You don't need to be a leader. You can go on the APTA website and you can put in what's called an NC1 form, which stands for nominating committee one form. And you put that in and as an individual and you recommend someone that the nominating committee should contact as a possible lead for them to slate for office and you can you choose, I think this person would be a great secretary. I think this person would be a great treasurer. And you put in the recommendations for the offices that are up for election in the following year and the nominating committee collects all of that information. They also keep an ongoing spreadsheet of people who have expressed interests cause sometimes people will say, yes, I'd like to do this in the future, on completing a residency now and I'm getting married the year after that and I'd like to practice for three to five years and then maybe I'll be ready.

Kathy Mairella:             08:47                They start to keep that spreadsheet and they turn that over every year from nominating committee to nominating committee so that they have a database of potential candidates.

Jenna Kantor:                                        I have a question. I have a question about that. I'm definitely a person who wants to work on the board one day. Definitely a dream of mine. And what if I'm in a position where I don't have somebody saying, Oh, I submitted for you. Like what if you don't have something like that? Does that look low upon yourself?  I would love to know that perspective.

Kathy Mairella:                                     Sure. So the volume of those NC1 forms really doesn't make a difference. It's important to have a few people say, yeah, it would be nice for nominating committee to talk to that person. You're not committing to anything. It simply gives your information to the nominating committee as someone that they should talk to and it just gets you in kind of in the system.

Kathy Mairella:             09:47                So, I think for anyone who is interested, you can contact someone on the nominating committee directly. Their list of names and contact information is on the website. And usually they’re assigned to a region. So who's ever assigned, you know, if you're from New York, from the northeast, you know, you can directly contact, you don't have to have NC1 forms until you're actually ready to run for office. So once you decide you are ready to run for office, it usually is a good idea to ask a few people. Would you be willing to put in an NC1 form for me? And talk to people kind of before you’re ready, you know, do you think this is a good idea? Cause as I said earlier, you don't want to put in all the work and then find out that you're not successful.

Kathy Mairella:             10:35                You're spending this time looking at your leadership skills. Learning about leadership. Always growing, always growing. There are some resources. APTA has opened, a new platform called APTA engage. And they are in the process of transferring some of their leadership development resources to that place. When I was on the APTA board, I chaired the leadership development committee and we came up with some core competencies of leadership. So, they were self function, which is how an organization works people, which is managing people's skills and visions. So knowing how to be visionary. And so I would recommend that you would look at all of those areas and they're always, they're not linear. It's not as if you develop self first and then people and then they're cyclical. Right?  So you can be, you know, you can work on all of those things and constantly come back to developing yourself as a leader.

Kathy Mairella:             11:43                You're always developing yourself no matter how experienced you are. So the nominating committee, these NC1 forms are available between now, which is June and November. Usually it's around November 1st they close and then the nominating committee takes those forms. They look at who the possible people are that might be good to be slated for these positions and they actually reach out to these people. They interview people, to figure out who should be slated for this next year's offices. And they come up with a slate and what they decide how many candidates to slate. So usually if it's an officer position, president, vice president, secretary, they try to slate two people because there's one position. And for director there's usually three positions. They try to slate six individuals for those three. So two for each position is the goal. And that's what they would consider a full slate. And sometimes that's a challenge to get a full slate to get people to commit to run and you have to consent to run. They will call you to say, do you consent? They don't just put people's name on a list.

Jenna Kantor:                13:15                So for you, you went through this whole process yourself and several times. Oh my gosh, this is for those who do not know, Kathy, she has the stamina of wonder woman just doing the whole process. So you knew you were going to run. Is there a meeting to teach you about principles or how are you trained for what is to come.

Kathy Mairella:                                     And that's a really great question. So the nominating committee members are mentors or guides for you. They're not your advocates because they remain neutral in the election process. But they will assist you with some resources. But then APTA staff who work in the governance department become your assistants as well with the process. There is a candidate manual that contains much of the information and that's available to anybody. You don't have to wait until you're a candidate.

Kathy Mairella:             14:16                Any member can go on the website and locate the candidate manual and read lots and lots of information about this whole process. And it really describes the nominations process, the candidacy process, and the elections process. So once the nominations process ends, the candidacy process begins and the nominated committee publishes the slate and the slate goes up on the website. And that's when people find out, it's usually early in December. They usually find out these are the people who are on the slate and then the campaigning begins. And as candidates, you are given a question to answer that goes in written form that goes on the website, on your candidate page. You also have to have your CV that gets posted there and that becomes available to the delegates and to the members to look at who are these people.

Kathy Mairella:             15:21                And that's how you get information. The CSM meeting in February is usually the first live appearance of the candidates. When delegates start to pay attention to who are these people who are slated? And so the candidates pick a campaign manager and your campaign manager is the person who helps you. They are your advocate. They are the ones who help you navigate the candidacy and election process.

Jenna Kantor:                                        I love that you guys do that.

Kathy Mairella:                                     Yeah, and I actually I served as a campaign manager last year and I loved it. It was really a lot of fun. I really enjoyed that. So usually you want your campaign manager to somebody who does understand this whole process and who can again be your advocate, you know, let you know if your hair is straight and you know what you know, look at the things that you're writing and give you feedback and be sort of your sounding board when you have questions on strategy and who should I be talking to and here's what I'm hearing and how do you think I should handle it?

Kathy Mairella:             16:38                That's your campaign manager's job. Because they have the job of being your advocates. Do you show up at CSM, you go through the process of contacting people, you know, asking them for your support, putting together your platform. Why are you doing this? Why should somebody vote for you? You have to have a pretty clear picture of why, if you're going to convince people, you know, to vote for you, it's politics. It's absolutely politics. And the thing about elections is that not everybody can win. You have to understand that the delegates vote for a variety of reasons. It's not always personal. If you are not the one who is elected. And there are multiple reasons why delegates will look across the slate at everyone that they're electing. They will be looking at the balance, they'll be looking at geographical balance.

Kathy Mairella:             17:43                They'll be looking at age, they'll be looking at male versus female. So they're looking at all of those things for a mix. Again, because your board is a team of 15.

Jenna Kantor:                                        I would love for you to go into now the day off, so the day off. So, for those who don't know, at the house of delegates, it begins of course with a bunch of meetings, but the real star time where people are coming together for delegates to start voting on things are the interviews for these candidates. So if you wouldn't mind talking about that experience.

Kathy Mairella:                                     Sure. And candidate interviews are identified by potential candidates as being one of the biggest barriers to serving because many members find the idea of doing these candidate interviews to be really intimidating.

Kathy Mairella:             18:42                The candidates at this point get at least one of their questions in advance. So you work on that and get it, you get that one prepared. So I ran this year for the office of Secretary. And so there are 20 minutes allotted for your interview. You get a two minute opening and you get a one minute closing and then the other 17 minutes you are interviewed by delegates to the house. They're divided into four groups. And so you how you do this four times, so you do 20 minutes, four times with a break in between each. And really, the delegates can ask you almost anything. And there's a standardized rotation and about who gets to ask the actual questions. So again, because I've done this a number of times, I actually enjoy the experience. The first time I did it, I found it to be, you know, completely intimidating and scary.

Kathy Mairella:             19:39                Because it's been identified as a barrier, there's been a lot of discussion about how else can delegates get information about candidates besides these interviews. You know, when you’re a board member, you're not necessarily a performer. You know, it's not necessarily about being a good person who answers questions well on your feet, but yet that's how you are being evaluated based on, you know, on these interviews. There's a lot of behind the scenes leadership roles. So this process I think does favor those who interview well for lack of a better term. And again, it scares a lot of people.

Jenna Kantor:                                        I get that. I get that. I was wondering for the last question now. So you've done all these interviews, who you finally get to go eat, drink, try to take a nap cause then you're waiting for the votes. So the votes go through. What's that experience? And so the last question, what's the experience of getting the votes and how it ends?

Kathy Mairella:             20:36                This is a great question. I had to explain it to my husband the other day. So, the actual election takes place in the house of delegates and the delegates use a ARS device for electronic voting. So it is anonymous. And so they vote for each office and then ARS system tabulates the results. As that's happening, the candidates are asked to go with their campaign managers to a special room and you are handed in your hand an envelope with the results. So you get, as a candidate, you get the results before they're publicly known, which is very much a kindness. So you're not like sitting in the house of delegates getting the results at the same time that everyone else is. So you have some privacy around getting the results. You get that envelope, you either stay in the room, you go somewhere else with your campaign manager, and then you open the envelope and there you see the entire slate with the vote tally and how many each candidate and who you know, who is elected and who's not.

Jenna Kantor:                21:57                And for anybody listening of course there can be mixed opinions on how this is run at seeing the tallies, seeing the numbers. I've honestly heard the ying and the Yang version of that, but overall this is the process. So I'm not doing this interview to add on all those opinions. This is just for just that blanket, like this is how the candidacy people running for the APTA. This is how it's run. This is how it works. Of course. Thank you so much Kathy. You just gave all these references for people, for them to look up and find out more details on their own if they really want to see details by details. That's amazing that there's a packet of book you said. The candidate manual. That's amazing. But thank you so much, Kathy, for coming on. This is a pleasure and I cannot wait for people to learn this information though.

Kathy Mairella:                                     I think it's really important that this information is shared. I think it's really important that members and potential members know how their leaders are elected and how they can get involved.


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Aug 29, 2019

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Sneha Gazi and Maria Muto on Physical Therapy International Service. Dr. Sneha Gazi is a physical therapist based in Manhattan who specializes in orthopedics and pelvic health. Sneha’s desire to bring her skills beyond her immediate reach drove her to start PTIS in the hopes of bringing PT services to underserved populations. Dr. Maria Muto is a physical therapist based in Manhattan who specializes in orthopedics.

In this episode, we discuss:

-How Sneha and Maria started Physical Therapy International Service as students

-The logistics around organizing a volunteer event abroad

-Roadblocks Sneha and Maria encountered along the way

-Advice for those interested in following in Sneha and Maria’s footsteps

-And so much more!



#PTIS #PTInternationalService #CerveraDelMaestre #Spain

PT International Service Website



For more information on Sneha:

Dr. Sneha Gazi, DPT earned her Doctorate of Physical Therapy from Columbia University with a focus on orthopedics and pediatrics. She holds a BA in Honors Developmental Psychology from New York University where she completed a Concentration in Dance and published a scientific article on infant motor learning and development.

Dr. Gazi worked at clinical rotations in both outpatient orthopedic practices and acute care hospitals, gaining knowledge on high-level manual therapies and evidence based exercises to help her patients return to the activities they loved. She’s treated pelvic pain in pre/post-partum women, rugby players in New Zealand’s sports training facility and helped many NY’s Broadway and Off-Broadway dancers, actors, vocalists, and instrumentalists to get back on stage.

She combines her knowledge of how to rehabilitate lower back pain, neck pain, TMJ dysfunction, sports and dance injuries along with a compassionate energy. Sneha is also a certified yoga instructor and professional Indian classical dancer. She integrates yoga asanas, breathing techniques, guided mediation, and mindfulness exercises into her treatment sessions to enhance her patient’s recovery process. Sneha has a strong passion for service overseas and pioneered the first ever Physical Therapy International Service trip to Spain with Dr. Maria Muto.


For more information on Maria:

Dr. Maria Muto is a physical therapist based in Manhattan who specializes in orthopedics. Maria received her Doctorate of Physical Therapy at Columbia University where she began to analyze runner's running mechanics. In recent years, Maria has worked with the athletic population as a personal trainer. She hopes in the near future to obtain her certified strength and conditioning specialist certification (CSCS) to practice both training and rehab with high level athletes. As a physical therapist, Maria’s treatment approach is team-based between her and her patients. She believes that getting to know and involve her patients as much as possible within his or her care is the best way to optimize function and maximize movement mechanics for a true recovery. This belief of involving patients within his or her care at this level persuaded Maria to expand herself to this world and discover how to truly connect with others of varying conditions, cultures and fortunes. Maria has now practiced in Italy and Spain. Overall, Maria is excited and eager to continue to learn more about the world and her profession by these experiences.


For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas ( until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website:


Read the full transcript below:

Jenna Kantor:                00:04                Hello. This is Jenna Kantor. I am partnering as a host with healthy, wealthy and smart. And today I get to interview Sneha Gazi and Maria Muto. And they are the creators of physical therapy international service, which is PTIS, where they led the first ever international service trip in Spain, which is incredible. So I'm extremely excited to be interviewing these two. One they're good friends of mine, two their big goal getters. Literally this wasn't any teacher or any mentor telling them to create this service trip. This is something they just found a real hardcore desire to create from scratch. So this podcast is extremely valuable because they are going to be sharing exactly how they did it, maybe a little bit of obstacles, and then hopefully put a fire in your flame if you're considering doing something like this yourself. So the topic for today is very simple. It's just creating a service trip. All right, so first Sneha, would you just mind just saying hello one more time so people can really hear your voice. And Maria, would you do the same? Perfect. Alright, so first question, why did you decide to create a service trip?

Sneha Gazi:                   01:31                So we had multiple reasons to create a service trip, but two of the main reasons were, one, we wanted to provide physical therapy services to a group of people in a different country who didn't have that opportunity already. So we chose a small town in Spain. They have no physical therapy services in that town and the closest medical services they have to travel quite far to obtain even basic medical services. So physical therapy is sort of a luxury treatment for them in that town. And these are also people who work high levels of labor, their agriculture workers, they do a lot of physical demanding work, so they end up having a lot of physical stressors. So, that's one main reason we wanted to provide a service to people who didn't have it. And then the second reason, our main reason to join with two folds.

Sneha Gazi:                   02:23                The second one was to provide an opportunity for students to learn in a different setting. So this provides cultural awareness. This provides an opportunity for students to bring things outside of a classroom setting, even outside of a clinical affiliation setting where they have, you know, very structured environment into sort of the blue and an environment where they won't have a chance to, you know, readily look something up on the Internet, but they have to think on their toes. They have to know how to modify a treatment. They have a licensed physical therapist there to guide them throughout to make sure everything is safe and everything is moving forward very well for the patient to have the patients' interests in mind. But it's to provide these students an opportunity where they're kind of thrown out of their comfort zone.

Jenna Kantor:                03:05                That's excellent. So, okay, you started from scratch. How did you guys fundraise for this trip?

Maria Muto:                 03:14                Yeah, so we had three separate events. These were a happy hour events, that we advertised to people that we knew in the local area to come hang out with us downtown, come out and support this service trip. We had great turnout the first two times. It was so much fun to just gather with these people to help promote this amazing trip. Super supportive. It was a true gift, honestly. So, you know, we hope to continue doing this.

Jenna Kantor:                03:49                That's great. Yeah. Sounds so simple that you guys were just able to create these social nights and you're able to just make money from that. Was it difficult just to follow up a little bit more money? Yeah. So was it difficult putting together these fundraising events or was it rather simple?

Maria Muto:                 04:04                Well, the simple fact that we are housed in Manhattan kind of make it easy because there's so many opportunities to go out and explore the city. So, you know, between Sneha and I, and a third member, we kind of were just thinking about, you know, where do we want to be? Thinking about the audience that we were targeting, like young 20s, let's think about the area and location. So we did our research, we contacted, the coordinators of these local areas that we were interested in and things, you know, led to another. And we were talking about deals and we got really great offers and apparently our audience loved it too. So, it wasn't really that difficult. You just have to kind of reach out and speak to the right person.

Jenna Kantor:                04:50                That's great. I like how you say it. It almost sounds like boom, Bada Bang. It happens.

Maria Muto:                 04:56                New York is a land of opportunities so it is put yourself out there and you never know what you're going to get.

Jenna Kantor:                05:03                Yeah. So we learned right here, moved to New York is a good suggestion. Did you choose a location then for your actual service trip? Sneha you start to go into this a little bit saying all the benefits of Spain, but I'm sure you must have explored other locations as well. So would you mind telling me that journey?

Sneha Gazi:                   05:24                So, I actually had the wonderful opportunity before joining PT school to do a Yoga Shiatsu program where I got my yoga teacher certification in this very town. So the way I found that was I just looked up yoga teacher certifications in Europe because that's where I wanted to do it. And I know a little bit of Spanish. So I knew that that would be a little bit easier for me to mingle in with the folks in the town and have a good time and get to know different cultures. So I chose Spain, I ended up going there, made some amazing connections, you know, the smaller the town, the lovelier the people in a lot of ways. Everyone is so humble in that town. Everyone is so open and warm and you know, willing to let you into their homes and their town in their community, which is already so small to begin with.

Sneha Gazi:                   06:11                So I made some really good friends there and when I was thinking about places, Maria and I were discussing, that was one of our many options. And it also was the one that flew the quickest for us because of that connection that I already had there. So it wasn't easy to do the communication and you know, do the long distance back and forth, emails, thousands of emails, thousands of things to coordinate. But at the end of the day, that was the best route for us to go to because I already had been there before and I had known that it was a safe place. The people were wonderful and I knew that this would benefit both the town in the students and the licensed therapists who are coming along with it to make it a safe working environment and a safe learning environments. And that's why we chose that.

Jenna Kantor:                06:52                Yeah. Yeah. That's great. Oh so good that you knew that it was a safe area to cause I know for people traveling overseas that would be a concern. So having that background with Yoga, by the way, power to you being a physical therapist and knowing yoga. Wow, that's definitely given you a leg up for sure. But being able to have that experience before that, that's great. What a great way, how your life and kind of led you to creating something more in this area that you fell in love with through yoga.

Jenna Kantor:                07:53                So we talked a little bit about fundraising. Now my mind's going to how much would this cost if I was a student now I wanted to participate. How much did it cost for a student to go and be part of this service trip?

Maria Muto:                 08:17                So, because this was the first event, we kind of hope that the next following will be similar into what the expenses were for this one. But you know, as a student, finances can be very difficult. So, you know, trying to keep that within our minds. We calculated a fair of 450 euros, that would be per students. So kind of just thinking of the numbers, we were, you know, that's why we had those three fundraising events to try to cover for those costs. So, you know, we were planning accordingly. We did tell the students, which we have three students with us and two licensed PTs, we did tell them that their airfare would be on them. Because we wouldn't be able to cover that. Hopefully as we grow as an organization, we will be able to, you know, create larger fundraising events and have, you know, even more money to, you know, help us move this opportunity along and help you know, out the students, or whoever's participating more. But for the first time, that was pretty much what we had the students pay. So, you know, we'll see what happens in the future. But, it wasn't really that expensive. When you look at a larger scale of what it actually could potentially be per person.

Sneha Gazi:                   09:46                We have to say what the fundraising money went to. So we have to say that we covered the entire cost for the licensed therapists. 450 euros for two people.

Maria Muto:                 09:56                The 450 was covered like we provided coverage for the PTs and then everything, the airfares and all that stuff was on their own.

Jenna Kantor:                10:17                Selecting students and selecting mentors, I feel like this is almost like a raffle, you know, like who gets it? How did you do this? Was there some sort of like people wrote in letters and mentors. I mean, you were students at this time. So how many professionals did you know at this point to be able to pull in the ideal people to guide you over in Spain?

Sneha Gazi:                   10:40                Yeah, so the licensed PTs who came on this trip, the way we approached that was we emailed, texted, Facebook message called, kind of in any way, a form of communication to every license PT that we knew and our contacts list, and then ask our friends to give us more context. We had many people show interest, but we knew that we were asking a lot from them because they weren't getting paid to go on the trip. All we were able to do was completely cover they're living, food, transportation in Spain, which was the 450 euros that Maria mentioned, but we weren't going to be able to cover their airfare. So what these therapists had to do, and we are forever grateful for you, Patty and Michelle for doing this. They actually took off of work and paid their airfare to come to be a part of this trip.

Sneha Gazi:                   11:32                And the two therapists who came in were the ones who were able to give us a commitment as soon as, and we knew that everybody who we reached out to was a reliable, intelligent and wonderful therapist who we knew would be an amazing form of guidance for the students and for ourselves because we were students while we went on the trip. So we knew whoever came in and whoever signed our contract and said they were on board. And you know, there were many who are very enthusiastic about this. But whoever came in first were those. And then in terms of the students, we reached out to several schools. We did not want this to be a school trip. You know, never really was a school trip. This is an independent project. So we reached out to several schools outside of our own school.

Sneha Gazi:                   12:18                Maria and I go to the same school but reached out to other students to make sure that we get a diverse group of people so we can learn from other schools as well. And we wanted everything to be a sort of from different pockets of the states. So we were able to get three students from three different schools who joined in.  A lot of people sent in their applications and we sort of chose based on, you know, their essay of why they wanted to do it and sort of their background on the classes that they had taken just to make sure that we had a diverse group of people but single minded in terms of what we wanted to accomplish, which was service and learning because it's physical therapy international service trip. So yeah, that's how we chose everyone. And you know, that was initially we thought that this was a struggle but we found very quickly moving forward that that was the least of our worries. It was easy to get those.

Jenna Kantor:                                        Oh that's so good to hear. Cause I mean putting everything together from scratch is already enough on its own. So that's great that that ended up being a smooth journey for you both. Now, what was your biggest obstacle, because I'm sure you've had many obstacles as you were putting this together, but what would you say is your biggest obstacle that you encountered and how did you overcome it?

Maria Muto:                 13:30                I'm really glad that you were asking that question now. Just because the last thing that you said kind of segways into my response in that starting from scratch is pretty difficult. So as students, you know, we're trying to think of who do we know, what do we know, where do you know we want to go and how do we want to do this ourselves? You know, as very ambitious PT students, we really tried to, you know, Gung Ho and take sail what this in which we did. But that wasn't really easy to do because of who we are as just students. And with the experience that we had at that given time, which, you know, was a decent amount of experience and, you know, led us to having this project follow through. But I think, you know, we just had to kind of keep on rolling, keep on thinking, make sure that, you know, we had all of our grounds covered. You know, just having the trust in the people that we selected and which we did. So I think that that was hard to kind of try to really piece everything together. But you know, we just kept on powering through. We just really wanted to make this work and we're so thankful that it did.

Jenna Kantor:                14:52                We're up to the last question and this is just getting words of wisdom from each of you. What words of wisdom do you have for someone who's listening to this and goes, that's it. I want to plan a service trip now. What do you have to say to that person?

Sneha Gazi:                   15:20                So there are many, many things that go into planning this trip. I'm going to tell you that it ends up being sort of a part time job, especially towards when you get to the end of the race, when you're putting everything together. It took over a year and a half of preparation. We had many obstacles along the way like Maria had mentioned, but even through that, it did take quite a bit of time to put everything together. So I would say number one is make sure that you have a contact in the location that you want to do your service in A to make sure that this place is a safe learning environment and a safe working environment. And secondly, to make sure that logistically that you have a point person to get information from, to coordinate the patient's there to coordinate the simple things.

Sneha Gazi:                   16:10                And we had a wonderful lady Alaina, who did all of this for us while we were there and Kudos to her because if it wasn't for her, we wouldn't have been able to do this trip. But she was a local who volunteered her time to put together plints, towels, pillows, sheets, dividers, coordinate the schedule of the patients, get together the schools when we did our educational workshops to coordinate the location, the projector, everything. So I would definitely say you need somebody like that in this location. If you are not yourself able to travel back and forth throughout the year or however long it takes for you to plan it, to get there, you need to have somebody there. And the second thing is to make sure that you know how the money is going to play out from the beginning.

Sneha Gazi:                   16:56                So making sure you're very transparent with how much is food, how much is transportation, and how much is living costs, how much your supplies, and then devise a plan of how you're going to make this feasible. Like Maria and I had planned before we even got the location, we already started fundraising because we knew this was going to be expensive. So we put together the fundraisers, you know, three months before we even nailed the location down. So I would definitely say, make sure that you have a plan financially to get everything together and make sure that the place is a good place to be in and you will do wonders if you just have those two solid.

Maria Muto:                 17:51                So everything that they have said totally feel the exact same way. Wonderful, wonderful advice. But I think when you go abroad into another country, be very accepting and welcoming to the new culture that you're in. Embrace where you are, feel it, feed it, do everything that you can. Because at least from my experience, these people are so welcoming and just want to know about you as a person. They're very intrigued that you're American and there's so many other ways that you communicate with people other than just words. But I would advise for you to study up on the language in which that you're going to be treating in because it makes it a little bit easier. But there are other ways to, you know, understand people if you have that language barrier, but for sure, really tried to, you know, embrace the culture that you're in. And I think that would really make the experience even more fulfilling.

Jenna Kantor:                18:36                That's great. I actually just thought of something, I'm wondering what Spanish phrase did you use the most there?

Maria Muto:                 18:46                Because I was speaking so broken Spanish, like I was actually speaking more Italian. I think I would say like siéntese, por favor. Hola. Or Ciao. Aquí. Dolor.

Sneha Gazi:                   19:05                I think I used boca arriba the most, which is face up. It literally means upwards. Oh yeah. But it means supine. And I had to say, I had to tell people, can you lay flat or lay on your back? And it was very difficult for people to understand this. So one of my patients who spoke broken English was like Boca arriba.

Jenna Kantor:                                        For anyone who was interested in starting a service trip. Please reach out to Sneha and Maria. They are huge Go getters. I really, really appreciate you guys coming on here. This is extremely valuable. Thank you so much.



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Aug 26, 2019

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Evert Verhagen on the show to discuss qualitative research and how the outcomes can be useful for clinical sports practice. Evert Verhagen is a human movement scientist and epidemiologist. He holds a University Research Chair as a full professor at the Department of Public and Occupational Health of the VU University Medical Center and the Amsterdam Movement Science Research Institute. He chairs the department's research theme 'Sports, Lifestyle and Health', is the director of the Amsterdam Collaboration on Health and Safety in Sports (one of the 11 IOC research centers), and co-director of the Amsterdam Institute of Sports Sciences (AISS).


In this episode, we discuss:

-The difference between qualitative and quantitative research

-How qualitative research influences sports medicine and injury prevention research and clinical practice

-How to design a qualitative research study and control for biases

-What is in store for the future of qualitative research in sports medicine

-And so much more!



Evert Verhagen Twitter


Sports Lifestyle and Health Research Website

IOC World Conference Prevention of Injury and Illness in Sport


For more information on Evert:

Evert Verhagen is a human movement scientist and epidemiologist. He holds a University Research Chair as a full professor at the Department of Public and Occupational Health of the VU University Medical Center and the Amsterdam Movement Science Research Institute. He chairs the department's research theme 'Sports, Lifestyle and Health', is the director of the Amsterdam Collaboration on Health and Safety in Sports (one of the 11 IOC research centers), and co-director of the Amsterdam Institute of Sports Sciences (AISS). His research revolves around the prevention of sports and physical activity related injuries; including monitoring, cost-effectiveness and implementation issues. He supervises several (inter-)national PhDs and post-docs on these topics, and has (co-)authored over 200 peer-reviewed publications around these topics.


Read the full transcript below:

Karen Litzy:                   00:00                Hi Evert. Welcome to the podcast. I'm so happy to have you on.

Evert Verhagen:            00:04                Yeah, thank you very much. I'm really happy to be here as well.

Karen Litzy:                   00:08                All right, so today we're going to be talking about qualitative research in mainly sports medicine. But before we even start, can you give the listeners the definitions and perhaps the difference between quantitative research and qualitative research?

Evert Verhagen:            00:30                Sure. I think that is a really valid question to start with. I believe most people are familiar with quantitative research. It is what we do like in the word already, quantification of a problem by counting, by having numerical data or data that we can transform into statistics. And then we can quantify attitudes, opinions, define variables. And we can generalize that across the whole group of our population. So we can generate averages in given populations and we can compare averages between populations. Qualitative research on the other hand, doesn't go by numbers, it's more exploratory. And we try to get an understanding of reasons, opinions, motivations and instead of quantifying a problem. So, giving a number to it, giving a magnitude to it, we get insight into the problem and it helps us to develop new ideas and our policies. And that can be a precursor to do a bigger quantitative study in which you have an idea of where to look and where you would like to quantify and get some more thought. But you can also do it afterwards, where you have a quantifiable outcome and you want to understand better what that outcome actually means and what it means to your population and in the population. I think that is in essence the big difference.

Karen Litzy:                   02:06                Yeah. Thank you for that. And, now you have had over 200 peer reviewed articles in different journals and you yourself had done a lot of quantitative research. So why the shift now for you into more qualitative research?

Evert Verhagen:            02:22                Oh, it's not the first time I get asked that question. I'm a trained quantitative research. I'm an epidemiologist. I'm a human movement scientist. So I kind of live and swear by numbers. If I can't measure it for me, it shouldn't count that many people think. Now, I learned that through the years, if you can count it, it still doesn't mean anything. It still needs to have a meaning. So a difference between two groups in a trial, it just gives you the difference between the groups in a trial. It doesn't tell you how the individuals within that trial actually experienced it. The same with trying to get your head around an injury problems so you can capture an injury problem in incidences in prevalences, in severity, in numbers of days, lost availability during games. But what does it actually mean for the individual athlete?

Evert Verhagen:            03:23                What does it mean for the patient? And the same maybe with treatment outcomes, rehabilitation outcomes. It's nice to know that, you know, you reach a certain degree of range of motion after rehabilitation or reduced level of pain on a visual analog scale. But what is actually the opinion of, of that patient, does that actually align with what you can measure? And if not, where does the different come from? And if you do, it kind of shows you that you’re in the right direction. And over the years I learned that quantitative research can only help so much in solving the bigger issues we have where it concerns, prevention targets for presumed prevention. It stops at your number and then you need to do something with it. And the only way to do something with this, it's to understand where it comes from and also to understand what it means. That's where my interest kind of started.

Karen Litzy:                   04:23                Yeah. And that makes a lot of sense coming from myself from the clinical side of things. And I'll use the VAS scale when you're looking at pain as let's say one of those quantitative points. And I think this is a good example. Looking at the VAS scale, a four or five for me is a very different experience for someone else with the four or five out of 10 pain. Right? And so just looking at that number from quantitative research saying, well, this proves that this treatment, whatever it may be reduced pain by, I don't know, four points on the vas scale. Well, okay, that's great, but then what does that mean for the individual person and that you're just moving it because qualitative someone's opinion. This is an opinion of what my pain is and then we take it to quantitative data, but then it doesn't say how that patient is living with that pain. The pain has decreased, but I still can't walk to the store. I still can't play with my kids. So what does it mean?

Evert Verhagen:            05:27                Exactly. I think that what you just said that is purely qualitative talks about what does it mean, what impact does it have as one little, one little thing I would like to specify is that a VAS scale in essence, which is a subjective outcome measure, is still a quantifiable objective measure. It's not qualitative and that is something I run into every now and then in a discussion where people seem to think that a subjective outcome on a scale or a subjective outcome measure in a survey is qualitative. It is not you have to look behind those measures. So why does someone report a reduction from eight to four on a visual analog scale? That is what we're looking at and you're completely right from eight to four in someone who has a seating job for instance. Mostly behind the computer means something completely different than someone who moves from eight to four who has a really active job and we have four is still really limiting for them.

Evert Verhagen:            06:35                We may go to athletes, for instance, a pain of four today in preseason maybe or at the end of season when there's no big competitions around, I'm okay, I can skip the training, but a pain of four during competition when has a big game coming up? You probably will suck it up. And even though the pain level is the same, your experience and the burden it gives you is completely different. And those are the things we do work capturing in numbers. And those are the things that make the big difference for the individuals we do our research pool and our target population.

Karen Litzy:                   07:14                Yeah. And that actually leads nicely into the next thing I wanted to talk about and that's, how does qualitative research manifest itself in sports medicine or injury prevention?

Evert Verhagen:            07:25                From the research perspective you mean? Or the practical perspective?

Karen Litzy:                   07:28                Let's take research perspective first.

Evert Verhagen:            07:31                On a research perspective, I think it adds a new layer of information to what we already know. And you can think that in multiple ways. It gives you direction to where you would like to go with future research because you understand better your population, you understand their needs, their wishes, their opinions, their fears. You understand, their foci and based on that you can have more targeted either interventions or more targeted outcome measures to chart a problem or to monitor a problem. So it will guide quantitative research in that sense, which I would say is also really interesting in regards to machine learning and the complexity theories that are out there. We can't measure everything but if we get a sense already based on the public, the population where we should focus on it will gives direction to those novel technologies where we do data mining and all that.

Evert Verhagen:            08:38                Also on the other hand, if we do interventions or if we do objective measures of what we try to assess in research, we need to find a way to translate that to the population. Research of course it is about putting it in a nice article and publish it in a high impact journal if at all possible. But in the end, and I'm speaking for myself here, I do research because I want to help people, I do research because I have a general question that I feel is valid to ask in relation to an issue or problem I see in athletes. So I want that number to come for athletes as well. And in order to do so, I need to talk to them and get their opinions about how they feel about this number, how they feel they can use it, how they feel they may not be able to use it.

Evert Verhagen:            09:38                And based on that I can develop my next steps and I understand better what I did right, what I did wrong. I understand better what it means actually because I have my own opinion. And that's why I think qualitative and quantitative are synergetic to each other. Let me give you a clear example, which may be a bridge also to more the practical side of it. Maybe that's injury definition. If I ask athletes or students and fellow researchers how they would define an injury. Usually they come with the technical definitions. We also have in our manuscripts, like it is tissue damage. It leads to pain. That pain may lead to a diminished performance, maybe a limited availability, which is all fine. And if you ask athletes like, when are you injured? The elite athletes will say, well, pain is actually part of the game.

Evert Verhagen:            10:34                I always have pain. I'm used to that and I know how to deal with that. And I will not think this pain is a problem unless my performance is limited, which is already a little bit of a different injury definition. So the problems we see and we have in terms of pain and availability may not even be the problems they perceive to be problems. So we solving maybe something they don't even see to be an issue. Now if you translate the same thing to maybe recreational athletes or novus athletes, people who sit on the couch and say, okay, let's be a bit more active. They're not used to pain, they're not used to how their body reacts to physical activity. So we think they have more injuries, but maybe their perception of injuries is simply different from the perception of injuries we see in most of the papers we read. And I think there's a clear clinical message there is that, perspective, context, experience of the patients you have in front of you determines their perception of the issue they have. But it also determines for you as a clinician what you need to do and how you need to approach that. Because the numbers you see in the quantifiable manuscript that's all based on averages and not on that one single person in front you. And this is where qualitative research can help a lot to understand that.

Karen Litzy:                   11:59                Yeah, and that makes a lot of sense to me. And as a clinician, I think sometimes we can get caught up in the quantitative data and those numbers and lose sight of the person in front of us. Meaning sometimes we may say, and I see this on social media threads and things like that, which I'm sure you've seen as well. Well this is the study and this is what the study says. This is what you should be doing with your patient. Yeah. Well, there are a lot of nuances to that because like you said, you're talking about averages and not the person in front of you. And, I love the example you gave. What is an injury and what does that mean to different stakeholders within, let's say, injury prevention realm if we will. So the athlete versus the average person versus the clinician?

Karen Litzy:                   12:56                Well we have three different definitions of what an injury is. So how can we fill those gaps to be a little bit closer? I mean I can say, let's say I'm the average person who's working out. I know I am not anywhere near a professional athlete, but the problem is, and you alluded to it a little bit, is that when people have an injury, they read about an athlete that has an injury and they say, well, this athlete had the injury and they were back at their sport in four weeks. How come I have to wait four months? And I think that's a big disconnect. And maybe that's where getting some better qualitative research and around these definitions can actually help with the perception of what an injury is across the board.

Evert Verhagen:            13:49                Yeah, it's sort of framing but it's framing from both sides. It's framing for the patient so you can even better, why it takes for them four months instead of four weeks. Right. And usually in all honesty, by the time a professional athlete is already back training again, a recreational athlete maybe hasn't even seen a therapist. How then can you take a protocol or a guideline based on evidence that shows that on average after four to six weeks you need to be at a certain stage in the rehabilitation phase where that one single person in front of you as already been looking three weeks for a proper therapist to treat the injury and then they come in and they've seen this evidence like you said, but then you would like to know a bit better where they come from, what their context is and what they need to do, which is not shown in evidence is also not what the patient thinks about.

Evert Verhagen:            14:55                So having some knowledge about such perceptions and where they come from and what they mean I think can really help to support you in your clinical practice to use the evidence to a better extent. You know, in some of the issues we have in objective quantifiable research also apply here. I would say there is, for instance the discussion started a couple of years ago about we should screen or not to predicting injury actually to see if someone's at an increased risk. And one of the main arguments in there is, well basically what we're doing is we create two normal distributions and normal distribution is the Garcian curve where we think most of the population is in the middle and we have a few outliers and that is nicely distributed. So we have a normal population with our risk factor and a normal population without a risk factor. And if you know, the averages don't overlap too much, then Oh, we have a significant difference. But that negates the outliers on the top side and on the bottom side of both. And then you talk about an average, but there's even an equal amount of people who are in that overlapping phase that we still give the average treatment. And if we understand better why these people are on the outskirts and why are they in a position, we can actually make that evidence for them work. Because we can model it to their specific situation.

Karen Litzy:                   16:31                Got It. So that qualitative research, like you said, can help to guide quantitative research, which can then help to guide actual treatment practices for the average clinician. In a very simplified, overly simplified nutshell. So yeah, very, very, very oversimplified of nutshell there. Can you give us an example of what a qualitative research project may look like? Can you give an example of what that looks like in it's sort of set up phase and then throughout the project.

Evert Verhagen:            17:19                Okay. Well in essence, it looks a little bit simpler because for quantitative researching in big groups of people, because of those averages for qualitative research, you need smaller groups. One issue though is in case of how our specific needs, we would like to have groups that are quite specific. So if we have a group of elite athletes combined to recreational athletes and we want know perceptions about injury, like we were already talking about. That doesn't work because we get too many deviating perceptions in there. So you need to, you need to frame your research question correctly there. And the essence here is that you start doing your interviews until you reached so called saturation. So you do interviews, you get answers, and your next interview will give you a deeper understanding. You get different answers, you get more answers, you can ask a bit further.

Evert Verhagen:            18:18                But at a certain point of time, you start hearing the same thing. So you don't add any new information. That's when you're done. And now, depending on your group or your specific focus, that can happen between eight to 15 interviews. So in that sense, it sounds really easy. Then what do you need to do is you need to type those interviews out. So you need to transcribe them. And then the analysis start. And for most people, this is boring, but this is actually where for qualitative researchers me as I'm a changed person. I like that too, because you start to go, so you start to read through the interviews and you start to look for clues of what people say and what it might mean. Now as we need statistics, there are several philosophies you can follow. The different philosophies make a big difference. The same as in qualitative research, but that on the side.

Karen Litzy:                   19:21                So you go through this series of interview questions and you keep narrowing those questions down until you reach a saturation point and then you can start the analysis. And so then my next question was what set of statistics do you use to analyze qualitative research? And this might be a stupid question.

Evert Verhagen:            19:44                No, no, no, no, no. We don't use statistics. And that's not a stupid question because, you know, there's very few ways in qualitative research and arguably the most simple way to go is this so-called thematic analysis. So you do your analysis and you start to find themes in the interviews by coding. So you have overarching themes and within these overarching themes, you find sub themes, and you just report those themes. And that is really interesting because, for instance, if you're looking for barriers towards implementation of an injury prevention measure, you can say, okay, these are named barriers and these barriers can be categorized as time as  disinterest or as non belief in the effectiveness. And then within those main categories you can have sub categories of where that comes from. That's I would say one of the simplest versions of how we can use qualitative research.

Evert Verhagen:            20:46                Or you can also make it more intricate. You can build models, you can validate models. And for each of those research questions you have, you require a little bit of a different approach thematic analysis is easy. You just sit down, you have just semi structured interview, you ask people, about opinion, about a certain topic, they give you an answer and then basically you say, okay, can you give me an example of that? Can you explain that a little bit further than what you already know, the topics you're interested in. So you want to talk about barriers or facilitators so you can focus on that. You can also go open minded where you say, okay, I just want to know how elite athletes perceive an injury. So you need a different kind of approach of first you need, you would like to make them feel comfortable that they can talk about it, that it's a safe environment.

Evert Verhagen:            21:42                You would like to ask them about their previous injuries. So you get a sense of which of those had a high impact. Then you can dive a little bit deeper into, so what did it mean for you? How did you feel, what were the consequences of it personally, how did you recover? Did it take longer or shorter than expected? So you kind of, you kind of follow a story and that story unfolds itself. And if you do it really open, then you can do one interview. It gives you a direction and your thoughts and based on that direction in your thoughts, you look for your next participant and you continue where you were with your previous and then a bigger story unfolds. And that takes a bit more time because you do it by interview. But it's a lot more deep and rich information. But it all starts with the research question I would say. And it's different types of research questions that we have in quantitative research. It's not to compare this to compare that, it's not how big is this problem, but it's really diving into beliefs. It's diving into opinion, diving into reasons. And that can be because of something you did, but that can also be to understand better what's going on in the minds of people.

Karen Litzy:                   23:17                As the interviewer within these studies, how do you control for that interviewers biases? So you know, the leading question. So let's say you're doing this long form where you interview someone, you get really in depth, they give you their answers, you go onto the next person. How do you not then guide that next person to kind of be like what the first person said and then the third person, like the first and second person. So how do you control for like leading as an interviewer you can lead the direction of that interview really in any way you want.

Evert Verhagen:            23:52                Exactly. But isn't that the same in quantitative research? The way you're framing the question, you can already guide people towards answering questions. A really good example I encountered like last year in a project where the premise was that, there was a funding scheme and the premise was that projects that were driven by questions from practice would have a preference. So they asked in a particular sport and a particular association, two older members. Do you think injury prevention is important? That was the first question in a survey. Of course, everybody says yes. Then the second question was if you think it is important, do you feel that an app on an iPhone would be helpful? Yes or no? Of course. Many people say yes. So their conclusion was okay, 80% wants injury prevention and 80% want that in an app on an iPhone.

Evert Verhagen:            24:51                So we should have a lot of money to develop such an app was well a disaster. Because they finally developed it and they kind of scoped already with the public what they had of an idea. Instead of really have something driven by the audience. And so I think by in that sense, it's not only applicable to qualitative research. Subjectivity maybe is because you as an interview, have an understanding most of the time on what the topic you're interested in. And that's why in qualitative research. You also see a little paragraph on reflection where the interviewer or the authors explain what their background is, where they come from. And of course it's really hard to take that out of the interviews. It's practice and it takes a lot of self control. You can tell you that and it's not always possible. So that's why you need to be frank upfront that you are a physical therapist and that you ask questions about physical therapy guidance or physical therapy conduct.

Evert Verhagen:            25:58                And of course you have an opinion about them. And also of course it is the connection between interview or an interviewee that is important. If you interview someone who thinks you are a prick, you will not get much, much out of it. But if you have a good connection with someone and you really are empathetic, then they will open up. But that requires experience I would say. We do have some tricks in the analysis to reduce that. Two main tricks that may be of interest to say is we call that triangulation where you're not only interview patients but you also interview other stakeholders on similar topics and tried to find connections and similarities between answers. Because if three people from different perspectives say the same thing, that must be something that really counts, right? So it's not one thing and it's not just one person interpreting. That's one. And the other one is you can do is multiple coders. So you have one interviewer and you need to code the interviews. But you can do that with two people separately. Much like we do with systematic reviews where you check for the quality of papers. We have two independent reviews and then we compare notes. We can do the same here too. So you take a bit of that subjectivity out and that preoccupation out.

Karen Litzy:                   27:21                Yeah. Great. Thank you for that. And now where do you see the future of qualitative research moving?

Evert Verhagen:            27:29                Hmm, that's an interesting one. For how a specific field I would say it as a lot of ground we have to cover. We're getting there. There's a lot of interest in it at the moment. There is more and more papers being published at the moment. One of the, not issues, but one of the fears I have is that most of these papers still get published in not the mainstream sports medicine literature that is being read by the clinicians even though the messages are supposed to be targeted to the clinicians or the therapists. So we need to find ways to grasp that clinical message in such a way that it doesn't become this lengthy qualitative research paper and it will become a succinct, easy to read paper with a clinical message though with a constructive, strong methodology. We've been battling with that for a couple of years now I would say. And, I just got the word this morning from one of our PhDs that she got a full qualitative study accepted in British journal of sports medicine. That's nice because that was a journal that said one and a half, two years ago. We're not interested in qualitative research. I think that whole movement is gaining ground and we're finding ways to communicate our messages that it really is helpful for clinicians and it's readable by those journals, which I think are a few big steps we have taken.

Karen Litzy:                   29:13                Yeah, I would say they're very huge steps because if the research is there but no one's reading it and no one's talking about it, where is it going? It doesn't make the research any less meaningful, but it doesn't make it applicable if no one's reading it cause no one can apply it to their populations.

Evert Verhagen:            29:33                Hmm. But you know, the true theory is it's still quite difficult because if you want to write a manuscript that has the full qualitative methods and traditional version of the outcomes, in my opinion and probably people will be mad when I say that, it's kind of dry to read. It's not really interesting to read. So if you juice that a little bit so it becomes interesting and more concise and easy to digest for the more clinical oriented reader you lose a lot of information that for qualitative reader is required to assess the validity and the reliability of what you did. So we're kind of in the middle. We need to have suppression of information in there, in such a paper for the knowing reader that we did right. But it also need to be dumbed down to such an extent that for the unknowing reader, it's understandable and they see the method and understand the clinical meaningfulness of the message. And that is still a bit finding the balance. And I think that is one of the main challenges to do.

Karen Litzy:                   30:51                I will say that as the clinician, I very much appreciate your trying to kind of find that sweet spot between the dryness of what may be some people would think qualitative research write up would be to this applicable like you said, more juiced up version that a clinician can take and digest very easily. I think there is a space for that for sure. And I look forward to I guess more progress on that end. So it sounds like you're getting there but that there is maybe more work to be done, but I am sure there's always more work to be done, but you know, I think if you can find a way to blend those and make it digestible and allow clinicians to take this information very readily to their patient populations, then in the end, like you said, you got into research to help people. Clinicians are there to help people. So in the end it's hopefully this blending of research and clinical care that's there for one reason and to benefit the person in front of us.

Evert Verhagen:            32:14                I believe so, yeah. I believe we can achieve that. I don't think we are there yet still finding a direction. But in all honesty, if you look at most journals 10, 15 years ago, even quantitative research, it was sort of dry, straightforward academic language as well. And we have made big grounds there and I think we can draw on those experiences and that expertise that has been created there. And our field of sports medicine has been in the forefront, I would say. There are some journals who really, really do that really well. And it has helped us to get this topic on the attention. One other sign that is gaining the attention I feel it deserves is for the last two additions we tried to get it on the program of the IOC prevention conference and this year for the first time we got a dedicated symposium on qualitative research in sports injury prevention on the program. So that already shows that in the wealth of proposals they can choose from ours stood out and the topic is found interesting at such a platform. So it's now up for us to grab this opportunity and make it count.

Karen Litzy:                   33:41                Yes, it's up to you to deliver on in that focus symposium. And just so people listening we will have a link to this, but that's the IOC, the International Olympic Committees Injury Prevention Conference, which is march of 2020 in Monaco. I don't have the exact dates, but I know it's march. I think it's like the 14th and around there. Maybe. I'm not a hundred percent sure. I think it's around there. But we'll have a link to it in the show notes at if people want to check that out as well. So now if you could leave the listeners with let's say a highlight of the talk or a highlight in your opinion of the importance of qualitative research, what would that be?

Evert Verhagen:            34:33                My highlight would be that qualitative research gives deeper understanding and deeper meaning to the quantitative evidence we have to use in daily practice.

Karen Litzy:                   34:47                Perfect. And one more question. I probably should have told you this ahead of time, but I forgot. So I'm going to surprise you with it, but it’s the question I ask everyone, and that is knowing where you are now in your life and in your career, what advice would you give to yourself, let's say straight out of your graduate program, let's do that. So maybe even before PhDs happened. So what advice would you give to yourself?

Evert Verhagen:            35:22                I would give the advice to just follow your heart and follow wherever your thoughts lead you, don't plan ahead.

Karen Litzy:                   35:36                That is great advice and so difficult to do. I'm a planner. That is so hard to do, but I agree it's great advice.

Evert Verhagen:            35:46                I plan next week but I don't plan two years ahead. So it hasn't disappointed me.

Karen Litzy:                   35:53                It's worked well. That's excellent. Well thank you so much for coming on. Where can people find you if they have extra questions?

Evert Verhagen:            36:05                I'm sure you will share my email address.

Karen Litzy:                   36:08                I can if you want, or social media.

Evert Verhagen:            36:15                Twitter account, just drop me a line there or private message.

Karen Litzy:                   36:19                Perfect.

Evert Verhagen:            36:20                I have a website we should probably post as well. And most of the work we do also in qualitative research will be posted there once it's published.

Karen Litzy:                   36:32                Perfect. Perfect. So we will have all of those links for all the listeners. So thank you so much for coming on and sharing all this great information with us. I really appreciate it. And everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.


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Aug 19, 2019

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Brenda Walding on the show to discuss Whole-Hearted Living. Dr. Brenda Walding is a Women’s Holistic Wellness Expert & Coach, Doctor of Physical Therapy, Functional Diagnostic Nutrition Practitioner and HeartMath certified coach. Brenda specializes in supporting women health/wellness professionals in overcoming burnout and health challenges in order to truly thrive and give their gifts to the world.

In this episode, we discuss:

-Brenda’s incredible story of illness and recovery

-The 9 Essentials to Whole-Hearted Healing

-The importance of the biopsychosocial model in healthcare

-And so much more!



Sick of Being Sick: The Woman's Holistic Guide to Conquering Chronic Illness

Brenda Walding Website and a Free Gift: Dr. Walding is offering a complimentary 45-minute consult for any woman dealing with burnout or health challenges that has a deep desire to THRIVE. Schedule your consult and see how she may be able to support you in creating a life you love.

Brenda Walding Instagram

Brenda Walding Facebook


Heart Math Website

Women in Physical Therapy Summit 2019

Outcomes Summit: use the discount code LITZY

For more information on Brenda:

Dr. Brenda Walding is a Women’s Holistic Wellness Expert & Coach, Doctor of Physical Therapy, Functional Diagnostic Nutrition Practitioner and HeartMath certified coach. Brenda specializes in supporting women health/wellness professionals in overcoming burnout and health challenges in order to truly thrive and give their gifts to the world.

She currently resides outside of Austin, Texas on the beautiful Lake Travis with her husband and dog. Brenda loves spending time in nature, connecting with her family and friends, dancing, facilitating women's circles, and learning about holistic wellness.


Read the full transcript below:

Karen Litzy:                   00:01                Hey Brenda, welcome to the podcast. I'm happy to have you on.

Brenda Walding:           00:06                Oh, thank you so much for having me, Karen. I'm excited to be here today.

Karen Litzy:                   00:11                And like I said in the intro you are a recently published author of the book sick of being sick, the women's holistic guide to conquering chronic illness. So without giving away the entire book, can you give the listeners a little bit more about your background and your story of illness and where you are and how that led you to where you are today?

Brenda Walding:           00:36                Yeah, sure. I'd love to. You know, it's really, I'll give you do my best to give you the cliff notes. It's spans the time period of over a decade. So really I grew up seemingly really healthy and vibrant. I was a collegiate athlete. I played soccer at TCU in Fort Worth. And then I went on to physical therapy school to get my doctorate in physical therapy. And then after that moved to Austin, Texas with my now husband. And during that time we passed our licensure exam, got new jobs, moved to a new city, got engaged, got married, and then after this whirlwind of all these major life events, my health started to rapidly decline. And you know, I was in a busy physical therapy practice and seeing a lot of patients, and you know, all of a sudden I'm just getting weaker and more tired and getting sick more frequently.

Brenda Walding:           01:35                And then it got to where I could hardly even get up and down the stairs. I was experiencing chronic fatigue and experiencing, I broke out into these rashes that literally covered my entire body for two and a half years. No one could really figure out what was going on and I just kept getting more and more sick and I was seeing specialists all over trying to figure out what was wrong with me at this time I didn't really know much about natural health nutrition, holistic wellness. I was just kind of in the conventional medical model, taking the steroids and the pills and you know, my blood work had come back pretty normal, so they couldn't really figure out what was wrong. But literally I had oozy itchy rashes, like covering my entire body where I had to pack my body full of ice in the evening to fall asleep and eventually developed in a systemic infection that led me to going on disability from my job as a physical therapist.

Brenda Walding:           02:40                And granted, this is, you know, I am in my late twenties, not even 30 yet, so very young. And you know, I got to the point where I thought like doctors kept giving me antibiotics and they were worried that the infection would get into my bloodstream and I thought I was dying. I was really, really at that point of like, okay, I think this is it. And by the grace of God, I had, I took four rounds of antibiotics and a month and a half, kept being sectioned, kept coming back, had pus all in my mouth and throat, couldn't swallow, couldn't hardly eat. So this was a pretty intense experience. And I found this article I was looking, researching and found this article called natural solutions to drug resistant infections. And it caught my eye and I thought maybe I have a drug resistant infection. And it talked about wild Mediterranean, Oregano oil and how it was, you know, healing people with malaria and different, you know, chronic.

Brenda Walding:           03:45                Very, very severe illnesses. So I thought I would try it. It's like $20 and I know bought it online and in, within a few days the infection went away. And for the first time in years I got some relief from the pain and itching on my skin. And so that really was the portal to opening me up to natural healing. And I thought, what is it? What do I not know? What else do I not know, you know, about this? And so that really became this entry point into studying natural healing and nutrition. And I started seeing more alternative and holistic type practitioners. And that over time started to gradually heal. I started to get some answers. I was full of toxins. Had lots of infections and a poor ability to really clear toxins from my system. So I started to get more answers, started to change my diet, slow down my life a little bit, you know, as that type a over achieving, you know, hardcore athlete and academic.

Brenda Walding:           04:54                And I realized that also was part of the puzzle here ever learning to slow down and then, you know, so for eight years I really focused on healing my body. Like it was a full time job. I was able to go back to physical therapy after a while and start working again. But it really opened up my passion into natural healing and started a nutrition lifestyle company with my husband and helping people heal their bodies through nutrition and lifestyle changes. And you know, it was a slow and gradual process and I started, you know, getting better gradually and then almost to the point where I felt okay, I think I'm almost ready to, you know, start a family. I had a few lingering symptoms but I was like, you know, I'm doing pretty well. Got my strength back. This is eight years later. And then I was diagnosed with breast cancer.

Brenda Walding:           05:51                And so this was a few years ago. So this was like, what am I missing? What am I not getting? Cause I was really, you know, dialed in my diet lifestyle. I started meditating. I was really, you know, spent hundreds of thousands of dollars on healers and treatments, natural remedies. You couldn't find somebody more committed to their healing. And it was like a full time job. And I wasn't really living, I was just trying to get better and feel better. And then the cancer diagnosis came and so I had to step back and go, what am I not getting? And I really, you know, I share this in my book. I had to step back and I was in, this is actually, I found the mass in my breasts right before this, we had planned this epic trip to Italy where we were going to start our family.

Brenda Walding:           06:50                So it was this tragic, you know, oh my gosh, you know, why is this happening to me? And then, yeah. And so, you know, in the middle of the night at 3:00 AM I'm, you know, tears coming down my face going like, God, what do you want me to do? Because I knew that conventional chemotherapy and radiation was not going to be my path. I just didn't know what I was going to do. And you know, I heard this, I call it the divine whisper that said, if you're going to survive, you're going to have to learn to listen to your heart. And I just felt this immediate peace. And then I started to kind of panic because I thought, I don't know how to do that. I really don't know how. I don't know, like maybe like so many of the listeners and people and my clients that I work with, we're really stuck in our heads so much of the time.

Brenda Walding:           07:42                And, you know, my immediate reaction to a challenge would be to research it, to try to figure it out, to strategize. And this was like, no, no, Brenda, it's time for you to really go within and listen and allow your heart to guide you. And, so I knew there was a level of emotional and spiritual, you know, healing too that needed to take place. And so I committed at that point to learn to listen to my heart. And over the next few years I had a pretty interesting and incredible journey through healing, holistically and wholeheartedly I should say from cancer. And it really became the catalyst for me to live in even more extraordinary life. Now I can say that I can access joy and just living a life of purpose and wholeheartedness that I'd never experienced before cancer. And so now that's really why I'm, you know, I kinda quit physical therapy and I'm focusing on helping women, especially women, wellness professionals, to truly heal and thrive so that they can give their gifts fully to the world. So that's kind of my story in a nutshell.

Karen Litzy:                   08:56                And are you now cancer free?

Brenda Walding:           09:01                Yes. So I'm doing great. And yeah I'm doing awesome. And that's really where my focus is now, is helping women to heal and thrive and connect more fully to their hearts.

Karen Litzy:                   09:15                And quick question on, you know, so you're diagnosed with cancer, you did not do traditional cancer treatments.

Brenda Walding:           09:24                I did sort of a mix. I didn't do traditional chemotherapy and radiation, but I did do surgery. So I went to a couple of different clinics in the United States that focus on holistic and alternative cancer treatments. And so I did. It was a pretty wild ride. So we spent our entire life savings and did this treatment but then I also had a mastectomy.

Karen Litzy:                   09:56                Okay. I guess sort of a combination. Yeah. Cause I just don't want to give the listeners the impression that you don't have to go through traditional medicine when you have a very serious diagnosis as cancer and that, you know, sometimes that is the route that one needs to take. And like you said, combining it with other holistic treatments I think is perfectly reasonable. But I don't want people to think that we're saying no shun traditional treatments.

Brenda Walding:           10:27                Exactly. And you know, for me, this is what I do. What I do know to be true is that, you know, a decision made out of fear is never the highest best choice. So when I work with women, where you're working with people on their healing journey is like learning how to really access the heart to be able to tune in to that guidance to make decisions. So yes, you get the tests and get the information from doctors and healers and then trust your own heart to lead and guide you down that path. And that might look like conventional therapy for some people and that might look like alternative therapy for others. And that might look like a combination. So it's really, you know, definitely not shunning conventional medicine. But I knew for me in my heart that in this particular moment, you know, chemotherapy and radiation wasn't going to be my choice, that I was going to do a combination. And it really does differ for each person. And that's the thing is, you know, oftentimes we get scared into, you know, doing things because someone else tells us that we have to do this and we have to do that. And you know, my recommendation is to take the information but also really listen within and let your heart guide your journey as well.

Karen Litzy:                   11:42                Right. Yeah. Yeah. And I think in combination with your physicians and other practitioners that you're working with as well.

Brenda Walding:           11:53                Yes. It's important to have an amazing support team.

Karen Litzy:                   11:54                Yeah, I just don't want people to think that we're saying, no, don't, don't listen to your doctors, because that would be really irresponsible. But yes, you have to, and it's like what we say within physical therapy as well as you as the practitioner and wanting to give the patient all the available information and guidance that you have and then along with the patient, you make those decisions on what is best. And I think that that is what every healthcare practitioner strives to do and strives to educate patients as best as they can. Give them the knowledge, give them the odds, give them pros and cons and then along with the patient and their support team and physicians and nurses and whoever else you have working with you kind of make that decision on what is best for you. And, those decisions aren't always easy.

Brenda Walding:           13:01                No. Yeah. And Yeah, work with people, you know, work with people on your support team that you feel good about. That you feel supports you fully and is in alignment with your values. You know, I definitely navigating this path, you know, I definitely had practitioners that, you know, were trying to force me into something or I just had a gut feeling that didn't feel good. And so to really follow that and find, you know, doctors that are really on board with you and are listening to what you desires are. Because they exist, they exist for sure.

Karen Litzy:                   13:31                Yes, of course. Of course. Okay. So you've obviously gone through a lot, over a full decade plus it sounds like, of your life. So let's talk about kind of what you're doing now and how you're helping other, like you said, mainly women kind of navigate through a healing process.

Brenda Walding:           14:00                Yeah. So like Karen mentioned earlier, that I felt really called to write a book. And so this book really is my love letter to all women and it's applicable to men as well. But you know, it's really all the information I wish I would have had 10 years ago to really truly to heal and to really thrive. Cause it's, I spent eight years really focusing on the physical aspect of healing. And I think that's where we're naturally inclined to as sort of these physical beings is that we're like, okay, nutrition, lifestyle, medication, you know, the various things, focusing on our physical body. But, what I've come to find out that, you know, really looking at ourself holistically, taking into account our mental and emotional and spiritual bodies, so to speak and healing on those levels are equally as important as the physical.

Brenda Walding:           15:00                And then this sort of heart centered approach of really learning to get out of the head and allowing the heart to lead. So that is where I call it, like this whole hearted healing or this whole hearted living approach. And so that's what I share in my book along with my story. And, I did research on, you know, what, who are these men and women that were not only healing from catastrophic illness but that were really thriving and using that illness as an opportunity to create an even more extraordinary life and what did they all have in common? And so that's really how I, you know, navigated my journey. And also, you know, taking that research into consideration really came up with these nine wholehearted healing essentials. And I share that in my book. And that's really sort of the framework I use when I work one on one coaching with women.

Brenda Walding:           15:55                And then I also do, you know, create a curated experiences, a women's circles and workshops and things to help women to have an experience of some of these things. So that's kind of what I'm up to now.

Karen Litzy:                                           And can you share with us what your wholehearted healing 9 essentials are?

Brenda Walding:                                   Yeah, I'd love to. So the first one is taking responsibility for your health and your life. And that really, it just, it kinda comes down to so many of us, we kind of rely on other people, maybe it's even relying on a doctor or relying on, you know, other people to tell us what to do or to have authority over our life and our health. And this really is just taking your life and your health in your own hands, stepping away from that victim mentality and really taking ownership of everything that's ever happened in your life and taking responsibility for you right now so that you can be in the driver's seat of your life and what happens moving forward.

Brenda Walding:           17:06                And so the number two is creating a vision. And this is really, I have a mentor that I said, it's better to be pulled by your vision than pushed by your problems. And so there's a lot of research that has come out in the realm of quantum physics and the power of imagination of using our mind and elevated emotional states to actually change to affect us on the level of our DNA. And so I really got fascinated with the work of, you know, like Dr Joe Dispenza and Greg Braden, and really tapping and honing in the power of imagination and vision when it comes to healing. So that is something I really work with, with people to do is like what is it that we want to create and when we tune into that and imagine and tap into that elevated emotional state, that really helps to begin to pull that event towards us, whether that's healing or creating more of what we want in our life.

Brenda Walding:           18:12                And number three is thoughts and beliefs. So just learning to manage our mind and harness the power of our thinking mind to create healing and really looking at beliefs because our beliefs are our underlying beliefs can be something that is really in alignment with our vision and what we want to create. Or it can be subtly sabotaging if we don't really believe we're worthy of healing or we have beliefs that are contrary to what it is that we really want. So that's a piece I think often a lot of people overlook. And number three is feel your feelings. And so that is sort of tapping into that emotional part of healing, which I feel like there's a lot of energy that we deplete in waste because we are dealing with a low to moderate level of anxiety and stress a lot of the times.

Brenda Walding:           19:12                And that has a really huge impact on our physiology. So there's that whole element, it can dive into that more. But that's number four. Number five is nutrition. So really looking at what we're putting into our bodies, the quality of food, but not just what we eat, but how well we're able to digest and absorb and assimilate that food. Number six is live to thrive. And so in this essential, I really dive into lifestyle factors. So this is where exercise and movement and connecting with nature and getting sunshine and play and you know, these different how we go about living our life on a day to day. And then the next one is connection and relationships. So really looking at the quality of our relationships and, you know, found that in our relationships.

Brenda Walding:           20:17                That's where a lot of people can experience a lot of emotional drain. And we know that how our emotional state, you know, negative quote unquote depleting emotions affect our physiology. So really looking at the quality of our relationships and this piece around authentic connection. And I love this topic because this was actually a huge blind spot for me in my own life, is really learning what true connection really was, which is, you know, the ability to be, this sense of being, feeling connected energetically and being able to be seen, heard and valued and deriving strength and sustenance from the relationship. And, you know, there's so much research on the impact of chronic loneliness, you know, we're so disconnected. We're connected very much with technology, but there's so much loneliness. I think it was one study was talking about how chronic loneliness is equivalent to smoking, like several cigarettes a day.

Brenda Walding:           21:25                And the impact that has over time on our body of not being connected with one another in a deep and meaningful way. So that is a really incredible piece to look at. And then we have self love and self care, so love yourself and that really can encompass a lot of different things and can be an even bigger conversation. But really I found underneath it all is really healing and thriving is about all about truly falling in love with who you are and loving your life. And how does one do that? And then finally trust and surrender. So I found that, you know, of all the people that I researched, they all spoke about elements of really having this higher power that they were trusting, trusting, you know, source God, trusting within themselves, you know, and surrendering the outcome really learning to trust and as a power bigger and greater than them to guide them on their path. And so that is the last one is learning to trust and surrender.

Karen Litzy:                   22:36                I mean, that's a lot.

Brenda Walding:           22:38                Yeah!

Karen Litzy:                   22:40                That's a lot. But if you think about it and break those down, that's as human beings kind of what we need. So it seems like, oh my gosh, this is so daunting. This is so much work. This is going to be work. But if you take each one individually and break them down, I mean, it's pretty simple. It's what we all need to be happy and healthy and live our lives. So I get it. I'm on board.

Brenda Walding:           23:04                Yeah, exactly. And you know, like I said, they intention really was to create this holistic healing living roadmap. So it's like these are, I wanted to like, I've got this, all of this information downloaded and experienced in my life over the decade and I got the little bits of information here. Oh, you need to learn about nutrition. Oh, okay, great. I will focus on that for many years. Oh, okay. I need to understand how my emotions impact my health. Okay. You know? And so I got these little, these, this information and different from different books or different teachers. Then I realized like, oh, really, it's really about it. All of these things. And they're all important to really living your best and most full life. And it takes all of those things to some capacity to really, really live and thrive. And it doesn't, you know, like you said, you know, you don't dive in and try to do them all at once, right, yeah, you focus on one thing and you began to implement that.

Brenda Walding:           24:08                And that's why coaching is really amazing. It's like I had so many coaches and mentors and teachers that helped me begin to integrate all of these pieces. And so it's helpful too. Yes, my book is a good resource, but it's also helpful to have, you know, someone that can see your blind spots and can see, oh, hey, you know, let's dive into, you know, there's this emotional piece that you have held on to all these emotions from the past and that's taking up a lot of energy and negatively affecting your body. But I didn't really see that. And so let's work through that together. So there's a lot of things that can be helped when you have someone to help you move through some of these things together.

Karen Litzy:                   24:52                Sure. And how has your training as a physical therapist, how does that play into the role that you're doing now with coaching? Because I know there are a lot of physical therapists who might be looking for nonclinical roles or nontraditional roles. So how has your training helped prepare you for what you're doing now?

Brenda Walding:           25:09                How has my physical therapy training help me in what I’m doing now? Well, I think, well, and you know, I actually had the really beautiful experience recently of going back and doing some physical therapy part time. And so I've been able to kind of go from both directions. See the difference, how my training up until this point with all of this work has made me and even different, physical therapists how I interact. So from that perspective, I can, and I think there's a lot of value for physical therapists and any healers or practitioners to interact and address the patient or the client from this holistic perspective. Knowing that coming in this person with chronic pain or this, you know, ailment has, there's many pieces. Generally speaking, generally speaking, especially if it's a chronic issue and that it's more than just the physical aspect, oftentimes that there's an emotional piece and that there is a mental piece perhaps. And so being able to relate to that person in their wholeness can help me be a better overall practitioner to be able to offer some insights or how to relate to that person and help them, you know, experience a greater outcome.

Karen Litzy:                   26:37                Yeah, absolutely. And you know, it's that shift from a strictly biomedical to a biopsychosocial framework of treatment, which we talk about all the time on this podcast. I'm sure people are sick and tired of me saying it, but that is the way things should be in healthcare. So I will keep saying it many, many times. Now before we finish up, is there anything that maybe we didn't touch on that you're like, oh wait, I really want the listeners to know that.

Brenda Walding:           27:10                I think really a piece that I think is really helpful, especially for practitioners and you know, I don't know much if we'll have time to go into this, but this, I am a heart math certified coach and really we look a lot about energy management. And so we waste a lot of energy in the domain of emotions and repetitive negative and repetitive thoughts. And that affects our physical abilities and our physiology. And so really learning to manage our energy. And we do that through being able to get into a coherent state. So getting our heart, mind and emotion and energetic alignment through slowing down the breath and experiencing elevated emotional states like love and gratitude and can actually get the heart into a smooth coherent rhythm, which impacts the way that the rest of the body feels and how it can heal. And so I think if we learn some techniques, as practitioners to help manage energy we can improve outcomes for our patients and our clients. So this is sort of that combining of going beyond the physical and that heart math has some really incredible tools so that you can check them out I think it's a really great tool for a lot of practitioners. I just wanted to throw that out. Yeah. So I think that, yeah, that's helped me a lot in my own coaching on and with physical therapy.

Karen Litzy:                   28:48                Great. And we'll have all of that info at the show notes over at So if people want to learn more about they can just go click on it and you're there. So thank you for sharing that. And now the one question I ask everyone is, knowing where you are now in your life and in your career, what advice would you give to yourself as a new Grad right out of PT school?

Brenda Walding:           29:16                Right out of PT School? So I would definitely, I wish I would know now is really learning how to listen and lead from my heart. I feel like I got myself into a position where I was burned out running ragged, just trying to do the best I can as a new Grad. And I've missed a lot of the cues, you know, internally of Hey, slow down. These other aspects of your life are important to you. And you know, I think that was really the catalyst for me to start to get burnt out and sick. And so really to slow down and really listen to my heart is what I would tell myself.

Karen Litzy:                   29:42                Great Advice. And burnout is real. This year at the women in PT Summit in Portland, we have a whole panel on burnout. I'm really looking forward to listening to, cause I am not part of this panel. I'm not part of the creation of it. It was sort of pitched to us and I'm really excited to hear what the women on that panel have to say. Cause it's a thing and I think it's happening more and more with the newer grads because they're trying to work more and more. They've got student debt out the yes. What? Um, so I feel like it's a real thing, you know, and like you said, just to take a moment to slow down and focus on other parts of your life is, is something that that can help. So thank you for that. And now where can people find you if they have questions? Where can they get your book?

Brenda Walding:           30:49                Yes. So you can find me. I'm in the process of creating, readjusting my website. So right now you can really connect with me by emailing me at And then I'd also love if any of this resonated with you, if you're a woman that is dealing with burnout, exhaust exhaustion. I love working with wellness professionals. If you're interested in some of these heart math tools that I use, I'd love to hop on the phone and I'm happy to offer your listeners a complimentary 45 minute consult.

Karen Litzy:                   31:32                Oh, that's awesome.

Brenda Walding:           31:34                Yeah. So if you'd like to take advantage of that and you can go to and that is my calendar link. And so you would just set up a time to chat with me. Okay. And I love hearing your stories and hearing where you're at and what you need most support with. So happy to do that. And then my book is coming out in hard copy at the end of this year, but you can find it on Amazon.

Karen Litzy:                   32:02                Perfect. And you'll give me all the links. I'll put all the links up on the podcast website under this episode so that way people can get to you, they can chat with you. And thank you so much for offering a session for everyone. That's so nice.

Brenda Walding:           32:21                Yes. Awesome. I look forward to connecting with some of you.

Karen Litzy:                   32:24                Great. And, again, Brenda, thank you for coming on and sharing your really incredible story. And we are all very happy that you are today healthy and happy and moving forward. So thank you so much.

Brenda Walding:           32:39                Oh, thank you, Karen. I enjoyed it. I enjoyed being here, so thank you for the opportunity.

Karen Litzy:                   32:44                And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Aug 12, 2019


LIVE from the NEXT Conference in Chicago, Jenna Kantor guests hosts and interviews the teams from the Oxford Debate which covered the question: Is Social Media Hazardous? The Pro team consisted of Karen Litzy, Jimmy McKay and Jarod Hall. The con team consisted of Ben Fung, Jodi Pfeiffer and Rich Severin.

In this episode, we discuss:

-How each of the debaters prepared and crafted their arguments

-Bias and how to research a question openly

-The importance of respectful debate on controversial subjects

-And so much more!



Jimmy McKay Twitter

Rich Severin Twitter

Ben Fung Twitter

Jarod Hall Twitter

Karen Litzy Twitter

Outcomes Summit: Use the discount code LITZY


For more information on Jimmy:

Dr. Jimmy McKay, PT, DPT is the Director of Communications for Fox Rehabilitation and the host of five podcasts in the category of Science & Medicine. (PT Pintcast, NPTE Studycast, FOXcast PT, FOXcast OT & FOXcast SLP.)

He got his degree in Physical Therapy from the Marymount University DPT program and a degree in Journalism and Mass Communication from St. Bonaventure University. He was the Program Director & Afternoon Drive host on the 50,000 watt Rock Radio Station, 97.9X (WBSX-FM).

He has presented at State and National Conferences. Hosted the Foundation for Physical Therapy research fundraising gala from 2017-2019 and was the captain of the victorious team in the Oxford Debate at the 2019 NEXT Conference.

Favorite beer: Flying Dog – Raging Bitch


For more information on Rich:

Dr. Rich Severin, PT, DPT is a physical therapist and ABPTS certified cardiovascular and pulmonary specialist. He completed his cardiopulmonary residency at the William S Middleton VA Medical Center/University of Wisconsin-Madison which he then followed up with an orthopedic residency at the University of Illinois at Chicago (UIC). Currently he is working on a PhD in Rehab Science at UIC with a focus in cardiovascular physiology. In addition to research, teaching and clinical practice regarding patients with cardiopulmonary diseases, Dr. Severin has a strong interest in developing clinical practice tools for risk assessments for physical therapists in a variety of practice settings. He is an active member within the APTA and serves on the social media committee and Heart Failure Clinical Practice guideline development team for the cardiopulmonary section.


For more information on Karen:

Dr. Karen Litzy, PT, DPT is a licensed physical therapist, speaker, owner of Karen Litzy Physical Therapy, host of the podcast Healthy Wealthy & Smart and creator of the Women in Physical Therapy Summit.

Through her work as a physical therapist she has helped thousands of people overcome painful conditions, recover from surgery and return to their lives with family and friends.

She has been a featured speaker at national and international events including the International Olympic Committee Injury Prevention Conference in Monaco, the Sri Lanka Sports and Exercise Medicine Conference, and various American Physical Therapy Association conferences.


For more information on Jodie:

 Jodi Pfeiffer, PTA, practices in Alaska, where she also serves on the Alaska Chapter Board of Directors.


For more information on Jarod:

Jarod Hall, PT, DPT, OCS, CSCS is a physical therapist in Fort Worth, TX. His clinical focus is orthopedics with an emphasis on therapeutic neuroscience education and purposeful implementation of foundational principles of progressive exercise in the management of both chronic pain and athletic injuries.


For more information on Ben:

Dr. Ben Fung , PT, DPT, MBA is a Physical Therapist turned Digital Media Producer & Keynote Speaker. While his professional focus is in marketing, branding, and strategic change, his passion is in mentoring & inspiring success through a mindset of growth & connectivity for the millennial age.


For more information on Jenna:

Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas ( until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website:


Read the full transcript below:

Jenna Kantor:                00:00                Hello, this is Jenna Kantor with Healthy, Wealthy and Smart. Super excited to be talking here because I am at the NEXT Conference in 2019 in Chicago, Illinois. And there was an awesome debate an Oxford debate and I'm with almost all the team members. So that being said, I want to just interview you guys on your process, especially because everyone here is either extremely present on social media or uses social media. So it's funny that we had these two opposing teams really fighting different arguments here where everyone pretty much is on the same page that we all use social media. It's great for business. There's no denying. So as I ask my questions, would you guys say your name because people aren't going to necessarily, well maybe for some recognize your voice and also say what team you were on, whether it was team hazardous, which was correct me, Jimmy, which was the pro argument. The pro argument was saying that social media is hazardous and then the Con team was team Blues Brothers, which I've learned from Ben Fung it would have been the star wars theme except it had already been used in the past and they needed to be original. So that being said, I want to start off with #teamhazardous. What was your individual processes with finding your arguments since each of you are very present on social media?

Jimmy McKay:               01:39                Jimmy McKay team #hazardous. I think first of all, this was a very difficult argument for our opponents because, well, first of all, we didn't get to pick which sides. A lot of people think that we've vied for the sides. We were literally just asked if we wanted to do the Oxford debate and then been given a side and given a team. So I want to make that very clear. I think they did a great job. I was keeping track of all the points that I would've hit if I were on that side, I thought that was the uphill battle. Because people, when they found out we were pro social media it was like, oh, you don't like social media. But if you read the prompts for a debate very closely, it's like, is it hazardous?

Jimmy McKay:               02:18                Not is it good or bad? Right? So we agreed like all the things that the con side said, we agree with it's fantastic. It should be utilized. But just like PT why do we take the NPTE for example? Because if improperly used physical therapy could be hazardous. So that's why we take a test that makes sure that we're a safe practitioner of physical therapy. So, my thought process was I went on social media and wanted to grab all the kits, right? Like emojis and gifs and videos and Beyonce doing dances because that's what people resonate with. But then focus on the things where I think it falls short. Everything falls short, right? There's no Shangri-la and social media is no different. So just focus on the issues that stood out, right.

Jimmy McKay:               03:01                So all I had to do is can I just ask, what do you love about social media? Like what irks you, you know, what are things that you wish were better? And as you heard from tonight, I think in past Oxford debates, sometimes it was hard to get four or five speakers to ask questions. And I think they had to cut them off because everybody, it resonates with everybody and it's super personal, right? I mean, what was the stat? How many people, I mean minutes that people spend a day, 140, 116 minutes a day

Jimmy McKay:               03:29                It's probably hard, so it's super personal for people but I think again, the argument from the other side was just is really hard. I mean, I think you guys were put in a corner. But here's the funny part. Like you defended it, I think you defended that corner pretty well. So that was my process.

Karen Litzy:                   03:50                Hi, Karen. Let's see, #teamhazardous and yes, this is also my podcast, so that's, yeah.

Karen Litzy:                   04:00                So my process was pretty easy because I had just spoken about social media and informatics at WCPT in Geneva. So I was able to use a lot of that research and a lot of that information to inform this debate. And what I wanted to stick to was, I wanted to stick to the idea of fake news, the idea of misinformation versus disinformtion because there are different and how each one of those are hazardous. And then the other point I made was that it's not individual people, it's not individual groups, it's not even an individual platform. But if put all together, all of the platforms add in misinformation and disinformation, add in people who don't know the difference between something that's factual and not. So if you put it all together, then that's pretty hazardous. But the parts in and of itself maybe aren't. And then lastly that social media is a tool we need to really learn how to use it as a profession because it's not going anywhere as the team concept. It's not going anywhere. So the best way that we can reach the people we need to reach is by using it properly and by making sure that we use it with integrity and honesty and good faith.

Jodi Pfeiffer:                 05:22                Hi, I'm Jodie Pfeiffer. I was for the con team blues brothers. I got to be the lead off person as well. So I really just kind of wanted to set the tone. It was a hard argument. Everybody uses it. I would like to think most people try and use it well we know this isn't always the case and it is a really useful tool for our association and for our profession. But there are times when it is not, we were trying to just, I was trying to set the stage for my other team members to give them things to work off of, give everybody a little introduction of the direction we were going. And I also tried to play off of our opponents a little bit as well because you know, really their argument that they made so well kind of proved both sides, how good it is and the hazards. So yeah, that was the direction that I went.

Jarod Hall:                    06:20                This is Jarod Hall. I was on the pro team #teamhazardous and I remember when I was asked to be on the Oxford debate panel, the same day I was scrolling through social media of course, and I saw Rich Severin on Facebook saying, Hey, look, I was selected to be for the Oxford debate. And I thought, man, he's super well-spoken. This dude knows his stuff. He's going to come in strong. And then like I checked my email an hour or two later and I had been asked as well and I was pretty floored. I didn't know what to say. And they're like, do you want to do this Oxford debate and what side do you want to be on? And of course I said, I'm super active on social media. It's been helpful for me to find mentors and it's really positively influenced my career. I want to be on the side that's pro social media. And they said, cool, you're on the opposite side.

Jarod Hall:                    07:21                And I thought to myself, oh, ouch. Okay, I need to look at this subjectively. You know, I need to, I need to step back away from the situation and look at ways that either I myself have been hazardous on social media or things that I've seen that were hard for me to deal with on social media. And, when Karen and Jimmy and I were strategizing, you know we kinda came up with a couple of different points. We wanted to 8 mile, you guys, we wanted to 8 mile the other team and kind of take the bullets out of your gun. We wanted to address the points that we knew you would address. And Karen did a really awesome job of that because we knew you guys were gonna come with such a strong argument and so much fire that we had to play a little bit of defense on the offense.

Jarod Hall:                    08:07                And Karen got everybody hyped up and then our strategy was maybe, go the opposite way in the middle with me and maybe bring a little bit of the emotional component the other side of emotions and have people reflect on what does it feel like to feel not good enough? What does it feel like to see everybody else's highlight reel on social media when in reality, you're doing the day in the day out, the hard grudge, the hard trudge, you're putting in so much hard work and all you see is everybody's positive stuff around you. And it can, it can be a really defeating feeling sometimes. So we wanted to emphasize, you know, a lot of the articles that have been coming out across the profession about burnout and how that could potentially be hazardous. And you know, obviously we're all in favor of the appropriate usage of social media and when done the right way.

Jarod Hall:                    08:55                But to take the pro side of this argument, we had to reflect on how could this really actually pose a hazard to us both personally and professionally. And, you know, I think that that's one of the things that directed our approach. And it was a hard thing to do to take the opposite side of, you know, how I position myself. But, all of my own errors on social media were really good talking points and learning points to drive home the discussion. And, you know, we just knew that the other team was going to have such a strong argument. We knew that it's really hard to ignore the fact that social media has connected us. It has allowed me to meet everybody sitting at the table with. It's allowed me to have learning opportunities and mentorship and it's allowed me to have business opportunities that I wouldn't have had otherwise. So we knew that the argument was just, it was going to be tough to beat. And, you know, I think that the crowd just resonated with everything that was said from both teams. And at the end of the day we were able to shed light from both sides on a really difficult topic and have people, you know, reflect on it and really have some critical thought.

Ben Fung:                     10:10                Ben Fung here. I was a part of the con team. So that was so difficult. Pro Con. So I mean like it was interesting. I had a very similar experience when they asked me to be on the Oxford Debate. They're like, hey, you know, we'd like you to captain the team. I was like, okay, great. What am I debating? Or like, then when they would actually did tell me, they're like, oh, it's about social media. I was like, okay, yes, I'll do it. And then they're like, okay, you're on the con team. And so immediately I thought like, Oh, I have your job. Like I have the team, you know, #Hazardteam, I needed to somehow slam on what much of my success had been attributed to, you know, and I was like, okay, that'll be a tough job.

Ben Fung:                     11:01                Right. And then what's interesting is that, you know, then they sent me the prompt and I was like, oh no, no, no, I'm against the against statement. So I'm pro social media and, you know, then the other side I can promote this. And it was actually only in retrospect that I was like, oh, it can be an uphill battle. But then I decided just personally not to think about it from that perspective, from my, you know, debating approach cause we're trying to present, you know, we're trying to present a point, more importantly, just engage the audience, you know, because, the Oxford Debate in the past, for the most part it's been really positive and entertaining. But then in some past years have gotten a little too intense I think for the audience and some afterthoughts.

Ben Fung:                     11:40                So I just wanted to make sure that the thumping in the background stops, but also that you know, people were engaged, entertained, you know, that generally said some critical thought. You know, like those might've come into this being maybe a con member goes over to pro and vice versa. But really, you know, it was just really, really fun. You know, as people, I was like, you know, I know all these folks, it's going to be so much fun. And you know, if we can bring even like an ounce of the kind of energy that I know we all have and put it together, that stage is just going to be vibrant. So, you know, from what I can tell, that's what happened. And, you know, I'm very pleased regardless of who won, but congrats you guys though. You guys did a great job.

Rich Severin:                 12:32                And this is Rich Severin, was on the con team, which is again this incredibly difficult to kind of, yeah, team blues brothers. That's a better way to go about it. Everyone's said it, you know, this was, it's a difficult topic. You know, I asked like, who were, you know, were on the other teams, you know, realizing that, you know, we're going against some of the people who have, you know, some of the largest profiles in PT, social media and Karen and Jimmy and like, they have a really tough task here. I'm interested to see how they're going to go about this. Cause it's like, I even, I was like, man, I'm kind of glad I met on that side, but I don't know if I could somehow think of a tweet quoting me and like saying, ‘PTs social media is hazardous’ or whatever.

Rich Severin:                 13:12                But anyway, realistically the Oxford debate, you know, it's to present a topic that's challenging, that's facing the profession and dissected and debated. And that's kind of the beauty in having fun. And I think everyone there had fun. I had a lot of fun. And it was just, it was just good. And I think, you know, the pro team, or #hazardousteam, you know, they did a really good job. It's not an easy topic to debate because again, social media is kind of a tool in a lot of the problems are kind of the human nature in a certain stance on a platform. But, you know, addressing the issues of burnout, addressing the issues that people wasting time, fake news, misinformation, you know, those were our, you know, those were all good things, but you kind of brought to light throughout that debate.

Rich Severin:                 14:04                And I think our group, you know, came across with obviously with a good argument, but, you know, Karen came on the short and a little bit today. But, you know, it was a great spirit's good spirited debate. It's a lot of fun. It's a great time and having these conversations about tough issues, having to kind of take some time for introspection and looking through things was enjoyable. And enjoying hearing other people kind of, you know, doing the same. You guys definitely did like, I think put a lot of time into researching and discussing topics cause it's a serious issue, you know, our younger populations growing up using social media in middle school, you know, and it will, you know, the topic I thought you guys would get into was like the bullying and esteem issues that are happening and the mental health issues, anxiety, depression, it's linked to social media, you know, and whether or not that's the cause or it's a vehicle for that outcome.

Rich Severin:                 15:03                So like, you know, I do agree with the safe  #safesocial, right. Like you know, and it kind of led to like kind of on our side too. It’s a tool and how you use it, it's kind of really an issue and I think you guys brought a really, really good light to that issue. So yeah, I was like, it's a great spirited debate and the crowd had fun. I mean dressing up as the blues brothers in Chicago, right? I mean, so, so much fun.

Jenna Kantor:                15:28                Thank you so much. Now, I just want to leave it. Not Everybody needs to answer this, but I would like if anybody would like to do a little last words in regards to this debate, whether it be some sort of wisdom on doing an Oxford debate in general or pretty much what rich started to do on when he was just last talking in regards to social media being hazardous or not so hazardous. Would anyone here like to add onto that as a little like last mic drop, which is your outlet.

Rich Severin:                 15:54                I think we've hashed out the debate on both sides pretty well. Which I think, again, it's the spirit of the debate is they present both sides. And that's kind of where I'm getting yeah. Is that we need to have more of these kind of conversations and discussions. And you know, to me it's almost kind of a shame that this is the only really time in our profession. Like, you know, at a high level where we have these discussions where both sides do their due diligence and say, like, legitimately argue, like, you know, and like arguing is not a bad thing. Right? Debate is not a bad thing if it's done well done amongst colleagues and friends and with mutual respect and we need to have more of that.

Rich Severin:                 16:39                Social media is not necessarily a bad thing, but arguments necessarily a bad thing, but it's how you go about doing it. So, you know, I would encourage the profession to have more of these outside of just the Oxford debates. Well, when it was the women's health section, they did one on dry needling a couple of years ago and that was awesome. And I'd really encourage and support that again, you know, so that's my little, I don't know if it's a mic drop or not, but we need to debate more and do it well.

Karen Litzy:                   17:29                Rich, I totally agree with that. And this is the thing, we were able to do that because we were in front of each other and we knew that there is no malicious intent behind it. We can hear each other. We know that we're smiling at each other, we're clapping for each other and we're kind of building each other up. And I think that's where when you have debates on social media, as Jarod attests to and Rich, sometimes those spiral into something that's really not great. And so I think to have these kinds of discussions in person with our colleagues and it's good modeling for the next generation. And it just, I think, you know, social media has a lot of great upside to it. There's no question, but there is nothing that beats in person interactions.

Karen Litzy:                   18:20                And I think that that's what we need more of and I do see that pendulum shifting and you do see more in-person things happening now. But I agree. I also thought it was like a lot of fun and I was really, really nervous to do it and super scared to get up on stage and do all of this. But then once it started, it was a lot of fun.

Jenna Kantor:                                        Thank you so much you guys for taking this time, especially after, literally right after the debate. It is an absolute pleasure to have each of you on here.


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Aug 5, 2019

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Andrew Tarvin on the show to discuss humor in the workplace.  Andrew Tarvin is the world's first humor engineer, teaching people how to get better results while having more fun. Combining his background as a project manager at Procter & Gamble with his experience as a stand-up comedian, he reverse-engineers the skill of humor in a way that is practical, actionable, and gets results in the workplace.

In this episode, we discuss:

-How to construct humor and learn the skill of humor

-The benefits of humor for the individual and the organization

-Types of humor that are appropriate for the workplace

-The importance of the “Yes, and” mindset

-And so much more!



Andrew Tarvin Website

Andrew Tarvin Twitter

Andrew Tarvin Facebook

Andrew Tarvin LinkedIn

The Skill of Humor TedX Video

Humor That Works Website


For more information on Andrew:

Andrew Tarvin is the world's first humor engineer, teaching people how to get better results while having more fun. Combining his background as a project manager at Procter & Gamble with his experience as a stand-up comedian, he reverse-engineers the skill of humor in a way that is practical, actionable, and gets results in the workplace. Through his company, Humor That Works, Drew has worked with more than 35,000 people at over 250 organizations, including Microsoft, the FBI, and the International Association of Canine Professionals. He is a bestselling author; has been featured in The Wall Street Journal, Forbes, and Fast Company; and his TEDx talk has been viewed more than four million times. He loves the color orange, is obsessed with chocolate, and can solve a Rubiks Cube (but it takes like 7 minutes).

For more information, please visit, and connect with Drew (@drewtarvin) on Twitter, Facebook, Instagram, YouTube & LinkedIn.

Humor That Works is available on Amazon and wherever fine (and funny) books are sold.


Read the full transcript below:

Karen Litzy:                   00:01                Hi Andrew, welcome to the podcast. I am happy to have you on. And now today we're going to be talking about humor and why humor is important in the workplace and in life. So the first question I have is you say humor is a skill, so how is it a skill and can that really be learned by anyone?

Andrew Tarvin:             00:28                I think a lot of people have this question or this belief, like, you know, humor is just an innate ability, right? You're either funny or you're not. I will say that I've done over a thousand shows as a standup comedian and spoken word artist, storyteller, et cetera. I have spoken or performed in all 50 states and 25 countries and on one planet. This one. But when I went to my high school reunion and people found out that I did comedy, they're like, but you're not funny. And that's because, you know, growing up I was never the life of the party or the class clown. My senior year. I was voted teacher's pet. So much more of an academic, much more quiet. You know, I'm a very much an introvert. And then I started doing Improv and standup in college and admittedly was terrible when I first started out.

Andrew Tarvin:             01:22                Like we often are in a new skill that we try, but with practice and repetition I got better. And so I realized that, you know, really there there's an art and science to humor. And so what we do with our organization, with humor that works is we teach people the science. So we teach things like comedic structure, things like a comic triple things like timing and understanding how to like position things in different, you know, strategies that humorous use between say association or incongruity or a story, et cetera. All of this kind of science stuff that's easy to, you know, this conceptually you can learn and then there's an art, there is an art piece to it, right? There is, you know, some of that comes from your own perspective, the thing that you like and that you improve with practice and repetition. And so what we say is, you know, with the skill of humor, we can help to teach anyone to be funnier not necessarily, you know, across the board. Funny. It's not like, you know, you can magically teach someone to be so funny, they're going to magically have a Netflix comedy special, but you can learn certain things that are gonna take whatever your base level, you know, ability to use humor is now and take it up to the next level.

Karen Litzy:                   02:30                Okay. So let's break this down a little bit because I know the listeners love to get these little nuggets of knowledge that we can start applying today in our life and in our workplace. So you said that with your company that you can teach people what is comic structure and timing. So can you first tell me, cause I don't even know the answer to this question, but what is comic structure?

Andrew Tarvin:             02:55                Yeah. So there's certain things that, you know, there's certain ways that you can structure a sentence or a joke that make it more effective. So, one of the big things is, is learning to put the funny part of the punch line of something at the end. So a great example of this is, I think it's a George Burns quote that says, ‘happiness is having a caring, a close, tight knit family in another city’ right? Which I think is a pretty funny, you know, a humorous line. That line doesn't work if you say, ‘happiness is having a family in another sitting who is in another city who is carrying and close and tight knit, right? So you put the funny part, the unexpected, the surprise piece at the end, right? So that's just a simple structure thing. It's kind of the structure of set up and punchline another example of that is something called a comic triple.

Andrew Tarvin:             03:52                And so a comic triple is anytime when you have a list of three things, the third item is something unexpected. So, for example, when I give my, you know, when I'm talking about some of the clients that we've worked with, we'll say, you know, we've worked with organizations such as Microsoft. The FBI and the International Association of Canine Professionals. And so that last one is just something different, something unexpected where it's like, okay, Microsoft, okay. Corporate FBI, all that's kind of interesting. They seem serious. That's kind of cool. International Association of Canine Professionals. What does that mean? Right? So it, and again, we put that at the end. So simple things like structure or things that you know, kind of anyone can learn. And that's a starting point. The other thing that's kind of important to understand, maybe not necessarily specifically about comedic structure, but about the skill of humor, is that humor is more broad than comedy.

Andrew Tarvin:             04:46                So a lot of times when we think of humor, we do think of comedy. We think of funny, we think of laughter, we think of jokes. But humor is defined as a comic absurd or Incongruence, quality causing amusement. So it could be a joke or it could be just something a little bit silly or something a little bit different that you do that doesn't necessarily make someone laugh, but maybe it makes them smile. And that broader definition means that, you know, maybe you're not a great joke teller, but maybe you're good at telling stories or maybe you're not going to storytellings or jokes, but you're really good at drawing interesting visuals that will get people to pay attention. Right? So that's, that's part of what we mean by this skill.

Karen Litzy:                                           And what about timing? How do you teach timing?

Andrew Tarvin:             05:33                It can be a tough one to do, but that's, that's where the practice and repetition comes from because even as standup Comedians, like, you know, Seinfeld or, Ellen or that kind of thing, when they're doing new special, when they're going to new materials, they have to get it in front of people to see, okay, where do people actually laugh and how long of a pause should it have. Cause sometimes the difference between getting a big laugh and no laugh at all is how long you pause or how long you allow someone to get something. So, one example within timing is a lot of times when people are first starting out with humor, they'll say something that's actually pretty funny. And they'll leave a brief pause and then they'll start talking again right away. And this is something called stepping on your laughter is if someone starts to kind of laugh, but then you start talking again, people will stop laughing, they'll shut down the laughter response because they want to hear what you say next.

Andrew Tarvin:             06:25                And so sometimes one of the hardest parts is a brand new comedian to learn. And sometimes you have to be quiet a little bit longer because it takes the audience a second to actually get the joke to then process that it is a joke process that it is funny and then start to laugh. And that, you know, you need to be comfortable kind of in that short silence to allow them to then laugh and then also to not talk while they're laughing so that, they kind of finish that laughter out as opposed to stopping at short.

Karen Litzy:                   06:50                And I would imagine if you're up on stage and your, you know, telling the story or joke that time from the end of you finishing your sentence to a little, maybe pause to laughter building must feel like it's an hour.

Andrew Tarvin:             07:10                Yeah. It can feel like a really, really long time, especially as you've, if you do a certain joke over and over again or one that you know, that works because as you went, you think about it and like, oh, that's funny. I want to share that you've already thought about and processed why it's funny. And so you're like, oh, if they don't get it immediately, they must not think it's funny and it's they've never heard that construction of those ideas together before. So for example, I love puns and wordplay and I recently tweeted out, you know, that I'm a pale person. The only time I get Tan is when I do trigonometry.

Andrew Tarvin:             07:47                And that joke, particularly when said verbally is it's talking about get Tan. So Tan being short for Tangent. Exactly. So the only time I get there is, you know, it takes a while. It takes a moment for people to be like, wait, why is that funny? Is that a joke? That doesn't, you know, what is what is, you know, that has to do with trigonometry. Oh wait, 10 to there was like cos sign and tan like, yeah. So it takes time for that to happen and you have to get comfortable kind of in that silence. The other thing to, to recognize though is that that's true specifically of, kind of planned humor. Things like conversational humor. They don't necessarily, one you may not have, it might not be a preplan thing, but even conversational humor, something that can be learned and something that can be practiced through, you know, drawing on some principles from improvisation.

Karen Litzy:                   08:40                Right. So now I actually took a number of Improv classes to help me with the podcast to help me, like you said, just carry out a better conversation and to yes. And, and all of that. So can you a little bit about improvisation and how that can help with general conversations, especially let's say at work.

Andrew Tarvin:             09:05                Yeah. So, you kind of mentioned the fundamental mindset of improvisation. The key that really helps with a lot of that in that is the mentality of yes and, where yes. And is really about kind of taking whatever was offered and building off of it. And so that can be fantastic for conversations. In fact, if you're ever in a conversation and you don't know what to say next, you can just simply yes. And the last thing that was said, so like you can even take, you know, the stereotypical small talk example of, how, how about this weather, right? So I'm in New York. It's sunny, it's 85 degrees. Someone asked me, how about this weather, if I'm say at a networking event, right. Or say one-on-one with a client, how about this weather, I can be like, yes, it is, it's beautiful out. It's, it's sunny out now. You know, if you weren't at this meeting, if we weren't interacting right now, how would you be out enjoying, you know, 90 degree weather? Right. And then so that gives him a chance to be like, oh well, you know, I'd go swimming because it's hot out or I'd stay indoors because it's too hot. Or I'd go out on the bike, you know? And that turns a conversation that was about weather into something more interesting about like in getting to know that person in terms of things like their hobby.

Karen Litzy:                   10:16                That's great. I love that because that networking and going to those kinds of events is always so daunting. And especially as an entrepreneur or a small business owner, you kind of have to do those things.

Andrew Tarvin:             10:30                70% of jobs are found through networking and, and to your point, entrepreneurs, I'd say it's a way that a lot of people drum up business. And I learned that pretty early on as an introvert, you know, going to networking meetings, like you said, is daunting. It's a little bit awkward. And so for me, I developed a three step process for being able to network with people. And that yes, and piece is the third step is how you continue the conversation is just to continue to build off of what was said.

Karen Litzy:                                           Nice. What is step one?

Andrew Tarvin:                                     Step one is to ask interesting questions. And so, you know, if we think about Dale Carnegie and how to win friends and influence people, you know, great quintessential business book, he said that you will get, you'll make more friends and a month by getting people interested, by being interested in other people than you will in an entire year in trying to get people interested in you.

Andrew Tarvin:             11:24                And so what that translates into is basically getting other people to talk and then shutting up and then listening to them. And you know, if we go to a networking event and we have the same kind of boring questions, the same, you know, what do you do type questions and at least the same boring answers. And that's not distinguishable. That doesn't stand out to anyone. And so instead of you, if you ask more interesting questions, so simple questions, you know, what's the coolest thing that you've worked on in the last three months? That a lot of times people, you will end up answering the question of what do you do, right? They'll say, oh, when I was working at blank. But it gets him to think a little bit differently. It gives him a more interesting response and you can actually kind of connect a little bit closer.

Andrew Tarvin:             12:11                And that's an example of something that's a little bit in congruent. So maybe it's not laugh out loud funny, but it is something a little bit different that maybe gets people to smile a little bit more or at least thinking a little bit differently. So that's step one is to ask interesting questions. The second step is to tell a compelling stories. So when someone asks you a question, right? Sometimes we hear this advice of like, Oh, you've got to ask people questions. That's how you build rapport. But if all you ever do is ask them questions and never answer anything that they say, it starts to feel like a weird interrogation. Or like why is this person being so closed off? And so when someone asks you a question rather than just giving a yes or no answer, you can give a little bit of a story or a little bit of a background.

Andrew Tarvin:             12:54                So if they're asking, you know, why did you get into healthcare? Why did you get into physical therapy? Or why didn't, you know? Rather than just being like, oh, it was fun. Like, you know, oh, growing up I always felt like this, or I was an app. Like just giving that background allows people to connect with those ideas and maybe they don't connect with physical therapy. But if you're like, oh, well growing up when I used to play soccer, I felt like this. And then on to the next thing, people are like, oh, I played soccer as well, and now you've created a connecting point with this person through a shared interest or a shared commonality.

Karen Litzy:                   13:25                That's great. Thank you. Those are great tips. And finally finishing up, like you said, using the yes and to continue that conversation is great. Now since you brought up health care and physical therapy, a lot of the audience, are in those professions. So sometimes humor in that workplace can be a little difficult cause there are times where we have to be pretty serious. So can you kind of talk a little bit about how using humor at work can even work when we have to, you know, sometimes give bad news?

Andrew Tarvin:             14:01                I think your is a great point and this is something I think for, for all professions to, to recognize with humor is that it's simply another tool in the tool belt in the sense that it's not something that you're going to use all the time. 100, you know, 24, seven and everything that you do. It's, it's true that there are times that humor may be inappropriate. And, one of the ways that we can avoid inappropriate humor is by following what we call a humor map. And the map stands for your medium, your audience, and your purpose. So your medium is how are you going to execute that humor? Is it an email? Is it in a one on one consultation or conversation? Is it in a phone call? Is it in a presentation to a bunch of people? Because that medium impacts the message, right?

Andrew Tarvin:             14:47                The second piece is the audience and who you know, who is the, what do they know? What do they need and what do they expect? Because when you're using humor and say communication, you probably are, you do want to deliver on what that person needs while doing it. Maybe in a way they don't just 100% expect by adding a little bit of something different can add be that humor component. The other thing is also understanding your relationship with that person because you know something that you, if you have a client that you're meeting for the very first time, that's going to be very different than the humor that you might use with the client that you've been working with for 15 years, right? You've got to know each other a little bit better. And then the final piece is the purpose. Why are you using humor?

Andrew Tarvin:             15:27                And this is the most important one. This is why as an engineer, I like it because humor can be effective in using or achieving certain goals. So you could use humor as a way to get people to pay attention. Or maybe you use humor as a way to build a relationship with someone to build rapport, right? If you're meeting a client or if you're just now starting to work with someone, you can find a way for you to both laugh together. You kind of show that where you're standing on the same side and then after you've built that rapport, then if you have to get more serious news, that's, that might be when you become a little bit more serious or a little bit more somber or whatever. Right? So again, it's just recognizing that it is, it's a tool. It helps us achieve certain goals and that when we have those as goals, it might be the appropriate tool to use.

Karen Litzy:                   16:10                Great. I love it. And I like that acronym of the humor map. That's really easy to remember. Now let's talk about, we're talking about humor, right? There's maybe good humor, bad humor. What is the type of humor one should kind of stay away from in the workplace?

Andrew Tarvin:             16:34                I think that's a great question. So to give it a little bit of additional context, a psychologist Rod A Martin defined four styles of humor. He said in general, humor kind of falls into these four buckets. The first bucket is affiliative humor and this is positive inclusive humor. This is to me, I think of like Ellen Degenerous, like her style of humor, her TV show, it's very positive, upbeat. Everyone is included. There is no target, if not aggressive. It's not calling anyone out. It seems like team building events in the corporate world or activities that you may be doing with your clients or your patients, right as positive and inclusive, everyone is included. The second style is self enhancing humor. And this is a humor where the target is kind of yourself, but it's positive in nature. To me it's kind of best summed up by, there's a great Kurt Vonnegut quote that says laughter and tears are both responses to frustration.

Andrew Tarvin:             17:33                I myself prefer to laugh because there's less cleaning up to do afterwards, right? It's that idea of like when we're thinking about the challenges or the hardships that we have to go through day to day, it's finding the humor in them so that you laugh about them instead of cry about them. So that's another great form of humor and that's, that's kind of like, you know, finding ways to make your own work more fun. It's, you know, listening to music when you have to go through email or you know, rocking out to a song and you're in the car on the way home, or you know, these small examples of things that are just improving your life day to day. A third style is self-defeating. Humor, self-defeating humor as a negative form of humor where the target is yourself. And so this is, you know, Rodney Dangerfield.

Andrew Tarvin:             18:15                I get no respect. That's kind of poking fun at yourself. And this can be a great form of humor when used one in a high status position. So if you are a presenter that sometimes adds a little bit of status to it, or if you're the boss or the CEO as a way to reduce status. Differentials can be very good. And it's best used when sparingly. So like you don't want to use it as every single joke that you do, but every now and then on occasion, and that can be a good form in many ways. But if it's used too much since people started to think like, oh, this person isn't confident or they're not actually good at what they do, or you know, they're throwing a pity party and I don't know if I laugh or not. So there's some limitations to that one.

Andrew Tarvin:             18:55                And then finally there is aggressive humor and aggressive humor is a negative form of humor where the target is someone else. You're doing it to try to manipulate them or try to make fun of them or that kind of thing. And so that tends to, to not be appropriate in the workplace. It includes things like sarcasm and satire, which can be okay in a group setting where you're all very comfortable with you, with each other, and it can be a very good form of Catharsis. So I know a lot of like say doctors, surgeons, we do some work with emergency first responders. They sometimes have a dark sense of humor as a group, because it, you know, serves as Catharsis. They see so many stressful, so many crazy things that they need some outlet to relieve that stress. And so that type of humor can be helpful there. But again, only when it's a very close knit group, when the relationships are kind of already formed and you know that it's going to be seen as catharsis and not seen as aggressive.

Karen Litzy:                   19:52                Yeah. And I think we've all been in those situations where you're just sitting there and it's like awkward. Like this did not fall the way that the person intended it to.

Andrew Tarvin:             20:03                Yeah. And that's why, you know, if you stick to the other three forms a lot more, you're going to be, it's gonna be a lot better. And, and that's the other differences, again, we're not trying to teach people how to use humor to become stand up comedians. Cause yes, absolutely tons of comedians or kinds of comedy shows, you'll see a lot of sarcasm, a lot of satire, a lot of aggressive humor. But that's not our goal. Our goal is using humor so that we get better results.

Karen Litzy:                   20:29                And so that was my next question. You just led me right into it. So let's talk about results. What kind of benefits can, let's say myself as an entrepreneur or within an organization, get from humor at work

Andrew Tarvin:             20:44                It's great question. And as individuals, there are 30 benefits at least that we found. 30 plus benefits from using humor in the workplace that are all backed by research case studies and real world examples. And so they range from ways to improve your communication skill as a way to, you know, for example, do you use a little bit of incongruity, get people to pay attention a little bit more cause they're like, oh that person just made me laugh. That's a little bit different than what I was expecting. Now I'm listening and paying attention, to helping with creativity and backed in one study they found that kids to watch a 30 minute comedy video before trying to solve a problem. They were nearly four times more likely to solve that problem in kids. You watched either a math video or no video at all.

Andrew Tarvin:             21:28                So we can use humor as a way to kind of just warm up the brain to be able to think about things a little bit differently. Give ourselves a different perspective. We can use it for things like relieving stress so we know that, you know, stress by itself is not a bad thing, right? As a physical therapist, you know that you have to stress muscles to some extent in order to get them to grow. That's what we're doing when we're working out is we're breaking down muscles, but then they grow when we rest and we feed them and the body, our capacity for being able to do work is the same thing. We can stress, you know, we needed a little bit of stress to sometimes get to that next level in terms of productivity. But if we never relieved that stress, that's when we see an increase in blood pressure and increase in muscle tension, a decrease in the immune system. Well humor can help counteract those things. When we take a break to actually laugh, we increase oxygen flow through our body, we relax our muscles and we boost our immune system as well. So we can use it for things like that as well.

Karen Litzy:                   22:25                Well they are all really great benefits especially to use at work. And now these are, like I said, these are all great benefits. So why is this not being implemented more? Why aren't more people quote unquote funny at work? And I know that's not the right term, but I think that's what people think. Right?

Andrew Tarvin:             22:46                Right. Yeah. And what we say kind of with humor in the workplace as a goal isn't necessarily to be, to make the workplace funny, but it is to make things a little bit more fun. And you ask a very, I think, important question to say, okay, why don't people use humor more? And we wanted to do the answer to that. So we ran a study through our site and we found that the number one reason why people didn't use humor in the workplace as they said that they didn't think that their boss or coworkers would approve.

Karen Litzy:                   23:12                Interesting. I can see that. Yeah, I can totally see that.

Andrew Tarvin:             23:15                Right? Yeah. Cause if you work in a culture and no one's really laughing or smiling all that much, then you're kind of like, oh, I guess it's not welcome. I guess it's not what we do here. It's a, you know, quote unquote serious workplace. And the reality is that 98% of CEOs preferred job can edge with a sense of humor and 81% of employees at a fun workplace would make them more productive. So I think people actually want it. It's just that we're still stuck sometimes in this old mentality that work has to feel like work and we don't that well, we're human beings. And humor is an effective way to reach human beings. And so if we want to be more effective in what we do, we have this tool that we can use. And I think specifically for entrepreneurs and leaders of others or team leads and stuff, that's an important thing to recognize is that if you're the leader of a team or an organization and people don't constantly laugh or people don't kind of have that sense of humor, it doesn't seem like you might be part of the reason why.

Andrew Tarvin:             24:12                And it's probably not intentional, right? You probably like haven't gone out to be like, all right, let me squash any remote mode of fun. That happens every single day. But if you don't use it yourself as a leader, if you don't encourage it, if you never laugh or smile in the workplace, if you never kind of express some humor or share a little bit more about yourself, people will kind of take whatever the leader does and say, this must be how we have to act.

Karen Litzy:                   24:36                I mean things trickled down from the top. There's no question. It makes me, as you were saying that the thing that came to my mind was the movie the Devil Wears Prada and Meryl Streep's character who was just, I don't think she cracked a smile except like the very end of the film. And you can just sense the tension among everyone that worked below her.

Andrew Tarvin:             25:02                Exactly. And I think we, I think we need more, we need more metaphors to the movie devil wears Prada. So I'm happy that we've gotten there for this. But I think you're exactly right. How the managers behave does tend to set the tone. And, but with that being said, one of the things that, you know, I'm a big believer in is that, you are responsible for your own happiness. And so even if you do work for an organization or you do work for a manager or a leader who doesn't really use humor, I think that it's still up to you. You choose how you do your work every single day. And, and it's not really the responsibility of your manager, your coworkers, or your patients or clients or customers to make sure that you're having fun, right? That's an individual choice that you make. And hopefully they don't detract from that. But even at a minimum, like they can't control how you think. Right. One of the things that I like to do when getting bored and emails that I'll start to read each of the emails in a different accent in my head. And this is something kind of fun, something a little bit different to do and no one can stop me from doing that, right? No manager could come up and be like, hey, you're reading emails in the accent in your head. Stop it.

Karen Litzy:                   26:10                Yeah, totally. And so when you go into these companies, you go into Microsoft or in working with the government, how do you enter into those situations to kind of explain to them that using humor in the workplace is important? Because I would have to think you have had to encounter some hard nuts to crack.

Andrew Tarvin:             26:38                Yeah, absolutely. And in conveying the value of humor is a little bit of a challenge. You know, no one really thinks of humor as a bad thing. They typically don't think of it as kind of a nice to have. But to me it's a must have. If you just look at kind of the statistics, if you look at the numbers, you know, 83% of Americans are stressed out at work, 55% are unsatisfied with their jobs and 47% struggle to stay happy leads to 70% of the workforce being disengaged. And then Gallup has estimated that's a cost on the US economy of about $500 billion lost, you can do the math of that. That's, you know, you take the number of employees and all that. It's an average of about $4,638.

Andrew Tarvin:             27:29                And lost productivity. And so then when you're starting to talk with people, so if you're talking with Microsoft or other organizations and saying, Hey, if you know 70% of your workforce is disengaged and each one costs you $4,700, now they start to see like, oh, okay, there's numerical losses here. Because if you look at the benefits of using humor, we talked about some on the individual level, when an organization uses humor, you see an increase and you one create a more positive workplace culture. You see an increase in employee engagement, you see an increase and company loyalty, see a decrease in turnover. And on a lot of organizations, you also see an increase in overall profit. And so when I'm talking with the organizations, it's talking about the business benefit of it. It's recognizing that, you know, well, as a gross simplification of it, I have a dumb question for you.

Andrew Tarvin:             28:22                But it's still wants you to kind of answer it, but, would you rather do something that is fun or not fun? Fun, right? Yeah. You'd rather do something fun. So if you were to make your work a little bit more fun, probably stands to reason that you might be a little bit more engaged in it. Or if you were to make your kind of conversations with your patients or your clients a little bit more fun, you might see that they might be a little bit more willing to actually want to go to them or pay attention in them. So that's a big part of when you consistently use humor, that's when people are like, oh they actually look forward to that meeting. They maybe know that it's going to be hard or they know that, you know they're going to have to do some work, but they're like, at least it's not going to be terribly boring.

Andrew Tarvin:             29:10                At least it's not going to be awful and that's that fun component. And so that's kind of the higher level. And then we have a bunch of studies and a bunch of background kind of back all those things up. But that's been the messaging is like, this is again, it's not about let's all hold hands, Kumbaya. You know, we should all enjoy our work just because we're happy. Go lucky. It's more of here's a strategic use of a tool that will get you better results. And here's all the research that says that it has done that.

Karen Litzy:                   29:42                And when, when we're talking about humor in the workplace, it doesn't mean like your boss coming out and doing a standup bit every morning.

Andrew Tarvin:             29:47                Exactly. Yeah. Right. It's more about making it a little bit more fun. It's more about bringing the your humanness to work. Right. And this is one of the things that I'll share with my corporate audiences, you know, I'll say to an entire room full of people is I'll be like, you know what my guess is that many of you, and this is probably true of your listeners as well, many of you are likable people at home, right? And then they go into the workplace and something changes right? At home. They laugh with their friends, they smile, they make jokes, say, are conversational, et cetera. Maybe a little bit silly, you know, maybe they sing in the shower, they dance in the kitchen, whatever. And then they go into the workplace and something changes. They put on a work face and they feel like they have to be like a robot with no emotions or anything like that. And that's not effective for the way that we work today. Maybe that made sense, the industrial revolution, whereas all about efficiency and the most widgets that you could produce. But now when humor, interactions are important now when your emotions impact your ability to be, say, creative or productive, we have to manage the human experience. And humor is just one effective way to do that.

Karen Litzy:                   31:00                And so if I'm hearing you correctly, when we're talking about bringing humor into the workplace, it's really about being kind of open and trying to be a little bit more yourself and perhaps letting your guard down a little bit to allow yourself to be present and to, like you said, be funny or to not be so serious all the time. Or to, you know, have more conversations where you're injecting your personality. Because I do think most people have funny things to say in conversation. We're not all like Debbie downers. Yeah, I'm green. And so is that kind of what you're teaching when you're going in and talking about humor outside of, you know, how you talked in the beginning about timing and about the comic triple and having those unexpected things at the end of your sentences or punchlines if you will. So you're kind of teaching these tools, but in the end, as the worker or as the company, it's sort about changing the culture.

Andrew Tarvin:             32:10                It is. Yeah. I think that's a great articulation of it. So in the book we had a book that just recently came out and it's called humor that works with missing scale for success and happiness at work. And, you know, we talk about 10 humor strategies for using humor in the workplace across five different kind of key skills at work. And so if you want to use humor to improve your productivity, you know, you can gamify your work or play your work and here are the steps how to do that. Or if you want to use humor and connecting with people here as a way to, you know, kind of a three step process we mentioned earlier about and that's a way to build empathy with someone. But at the end of the day, the bonus strategy and I think kind of what articulates what you're talking about is the biggest thing that we encourage.

Andrew Tarvin:             32:52                The biggest takeaway, and I would say the same is true of your podcast listeners, is to simply think one smile per hour. You know, what's one thing that you can do each hour of the day that brings a smile either to your face or the face of someone else. And so that could mean, hey, if you like telling jokes and you want to learn more of them and you have that, you know, like you like that witty kind of feeling great, do that. If instead you're about to, you know, get in traffic and you know, like how can I bring a smile to my own face? Like, Oh, well let me maybe listen to a comedy podcast on my way home from work so that I laugh and show up more present for my family when I get there. These are all just small choices. And to your point, I think everyone, everyone has a sense of humor.

Andrew Tarvin:             33:35                I think it might be a very specific sense of humor and sometimes you don't always see it, but I think everyone has one. And so it's like, okay, how can you leverage your sense of humor to bring that smile to the workplace? And the other thing is directing that you don't always have to be the creator of humor. Instead, you can be kind of the conduit of it or the shepherd of it where you know, you don't have to be the one that makes a funny joke. Maybe you find one online and you added as a pss or the end of a long email. Or you find images online using a creative Commons license and have that in your presentation as opposed to having a bunch of slides with just full of text. Maybe you watch a Tedx talk that you think is really, really good that you really like and you like, you share that with people to say, Hey, you know, let's try to incorporate this type of thing a little bit more. So you don't always have to be the creator of it, but you can be that source of it, that shepard of it.

Karen Litzy:                   34:24                Yeah. Great Advice. Thank you so much. That really helps to kind of break it down in my mind. And I would assume in the listeners minds as well. And you know, before I have one more question that I ask everyone, but before I do that, you had mentioned Tedx and I do want to mention that you had a great tedx talk that's been viewed millions of times. I watched it, I loved it. Where can people find that talk?

Andrew Tarvin:             34:48                Ah, yes. So they can find it. If they just Google my name, Andrew Tarvin, Tedx, it'll show up. Or they Google a skill of humor. Tedx, it's on the official, you know, Tedx Youtube Channel. If you just Google my name, it's one of the first things that comes up and you can getting near your, a fantastic story about my grandmother and we go in and talk. It's funny, it goes into a little bit of that deeper dive of the scale of humor and for me at a, yeah, that can be a great starting point for people. And I know plenty of people have used that as a thing that they share out where they're like, hey, you know, I want to incorporate more humor into the workplace. People don't necessarily know why. So let me send this out to my team and say, Hey, this was a funny talk that I really like. Maybe it should encourage us to have a little bit more fun in what we do.

Karen Litzy:                   35:31                Yeah, I really enjoyed it. It was a great talk and it was funny in that bit with your grandmother is classic Classic Grandma classic grandma's stuff. So everyone listening, definitely check out the TEDX. It's really great. And like I said, before I finish, I usually like to ask everyone the same question. And that's knowing where you are now in your life and your career. What advice would you give to yourself as a new Grad?

Andrew Tarvin:             36:00                As a brand new Grad. Two things kind of come to mind. The first, is more tactical and I would say do stand up comedy earlier, frequently. Just because one, I love stand up. I love doing stand up. It's I think one of the hardest forms of public speaking you will ever do.

Karen Litzy:                   36:22                Yeah. I would never be able to do it. I give you all the credit in the world.

Andrew Tarvin:             36:26                Well, one, you absolutely could do it if I could do it. Anyone. But it is intimidating, but it's made me much, much better as a speaker. In fact, that I think the reason that the Tedx talk has been successful is because I did a lot of stand up before it to work on it, to practice it, to try jokes. And it's where I've refined, you know, my sense and my skill of humorous, I'd say do that, you know, first. And then I think the other thing would be get more clear on the articulating the value of humor. It took me a while Kinda to your point, you know, why do companies hire this? At first I was like, no, humor is just a brilliant idea. Shouldn't everyone see that? And the reality is that no one cares about humor and the workplace, like in terms of they never think of it as something that they need. And, and they know that they need communication training or leadership training or they know that they need to improve morale or they know that they need to help people relieve stress. It just turns out that humor can be the tool to do a lot of those things. So getting more clear on how humor can be beneficial, I think would've helped my personal career a little bit more and would've gotten me out to sharing this message with more people sooner.

Karen Litzy:                   37:32                Great. I love it. And I don't know that I would ever do standup. But you're making me consider it. Like even when I took, even when I took improv classes, I had like an Improv teacher come to my apartment cause I was too nervous to go to a class because I didn't want to screw up.

Andrew Tarvin:             37:51                Yeah. But here's the thing though is you just rock this, this podcast and plenty of other ones in the future. That's all Improv as well.

Karen Litzy:                   37:58                I know that's why I took the class, but I don't know. There's something about being, I dunno, it's a fear. I should probably, I'm working on my public speaking. I've been working on that for the past year. But yeah, I think taking an Improv class in front of actual people and with other actual people would probably only benefit me. But it's just so darn scary.

Andrew Tarvin:             38:21                It is. That's why you have to, you have to leverage that one light, that one evening that you like, have that like, you know what, I should do it. And then you sign up real quick and then force yourself to like go and there were only reason why I say that is is because I'm a big believer. Improv is fundamentally changed my life because as I mentioned I am very, very much was an introvert and everything growing up and that's how I kind of got into this and so I'm a strong believer that anyone listening, you know if they have the capacity, if they have any slight interest in it, I think should take an Improv class because it teaches you life skills. In fact, one of the most popular blog posts that we have on our website is 10 life lessons from Improv. So much application. It teaches you the human skills to interact with other people on ways to be more present, to think on your feet, to be able to react quickly, to build your communication skills and your confidence. Like there's tremendous number of benefits and once you get used to it, it's so much fun to do.

Karen Litzy:                   39:19                All right, I'll think about it next time UCB has like a one on one class. Granted that's upright citizens brigade for those who aren't, I guess in New York. They may not know that. If I can make the cut cause those classes fill up in about five minutes. But maybe I will do it this time. We'll, we will see. And now you mentioned your blog. Where can people find you?

Andrew Tarvin:             39:42                Yeah, so if they're interested more in the human in the workplace, if they go to we have a bunch of, you know, blog posts out there about different topics on humor. There's a free newsletter to sign up to. There's a link to our new book that has a lot of resources there as well. I information about our workshops and coaching and all that kind of stuff. And they want to connect with me directly. They can find me @drewtarvin on all social media. So whether that's Linkedin, Instagram, Facebook, Twitter, a recently discovered, I still have a myspace page. So if my space is your jam, then you can connect with me there as well.

Karen Litzy:                   40:23                That's amazing. Well thank you so much, Andrew, for coming on and sharing all of this great information on how to use humor in the workplace. So thank you so much.

Andrew Tarvin:             40:35                All right, sounds great. Well, thank you so much for having me, and hopefully this was valuable for the listeners.

Karen Litzy:                   40:41                I'm sure it was. And everyone out there listening, thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.



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Jul 29, 2019

On this week’s episode of the Healthy, Wealthy and Smart Podcast, I welcome Leda McDaniel on the show to share her experience with persistent pain.  Leda McDaniel is a Physical Therapist in Atlanta, GA. As a physical therapy student, Leda published a book that chronicled aspects of her three-year battle with chronic knee pain and ultimately led her down a path of discovery on her way to healing with a holistic approach.

In this episode, we discuss:

-Leda’s experiences with Complex Regional Pain Syndrome (CRPS) and how it impacted her life

-Pain neuroscience education and a holistic approach to treatment for CRPS

-How Leda’s approach to patient care has shifted to a biopsychosocial framework

-The importance of listening to the patient’s story and being a voice of hope

-And so much more!



Sapiens Moves Website


Painful Yarns Book

Moments from a Year of Healing: A Book of Memories and Essays

Leda McDaniel Facebook

Sapiens Moves Instagram

The Outcomes Summit: use code LITZY 

For more information on Leda:

Leda McDaniel is a Physical Therapist in Atlanta, GA. She earned her Doctorate of Physical Therapy from Ohio University and holds a B.A. in psychology from Trinity University, in San Antonio, Texas where she also played Basketball and ran Track and Cross Country for the NCAA Division III School. As a physical therapy student, Leda published a book that chronicled aspects of her three-year battle with chronic knee pain and ultimately led her down a path of discovery on her way to healing with a holistic approach. It was this experience that motivated her to become a physical therapist in order to help others recover from chronic pain. 


Her book is entitled: “Moments From a Year of Healing: A Book of Memories and Essays” and can be found on Amazon:


Leda’s Professional Blog:


Read the full transcript below:

Karen Litzy:                   00:01                Hi Leda welcome to the podcast. I'm happy to have you on and a big congratulations to you for being a new physical therapy graduate. So welcome to the field.  And you know, longtime listeners of this podcast will know that I often have people on the podcast who have struggled through persistent pain, who maybe are still having persistent pain issues and you are one of those people. So what I would love for you to do is just let the audience know who you are and tell your story and then we'll take it from there. So I will throw it over to you.

Leda McDaniel:                                     Thank you. Yeah, so I just recently graduated from physical therapy school and I’m entering my clinical practice as a physical therapist. So I'm in Atlanta, Georgia and I'll be starting residency at Emory university for Orthopedic Physical Therapy in August.

Leda McDaniel:             01:03                So I'm really excited about that. A little bit about what got me into this field and interested in being a physical therapist. I had an ACL injury that I suffered in my mid twenties, tore my ACL playing soccer and then I had surgery, reconstructive surgery, to repair that ACL. And the recovery from the surgery didn't quite go as planned, so I had had a prior ACL surgery, so it kind of knew what to expect. What's this time it was not quite so good and it was a little bit different and challenging in that the physical therapist I was working with kept pushing me to strengthen my muscles and try to get my range of motion back and all those things that I was familiar with, but I knew it wasn't really responding as you might expect it would after surgery. So I had this chronic pain and inflammation that developed over the next six months to a year.

Leda McDaniel:             02:04                And both my physical therapist that I was working with at the time, and then, a handful of orthopedic doctors, including the surgeon who did the surgery, they were a little bit puzzled as to what was going on because I had a repeat MRI. They couldn't find any structural issues. At the time I was really focused on that idea of well I still have pain, what is wrong structurally? And I just had this feeling that something is wrong. It didn’t feel right. It was always painful and it was always swollen and I really couldn't it over the hump to the extent that I was even limping when I was walking about a year after surgery. So I continued to try to rehab and over the next additional year and two years out of ACL surgery I had a second surgery.

Leda McDaniel:             03:00                The idea that they clean out some of the scar tissue in there.  It's the joint capsule is scarred up a little bit and try to get things work in a little bit better or feeling a little better after that surgery. Again, that kind of made my situation worse and I developed this mirror pain cause I knew I was hypersensitive at that point and had after that diagnosis of complex regional pain syndrome and just really severe nerve pain to the extent that not only was it painful to walk, but I really couldn't walk and I couldn't put pressure on that knee. I couldn't touch the knee without it being painful. And kind of just spiraled into it's really bad situation where I was pretty disabled. I wasn't able to work at the time. And in that time period had gone back to school for physical therapy because I'm flattered by this injury and wanting to help other people regain their health.

Leda McDaniel:             03:59                I had some really excellent physical therapists along the way who really try their best to work with me even though things weren't going in an ideal direction. So, anyway, so I had to take time off school. I couldn't work.  All of this really pursuing or being fixated on this idea of what structure is injured. And it really, the course of my injury and health didn't really change until my perspective or kind of switched my focus to more of a treating pain based on what were currently understanding is more of a progressive approach to chronic pain, which is pain neuroscience education where we're understanding that there are many components to pain not just structural ones and a lot of these inputs can contribute to these situations where you have this over sensitivity or hypersensitivity.

Leda McDaniel:             05:05                And that's kind of the place I found myself in. So I really started to self treat based on some of those principles and try to reduce the sensitivity that built up within my nervous system. And over the course of about a year, I was able to turn things around and get back to the point where I was walking. I was back to school, working, functioning in society like I wanted to and my pain levels were significantly decreased. And gradually, gradually got to the point where I was pain free.

Karen Litzy:                                           And can you talk about what specifically you did during this time in order to treat the pain? Obviously not treat the structural issues, but to treat the pain just so the listeners have an idea of what you did.

Leda McDaniel:                                     Sure, absolutely. So it's not a quick fix approach by any means, and it's not a singular approach by any means.

Leda McDaniel:             06:08                So I really had the perspective of creating as many positive inputs to my life as possible. And I was really diligent about addressing all the different components as we know, pain really has this bio, psycho social, construct. And so I really wanted to have positive inputs physically, mentally, and emotionally and socially. So physically, I was eating a really nutrient dense diet, so lots of full foods, real foods, fruits, vegetables, bone broths, collagen stocks, things like that. So really preparing foods from scratch and eating a lot of nutrient dense foods. I was meditating to decrease my sympathetic activation or over sensitivity work on the mental component. I was doing a psychological therapy at the time. So cognitive behavioral therapy to try to just that psychological component. I was using visualization to try to incorporate the lowest level input that I could to that system and really start preparing for movement in a joint that couldn't really take movement in the beginning, but trying to retrain my brain to prime it for the movements I want it to be able to do.

Leda McDaniel:             07:42                So I did a lot of visualization on walking, moving my knee. When I got a little bit better, I would visualize myself doing higher level athletic activities such as running or jumping or those sorts of things.

Karen Litzy:                   09:44                So over the year plus time that you started incorporating all of these different kinds of inputs into your system, did you start doing everything all at once or did you sort of slowly pepper things in?

Leda McDaniel:                                     Yeah, so there was definitely kind of a gradual addition of different components. As I learned more, I was trying to incorporate different types of movement to try to make a difference. So, for example, I'd started a mindfulness based stress reduction meditation course online. That was free. Because I had found out about that and that helped quite a bit. But I gradually added other things in. And one of the things I wanted to mention as well is I was doing, it's hard to mention every single treatment I was doing cause I was really trying to address all these little pieces and I think addressing all those little things really made the difference to turn the tide.

Leda McDaniel:             11:07                So one of the other important things that I was doing not overly relying on but definitely helped me get out of the most acute and serious pain so that my nervous system could reorganize was pharmacological treatment. So I was taking so medications to get me out of pain. And I think that as an adjunct treatment to the other things I was doing, it was actually really important. So you have these periods of not being in such severe pain that I had the ability to you some of these other treatments.

Karen Litzy:                                           Yeah, and I mean I don't think that there's anything wrong with pharmacological interventions, especially for people with CRPS. I mean this is really painful and I think that you're right, you kind of need the medications as a bit of a reprieve for your systems so that you can get to all this other stuff.

Karen Litzy:                   12:08                Now the question is, is are you now on the same medications that you were on in the sort of height of this pain process?

Leda McDaniel:                                     I am not. So I was pretty resistant to taking medication in the beginning. And I really used it for the smallest duration that I could to get me out of that really severe pain. Once I was on my way with this combination of lifestyle factors and I'd really seen the pain decrease to the extent that I could walk without being in pain, or I could touch my knee without having a severe pain reaction, I really started to taper off these medications with the guidance of the prescribing physician.

Karen Litzy:                                           Right. So I think for listeners is just important to remember that if you have pain, we're not saying do all of this other stuff and don't go a pharmacological route because sometimes that's necessary, but you have to make sure that you go that pharmacological route with your physician and that when you're ready to kind of taper down that you do that also under the guidance of your physician.

Leda McDaniel:             13:31                Absolutely. That's a great point. I think also it's important to mention that, and this has been mentioned by others in the field that are doing this work, really trying to get patients to take an active role in their treatment. So just taking medication but not doing these other active components such as meditation, the prescribed loading if that's appropriate. And really addressing lifestyle factors and taking ownership of those in addition to these more passive treatments I think is really important.

Karen Litzy:                                           Yeah, and I think when you're talking about people with persistent pain issues like CRPS, you kind of, I think it's okay to have that combination of active and passive treatments. But yes, the patient has to know that they're not coming to the healthcare practitioner to be fixed, but instead they're coming to be guided and that they need to, like you said, take an active role because all of this, you know, nutrient dense diet, meditation, psychological therapy, visualization, progressive loading, exposure training.

Karen Litzy:                   14:49                So exposure to movement, exposure to activities that maybe you have fear avoidance behaviors around. All of this requires active work from the patient, active work from you. Right? And if you're not doing that as the patient, I think that you’re not giving yourself an advantage. Would you agree?

Leda McDaniel:                                     Yeah, absolutely. Well said, Karen.

Karen Litzy:                                           Yeah. And so let's talk about timeframe here. So obviously changing your diet. We know that diet does have a huge ramifications to overall health, the psychological training, the meditation, the gradual loading, exercise, movement, visualization. This all takes time. So people will probably be thinking how many hours a day were you working on this stuff?

Leda McDaniel:                                     Well, for better or worse, I wasn't able to work or go to school at the time. And so really regaining my health over this year period, I actually deferred a year from physical therapy school.

Leda McDaniel:             16:00                I had started and completed my first semester, but then wasn't able to continue sequentially, but my program allowed me to defer a year. So for that year my fulltime job was getting back to health and I really took that seriously as a full time job. So, a majority of my time was spent trying to create these positive inputs. I was doing a lot of reading and trying to learn as much as I could about pain and physical therapy related things, because that's developed into one of my passions and I really felt like it was important to maintain this engagement in intellectual pursuits as well, so that I could have some connection and some purpose to my future, even though I wasn't actively in school at the time or actively working at the time. So really to answer your question I was working on this pretty diligently.

Karen Litzy:                                           And what was, and maybe you didn't have one, I don't know, but did you have this sort of Aha moment at any point? So from the first surgery to where you are now, can you say there was one point where you reached this crescendo and then things started to fall in place?

Leda McDaniel:             17:24                Yeah. Thinking back, I think, I can't pinpoint a specific time point that I would say generally it was about the time when I was forced to take a break from school. So it was almost at the lowest point where I wasn't able to walk on my leg, wasn't able to touch my knee because a sensitivity pain had gotten so bad that it really taken me out of a normal functioning, productive life. And somewhere around that point I was researching and reading as much as I could on my own. And I really stumbled upon this pain neuroscience education approach and some of the work of Lorimer Moseley and Butler and Lowe. And this idea that the pain that I was experiencing didn't necessarily have a structural cause. And to me that was the time period when I really changed my approach from this fixation on trying to find a healthcare practitioner who would tell me what is structurally wrong and how can we fix it to an approach of my nervous system.

Leda McDaniel:             18:42                My brain is just creating this maladaptive signaling, maladaptive pain response and I really need to target my nervous system sensitivity versus trying to pinpoint what is wrong structurally for me, that seems like the turning point, where I was able to really start making gains and gradually progressed back to health.

Karen Litzy:                                           Yeah. So it was kind of the light bulb went off and you said to yourself, I think there's another way. And was there any one piece of reading book article that you can say, you know something, this really helped me to understand what's going on?

Leda McDaniel:             19:30                Yeah. I think as somebody who's interested in health at the time, but you didn't have a great grasp on some of the biology and physiology surrounding pain systems and the nervous system one book that really helped me understand these things and I would recommend to clinicians and patients who are wanting kind of an easy buy in to these sorts of principles is Lorimer Mosley's book painful yarns. He tell stories to communicate these principles of how pain systems work in our bodies. And really does a lovely job making these principles accessible to people who might not have the scientific background to understand because pain is complex. These systems are complex. But listening to these stories, I think it makes it really understandable.

Karen Litzy:                                           Yeah. A little bit more digestible for folks. I often tell my patients to get that book because it really is a patient forward book because of the stories and the metaphor that he uses throughout the book to make you say, Huh, okay.

Karen Litzy:                   20:51                I think I'm starting to understand this a little bit. Because for the average person, maybe they don't need to get too into the weeds as to the chemical reactions happening in the brain and within the body in the spinal cord and why these persistent pain issues can arise and kind of take hold in the body. But we certainly can give patients stories and metaphors to help them have a better understanding of maybe what's happening and to decrease the fear around what's happening within their bodies. And I think painful yarns does a great job at that.

Karen Litzy:                                           And all right, so you are diagnosed with CRPS you dive in, you start treating yourself. Were you still seeing a physical therapist over this year? Or were you really just at this point working on all of the components you mentioned above on your own?

Leda McDaniel:             21:51                I had actually stopped seeing a physical therapist because as I was learning more, I was seeking a clinician who had some of these approaches in their toolbox. For example, the graded motor imagery. And I really unfortunately couldn't find one in my geographic area. And so I was actually doing these treatments, kind of self treating at that time, hoping that eventually I could work with a PT for some of the loading components. But knowing that at that point I just couldn't tolerate the exercise based physical therapy.

Karen Litzy:                                           Right. And now were you ambulatory at this time? Were you using an assistive device were you in a wheelchair. How were you getting around?

Leda McDaniel:                                     So after that second surgery I was using crutches for about nine or 10 months. And really non weight bearing. I couldn't put weight on my leg so I didn't go to a wheelchair.

Leda McDaniel:             22:55                Partly probably out of stubbornness. But yeah, I was using an axillary crutches to get around everywhere.

Karen Litzy:                                           Okay. Well that is not easy as we've all had patients who've been on crutches for like six to eight weeks and they seem to just be completely spent. I can't even imagine for 10 months. But I mean good on you for keeping up and I'm assuming you started seeing progress, which is why you kept with all of this stuff. Right? So how long into this year and a half or a year plus did you start to see changes within your pain?

Leda McDaniel:                                     I would say probably within, it took probably three, four months of diligently committing to these practices before I really saw some noticeable change. Which was really hard. But at the same time I think is an important thing to communicate where these changes and the sensitivity that's been built up in your nervous system, it does take time.

Leda McDaniel:             24:10                It does take some patience and some persistence and I would really encourage patients and clinicians alike to have this longterm perspective of if we can introduce these positive things just to kind of have trust and just kind of have faith that they're going to make a difference, that they are making a difference on some level, but that noticeable changes might take awhile to manifest.

Karen Litzy:                                           Yeah, I agree. I think it is very important when you have patients with persistent pain to be very honest with them and make sure that you're giving them some realistic timelines. Because let's face it, we're human beings and we get frustrated, right? We want things to happen sooner rather than later. Especially when you're in pain and especially if you're suffering. I mean you just can't imagine doing this for another month or week or even day for some people. But I think being honest and giving realistic feedback is very important because that also helps you to mitigate your expectations, which is important, especially when you have such a serious pain complications as CRPS. And now, how has this experience influenced the way you will now treat as a physical therapist?

Leda McDaniel:             25:48                I think ultimately while there are a lot of things that I think it adds to my ability to treat patients as a clinician, maybe the first thing is to have a little bit more empathy and compassion for what these patients are going through. Having had this experience, I think I understand what the chronic pain journey and struggle looks like, but also what it feels like to be in that. And I think it helps me relate with my patients a little bit better. So that I'm not just talking at them, but I'm really able to kind of imagine what impact it's having on their life and to try to communicate accordingly and really, really develop some good therapeutic alliance with these patients. I think the other thing that it allows me to do as a clinician is kind of as we were talking about, have a little bit more patience and approach these patients in a little him more of a calm manner.

Leda McDaniel:             27:01                I think in realizing that it's going to take time to see changes, but that doesn't mean that it's not worthwhile to work with these individuals on improving their function but also on improving their pain. And really promoting this expectation that recovery from pain is possible or could be possible, but that's more of a longterm goal for these individuals than some of the patients that we work with who are in an acute injury or an acute pain situation.

Karen Litzy:                                           Yeah. So it's really providing hope to the patient, allowing them to even visualize themselves pain free. Cause oftentimes if you're years into a painful experience, sometimes you can't even picture your life without it. So I think it's really important to give that hope to patients. And another thing that you had mentioned in some of the pre-podcast writing is that allowing the patients to tell their stories.

Karen Litzy:                   28:16                So just like today having you tell the story, it can be very powerful way for you to continue with your recovery and for others to learn from. So as clinicians, we have to allow these patients to tell their story and also noting that that story may not all come out at one visit.

Leda McDaniel:                                     Yeah, good point. I think there's just like in any physical therapy session or clinician patient relationship, depending on the personality of the patient and the clinician, there's just a natural unfolding of developing trust and developing an ability to communicate between the two people where you really can't force that story out of the patient and you really can't force that trust or rapport but I think as you're intentional about listening to your patients and understanding where they're coming from and how their injury is affecting their life, personally I think over the course of a few treatments or however long it takes to naturally work itself out, you really can develop a close alliance and improve your ability to the effect that patients' health in a positive way and garner some positive outcomes from your treatments.

Karen Litzy:                   29:48                Yeah. And I think the other thing that's important to mention is sometimes patients aren't ever pain free. And that's okay. Sometimes patients aren't pain free, but they're doing all the things in their life they want to do. You know, they're working towards the things they want to do. Or maybe they went from taking four pain pills a day to a half of one a day. So they may still have pain. And I think as physical therapists, it's sometimes a little difficult because we want to fix people, right? We want to make people 100% healthy, but it's okay if the patient continues to have some level of pain that they're coping and they're living the life that they want to live. So I think as new graduates, if I could give a little piece of advice to all of you guys, it's to not take on your patients outcomes as your own, but to really, like you said, have empathy, sympathy, step into their shoes and understand that hey, maybe they're not pain free, but they can do everything they want to do. And that's okay. They can live with that.

Leda McDaniel:             31:00                Yeah, that's a great point. There are different markers or ways that we can see positive change in physical therapy and decreasing pain is one, but improvements in function are another one and absolutely mentioning if we can reduce medication use that can have positive implications of a person's experience and their overall health as well. So I think all of those things are great. Great things to think about.

Karen Litzy:                                           Yeah, absolutely. And now, you know, is there anything that we missed? Anything and we're going to, I'm going to get to your book in a second, but is there anything that we missed about your story? Any piece of advice that you know, maybe you would like to give to clinicians as someone who's gone through it?

Leda McDaniel:             31:52                I think the first thing that comes to mind is as clinicians, sometimes faced with individuals with longer lasting pain or sometimes pain that doesn't quite match a structural issue or a clear PT diagnosis or medical diagnosis. Sometimes the inclination is to get uncomfortable and maybe distrust the patient or the cognitive dissonance that you're feeling into more of a situation. What I would really ask you as clinicians to first off, no matter what, no matter how uncomfortable this makes you or how puzzled you might be as far as what's going on, I would just ask that you really trust what your patient's telling you. Trust their story, trust their experience. And if it takes a few visits to kind of reconcile what they're communicating with, maybe what is going on, whether it's a sensitization or a longer lasting pain that's manifesting in some other way, I would really ask that you treat them as if what they're telling you is the absolute truth.

Leda McDaniel:             33:19                And give that a chance to really play out before making assumptions about a malingering or a psychological primary component to what they're telling you. I think in a lot of cases that's too soon of an attribution from clinicians who are uncertain about what's going on.

Karen Litzy:                                           Excellent advice. And you know, at the end of each podcast I usually ask someone, hey, what advice would you give to yourself as a new graduate right out of PT School? But since you literally are a new graduate right out of PT School, it doesn't seem like the right question to ask. But what I will ask is this, knowing where you are now in your recovery and in your life, what advice would you give to yourself during the height of your pain experience? So if you could go back in time knowing where you are now, what advice would you give to yourself then?

Leda McDaniel:                                     Oh yeah, that is a great question. I think what I would tell myself is, and I did this a little bit, but I think I would try to encourage myself further, is to keep an open mind about what is possible for your improvements in health and for the body's ability to really heal and recover given the appropriate inputs.

Karen Litzy:                   35:01                Excellent advice. Thank you so much. And now if people wanted to know more about your story and dig a little bit deeper into your year of healing, they could read your book Moments from a Year of Healing a book of memoirs and essays. And where can people find that?

Leda McDaniel:                                     Yes, so my book is available online. It's available from Amazon, both in a print paperback version and also as an Ebook, supported by kindle. So they can search for the title of the book, Moments from a year of healing, a book of memories and essays or search for my name as the author. And I believe either way they should be able to access that.

Karen Litzy:                                           Awesome. And what if people have questions for you? Are they want to talk to you a little bit more? Where can they find you?

Leda McDaniel:                                     Sure. My email is and I'm happy to open conversations and really talk to patients or clinicians who are wanting additional resources or just wanting to hear more about my story. Yeah, I think that would be great.

Karen Litzy:                                           Well, thank you so much for coming on and sharing your story. And again, congratulations on being a new physical therapist. Good luck in your orthopedic residency at Emery. And I am very certain that any patient that works with you will be very lucky to have you. So thank you so much for being on the program. Everyone listening. Thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.


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Jul 22, 2019

LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Christian Barton on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada.  Dr Christian Barton is a physiotherapist who graduated with first class Honours from Charles Sturt University in 2005, and completed his PhD focusing on Patellofemoral Pain, Biomechanics and Foot Orthoses in 2010. Dr Barton’s broad research disciplines are biomechanics, running-related injury, knee pathology, tendinopathy, and rehabilitation, with a particular focus on research translation.  Dr Barton has published over 40 papers in Sports Medicine, Rehabilitation and Biomechanics journals, and he is an Associate Editor for the British Journal of Sports Medicine.

In this episode, we discuss:

-The inspiration behind TREK Education

-Different mediums that facilitate knowledge translation from researchers to clinicians and patients

-Common misconceptions around running and injury prevention

-The good and bad surrounding social media and knowledge translation

-And so much more!



Third World Congress of Sports Physical Therapy

Christian Barton Twitter

La Trobe University Sport and Exercise Medicine Research Blog


TREK Facebook Group

Made to Stick

TREK Education Website


For more information on Christian:

Dr. Christian Barton, APAM, is both a researcher and clinician treating sports and musculoskeletal patients in Melbourne. He is a postdoctoral research fellow and the Communications Manager at the La Trobe Sport and Exercise Medicine Research Centre. Christian’s research is focussed on the knee, running injuries and knowledge translation including the use of digital technologies. He has written and contributed to a multitude of peer-reviewed publications and is a regular invited speaker both in Australia and internationally. He also runs courses on patellofermoral pain and running injury management in Australia, the United Kingdom and Scandinavia. He is on the board of the Victorian branch of the Musculoskeletal Physiotherapy Association, and a guest lecturer at La Trobe University and the University of Melbourne.

Christian is currently studying a Master of Communication, focussing on journalism innovation. He is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine, as well as Associate Editor at Physical Therapy in Sport.


Read the full transcript below:

Karen Litzy:                   00:00                Hey everybody, welcome to our live broadcast. I'm just going to take a look quickly on my phone to make sure that we are in fact live, which I think we are. Yes. Great. All right, so we're live, which is awesome. All right, so thanks to people who are already on and thank you to my guest, Christian Barton, coming all the way in from Australia. So it is my times as you're watching this. It's 9:30 New York time. So Christian, what time is it in Australia right now?

Christian Barton:           00:37                11:30 in the morning. That's quite a nice time to do this.

Karen Litzy:                   00:43                Yeah. So we're doing this over two different days, so Tuesday for me and Wednesday for you. So crazy. But anyway, thanks for taking the time out to come on to chat with us. So for all the people who are on right now and for as we go through, if you have questions, you can type them in the comments, we can see them and we'll be able to address them as we go along. But before we get started, Christian, what I would love for you to do is just to tell the viewers and the listeners a little bit more about you and how you got to where you are now.

Christian Barton:           01:18                Yeah, sure. So I'm a physiotherapist by background have been for nearly 15 years now. So it's getting on. I've always had an interest in research and clinical practice and continuing to try and juggle the two. And that probably started from the very beginning. I finished my undergrad course and well tried to find a position to do some research assistant work on clinical trials and things like that. And quickly my mentors taught me to do your PhD and actually started that about a year and a half out. And so I did that quite early in my career and probably since then I've been probably a mix of half, half clinic and research. So along the way, probably as I've gone through more recently doing more and more research because it gets harder to keep the research, you can do bigger picture things, which is something I've become really passionate about and I'll talk more about later.

Christian Barton:           02:05                And so currently I work three main roles. One is my own clinic in Melbourne, which is a sports and an injury clinic. And we work one day a week there and then also work at the Trobe university three days a week. And my main research focus areas around there it's translation and implementation. And then the past couple of years have been doing one day a week with a surgical group. So the Department of Surgery, it's in Newton's hospital in Melbourne and there big project or area of research is around preventing inappropriate surgery. So that aligns very well with what I do of trying to optimize what we do as therapists to prevent unnecessary or inappropriate surgery as we go along.

Karen Litzy:                   02:44                Yes. Fantastic. Busy weeks. You have busy weeks.

Christian Barton:           02:48                Yeah, I work alongside the three kids at home and yet it's not, not the easiest to juggle at times, but it's certainly all things that I enjoy.

Karen Litzy:                   02:55                Yeah, that's amazing. And every time all the interviews ever had with all of the speakers who are coming to Vancouver in October, all do so much. But we didn't do one time is just have an interview on how you manage your time. But that's for another interview. But I think people would really enjoy that. So now let's talk a little bit more about physiotherapy. So why this field?

Christian Barton:           03:23                Yeah, I think as a kid I was always active, playing a lot of sports and had a few injuries myself. And I think I always valued the physios guidance about getting back from some of those injuries. So that got me interested in the field and then you go to university, you actually realize physio has a lot more than just train sports injuries. And you need to have to think about pulmonary rehab and cardiac rehab and you're electrical physio. There's a whole range in spectrum that we through. But I think pretty quickly when I come out I would want it to go back to musculoskeletal and sports. And so we went back down that path. And I think what I enjoy about being a physio therapist is just keeping people active. That's your more sedentary person, where you're trying to motivate them through lifestyle changes to get active and manage their persistent knee pain or back pain or whether it's a really elite sports person. I really enjoy trying to get people to achieve their physical activity goals essentially is what I'm enjoying.

Karen Litzy:                   04:18                Awesome. And now I can see more and more people joining you. Again, if you're joining, please write like where you’re watching from and if you have any questions, put them in the comments because we'll be talked with, you know, so now let's, you had mentioned this earlier, talking about kind of what you do, part of what you do and you're involved in several knowledge translation initiatives. One of them being the trek group, which I remember I guess it was last year after sports congress and we all changed our social media to the trek elephants logo, which was really great. So this is a nonprofit initiative created to enhance knowledge translation to healthcare professionals, but also to patients and general public. So can you tell us a little bit more about trek and how it all started?

Christian Barton:           05:13                Yeah, sure. Also I think my research journeys being quite interesting. When I first started off doing research, I was in a gait clinic doing biomechanics research and I've always found that side of our practice really interesting. And you do this real integral research and you spend a long time for assessing data and finally end up with maybe a couple of things that you can share in the community and they share them. And then I started doing more clinical based research and trials. Firstly looking at biomechanics and then did you that exercise interventions. Very early on I actually worked on a lot of systematic reviews and my passion for doing that was, well we have all this great body of research, we need to bring it together so we can disseminate a little bit better. And then I actually did a project in London where it was actually looking at clinical reasoning of physical therapists and how they integrate evidence into their practice.

Christian Barton:           05:59                And what I discovered really quickly is not only were people not using evidence based practice all that often when I actually talked to them about patellofemoral pain, which I'd spent the best part of seven or eight years researching, they've never read any of my papers, never read any of my research. And so it sort of made me reflect a little bit and go, well, why am I doing all this research? And it's not actually being translated into practice. And so I started to have a bit of a flipping all I did and instead of spending time in the lab alongside doing clinical trials, I started to focus a bit more time on actually getting information out there. And so have a good friend of mine, Michael Ratliffe who's based in Denmark and we often catch up and catch up at conferences.

Christian Barton:           06:40                And actually one of the first times we spent a lot of time together was when I went to a Danish conference a number of years ago. It was actually after that conference, I was sitting down both quite frustrated, having a couple of Belgium beers talking about this problem and the acronym trek come up with just on a random occurrence sitting his kitchen table. I still remember it. It was like, how do we do this? We'd probably need to brand it with already and get people behind a movement and something happening. So trek stands for translating research evidence and knowledge. So it fits really nicely with that. It actually has more meetings in that. And if you look at English language for trek, it means a long and arduous journey, which I think an old translation very much use when you try and actually make change. And then it also fits with

Christian Barton:           07:22                probably one of my favorite books I've ever read, which is called switch, which is how to make change when change is hard. I highly recommend people read this book. It changed my life. And it's a really simple analogy. You have a rider sitting on an elephant and you need to get to a destination. So there's three main parts to that. The rider needs to know where to go. The elephant needs to be motivated because it doesn't matter if the writer tells them how often to go. It's not going to go anywhere to be big beast. Right?

Christian Barton:           07:48                We also need an appropriate pathway to get there. So if you picture yourself as an elephant rider on an elephant and an elephant in the middle of the jungle, we want to get to the beach. There's no path to get to the beach and it doesn't matter, you're not going to get there. So the concept of trek is that we have clinicians, we have patients searching for health information who are all motivated to learn more and to do better. They don't really know where to find that information and they certainly don’t know appropriate path to get there. So the idea of trek is to try and improve that. So that sort of started as an idea about how we do this. And then we've, I guess talking and trying to work with lots of people. It's been set up as a not for profit.

Christian Barton:           08:25                So it's not meant to be owned by anyone. No one's meant to profit from it. It's trying to bring everyone together and break down the silos of competition between universities because universities don't like to talk to each other and help each other because they're in competition for the same grants and that they might be buried. The knowledge translation. So it's been really important to me from the beginning that yes, we'll try here where I work supports it. But it's not meant to be owned by the tribe. It's not meant to be by myself. It's meant to be everyone seeing. And it comes from a socialist I guess, concept called connective action where we actually, it's basically a meeting which we connect people with the same ideas. And then I did a communications degree and was focusing on journalism and multimedia and social media and writing a whole bunch of stuff around that.

Christian Barton:           09:10                And I thought, well, this is a nice platform to use. I think about not just mainstream media, but also social media or whatever people turn. And then our favorite thing, doctor Google, where most people turn to health information. And when you start looking at doctor Google, it's a pretty broken system with a lot of misinformation. And so the concept and my hope is that in time, this trek movement or trek concept could maybe be something that we can't take over with Dr Google, but we can certainly contribute to the information that people find on doctor Google. And so it's getting people around the world to contribute information but create it in an engaging format that will actually get people to rate it and use it. We know there's lots of barriers to reading research for clinicians, understanding your research their reading, but also it's time.

Christian Barton:           09:53                And if you can consume the same information sitting on a train, listening to a podcast or looking at a brief video or infographic that maybe gives you the key information from some research and you can trust that source, that it's not biased, it doesn't have an agenda, then that means you can be confident that you can bring that into clinical practice. And for a consumer or a patient that gets that information, they can maybe make health decisions based on that as well. So that was kind of the origins of the project and it's still growing and developing. A lot of people were helped along the way and hopefully we'll get more as well.

Karen Litzy:                   10:24                And what has been, so this sort of launched last year, right? Like officially launched. So what metrics have you found from launching last year to where you are now?

Christian Barton:           10:39                Yeah, so what I did is actually was lucky enough to get a small grant from the Australian physio association to build a platform to improve physiotherapists knowledge of exercise prescription. And so we did a study last year where we basically built a website, which is and before we gave access to everybody, we made them do a test, which is about 20 minutes. And so I have this great data for grants. It's linked with your physios. You've still need to sit down and write up and we see big variations  of knowledge of exercise prescription. And we kind of expected, our hope was that we could then test the evaluate, right? This website helped to improve people's knowledge. Now out of 1,600, I think about a hundred filled in that follow up survey or questionnaire rate. But it was at least as the grant gave us the funding to build a platform.

Christian Barton:           11:26                And it's a multisite platform. So since this time we've built a website now for many patellofemoral pain, which is a big area of mine for clinicians. We've actually just finishing up a low back pain site and a knee osteoarthritis sites. So by the time the conference is around, we will have launched them and be available and working with some other researchers to make a shoulder side. So think of all the big musculoskeletal conditions with variables. And we've also been developing platforms, consumer patients as well. And so we have one which a PhD student in new idea, Olivia or Silva has been working with me for the last two years and we did a super little trial looking to see how beneficial that might be by itself. And then in conjunction with physiotherapy intervention. And certainly the website by itself is incredibly helpful for improving patient's knowledge and self management strategies, their confidence in doing things.

Christian Barton:           12:17                And it seems to lead to reasonable clinical outcomes as well by itself, but probably better outcomes if we combine it with physio. And we haven't done what to evaluation yet, but we're hoping that we can start to do that more and more as we go along. And most importantly, just have some quality resources that are free. You don't have to pay for it, just there, you can use them. And it's been nice to see the exercise site. And certainly the one with the value at the moment. There's plans to do this as well, but they've been embedded into teaching curriculum as well, which has been really good. So University here at La Trobe is using them, but other universities around the world have also used bits and pieces of content and that's the idea of it is to write and use it all way pointless multiple people around the world creating the same content when we could work, maybe be better together.

Karen Litzy:                   13:06                No, that makes a lot of sense. And now you're sort of like you said in the beginning, sort of doing a little bit of both your research and clinician. So why are we, in your opinion, why is it so important to bridge that gap between research and clinical practice?

Christian Barton:           13:23                Yeah, I think from, if I put not my research hat that my clinician hat on and I think about our physiotherapy profession, I think we have some amazing physios around. We do really, really good job. We have others who are very good physios that are working really hard to continue to improve knowledge. We have a lot of practice that I would also consider as pretty low value care and sometimes iatrogenic care where actually maybe delivering health education and information is actually detrimental to the patient. And so I think collectively we need to work really hard to establish our brand better and better because we can do better. And a big part of that is actually making sure that what we do know to be beneficial for patients all around the world is actually disseminated into the hands of people who can use it. And that's a big part of that is physios and other health professionals. So that's the big passion for trying to change it. And I see in my clinic second and third opinions and sometimes it's just the patient hasn't been motivated, haven't done the things that I need to do that have actually been given really good guidance. But equally we see cases where they've seen multiple health professionals and just the treatments and information being given is just not aligned with what we know of contemporary knowledge around evidence about what should help that person

Karen Litzy:                   14:36                As physio therapists, what do you think we're doing really well and were doing right and what do you think we need a little bit of hopefully they’re not doing wrong. But what they just need a little boost.

Christian Barton:           14:57                Yeah, it's a good good question. I think in the most part physio practice and physical therapy practice is moving towards more active management and there's lots of debates on Twitter and social media and people argue about the value or lack of value, whichever side to sit on about manual therapy and things like that. But I think overall we are moving to more active management approaches. We are moving more towards managing the pain science side of things and educating patients better about that. And I think that's probably what we're not doing very well is building that brand of what we deliver. And as a couple of hours to that one is I guess getting collective way across the board that we're all on the same page and delivering similar high value interventions. And what that means is some patients will go to see for therapists or physiotherapists, then they maybe get delivered a lot of electrotherapy or something else and they don't get better in a long time. And then they go back to their doctor or their surgeon and say, oh, I did PT, I did physio. It didn't help.

Karen Litzy:                   15:54                Yeah, yeah. Failed PT.

Christian Barton:           15:57                It failed. And I think that's something that drives me a little crazy is you don’t fail that profession, you fail an intervention. It's a lot of inappropriate surgeries and other treatments. I think collectively we need to be more on the same page, but that's something the knowledge translation probably helps with a lot. The other part that I think we do very, very poorly and actually worked with Rob Brightly, he's going to be presenting the conference and that is collecting outcome measures. So we don't actually measure what we do very well. We occasionally measured them and this is the same around the world for compensable patients because we're forced to. But if you were to audit most people's clinical practice and say, can you show me that what you do is truly valuable, it's worth something.

Christian Barton:           16:48                Most physio practices won't be able to. And I reflect on myself and I can't do this very well. So we need to get better at measuring the value of what we do. So we can take that information to funders and say, hey, we are actually worth something in what we do is worth something. And so I think that's a cultural thing and it's a systems thing and I think it's something we collectively maybe need to work pretty hard to, to try and change. And certainly locally I'm trying to work with the Australian physio association here and it started to come up with some processes that you can, we might do that and knowledge translation. One of the projects I've enjoyed the most here in Australia is a program called GLA:D. I'm going to talk to Ewa recently and that will be certainly discussed at the conference in the biggest strengths of GLA:D isn't it aligns with clinical practice guidelines.

Christian Barton:           17:34                That's education and exercise. So I'll bring that standard up across the board. So first to trust that when they send someone to the program they will get exercise with education and it also raises the outcomes related to that as well. So it can turn around and we have some great data in Australia which were yet to publish, but it certainly shows from now data that not only does pain improve, which is something that may or may not be the most often, but also changes things like medication and also changes things like surgical intention. So people may believe I need surgery or going down the line to surgery. Am I saying certainly in Australia that less people are desiring that. But we look at that in GLA:D that's great here. But the rest of  physio practice so you have nothing to contemplate. Suddenly we need to work. You don't run out.

Karen Litzy:                   18:19                Yeah. And I know the APTA here in the United States does have an outcomes registry that they started I think maybe a couple of years ago, maybe two years ago is starting to collect that data so that we can take it at least here in the US to insurance companies to show that what we do is valuable and that what we do should be reimbursed.

Christian Barton:           18:42                Do people contribute to it, do the people actually give data?

Karen Litzy:                   18:51                I don't know the answer to that question cause it is voluntary. So I don't know the answer to that question at the moment. But I would assume some people do, but do the 300,000 physical therapists that work in the United States? No, but hopefully it's something that will grow over maybe the next, I mean it's slow. Right? So it may take like a decade plus to kind of, if we're being realistic. Right? If someone were to audit my books so to speak, I dunno. I can certainly show that. I don't know. I don't know. That's something I need to get better at, so I'm calling myself out, I guess. And it's something that I certainly need to do better at myself.

Karen Litzy:                   19:52                So let's talk about your experience as a researcher. So we'll move from kind of the clinical dissemination to do you have any tips for, let's say, new and upcoming researchers or even physio therapy students who maybe want to go into the research track to kind of help maximize their potential for reach and for knowledge dissemination? So, you are the researcher, you're doing great work and then what? It doesn't get to where it needs to go. So what tips would you give to people to help with that dissemination?

Christian Barton:           20:37                Yeah, sure. So we put together a paper, which was just recently published in BJSM, trying to remember the exact title, but it's time. I think it's something along the lines of it's time for a place, publish or perish. We've got vanished. Yeah. So we have this in research that if you don't publish your work, then obviously there's no record of you doing it. But also you can't give credibility to your work in peer review processes. Very important to doing that. When we go for job promotions and we got the scholarship, for example, to do a PhD or whatever it might be, they're a competitive process and people look at metrics and one of the key metrics is really simple is how many papers have you published? What journals are they publishing? So it's really hard to get away from that. But ultimately, as we've discussed, that doesn't put the knowledge into the end users hands.

Christian Barton:           21:23                And what happens is we end up with commercial companies selling pharmaceuticals and nutraceuticals and surgical interventions. That can be, I guess maximize money. And even pay teams event and for that matter. And so therefore the researchers, good knowledge doesn't get there. And maybe in health information that if news information gets cut through to clinicians and to patients, so you simply have to allocate some time to do it and you have to be quite aware and understanding that that might mean that you take a little bit of a heat on your academic gap or from a publication perspective because when they have so much time in the day. So that's a thing. It's just having that expectation that you can't do it all. That's really important. Spending some time on it. But in saying that it's not a ton of extra time to, after you publish a great RCT that was part of a PhD or whatever it might be, to spend some time with your media team at the university, put out a press release about that RCT and what the implications might be, which there may be ways from a radio interview or getting picked up in papers.

Christian Barton:           22:27                And so that's not a lot of extra work on top of maybe two or three years of the study even. Right. I think linking in with me, your teams at different universities is a really good starting point if you can. Then we have the social media world, and the social media world as a challenging one because there's a lot of strong and loud voices on there. Some of them are good, strong amount, Sometimes there's misinformation from those strong loud voices. And so you're going into competition for the microphone essentially on social media to do that. And you can get on and you can have debates and arguments and discussions and conversations about your research that you've done. But ultimately the people who disseminating, interpret that are the ones with the loudest voice and that's kind of, you can lose your information, which is a bit of a frustrating thing.

Christian Barton:           23:12                So yeah, so people get very frustrated about that when they've spent two or three years doing some research and then it gets misinterpreted by someone on social media who's got the microphone. So there's a few options around that. I think one of them is either creating a skill yourself or working with someone who has the skills to create knowledge translation resources. So we know from research that we've done and certainly evaluation of this is that the general consumer and that consumer can be the coalition or it can be the patient won't engage with your article, but they are likely to engage with your article but they are likely to engage with an infographic or an animation video. And so spending some time and effort on creating those types of resources to summarize your research findings is probably time and money well spent. So I'd strongly encourage people to price some emphasis on that.

Christian Barton:           24:04                And then you've got an asset on social media, and if you already have a big following on social media, you have to be the one that shares that asset because you've created the asset. So you've controlled the narrative of what goes into that asset and the key messages. You can then leverage the people. We do have a market friend and hopefully they can then share for you, et Cetera. We help with so you can spend your time arguing with the people, misinterpreting your work on Twitter or you can spend your time maybe creating some of resources. And I guess the concept of trek is to try and create resources with those types of things can be embedded into a web page. So if you've done research on my back pain and it's game changing research, then those knowledge translation resources can be put onto a platform on trek.

Karen Litzy:                   24:50                Yeah. Great Advice. Anything else? So we've got getting to know the media team at your university to release a press release, which is huge because that can lead to other opportunities. And knowing how to either get your original research onto an infographic or an info video or a podcast, and then use that as your vehicle via social media, attaching that to some social media influencers, if you will in order to kind of get that out there. But I definitely think that's much better advice than banging your head against the wall and arguing with loud voices.

Christian Barton:           25:34                Yeah, exactly. Probably the other advice, if you go back a step in terms of designing search, it's probably really important and this hasn't been done well, but you engage the end user from the beginning. So going back a step and when you're designing your clinical trial, no good designing an intervention that no patient is going to engage or to use. So you might design an exercise program that you think is amazing and it's fantastic, but actually when the patients in the trial do it because they in a clinical trial, but then you go into the real world, It's too challenging for them to do. It's just too difficult. And therefore you're going to get criticized for your intervention that isn't clinically applicable. You want to cop that criticism in that design phase and people say, this is not clinically applicable. This won't work. Because then you've got time to redevelop on it and evaluating it and then realizing it won't cut through. So that's, yeah, I will probably important thing to think about. So when we talk about engaging the end user, particularly patients as the end user, but also clinicians as well, and getting their input because they're all going to be the ones delivering yet. And just to some extent, funders, they're a little harder to talk to.

Karen Litzy:                   26:45                Yeah. Yeah. A little bit easier to get in with the patients or your fellow colleagues, hopefully. And now earlier you had mentioned that you have done research into topics such as patellofemoral pain. We also know that you do research in running injuries, obviously knowledge translation. So let's talk about kind of some common misconceptions around, we'll take running injury prevention and management, right. Cause these misconceptions come about because of poor dissemination of information I think is one aspect of it. So what would you say are some common misconceptions around running and injury prevention?

Christian Barton:           27:32                Yeah. So we can go into lots of areas here.

Karen Litzy:                   27:35                No, it’s a lot of branches.

Christian Barton:           27:37                Yeah. So let's stick to running because it's a popular thing again. Everyone likes to manage runners and treat runners and not a lot of people like to run themselves. We actually put an infographic series out on our trek website. So James Alexander who is a master student environment moment putting together a series and we have the graphics and there's a few key ones for running injury prevention. One being stretching helps. And so that's something that has long been ingrained in people's beliefs that why you’re getting injured is that you haven’t stretched enough then stretching doesn't actually help us prevent injury. So it's not that it's a bad thing necessarily, although there is some evidence that stretching might impair muscle function, might actually reduce your ability to have muscle function but certainly it doesn't prevent injury.

Christian Barton:           28:31                So focusing on that as the problem is probably not the answer. Footwear often gets blamed for injuries, prevention and also as though the key focus. Now typically most of the times if you changed before where yes, it could definitely cause the injury drastic change, but a lot of times it's not the fault of a footwear. Someone buys a new pair of shoes, but they also decide they want to get fit and lose weight at the same time. And they go out and they overload and they train too much.

Karen Litzy:                   29:01                Yeah. So those things kind of do overlap cause you get motivated, you go out and buy the new shoes and then you blame the shoes and not so much the amount of load that you just put through your body that you haven't put through your body in months or years.

Christian Barton:           29:14                Exactly. This is not the shoes that are important because they will moderate where the loads go can to some extent. But I think we get very obsessed and part of that comes back to who controls information that gets out there. And it's shoe  companies, right? They sell shoes. There's all these motion control technology that shock absorption technologies. And so that's a big marketing campaign and that changes what people buy. And what I will say, it's a big problem. People have that answer. And then we have big pushes about minimalist shoes and they're the answer to everything. And in reality it's probably going to be very variable across different people in it. People with running shoes, all their life will be taken into women's shoe. That's a big change. So that will probably injure them. So yeah, might help. They need, they might get some acuities buying.

Christian Barton:           29:59                It might help their heel pain or forefoot stress fracture. So again, just that big emphasis on footwear and often because it's a commercial and marketable thing is offering the way what happens? I always love the example of Australia by a guy called cliff young. So some people are watching may know him, but those who don't, he actually run the first ever Sydney to Melbourne ultra marathon. So that's 800 kilometers or so. And one of our quite a few hours now, cause John did most of his training in numbers. He used to run two or three hours on his farm every day chasing sheep in Gum boots. So Wellington boots, clearly he didn't have any significant injuries. Right. And I have some great footage that I take when I teach my running course. That's some great footage of me doing that. And that's not to say everyone should go out and run in gumboots.

Christian Barton:           30:46                But certainly for him he was doing it his whole life. So he's adapted to doing that. And if you're adapted to doing something, don’t change it, right? Maybe maybe you might modify footwear to reduce the weight because that we know that helps with performance, but beyond that we don't really have a lot of good evidence that changes footwear will help with injury or performance or anything like that. So my philosophy mostly before where it ain't broke, don't fix it. But there are some nuances around some biomechanical considerations depending on what you want to try and change. But that's probably a couple of the key points of stretching and in footwear and the importance we place on them. I think it's probably more important to get our training loads right. And probably also thinking about, and these are my biases and there's not strong science on this, but doing a resistance training program might be more beneficial for preventing injury. We could do more loading with our muscles and tissues without that impact. And so that's possibly beneficial. And we do see some evidence that may be doing a resistance training program helps with performance as well. And most people get down because they're trying to run personal best times or beat their friends or whatever it might be. So rather than smashing yourself more and more on the training track, maybe get in the gym and do some resistance training would be my advice.

Karen Litzy:                   31:57                Great. All right. Now, we're gonna shift gears just a little bit here. So the next question is what is or are the most common question or questions, I'll put an s on there that you get asked. And this could be by researchers, clinicians, patients, maybe you've got one for each. I don't know. What are the most common questions you get asked?

Christian Barton:           32:28                Yeah, so I'll start with researchers. So academics, you sort of touched on this a little bit before, but it's often around how to dedicate time and make knowledge translation, but not just that. So creating the resources we've talked about before, but how to navigate media or platforms like Twitter, like you get on Twitter and someone's attacking your research and let me see, interpret it. Or you get on Twitter and you put something out there and someone gets offended and that's a problem as well. And so it's actually, it's very difficult on social media because when you're typing things and writing things in, emotion gets taken out of things and people interpret emotions. So you might write something that has really no emotion attached to it, just a simple statement, right? But someone who thinks that you might be attacking them, we'll take that as an attack and then that creates a problem.

Christian Barton:           33:19                All the time. And I know that I offend people at times because they tell me that I've offended them and that's what I really appreciate it at least it gives me a chance to reassure and go look. It's not meant to be offensive when used social media is a positive way of translating knowledge and then other people probably get offended and just don't talk to me anymore. Yeah, I think I've been blocked a couple of times.

Christian Barton:           33:51                So my advice usually to people about Twitter is I think it's immediate that you can get a really good understanding about how part of the world is thinking. It's only a small part of the world. And then I think it's important to understand that that's the case. You're only getting a snapshot of some people and often it's people who have louder voices and want to go on talking, but it does give you some insight into that. And I think for me that frame some of my research questions and maybe modify as and move it and helps me narrow it down. It gives me a media where I can use assets that we've created to put them in hands of people who will disseminate them. So I think that's really, so sharing a good infographic or podcasts or video on that platform is one of the influential people there who hopefully then share your message. So I think it's important to have some presence there for that reason, but don't get emotional about it. If you feel like you're engaging in a circular conversation, you probably are engaging in circular conversation. You just stop, don’t keep going.

Karen Litzy:                   34:48                Pull yourself out of it. Like I think often times what I see in those circular conversations is like somebody, it just seems like one of the parties within that conversation wants to win more than the other one. Or are they both really, really want to win. And so it's just like, I'm going to get the last word. No, you're going to know I am. No, I am. It goes back and forth and you just like,

Christian Barton:           35:14                My advice in those situations, for someone who feels like they're in a circle of conversation, they're beating your head against the brick wall. Just step back for a little bit and just think why is this happening? Why is what I believe or what I think not being interpreted the same way. Right. And it might be that actually you discover your own biases and it might be that. And that's a good reflective thing. It's ok to change you mind and beliefs. That's a good thing. That's a positive thing. Or it might be that actually you don't have as much supporting evidence for what you believe in. And maybe that's because you need to do some better quality research to test your biases and maybe you discovered that actually you were wrong, or maybe you test your biases properly and you discover I was on the right track, so that's good. Yeah. You usually have to prove myself wrong more than I proved myself. Right. That's a good thing. Yeah. Or actually worse what's happening, it comes back to that communications is you're not disseminating your messages very well. So you're actually not providing an adequate messenger. You can sit back and think about that and don’t keep argue with that person. You think about some strategies to disseminate and put together a podcast or a video, or write a blog about the topic that has really good details where you've got more than a couple of hundred characters.

Karen Litzy:                   36:30                Yeah, that is really useful. So, and sometimes in these kind of conversations, if you will, sometimes you can also just take the person and send them a direct message where you can write a novel if you want to do as a direct message. And I find that when you do that and you kind of can explain yourself a little bit better, it helps to kind of foster better communication and a better conversation. And oftentimes when it's in private, people are different.

Christian Barton:           37:07                Yeah, that's great. And, taking the conversation off the social media platform is often a really good strategy too. Navigate and get over those miscommunications that can happen. Yeah.

Karen Litzy:                   37:17                Yeah, I've done that before.

Christian Barton:           37:20                That's really spread enemies. Right. And then probably the other advice I'll give to people when I've actually put a tweet about this I think earlier this year or late last year. It's just, I'll refer to them as trolls and I'll call them trolls in until they show their face. People who are on there who don't have a public face. So it's social media. So for me you should have the transparent profile and the reasons for that is you want to know where people come from and where their beliefs come from so you can understand their point of view. And if you can understand that point of view, it makes it a little bit easier to have discussions with. But there's probably people on Twitter who just set up their identify profiles just to kind of attack and stir the pot and it's just not worth engaging with those people's I used to try and have their fun with them and make a few jokes and I've done that a few times. If you'd be probably saying that like, so that's also a time wasting. So it's kind of entertaining, but it's also time wasting as well. So I think when you identify, communicates, asking you persistent questions and almost feels like you're having circular conversations just block that person. There's no, you don't know what their alterior motive is. You don't know what their conflicts of interest are. You don't know where they're coming from.

Karen Litzy:                   38:28                Well, you don't even know who they are.

Christian Barton:           38:31                Exactly. And so I don't think we should engage with those people. That's my first way. Most people won't like hearing that and they just keep creating new profiles. Right. Well that's okay. I never used to block anyone until six months ago, are quite a few people in racing time for that very reason. In short, if you get it, get into social media and you kind of, so you can learn from it and focus more on giving some quality content and having meaningful discussions rather than arguing. Yeah.

Karen Litzy:                   39:01                Yeah. That's sort the idea of social media, especially when you're a professional, you want to be a professional because you're a professional and so, and the point of social media is to be social.

Christian Barton:           39:20                Yep. I like that.

Karen Litzy:                   39:21                You know, it's not to go on there and be antisocial and argumentative. You're there to be socially it's fine to debate. It's fine to disagree. But some of the things that people hear this all the time that you see on social media, you would never see that kind of an argument with people face to face. It just wouldn't happen. You know? So you have to remember to keep this social in the social media and not be like a maniac.

Christian Barton:           39:52                I like that phrase. Keep the social in social media.

Karen Litzy:                   39:54                Yeah. So if you could recommend one must read book or article, what would it be?

Christian Barton:           40:02                Yeah, so I mentioned earlier about with the trek origins and the concept around that. So switch is probably my book. I think it's influenced my life the most from many respects. I think I gave a really brief, probably poor synopsis of it. It is the elephant, the rider and getting to the destination. But it just changes the way you think. And when you're trying to make a change, it gives you nice, simple way for you where your barriers are. So is it people don't know what they need to do? Is it about the emotion and motivation? There's lots of great analogies that examples within that that I think will kind of really inspire you to think about the rest of your work. Not just research it, it's not just clinical practice but how to change relationships with different people and things like that. So I think it's a really good book to read. I'll give you a second one as well. John Rockwood. Yeah, no, he's translation and dissemination is a book called made to stick and that's basically made to stick. So it's around how to make your messages stick. So that's a really nice book as well. So if you're trying to communicate more clearly, that will hopefully give you plenty of ideas and concepts to look out for. That'd be my to go or recommendations.

Karen Litzy:                   41:12                Perfect. All right, now let's get to the conference. It is October 4th and fifth in Vancouver of this year, October 4th and fifth of this year. And can you give us a little bit of a sneak peek about what you'll be speaking about at the Third World Congress?

Christian Barton:           41:32                Yeah, sure. So we've got a couple of presentations. One is actually in the session review, which I'm really looking forward to discussing with yourself and all around knowledge translation. And one of the things I want to talk about in that is how healthcare disinformation develops and spreads? Cause I think it's important we understand the mechanisms of that. And that also allows us an opportunity to understand how we can spread good information because we understand how, how can this disinformation grows and spreads. And hopefully that gives us some insight into how we can grow and spread the good quality information. And so we'll go through some of that and break down some of the things we've talked about around using I guess digital assets for knowledge translation in. One of the things I've actually really looking forward to talking a little bit more about is some of the outcomes from the research we've been doing, particularly around patients and finding them and what we can achieve through a good quality website.

Christian Barton:           42:23                So we have a review at the moment, which is under peer review looking at patellofemoral literature and it doesn't just do a systematic review of patient education. It also looks at online information sources. Basically when we look at all of those is the vast majority of conflicts of interest, often financial conflicts of interest. There's a lot of missing information on there. And so for the person navigating that, that's really challenging for them. And we've done a lot of qualitative work with people with the patellofemoral pain. And then part of the new ways work I talked about before, we actually did reasonably if we needed to clinical trial where for a period of that trial all they had was a website that we developed for them. And we put multimedia and engaging resources with quality information and accurate information, simple exercise program that they could do.

Christian Barton:           43:12                And so we're still pouring through the results and we'll have it done before the conference and I can see from the preliminary stuff was actually do really well by themselves with quality information. And certainly that then makes your life easier as a physio cause you don't have to fill in as many gaps. I can focus on adequate exercise prescription or clarifying some information and things like that. So it makes us more efficient. So yeah, really looking forward to talking about that in our session. And then the second session I'll be talking on is around exercise prescription and I think the title is beyond three sets of 10. And so I mentioned at the beginning my research started in the biomechanics lab and I used to think biomechanics, were the be all end all and I've probably changed my opinion on that over the years and very subtly, very slowly and I still think biomechanics matter, and exercise prescription around that can be important, but equally education alongside your exercise prescription to address things like Kinesiophobia and pain related fear or something that we find is a really important factor in managing people’s pain.

Christian Barton:           44:19                So yeah, a huge barrier to actually getting engagement, but even getting, they might do exercise but they won't get as much out of it if you haven't tackled those fears and beliefs. We'll talk some of the research we've done in that space recently around how that can guide exercise prescription and some processes around that. And then I've had some fun almost on the other end of the spectrum where we've actually just got people in the gym and focus more on physiological responses and we just smashed it in with strength and power. And one in physical therapy in sport, which is just a feasibility study. Probably 10 people, people who we just put through a resistance training program of strength and power and the reason we did this study is when you look at all the patellofemoral literature, no one has done a program of adequate intensity of progression and duration.

Christian Barton:           45:10                You would actually see any meaningful changes in strength and power despite the fact that a lot of them say that they do strength from your title when you actually look at their protocols are not true strength protocols. So we decided to just put great people through this program and just smashed them in to do. And they did better than I thought they would do. I was actually surprised. And so we'll talk about some of the findings and implications of that and how to put that into your clinical practice. And I think the whole idea for me is we have these programs that physios focus on around motor control and they often low dose exercise. Don't know what the education part alongside that done very well around pain, weighted fear and even exercises to tackle that. And simple great exposure. But equally we don't get the end stage stuff done very well. Actual really good progressive resistance training. Yeah. I think we get the middle part done well, but we kind of miss those two elements that's trying to bring all that together. So I'm looking forward to that where it’s not just three sets of 10 of hip abduction and knee extensions.

Karen Litzy:                   46:11                Yeah, no, that sounds great. And, and I know that anyway, they'll probably be a lively discussion around that topic. I know here in the US, if people are using their insurance, they're often cut off before we would ever even remotely get that. Let's get you in the gym and really do it, you know, let's really kind of work and like you said, like smash it out, get them stronger, get them confidence and, and it's unfortunate, but that's the system that we have to play in and yeah.

Christian Barton:           46:44                Well, we can put a link up to the paper on the Facebook group. It’s actually open access at the moment? It's appendix of all the exercises. I think they're really simple exercises which was kind of cool about. So we just, we really just pushed it straight away and we only went for 12 weeks. And that was purely from a feasibility perspective of yeah, it just costs money to do these projects over a long period of time. Yeah. But my bargain is that if we kept going and with the clinical hat on, they continue to improve, at least in terms of function. A whole different kettle of fish, but they can do more exercises, more progressive. We make it, the more they can do and wherever their pain usually reduces. But wherever it gets to the point where they're happy or not, at the conference we'll talk about that.

Karen Litzy:                   47:29                Yeah. Sounds great. I look forward to it. And are there any presentations at the conference that you're particularly looking forward to?

Christian Barton:           47:38                Yeah. So I think, and not just because I'm talking to you now, but looking forward to our presentation, not just from me talking but also hearing from yourself and rod and I, I think one of the things I've appreciated about knowledge translation and using social media experts, there's no person in the world that knows everything you guys had it through. Then over the years I've actually learned quite a bit from yourself with the podcasts and stuff you do and really enjoy some of yours. And I think I like the process and approach you've taken and I think you've been quite inspirational about how you can actually find a model where you can spend time doing it, which is really cool. I'm so looking forward to hearing more about that and maybe you have some good tips for me, but also Rob Whitely presenting in the same session.

Christian Barton:           48:22                I really like the way rob thinks, he thinks very differently to most people. He's got my favorite Twitter profile picture that I've seen so enough. Those are not from Australia where I quite understand it, but there's a picture of a kid with his head down looking asleep. We've got ex Prime Minister Tony Abbott talking at the same time. So it's quite a funny picture. But he's, yeah, he's a bit eccentric, but also very clever for instance. The whole conference is really good with lots of, I think clinically focused presentations because everyone presenting going through it has a really strong clinical focus here in what they do. I think that's a real strength of it. The Saturday morning there'll be a couple of really good workshops I was looking at it yesterday and trying to work out knowing that you would ask this question where I want to go.

Christian Barton:           49:13                And you've got that and it's allowing presentation with Ewa Roos, Christine, both of which have a huge respect for and I’ve learned a ton about exercise. And so I'm looking to that and saying what other things I could learn from my clinical practice. But at the same time, talk to you about upper limb, the same stuff. Now I see a few cases in shoulders. I don't see as many as Rollin, so it'd be great to learn some things from them, but also I liked to take knowledge from other areas and see how I can apply that to lower limb in my research and yeah. One interesting to do that, but I reckon I'm going to have an apology to those guys for saying that I won’t be able to make both. I'll have to make sure I send someone along.

Karen Litzy:                   49:55                It’s going to be hard to choose, but you know, you'd take someone over, you have to divide and conquer. Exactly. You know, can you send someone with that? Yep. Need a team. Yeah, yeah, yeah. Over a beer or wine

Karen Litzy:                   50:32                No, for me, like a small little glass of beer. That's right. Yeah. Thanks. Yeah, that's true. That's true. And you know, look at sports congress. This past year I did not have the flu. So drinking those like small little ones kept me awake.

Christian Barton:           50:49                Good, good, good.

Karen Litzy:                   50:51                I found like this sweet spot. Well Christian, thanks so much for coming on and giving your time. Thanks everyone for coming on and listening. And Christian, where can people get in touch with you? Where can they find you? They have questions or they want to give you some unsolicited feedback or arguing.

Christian Barton:           51:26                Very happy, very happy with any feedback or questions. Probably easiest way to engage is probably on Twitter. So do you use Twitter a little bit for that? We also have a Facebook group for the trek exercise group. So if you look that up, I might put a link to that as well. So it's trek exercise group. And so that's not a bad medium to kind of start to engage with the trek initiative. And we'll actually use that to launch the back pain and also arthritis websites and I can put some links on there to the top from a website which we set up. And actually the other thing on that note, and I might put this on the Facebook page here as we have a course for anyone who's interested, it's a free online course learning how to critique randomized controlled trials.

Christian Barton:           52:14                So basically it takes you through some modules about how you go back to taking them. Before that we kind of get your knowledge and confidence on your capacity to do that. Do the course and then you could take a few articles and then at the end of it there's a followup test to see how you go. There are actually some prizes as well. So at this point in time we've had I think over a hundred people sign up to this. But only around about 20 finished. Yeah, there are two $500 prize as far as with Australian dollar prize. So at the moment those 20 people will have finished it or, and we've a one in 10 chance we'd pop your dollars. Say I would suggest that you jump on board and have it for learning, but chances to win a prize

Karen Litzy:                   52:51                This is 500 Australian dollars or US dollars.

Christian Barton:           52:56                It’s about $350 US. So it's not as lucrative. It's not a small amount. So this is actually part of the, the trek project in collaboration at the University of Melbourne who established this. And so that's the sort of stuff that we're trying to do with trek is to put these types of resources out there and Yep. So hopefully we can get a few people on board back.

Karen Litzy:                   53:21                Yeah. So you will try and put all the links. I'll find the links to books and everything that you had mentioned. Switch and make a stick and trek and we'll put them all in the comments here under this video. So that way people can click to them, and join the trek group and figure out how to get in touch with if you have any questions. So everyone, thanks for listening, Christian. Thank you so much. This was great, and I look forward to seeing you in Vancouver.


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Jul 15, 2019

On this week’s episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr.Tami Struessel and Colleen Rapp on the show to discuss holistic physical therapy.  Tami is an Assistant Professor in the Doctor of Physical Therapy Program at the University of Colorado Anschutz Medical Campus and treats patients in an outpatient clinic. Colleen Rapp has worked as a journeyman and press operator at The Denver Post for more than 30 years. Decades of physically demanding work plagued Colleen with back and shoulder injuries as well as significant chronic pain, ultimately requiring surgery. In 2014, she turned to physical therapist and University of Colorado faculty member Tami Struessel, PT, DPT, OCS, MTC for care.

In this episode, we discuss:

-The key elements that allowed Tami and Colleen to develop a strong therapeutic alliance

-The importance of a holistic treatment approach to physical therapy care

-How Tami’s treatment approaches have shifted to be more patient centered

-How physical therapy has changed all aspects of Colleen’s life

-And so much more!


Colleen Rapp Twitter

Colleen Rapp Facebook

Physio Pro Website

University of Colorado Tami Struessel

Clinical Outcomes Summit: use the discount LITZY

Benefit Concert for CU PT Scholarship

More information on CU Giving Scholarship Program 

For more information on Tami:

Tami began with Physio pro in 2018, and enjoys working with patients after all types of injuries and surgeries.  She is an Assistant Professor in the Doctor of Physical Therapy Program at the University of Colorado Anschutz Medical Campus, and has been awarded Bachelor’s, Master’s and Doctoral degrees in Physical Therapy. Clinically, she has been recognized since 2003 as an Orthopedic Clinical Specialist (OCS) through the American Board of Physical Therapy Specialists and since 1999 as a Certified Manual Therapist (MTC) through the University of St. Augustine. She is a past recipient of the American Physical Therapy Association-Colorado Chapter Physical Therapist of the Year, and teaches, and researches in the areas of clinical reasoning, orthopedic physical therapy practice, and practice management.  She is a member and past president of the Colorado State Physical Therapy Board through the Colorado Department of Regulatory Agencies (DORA).

Outside of work, she spends as much time with her family in the mountains as possible, enjoying cycling, hiking, skiing, snowshoeing and mountain music festivals. She has 2 adorable dogs, Daisy a boxer/great dane mix, and retired seeing eye dog Donovan, a yellow lab.


For more information on Colleen:

Life-Changing Experience with Physical Therapist Inspires Patient to Give Back

Colleen Rapp has worked as a journeyman and press operator at The Denver Post for more than 30 years. Colleen noted, “I'm very proud to be a woman working in a ‘man's world’ where the work is difficult, but rewarding.”

Decades of physically demanding work plagued her with back and shoulder injuries as well as significant chronic pain, ultimately requiring surgery. In 2014, she turned to physical therapist and University of Colorado faculty member Tami Struessel, PT, DPT, OCS, MTC for care.

After being introduced to and working with Tami at Physio Pro Physical Therapy in Denver, Colleen’s outlook on maintaining a healthy lifestyle began to shift. Colleen reflected, “Life-changing care, to me, is defined as care that influences great changes in self.” From the beginning, Tami approached Colleen’s treatment from the whole-person perspective. “In addition to my treatment, Tami showed me online anatomy classes so I could learn muscle groups and have a better understanding of my body,” she said. Additionally, Tami introduced her to things like a calming application, in efforts to reduce stress.

Tami said, “Colleen is one of those patients who truly embraces the idea of becoming stronger and healthier, and is a huge believer in physical therapy.”

“For years, I viewed my work as my exercise,” she said. Through the help of Tami, Colleen lost 30 pounds, has better eating habits and consistently exercises 5-6 days a week. “Tami has taught me the concept of working smarter, not harder,” said Colleen.

“I feel like a whole new person thanks to my care, and it has led to a newfound appreciation for exercise and for keeping my body strong,” Colleen added. “Tami really wants to see her patients succeed, it matters to her.”

Admittedly, Colleen wasn’t fully aware of physical therapy and its importance when she was first referred. From learning movement, stability and range of motion among other things, she realized there were many elements of physical therapy beyond what she initially thought. “I realized that physical therapy was the most important thing in between the points of injury and health,” she said. While every day presents challenges to stay on a good path of nutrition, exercise and the willingness to strengthen her physical fitness, Colleen is greatly appreciative of Tami’s influence and care in her life.

“Through her hard work, Colleen has transformed herself into a much healthier and more resilient person,” said Tami. “To me, that is what being a physical therapist is all about!”

Colleen’s experience and Tami’s impact was so life-changing that Colleen felt inclined to give back. With Tami being a Professor for the CU Physical Therapy Program, Colleen felt the best way to honor her was to support funding for student scholarships. Colleen initiated a fundraising campaign for the Physical Therapy Student Scholarship Endowment, supporting future leaders in physical therapy. “I not only personally donated, but I’ve run multiple online auctions where I have sold sports and music memorabilia,” she said. Colleen is not only motivated to improve herself and her quality of life, but ensuring the availability of funds to help the next generation of physical therapists impact their own patients.

CU Program Director Margaret Schenkman, PT, PhD, FAPTA has led the charge behind student scholarships since the inception of the CU PT Scholarship & Endowment Board in 2012. Colleen noted, “Margaret supported my efforts to give back and help the students. She reached out to me with so much kindness.”

“I know that my efforts will impact a student’s life just like Dr. Struessel has impacted mine,” added Colleen. “She’s far more than my physical therapist.”

 Read the full transcript below:

Karen Litzy:                   00:01                Hi Tami and Colleen, welcome to the podcast. I'm so excited to have both of you on. As I said before we went on the air, this is a first time I've had a physical therapist and a patient on at the same time. So I'm excited for the listeners to learn from both of you. So welcome. Welcome to the podcast. All right, so Colleen, let's start with you. So, why did you seek out a physical therapist?

Colleen Rapp:               00:32                Well I was working and I hurt my back and I went to a doctor and basically he had me go to physical therapy, which I had gone before maybe like a couple of weeks. So I wasn't really familiar with physical therapy, but I had hurt my back really bad. So I knew it was going to be a long road and I was kind of nervous at first. And so he recommended me to go to low high physical therapy. And that's where I met Tami.

Karen Litzy:                   01:02                And so I know you said you didn't know a lot about physical therapy, but once you were referred to physical therapy, did you look anything up? Did you have any expectations?

Colleen Rapp:               01:13                I really didn't have many expectations because I'm working with a lot of people that have gotten hurt in my job, I'm a pressman of the Denver Post. It wasn't a very good report from the people because they just didn't get a lot out of it. So it was kinda like, oh, I'm going to physical therapy, what a drag. And that's kind of what I was looking at. So I didn't really know a lot about it, so I just kind of walked in there and had to go basically.

Karen Litzy:                   01:45                Okay. And so Tami, let's talk about kind of that first visit. Did you know any of this before Colleen came in to see you or did she say, Oh, I'm just here because the doctor told me to.

Tami Struessel:             01:57                Well, this particular clinic, sees a fair number of people who are press operators at the Denver Post where where Colleen works. And, so I had seen, you know, a few people here and there. So I knew a little bit about the job. I knew it was a pretty physical job that they had a fairly high injury rate. I evaluated her and, you know, found out that she had had a long a history of being very healthy in her job until she hurt her back and that she was, you know, she was in a lot of pain and I'm having a really hard time getting back to work. And so that's where we started.

Karen Litzy:                   02:45                And it's kind of look at this as like a mini case study right now. Right. So Colleen she comes in with low back pain, injured at work calling. Were you unable to work at the time?

Colleen Rapp:               03:01                Yes, I was taking off work. I could barely walk. So I was taking off work. I couldn't even go down to modified duty. I was at home.

Karen Litzy:                   03:10                Okay. So Tami kind of walk us through your evaluation, meaning when she came in, what kind of questions did you ask for this subjective? And then what did you look at for the objective part of the eval?

Tami Struessel:             03:36                She'd had a long history of working in a very physical job and the vast majority of people that do the job or are men and that she had been very successful and really loved her job and worked hard at it and was very proud of it. And I think she's still very proud of it.

Tami Struessel:             03:58                And I think I asked probably fairly typical questions about the mechanism of injury, how she was injured and you know, what kinds of, you know, what kinds of things she was not able to do and what kinds of things she could still do. And then did a full lumbar and hip examination, which I always do. You know, kind of head to toe but focused on those areas.

Karen Litzy:                   04:31                After that evaluation, Colleen, what did you feel after that first visit when you left? Did you feel like, oh I think I'm in good hands here? Or were you like, oh maybe this might work but I'm not sure.

Colleen Rapp:               04:46                No, I definitely at first knew I was in good hands with the way Tami treated me when I came in. I think she knew I was a little nervous and so she kind of, you know, kind of joked with me and she kind of liked explained things to me and then she examined me. But through the examination it was very comfortable. So I was like, oh okay, this isn't so bad. You know, you have to feel comfortable at first and get that report and then you're just not like shaking going, oh my gosh, where am I at? And so I think after like 20 minutes of that and just talking to her, cause the first session was an hour and after her examination she sat with me for about like 10 minutes and explained everything to me about, not exactly what was wrong with me because she doesn't really believe in that she believes in, you know, the fact that I need to know to listen and not concentrate on that. So she kind of just explained to me about, that we were going to work together. I was going to see her twice a week in that we were just going to get me better and get me stronger and made me feel really comfortable. And that was the first step of like just being a good experience.    

Karen Litzy:                   06:03                And you know, before we went on the air, I've talked about this idea of a therapeutic relationship. And I think Colleen, you just really described a really great first step in achieving a therapeutic relationship. So Tami, did you have a sense when Colleen left that A she is going to be coming back and B she was probably going to be pretty invested in this.

Tami Struessel:             06:36                I mean, I guess there's always a possibility that you don't connect with people and that they, you know, they choose not to come back. But I didn't get that sense from her. I think, from the very beginning she was very interested and I think because she does like her job a lot and, really wanted to get back to it. Just in general she was invested and I think one of the things she talked about is, as most people do, to know the thing that was wrong with her back. And I'm pretty averse to the, you know, biological approach model and explaining all of the anatomy and everything.

Tami Struessel:             07:27                Because I've been doing this now for 28 years, so, I used to do a lot of that. And I realize now that that's just not healthy. And she, she actually, you know, she embraced that. And she already said that that clearly is kind of a core principle for me that, you know, I'm not gonna, I'm not gonna, you know, get that model out and say, here's the thing that's wrong with your back. And, you know, unfortunately sometimes, you know, depending on who she's talked to, whether that's coworkers or that's the nurse at work or that's one of the workers comp physicians or something like that. I think she got a little bit of that. And I tried to divert away from that mindset and that she's really been very receptive. She doesn't ask me very much anymore exactly what you know about my disk or about my, you know, I mean, we talked a little bit about your SI joint but we try not to focus too much on it.

Karen Litzy:                   08:32                Right. And so Colleen from a patient standpoint, what Tami was saying, is it just for your clarity, so a lot in the physical therapy world, we used to rely on the sort of biomedical model where you know there is an issue with the tissue A plus B equals C. So this hurts and this tissue is quote damaged. This is why you have pain. Now pain, we know is much more complex and we use what's called a bio psycho social model of care, which is, yes there is the bio part is still in there, but we also want to take into consideration that there are psychological aspects to pain and social aspects to pain. So Colleen, my question for you is, did you feel like not focusing solely on the biomedical part of it or just on the tissue part of it was helpful for you in your recovery?

Colleen Rapp:               09:34                Yes, because it made me realize that I needed to just work and get better instead of like, oh, this is what happened to me, this is what I have and if I knew, I think I probably would have been scared, you know, or like, Oh, poor me or this or that. And I didn't want to get into that, that view point. I wanted to kind of just say, okay, all right, I got somebody that just basically let's do this. Let's get working, let’s get me back to work. I'll work with you. You work with me, I'll teach you things and do the best for me. And I needed to listen and I needed to do those things. And that attitude gave me the will to do that and not focus on the other stuff. And that helped. It really did. If you get your mind focusing on what is wrong it doesn't really help. You got to kind of move on and try to do the things you need to do to get better.

Karen Litzy:                   10:32                Yeah. I think that's great advice for anyone. Instead of dwelling on what's wrong, let's start dwelling on what's right and what you can do to improve your function and to improve your life. Two very, very different ways of looking at things. And from a patient standpoint. I think that's great to hear. Now, Tami, you were saying before we went on that, okay, the back thing was a couple of years ago, but then there were also some other things. So Colleen is a bit of a repeat offender, no offense Colleen. But again, I think that shows the strength of the relationship. And now I don't know what the laws are in Colorado, but do you have direct access there?

Tami Struessel:                                     Yeah, we have a 100% direct access.

Karen Litzy:                                           Lucky. So, Colleen, when you were injured, let's say subsequently after the back, you had gone to see Tami for other things. Did you know just to go straight to her or do you still have to go through a system?

Colleen Rapp:               11:32                When I went I hurt my shoulder, I basically asked my doctor if I could see her and I told my doctor that I was comfortable with her and the success that I had with her, with my serious back injury and that I really felt comfortable with her and he was okay with that.

Tami Struessel:             11:54                These were work related injuries. So there's always going be a claims process and a physician, now take a little bit of a step back after we finished treatment related to her back. We did do some training sessions to really get her beyond, you know, kind of basic back to work and those kinds of things and work a lot on fitness and exercise and those kinds of things, which was fairly new for her. I mean, not that she didn't exercise before, but I think she can probably talk about like what her fitness routine was like.

Colleen Rapp:               12:43                Okay. So I think that the most important thing that we're kidding here and I have to kind of come on and for 33 years I worked at the post and I'd never really had an injury and like little things until like five years ago when I hurt my back and that it just seemed like, the last few years with the, you know, staff decrease in everything, we might work a little bit harder or faster and stuff. And I think things have gotten a little bit to where I had had like three injuries and so that's really cool cause Tami actually working with her has reminded me to always make sure that I work smarter than harder and got me back to where no matter what my position is, my work or my life or anything, I always have to be smart and I always have to take care of myself first and you know, be careful what I do and think about what I do. Cause it's the job I do is very dangerous and it is really scary. And, this whole PT thing is really important because it did change everything that I do at my job and it has made it so much safer for me.

Karen Litzy:                   14:04                So Colleen, I'm going to ask out of pure ignorance here, what exactly does your job entail?

Colleen Rapp:               14:21                I actually worked on a five story press. Like on TV where the paper's coming on a conveyor and yeah that's what I worked on. They're a little bit more fancier but they're a little bit bigger. Now there are about five stories high. They're really long. I'm really not sure how long they are, but I do like 600 steps a day. I lift 50 pounds, I push a 1500 pound rolls. I do a lot of climbing. I do a lot of everything. It's eight hours, 10 hours, sometimes 12 hours of just physical work.

Karen Litzy:                   14:56                Okay. Wow. So that's a lot. So now Tami, as Colleen is coming to you for various injuries. You obviously have this in mind. So my question for you, and this might be some good advice for other physical therapists who might be listening, is how did you take into account her job and the requirements of her job when it came to exercise prescription and things like that. And then, and now I understand why you moved onto the fitness part of things because you know, you hear a lot like, well, insurance cut me off so all we could do or just these little exercises or I only saw the patient for six weeks when in reality, we know they need a lot more to stay healthy and to not reinjure themselves. So what advice would you have for therapists who need to take into account the person's very physical job?

Tami Struessel:             16:02                Yeah, so I think there's probably two components of that. So, one is definitely, the work itself and, you know, if I was having her do basic, you know, transverse abdominal contractions and, and those kinds of things, it was just never going to be, you know, to a point where she was able to, you know, get strong enough to actually physically do her job before. And I knew she was able to do it before so she would be able to. So there was definitely, I believe in Colleen could tell you this. I believe in hard exercise. I think sometimes we don't push people enough and some of it does have to do with, there's times where we have a very short, you know, we see somebody for three weeks and, you know, how much can you do from a fitness standpoint.

Tami Struessel:             16:55                But we were lucky. We got to see Colleen for longer. And so I had her work hard, as far as kind of general exercise and fitness and getting stronger. There was a time in my career where I would go out and visit the patient and see what their job was and those days are mostly gone, honestly. We get video, you know, off of people's phones. And so I had a pretty good idea of what the work was. But, several times Colleen, brought in, you know, we've talked about it and she's brought in video of, you know, the types of work that she needs to do. And then we would go through things like, you know, so what of your job duties do you think is the hardest or most trickiest? Because she would have to get into like, you know, awkward positions or I think I remember trying to work with her on like what her foot position was or something. She's like, you realize I'm standing on this little bitty platform that I can't really move off of. And I was like, oh, well maybe we need to re rethink that. So I don't know if Colleen you want to talk more about that asset

Colleen Rapp:               18:10                There’s sometimes where like I'm standing on a platform and there's like a drop on either side of me and I have to reach up and lift up probably about a 45 pounds piece of press. It's called a bar and turn it around and position it in a different way without falling. And it's really crazy because on this precept, the press, there's an air connection to it. So once you take it off where it goes, it pulls you back. And so you have to be pretty strong and you have to be pretty smart or you know, you're in trouble. You can drop it, break your toe or something. So I think we worked on that and that was the most important thing that I think while we're on the subject is the greatest thing about Tami was, is that she saw that I needed to stay strong. When you injure yourself, I think that you have to learn that it's not over.

Colleen Rapp:               19:11                As soon as you walk out at therapy, you have to stay strong. You have to keep on doing your job and you have to do the things that are going to make you able to do that and not keep getting hurt. So would this keep working together? I learned all kinds of stuff. I learned how to, you know, just talking with her, she would say, well, can't you move the press down a little bit so you're not, your arms aren't up so high or can you just position yourself or can you not twist? Then, it just all made sense to me and I always say that you can walk up some stairs and you come up really fast. This for example, but if you walk up the stairs right, sounds weird. But if you walk them up right, you can do a whole bunch of them and you're not hurting yourself. But if you don't do things right, the repetition does wear on you. So my period of time with Tami and learning all these things and doing the things that I needed to learn just totally, it was life changing for me.

Karen Litzy:                   20:12                That's amazing. Tami what a great job. And if I can go back to kind of just reiterate what you had said before. So when you're working with someone who may be has a complicated job situation, not everyone sits at a desk for, you know, eight to 10 hours a day. Not everyone does that. I love the advice of asking the patients to take video of what they need to do. And then the question that you asked, well what are the things that you know are most problematic for you? What are the trickiest things you need to do at your job? Because if you can get the things that are the hardest things to do, I would imagine that working on those and getting some confidence and to be able to do those really difficult parts of the job, then you can get down to like some of the easier work after.

Tami Struessel:             21:04                Definitely. Yeah. I mean, and some things are not modifiable. I mean, when you're a large piece of equipment. But what I found with Colleen is she was so familiar with the job and what she had to do that, you know, both we could work together to find alternative ways or alternative positions. I'm like, is there any way you could step up or, you know, do something so that you're not reaching so high or, you know, whatever. And many times she was like, Oh, actually, I've never really thought about doing it that way. I'll try. And, often she was successful with that. And the other aspect was that she had such seniority that she is able to, she has such seniority that she's able to bid on shifts that are a little bit healthier for her in general now. We can talk about things like sleep and diet and stress reduction and weight loss and all these things are a result of her really embracing the idea of, you know, she wanted to continue to work. She knew that she wasn't probably going to be able to, if she didn't really change her lifestyle. And to her credit, she absolutely did. And I repeatedly tell her she's the one that put in the hard work cause I can do all of these same things with somebody else and if they don't take it seriously and they don't really embrace it, then it doesn't matter.

Colleen Rapp:               22:42                I think that that's the greatest thing about this is Tami taught me it’s not the exercise it's eating well, nutrition, losing weight, sleeping good, using your environment. I was hiking today and I was thinking about, you know, about what the most important thing about, you know, physical therapy and everything was, and I always think that some people that are really working out and stuff, they have to use weights and they have to do things and they think they're so strong and they still do things wrong. And I was hiking and I was like, I use my environment to make myself better every day because of Tami care. By the way, I walked,  at work, the way I move and the way I eat, the way I sleep, the way I think because actually, injuries and especially a couple injuries, you know, I just got out of one injury and got hurt again and that was totally mentally hard on me and all this connects to the patient and that's what a patient goes through.

Colleen Rapp:               23:58                So when you can correlate all this in your life as a whole body and like Tami teaches, it's amazing. It is. I truly believe that physical therapy is the most important thing between the point of injury and health. And if you keep on going, I'm going to be walking when I'm 62 and I want to be doing a whole bunch of things and it has just changed my life.

Karen Litzy:                   24:23                I think this is such a great example, Tami, of being a physical therapist, treating at the top of your license and really, really incorporating lifestyle change into your practice. You know, it sounds to me like you're more than I see someone for a bout a therapy they're discharged, Versus giving them a lot of skills and tools to not just take care of that bum knee or the painful shoulder, low back pain, but rather let's look at this person as a whole. Let's take a holistic view of this person. So you know, you said you've been


Karen Litzy:                   25:23                practicing for 28 years. I've been practicing for like 20, so I can certainly attest that my views have completely changed from when I first started. So I'm not going to assume that yours have or haven't, but if they have changed, where was it in your career where you feel like you had a major shift? Like I can say I know exactly when I had sort of this major shift in treatment paradigm. Did you have that major shift or was it just as more research came out, you just started incorporating all of this? Or were you doing it from the beginning.

Tami Struessel:             26:03                I would say that I don't know that I had a shift. I'm fortunate enough to teach at the University of Colorado and so I'm around really smart people all the time and I don't want to minimize how that is so important including people that practice in all different areas. And so I've learned a lot from, you know, from our neuro folks, from our cardiopulm folks, from other, you know, musculoskeletal people. I guess, you know, there was a shift at some point, and I don't even remember, I think I might've gone to a course where the emphasis is like, you know, your orthopedic people have neurological systems. I would say that's probably, if I had to have a point of shifting that was like, oh, of course, you know, if I'm not addressing that, then, you know, then I'm missing the boat.

Tami Struessel:             27:06                That was a while ago. But, I would say from a language standpoint, you know, therapeutic neuroscience education and motivational interviewing and some of the things that, you know, I think probably took the first of those about maybe four or five years ago. So, I was never a big, well, I can't say never, but I think I figured out that, you know, just pulling out the spine model and scaring people to death was probably not a good idea a long time ago. But I do think that that, you know, I think we all have learned that probably some of the language that we use is not helpful. I don’t know if I had a Aha moment or it's just, I think I've always been very open and from my first outpatient job, I remember I did inpatient for a couple of years and then, I worked at a clinic where the people had continuing education lists that were just enormous and that had a big impact on me. I specifically remember thinking, you know, wow, these people really are invested in learning and learning from each other as well. I think that was instilled in me very, very early in my career and it's continued with me. I have a pretty long continuing education list because I've, you know, been able to glean something from every single thing that I've gone to.

Karen Litzy:                   28:40                Yeah. That's amazing. And Colleen, as the patient, do you get a sense of that, this sort of lifelong learner in Tami?

Colleen Rapp:                                       Oh, yeah. I think Tami inspires me. I mean, I kind of look at her like, who else could you be in your profession? I meen, you teach, you practice, you govern, you everything, you know, I mean it's so inspirational. I have to tell you one thing that she did for me that was kind of relative for this. Not only did she teach me about my health and help me see my things, I kind of like, I'm in a world where the press room so I'm not like very, I'm educated, I'm smart, but I'm smart and the things that I know, and she introduced me to classes online where I could learn about anatomy. And so I took them and it was amazing. She taught me how to be a better person in a whole bunch of ways and being able to go into a doctor's office and know what my quads were and kind of explain things a little bit more and understand what we were doing and what was firing and actually all the way around. It's really incredible. So yeah, I think very highly of her. I think that she totally is a true inspiration. And a gift for her profession.

Karen Litzy:                   30:12                Sounds that way to me. That's for sure. And it also sounds that, you know, from the patient's standpoint, and I think this is so important, it's something that we hear so much about is that through education she was able to empower you to take control of your own health. You were partners in your care versus her just telling you what to do. And you did it without knowing why or what behind it. And, like you said, really inspired you to reach for more. And if every physical therapist can do that with every patient, then I think that would be such a boon to the profession.

Colleen Rapp:               30:52                Oh, definitely. It would, it would kind of, yeah. I mean, you guys, you guys are really important and you guys change lives, but you know, it's hard because not everybody's accessible to that. So, but in this story, I was and it's changed me. I've lost like I think, tell me what, like 35-40 pounds and I exercise like, yeah, like three or four times a week. And I'm just overall a better person. And, it's just a wonderful thing. I'm very, and as, you know, it's in me now and it's not just physical therapy. It's life. It brought life back in me. I can say it that way.

Tami Struessel:             31:44                You already said, well, you know, I was hiking today and, you know, I mean we're fortunate enough to live in one of the most beautiful places on earth. Colleen has taken full advantage of that. You know, I think there was a time where she would come home from work and was tired and he wouldn't do a whole lot. And now she's really, she's really a drank the Koolaid of being an active person. I think she exercises, but she's also just a more active person in general and thinks about activity and exercise differently. And, she embraces that and embraces making some lifestyle changes that has made all the difference.

Karen Litzy:                   32:36                And you know, before we kind of wrap up here, I just have one more question for each of you. They're going to be slightly different, but Colleen, I'll start with you and you've kind of, I think might've already answered this question sort of throughout, but as a patient, how has physical therapy changed your life? And part two of that, what advice would you give to someone who's on the fence about physical therapy?

Colleen Rapp:               33:10                I think physical therapy changed my life because I've learned that the most important thing is mobility and stability and so movement. I was always thought that to be a strong person, I had to go out and, you know, get a trainer and do 50 pushups and 30 squats and walk home, couldn't breathe, you know, and what I learned through physical therapy is that the exercises that you get are, are really important to learn how to balance. The simplest things can impact you in a certain way. And the other thing is that I had to embrace it because if I embraced it and learned how to do the things Tami taught me, not on any of the exercises, but if my leg hurt and how to take my leg, or I said, or something I could achieve to be better and to stay better and not be a person that was going to a year from now say, oh my shoulder still hurts or my back still hurts.

Colleen Rapp:               34:20                And that's what I worked every day for is finally instead of, you know, I finally found something that like physical therapy that just had an impact to me. And it's very important and it's very important if you do those things, you'll be successful. And that's the way I believe. I think that to tell somebody is to give it a chance. Because I work with so many people that don't, they automatically say, I want to have surgery, I don't want to go to physical therapy. And, I think you get into that stuff where they just assume that it's a waste of time. But I think if you would just give it a chance and just see and, and give it, you know, give it a try and listen, I think you'll learn that it's gonna Change Your Life. Like it did mine.

Karen Litzy:                   35:11                Incredible. And Tami, this is a question that I ask a lot of my physical therapy colleagues that come on the program and that's given what you know now where you are in your life and your career, what advice would you give to yourself as a new Grad right out of PT School?  

Tami Struessel:             35:38                Wow. That seems like a long time ago. You know what I think, it might be similar and actually I give this advice to my new grads that I teach. And that is that first of all that your first job or two is so formative and so select wisely, you know, look for places where you have a sense that the culture is good, that there is a lifelong learning mindset. I want to be sure that my patients that have come to see me, if I'm on vacation for a week, then they can go to somebody else and I know that they're going to get really good care. And then just that lifelong learning for yourself. You know, if you get stagnant and, you know, kind of bored, maybe you need to kind of figure out what you might be able to do to kind of spark that again.

Tami Struessel:             36:45                There was a time where I decided that I wanted to pursue teaching and I really sought out that opportunity and that's been extremely enriching for me as well. So I'm really fortunate there, but I also don't want to, you know, teach and not treat patients. As long as my body can hold up. I want to, I want to keep doing that because it gives me all kinds of great stories for a class. And it’s also fun. I think I was born to be a physical therapist, so, I know I made the right choice a long time ago and it still is really a terrific profession.

Karen Litzy:                   37:32                Amazing. And Colleen, can you tell us a little bit more about your student scholarship fund and what you have coming up?

Colleen Rapp:                                       Well, Tami changed my life so much that I wanted to do something in return. And so I found out this scholarship fund at her school didn't get a lot of funding, so I worked like a year and sold, sports memorabilia and I basically sold concert tickets and all kinds of stuff and I put all the proceeds for a year to the fund. And so the year was up and I kind of wanted to do something. I was like, well, this was really good. I want to do something like really crazy fun, you know, go out with, you know, happy, you know. So I decided to arrange a concert on September 5th, and it's going to have a pretty good artist in Denver. Her name is Hazel Miller and all the proceeds will go to the scholarship fund. They will be donated. So I'm kind of excited about it.

Karen Litzy:                   38:37                That's incredible. And what a great way to kind of pay it forward. And then just to be clear, this is a scholarship fund at the University of Colorado.

Tami Struessel:             38:48                The doctor physical therapy, specific student scholarship fund.

Karen Litzy:                   38:54                Awesome. Well, I mean, Colleen, what a great way to give back to the profession and to the future of the profession. So, and I'm sure those at the University of Colorado are very thankful for all of your help and enthusiasm in getting the word out about physical therapy. I know. I am. So Colleen, thank you for coming on and sharing your story. And Tami, thank you for coming on and sharing your story. In the way that you've worked with Colleen, and I think that you're giving a lot of therapists, especially newer grads or students, a nice glimpse into really how we can move beyond just take an injury and rehab it to take an injury and change a lifestyle.

Tami Struessel:             39:42                Yeah. Thank you so much, Karen. That's what I'm practicing at the top of your license, as you said before, you know that’s where you can really feel good every day about inspiring people and getting people to make lifestyle changes, like Colleen made, so that they can be a better, stronger, more resilient person. That's what it's all about.

Karen Litzy:                   40:08                Amazing. Well, thank you both ladies, for coming onto the podcast today and to everyone listening, thank you so much. Have a great couple of days and stay healthy, wealthy, and smart.


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Jul 11, 2019

LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Lars Engebretsen on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada.  Lars Engebretsen is a professor and consultant at the Orthopedic Clinic, University of Oslo Medical School and professor and co-chair of the Oslo Sports Trauma Research Center.

In this episode, we discuss:

-Dr. Engebretsen’s career shift from being reactive to proactive in injury treatment

-The importance of a team approach for injury prevention in sport

-Programs that focus on translating injury prevention research to coaches and trainers

-How to develop your research portfolio

-What Dr. Engebretsen is looking forward to at the Third World Congress of Sports Physical Therapy

-And so much more!



Third World Congress of Sports Physical Therapy

Oslo Sports Trauma Research Center

Lars Engebretsen Twitter


For more information on Lars:

Dr. Lars Engebretsen is a professor and consultant at the Orthopedic Clinic, University of Oslo Medical School and professor and co-chair of the Oslo Sports Trauma Research Center.

He is also a consultant and former Chief Doctor for the Norwegian Federation of Sports, and headed the medical service at the Norwegian Olympic Center until the autumn of 2011. In 2007 he was appointed Head of Science and Research for the International Olympic Comittee (IOC).

Lars Engebretsen is a specialist in Orthopaedic and general surgery and authorized as Sports Medicine Physician (Idrettslege NIMF) by the Norwegian Society of Sports Medicine. He serves as chief team physician for the Norwegian Olympic teams.

The main area of research is resurfacing techniques of cartilage injuries, combined and complex knee ligament injuries and prevention techniques of sports injuries. He is currently the President of ESSKA (European Society of Sports Traumatology, Knee Surgery and Arthroscopy).

He is the Associate editor and Editor in chief for the new IOC-BJSM journal: Injury Prevention and Health Protection. In addition, he serves on several major sports journal editorial boards and has published more than 200 papers and book chapters.


Read the full transcript below:

Karen Litzy:                   00:01                Hey everybody, welcome. Happy Saturday to everyone. For those of you who are on the Facebook page right now, welcome. I'm just going to check and make sure it's on. Yes. So we are live, which is awesome. As you know, we've been doing live interviews with speakers from the Third World Congress of sports physical therapy. And for those of you who, if you're on this page, I hope you know when it's going to be, but it's October 4th and fifth in Vancouver, Canada. And today I have the distinct pleasure and honor to be talking with Professor Lars Engebresten. So, professor, welcome. Thank you so much. And as we said before, I've been practicing that name for at least a week, so. All right. Chris Napier, welcome. We said welcome, to you, thanks Chris for being on. It's a little bit early. They're over in Vancouver. So professor, before we get started, can you please tell the audience and tell us a little bit more about you, your career trajectory, and what you're up to?

Lars Engebresten:         01:17                Yeah, I'm a professor at the University of Oslo Department of Orthopedic Surgery. And then I work, at the Olympic Center of Norway getting gold medals for Norway. And then I do work at the Olso sport Trauma Research Center, which I run together with Rollbar. And then I am a professor at the medical school and I work every other week for a couple of days in the Olympic national committee. So I have a very good combination or clinical practice. I still operate and I see patients quite a bit every week and research. I have many PhDs working on projects that I would say coordinated by myself.

Karen Litzy:                   02:02                That's an amazing amount of work to do. It's like five jobs all rolled into one and I'm sure, although this is not what we're going to be talking about today, but maybe another time we'll have you talk about your time management skills. I mean, how you get all of that done because that's an amazing amount of work to fit in. But let's dive right into, since you just mentioned that you're still doing clinical work and research, so how being that clinician scientist, how important is that to merge your clinical work with your research work?

Lars Engebresten:         02:38                Well, you know, I think I found out very early in my career in orthopedics how important researchers, I was actually, you could tell this story I was doing in clinic as a resident, up in Trondheim where I did my residency and next door to me was one of the professors. And I had many patients with anterior knee pain. And I would ask him, what do you actually do with those patients? Cause they now see him a little bit strange now on them and then suddenly I operate and all that. So I said, yeah, what kind of operation do you actually do? And then it sounded, you see, I do a Mickey operation, like, elevating the tibial tubercle to reduce the load on the Patella site. And I said, oh, that's strange. How are they doing? And he said, oh, they all do very well.

Lars Engebresten:         03:35                And then I actually looked up 50 of those patients. I am in the hospital and then sure enough about one third did pretty well. One third was about the same and one third was much worse. Then I realized, you know, you can't really trust the old professors. You have to in the areas where there are some doubts here and there and what to do, you have to do research in those areas there. There's no way you can be a clinician in your university clinic without, doing that kind of research. So since that time, which was a long, long time ago, I've actually been doing all kinds. So both clinical and basic science research

Karen Litzy:                   04:18                How does one inform the other? So how does clinical inform research and research informed clinical for you?

Lars Engebresten:         04:28                Well, for me it's been like a, you know, I see patients, I follow a various teams. I'd done all kinds of soccer teams, handball teams, ice hockey teams and so forth. I see the issues, what kind of problems do patients have. And I see what we have to, give them in the form of various therapies or various surgeries. And I realized that we aren't really perfect. That there is a lot of research that remains to be done actually. So that's a general in general speaking the way, I've found out that this is something I have to do. And, when I was young I was doing all kinds of sports myself. And I also realized that, you know, when you got the injured really, we really didn't have that much of a argument for getting people back. And that was a long, long time ago. And now we're better, we aren't getting better, but, we still have a way to go. So the last, I would say, 30 years I've been working on the three different research areas. So I've been working on a cartilage issues, a ligament issues, and then later on the prevention of injuries issues.

Karen Litzy:                   05:48                And you know, since you mentioned the injury prevention issues, let's dive right into that now. So, you've been involved in conducting a number of studies regarding, sports injury prevention. So what would you say are some of the common misconceptions around injury prevention?

Lars Engebresten:         06:10                Right. It's very difficult to get people really interested in that area because, you know, it doesn't really pay much on an individual basis. It does pay back to society because you get less injuries by doing it, but to the individual doctor or Physio, it is a difficult because of the payment schedule in these cases. In my case it was actually more specific at what made me change my attitude to this. So I was doing, all kinds of basic science and also can you go studies in the ligaments and tendons and then, you'll see them and they are very good. They were supposed to win the gold medal. Actually in Sydney. The star player had an ACL eight months at a time. And, which was a major issue of course.

Lars Engebresten:         07:17                And we operated on her and the most successful and she came back, Nora did not win the gold medal. Olympian bronze medal and she didn't really perform the way she was supposed to. And I realized then actually, that, you know, what we were doing was not really that great. I realized that she was on track for getting osteoarthritis pretty early after the surgery. And I realized, Oh, all my efforts in the, you know, ligament, design and, new ways of doing the surgery and stuff wasn't that great because I thought, you know, I should spend more time on how can I prevent these types of injuries at the same time as I treat them later on. But I kind of refocused towards prevention all these injuries after that incident.

Karen Litzy:                   08:25                So getting back to this injury prevention, so based on our current knowledge of injury prevention in sports, what would be your recommendation or go to strategy intervention for injury prevention? So for example, is it exercise? Is it load management? Is it education?

Lars Engebresten:         09:05                The most important thing is to look upon this as a team effort. There's no way you as one person, I would be able to make a huge difference in this area because prevention is all the aspects that you mentioned. And therefore, you know, in our case, you know, also sports trauma research center, we are a quite a few people working in this field and there's no way that not one of us could make a big difference. Yeah. It's all about the team effort. Because you have to do research, just figure out whether your program is working. Secondly, you have to make people do it. And third, you have to look at results of it. And that really demands a manpower, budgets, long term studies in this area.

Lars Engebresten:         10:13                We’ve done a lot on randomized control studies showing the effect of these programs, but we still don't have perfect compliance, you know. What we have found out lately is that, we are changing our approach and it can be towards instead of travel around I get a mixture of some of this to athletes and stuff. We actually tried to teach the coaches in Norway anyway. The coach educational programs are now filming this prevention programs we have. So it's all about, I think parents and coaches, then the doctor or the physio doing it. So we have to be able to relate all the knowledge we have and to be able to implement it. And that is the biggest challenge at the moment.

Karen Litzy:                   11:17                Yeah, that makes a lot of sense. Changing people's behaviors is not easy.

Lars Engebresten:         11:25                It's not, but you know, at least where I live and I'm sure also in the US, we have been able to stop people from smoking. Very, very few smokers left here. So we should be able to, you know, instigate the system where, if you are young and you're doing a sport, part of your sport is the prevention part.

Karen Litzy:                   11:50                Yeah. And, and I think that that's great example that yes. Smoking, when I first moved to New York City, so many people smoke. Now it's a rarity mainly because of good outreach campaigns, via media and things like that. And sometimes they think that's where, injury prevention and sports injury prevention is just not getting its fair air time, I guess. Right. So when you look at mainstream media and news and things like that, they focus on the injury. So the professional player who gets injured or the collegiate player that gets injured, this is the injury. This is the surgery versus look at all the people who haven't gotten injured and why is that?

Lars Engebresten:         12:33                Hmm. Yeah. You know, there are some good examples. For example, hamstring injuries, we have a pretty good way of reducing and reducing those by maybe as much as 75%. And even in the premier league in England, the best, very best teams, you don't really do those exercises. And it's really, really crazy cause the number one injury, keeping people out of premier league soccer is actually hamstrings, it's a very strange thing that I've not able to, and I think that's all about, you know, the coaches being involved and understanding how important is this.

Karen Litzy:                   13:15                Yeah. And are you doing things in Norway? I know you said that now you're getting more coaches to come to lectures and things like that. So if there are people listening from other parts of the world, what sort of system are you using to get those coaches in?

Lars Engebresten:         13:32                Well, there, you know, almost every country has some sort of cultures of education and it's like level one, two and three and so forth. And, now we have introduced international programs, you know, all those levels. That’s part of some sort of daily education is about prevention. And I think that's I must add a key in this area. We have shown that we are able to reduce the number of serious knee injuries for example by more than 50% in some sports that are really prone to those type of injuries. Team handball is a very good example. Basketball could be another one. So I think that education day is very, very important. But as I said, we are trying out new ways of getting compliance improved cause that's still an issue.

Karen Litzy:                   14:30                You can have a great injury prevention program but if nobody does it.

Lars Engebresten:         14:36                Hmm. I know, you know what we are trying to do is to teach the parents. If you have a daughter, 12, 13, and 14 year old and if she plays soccer or team handball, the chance of having a serious knee injuries are very high and you can really take out insurance by doing a these kinds of exercises at the same time that you are training. So maybe spend 10, 15 minutes, three times a week on this that would be able to reduce the percentage risk for having an injury like that.

Karen Litzy:                   15:13                Yeah, I mean from the standpoint of the clinician and the researcher just makes so much sense. We just have to get the coaches and the players and the parents and team organizations in schools and things like that on board. And I would assume that takes time and some effort and the incentives.

Lars Engebresten:         15:35                I think that in the US you have all the sports in schools, right? Whereas in the rest of the world, for the most part the sports are outside schools and community teams and stuff like that where it is a little bit more difficult to get this through. So there should be good chances in the US and Canada as well.

Karen Litzy:                   16:01                Alright, well hopefully people listening to this will kind of take this to heart and go to their local high schools and middle schools and try and educate those coaches and parents. All right. Now you already touched upon this I think a particular patient case that you personally treated that caused you to reevaluate your whole treatment paradigms. And I feel like you touched upon that a little bit already. Do you want to expand on that at all?

Lars Engebresten:         16:31                Yeah, in a sense that, for me personally, it really changed me from, you know, doing surgery four times a week, four days a week, to spending more work in the research lab, trying to design exercises to help in preventing these kind of injuries. We have done a lot of work on looking at why are they happening and how are they happening. And our team here in Oslo has relatively good knowledge in this area and that has helped us in designing programs. It's taken a long time and takes your way from the OR and into a different environment and that has really put the major change in my medical activities.

Karen Litzy:                   17:24                And are you happy with that change?

Lars Engebresten:         17:30                I am, I'm going to a meeting, for example now in a couple of weeks and I'm preparing for it in Pittsburgh on the ACL, various kinds of injuries. And that just tells you here all these, experts from around the world. They still attending as still the same question comes up. And again, there hasn't been a huge development, I would say, when it comes to serious knee injuries in the results of the treatment we have. So there, you know, the area that I'm interested in, this prevention area probably have still a lot to contribute to the field because you would, the surgeons haven't really caught on, at least not on the measure where of them. I would say in this, even though if you guys have done it, the physios have done it. The big story is still lagging behind a little bit.

Karen Litzy:                   18:36                Yeah. And it's to me, what it sounds like I'm hearing from you, is it sort of forces you to be instead of a reactive doctor, a more proactive physician.

Lars Engebresten:         18:47                Absolutely. That's a good point. That's a difficult change.

Karen Litzy:                   18:54                Yeah. Especially because you had a lot of training, but it's still, I mean, it's still all medicine and in the end it's helping the patient, which is the most important thing. That's why we do what we do. Right. As we said in the beginning, you're also a researcher. You have an impressive publication record, hundreds of peer reviewed articles. So if you kind of take a look back at all of those articles that you published, which one of your research projects or papers is most meaningful to you? So maybe it doesn't have the highest altmetrics score, but which one to you is like most meaningful?

Lars Engebresten:         19:40                For me that's very difficult to say actually because you know, not because I have some many, but more so because I have various fields and I've been very heavily involved in, there were some really important ones in a mechanism and I was working in the lab and then taken lab or to the OR. But I think that, overall the most important one is probably the one we did on, prevention of ACL injuries and team handball and follow, this for 10 years. I mean, you could see, you know, when we went in there actively and we were able to reduce number injuries and then we kind of stepped out and let the players do themselves, ramp back up, all the injuries. And then we really, reinforced our efforts and all of a sudden we were able to really reduced the number of injuries again and just shows us that if you really, put your mind to it, you can really achieve something. So that's probably the most important paper to come up with. Then again, you know, this is all about a team, a group, a team thing. It's not something I've done myself. Yeah. I've been part of the whole team, so really that's probably the most important.

Karen Litzy:                   21:00                Nice. And then what advice would you have for young researchers who are trying to develop their publication portfolio?

Lars Engebresten:         21:10                Yeah, I keep telling my coworkers in the hospital, that's not the university that although it is great to have patients and to treat them and see that they're doing fine. Still if you've been doing that for 10 years, you kind of get bored after a while if you don't really progress and develop yourself. So you have to be able to do some sort of research during your clinical work as well. I'm really trying to tell them some examples here and there, why I did this and that. And then it is absolutely possible to combine a missing clinical practice with some sort of research at least if you're able to work as a team. So you still as you know, have other orthopedic surgeons or in my case physios and trainers that you work with, which will enable you to do much more then you can do only by yourself. I think their whole, the most important advice is to, you know, if you look at your 10 last patients and you see and you really look, take a close look at them, then you realize that, you know, there are many things you don't really know. So there many things that needs to be researched. I had one young person come up to me a while ago saying that he was discouraged because there's nothing more left to research. That’s all wrong.

Karen Litzy:                   22:51                Yeah, everything's been done?

Lars Engebresten:         22:54                Everything has been done and you know, that is absolutely wrong there's so much left to do. So there's work for everyone.

Karen Litzy:                   23:07                Yeah, I would think there would be. And now let's talk about what you're going to be speaking about at the Third World Congress on Sports physical therapy. So can you give us a little sneak peek as to what you're going to be speaking about?

Lars Engebresten:         23:20                Yeah, I see from the program that I'm going to talk about ACL or ligament injuries and a surgical treatment versus non surgical treatment. And that's something that we have been working on for awhile in Norway and also with other groups, where we have lots of research have been showing that in Norway we actually do about 50% of our ACL patients are having ACL surgery. The reason is that, you know, people that are not doing pivoting activities or pivoting sports they are completely able to continue what they're doing without having a reconstruction, things like that. The key there is of course, range of motion proprioception and strengths. And, if you are able to do that, then you can do well without having an ACL reconstruction. And even if you have an ACL reconstruction, if you don't do those kind of rehab are, you'll never be successful. That's probably what I would be talking about and some of the results we have from our area in the room.

Karen Litzy:                   24:39                Sounds great. I look forward to it. And I think it is amazing that it's only 50% of people in Norway. I feel like in the US it's much higher. You probably know the figures better than I do. But just from an anecdotal standpoint, it seems like the moment someone has an ACL tear, they're having surgery regardless.

Lars Engebresten:         24:57                Yeah. I'll let you know. The point is nobody knows that in the US because you don't really, you know, how the numbers on people and not having a ACL injuries. It's very interesting because I been working with China actually on developing an ACL program for them. And you know, they have thousands of ACL injuries, but I have no clue on how many actually, because I think they have mostly injuries and China is not really being operated on, at least not until now. But you are right in your part of the world. If you have an ACL injury, you will be operated on automatically almost. And the same goes for central southern Europe. It's the same thing. And in Scandinavia, Sweden, Finland, Denmark, Norway. We're trending to operate only on the ones with the pivoting work and the rest we don't do so in Norway we have about 4,000 ACLs a year. You know, 2000 see surgery.

Karen Litzy:                   26:14                Right. We'll see what happens as time goes on and people start to realize that maybe there are some other options. But I'm definitely looking forward to that talk in Vancouver. And are there any talks that you're looking forward to or people that you're looking forward to seeing?

Lars Engebresten:         26:32                Yeah, you know, I look forward to see some of the PT work on the new ways of getting people proprioceptively sound new ways, testing people for it, in sport, things like that. That is really something that interests me.

Karen Litzy:                   26:50                Well, I have to say, I want to thank you so much for taking time out today. Is there anything we didn't cover that you have like a burning desire to talk about before we end?

Lars Engebresten:         27:00                No. I look forward to come to Vancouver. It's a wonderful city. I was there during the Olympic Games in Vancouver, and Whistler and also down in Vancouver and it was a beautiful area.

Karen Litzy:                   27:16                Yeah, me too. The only time I've been to Vancouver was when I went to whistler to ski. I was only in Vancouver for as long as it took me to get off the plane, get into a car and drive up to whistler. So I'm definitely looking forward to spending a little more time there. But thank you, professor so much for taking the time out and speaking to everyone and Chris and everyone else that's watching. And Mario gave a thumbs up. Mario Bozenie, thanks so much for tuning in and hopefully we will see you all in Vancouver October 4th and fifth so thanks so much.

Lars Engebresten:         27:50                Thank you.


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Jul 8, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Tamara Rial on hypopressive exercise.  Tamara Rial is the creator and co-founder of Low Pressure Fitness which is an exercise training program based on hypopressive, myofascial & neurodynamic techniques.

In this episode, we discuss:

-What are hypopressive exercises?

-Patient populations that would benefit from hypopressive exercises

-The latest research on the mechanisms and effects of hypopressive exercise

-Common criticisms of hypopressive exercise

-And so much more!


Shannon Sepulveda Website

Shannon Sepulveda Facebook

Tamara Rial Website

Herman and Wallace Website

Pelvic Guru Website

Tamara Rial Instagram

Hypopressive Guru Instagram


The Outcomes Summit:Use the discount code LITZY

For more information on Tamara:

Tamara Rial earned dual bachelor degrees in exercise science and physical education, a masters degree in exercise science and a doctorate with international distinction from the University of Vigo (Spain). Her dissertation focused on the effects of hypopressive exercise on women’s health. She is also a certified specialist in special populations (CSPS).

She is the creator and co-founder of Low Pressure Fitness which is an exercise training program based on hypopressive, myofascial & neurodynamic techniques. In 2016, this program was awarded the best exercise program by AGAXEDE, a leading sports management association in Galicia, Spain. Dr. Rial is the creative director and professional educator for Low Pressure Fitness. At present, over 2000 health and fitness professionals from around the world are certified Low Pressure Fitness trainers.

Dr. Rial is a professor of pelvic floor rehabilitation in the masters Degree at Fundació Universitaria del Bages in Barcelona, Spain. She is the author of several scientific articles and books about hypopressive exercise. She has also published numerous articles and videos about pelvic floor fitness, hypopressive exercise and women’s health. She is an internationally recognized speaker and has presented at conferences throughout Argentina, Canada, Mexico, Portugal and Spain. As an established researcher and practitioner, she continues to collaborate with colleagues at universities and health care settings to explore the effects of hypopressive exercise on health and wellbeing.

She lives with her husband and two dogs in the United States and Spain. Dr. Rial is available for consulting, speaking and freelance writing in Spanish, Galician, English and Portugues.

 For more information on Shannon:

Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.

 Read the full transcript below:

Shannon Sepulveda:      00:00                Hello and welcome to the healthy wealthy and smart podcast. I'm your guest host Shannon Sepulveda and I am here with Tamara Rial. Hi Tamara. Can you tell us a bit about who you are and what you do?

Tamara Rial:                                         Well, we're going to introduce a little bit how we met because Shannon came to our hypopressive course that we hosted in Portland with Bobby Grew, right. So I like to call myself a hypopressive expert. I been studying and practicing and teaching this technique for over 10 years and I did my PhD based on hypopressive and its effect on urinary incontinence. And then I began teaching this technique to professionals as also to practitioners. And well, I happened to live in Spain also almost all my life and they do my work there. And also I have been a professor in the University of Vigo in Spain.

Tamara Rial:                 01:13                But two years ago I came to United States because I married my husband who happens to be American and we moved into New Jersey and that's where I currently live.

Shannon Sepulveda:                              Well, can you tell us a bit about what hypopressives are and what low pressure fitness is because I would assume the majority of the audience has no idea what that is. I think some of us pelvic health PTs know and some other people in the world, but it's all the rage in Spain. So tell us about what it is.

Tamara Rial:                                         Yeah, I understand because there's this word hypopressive and some people kind of listen to this word for the first time. So if we look at the etymology of hyper pressure, really what it means, a hypo pressive, it's Hypo. Less pressure pressure of course. So it's an exercise that reduces pressure.

Tamara Rial:                 02:16                It's specifically a intraabdominal pressure intrabdominal pressure and intrathoracic pressure. So normally we call the hyper pressive exercise as a form of exercising with different postural cues and different poses throughout and a specific mechanism of breathing. And the general name of these exercises was named after that reduction in pressure that we have observed after doing these poses, combined with this specific hypopressive breathing technique. So yes, I know that sometimes it’s quite hard to understand, but they name and especially in some countries are for those people who are not familiar with it pelvic PT area. But, it will be the name given to a form of exercise.

Shannon Sepulveda:                              So can you talk a bit about what you mean by poses and then what you mean about the breathing technique?

Tamara Rial:                                         Well hypopressive exercises are also known as the hypopressive technique as I said, as a form of exercise that is mainly postural and breathing driven.

Tamara Rial:                 03:42                So I also like to say that it's a mind body kind of technique because it is based on low intensity poses that can resemble a little bit of the kind of poses we were doing pilates exercise or when in Yoga many yoga instructors will find that many of those poses and breathing techniques are very similar of the ones they also practice. So the postural technique of hypopressive is basically one that aims to do a postural correction, a postural correction in a more body awareness. Like how is our spine, how do we activate our pelvic girdle, how do we activate our pelvic, abdominal muscles or shoulder girdle? So we would focus a lot of body awareness as I said, and on posture reeducation, making the person aware of how they stabilize their spine, how they stabilize their body.

Tamara Rial:                 04:54                And from there we would progress the exercise from a more static poses. And then from there going to a dynamic postural position, and then the breathing exercise is mainly the technique made up of lateral costal breathing that is also practicing in pilates and also by a form of exercise that is also called the Ooda bandha technique. So this is a Pranayama, yoga Pranayama that we use in hypopressive and we call it the hypopressive breathing. So it's a very noticeable and visible technique. But you, because when you practice it, you see how they add them in draws in and the thorax expands and sometimes people confuse it with a hollowing, abdominal vacuum hollowing. Because when you're doing abdominal hollowing, you see how they belly button draws in and there is actual a little scoop in your abdomen, right?

Tamara Rial:                 06:10                But really when you're doing abdominal back q or a do the Anna Vanda or hypopressive breathing technique, what is happening is that you're actually opening your rib cage throughout a breath holding maneuvers. So that means you expel all the air or you expel the current volume of air you have in your lungs. And then after that you open your rib cage. And that will lead to a observable and very noticeable draw in of your abdomen. It is going to be even more noticeable that the actual abdominal Holloway maneuver. Why? Because their rib cage opens and lifts and that's gonna draw in the abdomen and in and create this vacuum that we call in yoga with the Yana Veranda, which is a Prana Yama. They are yoga teachers in some practitioners may be also aware of. And the combination of this type of breathing in a sequence with different poses that they instruct are not normally a progressive. The person through these form of exercise, the low pressure fitness technique.

Shannon Sepulveda:      07:31                That's awesome. So let's talk about who can benefit from this form of exercise because I think that it's become really popular in the pelvic organ prolapse community and the urinary incontinence community. But then we also had a bodybuilder in our class because she needs to learn these poses for her bodybuilding. And we also learned about other types of athletes in particular in Spain that use this technique to help with their sport. So could you talk about like who can benefit from this?

Tamara Rial:                 08:03                Right. That's a great question. Well, hypopressives at the beginning where as you a correctly said, we're especially aimed for the post natal woman. And so specially after giving birth woman began to have some urinary incontinence and many women develop some type of prolapse and also they want to rehab there mommy tummy. So the application of this type of exercises that reduce their waistline and also reduce pressure, especially at the first weeks after giving birth where especially in France and in Belgium, the exercise that they were doing and performing and in France and in Spain, these exercise became to get a more popular and I think almost all a postnatal woman do this kind of routine and pelvic floor physical therapist and also midwives and duolas recommending and teach this kind of exercises in the postnatal phase.

Tamara Rial:                 09:18                So that's why I think it got very popular. But it's true that many other people and at the beginning I wasn't very aware of it because I also began focusing a lot in urinary incontinence because I thought that we're dealing with pressure, right? So this thought of I want to reduce pressure so it will benefit those women or those people who have some type of issue related with increase or dynamic pressure. So the one that always can come to mind or what stress urinary incontinence and pelvic organ prolapse. But there are other pressure issues that can go that people can deal around. And in the woman's health community we are very aware of constipation because it could also lead to constipation in the way we breathe and we push when we go to the bathroom can also lead to some symptoms.

Tamara Rial:                 10:23                So we've seen that people who a incorporate hypopressive breathing and also hypopressive technique from a regular basics and have constipation issues can benefit. And also there has been some research done on pelvic who suffer nonspecific, lower back pain and who have shown good results doing a basic series of exercises because many people ask what are the exercises? Are they're doing a lot of a complex exercise or are they doing dynamic? No, the basic routine. For example, in the course we learned the basic normal static exercises and in the easiest vacuum, that means a vacuum that is performed with a low breathe breath holdings only between 6-10 seconds. And also very easy poses that almost anybody can do in a standing position in a sitting and a kneeling. So really you don't have to be at gym to perform it and even our elderly in our and people with any type of a movement issues or even people who are in wheelchairs can also perform it because really the exercise is very easy.

Tamara Rial:                 11:52                It's basically controlling your breathing and control your pose. So it's specifically, we began to see that not only the woman's health, a community could benefit from hypopressive, but also people suffering, as I said, with a constipation, low back pain. And then there has been an increasing application of this type of training from an aesthetic point of view. Why? Because doing this type of exercise, the transverse abdominis muscle gets quite activated and when you see the abdominal vacuum maneuver, you can see that really the transverse and all the abdominal muscles have this corset effect. There's a visible waistline reduction so that waistline reduction is visible during the exercise. But after two or three months of continuous practice, that means doing two or three sessions of 30 minutes over a period of three months. You can observe a statistical reduction.

Tamara Rial:                 13:07                Yeah, significant statistical reduction in waistline, we're talking about between two centimeters of average or 2.5 between 3.5 right? So that will be the average waistline reduction. So for people who really want to reduce their waistline because they want to look better or they're doing a competition for bodybuilding for example, they are really want to find exercise  that can achieve a waistline reduction without only thinking. Of course we all have to think about our food intake and our caloric expenditure. But when all those variables are taken into account and you also want to want to work on your natural corset that means your abdominal muscles. We all know that we have to train our core, but we can train our core in different ways. And one way that we have seen that also can be an alternative to normal or traditional core training methods is also the stomach vacuum or the abdominal vacuum or the hypopressive technique.

Tamara Rial:                 14:27                In fact, it's funny to observe that in the body building community they have a pose that they execute. That is called the stomach vacuum pose. And this stomach vacuum pose was a popularized by Arnold Schwarzenegger in 1970. There are many, there are some pictures of him that if you go to the Internet and you put an Internet Stomach vacuum pose, you can really see how he had a pose I think he's the king of the stomach vacuum pose. And he really popularized it because when he would go on stage, he will want to show his serratus. So a way to show the great development or the mass development of his serratus would be going into a big rib cage expansion, lifting his arms behind his head and just pulling in his stomach throughout this abdominal vacuum technique that is really hypopressives.

Tamara Rial:                 15:29                So he even wrote in his bodybuilding, he wrote that he usually trained this technique to achieve a waistline reduction. And if you see his body, it was amazing. He really had a very thin waistline and a big thorax. And now bodybuilder nowadays they're there. Well at least what they are seen as they're getting, they're having trouble in and getting a great lat spread and a great big thorax and in comparison have a very, very thin waistline. So that's why now we're recovering a little bit. This knowledge that he brought us in the 70’s it seemed that now more bodybuilders are being aware of doing this type of a stomach vacuum exercises. And even in Spain, the Federation of bodybuilding has a included the stomach vacuum pose again as compulsory for the male competition, which is kind of cool.

Tamara Rial:                 16:34                And that's why I think it was two years ago. And we begin to see a great demand of body builders to come to our classes to learn, only from aesthetic purpose is to learn the technique because it's not easy. It's not easy to be onstage, hold your breath, be smiling, and at the same time hold your breath for 10 seconds when you're already very tired and open, open your ribs and show that stomach vacuum so you really have to train it. And in our bodybuilders, that came to the course. She is amazing. Of course she was absolutely gorgeous, but she wanted to work a little bit more on her stomach vacuum pose.

Shannon Sepulveda:      17:20                Yeah, yeah, yeah. She told me that, that maybe the difference, like it like she's like, I need to learn this. And I was like, wow, that's, I didn't even think about that. And then when you showed us the pictures of Arnold Schwarzenegger I was like, oh yeah. I mean I remember seeing them as a kid, but I was like, oh, it totally is a stomach vacuum. And so I think it's really fun when you have all of people from different

Shannon Sepulveda:      17:50                backgrounds in the courses because it's just fun to talk to them and pick their brains and see like why they're here. So I thought that was, that was really cool.

Tamara Rial:                                         And how different people from different areas, from fitness professionals for women's health, from even massage therapists, it can have a common link. There was also the course, we had a several yoga instructors because I guess it also makes sense to incorporate a technique  that has so much in common with already yoga.

Shannon Sepulveda:                              Yeah. Can you tell us a bit about your research and your education and your PhD work?

Tamara Rial:                                         Okay. Yes. So as I said I was Spanish and I think some of our listeners have noticed that I have a little accent. Well say. I've grew up in Spain. I did my education, all of it over there.

Tamara Rial:                 18:54                I also did a semester in the University of Porto, part of my PhD and they laboratory of CNN, Tropo Matree with the professor. But my main focus was always a pilates, and some type of mind exercise. Mind body exercises a woman's health. So I began to get interested in this because I've seen at least in his Spain, it wasn't a woman's health wasn't a topic that was taught so much in the physical education and fitness community. We were talking about the benefits of exercise for health, but we were looking so much of the benefits of exercise also for Woman's health and how some type of techniques and pelvic floor muscle training could also benefit a lot. Mainly females and males who have some type of dysfunction.

Tamara Rial:                 20:00                And we really had to bring this knowledge into the physical education to the exercise science community and into the gyms. And I also think into the woman's community because sometimes there's that, well I really think there's this feel like great taboo talking about women's health issues. So maybe it will be easier if we begin to talk about it in a easy way from the gyms and bring this topic into the fitness instructors. So they would bring more awareness and also the coaches into the sports community and that way make aware to our woman and our males that there is option to, and there's options to take care of your pelvic floor and your health with exercising correct movements and how just by breathing you can affect immensely your pelvic floor health because we are not aware of how we breath, how we are standing now.

Tamara Rial:                 21:06                Now our listeners they’re maybe they're sitting in the car they're walking, but are we taking our time? Are we looking in was and are we feeling our brand that we fit in our body? So all those things I thought we, I had to bring it into the fitness community. And that's why I really wanted to focus on how some type of mind body techniques could impact urinary incontinence. And at that time hypothesis was not a very famous thing in Spain. I think it was not famous. Nothing. Maybe some pelvic floor PTs who had been taught in France. Know a little bit about it, but really it wasn't a big thing. So I learned about it from Marcel Frey, who was one of the main people and teachers who begin to get interested in this topic. So I thought, why don't I do a research study on this on urinary incontinence?

Tamara Rial:                 22:12                And I remember at the beginning it was hard because imagine telling your doctoral advisor that you want to do a study on woman that's kind of, okay, I'm focusing on women and then say I want to focus urinary incontinence. So I'm getting more specific. And then I say, I'm going to assess the effects of hypopressive exercise. When I said this word, he was like, what is this? And we went into the literature and there was nothing in the literature, nothing at that time. And right now there's still nothing. Okay. But at that time there was negative and it was kind of hard because what is the basis? There is almost no basis. And I know, I know I took a risk, but I began to apply it on myself and I begin to apply on some practitioners and I saw results very quickly and they were telling me even after three sessions that they already were feeling a decrease in their ordinary symptoms and they were, I was even shocked because I like time.

Tamara Rial:                 23:25                I didn't believe it. I was still one, I was one of the skeptic that's a little bit the reason why I said I want to study this to prove it's not working, but when people begin to already tell me, you know, I feel great and I begin to see how women were enthusiastic about it. I said, okay. I really had to give it a chance and that's how I got paid. I'm really passionate now about it and people say, you're very passionate. Why? I think that people who I work with made me passionate because whenever I see that somebody can benefit from what I'm teaching, that makes me happy. And that makes me really think that maybe I'm, if I'm making somebody better, I'm helping in some sort of way, I think that's how I've been driven to keep on in this path.

Tamara Rial:                 24:19                And also because I want it to make it more on evidence based or a technique that would have more support. Because at the beginning I would hear people say, hypopressives does this, or hypopressives does this, but there was no, there was no basis behind that. Even sometimes the physiological description of the exercise was wrong and people were very assertive. Like people would say, it does this to the body or you can achieve this, whatever. But what is the research like? What is the, what is the, even the physiological mechanism, which explains that. And, and there was very contradictory explanations in the literature because I guess nobody has really wanted dive into it and study to show that maybe it's correct or not as correct because I even at the beginning thought that maybe intraabdominal pressure doesn't increase or maybe decrease.

Tamara Rial:                 25:29                We still don't know. We still don't know what has happened at the thoracic level so we cannot just assume things if you really don't study it. I think that was the big mistake with hypopressives. People got excited and they began to say, there's no thing called hypopressives. It's fantastic and blah blah blah, but you cannot put something out in the market and say it is great without really having to first apply it with real people as it in a clinical way and then begin to do some short term studies or some physiological studies. That means, for example, if you argue that there is a decrease in pelvic pressure, you have to assess it. You cannot say it without even assessing, maybe not 200 people, but at least a group of people. And then from there, which we would have to see if there is some type of chronic effects.

Tamara Rial:                 26:39                We still don't have a research that really shows many claims that people say. So those are lacking in the literature. So we always have to be cautious and see, you know, we don't know. We don't know. People are getting some good benefits and they're claiming that they're feeling better. For example, they're feeling more posture rehabilitation or they feel there breathing capacity has increased. But that's anecdotal evidence and we have to prove that with more randomized trials. Right. So, that's a little bit how I started and I got interested in it and I'm still working with it and teaching. I came to United States and I did my first courses through Herman and Wallace, pelvic rehabilitation institute, and also through pelvic guru that we're the first people who trusted me in United States.

Tamara Rial:                 27:52                And they led their hand and they began also to hear from some pelvic floor practitioners who in United States who were already working with this. And I guess there was a little bit of spread of the word and that's why I think in the United States some people began to get interested in it and now let's just see how it works and hopefully more universities can open new lines of research on this topic because I think women's health and pelvic health, although if we focus a lot on urinary incontinence in pelvic organ, there are many other issue that have not been so much address like a hypertonicity, a topic for dysfunctions, pelvic pain. So there is still a lot of research that we can do. And I think also the area of alternative movement exercises, for example, Yoga and even pilates, there should be more, more interested in it because our woman and our people, our population, we need to move, we need to do exercise.

Tamara Rial:                 29:13                And we really, when there is a public condition, many women are afraid of moving and doing exercise. And I don't think it's good to tell a woman or to tell a postnatal mom, you know, you have to be careful, don't lift weights or don't do this exercise or don't do curl ups. So are I feel that sometimes we're frightening too much are woman and there and instead of going to the gym or maybe sometimes you can have a leakage and you say, Oh, I'm a little embarrassed because I'm leaking during my crossfit activity, but I love going to crossfit. So maybe I can also compliment my activity with other more pelvic floor friendly programs or with some programs that kind of counterbalance that high intensity activity. I kind of, I sometimes say that a low pressure of hypopressives are the best friends of high impact activities because we have the metabolic benefits of a high intensity interval training, which has a great background of research that shows that is one of the best type of training for many metabolic conditions for our cardiovascular health. So we want people and we need people to be doing their physical exercise. And on that note, we're going to take a quick break to hear from our sponsor and we'll be right back.

Shannon Sepulveda:      31:36                Okay, so we learned about some awesome new research in the course. So can you share that with us?

Tamara Rial:                                         Yes. Well, we still didn't know until some weeks ago what was happening in the diaphragm. Because it's true that when you do the abdominal breathing maneuver, the hypopressives maneuver, you're actually opening your rib cage in, you're holding your breath. So it was hypothesized that because you're using your inspiratory muscles to hold and expand your rib cage, that diaphragm what is happening it raises up, right? So imagine when you breathe in your diaphragm goes down, contracts and lowers the position and also the pelvic floor because the movement of the breathing and the synergy or the diaphrgm the pelvic floor diaphragm is synergistically, right? So then when you exhale, the diaphragm raises up and also the pelvic floor contracts and raises.

Tamara Rial:                 32:38                So when you're doing this hypopressive maneuver, what has happened is they're opening your rib cage in your allowing to your Diaphragm to raise up a little bit more. So that means that it achieves a little bit of higher position than when you're only exhaling because it's kind of a stretch of the diaphragm. But the question was, well, but what happens? Because we have some studies that have shown through ultrasounds and MRIs that when you're doing this hypopressive breathing, there is a pelvic lift, right? There's a raise of the pelvic floor and also the bladder and the uterus. So this is something you can actually see. And in the course we also see it in ultrasound measurements, but it's difficult to have an ultrasound measurement of the diaphragm and also it's difficult to see the pressure in your esophagus or in your abdomen.

Tamara Rial:                 33:40                Because that would have to be through a more difficult assessment that normally in the pelvic settings we don't have have. So normally if we want to assess in a pelvic floor or physical therapist setting the pressure, we can use intrarectal devices or intra vaginal devices. And that way when we're doing different types of maneuvers, we can assess what's happening, right? So when you're doing the maneuver, what happens with hypopressive is there's going to be a decrease of intrarectal pressure intracolon and also vagina, right? If you performing the exercise with the correct form, and I always like to say and this and make it a specific, that it's not something that you can achieve the first day of practice. You have to know how to correctly perform the technique as well as we teach how to correctly perform up pelvic floor muscle contraction to enable the pelvic floor muscle to really lift and contract and not to, for example, Bulge.

Tamara Rial:                 34:51                That can happen if the technique is not correctly performed or if they breathing phase doesn't accompany the contraction. So in the same way, when we're doing a hypopressive maneuver, what would happen is that we would exhale first and then after that exhalation we would hold their breath and we would only perform a voluntary muscle contraction of our rib cage muscles. So the question is the diaphragm what happens is a very relaxed is a very contracted, is it not? So Trista sin, which is my colleague and one of my friends who have, I been working also very closely and she teaches courses over there in Canada, she actually flew to Vancouver because there's a research group there who's going to access actually with the group of people who are going to do hypopressives and I can't recall right now his name, but he's a phd candidate who is a looking forward to do his phd on the effects of a hypopressive technique on the EMG activation of the diaphragm and also into the pressure management, intrathoracic pressure.

Tamara Rial:                 36:29                So we won't call it the pilot testing and because Trista is a very good practitioner, she already knows how to do the technique and I know that not everybody wants to introduce a catheter, it's not one of those research that a everybody would want to do. So she did it. And, we have the preliminary results that I can, I can read you some of them. And she also did different poses. So she did the analysis in the standing pose, which was more easier to assess also in kneeling. Because you don't have to move your face or you're not on a board where sometimes you can change the position of the catheter.

Tamara Rial:                 37:32                Yeah. And, also supine was an easy pose. So that's the assessment and there actually was electromyographic activity shown in the diaphragm from which would make sense because the diaphragm cannot relax. So there's a quite of lengthen in an activity going on even if you're doing the breath holding maneuver. So I guess that when they results on the group, they're going to test on the trial. We will get to know more of really what happens, not when you're doing actually that technique, but what would happen, what chronic effects would have your intercostal, your breathing muscles. And also your Diaphragm from when you're doing this kind of vacuum technique and also what happens into the pressures. So we would be able to show that there is a reduction, the reduction of thoracic pressure and intrabdominal pressure, which is kind of cool.

Tamara Rial:                 38:40                It's pretty cool because at least now you can say that it makes sense to call it hypopressives. So, well, that's the thing. And also when you're doing hypopressives, the thing is that you're lifting your rib cage and you're using your breathing muscles. So for example, they, SCM muscle increases his electromyographic activity because it's all it has, it enables their rib cage to lift, right? So whenever you're doing a hypopressive, you will really actually see the lift of the rib cage and also the widening of your intercostal rib cages. All the rib cage actually open. So also this serratus is a muscle that is also going to increase as is electromyographic activity. Right. And there has been another group from Brazil that actually did not a chronic study, but they did an acute study that they assessed the electromyographic activity of the abdominal muscles, so transverse, Oblique and internal oblique.

Tamara Rial:                 40:01                They did it through superficial electromyographic activity and it was with some female practitioners. They were healthy. There were no pelvic floor dysfunction. Just testing when you're doing the vacuum, what actually happens in the core muscles because some people think that when you're doing a hypopressive, maybe there's a high electromyographic activity, but really you're not doing an active contraction. For example, if you do a a crunch exercise or you actually contract forcefully your abdomen, you will have a very high electromyographic activity, but because what you're doing is just having a stabilizing pose that makes your spine grow and you're actually doing a low intensity postural activity and you're opening your rib cage in your muscles. There's not going to be such a high activity. There is an increase of activity but not so much on the rectus abdominis and the external oblique as much as there is in the transfers and in the obliques. So that's why it's especially indicated for people who need a rehabilitation of their deep inner unit and not so much of the outer unit. So especially in the first rehab phases for example, for those with lumbar pain and want to achieve

Tamara Rial:                 41:34                a greater mind body connection of your deep core muscles or we want to a connect that transverse and the pelvic floor. This could be a technique that we could use for example. So especially more indicated for our deep system. And then from there we can build on a more dynamic exercise that will recruit the larger muscles and the larger dynamic muscles.

Shannon Sepulveda:                              Cool. That's awesome. Thank you so much for that explanation of the new cutting edge research. I think that's awesome. In my experience, it seems like there's a little bit of controversy surrounding hypopressives and low pressure fitness where some women's health people are like, yes. And some women's health People are like, no. And in my opinion, not that it means anything, but my opinion about something like this is if it works for somebody and there's no harm in it, then why then what's the problem?

Shannon Sepulveda:      42:41                Because it's not like we're causing any harm with any of this. And so if it's a tool in your toolbox and it works for certain women, what's the harm? Yeah. Because really there is none. And so why not try it? But I just wanted to get your thoughts on, you know, what's going on in the, I mean, I feel like hypopressives are so hot right now. It's Kinda like diastasis is just so hot right now and it's the new buzz word I think in women's health, physical therapy. So, but there's been, you know, people are like, if people don't, I don't really know. But what's your take on all of that?

Tamara Rial:                                         There has actually been all a lot of controversy and even a lot of controversy in the scientific literature because I think it was last year there has been a discussion paper published by Carrie Bowen, a researcher from Spain, on hypopressives saying that there wasn't enough evidence to support that hyporessives could be an alternative exercise for women with pelvic organ prolapse.

Tamara Rial:                 43:54                So they based their discussion paper and their results on the articles that our group has published it on this topic. So I wrote a letter to the editor and it was published on the British journalist sports medicine blog. It's available and they had also a reply. So it's kind of funny when you get to have these replies. So there has been a lot of controversy even in this field because as I said before, it's true that there has not been a lot of research and there are studies that have been publishing from the Brazilian groups. They have done some studies on woman with prolapse. We can find a on pub med with the word hypopressive but my argument and my counter argument in the letter and the response to the letter to the editor that is available as you said in British Journal of sports medicine, you can read it is that the thing is when we are applying a technique and especially a technique as hypopressives, that is first difficult to teach, difficult to a specially properly perform if there's not a good instruction and supervision.

Tamara Rial:                 45:25                That means that first we have to assess if the person is correctly performing the exercise as well as anything as well as pelvic floor muscle training. We will teach first how to do a optimal pelvic floor muscle contraction before beginning the trial. We have to perform or assure that the person who is really doing that vacuum is actually doing a vacuum and if the form is correct that means does that person do a vacuum that is really lowering the pressure. Is that person really in the correct positioning or does that person need a little bit more of supervision of somebody who really knows how to correct and see if the pose is correct? Is the breathing so in the description and they papers and you can read the paper. They don't describe the exercise as a form of different postural exercises.

Tamara Rial:                 46:25                They only described that they performed on a technique where there is an abdominal contraction a transverse abdominal contraction. But that is that you don't really know. They have been doing the whole series of exercise as this has been described in the literature because hyporpressives are currently describe the technique as a postural base and a breathing base. So that was my critique that you're basing your argument on the low number of research that is still available and on research that doesn't describe quite maybe let's use the word accurately as all their manuals and other professionals and other also because we can see other research common from other groups that are already doing and describing the technique. And this happens a lot in exercise science and physical therapy. Whenever we're using exercise that involve a lot of supervision and technical instructions, we have to be very clear and describing that technique.

Tamara Rial:                 47:37                That means how many repetitions did you do, how many rest breaks, how many seconds did you rest between exercise and exercise? Because we know that changing one little variable can change the whole exercise. And, even when it comes to breathing exercise, we have to very accurate accurately describe the time that means, for example, you're breathing in how many seconds you're breathing out, what way you're really now doing a four, six inhalation, or you're breathing out doing a a more relaxed maneuver. Are you for example, doing a more intercostal breathing? Or are you doing a more diaphragmatic breathing using, you know, there's so many different aspects that if we really don't describe how is that technique, it's gonna be more difficult to replicate that and more. And it's going to create even more controversy between the readers or the listeners because we really don't know what the technique is about.

Tamara Rial:                 48:49                And many times we see a video on youtube. This is the worst thing to learn from youtube. I know that we all go to youtube many of our listeners are now, many people that are doing it, but you can see the person do the exercise. But how did you know if you're really doing what that person is doing it maybe you are contracting or you're trying to pull your shoulder up or it's Kinda hard and I would never I love watching those youtube videos and there are some yoga professionals that do amazing exercises, but it will be very hard for me to know if I'm doing the exercise correct if I don't have somebody that is telling me I think, I think you're doing the pose or even when I'm instructing pelvic floor muscle training, we really have to have somebody that is supervising that technique and giving us advice to progress in the technique.

Tamara Rial:                 49:56                So I think this has been the first controversy, the lack of research and the claims of some Gurus and like they is the best exercise for the pelvic floor. Well that's a huge claim. You can never do the say that and, or some people will have, I have also claim a hypopressives if you do hypopressive's is much better than Kegal Well, no, no, no, you can never have those because that's going to go against you and, and that's why maybe I think there has been such a bad reputation and also because maybe there has been a lot of marketing towards that waistline reduction. So if people say you're selling it as a tool that is only aesthetic, but it kind of sounds like a selling thing, right? Where we want to sell a product only because it Kinda is new, but why, what is it, how is it an other profession?

Tamara Rial:                 51:07                Is it professionally driven, technique driven, and that has been the big, I think, huge controversy in the literature and also between practitioners. Right. And I think also another controversy that I see from my point of view is, is that one of people trying to learn, learn it from professionals who learn it from youtube. If I'm not sure about it and I would rather not do it or if you really want to practice it. I always advise people even to exercise under the guidance of professionals and I know that sometimes hiring up a personal training or higher, you know, going to a physical therapist once in awhile people can say it's a waste of time. I think I'm good on my own. But no, even, even us as professionals, we should be instructed on the care of over there people because the eye of a professional is better than your own eyes and we need that supervision.

Tamara Rial:                 52:20                We need to a planification and we also need an assessment. So maybe when you're under the guidance of a pelvic floor physical therapist or a instructor, they would assess you and say, you know, maybe we should do other exercise or we should begin with this. But then progressed to other phases and talking about progression, the idea that hypopressives would be like the magic pill. No, I don't. I think that that's a very wrong message to tell our people because there's nothing that is magic pill there. It's a tool in your toolbox. So it can be something that you can do to help you in some part of your life, but then you're going to progress and then you're going to do more things. Because for example, hypopressive is a good maybe reputative tool kind of. Yeah, kind of reputation tool.

Tamara Rial:                 53:20                But I won't think that I'm going to get better improvements in my cardiovascular health doing hypopressives, for example, I'm not going to lose weight doing hypopressives it's not an aerobic driven kind of tool. So if you're beginning to sell a technique as something that is the best for everything, or maybe that thing of a reduces waists. So people say it's because it's because you're losing weight. No, no, no, it's maybe because you're getting a better posture so then you don't have such a bulge in your abdomen. We all know it. Right? If you have bad posture, your abdomen is going to bulge more so by again having a better posture or by having a better breathing habit, you're going to help you to have a better abdominal appearance. Right. And then if you tone your inner unit, that will also help, but we will never, never achieve a waistline reduction or a better appearance without a loss of weight because you almost don't use a lot of energy.

Tamara Rial:                 54:33                In fact the heart rate will even decrease a little so, so not not increase. Interesting. So we still have to do cardiovascular work. We can then counterbalance our running.

Shannon Sepulveda:                              I know. I was like I love to run and I was like okay, 20 minutes a day, 10 or 20 minutes a day. Like I can do this. And it actually felt really good because I'm so tight for running and I just like them. Then it was actually pretty awesome doing it in the class.

Tamara Rial:                                         Yeah. And many, many people who perform running or other type of high intensity activities or aerobic cardiovascular training, they use what he'd do this training, they could operate it after. So as a way of cool down. Yeah. So it's a set of doing other type of exercise or we can incorporate it into our cooling down or even our stretching because many poses are like our stretching houses lying on the floor, stretching and our arms stretching our legs.

Tamara Rial:                 55:41                So we just incorporate it and it's 10 minutes. You don't need much, you really don't need much. 10 minutes for those that need other 15 maybe 50 minutes and, and I think everybody can find 15 minutes in their day to have sum up some sort of mind, body practice. We really need it nowadays with so much going on. Social media.

Shannon Sepulveda:                              Yeah. Well, it actually, it was interesting, I was thinking about why it felt so good and why say I would stick to something like that instead of yoga. I've tried yoga before and I wasn't too into it. I think it's because never in my life have I stretched that area. Like it's so hard to stretch your thoracic area, right? Like I couldn't, there's no way. Or like even my rectus, right, your front abdominal muscles. Like it's, unless, I mean you could do up dog to stretch, but it's really hard to lengthen and stretch all of that. So it was like the first time in my life where like those muscles stretch and it feel really good.

Tamara Rial:                 56:39                Because we're stretching from the inside. You've seen our breath instead of pressing it down, we're pulling it inwards. So that's why maybe this sensation is different. I think also the concentration on the breathing in that now it gives you a kind of mindful sensation. So for many people, they only do it as a mindful practice. They're pressing because they're so focused in on their breathing. It takes you out of your daily worries.

Shannon Sepulveda:                              I think that's what I found too because it gave me something to like focus on, like I had an objective so I wasn't thinking about anything else because it's hard to do. And so it's also like a new challenge.

Tamara Rial:                                         Yes. Yeah. So it was really great. And to challenge your breath Holding and to only think as well as we count, we always tell people sometimes when they're breathing to count breath up to one, two, three.

Tamara Rial:                 57:41                So whenever you're counting, you're mindful in your present. And also we're gonna add they've beneficial effects of having us slow paced breathing. That's to add down train our nervous system. So we're also going to help us if we want to just do a mindful or a relaxation kind of technique.

Shannon Sepulveda:                              Well thank you so much for coming on the podcast. And so where can we find you? Email social media courses and you teach people like where can people find you if that.

Tamara Rial:                                         Thank you. My name is Tamara Rial So my website is but I'm very active in Instagram, so you can find me as Dr.tamararial and I also have another, another Instagram account that is a specific only, only for hypopressive that is called hypopressiveguru because I also teach other women's health programs, not only hypopressives.

Tamara Rial:                 58:53                So I focus also on the female athlete. Pelvic friendly exercises, so, so you can see all my programs and courses on my website, although in my social media, especially on Instagram and know the courses I'm hosting in United States are throughout Herman and Wallance and also pelvic guru. So if we'd go to the websites we would see their announce all the hypopressive or low pressure courses. And I think contact email is

Shannon Sepulveda:                              Great. Well thank you so much. We really appreciate it.


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Jun 24, 2019

LIVE from the APTA NEXT Conference in Chicago, I welcome Duane Scotti on the show to discuss gymnastics medicine.  Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.

In this episode, we discuss:

-The most common injuries in the youth gymnastic population

-Differential diagnosis for low back pain

-Key features of a rehabilitation program following an ankle sprain

-How to enhance communication between athlete, coach and clinician

-And so much more!



Duane Scotti Twitter

Duane Scotti Instagram

Spark Physical Therapy Facebook

Spark Physical Therapy Website 


For more information on Duane:

Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.

Duane is currently the founder of Spark Physical Therapy, providing prehab, rehab, and performance optimization services either onsite or in the comfort of your home within the Cheshire/Wallingford CT region. He also is a clinical assistant professor in the Department of Physical Therapy at Quinnipiac University responsible for coordinating and teaching musculoskeletal examination, intervention, and advanced manual therapy within the orthopedic curriculum.

Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation, dance medicine, gymnastics medicine, and rehabilitation for runners.

Duane has been in clinical practice working with orthopedic, sports, and performing arts populations since 2003. He has strong clinical and research agendas in screening, injury prevention, and rehabilitation for runners, dancers, and gymnasts. Duane uses an integrative model of manual therapy including manipulation, mobilization, and soft tissue treatment including dry needling and the Graston technique for the management of musculoskeletal dysfunction. Duane is a physical therapy advocate and is actively engaged with the American Physical Therapy Association and serves as Vice President of the Connecticut Physical Therapy Association.


Read the full transcript below:

Karen Litzy:                   00:00                Hey everybody. Welcome back to the podcast. I'm coming to you live from Chicago, Illinois at the APTA Next conference. And I have the great pleasure to welcome back to the podcast. Dr. Duane Scotti physical therapists. And today we're going to be talking about gymnastics medicine. So Duane, welcome back.

Duane Scotti:                00:19                Thanks for having me Karen. It's good to be back

Karen Litzy:                   00:21                And I have to tell you, gymnastics is something near and dear to my heart. I was a gymnast for many, many years as a child. And luckily I didn't have any major injuries, but what we're going to be talking about today are kind of the most common injuries you might see in a gymnast. And this is something that Duane is so passionate about. These are the people he sees. So if you're a physical therapist out there, and maybe you have the off chance that you might see one of these young athletes, I think this'll be really helpful for you to give us your insight. So Duane, tell us what are the three most common injuries one might see in a gymnast?

Duane Scotti:                01:02                Well, I think first off is I definitely do have a passion for this area. Like you state because I have a daughter who's a gymnast. So that is one of the things that I kind of in my career from a clinical standpoint, kind of focused a little bit more in this area is spinning off of like dance medicine and got into the realm of helping gymnasts out because I did see there was a need in the local club in our region. So in terms of the most common injuries I would say, you know, definitely low back pain, in gymnasts and specifically extension based low back pain. So because of all of the kind of back bends you think about, they do like bridges, back walkovers, back handsprings all of those, especially in the young developing gymnast. So usually the smaller ones like the level fours and fives, they're doing a lot of those skills. A lot of times you'll tend to see that occur as well as a lot of the compressive loads that happen especially during your floor passes in gymnastics, there's a lot of compressive loads as well as shear loads that get transmitted to the spine.

Karen Litzy:                   02:11                And can you kind of briefly tell us what exactly you mean by when you say a compressive load and can you give an example of when a compressive load might happen and a shear load? Same thing.

Duane Scotti:                02:23                So it's really the compressive load is if you think of landing, right, so you're landing, your body weight is coming down. So we know that actually landing, you know, there are some studies that look at between 12 to 17% of your body weight is actually, or times your body weight is actually being loaded through the spine. So that's that compressive load as opposed to like a shear load, which would be something like if you think of doing that back bend or that bridge where you're getting one bone kind of shearing on the other. And in the young developing gymnast who is still growing, that can be problematic. And then that's where we start see things such as stress fractures. So that's kind of really the most you know, important thing. And the thing that I tried to intervene and educate because a lot of times most gymnasts have the perception that maybe back pain is normal with gymnastics due to the training and it's going to happen. But being a young gymnast with their bones developing, if they develop that stress fracture that could be detrimental to their long-term health if it goes undiagnosed.

Karen Litzy:                   03:28                Oh that was my next question. So let's talk about differential diagnosis of that stress fracture. Cause I think that's really important to think about. And I would imagine that a lot of therapists aren't thinking stress fracture when they're thinking of a young girl or a young boy. Most of the time we think stress fractures in our older adults with osteoporosis, osteopenia. So how do you differentially diagnosed that stress fracture from other causes of back pain?

Duane Scotti:                03:59                Yeah, so the stress fractures are, they call spondylolysis and it is really diagnosed based upon the history. So kind of taking a report, is that something that typically it can occur acutely from like a specific landing where they felt an acute kind of sudden onset of back pain, but usually it is something that's developing over time and it's not getting better with rest and it continues to get worse over time. And then there are some things on the physical exam that we can evaluate whether they have pain usually commonly with extension. So they're, you know, doing a standing extension test or a stork test standing on one leg, bending back. You can look at the irritability based upon if they have pain with that or if they don't have pain with like a press up on their stomach, then I feel pretty confident that this person doesn't have a stress fracture, that it is more muscular.

Duane Scotti:                04:50                But you always have to kind of make sure and rule that out and then looking at confirming that. So you, you know, you send them to a specialist, a spine specialist. It's not going to show up on x-ray unless it's chronic by that point that they'll see the callus formation on x-ray. But it's really an MRI or a bone scan. And a lot of times, you know, if it is kind of consistent with the history, then even the specialist may not even recommend an MRI just because it's sometimes not necessary. So sometimes it just requires that kind of protection phase and avoiding the extension based activities. And then that allows that to heal.

Karen Litzy:                   05:26                And how long is that protection phase?

Duane Scotti: