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Healthy Wealthy & Smart: Where Healthcare Meets Business. The Healthy Wealthy & Smart podcast, hosted by world-renowned physical therapist Dr. Karen Litzy, offers a wealth of knowledge and expertise to help healthcare and fitness professionals take their careers to the next level. With its perfect blend of clinical skills and business acumen, this podcast is a one-stop-shop for anyone looking to gain a competitive edge in today's rapidly evolving healthcare landscape. Dr. Litzy's dynamic approach to hosting combines practical clinical insights with expert business advice, making the Healthy Wealthy & Smart podcast the go-to resource for ambitious professionals seeking to excel in their fields. Each episode features a thought-provoking conversation with a leading industry expert, offering listeners unique insights and actionable strategies to optimize their practices and boost their bottom line. Whether you're a seasoned healthcare professional looking to expand your skill set, or an up-and-coming fitness expert seeking to establish your brand, the Healthy Wealthy & Smart podcast has something for everyone. From expert advice on marketing and branding to in-depth discussions on the latest clinical research and techniques, this podcast is your essential guide to achieving success in today's competitive healthcare landscape. So if you're ready to take your career to the next level, tune in to the Healthy Wealthy & Smart podcast with Dr. Karen Litzy and discover the insights, strategies, and inspiration you need to thrive in today's fast-paced world of healthcare and fitness.
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Now displaying: 2020
Dec 31, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Drs. Julie Sias and Jenna Kantor to the show for our annual end of the year review. I also wanted to welcome Dr. Alexis Lancaster in spirit. All three of these incredible women are the team that makes this podcast happen every week and I am eternally grateful for all of their hard work, support and love throughout the year. 

In this episode, we discuss:

  • The ups and downs of 2020 for each of us
  • How to deal with fraudulent Google reviews 
  • Being a brand new mom and a private practice PT owner 
  • What we are hoping for in 2021
  • And so much more! 

Resources: 

Jenna Kantor Physical Therapy 

Newport Coast Physical Therapy

Renegade Movement and Performance 

Karen Litzy Physical Therapy

A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. 

More about Julie, Jenna and Lex

Dr. Julie SiasI received my Doctor of Physical Therapy and Bachelor of Science in Biology degrees from Chapman University. I became a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association to better serve my wellness clients. I am also a member of the American Physical Therapy Association and Private Practice Section. In addition to working with my physical therapy and wellness clients, I provide consultation services for children and adults with neurological conditions. In my free time, I produce the podcast Healthy, Wealthy and Smart which features leaders in physical therapy, wellness and entrepreneurship.

Fun Fact: I love the sun! I am thankful there are 277 days of sunshine a year in Newport Beach! From hiking Crystal Cove, sailing in the ocean, scuba diving the seas and kayaking through the back bay — there is so much to take advantage of! As your Doctor of Physical Therapy, my goal is to help you maintain your active lifestyle because working with you inspires me daily to get out of my comfort zone and try new things here in Newport Beach.

Dr. Jenna KantorJenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, Regional Dance America Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre. 

Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia.

During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media.

Dr. Lex LancasterLex is originally from the Finger Lakes Region of New York. She graduated from Utica College with her Bachelor’s in Biology and her Doctorate in Physical Therapy. She also earned a graduate certificate in Healthcare Advocacy and Navigation.

She is very passionate about empowering the people she works with and is driven by their success. Lex has worked with people of all ages and her passion lies within the treatment of performance athletes and pregnant and postpartum women.

For Lex, the most important part of physical therapy care is ensuring that every person who sees her is given one-on-one attention, a personalized treatment program, and a plethora of resources to ensure ongoing results.

Outside of Renegade Movement and Performance, Lex practices in pediatrics, owns and operates her website design company, and is an Adjunct Professor at Utica College. She enjoys hiking and dogs of all kinds.

Read the Full Transcript below:

Speaker 1 (00:01):

Hello, welcome back to the podcast, everyone today, we're having an end of the year wrap up. We've done this every year, almost every year since the start of the podcast. And I'm joined by Dr. Jenna Kanter, Dr. Julie CEUs, and perhaps Dr. Lex Lancaster. She is currently driving through parts unknown in Vermont, so she can hop in. She can, if not, maybe we'll get her in at at at another time. But I just want to highlight the people who make this podcast happen because it is certainly not my, myself and myself alone. It's just impossible. So Jenna has been doing interviews for a couple of years now, and Julie has kind of been on board since the beginning almost I would say close to the beginning. Right.

Speaker 2 (00:54):

I think it's been five years. Yeah,

Speaker 1 (00:56):

Yeah, yeah. So she's been a part of the podcast behind the scenes doing the show notes beautifully. And then Lex Lancaster has been on board for the past year doing, helping with graphics. So I just it's for me, this is a big thank you to, to you ladies for being so wonderful and generous with your time and your gifts. So thank you so much. And let's start. So what I wanted to kind of start with is kind of talking about our highs and lows of 2020. So if you're listening, I mean, we, we all know that 2020 has been an exceptionally difficult year for almost everyone started out okay. For most people and then really started to go downhill pretty quick. So let's talk about, and then hot, like even through this, I think it's also important to note that good things have happened as well. So Jenna, why don't we start with you? Why don't you let the listeners know kind of, what's been your high and what's kind of been your low of 2020.

Speaker 2 (02:08):

Hi mom. I just want to first give a shout out to my mom, like I'm on a TV show. So I just want to say hi mom, I love you so much. Thank you for giving birth to me that one beautiful morning or afternoon. I'm not sure. Ooh, 20, 20, well, the low, I would say where, Oh, I want to talk about this because I know there are other practice owners who have dealt with it and I was a I was bullied and harassed online. And and, and this was for a group in which I do musical theater readings. It's a great group. I it's, that I've run into where I get a lot of patients, but the majority of people I know on there, I just know through musical theater and just performing, doing readings. And there were people who did not like how I ran the group.

Speaker 2 (02:59):

It's just like any place. There are people who don't like what you do. So they go off and do their own thing. And I eventually made a decision to block them out of my life because I didn't want this small section of people to still be present and judging me. I mean, I don't know about you. I like to feel the love in the room, not the hate. So I did that as a gift for myself finally, which did was very good. I was dealing with a lot of anxiety, just even knowing that they were around. Unfortunately, I wasn't strong enough to just handle it. I wish I could say it was, but I was like, Nope, I'm really unhappy right now what their presence. And they decided to go after my business and write false Google reviews. I was fine with the public social media posts on Facebook and everything.

Speaker 2 (03:42):

You know, didn't saying mine, you know, denouncing me. I was fine with that. I knew they were going to do that. That's why I kept them in my life for so long because I was so fearful of the public humiliation they would be aiming for. But then I was very okay with it. By the time I did it, you know, you come to that piece. But to me, the lowest part was having instilled, dealing with it, dealing with these false Google reviews where they've never been paid patients ever, ever. So I think that was, was a big, low yeah. And, and knowing that we're all going through it. And it's a hard year for so many of us. I felt like I had less people I could talk to about it because everyone's dealing with so much crap right now. So I would say that was like a very, very low point for me. And I know people have had so much worse. So I do want to acknowledge that this is so minuscule. I'm lucky my family is healthy. My, my friends have been healthy during this very, very lucky, but that was my own little piece of hew, toothpicks as positives go.

Speaker 1 (04:54):

I'm trying not to swear. I'm doing a good job

Speaker 2 (04:59):

This America way to network as, and do positive right back to back.

Speaker 1 (05:04):

Yeah, sure. Go ahead. Oh, right. Yeah.

Speaker 2 (05:07):

Cause it is I would say is, I'm not going to talk. I'm going to focus on business since I was already talking about business. So I'll keep it on that. Was the different branch. My practice took every business in physical therapy has been dealt with some sort of crap if they haven't, I'm so happy for you. But a lot of us have really dealt with some sort of big shift and, and stress and strain and sleepless nights, especially at the beginning of this and some States it's pretty new. It's new for the practices. For me during the shift, I was focusing on expanding more in-person and then of course I started doing more tele-health and now I'm a hundred percent tele-health yes. I refer out if they're not appropriate for tele-health yes. I'm a hundred percent. I don't see myself going because one, I love it.

Speaker 2 (06:00):

And that's the first thing to the performers I work with. Most of them can't afford that in person. Most of them can't, most of them don't have health insurance. And then the last thing with my practice I've developed these wellness programs. Yes. They're injury prevention, but honestly, no performers are Googling injury prevention. They're like my ankle hurts. I can't do boots. What's up. So, but with these wellness programs, it's not physical therapy. It's the many humans out there in the singing, acting, dancing world where they get the help they need from a PT. And then they're discharged when they're, you know, quote healthy, but their body's still not functioning to where they ultimately want it to be. That's where I'm coming in. And it's great. It's this, these group programs it's really supportive. I definitely have my own jokes in there. I'm a hundred percent myself.

Speaker 2 (06:55):

If anybody knows me, you're like, got it. And it's, and it's just a joy. The bonding, the, the growth everyone gets physically to get to where they are is just, it's, it's been the such a rewarding discovery and, and a lot of work to make it happen, but well worth it because just I'm happy, man. Like when you really get to do what you really want to do without even knowing that's what you really wanted to do all along until you actually get to do it. That's what I'm living right now. So yeah, I'm pretty happy about that. So that's my positive and I'll take it to the bank.

Speaker 1 (07:31):

Great. Now let's, let's take a step back to not to harp on the negative, but because I think this might help other people listening. What did you do when you were like, Oh my gosh, I'm getting these Google reviews for my business. I've never seen them. What did you do to mitigate that situation or if it's even possible

Speaker 2 (07:55):

Crying and vomiting? Let's see. What was the next? So I, I vomit when I get really stressed out. That's a new discovery in 2020. I don't recommend it. It doesn't make you slimmer just saying. So I do not promote that. Okay. [inaudible] so I already have a lawyer, but I even, I contacted Erin Jackson who is a great human my lawyer Stephanie wrote in, but I just, you know, who do I contact first? Because I knew this was now in some sort of it's the physical therapy where we have HIPAA. We have so many things legally we need to be careful about. And as much as I say, swear words, and I joke like there's liability for these things. Like, but this was just how do I handle this? Because Google reviews specifically, which I was fearful, I pre reported these people before it happened, because there was no way to block them on Google.

Speaker 2 (08:52):

Not because they were going to, I was going a little bit in the Cuckoo's nest. Like, how do I keep preventing? Cause they're doing all this stuff fine on social media, but just in case let's pre protect, there was no way to, well, getting Google reviews is difficult. So here's some things that you can do by hand that are suggested they, you can have friends report it. And if you have friends report it, make sure you have a written out exactly where they need to click step by step, what they need to do. And, and boom bought a bang. Another thing that I did is I contacted the patients. I felt comfortable contacting, cause that is a thing I'm saying, this is going on. I've never gotten a review from you. Would you please write a review so I can get some actual from actual patients on here.

Speaker 2 (09:38):

So I did outreach to those individuals as well. Which was great in that sense. I mean talk about like, you know, unexpected, positive. So that was good. Then with my lawyer, which we're still in the process of doing so a little bit slower in the holidays. It also, I'm just personally, not in any rush because I got so stressed out about it that just like, I'm okay, I've got, I've gotten zero patients from Google reviews, so it's not the end of the world. But she's writing out in legal jargon, what I'm going to be now sending to Google to ask it to be, and it's according to their policies, why these are inappropriate reviews. And so that is what our next step is. I have not met with anyone else yet, but because of enlight of how bored people are, are during the pandemic.

Speaker 2 (10:29):

And they're putting a lot more emphasis on these negative things, no matter how small or how big they I am in the process of being connected with the lawyer, through my lawyer to learn when I need to do a cease and desist. And when I, when I know it's actually necessary, I still am getting a little bit harassed by them, but I I'm. I'm okay. I'm good right now. But I do want to know, and that I look forward to learning, to be able to share with people like, Hey, here is when you hire the lawyer officially, because that is a good question. Lawyers should get paid for what they're doing, but it's just knowing when you bring that in, which is a very big deal that I think should just be common knowledge. And then where we were able to get one review, Oh, there's also a thing after you submit in there's you can write a post about it on Twitter and you tag people with Google.

Speaker 2 (11:28):

I forget who you tag. You guys will have to Google it. You'll have to Google the Google thing, but it you can do, I didn't get that far. I also was so hesitant to do that because then it would take it into the physical therapy world at large of, Oh, what's the going down with Jenna. I'm like, Oh my God, like it's literally children who are upset about musical theater. Readings has nothing to do. Like, no. Okay. And then my husband was helpful. He was able to get one of the reviews down by reporting the person's profile.

Speaker 2 (12:04):

And that was very good. So that was one there's still two that have written reviews. There are three with just one star reviews without writing anything. And none of them have been patients. And we believe that they created two false profiles to put in two of those one star reviews. Interesting. but at the end of the day, they're not in my Rolodex of patients, so they're not patients. So yeah, it's been a bit of a journey dealing with it, but that's a little bit of what I did. There's not one way to do it. There are suggestions on responding to the person where you can say, Hey, I'm so sorry to hear of this complaint. I don't have any records of you as a patient. Please feel free to email me at because there's no conversations that happen within the feed. It's like your reply and that's it. And people can look at it. That's

Speaker 1 (13:02):

Actually, that could be pretty helpful.

Speaker 2 (13:05):

My, my lawyer said right now, don't just because we, she was like, let's just, let's just, I'm fine with waiting right now. You know what? The level of stress gets so high, it got real bad for me to be throwing up from stress is a big thing. So the fact that I'm not throwing up, I'm doing well is good. So I'm okay with it being a slow occurrence because my body does start to shake going back into that world, which to me is also just another recognizer of why it's important to know when it's time to block certain people from your life. If they're making you shake and vomit, because you're stressing, like they're just not meant to be in your life. It's fun. It's that simple, you know? But yeah, no, it's, it's, it's it's a very humbling, very embarrassing situation to be dealing with. But I have learned that there are, there are definitely a lot more businesses right now dealing with that, unfortunately. Yeah. I wish people invested more time in the positive stuff to raise up to be the positive changes that we want rather than let's just tear people down because in that action, the wrong people are being torn down.

Speaker 1 (14:20):

Yeah. Well, thanks for sharing that. And also, thanks for sharing what you did to kind of help as best you can at the moment. Kind of rectify some of that because now if people are listening and they go through that as well, they'll have at least an idea of like, okay, well here's a place where I can start. So thank you for that.

Speaker 2 (14:36):

Yeah. If anybody ever wants to talk some crap about what you're dealing with, I'm here for you.

Speaker 1 (14:41):

Yeah. Great. All right, Julie, let's go to you to your, your, your ups and downs of, I have a feeling that your, your and low point might kind of be the same thing, but I don't, I don't know. So go ahead. I'll, I'll throw it over to you. Yeah,

Speaker 3 (14:59):

Yeah. So I actually remember when we did the show last year, I said that I wanted 20, 20 to be more of a focus on more of my personal life and focusing on family and things in that direction, because in the past it had been all about my business and everybody has had challenges in the physical therapy world with their business. And we have with Newport coast physical therapy, we've actually come out strong. And that isn't really what I wanted to focus on because it's supposed to be personal. So I guess for my lows. Hmm. So me and Wade we've been together for 11 years. We had our 11 year anniversary. And when we're thinking about starting a family and everything, we were like, okay, we have to kind of celebrate the last year that we're going to have together. Just me and you. So 2020 we had like, all these things planned for our relationship.

Speaker 3 (16:03):

We were going to go to Switzerland, literally the day of the lockdown, that was our flight to Switzerland. And we were like, Oh no. Okay. So we can't do that. And then we had planned some things in the States, like going to national parks and all of those ended up closing down. And then, and then I I'm pregnant. I was pregnant with twins throughout all of this. So then as you know, I get further along in my pregnancy, it's getting harder to do anything just because pregnancy can for wound baby, but with two babies, it was just like, ah, I could give birth at any day. So I don't really want to be too far away from the hospital and everything. So I would say that for the lows, me and Wade didn't really get to kind of celebrate our last year together just as us and which is fine. You know, we, we, we made it work and did some other things, but I think that we didn't get to kind of grieve that aspect of our relationship changing. So that was a little bit of a challenge, but the highs, obviously

Speaker 1 (17:15):

I had my twins August

Speaker 3 (17:19):

In Westin and they're three months old right now. They are actually let's see, they're one month adjusted. So they were born two months early and they spent about two months in the NICU. So that was a little bit of a challenge, but given all the COVID and everything going on, luckily there was plenty of resources for my babies and they had great medical care and are super healthy now. So yeah, my highest definitely having my two boys, they're adorable and they're definitely a lot of work, all consuming basically, but hopefully in the next year, I'll get a better swing of, you know, balancing family life and managing my business and everything. So that's kind of a bit of a summary of my 2020

Speaker 1 (18:11):

Now let's, let's talk about quickly for, cause you know, a lot of people that listen to this podcast, they're physical therapists and might be entrepreneurs, women kind of around in, in your stage of life who are thinking about I'm going to have children and what's going to happen to my business. How am I going to do this? So do you have any advice and, and what have you done with your business as, and I mean, twins, I goodness, but we should say that Julie is also a twin, so it's not shocking that you had twins.

Speaker 3 (18:41):

I wasn't surprised when they see that as having twins, I was like, you know what? There was a chance that was going to happen. Yeah. But I would say that for anybody that's in kind of a similar life stage, I fortunately, since my business model is pretty flexible in the sense that I can pick and choose when I take on patients, I don't have much business overhead just because of the, the mobile concierge practice model. That it's good for being a mom because I can kind of pick and choose when I want to take on clients. I would say that if you're, you know, the breadwinner of the family, that's a really tough position to be in because it's, it is really hard to balance everything because I'm going to be able to, you know, pick and choose clients that I want to see when I want to see them.

Speaker 3 (19:35):

And not everybody has that flexibility. So if you do own your business, it is a good time that maybe you could take a step back and be more on the business management side of things, where you can do things from home, from your computer and then hire somebody to go out and actually do the service. And I actually have a therapist that is doing some client visits for me right now, which thankful it's my best friend. So she's really chill to work with. But that could be a strategy that some people take on is that they end up doing some of the business management side of things instead.

Speaker 1 (20:15):

Yeah. So you're still working in the business. You're just not out in the field, so to speak because I mean, when you have a new, a new a newborn, I can only imagine that it takes up a lot of your time.

Speaker 3 (20:30):

Yeah. Every two to three hours, which, you know, if you're, you've never been around kids, I was surprised they eat that frequently. I was like, Oh my goodness.

Speaker 1 (20:43):

And you've got two of them, two miles to feed. Oh, that's so funny. And what, I guess, what has been your biggest aside from, you know, not getting a lot of sleep from being a new mom, is there anything that surprised you aside from how much children eat? You're like, what the hell? Why did no one tell me this?

Speaker 3 (21:08):

I'm trying to think. I think that the reality of taking care of a baby, like, I guess I thought it would be not as much of my time, but maybe it's because I have twins. I don't know. I don't know. I don't know any about anything about this, but it literally is like a 24 seven type situation right now. And I can only imagine for people that are going back to work at this point, because technically I've been off work for three months and not a lot of women are able to do that. They have to go back to work. I could see how challenging that would be. Cause if my twins were still in the NICU, so say I took off that six weeks of maternity leave and then had to go back to work before they even came home. That would be so tough to juggle. So it is a lot of work. Like it's the hardest job, just, just the physical toll it takes to be up and take care of babies. It's it's tough.

Speaker 1 (22:08):

And have you had pelvic health physical therapy?

Speaker 3 (22:11):

So I actually, haven't gone to a pelvic health physical therapist, not because of anything against it. I just haven't noticed any symptoms. Okay. So I do actually have a couple friends that are specialists in pelvic floor PT that I could reach out to. Maybe they would be testing me for certain things and be like, we need physical therapy. So that could be something I do in the future, but it's yeah. I fortunately have had like a very good recovery and haven't had to deal with anything on the surface at least.

Speaker 1 (22:47):

Excellent. That's so nice. Well, I love hearing your, your ups and downs and, and we should also say, cause I don't know that Lex is going to be able to come on here. Maybe we can splice her in later, but she did get married. So I can assume that would be her high point. If it's not, then she's, she's going to have some answering to her new brand new husband. I would assume that's her high point. And she also started her own practice in New Hampshire, which I would assume could, would also be a high point for her as well. And then what do you see happening moving forward? What are you, what are you, what are your goals, your dreams, if you will, for 2021, Jenna, I'll throw it back to you.

Speaker 2 (23:34):

Goals and dreams. Well we are moving to Pittsburgh. It's taken almost a full year, so I'm looking forward to moving there with husband and I have a dream office room cause I'm an actor as well still, and it's going to be decorated Disney theme. So I'm really excited to decorate and make my imagination finally come through and have the walls of tangled with the lanterns, hanging from the ceiling and have all my different collectibles up on display and my lights and my cameras and everything up permanently. So I don't have to keep putting it down and putting it under the bed in a New York studio apartment. I, that will be like

Speaker 1 (24:21):

For me, cannot wait, cannot wait, Julie, how about you? I'm definitely going to be going to Switzerland. Does I rebooked these tickets like three times and I don't know it's going to happen in 2021. I'm not from eight or tots with me. Well, yeah, go ahead Karen. I was gonna say I, if, if all goes well with 2021, I'll be in Switzerland in November. So you could come to a course, write it off. Oh my goodness. That's a great idea. What is the course? The course is only one day and if it happens I will tell you about it. Cause I don't think it's been announced officially yet. But it's just a one day course. So you can go to Switzerland, just pop over to burn for one day and then you pop out. Oh my goodness. It's it's the the, I think it's like the Thursday or Friday before Thanksgiving.

Speaker 1 (25:25):

All right. That'll be good. Cause the twins will be over one years olds. Okay. Throwing it out there. You guys, I will be in Switzerland. It's going to happen. Awesome. Well, I have to say Switzerland is really, really beautiful, so I'm sure you will love it. Love it, love it. I don't know. Should I talk about my highs and lows, I guess highs and lows. So I guess my lows were I think when, when everything happened here in New York and Jenna can probably corroborate this, but it was an, it was a little scary, you know, because it was everything locked down, nip. It, it locked down so quickly, but and nobody really knew what was going on. And I think that was a big, low, and I think I had, again, the sleepless nights and the anxiety about, well, what's what, what will happen with my practice?

Speaker 1 (26:29):

W what am I going to do? I see people in their homes, like you couldn't go anywhere, couldn't do anything. And, and so I think that, that, that sort of stress around that was definitely a low point professionally and then personally, well, my boyfriend and I broke up, but that's probably for the best in the long run. And then my sister had some health trouble, so it was a big sort of just like everyone else. 2020 was like a big sorta show. But that being said, the not knowing what I was going to do for work and being stressed as a low point turned into, I would say a high point along with Jenna is I started integrating tele-health, which is something I will continue to do. So now I do probably see half the people in person and half people via telehealth.

Speaker 1 (27:23):

And I love it. I love doing it. I think it's it's working very well. And I was also able to launch a business program to help physical therapists with the business and the business side of things. And that's been really fulfilling and getting nice reviews from that from people who have taken the course. So that, which makes me very happy because my whole anxiety was wrapped around. That was like, what do people take it? And they hate it and they think it's stupid and they don't want to do it. What am I going to do? And, and so, you know, you have all these doubts about like self doubts about what you do as a person and what you do as a therapist professionally. So I think those were, it was sort of a mixed bag of highs and lows.

Speaker 1 (28:08):

And I guess what I'm looking forward to, I too, am looking forward to going to Switzerland. And and just being able to travel and see people, like, I would really love to see my parents who I haven't seen in almost a year. And so that would be lovely because we did not, I did not see family for Thanksgiving or Christmas and probably won't until we all are vaccinated. Just to give everyone a little sense of that, like we're doing the right thing. So I think that's my, the biggest things I'm looking forward to is seeing my family, being able to see friends in person and colleagues in person, because, you know, we miss seeing all of you guys too, you know, so I think that's the things that I'm most looking forward to for 2021 is, and I don't, I don't think that things will go back to the way they were quote unquote, but I think that they'll be an improvement on where we are now. I don't know. What do you guys think?

Speaker 4 (29:18):

Yeah. I think having our support systems slowly return is going to be really, really fulfilling to just for humans. Like we love human contact and our relationships having all those kinds of slowly come back together is going to be amazing. Yeah.

Speaker 1 (29:35):

Yeah. I love the way you put that. Having our support systems back is huge. Yeah. Hugging. Yeah. I miss hugs. I know, I know one of my friends hugged me like a friend that lives here in New York. She hugged me and I was like, you know what to do? I froze up. I was like, Oh my God, what is she doing? Hugging is so good.

Speaker 2 (29:57):

Why my husband gives me time limits for my hugs. Cause I'll keep hugging. I love hugs and I miss hugs. I even miss the Wilson's a musical theater specific thing, but go into a musical theater audition and all the annoying screens of people reuniting with someone they only saw just a week ago, you know, cause we won't want to feel cool, but the people will see and know, but then we do it too. When we run into the people we haven't seen. Who's guilty of it. But yeah, hugging, hugging is just beautiful.

Speaker 1 (30:32):

Yeah. Human contact.

Speaker 4 (30:36):

What if on my flight to Switzerland, I have a layover in New York and then I can see you.

Speaker 1 (30:45):

Yeah. What is that quick? Have a quick one day layover and then Optus. Switzerland. Oh, I know. I forget. You're in California, such a long flight.

Speaker 2 (30:54):

You need to get pizza. You would need to get Levine's cookies. Oh yeah. And what else, what else would the food wise I'm thinking? I was thinking,

Speaker 1 (31:06):

Yeah, I just had, I just had a Levine cookie a couple of weeks ago. I eating live only a couple blocks. So the vain bakery was, it got really, really popular because of Oprah. It was like one of Oprah's favorite things like maybe a decade ago. Yeah. That's why they're so popular. But the cookies are like scones, like they're thick and gigantic. Like I got a cookie, it took me like three days to eat it.

Speaker 2 (31:31):

Yeah, no they're thick. It's,

Speaker 1 (31:33):

It's a lot, it's a lot of cookie dough there. But they are, they are pretty delicious. Now. You'd swear. We were sponsored by Levine. Speaking of sponsors, I have to say thank you to our sponsor net health.

Speaker 4 (31:47):

Great segue right there.

Speaker 1 (31:50):

Just getting it to me. So net health has been sponsoring the podcast for a couple of years and I'm really, really grateful and thankful to them and their support, their continued support. And net health has grown by leaps and bounds since they first started sponsoring the podcast. And so I'm really happy to see their growth, their Pittsburgh company, by the way, Jenna. Oh yeah. Pennsylvania company. And and so I'm really, it's really been exciting for me to see their growth and their movement upward and the fact that they are doing their best to help healthcare providers, which I think is awesome. And they also have, and not that they're telling me to say this, but they really do have some really good webinars. So they're usually free. So if you want like good webinars, business-wise they really have some good stuff, especially if cash based or non cash based. So I would definitely check out their webinars because they're all pretty good and usually free. I like free. Yeah. And everybody loves free. Okay. So I guess I'll ask you guys one last question, knowing where you are now in your life and in your career, what advice would you give to your younger self?

Speaker 4 (33:05):

Okay. I should be prepared for this because you know, this happens every single episode and did not think this question was coming at me. Okay. So the first thing that comes to mind, and I think it's important is that you should always maintain a sense of curiosity about everything going on in your life professionally, personally, I think that if you're open-minded and you can kind of think on things a little bit differently, just because you're not closed off, you might be able to see solutions in ways that you didn't think of before. So that is very theoretical, but I just think that that kind of vibe, if you maintain that sense of curiosity about everything, it can kind of lead you in new directions. What do you think? I think that's great advice.

Speaker 2 (34:00):

Oh my God. I'd love that. I, I I feel like I should have gone first because it naturally segues to what you just said. Oh let's

Speaker 4 (34:10):

Oh no,

Speaker 2 (34:11):

No, no, no. I think it's perfect. I loved it. I was like, Oh, you know, like for me, I get my best ideas on the toilet, but I still, I thought that was amazing. I was thinking the first thing that popped into my head was don't waste your time on the, focus on where, what your vision is for your life and put all your energy into that as it, and this is why it's like, why it's so good to yours. And now like the candles, I was like, Oh my God, this is perfect. It's so great for us.

Speaker 1 (34:42):

Perfect. I think that's both great advice. And, and I know I asked this question every time and how I would answer it, knowing where I am now in my life and in my career. I think that what I would tell myself, even like fresh out of, out of college is when it kind of goes along with maybe what a combination of what you guys both said. But what I would tell myself is to don't limit myself by what I see other people doing. Because sometimes like when I first graduated, I knew PTs worked in a hospital, they worked in a clinic and that was kind of it, you know? And so I didn't never saw that sort of broader vision. And so I think I would tell myself to look to people outside of the profession to help you your state in your own profession and seek out those people that have, that genuinely have an interest in you as a person and, and want to be a part of your life and a part of your success. Because I think I've fallen victim to people who I thought had my best interests at heart, and I'm a trusting person. And as it turns out they didn't. So I think really, I think as you get older, you sort of, you maybe, maybe I just have a better sense of who I am and what I want. And so I'm no longer kind of easily swayed and convinced by people who in the end don't really have my best interest at heart,

Speaker 4 (36:28):

But that's one of the qualities I love about you though. Karen is how trusting you are. I think that does serve you too in your life. So I think that don't ever lose that. That is something that it's, it's a gift and not everybody can be vulnerable. And I think that you wear that really well.

Speaker 1 (36:46):

Oh, well, that's nice. Yeah. I don't think I would, I'm not going to become that cynical of a new Yorker, but I'm going to, Jenna knows what I'm talking about. But I think that I'm just going to just be a little bit more discerning on the people that I choose to kind of surround myself with. And I think that I've been doing that more recently over the last couple of years, and I think that it has served me well, but that's what I would tell my younger self out of college anyway. Yeah. All right. So any last bits, any last, anything

Speaker 4 (37:23):

We're all gonna make it we're all gonna survive hopefully. Yeah.

Speaker 1 (37:27):

Yes. Rules. Yes. Jenna will be going to Florida next year because she missed it for CSM. I know, I know no CSM in Florida this year, but we did videotape our performance, little plug, Jen and I to have a thing at CSM on February 11th at 7:00 PM. Join us for our prerecorded topics on social media, social media. Yeah. Basically. How do you social media, mainstream media to improve your presence as physical therapist and then I think, but I'm not sure we might have a live Q and a afterwards at 8:00 PM. We're so clear.

Speaker 1 (38:10):

So we'll find out. So anyway thank you so much, Julie and Jenna and Lex for all of your hard work and all of your commitment and I love you all, all three of you. I was going to say, I love you both. And then a Lex, and I'm just getting, I love all three of you. And I really, from the bottom of my heart. Thank you so much. Thank you as well. All right, everyone. Thank you so much for listening. I wish you all the very best and, and fingers crossed for a better 20, 21 and stay healthy, wealthy and smart.

Dec 21, 2020

In this episode, John Honerkamp talks about all things running.

John Honerkamp, affectionately known as Coach John, has coached runners of all ages and abilities for more than 20 years. A graduate of St. John’s, John was an eight-time All-Big East and six-time All-East (IC4A) athlete while running for the Red Storm. He earned 12 Big East All-Academic accolades and was the youngest semi-finalist in the 800-meters at the 1996 U.S. Olympic Trials.

John is deeply involved in the New York City running community. He launched the Off the Hook Track Club, a local training group based in the Red Hook neighbourhood of Brooklyn and created The Run Collective — born out of a desire to unite the running community and connect, collaborate, and celebrate all efforts from various clubs, crews, and people in the city.

Today, we hear some of the mental blocks and physical issues that John often sees with his students, and how he creates milestones to motivate himself to keep running.

John tells us about choosing the right shoe, when to replace them, and he gives some advice to new runners, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

  • “Everyone’s a runner. Some people just choose not to run.”
  • “You can’t change overnight.”
  • “It takes 3 or 4 weeks to find a rhythm, sometimes even longer. Just be patient, slow down, and make sure it’s fun.”
  • “Taking care of yourself is really important. There are a lot of little things like massage, stretching, eating right, and all these things that are small things that add up to bigger gains.”

Suggested Keywords

Running, Coach, Exercise, Jogging, WaterPik, Massage, Wellness, Health,

To learn more, follow John at:

Website:          Run Kamp

Facebook:       @johnhonerkamp

Instagram:       @johnhonerkamp

LinkedIn:         https://www.linkedin.com/in/johnhonerkamp

Email:              john@runkamp.com

WaterPik Power Pulse Showerhead

WaterPik Water for Wellness Council

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264

Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73

SoundCloud:               https://soundcloud.com/healthywealthysmart

Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart

iHeart Radio:                https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927

Read the full transcript here: 

Speaker 1 (00:00):

Hey, John, welcome to the podcast. I'm happy to have you on.

Speaker 2 (00:05):

Thanks for having me. Yes.

Speaker 1 (00:06):

A fellow new Yorker, just over the bridge in Brooklyn.

Speaker 2 (00:10):

That's right. I'm a couple blocks from prospect park. So I do a lot of my running and activities and in prospect park. So I feel fortunate to have access to that space.

Speaker 1 (00:20):

Perfect. Perfect. So now let's talk a little bit more about you before we go on. So people know you're a run, a running coach and you've been running for the good portion of your life, but can you kind of fill in some of the gaps and let the listeners know a little bit more about kind of what led you up to where you are today in the running world?

Speaker 2 (00:40):

Yeah. I was fortunate to have an uncle that lived next door to me, and he was trying to lose weight and training for the marathon. Either the New York or the long Island marathon or both, this is probably like 1982, 83. And to DeVos's neighbor, he would just bring me along to some of these 5k and 10 K races. And that was kind of like in the first kind of first a second running boom. And, you know, I do the kids fun run, which to be honest, not a lot of kids were doing, it was usually about a mile distance. And then it gradually, I would, you know, after a year or two, I would, you know, take a stab at the 5k, which was a pretty far distance for seven or eight year old. But I just got exposed to running at an early age and, but not really, I mean, competitive against myself, maybe the clock, but not super serious.

Speaker 2 (01:24):

I did other sports, but when I w when I got to high school, when I went out for the cross country and track team, and we had a pretty good high school in sports in general. And I kind of had a leg up as far as I've been running for races for a couple of years. And I kind of had, you know, a little bit more experienced than the average freshman, but I definitely was better at running than basketball, football, baseball. I was very good on defense and I realized that equates to like, not scoring a lot of baskets, but it really annoying the other competitors where I had a good engine. And so, you know, I ran very well in high school. I got recruited and I went random, got a full scholarship to St. John's in Queens and ran there for four years.

Speaker 2 (02:10):

And I was fortunate enough to get better each year. And I had a really good year, my junior year and 1996, I qualified for the Olympic trials and the 800 meters. And that was also the year that the Olympics were in the U S and Atlanta. So it was just actually that kind of a perfect year. It was 20 years old. I got, I just advanced really, really well. That's, that's that's spring season dropped about four seconds of my 800, which is a pretty good chunk of time for that distance. The next thing you know, I found myself at the NCAA at the Olympic trials competing in Europe as the 22 and as a 20 year old. So that was kind of the beginning of it. And then obviously I got into professional running post-collegiate Lee. I ran for a team Reebok team based out of Georgetown university, but the legendary coach, Frank Gagliano.

Speaker 2 (02:51):

And I did that for a couple of years training for the trials in 2000. And in 2001, I moved and I was living in DC for those three years. And then I moved back to New York and I was still competitive. I ran for the New York athletic club, but I had to gradually kind of turned from competitive runner to not necessarily weekend warrior. I was still running a fair amount and I'm still competing, but I was focused on other things and then got into coaching and initially at running camps over the summer as a college kid, and then I coached high school was my first gig when I was coaching. When I was running professionally, I coached high school down in Virginia and then got up here in New York. And next thing I know I was coaching. I worked for the New York Roadrunners for five plus years and handled all their training and education and launched virtual training platforms where I was coaching 5,000 runners for the New York city marathon. At one time, the life I was just emailing people all the time, but it really gave me a nice quick you know, again, it's just different. I mean, there's a lot of same principles and at whatever level you're at and running, but coaching the folks that maybe aren't elite or don't have two hours to take a nap every day and do all the recovery things that we'll probably talk

Speaker 1 (03:55):

About are most people.

Speaker 2 (03:58):

Absolutely. I got a really, you know, a crash course in coaching, like the everyday adult who has two jobs and has kids and running as again, as I can sneak it in on the weekends, trying to get in before your kids get up, I'm finding I do that myself now being a father too. Yeah, so I started early and I never got burned out from it. I always had great coaches that didn't run me into the ground. And there's plenty of stories out there where kids, whatever sport we're talking about, or even other disciplines like music or dance or art or whatever, if you do too much, and it's not fun anymore, and you start not liking it. And I was able to, even though I didn't enjoy it all the time for the most part, I really enjoyed running throughout my life and at different levels of competitiveness.

Speaker 2 (04:40):

And and I'm very proud that I, I do, I do call myself a I've run races and stuff, but I'm not offended anymore when people call me a jogger or they asked me how my jog was. I actually realized that I was doing a lot of jogging, even when I'm at the elite level, the recovery runs were very easy paced. So I'm quite proud to be a jogger. And but yeah, that's kinda like my quick and dirty version of how I got into running and the kind of trajectory that I've been on. And again, I've been running for about 35 years and probably kosher for close to 25 at various

Speaker 1 (05:12):

Amazing. So you've coached, we can easily say you've coached thousands of people.

Speaker 2 (05:17):

Absolutely. Yeah. The technology and the online platforms recently, it does make it easier, very scalable. And you can say, yeah,

Speaker 1 (05:24):

Yeah, amazing. And just so people know the way John and I met was through so people who who listened to this or see me on social media, you know, that I'm part of the water Waterpik water for wellness council as is John. So they've got two new Yorkers and we're both council members. And one of the things that we have been working with is a Waterpik power, pulse, therapeutic strength, massage, shower, head, try and say that 10 times fast. But we'll talk about kind of how, how John sort of incorporates that with his runners and any benefits that they're seeing from, from switching a shower head, which is pretty easy. But before we get into all of that, John, let's talk about some of the common complaints or common issues that you're seeing with your runners. And just so people know, we spoke a little bit before we went on the air here. And the one thing I really want to hone in on first before we get to the physical things that everybody thinks of that happens with runners, but there's the mental side of it too. And sometimes that could be the more important side. So talk to me about what kind of mental blocks you're seeing from your, your students.

Speaker 2 (06:40):

Yeah, I mean, mentally it's it's funny because people, when they find out that I've given coaching all these years and been running and maybe I was faster and fast and slow is a relative term, but you know, competed at the Olympic trials, they're always Oh, well, you wouldn't want to coach me because I'm not a real runner or, Oh, I don't run like you. And I'm like, how do you run? You put one foot in front of the other, you leave the ground and move forward. It's very simple. And so people often have a love, hate, or just hate relationship of running because either it was a punishment for other sports growing up, we had to do laps. Oftentimes it had to do with pre-season conditioning. And if you're coming off the summer and like, you like me in high school, the first couple of years, you didn't do your homework over the summer. So you show up and you're, you know, you're out of shape and you're doing laps and it's hot. I remember that in football practice as an eighth grader, just being like miserable and like running was, was, was terrible,

Speaker 1 (07:30):

Especially in the Northeast when you've got the heat and the humidity and everything else. Yeah.

Speaker 2 (07:34):

So or they, you know, it was a gym class and they had it, they know the presidential fitness test and they had to do a time tomorrow on a terrible thing. But like, I was actually good at that because I liked running ahead at like an early traction to running. And I was doing pretty well at it, but for the most people, it was not fun. And it was just an awful experience. So whether they come to they're new to running in their adult life, or they were even if they were faster and fitter and did other sports as a, as a youngster that maybe they took 10, 20 years off based on whatever. And now they're getting back to it. And they're really the mental block of, Oh, I'm not a runner and maybe I shouldn't do this. And you know, and that is really oftentimes getting people to accept that they, that they're falsely claiming that they're not a runner when they're really just, I always say, everyone's a runner.

Speaker 2 (08:22):

Some people just choose not to run or they don't know how to start. So I really enjoyed that process of getting people over that mental hump, if it exists of, Hey, you're a runner I want to find out where you're at, and then we're going to take you from there to where you want to go. And you need to know where you are before, you know, where you're going. And so it's really like, I think oftentimes changing their mindset and saying, it's okay to run 10 minute miles or 12 minute miles or seven minute miles. I don't care. I like numbers and data when I'm crunching numbers about your training and maybe how you paced properly or improperly. So I'll get geeky about that. But I don't really care. I, I coach someone who runs 15 minute miles the same as I would someone coaching seven minute miles.

Speaker 2 (09:01):

And so it's just the mental space that they're in of, Oh, I shouldn't be here. I don't belong. I'm not really doing it right. And oftentimes they'll say, Oh, I'm not running is not for me. I get this all the time. I can't run more than a block. And I'm always like, well, what block you running up? Is it uphill at altitude when you're carrying a backpack of weights? Because probably most people could run a block and they're just running too fast. And they think of running as being painful. So that has to hurt. But to be honest, most of my training, especially for like a marathon, for example, I have a lot of first-time marathoners and most of the running is actually easy. Pace. Marathon pace is actually quite easy. It's just hard to do for 26 miles. So the barrier of like not pacing yourself or not going out too fast for a couple of minutes where they have to stop, those are quick fixes in my opinion. And that's the mental side of things. And then there's a couple of common physical issues that come up, which I can talk about for sure as well.

Speaker 1 (09:54):

Yeah. I know. I love the, that sort of mental barriers, because I think if we're talking about new, new to new to running folks or folks who maybe took a year, five years, 10 years off, and they're coming back to it, like you start and you think to yourself, God, it's taking me 15 minutes to run a mile. I feel like such a loser, everyone else, like, cause you hear Oh, eight minute mile, seven minute miles. Like that's where you should quote unquote, should be. If you want to run a marathon, you don't want to be running for seven hours. This is, you know what I mean? And, and I think that that's, that can be really difficult for people and kind of turn them off before they even start. So what kind of techniques do you have for someone like that who's coming to you saying, I feel like such a loser. I can only run a 15 minute mile or 18 minute mile, whatever it is.

Speaker 2 (10:48):

Yeah. I think I also encourage people to have a running log or a diary, which is an extra step, but it also helps you get progress. It also helps you with injury prevention and to deal with injuries when you do have them, which I'm sure we'll get into, but I often buy I'll run by minutes. So it's like today you're doing 20 minute run versus a three mile run or a five miles. So they don't honestly know how many now, if they have a GPS watch and they're tracking things, they'll know after the fact that, Oh, that was the 13 minute mile or whatever, but I'll run by minutes. So you don't, you know, and then that, I think sometimes it's a different mindset or a way of tracking where it does free you up a little bit of not having to do the three miles in 30 minutes.

Speaker 2 (11:23):

That's easy math. That's only 10 minutes or whatever it is. You just run for 20 minutes or whatever it is, 30 minutes, 40 minutes. And even when you get in your longer runs for longer distances, you're, you're, you're increasing by five or 10 minutes, not a full mile. Sometimes I liked that worked and that's kind of how I'd run anyway. I'll just do a 30 minute shakeout run or something and I'm not right. Especially if it's not a workout, it's a workout quality day where I'm doing six times 800 or I'm doing something like that. It'll, it'll be more important to know the pace and effort, but most of the running, just getting out there and doing it. Yeah.

Speaker 1 (11:55):

So it's like, you, you can accomplish that 20 minutes. You get that win and you gradually build your confidence, right? Yeah. No, that makes perfect sense. I really liked that. And I also like keeping a running log or a running diary. It's the same thing. We tell people if they want to lose weight, one of the, almost every nutritionist or dietician will tell you to keep a food diary. I do that with patients with chronic pain, I'll have them keep a pain diary so that they can kind of keep track of maybe what they did and what their pain levels were and things like that. So it doesn't work for everyone, but I think it works.

Speaker 2 (12:28):

I have a quick story about that when I was just just first year as a professional runner, I had all these shin problems. I got down to DC and I felt like this kind of like loser, cause everyone was just professional runners. They're all qualifying for the Olympics and trying to qualify for the Olympics. And I had shin splints. So I was like running 20 minutes by myself and I couldn't work out. And I was seeing like a, you know, PT person and I was doing exercises and just seemed like I wasn't getting anywhere. It wasn't improving. And then the PT said, Hey, you should really just monitor your pain on a scale of one to 10. And obviously you have a left shin and a right shin and both were hurting me. So I thought that was really silly and kind of stupid as a, as a 22 year old.

Speaker 2 (13:05):

And but I started doing it cause I had nothing else. I wasn't running riding much of my youth log. Other than I ran 20 minutes. I didn't have to take me a long to write what I did cause it wasn't a lot. So I had stuff to write about and to be honest, you know, say I had a six out of 10 or seven out of 10 was the pain level. And then all of a sudden, as I was ranking it throughout the weeks I was doing these PT exercises and, you know, strength exercises. And I'm like, are these really working kind of going through the motions? But then I did realize like one week or so in the sixes were fives and the fives were four weeks. And so I w if I didn't have that to document, I wouldn't know, I wouldn't be able to see the trend of in the right direction.

Speaker 2 (13:43):

So then I got more excited and I was more diligent about the exercises and I did them correctly. It was more intention. And that was really helpful because I could see progress where if I didn't have that, I would just be like, Oh, my shins hurt and not, you know, see, you know, again from five to four and everyone has their own relative scale of that, but it's just for that each person. And so that, I always tell that story. It was, I thought it was really silly, did it anyway. And it really helped me kind of snap out of that mode where I was like, wow, that really I could see progress. And I wouldn't be able to do that without having the data or the, or the documentation that I have it writing it down. So I'm a big believer in that. And I really it's, it's fun to see that you're, you're doing that with your patients as well, because that's one way to, you know, this, you can't remember everything and it's, we're all busy.

Speaker 2 (14:29):

And so if you can write it down and go back to it, even if they don't see the trend that you look at their, their, their diary, they might not see. And they're not going to be able to remember all these things, but if you can like read through their notes, you oftentimes, the coach will we'll pick up stuff before the athlete. And that's just like being a detective. Oftentimes I'm a detective as a coach, try to piece together. And the more information we have as coaches or detective detectives, you can get the root of the problem quicker. So document everything, it's, it's kind of like old school, but I, I can't speak more highly about that because that's really a game changer for me as a young 22 year old, but even to my athletes today.

Speaker 1 (15:09):

Yeah. Awesome. And now you mentioned shin splints. So let's talk about it. One of the common complaints that you get from your runners are shin splints. So as a running coach, what do you do with that?

Speaker 2 (15:21):

Yeah, it's funny. I was thinking about this in prep for this. And I got the same similar injuries as an elite athlete, as I do now is like weekend warrior. You know, dad, Bob jogger you know, shin splints and, and that's, shit's meds are pretty common because someone who's new to the sport either they're doing nothing. And now all of a sudden they're running 10, 20 miles a week, or they're someone who maybe was jogging and then they're training for a marathon all of a sudden, and they're upping their volume. So it's usually just an overage, an overuse issue. It can lead to stress fractures and things, a little more serious, but for the most part, if you have a good pair of shoes, which is super important, you don't need a lot of equipment, although it is getting colder here in the Northeast, and you do need to layer up a little bit, but you really just need a good pair of shoes.

Speaker 2 (16:04):

So that's really important and making sure that you're not doing too much too soon, because if someone is not shepherded you know, they're worried about calling themselves a runner and they get excited. If for whatever reason they get into the New York city marathon through the lottery or something, it's very easy to get overexcited and do too much too soon. And then you're kind of sitting on the sidelines. So it's really just kind of, and then I think a lot of new runners or new athletes, it's tough for them to decipher between pain and injury or soreness being uncomfortable. It's a guy I got to run through it that could lead to like, well, actually that pain is telling you something to slow down or to back off. And sometimes it is kind of navigating through aches and pains that just come with doing something new and doing it more often. So that's something that's always tough to decipher first time through, like, if you've never had shin splints, you're like, what are they? Like? You can ignore them and they don't go away and they become bigger problems. So shin splints, plantar, fasciitis, Achilles issues muscle poles it band with junk currently dealing with now my knee. Those are just kind of the common things that any runner will get, whether you're a professional at being or someone just starting out.

Speaker 1 (17:13):

And what are your thoughts on cadence? So oftentimes we'll all read or I'll see that if sometimes if you up your cadence and shorten your stride length when you're running that it's beneficial for some of these injuries, what are your thoughts on that?

Speaker 2 (17:32):

Yeah, I think if there's a chronic issue that keeps reoccurring, I definitely will kind of look at that, but oftentimes, and actually this is a good kind of tip for someone who's new to running. They often want to me to see them run the first time and like fix their form. And if they're 45 years old, like I am, you've been running for 45 years a certain way, or maybe 44 years because you didn't run as a six month old. But and my son just took his first steps this week. So that's exciting, but it's, you know, you're gonna get you, I, if you gotta get chased by a dog, you're gonna run a certain way. And so you don't need to change something you've been doing drastically, unless it's a chronic issue. That's always happening. People often say there's a breathing.

Speaker 2 (18:15):

How do I breathe in through the nose, the mouth? I said, however, don't even think about it. It's when you have a side cramp, that's keeps reoccurring that I tell people to kind of pay attention to that. But for the most part, don't worry about your form. Don't worry, your breathing just kind of get out there. And if it's something where you want to pass the time and count your steps, or there's some GPS devices that help you count. I really just pay attention to that. If there's something that's reoccurring, because otherwise I feel like you've been doing something and creating all this muscle memory for all these years and to drastically change form. And I often I'll hear this a lot where, Oh, my doctor told me I should run on my toes. I'm a heel striker. Well, then I see people running on their tiptoes in the park.

Speaker 2 (18:55):

I'm like, what are you doing? I know you can't just go from that to that. Yeah. When you run faster, you're naturally up on your toes. There's obviously certain shoes will help facilitate that. But like this, a lot of fast runners that run up their heel strikers, you don't have to be a toe runner, but I, I hear that a lot where my doctor said, or my coach or someone said on my toes and I'm like, not like a ballerina. So those are things where I think if you hear someone say, do this or work on your form, I think there's things to work on, but it's it's not something we want to change overnight because that could lead to overcompensating. And just other issues that I think people may make you maybe worse off than you were with just kind of figuring out something else, but your current form.

Speaker 2 (19:37):

And you can always improve things with drills and stretching and flexibility, which obviously the the power pulse therapeutic strike massage is, has helped us do. And we do even in my mid forties where I'm spitting up and spending a couple minutes a day focusing on that. But you can't change things. Even if you're 25 years old, it's still a lot of muscle memory made it. So you can't change it overnight just to be patient with that. And don't worry about it until it's kind of a problem that you see a persist, you know? Totally.

Speaker 1 (20:07):

Yeah. And you mentioned shoe selection. So this is always a question that I get as a PT. I'm sure you get it all the time, multiple times a week or hundreds of times a season, what shoes should I get? What sneakers should I get? And everyone wants to know what brand, what this would that. So what is your response to, what shoe do I get? Do you get, do you have like some guidelines to follow or what do you tell your, your athletes and your runners?

Speaker 2 (20:34):

Yeah, that's, you're absolutely right. I get that a lot. And it's really, I always tell folks, there's like, you know, everyone knows they're running brands, you know, there's new balance, Nike, this Brooks, you know, they all Saccone Mizuno, Hoka is on. Elena is new on running as a new, at a new company out of Switzerland. All those shoes will have the gamut. They'll have super neutral shoes, neutral being like you don't, you have a high arch, you don't need a lot of support. They have kind of the middle of the road where you have some support, some cushion, then you have like, you know, the Brooks base, for example, it's called the Brooks beasts or the new balance nine nineties. They're, they're meant for heavy duty. You know, someone might have a flat foot. And so there's the whole gamut. So there's usually, there's a shoe that's in that line.

Speaker 2 (21:24):

That's going to work for you. And you might not know that. And I was people tell people to go to a running store if they can, because, and they get intimidated by the Wallace shoes and they go for the pretty ones, oftentimes, but every shoe brand will have the same kind of like kind of small, medium, large, or they'll have the categories of neutral cushion all the way to really support and really corrective shoes and some shoes that are going to fit certain feet better. You know, and I've done some brand work for my business where I'm affiliated with a certain brand and I have to wear those. I'm always hoping that I can wear those and they're going to keep me healthy. But even when I'm repping those brands, I'll say, I don't, you don't have to wear the shoe that I'm wearing, even though I'm getting paid by that company to do various things, the shoe companies should want you to be healthy because then you can run and do more and more.

Speaker 2 (22:12):

So you know what one or two shoes might brands might work better for your foot? And some shoes are just run bigger. Some run wider as far as the shoe brands, but if you'd like a certain brand, historically, that's what you will and others haven't. But try on a bunch, take notes, document how you feel in them, but that every, every shoe company will have something for you. It's just going into a shoe store or doing some research of asking questions. And I was people that always afraid to go into a running store. They're there for mainly for beginner runners, because once you're like me and you know what you like, you just, you can, you can either get it from the store or you order it online shoes. I it's, you know, and obviously if I work for the new brand, I need to kind of re if I have to familiarize myself with different options, but it's really, I can't tell you, I mean, I can look at your foot and kind of see, okay, you're have a wide foot, you have no arch.

Speaker 2 (23:06):

You probably need a supportive shoe, but that's not like a blanket thing. You know, you also look at the wear of people's shoes from previous shoes and you can see where they're wearing down and I'm a podiatrist. But again, back to being a detective, you can, if you can look at things and say, but even my neighbor, the other day was like, what shoes should I wear? I don't like these they're too squishy. I'm like, well, you probably need a little bit more support. They're probably not too soft for you. Sure enough. I gave him the middle of the road running and these are great. It's also probably, I don't know how old the ones he was wearing were. So that's another problem. You go to the running store, you try on something a, maybe you're wearing heels all day at work, and then you go and try this awesome shoe on it's fluffy, and it's great.

Speaker 2 (23:45):

Then you go home and run out on a couple of times. And it's like, ah, maybe this is rubbing me the wrong way. I'm getting a blister. And oftentimes there's also the sizing. If you're a size 10 dress shoe, you might be a 10 and a half running shoe. And I'm someone who actually is 10 and a half in dress shoe and running shoe. But some of my spikes and performance shoes like flats and more racing shoes made it might've been a 10 because you actually want them either. So those are some other things to kind of think about sizing.

Speaker 1 (24:13):

What is the, what is the running, the mileage that you put on your sneakers before it's recommended to change?

Speaker 2 (24:21):

Yeah. I think the industry says the two 50 to 500, which is a big range. So it also, it depends on how often you're running, what surfaces, if you're running on the treadmill every day, then obviously you're probably getting less wear and tear than if you're running on the trails, getting them all dirty and stuffing them up on rocks and stuff like that. So, I mean, I would say close to the, and sometimes people say, I'll just say you should get shoes depending how much you're running like two a year. If not more, if some people would wear the same shoes for three years, I'm like, you probably be, yeah. So you need to invest in that, put that on your, on your shopping lists for the holidays or whatever. But I mean, I'll, and I also do this where I don't wait for the one pair of shoes to kind of run out, especially if I, if I like a shoe and I'm especially to train for a marathon, I might be, I might have one pair of shoes for a couple of weeks.

Speaker 2 (25:09):

I'll get another pair of shoes and I'll start alternating them. Actually one gets cycled out because you kind of know, people often say, how do you know, well, your knees start hurting more. You shouldn't start hurting more and it's not an injury. It's just more of an achy soreness and that's usually stuff. And also I get much more motivated when I put new shoes on you kind of like, you're more anxious to get out there and you know, you do have to break them in sometimes depending on what type of shoe they are. And, you know, I would just jump in, in a marathon without breaking in those shoes. But I mean, I've heard, I would say two 50 or 300, I feel better about, but I've read and I've seen, you know, up to 400 to 500, which is a little higher than I liked, but depending on what type of running you are and how hard you are on the shoes and what surfaces you, you, you could last, but definitely I think, you know, more than one pair of shoes for sure for the year. Yeah.

Speaker 1 (25:59):

Great, great, excellent advice. And now before we start to kind of wrap things up, what I'd love to hear is maybe you have a new runner, right? Because the majority of people, like we said, let's be honest, are more recreation. Runners are not professional runners. They might be new to running, or they're running after a little bit of a break. So if you could give that runner who you've probably seen thousands of times what would your top three tips be for those new runners?

Speaker 2 (26:34):

I would say, give it have some patience. It's like, you know, again, even if your S your pace is too fast at first block and you're stopping, you know, I always said, like, it takes three or four weeks to kind of find a rhythm sometimes even longer. So just be patient slow down, make sure it's fun. Whether that's, you know, I love the running community here in New York. It's so vast. It's actually a card to keep track of all the things that are going on. And even if you're in a smaller city, it's usually like their local running store and there's, there's, you know, you go get a beer or coffee afterwards. It's a great community sport. Cause it's, there's a lot of, there's a lot less barriers involved in entering the sport and you can also be a Walker everyone's kind of invited to the party.

Speaker 2 (27:13):

So, so yeah, I would say, you know, give it time patients make it fun, make it community oriented. Although I do my best thinking and problem solving when I'm running by myself. So definitely, you know, you don't always have to make it about a group training, but that's something that I think it's a great way, appreciate and meet new people in a new city and then take care of yourself. I think don't ignore the things that bother you get good shoes. I mean, my number one, when people are injured, come to me, they often come to me almost too late where it's, so their pain is so bad and their Shannon or their knee,

Speaker 1 (27:45):

Then they're thinking I should get a coach. Like that's the impetus for them to get a coach.

Speaker 2 (27:49):

So you're like, you know, take care of yourself. And to be honest, this might be a good segue for what we're talking about, because my first line of defense is go see a massage therapist because massage throughout my running career is like, you know, you go to a doctor and they say, it hurts when I run, they're going to say, don't, don't run. It's like my mom said back in the day, mama hurts when I do this. Okay, don't do that. That's kind of, that's often, but some doctors will say like, Oh, that's bothering. You just don't do it. Well, we want to do it. We want to be active. We want to keep doing it. So taking care of yourself is really important. And there's a lot of little things like massage and stretching, eating, right. And all of these things that are small things that really add up to bigger gains. And it's, it's fun to, to improve at it. You know, I mean, I'm never going to run a PR again because I ran faster than my youth, but I have, I have to make up goals now, like fastest mile as a dad. You know, whatever. So if these are all things that I have to kind of reinvent to kind of give me the motivation to get out there, but the self hair, the self-care piece is super important and often neglected.

Speaker 1 (28:52):

Yeah. And that self care involves sleep, recovery, nutrition. I think the massage, and like I said earlier, we're both on the Waterpik water for wellness council. And one of the, a couple of things that they're, and again, power pulse, therapeutic strength, massage, shower, head a couple of things that they have actually been shown that clinically shown to provide, like to help soothe muscle tension, to increase flexibility and to improve restful sleep. So the way I look at it as a PT, and I'm sure you may say the same as a run coach. Like we like to keep the risk continuum a little bit more on the reward side and a little less on the risk. Right. So if you can recommend things for people that have less risk and more reward, great. And if you can recommend things to people that are economical. Great. And I think that that's where that the power pulse massage shower kind of comes in along with, like you said, seeing massage therapists one of the things that I'm so glad that you mentioned is about the community oriented part of running. Cause I think a lot of people think that if you're running, you're just running on your own.

Speaker 2 (30:21):

Right. And then that's been the biggest challenge for me. It's just my own running is I've actually, I've been running 60. I usually run five or six days a week and it's done a lot of mileage cause it's, you know, being a dad and, you know, jogging stroller and whatnot. But I was running the same amount of times per week, but I was running and say 30 miles a week. And then I was running like 20 and I'm like, how am I running less? You know, I have more time to one degree. And I wasn't like, I would actually often rely on, especially for longer runs is to go to prospect park, which is very well trafficked with runners. And I know a lot of runners, so I, I usually run into people. I know. And then we go, we can, we run a mile or two or add on, and I didn't have that because everyone was running alone or, and so I was like, Oh, I'm not getting that extra motivation or, Hey, Hey, Karen run into Karen and we do an extra three miles because we're talking way and catching up.

Speaker 2 (31:07):

And so that's something that the community piece to that my mileage is that definitely I mean, I since realized that and, and try to pay attention to doing a little bit more, but I'm like, how am I running last? I'm still running six days a week. And that was the number one thing that I was different was I didn't have the buddies and I was running by myself all the time and that you weren't casually running into people and adding on. So but yeah, I think, and everyone says, you can run with people. It's just doing it safely. Yeah. Certain protocols. So it's just, and some of that was new in the beginning. And so, but there's definitely been a second kind of volt. Second, third, fourth, depending on who you talked to like many running boom, because gyms were closed and other things, so you have less, you know, nature get outside, walk run. So I guess a lot of more questions from new runners, especially neighbors because they're out there running and they knew, Oh, this guy runs on the block all the time and he must know something and all the questions that we went over already getting those. So it's you know, as far as silver linings to some of this stuff, that's going on.

Speaker 1 (32:08):

And now before we finish, I have one last question for you. And it's when I ask all of my guests. So knowing where you are now in your life and in your career, what advice would you give to your younger self? So maybe that 20 year old at the Olympic trials in 1996, what advice would you give to that kid?

Speaker 2 (32:30):

Yeah, well, I mean, back then running, talk about love. Hey, like it was so nerve wracking once I got the certain levels. And even that I ran the 800 meters, which is arguably one of the toughest events in track and field, they say the 400 hurdles experts today, the 400 hurdles and the 800 meters are the toughest. I think the 10,000 meters on the track is twenty-five laps. That that's hard puzzle to me because the hard I can't do it to cath on and heptathlon is all these different things. I think those are harder, but as far as the body and the body makeup that that event is kind of in between speed and endurance. And so but it, it just was so nerve wracking at the, at, when I got to that age, in that level, that running was and if I was running well and healthy, the world is great, but there was times where running was not so fun and I was sick or I was injured.

Speaker 2 (33:21):

And so I guess I would probably say, you know, it's tough to say, don't take yourself too seriously because I was training for the Olympics and it's really scary, really focused. But and actually, I, I, once I stopped competing, I actually took on a couple of years off where I don't even know how much I was running maybe once a week. And I definitely got out of the Cape. And I think when I was like maybe mid to early thirties, I got reengaged that there was a local team that needed some people to run for. And I kind of said, all right, I'll help out. And then I was kind of needed again, it felt somewhat relevant, but then the community of that as well, the peer pressure in a positive way got me into the fold. And I actually got, was able to get pretty fit again in my mid thirties.

Speaker 2 (33:58):

But it was one of those things where I did it to be really good. And then once that was no longer the goal, it was like, why do it, and sort of, it's a little bit of a gap there that, you know, probably mentally and physically, it was good to have because, you know, I get healthy and kind of cleared my head a little bit, but I wish I didn't take that long of a gap because there was only one reason to do it was to get fast, to win races, to make limpic teams. And as we all know now, and I know now is there's many reasons to run released best, you know, be competitive with yourself, you know, have be part of a community. See nature. Even though I started one of these things recently where I took a bunch of runners to to Ireland and I called it a run location and we spent four days and you actually can explore a lot of people.

Speaker 2 (34:40):

I coach where they're training for the marathon, we'll say, Oh, I can't, I can't run these two weeks. I'm going to be on vacation. I'm like, well, tell me more about this vacation. And it turns out that, like I had someone run on a cruise ship once and they actually sent me their GP. I'm like, there's probably a track on the, on the cruise trip. It's probably not that exciting, but don't say you have to take two weeks off. I would kind of like a little tough love there. And someone, I think of some woman sent me, she was going across the Atlantic to like Norway and her GPS was over the water, three 30 pace per mile. And it said she ran like 50 miles would showing around like 10. Oh. Because she was more like, not trying to get out of running. She was just like, Oh, I have to, I'm on vacation.

Speaker 2 (35:19):

I can't run. And I was like, you can make it a part of your everyday, regardless of where you go and you often can see more on foot then. So it's one of these things that would just I don't know, you can make it part of your life or it's not such this arduous thing and horrible thing. It, most of the time it could be pretty pleasant and fun. And I mean, I don't, I don't knock myself too much for being so serious about it, but I wish I didn't. I let myself off the hook a little bit and when I was younger and enjoyed it more and didn't take it so seriously all the time, even though there's reasons for that.

Speaker 1 (35:50):

Yeah. Oh, I think that's great. I think that's great advice to your younger self and John, where can people find you? What's your website? Where are you on social media? How can they get in touch? If they have questions they want to work with you, they want to learn more about

Speaker 2 (36:02):

The programs you have. Yeah. My, of a website is run camp and that's R U N K a M P. And I'm spelling incorrectly because my last name is Hunter camp with a K. Yeah. So nice play on words. Yeah. So run camp, you know, and you know, it's all things running, whether a training for a race or just getting fit or travel in this case, once we can travel again. And then my Facebook and Instagram is just John Hunter camp. My name's spelled so you can find me that way. And then email me a john@runcamp.com. If you have any questions, you, you know, you want to get ahold of me for any reason, I'd be happy to chat and help you through your training journey as, as you see fit. And as, as, as you see necessary.

Speaker 1 (36:41):

Perfect. And of course we will have the links to everything at the podcast and the show notes for this episode at podcast at healthy, wealthy, smart.com. So, John, thanks so much for giving us a little bit of your time today. I really appreciate it.

Speaker 2 (36:57):

Thanks for having me. It's a pleasure to join. You're happy to do this again and stay in touch even though we're so close so far.

Speaker 1 (37:03):

I know, I know just over the Brooklyn bridge but thanks so much for coming on and everyone else. Thanks so much for tuning in, have a great couple of days and stay healthy, wealthy and smart.

 

Dec 14, 2020

In this episode, Dr. Steffan Griffin talks about his research into ‘Rugby Union, and Health and Wellbeing.’

Dr. Steffan Griffin is a junior doctor based in London, pursuing a career in Sport and Exercise Medicine. He is a Sports Medicine Training Fellow at the Rugby Football Union, deputy editor at the BJSM, and a part-time Ph.D. student at the University of Edinburgh, where he is researching the topic of ‘rugby union, and health and wellbeing’. Steffan also works clinically with a range of elite sports teams including Chelsea Football Club, and London Irish Rugby Football Club.

Today, we learn about the different forms of rugby, and Steffan elaborates on the findings of his research regarding the health and wellbeing benefits associated with playing rugby. What does the review mean to those who are interested in gaining the health benefits from rugby? How does this review affect policymakers? What does the review mean for researchers?

Steffan tells us about the common misconceptions surrounding rugby, and how his research aims to change that, and he gives his younger self some advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

  •  “There are 10 million people playing the game rugby, and they don’t play this blind to the fact that there are risks associated with ”
  • The different forms of rugby:

Contact Rugby: It’s the “collision game” that you typically see when tuning in on a Saturday afternoon.

Touch Rugby: It’s a glorified version of “tag” with a ball.

Tag Rugby: Players wear a belt with Velcro strips, and a tackle is when players manage to grab one of those Velcro tags.

Wheelchair Rugby: Nicknamed “Murderball”.

  • “Our research found that all forms of rugby can provide health-enhancing moderate- to-vigorous intensity physical ”
  • “Symptoms of common mental disorders were higher in professional players compared to general ”
  • “People are well aware; rugby compared to other sports has a higher injury ”

 

  • “What the review isn’t doing is saying that everybody in the world should play rugby… It provides an objective piece of work that can help people make a decision based on evidence and not on emotion and ”
  • “We need to try and move away from just looking at studies where all the participants are white middle class ”
  • “One of the potential conclusions that a reader could get from this study is that non- contact rugby is the holy grail of rugby, but actually there aren’t any level 1 studies looking at the injury risk of ”

More About Dr. Griffin:

Dr Steffan Griffin is a junior doctor based in London, pursuing a career in Sport and Exercise Medicine. He is a Sports Medicine Training Fellow at the Rugby Football Union, deputy editor at the BJSM, and also a part-time PhD student at the University of Edinburgh, where he is researching the topic of ‘rugby union, and health and wellbeing’. 

Steffan also works clinically with a range of elite sports teams including Chelsea Football Club, and London Irish Rugby Football Club. 

Suggested Keywords

 Rugby, Health, Wellbeing, Injury, Research, Review, Benefits, Risks, Sport, Policies, Union, Activity,

To learn more, follow Dr. Griffin at:

 Website:          Rugby, Health and Wellbeing

Twitter:          @SteffanGriffin

Review:           https://bjsm.bmj.com/content/early/2020/11/23/bjsports-2020-102085

Subscribe to Healthy, Wealthy & Smart:

 Website:                      https://podcast.healthywealthysmart.com

Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy- smart/id532717264

Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73

SoundCloud:                                    https://soundcloud.com/healthywealthysmart

Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart

iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927

Read the Transcript here:

Speaker 1 (00:00):

Hey, Steffan, welcome to the podcast. I'm happy to have you on

Speaker 2 (00:04):

Thank you very much for the invitation, Karen. So it's a real privilege to have been asked to come on and to have a good chat with you.

Speaker 1 (00:11):

Yes. And for those of you who may think to yourself, God, this voice sounds familiar it's because Stephan is the host of many, many podcasts for BJSM. So if you have the chance definitely, and you haven't listened to BJSM podcast, definitely go over and listen to all of them because they're all really wonderful. So but this is your first time on the other side, which I find hard to believe

Speaker 2 (00:36):

It is. Yeah, absolutely. As you said, it's something I've been doing for a few years for the journal now and yeah, it's the, it's very strange to be on the other side of the podcast. So I'm a different set of nerves. I'm really looking forward to it.

Speaker 1 (00:49):

Great. Well, thank you so much. And today we're going to talk about a recent review that was published in the British journal of sports medicine, the relationship between rugby union and health and wellbeing, which was a scoping review with you and also our good friend Nim but amongst other wonderful authors, but let's start out with the basic why behind this review.

Speaker 2 (01:19):

Yeah, sure. And I think that the main, why about this is that it was just, it's just a completely unexplored area. So I'm sure that, you know, for people in America, maybe their perception of room B probably comes from our friends at absurd with Ross, where I think he comes out pretty battered and bruised. And actually that's actually not too dissimilar to a lot of the perceptions in the, in the kind of the health and the sports science, sports medicine research landscape. We know about rugby's relationships with injuries and concussions. They're highly publicized and probably rugby is a victim of its own success in that because it's leading on player welfare and it's, you know, really pushing the boundaries in terms of trying to make it as safe a game as possible. Everyone's very aware of of the injury injurious nature of forgetting.

Speaker 2 (02:12):

But what I think for me personally, I've, I'm, I'm Welsh by birth. So I brought up on rugby and, you know, there are 10 million people playing the game of rugby and they don't play this blind to the fact that there are risks associated with it. So we know people know there are benefits to it, but looking at the actual scientific literature, there's nothing really providing a big picture overview of some of that, the health and wellbeing benefits associated with the sport. And really as we know, to make an informed decision about anything in life, be that sport, be that buying a car, for instance, people need to know the, the data surrounding the risks and the benefits, and, you know, we had a lot of the former so what we, what this really has been as aimed to do is provide, you know, some, some evidence not just emotion around some of the benefits associated with the sport. So really is a piece that hopefully prides balance to that, to the wider picture now.

Speaker 1 (03:17):

And what did, what did the review find? So what were those benefits to health and wellbeing?

Speaker 2 (03:23):

Yeah, sure. And before we jumped on the call, we kind of discussed the different types of members. So I'll probably just spend a tiny bit of time just covering and providing a tiny bit of context. So what we wanted to do is rugby, as we've mentioned, the friends app. So there is the contact form of rugby union, which is, you know, this collision gamers, if you're tuning in on a Saturday afternoon, typically here, especially in well-established rugby countries like England, like New Zealand, and it is growing in the U S and over in Canada as well, you know, that's the contact forms of the game, and there are other forms of rugby. So there's, non-contact rugby such as touch rugby, which is basically a glorified version of, of the game tag with a ball involved. And there's also something called tag rugby, which generally people wear a belt with the Velcro strips and tackle is where you manage to grab one of those Velcro type tags off.

Speaker 2 (04:17):

The other form of rugby then that we looked at was wheelchair rugby, which is I think given the lovely nickname of Murderball. But actually we want to, so you may have some of the listeners may have heard admirable being referenced and there are some wonderful documentaries on Netflix, you know, that really provide a good insight into the game. So basically by breaking it down to the type of rugby, we then wanted to break it down further. So people who read the review could really look to see exactly where the benefits lay. So if we kind of look at it from and I'll split it into, into some themes that some listeners might be might be familiar with. So as we know a big, I mean the world health organization, physical activity guidelines came out yesterday. So if we look at physical activity, so we know this is a huge global health priority at the moment, and our research found that all forms of rugby be that contact be that non-contact and wheelchair rugby can provide health enhancing, moderate to vigorous intensity physical activity, which, which really wasn't well known before.

Speaker 2 (05:27):

And then now it puts, it allows people like governing bodies and policy makers to align the sport of rugby with some of those global health priorities. As, as we all know, as practitioners, as practitioners, that muscle strengthening balance coordination and huge parts of these physical activity guidelines. And although we didn't find any studies that really look, look at that, per se, we found that lots of national population surveys, which are really based on expert consensus, consider rugby and all sports such as rugby to provide some of these benefits as well. So again, that was a kind of a landmark finding of this study in terms of the, we then looked at different kinds of health benefits. So we, first of all, wanted to look at physical health and we stratified by that by different domains. So for instance, cardiovascular health, respiratory health, musculoskeletal health, probably the best way to summarize this is non-contact rugby and wheelchair rugby have very supportive research kind of around that, you know, that rugby can provide quite significant physical health benefits into the contact drug B, which is kind of the traditional form of the game.

Speaker 2 (06:43):

There's a real mix there, lots of mixed studies and also just a lot of conflicting findings as well. Although a lot of the studies that look at that, you know, look to control for things like age you know, some of the demographic variables did show some supportive data that is conflicted by some other studies. And you know, what we couldn't do as part of this scoping review was really delve into the pros and cons of each of those individual studies. So in terms of, in terms of contact rugby, slightly more mixed findings in terms of physical health mental health and kind of wellbeing. So psychosocial measures such as quality of life and things, again, non-contact rugby or wheelchair rugby, rugby can provide a real wide raft of of mental health and wellbeing benefits. And most of the research in the contact game was, was, was focused on professional athletes and that fans that have symptoms of common mental disorders were higher and in professional players compared to general population though that is, you know, similar actually to professional athletes in other sports, such as football and things.

Speaker 2 (07:58):

And then the last thing is, as we've discussed right at the very top was the injuries associated with the game because we were very aware of is that it wouldn't be all well and good. That's just providing the health benefits, but also, you know, we didn't, we, although we didn't have the capacity to look at every single injury study to do with rugby relate to all the systematic reviews and Metro analyses around this. And as people are very, Oh, well aware, rugby compared to other sports has the higher injury profile and especially around concussion and things. So, so yeah, so sorry, that answer probably a bit tiny bit longer, but just to kind of try and break it down a little bit you know, in terms of the different types of rugby and then the various kind of health domains.

Speaker 1 (08:38):

Yeah. No, that was great. So let's break it down even further now. So let's say I am a player, or I'm a parent of a child who we want them to have these benefits of physical activity. And if rugby is something that maybe we're looking at to accomplish that what does this review mean to that parent or to that player?

Speaker 2 (09:08):

Yeah, sure. So, I mean, six months ago, if you, I mean, if I was a, if I was a, if I was a parent, you know, I was thinking about, you know, do I want my kids to play rugby, then I probably would have done, you know, Google search health and wellbeing rugby. And the vast majority would have been around purely to do with, you know, concussion injuries and not letting my kids anywhere near this kind of sport. Although, you know, rugby unions and, and people know there are loads of testimonials. As I said, at the top of the podcast, there are 10 million people playing rugby. They ha there has to be a benefit. It's just probably the scientists a bit slow to catch up. People can, kids players can reach all their physical activity guidelines and tick that box by playing any form of rugby.

Speaker 2 (09:51):

And then it's about individual perception of risks and benefit as to what kinds of rugby they want to play. So for instance, you might have, I might have, I might have a child for me. I don't know that, you know, the research says that participants in contact rugby, they say they, they there's Reese qualitative research really supporting the fact that it could provide a lot of psychosocial benefits that instills lots of confidence in people that builds teamwork. And people will say that they feel stronger by doing it and that's across across women, across youth players, across adult players. But also at the same time, you know, I think what there isn't doing is saying that everybody in the world should play rugby. It's providing people with the, with kind of a, some objective data so that, you know, someone else might come along and say, okay, we want our kids to be getting know taking all the physical activity boxes.

Speaker 2 (10:43):

Cause we know that it reduces the incidence of diabetes, heart disease. We know it provides X amount of benefits, but for me, the injurious side of it means that I don't want my kids or I don't want to expose myself to that risk. So what I'm going to do is look for a non-contact form. And I'll, I'll try and get and get, you know, reap the benefits by, by going down that route. So yeah, we hope that it provides an objective piece of work that can just help people make a decision based on, on evidence and not just pure kind of emotion and headlines,

Speaker 1 (11:19):

How novel, especially in this day and age now let's go, let's move on to what does this mean for the researcher?

Speaker 2 (11:29):

Yeah, she also, I mean, we, we found offset strategy. We found six Oh six and a half thousand studies of which we included 200 studies. And, you know, as, as I can, as I kind of said, like having broken it down into different forms of rugby in different healthcare domains there are some huge research gaps. So for the research right there, you know, we've identified we've identified a lot of research gaps that really, you know, there are some real low hanging fruit there that could really help them inform, help inform decisions further and provide more evidence in these areas. So for instance, I think there's a real pressing need to, first of all, look at populations outside of just the white, 70 kg male playing player. So we know that I think women's rugby had a growth from 2018 to 19.

Speaker 2 (12:24):

Excuse me, if the, if the exact percentage is off, I think it was that 28% increase in participation and it's growing in, in areas such as Asia, especially. And, you know, we, we, we need to try and move away from just looking at looking at participants and looking at studies that look at the benefits or look at, you know, studies where all the participants are, as I said, kind of white middle-class males, that's one big thing. And looking then at, you know, we do need to do more research. We need to, we need to try and quantify how rugby integrates with the physical activity guidelines even further. We need to be looking at more you know, how rugby interacts with various health and wellbeing outcomes you know, across more diverse populations, as I said. But also then I think, you know, I think one of the potential conclusions that really could get from this study is that non-contact rugby is, you know, the Holy grail now with rugby, but actually no, there aren't any kind of level one studies looking at the injury risk of that. So, you know, there are a ton of research areas that we've identified that that are going to be really important moving forward to allow people to make fully informed decisions.

Speaker 1 (13:39):

Excellent. And then moving on, how does this review then affect policymakers? You touched on it a little bit earlier and also international federations.

Speaker 2 (13:53):

Yeah, sure. So again, I've been very fortunate to have to work NAFA 18 months with the rugby football union, which is the essential England's national governing body for rugby. And two of the medical services director and the head of medical research that Simon Kemp and Keith Stokes to, to they for part of the scientific committee of the, of the PhD and their co-authors of the study. So we what's been great at doing this research and doing this PhD is that we're trying to answer questions that we know are relevant to governing bodies and to policy makers. So for governing bodies, for instance, you know, we're now able to provide the English from BMC, the RFU the likes of world rugby. Who've been really receptive to this kind of research with again, objective health objective scientific data that allows them to align the game with some of the current global health priorities, you know, be that physical activity or be that, you know, that we know physical activity levels are down because of COVID and because of lockdowns and you're could the sports such as rugby, such as football, tennis play a role in actually getting, you know, increasing health globally and then says as a policy makers, again, it's it provides because, you know, we know that sports such as rope in your needs, look at football or soccer.

Speaker 2 (15:12):

Now, you know, there's such a huge debater on head injuries and things, and these are, there's a sense that sensationalized to a certain degree, but they're also brought up in pretty in high places, you know, and government level. And, you know, what I'm hoping that this kind of research does is it provides, you know, a big picture for them to see and to look at it and say, well, actually, you know, we can promote rugby before. You know, whether it be that to kids, we can, you know, we need to make sure that rugby is a it's the welcoming environment for all types of all types of people and, you know, across society, because we know that it could provide people with lots of benefits and yes, we know that it might be more injurious relative, but, you know, as long as we put pressure on rugby to keep on making it as safe as possible, and that's where it's great, you know, that we're dropping all these governing bodies have player welfare as they're kind of strap by the number one priority, but it just provides a, you know, a broad picture that people government bodies and policy makers, like you said, can start to actually, you know, start promote things and to provide you filter that down to individuals and groups.

Speaker 1 (16:22):

Yeah. I think that's wonderful. And I love the thing that I really liked about this review. And we sort of spoke about it before we went on the air is I love that you included wheelchair rugby. I did not know that was murder ball, but now that I, now I'm like, Oh, okay. Yes, I get that. But I thought that was really important to include that because there are a lot of people in, across all countries who are wheelchair bound or who maybe cannot participate fully in, you know non-contact or contact rugby. And to include this, I thought was, was really, really great. And it, even in the wheelchair, rugby still had all of these physical, it's still taking the physical activity boxes, right. And still increasing muscle mass and improving cardiovascular and mental health and that feeling of a team. And so I thought that was really great. And to me, the non-contact rugby seems like a much much more forgiving game for people who are like, I would never do rugby. Cause I would like literally be in, you know, laid out for days or something like that because it looks so intimidating.

Speaker 2 (17:38):

Yeah, absolutely. And actually that's a lot of what you just mentioned, actually, it's pretty much going to be our next steps in terms of what we, what we do, because what we don't want to do is we don't want to set up in awards in like a research ivory tower and say, this is our research now go forth and do what you want to there. We really now want to see how people perceive our research. And I think rugby and rugby also wants to know what, so there's no point us, one of the, you know, one of the main points of the resets being, you know, playing rugby, which is your contact, rugby is good for you. Therefore everybody should do it because we need, what isn't known at the moment is how different population groups might perceive those risks. So for instance, if, for instance, you know, if someone's never played the game before, you know, is the fact that there are only really contact versions of the game available locally, is that a huge barrier to them then getting involved?

Speaker 2 (18:36):

So, so I think, yeah, you've touched nicely upon, you know, some of the real practical key issues there. And that's really what we want to be going into next is kind of being able to now piece together and also pretty much providing a toolkit to not just participants, but to governing bodies that says, you know, if you want more people involved, this is what matters at the, at the coalface and this is what you need to be providing. So no, you're, yeah, you're completely right. Because, you know, look watching, you know, watching 20 stone, you know, 250 pound blokes run into each other on a Saturday sometimes quite hard to think, how am I going to get from the sofa to that? Yeah.

Speaker 1 (19:13):

You can't even, you can't even picture it. You can't even imagine. Imagine it because it looks so scary. You know, and even as let's say, as a woman, if I were interested in playing, I wouldn't even know where to start. Right. So this research eVic, and I'm sure there's places I'm in New York city, there's gotta be rugby clubs and things like that, but I wouldn't even know where to start. And so I feel like this might spark some curiosity among people to say, Hey, listen, I can't do the contact. I just can't do it nor do I want to do it, but Oh, I didn't even realize there was a non-contact option. Or if you're wheelchair bound, gosh, I didn't even realize that this is something that I can do so great parts of the research.

Speaker 2 (19:59):

Oh, thank you. Yeah. and yeah. And just to kinda touch on you at the wheelchair, every point. Yeah. We were, we wanted to make this as big picture, as inclusive as possible. And that was one of the real, almost surprising things that the, that the evidence of, you know, of benefits associated with wheelchair rugby were so significant and so wide ranging. It was yeah. A really pleasant surprise. And the population group that isn't as well studied, you know, as we know.

Speaker 1 (20:25):

Excellent. All right. So before we start to wrap things up here, what do you want the listeners to take away from this discussion and also from this, from this research article, from this broad scoping research?

Speaker 2 (20:38):

Yeah, sure. I mean, I think some of it is, is probably a bit broad in that, you know, trying to, you know, we, so, so for when, so for instance, in my role with in revenue, we're looking at how to reduce concussion. We're looking at exactly, you know, nailing down what the incidence is kind of across various playing groups. You know, and that is the kind of thing that generates headlines in terms of you know, cause it, well, it's actually, as soon as something's published, it's now concussion rates up down the same for X consecutive year. That it's, it's, it's a, it's a common thing. Whereas hopefully what this does, it just provides the people. If people are aware that this now exists and there's this research going on, that they can touch base with either the paper with the website kind of with with any of our kinds of sites, social media platforms as well.

Speaker 2 (21:32):

I can just see what that, you know, if I do know someone, if I know a parent's a play, who's looking into it, this is actually, you know, this is where I'd go to make to be able to make a fully informed decision. So yeah, we're not, you know, the, the point of the research wasn't to show that rugby, you know, is this all singing, all dancing, wonderful sport you know, we're, it's always sunshine and rainbows just by the fact that for some people, it, it really is. But you know, it's just, it's just something that can provide, you know, as you, as you said, what sometimes feels like a bit of a novelty at the moment, just an objective overview, so people can make fully informed decisions.

Speaker 1 (22:11):

Excellent. And before we end, I'm going to ask you the question I ask everyone, sorry, I didn't bring this up to you earlier, but surprise now. So knowing where you are now in your life and in your career, what advice would you give to your younger self?

Speaker 2 (22:27):

I think just, just keep going, just keep doing what you're doing head down and hopefully everything so far, it all ends up working out. Yeah, just work hard and keep going.

Speaker 1 (22:40):

Excellent. Excellent advice. And now where can people find you social media websites, et cetera?

Speaker 2 (22:49):

Yeah, sure. So I'm probably I'm most active, especially from a kind of a professional research point of view on Twitter. So is that Stefan Griffin with Welsh spelling? So it's too, otherwise I'm not would kill me. Yeah. And then there's a website www.rugby, health and wellbeing dot com and, and yeah, and, and as, as you, as you've mentioned at the start, we publish the scope review and the question was sports medicine. So it's very easy to find to find the scrap from view on there as well. So, yeah. And if anyone has any questions and you, you know, once access to the PDF or anything, so unfortunately it is behind a paywall, then I'm obviously more than happy to provide all of that.

Speaker 1 (23:30):

Awesome. And we will have all of this information at podcast dot healthy, wealthy, smart.com under the show notes. Thank you so much stuff for coming on. This was great. Lovely to catch up, lovely to see you and congratulations on a great article.

Speaker 2 (23:45):

Thank you very much, Karen. It's lovely to know to chat to you and that's here. Everything's going well.

Speaker 1 (23:49):

And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

Dec 7, 2020

In this episode, Founder of Working Simply, Inc., Carson Tate, talks about making any job your dream job.

Carson has a BA in Psychology from Washington and Lee University. She also holds a Master’s in Organization Development and received her Coaching Certificate at the McColl School of Business at Queens University. She has 15 years of experience working with organizations across the globe, helping them each to improve employee engagement, productivity, and efficacy. Carson is the best-selling author of “Own it. Love it. Make it Work”, a sought after public speaker, as well as a staunch advocate for fair and flexible workplace practices. Her Productivity Style Assessment featured in the 2017 Guide to Being More Productive by Harvard Business Review.

Today, we learn about the 5 areas that we need to explore in order to make our current job the best job, and Carson gives us 3 ways to identify our strengths. She tells us about her Abilities Opportunity Map, and provides the tools to avoid the “inevitable burnout”.

Carson gives us the template we need to say “no”, we hear about the 15-Minute List and the importance of “protecting your 90”, and she gives some advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  •  “Any job can be your dream job because you define the dream.”
  • You’re in a job – how do you make it the best job?

Carson has identified 5 areas that we need to explore: Recognition and reward, Strengths, Relationships,

Recognition and Reward – What kind of recognition and reward do you need? “I’m talking about praise and acknowledgement.” We’re all human beings, and we really need to be seen for our work.

Strengths – What are those things that you do almost at near perfection? “You can’t not do them. Even on your day off you might try to do them… The reason they’re so important is because this is what you bring to the relationship with your employer.”

Relationships – Having real, authentic relationships at work is essential, not only for performance, but to be happy, fulfilled, and engaged.

Development – This is about owning your own professional development.

Meaning, Purpose, and Joy – Meaning is not defined by what happens to you; it’s your interpretation of the events in your life. “Every job has significance. Every job is meaningful. It’s up to you to figure out what that meaning is.”

  • There are 3 ways to find and identify our strengths: Reflection, Performance Reviews, and Highlighting Successful Tasks.

 

  • “The relationship with your employer is a relationship, and any relationship is based on social exchange theory – both parties bring to the relationship and both parties receive. In a relationship that’s healthy, both parties work towards mutually-beneficial goals.”
  • “When we are working from our strengths, the work is easier, there’s less effort but greater impact, more joy, and more flow.”
  • “Even at the end of the darkest week, you can pull back and find a source of hope for the meaning.”
  • “Every time you say no to something, you’re saying yes to something else.”
  • “Clarity creates opportunity. Doing the work to identify what your dream job looks like opens up infinite possibilities for you in your current job and in future jobs.”
  • “In play, that’s where you’re going to find those brilliant insights and connections, and the juice to not be burnt out. The one reason we get burnt out is we don’t play; we just work all the time.”

 

 More about Carson

 Carson Tate believes that work can be the full expression of who we are – the vehicle that takes us to a place where we reach the full potential of our greatness. As a visionary in the field of personal productivity and organizational excellence, Carson uses practical advice and empathetic training to guide and support her clients, helping them shine more brightly than they ever imagined possible. 

A best-selling author, teacher and coach, for 15 years Carson has worked with organizations of all sizes around the world to help them improve the engagement of their employees, the productivity of their workforces, and the efficacy of their leadership. It is her mission to change how and why we work so that we can each make a greater impact on our own lives, on our communities, and on the world at large. 

Central to Carson’s vision is her belief that when we do work that matters to us, it leads to greater success and wealth. It becomes the foundation of a harmonious life where we have the time, space, mental clarity, physical well being, and emotional energy to take care of ourselves and others. 

Carson Tate is also the founder of Working Simply, Inc. where she equips organizations with tools, strategies, information and insights that inspire employees and leaders to use their gifts and talents to build their legacies. 

Carson’s signature courses include:

  • Mobilize Your Inbox: How email can work for you.
  • Work Well With Others: Find joy in teamwork. 
  • Work Smarter, Not Harder: Get up close & personal with work.
  • The WORKshop: How To Work Simply and Live Fully.
  • Carson Tate Masterclass: Own it. Love it. Make it Work. 

A prolific public speaker, Carson teaches audiences how to identify what success looks like from a personal and professional vantage point; how to move beyond the way we’re working today, into a new world of productivity and accomplishment; and how to “own it, love it, make it work” by breathing life and inspiration into work. 

Carson is a staunch advocate and champion for fair and flexible workplace practices that create healthy, nurturing environments for workers everywhere. Her goal is to shift the focus from output to impact – our value as workers is meant to be measured by our contribution.  

There’s nothing Carson loves more than connecting with people. In her uplifting and empowering courses, one-on-one coaching, speeches and workshops, Carson shares surprising ideas and insights that clients and audiences can immediately apply to create fulfilling lives that align with their values and priorities. She inspires people to craft a future for themselves in which their work plays a joyful role. Above all, Carson believes that work is where your mission meets your spirit.

 

Book Mention

Own It. Love It. Make It Work: How to Make Any Job Your Dream Job, by Carson Tate

Suggested Keywords

 Productivity, Job, Work, Career, Burnout, Strengths, Relationships, Meaning, Opportunity, Possibility, Play, Recognition, Reward, Purpose, Reflection,

To learn more, follow Carson at:

 Website: https://carsontate.com

https://www.workingsimply.com

Facebook: @thecarsontate

Instagram:  @thecarsontate

Twitter:   @thecarsontate

LinkedIn:  https://www.linkedin.com/in/carsontate

YouTube:  https://www.youtube.com/c/CarsonTate

 

Subscribe to Healthy, Wealthy & Smart:

Website: https://podcast.healthywealthysmart.com

Apple Podcasts:            https://podcasts.apple.com/us/podcast/healthy-wealthy- smart/id532717264

Spotify:                       https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73

SoundCloud:                                    https://soundcloud.com/healthywealthysmart

Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart

iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927

 

Read the Transcript Here:

Speaker 1 (00:00):

Hi, Carson, welcome to the podcast. I am happy to have you on Karen.

Speaker 2 (00:04):

I'm so glad to be with you. Thanks for the invitation.

Speaker 1 (00:06):

Absolutely. And now, today, what I really love to talk about is how to make any job, your dream job. So this is the title of your, well, the subtitle I should say of your book own it, love it, make it work, how to make any job, your dream job. So let's talk about how to do that because there are a lot of people now working in areas or positions or working in ways that maybe they didn't think they would ever be working because of the COVID pandemic. Right. So let's talk about making your job, your dream job. So how do we go about doing that? It's just an easy question.

Speaker 2 (00:47):

Easy question. I love the easy questions upfront, right? Yeah. Great. Well, first of all, let's go ahead and make sure folks aren't going to give me the eye roll forever. So here's, here's the qualifying statement. So any job can be your dream job because you define the dream. So to create your dream job means that you're going to identify what that is for you and not believe there's a one size fits all or a must or should, but it's what do you need to be engaged and fulfilled in your current job? Because the other reality for most of us is that we can't just quit and go be a lavender farmer. And the South of France that sounds blissful or entrepreneurship might not be the right option for all of us. So we're in a job and I don't want you to stay in suffer.

Speaker 2 (01:46):

So how do we make it the best job? So there are five areas that I found in my research and work with clients that we need to explore for ourselves. The first is recognition and reward. So what type of recognition and rewards do you need? So I'm talking about praise and acknowledgement because we're all human beings and we really need to be seen for our work. But Karen, you might be the kind of person that just wants the email, great job, Karen, that goes out to the whole team and you're like, Oh God, I feel good. I might be the person that wants yeah. The boss to stand up in front of the whole group, have me there and this great grand presentation of my excellence, but we're all different. And so it's knowing what I need is the first step. So admitting that you have recognition needs and knowing what those are.

Speaker 2 (02:38):

And then the second one is strengths. And so you're in health care and a bit, a lot of your listeners are as well, physical therapists. So you went into your profession because you had an interest in probably an aptitude in science and working with people. The second step is to really identify and own your strengths. What are those things that you do almost at near perfection? You were really good at you. Can't not do them. So even on your day off, you might try to do them. And as something you want to develop and grow, so you might read about it. You might take courses. You're the one that has the magazine that you want to look at. Those are your strengths. And the reason they're so important is because this is what you bring to the relationship with your employer. Your strengths are what enables your employer to serve their patients, their customers, and earn revenue.

Speaker 2 (03:37):

And so knowing what the strengths are, a column, your relationship currency with your employer, they're the gold. And when you work from your strengths, your performance goes up, you're more in the flow and you're just generally more happy and fulfilled. So we want to spend more time working from your strengths. But the only way to do that with our employer is to demonstrate how they benefit your employer. So you have to know what they are, and then you okay to help you achieve your goal company. When I do more of this type work, we generate more revenue. We have more customers you're satisfied. So

Speaker 1 (04:13):

When we're talking about identifying your strengths, you don't only want to just identify them for yourself. You want to share them with your friends

Speaker 2 (04:22):

Employer. Yes, exactly. And in not sharing with your employer, Karen, it's being very direct and intentional with your employer around how those strengths support the company's goals. So when I do this work, we are faster. We are better with clients. We earn more money because what you want, the goal here is to do more of them. You want to be able to make an ask, Hey manager, I have a couple of tasks that we really are not driving revenue. And aren't really serving the company that I can see when to let go of those and do more of this.

Speaker 1 (05:02):

Yeah. That makes sense. And if you're working from your strengths, you would probably enjoy it a little bit more, cause you'll see more success.

Speaker 2 (05:09):

Absolutely. And I am, I come from the school of positive psychology. So I take a strengths-based approach, which means we're going to work on your strengths because I can get a 10 X lift, 10 X, times performance out of a strengths-based approach versus working on your blind spots or your, your growth areas. It doesn't mean we ignore them, but I'm not going to spend a lot of time and energy on those because the return on that time investment for the output and the impact isn't as great. Got it.

Speaker 1 (05:41):

How can, how do we go? How do you recommend people go about finding their strengths?

Speaker 2 (05:46):

Yes. So there are three ways you can do a reflection, big fan as a coach of journaling and reflection. So you reflect, what was your best day at work? What do your friends, your colleagues, praise you or acknowledge in your work day? Where do people ask you for help or advice or support? Great place to start. Then if you have any type of performance reviews or three 60 reviews, always a great place to go, to start to mind for those core strength themes. But my all-time favorite way to do it is to look at your task list in your calendar list and go through with a marker and highlight those tasks, those meetings, those calls, the podcast where you were on fire. I loved it. It was really good, strong outcome. And then you start to identify some of your core strengths that way.

Speaker 1 (06:42):

Let's say you are not an employee, but you're an entrepreneur. So do you give yourself performance reviews?

Speaker 2 (06:54):

Really? I've never been asked that question. I would say your performance reviews come from your clients. It would be, you know, that email that you get, or maybe you do a survey with your clients. You ask your clients for feedback. That would be your performance review. Got it, got it. And if you're an entrepreneur, that's where the calendar and task list analysis is super helpful for them. Because if you're not working in that formal structure of the yearly performance review, and as an entrepreneur, initially you have to do it all. And ultimately if I'm coaching you, I want you really working from your strengths and we want to start to figure out how do we automate or outsource those other items.

Speaker 1 (07:39):

Okay. All right. That makes sense. All right. So we've got recognition and reward, which I love and, you know, quick story on that, a friend of mine works for a publisher and she said so do you know what happened the other day? She said, I got this package in the mail and it was from the company. And it was just like some gourmet teas and a mug. And it, and it was a card that says, you know, so-and-so, you're just doing a great job and we appreciate all the work. And she was like, you know, some people need big bonuses. Some people she's like, this is what I needed. So she sort of recognized like my reward is, is just someone identifying, I'm doing a good job and writing a nice note and you know, she doesn't need like the grand fanfare. So I think it's really interesting when you said that it came to my mind and it got me thinking, what do I really like as, as reward and recognition? And I have to say, I sort of like the, just a nice email letter. Like I don't need to be on stage. I don't need it to be in front of a lot of people. And that is what really makes me feel good. Yes.

Speaker 2 (08:49):

Yeah. And how empowering, just to name and claim that, and then what you're going to want to do if you work for a manager is let them know how meaningful it is. And so for you, as you're as an entrepreneur and business owner, how do we create more opportunities for you Karen, to get those affirmations from me who I'm like, Oh my gosh, you know, I had this terrible injury and now I'm running again. And I just finished my first 5k. I mean, that's what we want in your inbox. Exactly.

Speaker 1 (09:24):

Yeah, exactly. Okay. So we've got recognition and reward. Strengths is number two, what's number three.

Speaker 2 (09:30):

This is all about relationships because none of us work in a silo. We all work on teams. And what's interesting is that social pain. So conflict feeling excluded from the group is processed in our brains the same way as physical pain, which is, was show interesting to me in my research. So having really authentic real relationships at work is essential. Not only for performance, but we're talking about being happy, fulfilled, and engaged. And if you don't feel like you've got a best friend or that you can talk to someone or work through conflict, which is part of business, that's a problem. So in this chapter, what we do in the book is we explore your work style, which is how you think and process information, because this is how you're going to work with other people and then identify their work style and learn to communicate with each other in a way that you aren't triggering each other and making each other one of, yeah, I'm not going to work with you and ultimately recognizing where you might be unconsciously undermining that relationship by treating everybody the same way.

Speaker 1 (10:43):

Yeah. That's so important. Yeah. I'm a huge fan of relationships. And I mean, I have stayed in jobs longer than I probably should have because I love the relationships. I was like, I don't want to leave. I love it here.

Speaker 2 (10:57):

Yes. And that that's exactly it, the people are important, right. And those relationships that is so important and we've got to do the work right. And that's why that this whole pillar is around cultivate, which requires some self-reflection, but really intentional, thoughtful work to build these relationships that bring us joy and really stretch us and help us grow. That's the fourth one is the development and it's the develop. We call it the five pillars or the five essentials. And the fourth one is to develop new skills. And this is about owning your own professional development, not waiting for your manager, not waiting for your team member to say, Hey, Karen, I think you might like this course. Or have you thought about this position? No, this is about what do I want, how do I want to grow? What's my next step. And being really about putting your own development plan together and then asking your manager to support you. So they might have an internal training program you can join, or maybe they would pay for the conference for you to continue to Uplevel your skills.

Speaker 1 (12:06):

Yeah. And you know, I think, again, that probably takes a little bit of identifying where, what gaps you might need to fill. So can you sort of, when you went and looked at your strengths and maybe you did find some weaknesses, is this where you would want to start developing those? Or would you take your strengths and continue to strengthen them? I guess, as an individual, you know,

Speaker 2 (12:33):

So I'm going to suggest that, and this is just my training and background. Let's further refund strengths because I know that the outcome of that is greater. And we also talk about a tool that I created. I call it an abilities opportunity map, where you start to look at the leadership competencies in your organization, certifications did you not get a position? The best person in your field does this? And we don't do it from a place of comparison or judgment. It's just an awareness. Ah, okay, this person has this skill set or this certification I don't just looking. And then once you build this abilities opportunity map, then you go and say, what do I really want to focus on? And how am I going to develop it?

Speaker 1 (13:26):

Yeah. That makes sense. And kind of looking at your organization and maybe looking at the organization and saying like, I could take, let's say from a physical therapy standpoint it's this great clinic, but while no one's doing pelvic health in this clinic. So perhaps I can develop my pelvic health skills to plug this hole, because like you said, we want to bring more to our employer so that they see us as, you know, boy, this person is a real asset to our company and then you're doing what you love to do. And then they'll continue to promote that. So it sort of circles around, right?

Speaker 2 (14:05):

It does because the framework and the thesis that I'm operating off of is that the relationship with your employer is a relationship. And any relationship is based on social exchange theory, which is give and take both parties, bring to the relationship and both parties receive. And in a relationship that's healthy, both parties work towards mutually beneficial goals. So developing a pelvic health program is exciting for you. You're passionate about women. This is a way to really expand your skillset, huge win for you, huge win for your clinic. It might not be the only clinic in the city that does this. So this is a beneficial win, more of what you want revenue for your company, your company is distinguishing itself. So that's where it's the employee has an equal and powerful voice in this relationship, right?

Speaker 1 (15:05):

Yeah. Okay. Makes sense. What's number five.

Speaker 2 (15:08):

The last one is design your work for more meaning. So this is where we talk about meaning purpose, joy.

Speaker 1 (15:19):

Hm.

Speaker 2 (15:20):

Point our point here is that meaning is not defined by what happens to you. It's your interpretation of the events in your life. So we go back to where we started with my premise at any job can be your dream job because you just, you define that dream. And I believe every job has significance. Every job is meaningful. It's up to you to figure out what that meaning is for you, and then start to craft and shape your work for more meaning. So let's say for example, Karen, for you, one thing that brings meaning and purpose to you is helping women that have been struggling for years within contents, so that it's damaged their self-esteem. Maybe they're not going out in public as much. And this is really important that you help these women. It feels like a passion calls for you and meaning, okay. So by developing the skillset for the pelvic therapy, and then you bring it to your company, we're creating meaning you're doing more of what you love and we're generating revenue for your company. The meaning is in the service to these women and how you were an agent of change in their life,

Speaker 1 (16:40):

Right? So the meaning goes beyond can go beyond just you and just your clinic or just your office or your job, but it can go into sort of the world as a whole, as a whole, which I think is what a lot of people hope that their job can do.

Speaker 2 (17:00):

Absolutely. And I would suggest every job does that. If you will just step back and look at it. So if we go back to I'm a runner and I'm always injured. And so physical therapists, you are my heroes because you need to doing what I love. And so just a big shout out because you keep me up, right? Cause I'm invariably always doing something and not stretching. So, but if you keep me running and I'm staying engaged and I'm healthy and I'm able to care for and keep up with my kids, like we're now talking about a ripple effect of positivity that you can draw meaning from, but you just gotta reframe because what happens, I'm guilty of this. Karen is that we get really caught up in the transactions of our day at 14 patients to see, Oh my God, have you seen my inbox? The paperwork sucks. Yes. I'm not saying that's not hard, but if we can come back and look at our task as a collective whole, that's where we can draw the meaning from.

Speaker 1 (18:08):

Yeah. And I'm so happy that you brought up the emails and the paperwork and, you know, cause everybody, I don't care what line of work you're in. You can relate to the emails, the paperwork, the meeting after meeting, after meeting patient, after patient, after patient. Right? So this can often lead, I think, for a lot of people to state of burnout. Right? So how can we use these five tools to help us avoid that? That what some people think is an inevitable burnout?

Speaker 2 (18:40):

So I'm an, a challenge. Inevitable is I don't believe anything is inevitable. I here to put quotes, air quotes. No, I'm just gonna push back. Cause I think we're aligned on that. I think we better they're like no enough, you know? So two ways, one, we double down on strengths. So when we are working from our strengths, the work is feels easier. There's less effort, but greater impact, more joy, more flow. So the more we identify connect that to how it helps our employer and really intentionally push ourselves to keep doing more of that work can help tremendously the other, Oh, there's two more things. The other thing is back to this meaning that we'll want to pull on. So even at the end of the darkest week of, I am beyond exhausted been doing this, you know, my student loan debt does not seem to be going anywhere.

Speaker 2 (19:40):

I'm chipping away at it. Can you pull back and find a little source of hope from the meeting? And then the third piece is the productivity. So where are you getting really thoughtful about? Let's take your inbox. I believe your inbox can be the best personal assistant you've ever had. The technology is powerful. We just don't use it. So why are we not automating our email management? So you can write rules, you can automatically schedule and send emails. We can create whole systems that filter what comes in. We can create templates. There's so much that can be done with not a lot of effort that can save you hours. So I think sometimes in the burnout we're like, Oh, it's going to take me energy and time to spend 10 minutes in my inbox, setting up that rule and two templates and

Speaker 1 (20:30):

Yeah, exactly. I'm like, ah, one more thing.

Speaker 2 (20:35):

And you're not saying no way. You're probably having an expletive in there. And I'd say, if you do this set a timer, 10 minutes, I'm going to set up one rule and write one automatic template because people ask me this question all the time. I just want to be able to use it over and over again, and then I'm done. But those two actions could potentially save you hours. So it's 10 minutes on productivity tools, looking for automation saying no to meetings that you don't need to attend because they're going to print everything they talked about and posted on the bulletin board. Or you're not even sure why you're there and there's no agenda. And it's just going to people rambling. Don't go say no.

Speaker 1 (21:23):

Yeah. I think that's a huge thing for people. And I've just really come to get better at the saying no thing. Of like when it's not like, when, if it's something that's not working for me, like I have to get better at saying no, because then I over-schedule myself and then I'm all stressed out.

Speaker 2 (21:44):

Right. And it's a self perpetuating hamster wheel. Right. Just keep on it. And the no is freedom. So one way to look at it is every time you say no to something, you're saying yes to something else. Right.

Speaker 1 (22:02):

So how do you, what's a gracious way to say no,

Speaker 2 (22:06):

At this point, I'm not able to take on any more projects with the level of attention and detail that I like to bring to projects. So thank you so much for thinking of me. Well, that's good. I like that. Yeah. Thank you for inviting me to your meeting on Friday. I can't attend. If there's anything that you would like for me to think about or reflect on in advance, please let me know. And I'll send you an email.

Speaker 1 (22:30):

Oh, that's nice too. Oh, very good. Very good. Hopefully people are taking notes on those. Yeah. That's really good. That's a nice way to say no, versus just saying, Oh, I'm sorry. I don't have the time.

Speaker 2 (22:44):

Right. And the other piece of the, no, I learned this the hard way and I'm sure your listeners have tucked up, but I live in the South. And so Dan said, we've got a little polite niceness culture going on. And part of a, no is not inviting the second email or you not busy now, Karen, how about now to meet for coffee? So we want to know that has a firm boundary that isn't going to get the creeping back.

Speaker 1 (23:14):

Yes. Yes. And that's hard. So, cause I know sometimes I'll say, Oh, you know, I'm, I'm really busy for the next couple of months, but why don't you check back later? No, no. Should not be doing that.

Speaker 2 (23:24):

No, no, no. And there's also an, I think there's tremendous value of going back to my first example of you value and respect that person you value and respect to the board, the project, the ask enough to say you aren't going to get the best of me. I can't, I can't bring you what you deserve, what this organization deserves. Thank you for thinking of me.

Speaker 1 (23:50):

Yeah. Kind of putting, putting them before you. Yes

Speaker 2 (23:53):

It's because ultimately I, I do believe we want to do our best work and when we're stretched so thin, it's just not possible. And then we began disappointing ourselves and others and that's not a cycle we want to be on either. So the door firmly don't get the creepy crawlies coming back, asking how about now? It's two months later. Where are you? No, I'm still not available.

Speaker 1 (24:17):

Yeah. No, that's so good. That's so good. Have a firm close to that door. Gosh, that's great. Yeah. I love that. Now is there anything else that you kind of want to add on here? That maybe we didn't cover on, on allowing people to really love their work and love their job?

Speaker 2 (24:39):

Yes, but I have to share, I'm going to give you one more productivity hack. Can I do that?

Speaker 1 (24:44):

Oh my God. I didn't want to, you can give me 10 more. I didn't want to keep asking on what, what about this one? Do you have three more that I want to give you? I can't help myself

Speaker 2 (24:57):

Then listeners bear with me. If you don't like this, just speed up just fast forward. Okay. So the first one was stack. So stack saying no is hard. So what I coach my clients on is let's create a template and email to say, no, these are the no templates, no, to be on the board. No, to do this project. So you think about it. You write the know and when you get that ask click.

Speaker 1 (25:25):

And so when you have a template, so do you mean you sort of just keep it in like a word doc and then copy paste into your email.

Speaker 2 (25:33):

So depending on your email platform, so I'll start with outlook and outlook. The best way to do this is to create multiple signatures. So an outlet, people think about a signatures. Haven't, you know, Karen and your phone number. Well, you can create as many, many signatures as you want. So you go in and create a signature that is gracious. No to project ask you type it, you save it. Then when I send an email, Karen I've gotten great new task force really wants you to be on you. Hit reply, insert gracious, no project signature. And in 30 seconds we've saved time. And we haven't gone through the angst of how do I say no? How do I let them down? How do I close the door? No, we do the thinking on the front end. And we just use this over and over again. So we're stacking two habits here and leveraging technology.

Speaker 1 (26:36):

Nice. Yeah. That's great.

Speaker 2 (26:39):

In g-mail you can set up templates too, as that function the same way and absolutely care. Nothing wrong with the word doc I'm copy and paste key is we write it once and you use it over and over again. We don't do the rework time. Copy paste, drop and go. Yeah, that's fabulous. The second one that is one of my favorite ones for healthcare workers is so your day is scheduled for you patient, patient, patient. And so what happens during the day is a lot of things that you could potentially do, like little tiny task or maybe call. I don't want to get your hair cut or whatever doesn't happen. And so you have all this buildup of tasks that now you're trying to do on the margins of your day. So I tell my healthcare providers build something called a 15 minute list, and this is a list that lives with you.

Speaker 2 (27:31):

So put it in your lab jacket as a piece of paper, put it on your phone. I don't care Magnasco and how you get it around, but it needs to be with you. And these are tasks you can do in 15 minutes or less. So schedule your cats, that checkup prep for the one-on-one with your team member, call and cancel call all of the little itsy-bitsy things that don't take a lot of time. And then what you do is when you have that patient, that's 10 minutes late, you pull out your list and you go because I can get these things done and these micro segments of our day. So it's a really efficient way to stay on top of the nits and NATS that can add up and feel overwhelming. Great. And then the third one that works well and healthcare and for everyone, but a love it from a healthcare providers is something we call protect your 90. So this is 90 minutes a day on your strategic priorities. So it could be professional development. It could be, you might be doing some research, writing a paper, it could be catching up on your charts, whatever it is. But the way it works is it's 90 minutes a day. That's focused now it's not 90 continuous minutes.

Speaker 3 (28:54):

That's what I was just going to ask. Yeah, no, I made only unicorns have that and without I haven't met a unicorn.

Speaker 2 (28:59):

Yep. So this is the power of it. So it might be 20 minutes that you choose during lunch to do your focus. Then you have another little 10 minute window where you might do another little sprint focus, but the goal is 90 minutes a day because the power and five work days, that's seven and a half hours of focus time. That is a game changer. I have had physicians write really complex research papers using this strategy because we're just chunking just yeah. Intention, intentional chunks focused, and then we go back, but it's the consecutive effort over time that up. And it doesn't feel overwhelming. I mean that versus saying I need seven and a half hours of your time.

Speaker 1 (29:47):

Yeah, no, that's great. Very good. Very good. I love it. Okay. So I feel like we've gone over so much but I'm loving the productivity, hacks and tips, and also loving your sort of five step template or plan to kind of love your job again. So is there anything else about that? And like I said, productivity hacks, we can go for days. People can go to your website and find more. But anything anything else on people loving their job and loving what they do? What would you like people to really remember about the chat

Speaker 2 (30:25):

Clarity creates opportunity. So doing the work to identify what your dream job looks like, how you want to be acknowledged and rewarded what your strengths are, the relationships you want to develop, the skills you want to grow in the meaning you bring, it opens up infinite possibilities for you in your current job. And I would suggest in future jobs, that knowledge is power.

Speaker 1 (30:55):

Yeah, that's great. And before we sort of sign off and find out where everyone can get in touch with you, I have one more question that I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to your younger self? Whether it be fresh at a college or what, you know, what advice would you give to yourself?

Speaker 2 (31:16):

Play more? I'm a type, a perfectionist recovering. Some days, some days I'm not recovering and I will get in that strive mode and I've done it since I was 18 years old and would go back and say, it's okay, play a little more. The work's going to be there. And what I've come to learn now is that in play, that's where you're going to find those brilliant insights and connections and the juice to not be burned out. So one reason we get burned out is because we don't play. We just work all the time.

Speaker 1 (31:52):

Yeah. That is great advice. And I have to say, I've heard that from a couple of people on this question is to just kind of like chill out a little bit more relaxed, a little more play a little bit more. So that is great advice. Now, Carson, where can people find you if they want more information about you and what you do and, and all of and yeah.

Speaker 2 (32:11):

And your book. Yeah. So the book own it, love it, make it work. All of your favorite retailers, Amazon is available online. And then my website, Carson, tate.com. Check out the blogs. If you want productivity hacks, they're there tips on loving your job. We've got assessments. All the goodies are on the website. Carson, tate.com. Awesome.

Speaker 1 (32:32):

And then for social media,

Speaker 2 (32:35):

Yes, LinkedIn, the Carson Tate. Awesome. Well, thank

Speaker 1 (32:40):

You Carson so much. This was great. I think you gave my listeners so much to work with, so I thank you so much.

Speaker 2 (32:47):

Thank you, Karen. I appreciate it. And thank you guys for all that you do for us.

Speaker 1 (32:52):

Thank you. Thank you. And everyone who's listening. Thanks so much. Have a great couple of days and stay healthy, wealthy and smart.

 

Nov 30, 2020

Episode Summary

Are you willing to experience anything?

In this episode, the Founder and CEO of MEG Business Management, Brian Gallagher, talks about the power of the intrapreneur and entrepreneur in private practice.

Brian graduated with a BSc in Physical Therapy from Daemen College in 1992. Soon after, he founded Gateway Health Services, which quickly became one of the largest staffing companies in Maryland. In 1999, he founded Cypress Creek Therapy, which was awarded the Anne Arundel County’s “Most Family Friendly Business” for several consecutive years, and in 2011, Advance Magazine awarded CCT as the “National Practice of the Year”. In 2006, Brian founded MEG Business Management and has grown to become among the top 10% of private practices across the US.

Today, we learn about the difference between an intrapreneur and an entrepreneur, the four types of PT owners, and Brian gives practice owners some advice on the interview process. He tells us why he sold his practice with a contingency, and how the current environment is ideal for entrepreneurs.

We get to hear about the 4 C’s, how we can become a successful Go-Getter Owner, and Brian gives his younger self some advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

Key Takeaways

 

•       “Typically, an intrapreneur is a manager within a company who assumes no financial risk, but they’re willing to promote and execute on the development and implementation of innovative products or services.”

“An entrepreneur is similar, but it’s one who will find the needs out there within the business community, and simply fill them by developing their own ideas into actualities, by assuming the full financial risk and development of that idea through a business model of their choice.”

•       “Your practice is a reflection of you as an owner. Figure out which type of owner you are first.”

•       “The secret to successful hiring so that you can be correct 85% of the time is that you have to get the entire team involved in the hiring process.”

•       There are 4 types of PT owners: The Innocent Owner, The Caregiver Owner, The Know-It-All Owner, and The Go-Getter Owner.

The innocent owner – the person that falls into ownership, and is managing based on census. They never really thought about being an owner; they just had an opportunity.

 

The caregiver owner – they assume the perspective of a clinician first and owner second. They tend to run their clinics like it’s a democracy.

The know-it-all owner – through their life’s experiences, they’re not open to new ideas.

The go-getter owner – they have an entrepreneurial spirit, they like to manage based on performance, and they’re in a continuous pursuit of knowledge.

•       “This is an entrepreneur heaven right now.”

•       “If we’re going to sit here and go through our profession, and continue to colour inside the lines and make our picture like everybody else’s, you’re only going to get that.”

•       “When you ask what the common denominator is to all success, the highest thing would be confidence.”

•       “Transparency breeds trust.”

•       “The secret to success is giving.”

“I hate a win-win relationship. A win-win relationship implies that I’m going to allow you to win as long as you help me win.”

•       “Don’t react; respond.”

Book Mention

The Go-Giver, by Bob Burg and John David Mann

Suggested Keywords

Intrapreneur, Entrepreneur, Owner, Courage, Capability, Commitment, Confidence, Success, Listen, Introspection,

To learn more, follow Brian at:

Email: info@megbusiness.com

Website

Facebook

Instagram                        

Twitter    

LinkedIn

YouTube

More about Brian: 

In 1997, Brian founded what became one of Maryland’s largest therapy staffing companies, while at the same time launching a multi-site private practice that resulted in a sale in 2006. Brian re-acquired the practice in 2008, thus doubling it, before winning “Practice of the Year” in 2011. MEG Business Management began in 2006 as an educational coaching company training owners and their key employees on innovative practice management strategies. Today MEG has taken another major leap forward by developing a Virtual Training platform that practice owners can now have the tools and training resources to professionally enhance, track and manage employee performance, and hold in compliance with every employee in the company. This platform is available 24/7, 365 days per year. When Brian is not coaching, or working on the VT training platform, he can be found giving lectures at the APTA, PPS and CSM Annual Conferences, as well as APTA State Chapters and DPT Schools across the country. Brian believes strongly in giving back to the profession of physical therapy and does so by supporting the APTA through lecturing, writing articles, and performing webinars.

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Read the transcript: 

Speaker 1 (00:01):

Hey, Brian, welcome to the podcast. I'm happy to have you on,

Speaker 2 (00:05):

Oh, thank you so much, Karen. Thanks for taking the time and hooking up with me and doing the show.

Speaker 1 (00:10):

Yeah, well, I'm actually really looking forward to the topic today because it's something that I've spoken about a lot and that I have friends of mine who are business owners and, and love to empower their employees. So today we're talking about the power of the intrepreneur and the entrepreneur in private practice. So before we get into it, can you define the difference between those two terms?

Speaker 2 (00:39):

Yeah. And there's lots of definitions out there. I think if we Google it or YouTube, it you're all gonna, you know, find various forms of definitions for this. But for me, and I've always operated under this basic definition that typically an intrepreneur is a manager within the company who assumes no financial risk, but they're willing to promote and execute on the development and implementation of innovative products or services. In our case, it would be services and they do that via marketing branding, or other various forms of public relations, but they're innovating within somebody else's company. And that's my definition, that's my operating definition of an entrepreneur.

Speaker 1 (01:19):

And so when you're, when you're thinking about an injury, an intrepreneur and it can be a person who takes the initiative to maybe start a new program and within a physical therapy practice or right, something like that,

Speaker 2 (01:41):

Something like that, it could be as basic. And as simple as that, where they've taken an idea, they've worked it through to a concept and then they've developed that concept into an actuality. So that's what I really see with an entrepreneur. I have certain characteristics that we look for, and I think we'll talk about a little bit later that will really give you the identifying markers of an entrepreneur and what you should seek in an entrepreneur within your clinic, because an entrepreneur is similar, but it's one who will find the needs out there within the business community, whatever the market is that they're in and simply fill them by developing their own ideas into actualities by assuming the full financial risk and development of that idea through a business model of their choice, through the development of their business operations. So innovating within your own company is more of that, of an entrepreneur, assuming that financial risk. And that's really the defining factors between the entrepreneur and entrepreneur.

Speaker 1 (02:37):

And so what does, what does it take for one to stand out as an entrepreneur? So if I'm the entrepreneur, I own the business. What am I looking for for this? For a standout entrepreneur? Okay.

Speaker 2 (02:52):

All right. Well, I have a good story for that. And just to give you an example of a, of an entrepreneur, you know, it was several years ago. I, my clinics are in Maryland and I live in Florida and so I had six offices in Maryland and I was running them from Florida and I had a team that I had built. And so I had a chief operating officer working for me. Her name is Denise, she's now the CEO of Meg. And she runs our whole billing division. But at the time she was running the clinics and our largest clinic, it's a, you know, a 8,000 square foot office. And I got to talking to her on one Monday morning and I was asking her about, you know actually I didn't do my normal, that, that's how it actually came up. I was talking to her Monday morning, I got right into business, which is unusual for me.

Speaker 2 (03:33):

I'm usually like, how was your weekend? And how's the kids what's going on, you know, fill me in and all right, let's get start. But I was in a rush and I just got right into it. And she just started spouting off the things I wanted to know and just hitting it. And then I caught myself and I said, you know what, Denise, I'm so sorry. I apologize. I didn't even mean to ask you about your weekend. You know, how's your weekend go. And to my surprise, she says, well, you know, the air conditioning unit kind of backed up and it flooded the whole place I had to bring in a fan system. And my husband, I lifted the carpets and we dried them all out and got them down. We didn't miss a beat. We were ready Monday morning when the, when the patients got in here.

Speaker 2 (04:05):

So we're all, you know, find a good, I'm like, Oh my gosh, I had no idea. Like she never called me. She never made that problem. My problem. And I remember getting off the phone and saying to myself, what a level of responsibility, you know, what a level of responsibility. And that's one of the key factors that I look for in an entrepreneur. Now, in this case, I'm not giving you that shining, you know, example of somebody who started a women's health program or a pediatric program. I mean, she's obviously had done that through her time with me, but just this personality characteristic of I'm going to own the responsibility of this situation or this individual or this environmental breakdown, because it is my level of responsibility. And that's somebody who is thinking beyond themselves. And that always stuck with me that she just took that being this on, if you will, of an entrepreneur, when in fact this isn't even her clinic and that's really the sign of a true entrepreneur.

Speaker 1 (05:00):

Yeah. So someone who's really willing to take the initiative and to kind of really think of the, it sounds like someone who's really going to think of that clinic as, as their own, and really have a stake in it. You know, a true sort of emotional stake in the clinic and a sense of pride in, in where they work and what they're doing

Speaker 2 (05:21):

Exactly. And they typically come to the table, you know, if you're hiring well, and you're building that management team around you, you're looking for the foundation, right? I mean, every bridge is only as good as the foundation. And the foundation that I'm always looking for is does this individual have the personality, characteristics of confront, right? Are they willing to say what needs to be said to whomever? They need to say it to now, of course you communicate in manners. You never go out manners, but you can't shy away. And we live in a culture. Now we're in an environment where nobody really wants to offend anybody. Nobody literally wants to tell anybody anything they don't want to hear. But in fact, if you're raising children and many of your listeners probably have children, you can't raise your kids and say yes to everything for a month.

Speaker 2 (06:02):

Yes. Chocolate cake for dinner. Yes. You can go to bed when you want. Yes. You can have candy in the grocery store line, I'll visit your house a month later. It'll be chaos. It'll be a nightmare. Right? So when we run our clinic, we have to have that level of discipline. And that means you have to have that quality of confront. I need to be willing to confront my staff, say what needs to be said, always within good manners. And that's when it comes down to the, the, the equation of communication, you know, how can I communicate in a manner that I can bring about understanding, right? Because after understanding comes agreement, and we're always striving for agreement, but you know, that's the final as the final marker. And then the, the last two building blocks of foundation, I think that really make an intrepreneur entrepreneur is accountability and responsibility.

Speaker 2 (06:43):

And the difference between those two in my mind is accountability is one who's who owns the obligation and willingness to be accountable for their own actions. But responsibility is like the example I gave of Denise, where she took full responsibility for the whole wellbeing of the clinic and everybody inside it. So just to summarize, I'm always looking for who has a high level of confront who can communicate and bring about duplication and understanding and the art of their communication and who can be accountable to their own actions as well as responsible to that of others as well as situations. So I'm always looking for that and if I don't have them, how can I grow me?

Speaker 1 (07:19):

And, you know, I love the fact that you're always looking for that. So what advice do you have for a practice owner who is interviewing people, you know, to come and work in their clinic? Cause it's, I think it's hard, let's say in one or two interviews to kind of get those for confrontation communication, you'll get countability responsibility. So what advice do you have for business owners in those first couple of interviews to hire someone to kind of get this, this type of intrepreneur, if that's what you're looking for in your clinic.

Speaker 2 (08:00):

Yeah. And if you're looking to get distance from your practice, if you're looking to get freedom and flexibility, that's typically what we're trying to hire. Right. So that's a great question. You're asking a fantastic question. I think my answer is going to surprise you. I don't think it's going to be the path that you may be expecting. I think what my advice would be based on my experience now, I've been in and out of 400 offices. I've been in every state in the United States, helping practice owners throughout the whole United States, except for four States. And in doing that, I've come to the conclusion that it has to start with you. It really has to start with us looking at ourselves in the mirror and asking ourselves, what kind of owner are we right. I mean, to some extent you're, you're you're and I like to use family analogies a lot.

Speaker 2 (08:38):

I don't know, maybe because I had a pediatric clinic and adult clinic. And so I always saw the dynamics there, but I think your family you know, performance, your children are somewhat of a reflection of you as parents, right? I think your practice is a reflection of you as an owner. So I think you really need to look at yourself. So my first bit of advice is look at yourself and kind of know what your own strengths and weaknesses are. You know, there are four kinds of owners out there, and I think we'll talk about that. So figure out which type of owner you are first, second, when it comes to the interviewing, which is kind of what you were leading to. It's a, it's a five stage hiring process, and I've been, I've been pushing this and teaching on this for, well over a decade.

Speaker 2 (09:17):

Now it's a five phase hiring process and the secret to successful hiring so that you can be correct. 85% of the time with every single candidate you're trying to hire is that you have to get the entire team involved in the hiring process. Your entire team know selectively, right? There's some key individuals, some individuals where you're like, Nope, that's not going to be a fit, right? But for the most part, you need to include everyone in your clinic, in that process. And let me just quickly summarize. So first and foremost, it starts off with phase one, the ad for the ad, you know, you're advertising for somebody you're trying to recruit somebody. Let's say you're looking for a therapist. Let's just pick what everyone's thinking about. Well, here's, here's, here's a tip. Always open your ad with a question, always open your, a question. When you start the ad with a question, it prompts the person to think and reflect on themselves and raises their curiosity.

Speaker 2 (10:06):

You know, here's an example. Let's say you were to say, you know, are you GM's next? You know, senior financial analyst. And then before you even get the next sentence, the person who read that for sense of like, I don't know, maybe I am, maybe I am qualified. Are you the next senior manual therapist who can work in an autonomous work environment? The therapist's coming? I don't know. Maybe I am. So it gets their interest in. So the ad really has to stimulate their interest and then step two, they have to reach in for a phone call, phone screen. Now the phone screen, here's the, here's the death to any interview process. Don't talk about you. Don't talk about the clinic. Don't get into that. Don't sell your clinic. Don't sell yourself. Look, you have to, this is dating one Oh one. You have to be more interested than interesting.

Speaker 2 (10:47):

Now what happens here is once you're demonstrating your higher level of interest, their comfort level goes way up when their comfort level goes way up, their natural persona, their natural personality is going to be there. And that's what you're really striving for in the interview process. You know, phase three, they come into the clinic, they meet the front desk. They, they introduce themselves, give them the application, they fill it out, then let some other member of your team, give them a tour of the clinic. It shows that you're so confident in your staff. You're so confident what you built, that you can leave that potential applicant alone with another staff therapist who can just give up five minutes who are, and now that candidates going to ask, you know, the popular questions you know, how, how do you like the way they run the schedule here, right?

Speaker 2 (11:28):

That's always a difficult question in, in, in hiring or what do you think of the EMR system, right? Encourage that, encourage that outflow and encourage that dialogue with another individual. And then of course you bring them into the interview process. And then finally, you're going to wrap it up and potentially offer them a position, but you have to ask the questions that are getting them to reflect on themselves. And I'll, I'll end with this in the interview and this one of my favorite questions, you know tell me about a time when you last help someone. You know, it's really interesting when people go blank and they pause, you know, I don't want to hear about work. I want to hear about like, when you genuinely tried to help someone, it tells me a lot about the person and how they live their life, because I think striving to serve others and adding more value to other people around us is what's fulfilling. And so I'm really looking for that when I'm hiring. I know I can make somebody a better therapist. I can't always make them a better person.

Speaker 1 (12:19):

Very true. Very true. And thank you so much for outlining that interview process. And hopefully that gives a lot of the entrepreneurs listening, a better idea of maybe how they can do that on their own and kind of make it their own. Now, before we went into that, you said there are four types of PT owners. So let's go back to that. And I want you to let, let, let, let us know what are those four types of PT owners.

Speaker 2 (12:43):

Okay, good. Now this is just based on experience, you know, for the thousands of engagements I've had going all the way back to, you know, I started the business in 2006, but I've been a physical therapist since 92. And so what I see out there and what I've been able to categorize is four types of owners. The first one is the innocent owner. All right. And I think we've all met that person. This is the person who falls into ownership and, you know, they're, they're, they're managing based on census, right? They're like a poll taker, you know? But they're always open to help. They're always willing to get help. They're always willing to seek some advice and some help, but they're the type of person like, yeah, I was in this clinic and the owner just decided to retire and they didn't really want to move on with it.

Speaker 2 (13:25):

They didn't want to get out on the market. You know, they told me a hundred thousand, I could just buy it out. And so, you know, it's less than a Tesla. So I bought the clinic. Right. So, you know, that kind of owner who never really thought about being an owner or whatnot, but they just had an opportunity and they just jumped out and they did it. They didn't give it much thought and then they quickly find out, wow, there's a lot more to this than just treating patients and being great therapist. Right. similar to that owner, you, you run into the caregiver owner and I, I run into this a lot, especially out in the Pacific, on the, on the West coast. You know, Karen you're on the East coast, I'm on the East coast. The average collections per visit in the U S is like 83 to $85 a visit.

Speaker 2 (13:58):

But if you get up in that New Jersey, New York area, you know, it's not happened. And I have clients and stereotypes. Yeah, exactly. It's such a, Oh my gosh, $68 a visit $73 a visit. But if I'm over in Portland, Oregon, 125, $127 a visit. So you get some of these owners that are in these very high reimbursed environments predominantly. And they're what I call the caregiver owner right there, that caregiver. And they go into practice. And they're the one who assumes the perspective of a clinician first, an owner second. And they can be a bit of a martyr. Right. And they tend to run their clinics like, like a democracy, like it's a vote like everybody has equal say, right? And so these are the people that, that call me and, you know, come to find out, they're paying themselves, you know, 45, 55,000. And they've got, you know, therapists two, three years out of school making 85,000, you know?

Speaker 2 (14:52):

And so, but they're always, they're always justifying well, will we put our patients first? And it's all about the patients. And I'm like, so is that to assume that the other 30,000 private practices in the us are not doing that? I mean, really let's, let's just keep this in balance, right? So you really have to, you know, my success with them is I really have to coach them that the minute you open up your clinic, your senior responsibilities to your, your flock, you know, to all the people coming into your clinic, you own that responsibility. You have to be an owner first and clinician second. And then one of the most frustrating owners, number three is the, know it all owner, right? This is the owner has been around a while. They've had some wins, they've had some losses and through their life's experience, they're not really open to a lot of ideas.

Speaker 2 (15:34):

They're not really very open-minded. They got off fixed ideas. They're a little resistant to change. And here they are like, you know, reaching out to us, Hey, Brian, how do you do your social media marketing? Or how do you do your hiring process or what's your, you know pay for performance model and you start going into it and they start, boy, I know that, or I do that, or I don't do that. Or that, you know, this, this know it all kind of thing. Well, you're only going to be as good as you're willing to open up and willing to look at new thoughts and ideas. If you're not willing to look, you're not gonna learn anything. So that's a real shutdown right there. And that's really hard to, to get past that the suite owner, the one that I go for every day, I'm striving for.

Speaker 2 (16:10):

I love it's usually my startups that I've run into that are the go getter owners. These are the ones that, you know, they have an entrepreneurial spirit. They like to manage based on performance. And they're in a continuous pursuit of knowledge. You know, they're just continuing to pursue their knowledge. You know, I always tell people I'm 52. I want to be a better 53 year old. And I was a 52 year old. The only way I know how to do that is listen to podcasts like yours, read books, do audible. I mean, there are so many great people that are adding value to people's lives. You just have to go and get it. You have to take it in. So that go getter that go get her owner. That's the one, that's what we're trying to move everybody into that bucket.

Speaker 1 (16:47):

Okay. So how do we do that? So we're ending 2020. It's been a hell of a year. A lot of unpredictability moving into 2021. I think it's safe to say we're still there still a lot of predictability. So how do we, how do we become that go getter? How do we become successful as that go getter?

Speaker 2 (17:11):

All right. So I was listening to Gary V earlier today, I was watching one of his interviews and he was talking about this exact moment in time. And he said something that I just could not agree with. More, just could not be more in agreement. And I know it's probably going to shock everybody when I say it, but this is an entrepreneur heaven right now. This moment in time, this period in our life and our society in our profession is an entrepreneur. Have it? I mean, this is a 89 degree swimming pool. This is perfect time for you to jump in. And I see it in my business. I mean, we're having our record year. This is our most, most expansive year, yet on record going all the way back to 2006. And I think it's because if you really think about the true essence of an entrepreneur, an entrepreneur like you, Karen like myself, and so many others that we meet, I mean, look, you and I were talking earlier about your practice.

Speaker 2 (18:06):

You have a mobile PT practice. You're doing tele-health, you're willing to color outside the lines. You've always been willing to color outside the lines. If we're going to sit here and go through our profession and continue to call her inside the lines and make every picture like everybody, else's, you're only going to get that. That's all you have available to you, but if you're an entrepreneur and you're a willing to experience anything, and that you got to think about those words, I have to be willing to experience anything. When I sold my practice the first time. So my practice, the first time, two years later, it's tanked the people. I sold it to tanked it. They stopped making their note payment to me. I had a clause in my agreement that if you stop making the no payment, I come back and I buy the clinic back for a dollar.

Speaker 2 (18:48):

I bought the clinic back for a dollar. I bought this product for a dollar. Yup. I was 30 years old, two years later, they tanked it, bought the clinic back for a dollar. I got rid of all of the offices. I kept two. I lost half of the staff. And my wife says, you know what, honey, you can go up there and rescue that clinic. But I am not going to live here in this house in Florida with these two little girls all by myself. That is not what I bargained for. So you can go away for two weeks at a time, but you have to come home for at least three to four days. And then you can go back. And I said, I promise that's what I'll do. I ended up doing that back and forth, back and forth. I turned that clinic around two years after I took that back.

Speaker 2 (19:24):

It became practice of the year practice a year. Why? Because I was willing to experience anything. It had vendors that I owed $150,000 to, it had taxes that hadn't been paid for a year. It was in a middle of a Medicare audit where the patient was seen 141 times a Medicare patient, 141 times. And when Medicare audited them, they failed the audit a hundred percent. I'm like, you didn't even sign your name. Right? And so then I come in and I take it over. And I, I said, I sat on the phone for four hours to finally get to the person whose desk that was running. The Medicare audit, who advanced the R we are an advanced documentation, right? Who are notes were being mailed to mailed to this person in Alabama who was reviewing the notes. Right? And so we found who person was.

Speaker 2 (20:18):

And I said, I'm going to talk to you every single week. I'm getting off this ADR as quick as possible. She says to me, and this really funny Southern accent, and she's like, I've never seen anybody get off an ADR in six months or less. It's going to be at least that, you know, they only pay you one third of your Medicare dollars. I got off that advanced documentation review that Medicare I got off in three months, I was a hundred percent success in three months. And she, she caught us off, but that was me being willing to experience anything in pursuing the knowledge that leads to greater. And that's all that was Karen was, I didn't know anything about that. I didn't know how, what it took to get off an advanced documentation review. I didn't know how I was going to pay those vendors back or rebuild a whole operation with half the staff, but I did what needed to be done.

Speaker 2 (21:00):

And that is what I think really makes an effective leader. Who's really going to be that go getter owner. And the last two P the last three things about that is I'll say I was listening to a audible book by Dean Graziosi. You know, he was mentored by Tony Robbins and he talks about the four CS courage commitment capabilities that naturally grow confidence. I think every successful person who's in this space, who's, who's in this entrepreneurial space business space. When you ask, what is the, what is the one ingredient that is the common denominator to all success? I think they'll all say if you took a tally, the highest thing off the chart would be confidence. It takes confidence, but you're not going to competence. If you don't have courage, like I had to go back and rescue that clinic. If you're not going to be committed to it, like I was going to go the distance, no matter what, if you're not going to have the ability to go to podcasts, read books, go to courses, go to seminars, invest in yourself and get the capabilities to actually do it. I ended up you know, took that clinic back, made it practice the year, two years after I took it back, I took it back in 2009 and it was practiced a year in 2011. So I like to pull from those natural experience. I like to pull from those and share them with everybody. I mean, that's, that's wild. It was a rollercoaster.

Speaker 1 (22:19):

And now, so when you, I have to, I have so many questions. So now when you sold this practice, so you sold it with the contingencies. So you didn't just sell it and be like, okay, I'm selling this and I'm outta here. So why did you not do it that way? Because I think that's an interesting question to ask for people who may be, might be in similar situations.

Speaker 2 (22:40):

Absolutely. I do a lot of mergers and acquisitions and sales. I have three owners right now that I'm working with helping get them, getting them connected to selling their practice and connecting the right people. So at that time, I had spent $115,000 between three different consulting firms and training firms to really train up my management team, train up myself. And that's what I did. And so I invested that money 115,000 to hook a home equity line out of my house. Now you're going to find like, I'm not your typical speaker. You know, when I do my podcast and I'm on other people's podcasts, I believe this Karen, I, and I hope you don't mind. I believe a hundred percent of my DNA that transparency, breeds trust transplants. So I'm willing to just like wear it on my sleeve no matter where it goes. So what happened?

Speaker 2 (23:26):

I manned up this management team. I invested 115,000 into this group. I got back to 2005, 2006, I'm working 15 hours a week. I'm making like $45,000 a month. I'm a thousand miles away living in Florida. I'm living the dream. I'm living the dream. I'm like, okay, I'm going to devote the rest of my life to showing other pet owners how you could be a remote owner and make this happen. A year of that goes by. I get a phone call my management team, the leader up there says, Hey, we want to buy your practice. So I said, all right, let me talk to my wife, Lisa, and I'll get back to you. So I tell my wife, I was like, absolutely not. Why in the world, I am not, we we've worked our whole lives to get to this point. This is, I am not. I said, Lisa, let's think this through. If I call them back and say, we're not interested. What's their next action.

Speaker 1 (24:15):

Find someone else to buy it. They're going to leave. Oh,

Speaker 2 (24:19):

Because they're thinking, well, wait a minute, I'm running this, this $4 million operation, $6 million operation at, why would I stay here? If I don't get a piece that I'm, I'm going to go. So I literally flew up. I wrote on a napkin at dinner, I wrote $6 million. They said, we can buy that. We're going to give you a third up front and we're going to give you no payments on the rest. And I'm like, well, I love these guys. Right? I built them. I groomed them. I put them in a position. I want to see them win. Right. Done deal. Now the nice thing about doing it that way is I already have the skills and knowledge to know how to run the business. So what's my risk. My risk is exactly what happened. They tanked and they crashed it, but I have the skills and knowledge and ability to go back and rescue it.

Speaker 2 (25:00):

Right? So that was the, that was the risk that I had to be willing to accept. What's the upside. Well, two thirds and a note I'm making, you know, fi was a 6% interest on that money. So I'm getting well over my asking price over the course of the time that I'm making, making the payments. It also gives me this guaranteed income, which I made for the two years. And I could go do other things with it. Right. So it was a really good win-win, but the nightmare happened. They defaulted. I had to step in, I had to do. And that goes back to my, you know, my four CS courage commitment capabilities. I had the ability to, I knew myself well enough to go do that. So of course that's what ended up happening. But in 2017 I sold it all again. So it's kind of like in the big scheme of things, it really worked out. But in 2017 I won and done, you know, here's the keys. Thank you. Here's the check. I love it. One and done. So it was a different, it was a different, so I've, I've lived through both experiences. I've lived through both of those opportunities. And that's how it went.

Speaker 1 (25:57):

Yeah. Wow. So I think it's great for people to hear that there are different ways to even sell a practice and, and that it really behooves someone who is in that position to find someone, to help them guide, guide them through that.

Speaker 2 (26:13):

Right. Absolutely. You know, even tiger woods has a coach, right. And he's the best golfer at the time. You know, Tom Brady has a quarterback coach. I think every practice owner needs a coach when you're running the practice. And especially when it comes time to sell your practice. You know, I paid somebody $5,000 just to be a sounding board for me when I sold my practice. Like, because it's an emotional rollercoaster. I said, I don't really need you to do anything. I just need you to pick up the phone when I call, I just need to bounce ideas off of you. And just tell me I'm crazy or tell me I'm being too emotional or tell me. And I just needed somebody to consult with. You know, I just needed a little counselor to help keep me on track. And, and that, that was well worth the $5,000 for me to, to move it on through, you know, I kind of despise the idea of people brokering these deals and taking 6% of somebody's livelihood that they built their whole business for 15 years for like a four month transition.

Speaker 2 (27:01):

I like to just coach people through the sale. I like to help coach them through it, just pay for the time don't pay a percentage of business, but that's me, that's just my opinion on it. You know? I mean, how many of us have sold a house in real estate? And the realtor, you know, blows in and sells a house in 60 days, blows out and walks away with 50 grand. I'm like, I don't care how many website things you did. There's no way I can justify that 50,000, but that's the market. Right. That's how that industry works.

Speaker 1 (27:24):

Right, right. Wow. That's a great story. Thanks for sharing that. And now, before we start to wrap things up what would you like the listeners to take away from what we just spoke about? What are your key discussion points? Well,

Speaker 2 (27:44):

I'll start with what is one of my most favorite books, and if you're going to start there, I think you, if you, if you get this book and you'll listen to it on audible, or you read it, it's, it's the Go-Giver by Bob Burg and John David Mann, that book completely changed my life. And what I got from that book was I got this, that the secret to success is actually giving the secret to success is giving all successful. People will keep their focus on what they're giving and that's what actually gives them their success. You know, I grew up on welfare, you know, my mom raised three boys on her own, you know, government, cheese, bread, butter, food stamps, the whole nine yards, no car. And, you know, I was always of this mentality. Like once I get successful, I'm going to give back. Once I get all my, you know, shelter and security and this and that, I'm going to give back.

Speaker 2 (28:37):

And along this journey, I realized that was completely false. That was completely false, like right here on my computer. I'm talking to you right now on zoom. And I'll just rip off this post-it note and just put it right in front of your camera. I mean, that is what I look at every single day. And it says strive to serve, strive, to serve. And I realized the more I embrace that philosophy of it's about giving more in value than you ever expect in return. I hate a win-win relationship, a win-win relationship implies. I'm going to allow you to win as long as you help me win. I want to see you win in spite of whether I'm winning or not. And I think once I really grasp that, and for those of you with are listening, the more you can focus on surrounding yourself in improving the lives, both personally and professionally of the people you work with. I think that gift of giving is going to pay off tenfold to your community, to your patients, to your employees, to your family and to yourself. That's what I, that's my message on that. That, that's what I've learned. It's been a long haul. It's been a lot of ups and downs, but I'm, I'm convinced that that is what has led to my success and the success of so many other people I've worked with. I've been blessed to work with over my lifetime.

Speaker 1 (29:49):

That's awesome. And now I feel like I'm going to ask you the question I ask everyone, and, but maybe you just answered it. I don't know, but looking at where you are in your life and in your career, what advice would you give to your younger self? Let's say right out of, you know, right out of college.

Speaker 2 (30:07):

Oh my gosh. Right out of college. Well, I think the advice I would give my younger self is to be more introspective, you know, be, be a better listener, you know? Don't, don't be so full of your own fixed ideas, you know, be willing to be willing to step down off of that and, and embrace the ideas of others, no matter how foreign they may be to you. So I've looked at it like that. I think that's really changed my perspective over the, over this, especially this last decade, but I've learned to not think of my thoughts. First. I've learned to focus on what's being said to me first and literally take it in, duplicate it to its fullest. Meaning before I communicate back and I'll leave this one phrase and this rattles through my head all the time, whenever I'm in a situation, I'm always reminding myself, don't react, respond, don't react, respond. And so many wild things are happening in our society today. And I think a lot of people respond, respond, respond, and I tend to sit back and take it in a little bit more. And I like to give an approach. I mean, react, react, react. I like to give an appropriate response rather than just be so reactive. So I think that's really changed a lot about me. And that's, that's about all I can say about that.

Speaker 1 (31:38):

Yeah. That's great advice. I mean, great advice. I love the respond, not react and guilty, guilty here of, of reacting maybe too much when I need to just sit back and respond. So it's something I'm going to remember now, where can people find you? If they have questions they want to get in touch with you, they want to learn more about you, the business, all that stuff.

Speaker 2 (32:00):

Oh, great. Well, they can reach out to us. You know, we're on Facebook at Meg business management, you know, that's our handle there and you can follow us on Twitter at Meg business or Instagram at Meg business management as well. Our website is www.megbusiness.com. One of the things we really like to do is we like to, like I said, give and without, so we give free practice assessments. We give free practice stress tests. So if they want to reach in, you know, they can email us@infoatmegbusiness.com, for sure. And for your listeners, you know, special for your listeners for this year, you know, until we hit 20, 21, any service they want to do with us any training they want to do with us, they get a 10% discount. We'll just take 10% off anything they want to do. And that's just for your listeners. Karen, all they have to do is reach into us and say, they heard us on this podcast and my team will just go ahead and honor that anything we can do to add value, I'm happy to do it.

Speaker 1 (32:51):

Awesome. And just so everyone out there listening, of course, we will have all of the links to this one, click away at the podcast website at podcast at healthy, wealthy, smart.com. So if you didn't take everything down, don't worry about it. It's will all be in the resources section under this episode. So Brian, thank you so much for coming on. This was this was wonderful. A lot of great advice, especially as we're winding up the year and kind of moving into 2021. I think this is the perfect info for all of those physical therapy, business owners and entrepreneurs, and intrepreneurs out there. So thank you so much. You're welcome.

Speaker 2 (33:30):

You're welcome. You know, I think we should look into next year and everybody should have a handle on the bottom of their email. I know when my email signature goes out, it always says, expect to do well. And that's one of the things I like to get people just wake out of bed, wake up out of bed, start every day, expecting to do well.

Speaker 1 (33:46):

Awesome. I love it. I may, I may add that as a little sticky note on my refrigerator in the morning. I'll frame it. I love it. Thank you so much for coming on and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

 

 

Nov 23, 2020

On this episode of the Healthy, Wealthy & Smart Podcast, I welcome Dr. Theresa Marko, PT, DPT, OCS, to talk about advocacy efforts in physical therapy. DR. Marko is a Board-Certified Orthopaedic physical therapist & Certified Early Intervention Specialist with over 20 years of experience. She is the owner of Marko Physical Therapy, a private practice in New York City, specializing in orthopedics, adolescents, and pediatrics.

In this episode, we discuss:

-Her path to advocacy

-Federal Bills that are important RIGHT NOW: 9% Cut, Telehealth permanence, Student loan Debt

-State vs. Federal Advocacy 

-Traditional Advocacy vs Armchair Advocacy

-Key Contact: APTA & PPS

-Social Media importance: AMPLIFY, Access, Recognizable, Find others

Resources:

Dr. Marko on Twitter

Dr. Marko on Instagram

Dr. Marko on Facebook

Dr. Marko on LinkedIn

Advocacy is not a Spectator Sport

A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. 

More about Dr. Theresa Marko: 

Dr. Theresa Marko, PT, DPT, MS is a Board-Certified Orthopaedic physical therapist & Certified Early Intervention Specialist with over 20 years of experience. She is the owner of Marko Physical Therapy, a private practice in New York City, specializing in orthopedics, adolescents, and pediatrics. She has helped thousands of people to overcome injuries, optimize their movement, and return them to work and sports pain free and better than ever.

When she is not caring for patients, Dr. Marko can be found in legislative offices in Washington, D.C. or Albany, New York. She is passionate about making a change in healthcare and has made advocacy a cornerstone of her practice. For over five years, and hundreds of hours, she has lobbied on behalf of her patients and her profession on topics such as repealing the Medicare cap, reducing student loan debt burden, and lowering copays. She forms public policy priorities as part of the American Physical Therapy Association’s Public Policy & Advocacy Committee, the advisory council for the board of directors of the association. In 2020, she was awarded the prestigious Doreen Frank Legislative Award, given to only one person a year, by the New York Physical Therapy Association for her outstanding advocacy work.

Dr. Marko’s expertise is featured in The Wall Street Journal, PopSugar Fitness, Self, Cosmopolitan, Muscle and Fitness, Business Insider, LiveStrong, and Healthline. She has spoken at Columbia University, Duke University, & Touro College about patient and physical therapy advocacy. She was recently appointed to the editorial board of SpineUniverse as the first and only physical therapist on the board. 

She lives in Brooklyn, NY, with her husband of 13 years and her French Bulldog, Rondo.  

Read the Full Transcript below:

Speaker 1 (00:07):

Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only, and should not be used as personalized medical advice. And now here's your host, dr. Karen Litzy podcast. I'm your host today's episode

Speaker 2 (00:40):

Is brought to you by net health. So net health has created the reduct patient portal, which provides a secure line of communication between you and your patients. You can use it for video conferencing for tele-health for secure messaging, to respond to non urgent questions from patients. You can share documents and photos, and your patients have 24 seven secure on demand access to their therapy, health information without phone calls and voice messages. If you want to learn more about the Redarc patient portal, contact them at redox that's R E D O c@nethealth.com. Now on to today's episode, we're going to be talking all about advocacy for the profession of physical therapy. And I couldn't think of a better person to have as my guest to talk about advocacy. Then the 2020 Doreen Frank legislative award winner, which is given to only one person a year by the New York physical therapy association for outstanding work in advocacy, dr.

Speaker 2 (01:44):

Theresa Marco, she's a board certified orthopedic physical therapist and certified early intervention specialist with over 20 years of experience. She's the owner of Marco physical therapy, a private practice in New York city, specializing in orthopedics, adolescents, and pediatrics. She has helped thousands of people to overcome injuries, optimize their movement and return them to work in sport pain-free and better than ever when she's not caring for patients. Dr. Marco can be found in the legislative offices in Washington, DC or Albany for over five years and hundreds of hours. She has lobbied on behalf of her patients and the profession on topics such as repealing the Medicare cap, reducing student loan, debt burden, and lowering copays. She forms public policy priorities as part of the AP TA's public policy and advocacy committee. The advisory council for the board of directors, her expertise has been featured in the wall street journal, PopSugar fitness, self Cosmo, muscle, and fitness business, insider live strong and health line.

Speaker 2 (02:45):

She has spoken at Columbia university, Duke university and Touro college, and she was recently appointed to the editorial board of spine universe as the first and only physical therapist on the board. So what are we talk about? So today we're talking about her path to advocacy and how you can get involved and why advocacy is so important. The federal bills that are important right now, which includes a 9% cut to Medicare, very important, call your legislator, tell them not to do that. The difference between state and federal advocacy, how to find your legislators and find out what Theresa calls, armchair advocacy, what key contacts are, social media around advocacy. And so, so much more. So this is a great episode. If you are at all, considering getting involved in advocacy efforts, then you're going to want to listen to this whole thing. Theresa gives a lot of really easy ways to get involved. So thanks to Theresa and everyone enjoy,

Speaker 3 (03:49):

Hey, Theresa, welcome to the podcast. I'm happy to have you on. Thanks for having me, Karen. Yeah, absolutely. And today we're going to be talking all about advocacy. This is one of your specialties. So you've been involved in advocacy around the American physical therapy association for the profession of physical therapy. For many years, you're a mentor to many up sort of younger physical therapists and physical therapists. Who've been around for a while, but are just new to advocacy. So why don't you give the listeners a little bit more about why this is one of your passions? Sure. So I didn't start out on this path and this is not something that I thought I would be involved in. There's two main events that kind of propelled me towards this. And, you know, the first is I've been a physical therapist now for about 20 years.

Speaker 3 (04:43):

So I'm older than I look. And what happened was I started to get some hip and back pain that was pretty substantial, you know, MRIs. They wanted me to get an injection. We were talking about surgery and unfortunately the things that I had done to try to rehab myself, didn't get me that much better, but I found dry needling. And I found a physical therapist who became an acupuncturist. Bianca bell, Deni leveraged a death, and she's a master at dry needling. And I loved what she did. And basically, you know, I had a severe spasm in my opterator internist that was killing me and my hip flexor and they were fighting. So I loved the needles. They made such an impact in my life. I can now walk around and not feel that pain in my hip and going down my leg every day.

Speaker 3 (05:28):

And I wanted to use the needles because I loved them so much, but we can't use them in New York. Why? Because it's the law. So that made me upset and I wanted to change the law. And I was really interested in that and why dry needling was such a, you know, variation from state to state, but it's a state law. So that was something I found out then kind of soon after that, or during that time, I also decided to go back and get my transitional DPT. And I took a professional development course. They talked a lot about advocacy and it just dawned on me. And I had an aha moment that basically all the things that I didn't like, the Medicare plan of care, the authorization, the way that you get like six visits than four visits than three visits, you get kicked off with some insurances.

Speaker 3 (06:14):

These things that I had been practicing inside the system for so long that I found so frustrating and so annoying, I realized where because of the law and that they could be changed. And I just decided that one day after taking that class, that it was going to be my mission to try to change these laws, to make the profession better for me, for those generations coming after me for our patients and basically for everyone. And it also dawned on me that legislators in general really don't know what we do. And if no one tells them, they won't know, and they won't make the laws in our favor that will help us our profession and our patients. So, you know, whether anyone likes it or not, we all have to operate in quote unquote, the system. And, you know, that's the government, the democracy, the bureaucracy, the politics. And in order to change that you have to be involved in advocacy. So that's, that's my why. And the other thing that I'd like to add is, you know, what's the alternative to not say anything, to stand by yourself, to get swallowed up by another profession that has a bigger association and a bigger lobby who would be our voice. So if not you then who I love,

Speaker 4 (07:28):

I love it. And I think that's a great reason to become an advocate for the profession. And so often, even when I ask people, why did you get into physical therapy? It's always, you know, you have these aha moments. You have these times in your life where you're like, well, this isn't right. And, and as you dig deeper, you think, Oh, there's actually something I can do about it. I can use my voice. I can speak to my local legislators. I can speak to my, my national or federal legislators. And so let's talk about that. So you've got each state has a state government, and then we obviously have our federal government. So how, as a, as a physical therapist, like, what's the difference? How do we, how do we advocate to each of these groups?

Speaker 3 (08:21):

So when I had to made that decision, that I wanted to become an involved in advocacy, it was tough to figure out at first. And that's one of my other passions is trying to help other people figure out the path because the path is not easy. And these things are very frustrating and confusing. So some things are, remember that. I get asked a lot of questions about art to remember that we have state government and we have federal government. And some of these laws are state laws. And some of these are federal laws. So when you look on the AP TA's website, under advocacy, apa.org, backslash advocacy, it'll show you the federal bills and the things that we're, you know, constantly fighting for now. And then if you go to your state chapter and they should have hopefully an advocacy page on there, on their website, it'll show you the state laws. So dry needling, as I mentioned before, is a state law. Whereas something like making tele-health permanent for the entire country, that's a federal law. So that's kind of, you know, you need to know the difference in like what you want to fight for. Do you want to fight at a federal level? Do you want to fight a state level or do you want to fight it? Both me personally, I think they're intertwined. So I go for both

Speaker 4 (09:33):

And there, but there are some laws that are very specific to the state, right?

Speaker 3 (09:40):

Yes. Like direct access. So that's another one, right? So direct access is super important in the state that you and I live in New York, we have a direct access that allows us 10 visits or 30 days, whichever comes first. So currently on the New York physical therapy associations agenda, we are trying to fight for unrestricted direct access. And that means you don't need a physician's prescription to go see a physical therapist. And again, when we talk about, you know, legislators don't know what we do, patients also don't know what we do. And I found that out and that's become another passion of mine is to get the word out and let society as a whole know what we do. And I repeat myself over and over. No, you don't need the prescription to go see a physical therapist, look up the direct access law in your state, all States now all 50, have some form of direct access. Some are a little bit better than others. But like, I think Texas, right now, you can only go see an evaluation and then you have to get a prescription, but that is a state law. And that does vary from state to state.

Speaker 4 (10:40):

Right? So if you are interested in advocacy, I think the bottom line between state and federal is know what your state is fighting for, and then know what, what the, what you're fighting for at the federal level, which brings me to my next question. And that is what are the federal bills that are important right now, as we speak today is Monday, November 2nd. What is important right now? And FYI, as we all know, tomorrow is tomorrow is election day. But that being said, what are the bills that the AP TA is fighting for right now on the federal level?

Speaker 3 (11:23):

So there are so many bills, but the two, you know, cream of the crop right now are going to be reversing the 9% cut that CMS centers for Medicare services has instilled upon the profession that will start January 1st, 2021. And the reason why this is so important. So this is federal okay. If CMS decides to cut Medicare recipients, 9%, that for some businesses is going to be, make or break, even with the pandemic loss revenue and everything, they might have to close their doors. They might have to stop taking Medicare patients. Medicare patients will have less access, there'll be less clinics. So that's, that's one aspect of it. But here comes the second aspect, you know, of the trickle down possibilities, whatever Medicare does is generally the precedent for what all the other insurances do as well. So the other insurance will probably start to follow suit and there you have cutting reimbursement to our profession.

Speaker 3 (12:20):

Again, more businesses closing all patients, having less places to go, less availability, less access through my years of advocacy, one of the phrases that I've come to realize is barriers to care, you know, access to care. There are all these stumbling blocks that make it hard for people to get the services that they need, you know, instead of seeing physical therapy, because it's difficult, you have to get a prescription or you don't only have, you know, six visits. It is easier to go see a physician and get an opioid prescription, things like that. So certain things drive it. So advocacy is intertwined with all these things. So that 9% cut is really important for that reason. And then the other hot button item right now is tele-health during the pandemic you know, here in New York city where I live, I shut down for a little while.

Speaker 3 (13:10):

I know a lot of people did. I didn't have tele-health set up with my practice at that time, but then I implemented it you know, in late March and many people across the country, physical therapy practices did have tele-health. We were not able to use it before for Medicare recipients, CMS applied a waiver, allowing us to use it. And it ends when they declared the pandemic over. So there we are going backwards again. So one of the things we're fighting for is to make tele-health permanent permanent again, access that people can get in the door and see their physical therapist. And I've used it. I had a patient who she fell down and she hurt her foot in the pool. And she said, Oh, someone at the you know, pool was a, I guess, a personal trainer, no disrespect to them, but they said, Oh, it's not broken. And I took one, look at it. I said, Oh no, your foot's broken. I could just tell. I was like, we need to get you in a boot. You need to go see, you know, get an x-ray. So, you know, tele-health is invaluable to people. They can get any immediately, the minute they hurt themselves. So making tele-health permanent is really important

Speaker 4 (14:18):

Because if we're supposed to be really taking care of the most vulnerable, especially during a COVID pandemic and the most vulnerable are over 65, it only makes sense to allow those people to have tele-health appointments.

Speaker 3 (14:34):

Yeah. I mean, also I used it with the patient the other day. She said that she wasn't feeling too well out of an abundance of caution. She was going to get a COVID test, but she opted for a tele-health session. So we switched from an in-person to a out just like that same time, same, same day. She was able to do that. She just didn't want to put me at risk. And I appreciated her watching out for my safety. So during these times we need that, you know, also people who live in areas where they have to travel far or snow treacherous conditions. Do we want people out in these conditions tele-health could be useful for that? I had a patient who I'm currently treating for her knee. She woke up the other day, her back was an agony. She said, Oh my goodness, my back's hurting.

Speaker 3 (15:18):

I don't know what to do. I said, let's get on a tele-health we did some gentle movements and some stretching. And she said, wow, by the end of it, my back feels much better. Thank you so much. I didn't know that a telehealth session could help that much. And all I did was show her some things to do to give her some advice. So telehealth is so useful in so many situations that I do hope that we can make it permanent. Yes. So do I? Okay. So now we know what federal bill bills are important. Your state bills, obviously you'd have to go on to the, your state PT association. And like you said, before we went on, hopefully there is an advocacy tab within your state physical therapy association website. And that's where you can find out what is on your state legislative docket right now. I mean, we're not going to go through every all 50 States. So for the people listening out there, that's where you would find it. Am I correct? Exactly. Yeah. Okay. All right. Now here's a question. How do we find who our state and federal legislators are? And on that,

Speaker 2 (16:28):

No, we're going to take a quick break to hear from our sponsor and be right back with Theresa's answers. This episode is brought to you by net health, helping you maintain strong relationships with your patients. The redox patient portal provides secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages, video conferencing for tele-health secure messaging, shared documents and photos and view health information, and appointments to learn more, contact them@redocatnethealth.com.

Speaker 3 (17:16):

So at a federal level a PTA makes it so easy for you. If you go to the APGA action app and that's downloadable in the I store and also Android. And I think you just type in APGA advocacy and the Apple pop-up. And if you're a member or non-member, you can use it. You just, I think if you're a non-member you just type in your address and it will, auto-populate all of your legislators. I actually think it does federal and at the state level too. So one way, but if you want to do it, you know, without that you could also, for federal, you could go to gov track.us, and that would look up your federal legislators, but then at a state level, your state Senator, and your state house or assembly person, you would have to just probably go to the, each one's website and look that up. Like in New York, we have a state assembly and state Senator website that you can search it for. So it's not that hard.

Speaker 4 (18:13):

Okay, awesome. Very easy. So people people understand how simple it is. Just one click or one downloaded app. So now let's talk about the act of advocacy, right? So we talked about why you wanted to be an advocate, how to find those legislators what bills are on the docket? How do we reach out to advocate? How do we do it?

Speaker 3 (18:37):

So the traditional way of advocacy is what we call lobbying. And that would be to go in person to have a meeting face to face with your legislator and ask them to do what's called co-sponsor the bill. That means like, say for the tele-health. If we have a bill number that has been introduced into the Senate or the house you would go, and you would ask them, would your member of Congress sign on to that bill? And then when you get enough co-sponsors you can get a vote. And that's how the bill can get passed into law. So that's traditional. And we can do that both at the federal and the state level. You could go to your state Capitol, like here in New York, it would be Albany. I could go there. So you can do advocacy, AKA lobbying to either one of those, but there's some stumbling blocks with that, that I found people.

Speaker 3 (19:30):

One are a little bit intimidated to do that, too. It can be far three. You have to take off time from work, usually because it's only during weekdays. You know, for me, I live in Brooklyn, Albany's a hike. So it takes a while. So there are some stumbling blocks with that, but that's their traditional way. It is a really fantastic experience. Anybody who wants to can come to Washington DC, the APGA does have a federal advocacy forum every year. It's generally in March this year, it will be in September because of the Centennial, but it's pretty exciting to walk the halls of Congress. And hopefully, you know, the country opened back up and we can have those face to face meetings this year. We did those kinds of meetings, virtual on zoom. It was okay, but I wouldn't say exactly quite the same energy.

Speaker 3 (20:15):

So that's the traditional way. But here comes my favorite part. I call it armchair advocacy. Literally things you can do while you are just sitting, you know, watching a movie, half watching. So there are things you can do where you can you know, go to the action app. You can fill out one of the templates there. The APGA has made for you where you can just send an email. You can go to your legislators own website and send them an email. There. There's always an email me button. You could just donate some money to PT pack to let other go do these things for you, let your money do the talking. But one of my favorite ways would be Twitter, right? So Twitter is free. Your legislator has an account. They're always there. You can follow them. You can like them. You can engage with their tweets.

Speaker 3 (21:05):

Just yesterday here in New York city, you know, speaking of legislators, I heard that mayor, bill de Blasio, he had to stand in line to go to early voting for three hours and he was complained. His back was her. And so I sent him a little tweet saying maybe he needs some physical therapy. So, you know, they're always on Twitter and you can send them a message anytime you want. You could also send them a message asking them to co-sponsor bills. I send out tweets to them doing that all the time. But one of the amazing things that I love about Twitter is you find like-minded individuals, you support them, you amplify their message. And, you know, you can kind of collaborate with people on advocacy there. Some other ways is that your member of Congress generally has virtual town halls these days, and they will post it on Twitter or Facebook usually only a day or two before. So you have to kind of watch out for that, but you can attend the virtual town hall and you can make comments and you can ask questions. I've been to several of my members of Congress town halls, and I asked them questions. I asked them about the 9% cut. That's something I will use support, you know, revoking this 9% cut. Those are the questions that I put in there. So, you know, lots of ways that you can do the armchair advocacy.

Speaker 4 (22:19):

And can you also talk a little bit about the key contact programs? So there's key contact programs. I know for APG as a whole, we're both part of the private practice section. They have key contacts. So what exactly is that and how can someone get involved if they're, if they want?

Speaker 3 (22:39):

Yeah, so AVTA has good point. APGA has key contacts and basically what a key contact is. It sounds a little bit more involved than it is. It just means that you are going to be that liaison to your member of Congress. That you're going to basically try to let them know what it is physical therapy does. And you're going to ask them to co-sponsor our bills. So the ask is, and you can be an apt, a key contact. And if you're a member of the practice,

Speaker 4 (23:06):

Have a

Speaker 3 (23:06):

Practice section, you could be a PPS key contact, and you can be a key contact for both APA and PPS. If you remember PPS. So what you would do is whenever there's a bill coming out, like say, there's going to be something coming out about the 9% cut. You would get an email from the key contact email list or from the PPS key contact email list. And it would just say, send this email and they generally give you a template. You could just copy and paste and you could send them the email on their website. You could send them a tweet. You could call the office. It's basically just asking your member of Congress to support our legislative agenda and our bills. And you would do that, you know, through those pushes. And then in August, we have August recess. When the members of Congress, your Senator and your house person comes home to the district to do district work. And generally we ask you to try to get a meeting with them, either on phone or zoom or in person, you know, before COVID to ask them to co-sponsor some of our bills then. So it's, you know, really a big push in August for those August recess meetings. But throughout the year, it's just a little pushes for the current bills that are going on. So it really doesn't take that much time. And how successful

Speaker 4 (24:19):

Are the, is the key contact program

Speaker 3 (24:22):

It's very successful because the whole point is good point. I forgot to mention this most members of Congress. If I called up your member of Congress, he is not going to be so interested in me because I'm not a constituent, that's the magic word. I don't vote for him. So yeah, he will care what I say, but his ears are not going to perk up as much as if you called because you are a constituent. So that's what key contacts are. They are a voting member in that person's district, AKA constituent. And so then the member of Congress cares more and they will listen more closely to that person. So you become that link, that voting constituent between the physical therapy profession and your member of Congress. And it's been very successful. We've had a lot of people sign on to bills, you know, currently with the 9% cut. I forget how many people signed on recently to a congressional letter, but it was the most that we've ever had. It was I think a couple hundred. And you know, hopefully that's something that we can get overturned and that's because the key contacts reached out to their member of Congress to ask them to sign on to this congressional letter.

Speaker 4 (25:31):

Yeah. So for me, what I'm getting out of this talk is that there's so much happening behind the scenes to advocate for our profession and advocate for our patients. But I think a lot of people don't realize, and if you want to make a change, then you have to let your voice be heard and advocating for the profession, whether you're a key contact or you're sending a template letter that you can easily get on the app is such a great way to get involved. And it doesn't take a lot of time. It doesn't take a lot of money and it's a way to help advocate for the profession and push us forward. So, you know, it sounds cliche, but like you, you want to be the, what is it? You want the change you want to be in the world or something like that, but be the change you want to see in the world. So if you're not in it, then, you know,

Speaker 3 (26:25):

Yes, absolutely. One thing I did want to mention is that APA has something called the advocacy network. If you just Google APJ advocacy network, it will take you to that link sign up for that newsletter, basically, that is part of the advocacy army. And you will get all of the news alerts of what's going on and they will send you, you know, literally a template that you could just fill out. We have this thing called voter voice, which it's just a automatic template. You input your name and address, and you can fill that out and you send a letter to your member of Congress. So sign up for the advocacy network. That way you'll always know what's going on. I am in a lot of Facebook groups and I see people upset and complaining. And I understand I used to feel the exact same way, but they are some uninformed and don't know what's going on. So join the network, know what's going on. You know, I always say one of my things is that I firmly believe the bigger voice, the bigger impact. If we can get a bigger collective voice, we already have a pretty big one, but let's make it louder. You know? And let's, let's make more of an impact and see real change because legislatively is the only real way to make the system different.

Speaker 4 (27:39):

Absolutely. And I was going to say what, you know, as we start to wrap things up, what do you want people? What's the message that you want to leave for the listeners, but I think you just said it, is there anything you want to add to that?

Speaker 3 (27:53):

Yeah. Join the advocacy network. And honestly, I would say, you know, don't be afraid of Twitter and come on Twitter because you can, we can build the army because when other, when you say something on Twitter and then you can amplify each other's message and then it kind of catches on and people, people, you know, get more informed and you can spread the message. So being able to amplify and spread the messages.

Speaker 4 (28:15):

Awesome. And now, before we leave, I'm going to ask you the same question I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad, fresh out of physical therapy school?

Speaker 3 (28:32):

I would say get good at what you do, your skills of being a PT. That was really important to me at first, but don't forget the professional aspect of it. That was something that I was lacking. And I think that, you know, recently I was also featured in an article for APGA on burnout that just came out last week. And I think that that was one piece I was lacking and being involved professionally in advocacy and not just, you know, becoming a super PT and good at my hands. But having that professional aspect, I think also does help prevent burnout because you, you see that there's a bigger mission and you see that there's something beyond yourself and you're fighting for that bigger mission and you feel part of the community. And I think it's

Speaker 4 (29:16):

Awesome. Great advice now, where can people find you? Where, where are you on Twitter? You mentioned a couple of times and then give us all the info.

Speaker 3 (29:24):

So of course I'm on Twitter. It's Theresa T H E R E S a Marco, M a R K O P T. And then I'm also on Instagram, dr. Theresa Marco, and I have a Facebook page, Marco therapy

Speaker 4 (29:42):

And LinkedIn too. You can find me there. Teresa Barco. Perfect. Very easy, very easy, very easy. So listen, if anyone has any questions, they want clarification on advocacy, Theresa is your go-to person. So I encourage you to follow her on social media to reach out with any questions because she will get back to you. So, Teresa, thank you so much for coming on and giving us such a succinct and informative episode on advocacy. Thank you so much. Thanks for having me and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

Speaker 2 (30:19):

Thank you to Teresa. So hopefully now everyone has some good action items that they can add to their list, to become advocates for physical therapy. And of course, thank you to net health for sponsoring today's podcast. They have created the Redarc patient portal, which provides a secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages to learn more, contact them at redox that's R E D O C at net. Hell.Com.

Speaker 1 (30:59):

Thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.

 

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

Nov 16, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Gina Kim, PT, DPT to talk about making the move from a physical therapist assistant to a physical therapist. Dr. Gina Kim is the owner of Maitri Physiotherapy, LLC in Central Ohio, the producer and host of The Medical Necessity Podcast, is certified in Integrative Dry Needling, is pursuing certification in MDT, and also uses her 10-year background in Tibetan Buddhism to educate her clients in mindfulness meditation.

In this episode, we discuss:

  • How to transition from a PTA to a PT
  • What is a bridge program for PTAs
  • The benefits of being a non-traditional physical therapy student
  • The ups and downs of physical therapy school while juggling work and life commitments. 
  • And much more! 

Resources: 

Maitri Physiotherapy, LLC

Dr. Gina on LinkedIn

Dr. Gina on Instagram

Dr. Gina on Facebook

A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. 

More about Dr. Gina Kim:

Dr. Gina originally wanted to play the trumpet when she grew up. Performance anxiety in high school changed her mind. But what was more worrying was the low back pain that began around that time. She endured that pain for years, but X-rays and muscle relaxers didn’t help. She was fortunate to work with a physical therapist. 

Being free from back pain was so dramatic that she decided that’s what she wanted to do with her life: Help people change their lives by treating pain, especially back pain, without drugs or surgery.

She stated at the bottom as a rehab aide. Next, she earned her license as a Physical Therapist Assistant and worked for years in settings ranging from outpatient orthopedics to acute care to home health. While working as a PTA, she completed her Doctorate through the University of Findlay Weekend College Bridge Program.

Dr. Gina is certified in Integrative Dry Needling, is pursuing certification in MDT, and also uses her 10-year background in Tibetan Buddhism to educate her clients in mindfulness meditation. She is also the producer and host of The Medical Necessity Podcast.

Read the Full Transcript below:

Speaker 1 (00:01):

Hello, Gina. And welcome to the podcast. I'm so happy to have you on,

Speaker 2 (00:06):

Well, I'm happy to be here, Karen.

Speaker 1 (00:08):

So you've got two podcast hosts here. So now you're on the other side of the mic.

Speaker 2 (00:15):

Oh goodness. It's great to be.

Speaker 1 (00:20):

So today we're going to talk about sort of your non-traditional route to becoming a physical therapist. So as, as a lot of people know, or maybe some listeners don't know the physical therapy profession, we're now a doctoring profession. So people are going to school for an undergraduate degree and then usually going right into physical therapy school as their graduate school of choice. But Gina made a definite detour from college through to where she is now as a physical therapist. So I will throw it over to you, Gina, and just kind of tell us your story, because I'm sure it will resonate with a lot of people.

Speaker 2 (01:04):

Oh my goodness. So my bachelor's is in computer science and I won't say how long ago, but let's say windows 95 was the hot new thing. Everybody was getting a computer science degree. I was even, I was even a company's webmaster for a time. So here's the thing, here's the thing. I have zero patience for technology longstanding low back issues. Okay. And especially sitting at a desk job, you know, we all, you know, PTs, you know, now I, now I know well when I was working one particular job, you know, and couldn't take the back pain anymore. And what do I do? I go to see my, go, to see my family doctor and it's x-rays and muscle relaxers, and guess what? Didn't help shocker shocker. And I can't tell you how many years passed between then. And finally, someone I remember I had hired a personal trainer who was himself, a physical therapist, and he said, Oh, you need to see someone who really specializes more in the low back, you know, cause so sky was kind of more on the equipment sales end of things.

Speaker 2 (02:38):

So I found I found my PT and he it's it's so trite, you know, saying he did his magic on me. It's like, I know what he did on me now. But I went from unable to touch my toes. You know, being in pain, you doing, doing that shuffle walk too. Hey, I don't hurt anymore. Yeah. And his reaction was right. And I'm like, wow. And I kind of went away and being kind of in the transitional phase that I was in with a kind of not loving, you know, computer, you know, computer science, you know, that kind of field and also being kind of a gym rat myself. So I was hanging, I was hanging out with with my PT and kind of, you know, kind of doing my own observation hours and doing my due diligence and asking about the education and everything.

Speaker 2 (03:46):

And he said, well, you know, because I was already I think at that point out of my twenties, right. He S he said, well, you should think about getting, becoming a PT assistant. So I looked into that, it's like, okay, I've got my bachelor's let me go to community college now, which, which involved you know, of course there was like a well years waiting period. And, you know, so I'm taking my anatomy and this, that, and the other completed that in 2013 and then worked as a PTA and all the time thinking, you know, I, I just want to go ahead and be able to practice on my own. So then that led to well basically looking at my, looking at my options for grad school and especially being someone by this time, let's see, what was I doing?

Speaker 2 (04:57):

I, I was, I w I'm trying to think about my day as a, as a like during my PT assistant time, I was going to school and then going to work as a rehab aid. And that at night I was going to skate with the Ohio roller girls. It's like, I don't know how I did it. So then I'm thinking if I go into a graduate program in, you know, physical therapy, I there's going to be this age difference at age and experience difference. And I remember I interviewed with one school and the she was, she was the admission secretary. And I won't say which school, but she said, you know, people are working later in life.

Speaker 3 (05:55):

Yeah. Yeah.

Speaker 1 (05:58):

So I,

Speaker 2 (05:59):

I had heard about the bridge program up at university of Findlay. We can college bridge program. So that required preparation, as far as retaking physics taking, you know, my chemistry series, you know, thank goodness I had already taken exercise fits, but doing, you know, doing the thing so I could apply. And then that I got in, and at the same time, I was still required to work as a PTA as we went up to Finley every other weekend. And when I say we, I say, I met with my cohort from who came in from all across the country. So I had a two hour drive. There were people flying in from Seattle.

Speaker 1 (06:51):

And where is, so is Findlay college in Ohio

Speaker 2 (06:55):

And like colleges in North West.

Speaker 1 (06:59):

Okay. And can you explain a little bit more about what a bridge program is, should that people kind of understand what that means from like a PTA to a PT?

Speaker 2 (07:10):

Sure. So it's a bridge in the sense of you're a PTA and you want to become a PT, here's the thing. You will need your bachelor's degree. Okay. So I had that check you know, plus prerequisites, you know, check. And then since part of the requirement for working was to help with assignments that we would have, you know, and we would be given so we could focus more on the evaluation part of because we were all over the treatment part, you know, and there were people in my class who were already directors of rehab. So I, I was in a very very well-experienced and pretty, pretty smart class. It was, it was pretty intimidating. But also you get that benefit from, you know, all this co-mingling. So then it's basically like any other DPT program. It was three years, you know, with clinicals at the end, and then you take your boards and your, then I became dr. Dr. Gina.

Speaker 1 (08:38):

Right. And so within that, those bridge programs, how many of those programs exist in the United States?

Speaker 2 (08:46):

My understanding is only two, this one and one in Texas whose name is escaping me. Right. But but yeah, and here's the thing too because I always always kind of had in the back of my mind, well, I can always apply to the bridge program. It was, it was kind of like in my, in my back pocket, right. University of Findlay is a private school. So you also have to keep in mind the two wishes that goes with it, right. Plus travel accommodations, and also time off work when you need to, you know, do certain things, you know, such as your, your research and projects and, and all that. Right.

Speaker 1 (09:38):

And when it comes to then your clinical affiliations. So at that point, do you have to leave your PTA job in order to do your clinical evaluation or your clinical placements?

Speaker 2 (09:50):

Yes. And I would say it was a little messy because we were, we were pretty much we work, we were kind of responsible for finding our placements. Right. so yeah, so then you are going off, you know, working someplace now you don't have the income. Okay. So you have, you have that to deal with. And there were Oh, I don't even know how many people in my class had children, some had young children but you know, somehow they managed, you know we got a big heads-up from the class before us, you know, like in our orientation, spoke to us and said, you guys are gonna need a team to help you get through this. You have to rely on each other. You have to rely on your spouses, your partners, your friends, you know, some things as basic as have a food plan. And I'm not even kidding because, you know, between, between working, coming home and studying, you're done, you're done. You know, so my, my husband, you know, I, I started out, you know, like with the food prepping and the making the healthy food and every, by the end, we're eating pizza.

Speaker 1 (11:26):

Yeah. I was going to say, are you going to be, yeah,

Speaker 2 (11:30):

Can you, can you please, you know, pick up, pick up something? Yeah,

Speaker 1 (11:34):

Yeah. It's it's pizza and take out at the end. So I think that brings up a lot of really important considerations for people. So if you are a physical therapist assistant and you are looking to become a physical therapist, we know there are maybe just two bridge programs in the United States. And that there are a lot of considerations that you have to think about before you go into that program. Like when did you do your clinical placements? You kind of can't work at your job as a PTA anymore. Right? Absolutely. And what did you do? What would be your best tips for time management? We know, obviously you just gave away that by the end you're it's pizza and take out now I'm just joking, but what, what are some good tips on, on time management, as you said, you have to study, do research, and you're still working as a PTA.

Speaker 1 (12:33):

My, my time management, I think number one you know, God love him. I, you know, I have cats, I don't have children, you know, on it, honestly, I didn't know how the parents did it. And I think they were even better time managers than I was. So for them, it was, you know, working around, okay, the kids, the kids are in bed or it's before the kids are up. And for me, it was kind of the same thing. Like if I wanted to, you know, spend time with my, with my husband, you know, occasionally it would be up, you know, first thing in the morning because I'm more I'm and it also depends, you know, if you're morning person, evening person, you know, cause I'm like out like a light, you know, if I've got something to do, I'm up at 5:00 AM, no problem.

Speaker 1 (13:32):

And I guess the thing that I'm taking away here, and this, this might be my like naive T here, but I thought like a bridge program going from a PTA to a PT would be, I don't want to say easier than your traditional program, but that, because you're already in the field, that it would be easier. Do you know what I mean? And that's clearly not the case. Like I didn't realize it was three years. I thought, Oh, maybe it's like two years and most of it's clinical. So I think this is really painting a clearer picture for people of like, no, this is still a three-year commitment, three years of financial commitments, perhaps loans, everything else that goes along with it. Was there anything about the bridge program that surprised you? Because I'm surprised number one, that it's three years and that it's, you know, I don't, I don't know what I was thinking, but this was not it. So I'm glad that you're bringing all this up. So is there anything about the program that really surprised you?

Speaker 4 (14:35):

And on that note, we'll take a quick break to hear from our sponsor and be right back with Gina's answer. This episode is brought to you by net health, helping you maintain strong relationships with your patients. The redox patient portal provides secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages, video conferencing for tele-health secure messaging, shared documents and photos and view health information, and appointments to learn more, contact them@redocatnethealth.com.

Speaker 2 (15:23):

Biggest surprise for me was for a program that had been a browned, as long as it had been that we still had to work around a university and kind of the cap, the system that I think really, really wanted us to be a traditional program, you know in the sense of, for example, I know after us clinicals were starting to be changed to, I think, get people into the field earlier, which was, which was, you know, once again kinda messing with people's employment. So they were, they were serving us, you know, would you prefer, you know, to do like two weeks at the beginning and we're thinking, well, how, how are we going to do that? If you know, our, you know, our clinic, our staff, you know, wherever we're working needs us. Yeah. Not that, not, not, not what you would have expected.

Speaker 2 (16:32):

And yeah, I guess the next question is and you sort of alluded to this when you said you were looking at other physical therapy programs and the woman said, Oh, well, you know, people are working later in life, but let me ask you, which is kind of an interesting thing to say, but what, what do you feel like, or would you feel that you're kind of coming into the doctorate of physical therapy, not coming straight out of high school or straight out of college? What advantage did that give to you? Coming into the field as a newly-minted DPT? I think it gave us a huge boost of confidence because I know that in, in my career, as a PTA, I worked for probably a dozen different PTs seeing how they worked you know, what what they could have done better, you know, what they did great how patients responded, you know, and plus you know, I've, I've got all my treating already, they're already in place. Okay. so I even, I even find it a little hard to imagine. Wow. If I were, if I were coming out of a traditional program and I've heard this spoken about a little bit of, you know, just trying to build that confidence in that first year. Well, I came out and it was kind of like, well, you know, I just had evaluations to what I'm doing.

Speaker 1 (18:20):

And when, let me ask you this, when you were a physical therapist assistant, what was your experience like as a physical therapist?

Speaker 2 (18:31):

It really depended on the PT. A lot of them, I felt had a lot of trust in me because they, you know, they saw that, you know, their patients were getting results and I had good rapport with them and, and so forth. Had a few, it became, it became a little more interesting once I was in school. Because I know there was, there was one particular person who he was, he was pretty fresh out of school and he seemed to want to challenge me a lot, like, you know, kind of like, you know, pop quizzes and, you know, things like that. It seemed a little light gatekeeping a little bit. But I mean, that was, you know, that was minor compared to, you know, the other the other PTs that I worked with.

Speaker 1 (19:33):

Yeah. Well, that's interesting. I know, cause I, I, I often wonder what that experience is like. And then, so for you moving from the physical therapist assistant to the physical therapist was all about having a little more autonomy and agency over your career, is that right? Absolutely. Yeah. And when you graduated, what were your, how did you feel then? So, you know, cause it's, it's, it was a difficult to make that transition. Did you kind of fall back into old habits after you graduated? Or was it more like I got this, I'm doing it,

Speaker 2 (20:10):

You know, I, I would think it, it really felt like I was ready for this. Now, the part that I didn't expect, and I think this was from my experiences in my clinical rotations as a PTA and then do it in doing it again as a PT and also couple of affiliations. They were kind of more in kinda more of those mill like settings. So I didn't go into PT school thinking I'm going to become a owner, but once I was finished, I was adamant that I needed to create my own career.

Speaker 1 (20:57):

And you knew that. So when did you graduate from physical therapy school? Couldn't get your DPT.

Speaker 2 (21:03):

So let's grow graduation was end of 2018. Yeah. And then test it for my boards in what was wow. May how, sorry, how soon we

Speaker 1 (21:20):

Forget. I know you seem to have blocked that out.

Speaker 2 (21:22):

Yeah. I'm sorry. April, April. Okay.

Speaker 1 (21:25):

Okay. So, so it sounds like the experience that you have previously really set you up to then say, I'm ready to, to become that entrepreneur. I'm ready to kind of do this.

Speaker 2 (21:39):

I think as far as mindset. Yeah. Still in our, our business class was kind of the classic. Okay. Let's write a business plan about how to build a brick and mortar clinic. So then the business knowledge some of, some of it I, you know, took away from the free resources on the AP TA website but being a solo clinician and cash based I felt that I needed to look for kind of more support, you know, as far as networking and, and all that. And because I was dealing with different issues than say a larger clinic with, you know, accepting insurance and several therapists and whatnot. Yeah.

Speaker 1 (22:38):

Right. So, I mean, and of course, like moving on through the business, that's a whole other discussion, which, you know, maybe one day we will have on here as well. But what I think it's important to note is that, you know, you mentioned it briefly is the mindset part of it. You're like, Oh, I had the mindset part and kind of skimmed over that. But that is so important because like I said, when I graduated from PT school, no way in hell, did I ever think I'd be able to own my own business? Just wasn't even on my radar, you know? So what advice would you give to, I guess, newer, newer grads, whether they're traditional or non-traditional like yourself who are thinking about starting their own practice

Speaker 2 (23:25):

To find people in and hang out with people who, who were doing what you would like to be doing, you know? Yeah, there were already folks in my class who, you know, they were, they were having their plans in place. Like one of them was going to be, become a partner in a clinic. You know, I mentioned several were directors of rehab someplace, another guy he already had, you know, his his athlete and sports training practice up. I mean, he was, I mean, he was running that well, he was doing everything else.

Speaker 1 (24:07):

Yeah. So it seems, I think what's so interesting is, is that sort of non-traditional path to physical therapy. It seems like it, you know, because people have already gone through so many life experiences or maybe different jobs and they feel like, boy, they're really ready to be in the space that they're in and own it. Yeah, absolutely. Yeah. Yeah.

Speaker 2 (24:34):

And I definitely, I definitely know that confidence was there. And even, and at the same time, I know of a few classmates, they were already looking at residencies, you know, they were looking at specialization.

Speaker 1 (24:54):

Yeah. So, I mean, I, so I think to my big takeaway here is to all of the more traditional PTs out there who maybe have a non-traditional student or a physical therapist in their class, or who are in class with people who may be were our, our physical therapists assistants and, and going for that DPT is to make sure that you seek them out and learn from them because they've got these life experiences that when you're 21 and 22, you just don't have, you know, and so seek those people out in your class and, and definitely learn more about them and learn where they're from and where they want to go. Because I think that as a, not as a traditional student, and when I say traditional, I mean, you know, you came out of high school, went to college and now you're in PT school is sort of straight linear track. That there's so much more that the non-traditional student can can offer because you've got some more life experiences under your belt. Absolutely.

Speaker 2 (26:05):

Let me add another point to that. As far as the confidence part, because especially working with older clients, they seem to have a little bit more comfort working with someone my age.

Speaker 1 (26:23):

Mm. Yeah. And yeah, that makes sense. Sometimes kind

Speaker 2 (26:29):

Of already assumed that I was a PT

Speaker 1 (26:33):

Working there even as you were a physical therapist assistant.

Speaker 2 (26:41):

Yeah. As I said, I was a student

Speaker 1 (26:44):

Yo, as you were a student. Yeah. Oh, that's interesting. That's interesting. Yeah, yeah, yeah. I didn't even think about that. So, so the, the confidence, not just that you exude, but that, that the patients can kind of feel it and yeah, that's interesting.

Speaker 2 (27:01):

Yeah. And also I think the the ability to quickly develop rapport and all those, all those good skills, you know, like listening and responding and, and hearing and seeing how people are presenting instead of, you know, being, you know, well, you know, I'm still learning these basic you know, I have to learn all the things I, I have to learn how to evaluate, you know, but also how to treat and progress and this, that, and the other I've already, I've already got the, you know, I'm already thinking ahead, you know, to what their course of treatment is going to look like, you know, because I've seen it. Right.

Speaker 1 (27:47):

Yeah. You've got the experience. Yeah. Yeah. And experience, as we know, is, is so important. So, so let me ask you as we start to wrap things up here. So I gave you what my biggest takeaway was, what's your biggest takeaway and what would you like the listeners to take away from, from our discussion of your journey of this, of being a non-traditional PT?

Speaker 2 (28:10):

My biggest takeaway. So you have the benefit of the non-traditional experience, you know, meeting all these people with different, you know, different knowledge bases and certifications and things like that. Also at the same time, there's a, there's a challenge to doing things such as, you know, say going to a conference, you know, like CSM, because you're, you have to think about, you're going to be in school when a lot of these events happen. So it's like you, if you really, really want to go, you have to plan, you have to make plans for it and, and, you know, get, get an excused absence, you know, for want of a better word. So that, that can really, I, I think you need to then really, really work on your networking when you're finished. I think because of that. Yeah.

Speaker 1 (29:20):

Yeah. That may be aware of that. Yeah. Yeah. Yeah. That makes a lot of sense. And then, you know, I'll ask you the same question I ask everyone, and that's knowing where you are now in your life and in your career. What advice would you give to your younger self? And let's not say when you graduated PT school. Cause that was like a year ago. So let's maybe go back little bit more like maybe when you graduated undergrad or something. Yeah.

Speaker 2 (29:45):

Back in the day. Not, not everyone who gives you advice knows what they're talking about.

Speaker 1 (29:58):

True story. Yes.

Speaker 2 (30:00):

Because that's how I ended up in computer science, which was not the right career path for you, which was not the right career path. Right? Yeah. So yeah, the thing, the thing that I wish I would have done a lot more of was extracurricular, so I could have, could have known myself a whole lot better. That's great. But to make, yeah. To make make a better guided choice.

Speaker 1 (30:29):

Mm great advice now, Gina, where can people find you? So first of all, talk about your podcast and then where can people find you?

Speaker 2 (30:36):

I would be happy to, so I am the producer and host of the medical necessity podcast where I help guide people through the flood of medical information out there. I love it. Yeah. Available on wherever you get your podcasts, pod, bean, Spotify iHeart radio at iTunes and my business is called my tree physio-therapy LLC. You can find me@maitri.physio. And I practice in Ohio. I'm licensed in Ohio. I bring a world-class world-class physical therapy to your home or via tele health. So you can, you can find me there and I would love to treat that

Speaker 1 (31:36):

Awesome. Well, we will have all of the links to everything at the show notes at podcast out healthy, wealthy, smart.com. So if you didn't, weren't taking notes, don't worry. One click will get you to everything, including your website and your podcast and social media as well. Jean has got a great Instagram page where she shares a lot of great free information with everyone. So you'll definitely want to check out her Instagram, what's your Instagram handle

Speaker 2 (32:06):

At medical underlying necessity.

Speaker 1 (32:09):

Awesome. So Gina, thank you so much for coming on. This was great. And I think it gives people a lot to think about, especially those physical therapist assistants out there who may be there on the edge, maybe they're thinking, Hmm. Do I want to go on? So I think you gave a lot of great information, a lot of great insights, so I appreciate it.

Speaker 2 (32:30):

Well, thank you. And I hope absolutely anyone who has questions about this bridge program, feel free to reach out to me.

Speaker 1 (32:39):

Awesome. Thank you so much. And everyone who's listening. 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 twitterinstagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

 

Nov 5, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Smith, PT, DPT to discuss how women can cultivate their core confidence. Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically, women who wear many hats and desire to leave a legacy with less burnout and greater personal joy. 

In this episode, we discuss:

 

-How women focus attention on external approval and achievements/external successes.

 

-Why we need to be connected, aware and in tune with our pelvis.

 

-Messages the pelvis (and body) may be giving us that we are missing

 

-Core Confidence-what it is. why it is so important

 

-How does reducing urgency in daily life payoff- how the mental affects the physical body.

 

-How mental and spiritual Core Confidence and awareness of our Core can affect physical core strength.

 

Resources: 

 

Dr. Sarah’s Facebook

 

Dr. Sarah’s Instagram

 

Dr. Sarah’s LinkedIN

 

Activate Your Core Confidence Workbook

 

Discover Your Joy Coaching Session w/ Dr. Sarah

 

A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. 

 

More Information about Dr. Smith:

Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically women who wear many hats and desire to leave a legacy with less burnout and greater personal joy. 

Her unique approach focuses on connecting women back to their Core which holds authenticity, choice and immediate solutions so one can thrive both personally and professionally in all life situations.

This activation is vital so that women leading their families, communities and companies can stay fully present in all situations in order to

  • Communicate & interact authentically and calmly
  • Finally feel their private life & success matches their professional success with greater freedom, confidence, peace, focus and direction.
  • Flow through daily tasks and commitments with more focus, ease and an organized plan
  • Improve physical strength & major health gains
  • Live Wild & Bright- meaning! connected to our true, authentic, soul calling

She has blended her professional expertise as a Doctor of Physical Therapy- specializing in Women’s Health and Chronic Pain Management, Certified Yoga Instructor & Certified Wellness & Life Coach. With every personal & group experience Dr. Sara Smith offers, she is dedicated to the goal of assisting women of all ages to step back into their Core Confidence.

 

Read the Full Transcript below:

Speaker 1 (00:01):

Hey, Sarah, welcome to the podcast. I'm happy to have you on,

Speaker 2 (00:04):

Thank you so much for having me, dr. Litzy. It's glad to be here.

Speaker 1 (00:08):

Yeah. And so obviously I'm a physical therapist as are you, you have specialized in pelvic health and women's health, and then you have also kind of made that transition for at least part of your career into coaching, mainly other women from around the world. So before we get into the meat of the interview, I would love for you to share with the audience a little bit about your sort of career trajectory.

Speaker 2 (00:40):

Absolutely. Yes. So it's a, it's a little professional and it's a little personal, so it's the story tends to track with a little bit of both. I also went and got my yoga certification and that was actually the first thing that I did after physical therapy, you know, from, from physical therapy. A lot of that came because you know, in our profession we have a high turnaround and burnout ratio there at times. And I was a chronic fixer and helper and I was good at what I was doing to the point where I, you know, anybody came in and I was ready to, you know, help them with their issue. And so I went to my first yoga class, really just to chill myself out, get a little bit grounded and get, get real. And then from there it really almost overnight, it, it drastically shifted the way I was showing up and treating my patients at the time.

Speaker 2 (01:42):

I realized that kind of less was more, I realized that it was more important for me to listen instead of coming in with a plan and, you know, my own action sheet and really meeting people where, where we were, I think I was always empathetic, but it, it really enhanced that. And on top of that, I stopped getting sick. I was averaging, you know, a sinus infection once a month and just burned out already and young because I didn't want to, you know, you didn't want to fail having that syndrome. So really yoga kind of came first and then that solidified me for a while. I kept into the physical therapy world. I've always lived in rural areas in Virginia and I was on the Eastern shore of Virginia and I'm an only child. So I do like to be the only one doing something I like to be a little special.

Speaker 2 (02:40):

And, and so I realized nobody in the area was doing pelvic floor work. I had in all of my internships had some sort of connection to pelvic floor and women's health work. So I, I learned about it. I kind of knew about it. I didn't know if that was something that I wanted to get into. But I knew that it was a niche in the area that I was in. And so it was when I got into pelvic floor physical therapy work that I really professionally started to see this and, and chronic pain management has always been something that I just love helping people that have been to lots of therapists, physical therapists, and in there need assistance with that. But I was just seeing this mind body connection. I was seeing how with all of these individuals, and for some reason, I just happened to be working with a lot of leaders, professionals, directors, CEOs, you know, it just was kind of happening that way.

Speaker 2 (03:41):

Even some like rockstars lawyers, I don't know, Olympic swimmers, all these different people and stress was also happening mentally. You know, there were things going on either in their personal life or their professional life. That just seemed to be kind of also coming into what I was noticing in their physical body. So I was learning about it personally and just my own interest. And then I also was seeing it professionally and I was seeing when I started incorporating some of the yoga, you know, some of the mindfulness based practices and stress management breathing that I was getting better results. And I just am a result junkie. You know, I'm not interested in putting a patch on something. I want somebody to come back to me six or seven or 10 years later and be like, I'm still using what you did. So there was that.

Speaker 2 (04:34):

And then on top of that what I got into pelvic floor therapy, my started having children and my, our, our first child who's now seven was we found out at a very young age that he had an ultra rare genetic mutation. So it was de Novo. It wasn't for my husband or myself and severe speech apraxia. So I started getting, you know, deep into the world of executive functioning and,ureally learning more and more about kind of, I always loved the nervous system, but, you know, I became even more fascinated with how to manage that,uand, and work with it. And so that, those two things kind of happening simultaneously are what brought me into, into coaching. Umnd specifically working with female leaders, hecause that, I don't know, that's just like a deep within personal mission is I feel like women are here to make a major contribution.

Speaker 2 (05:42):

I feel like the time, the time is ripe, the time is now. But we've learned and write in it in a great way. We've learned from a very male dominated structure,uwhich doesn't always work for women. And,uit can, it definitely works. It's not that it's, you know, not working, but there, there are some things that need to slightly shift and,uI'm just, I really want to be able to contribute to women, being able to be in these leadership roles and do it without as much burnout do it without as much self-sacrificing,ufamily sacrificing community sacrificing. Uso yeah.

Speaker 1 (06:32):

Awesome. Well, thanks for that. Thanks for kind of letting the listeners get a little bit deeper into kind of who you are and why you do what you do, because it all leads into our discussion today. And it's, it's really all about as you say, why we need to be connected, why we need to be aware and in tune with our pelvis. So as a physical therapist, we can all agree that yes, we need to be in tune with that area. Everyone has a pelvis, everyone has that musculature and, and the functions of but coming from, I think your unique perspective of both physical therapist and coach and looking really beyond just the pelvic floor, which we should all be doing anyway. So, so give us your take on why we need to be connected.

Speaker 2 (07:25):

Yeah. You know, I've seen in, in the realm of success, leadership, entrepreneurship anybody who's, who's type a you know, th there's a lot of overthinking long to do lists. There's a lot of being up in our head, you know, w where do we go next? And I say, we, because this, you know, I've, you're only a great teacher if you've been there yourself, right. And, and are still in the depths of it. And so, you know, we th there's lots, that's constantly swirling up in our head, but we also know, and, and, you know, a variety of different resource research sources have shown us this, that we can't access all of the solutions to our biggest professional, personal life challenges. If we're in constant thinking mode all day long, not to mention, you know, roughly 80% of all thoughts are habitually negative, which is not very helpful for solving problems. And so the reason that I am so drawn to what I call, you know, well, it's not just me calling it a core confidence and getting people specifically into their pelvis and back into their body is, is reducing the overthinking so that we can access again, creativity, focus, productivity, you know, improved, sleep, stress, relieving, you know, hormone responses. You know, I could, I could go on and on.

Speaker 1 (09:01):

Yeah. And so you brought up the, the the words, core confidence. So can you explain what, what does that mean? Because I have a feeling it may mean a couple of different things to a couple of different people, but in the work that you do in helping people become more productive, improve their leadership, improve their life, what does that, what does core confidence?

Speaker 2 (09:28):

Yeah. I love how you said that, you know, it means something to, there's lots of different ways to describe it in there. There really is. You know, to me, and also the, the clients that I've worked with for many, many years now, it means freedom. It means expansiveness. It means seeking joy. It means effectively, you know, being effective at what they do. Meanings means also having more energy core confidence really is being able to go within yourself and access that wellspring of inner wisdom really access your, your yes or no. And a lot of times, and this is, this is actually comes from, from those in the research field. Core confidence also is a mixture of self-efficacy of hope of optimism and resilience. External confidence. I don't think we should be talking about core confidence without also touching on external confidence and external confidence is what the majority of us learn to, to seek after.

Speaker 2 (10:43):

And we're constantly seeking after it. The external confidence is, you know, does dr. [inaudible] Like me, or, you know, what I should be doing right now, or, you know, these are the, the, the dreams that, that others are doing. So this marketing strategy has worked for them. This app has worked for them, let me do this, let me, you know, follow this meal plan. And so, you know, we're constantly as humans chasing others, things that have worked for them. And, and we're very often, again, not realizing we're up in our head and we're not really checking in with the, the little voice that's like, that's kind of a waste of time.

Speaker 1 (11:32):

Yeah, totally. I, I always find that it's so much easier to look for that external validation and get our confidence from that external validation, then what we do than what we think we are doing. Does that make sense? Solutely yeah, so I, I mean, and, and we're all human and all humans fall into that trap. So can you kind of give us an example of how you might work with someone to help develop this core confidence and help to bring in more joy and help get them a little more grounded into themselves? Are there any sort of exercises or things that you do with people that you can give this as an example? Yeah,

Speaker 2 (12:15):

That's a, that's a great you know, I I'd say one of the main tips that I, that is probably ended up being my, my signature Sarah move,uhas been really, you know, so listening to somebody, I really love deep listening. I mean, I think when you start listening to someone, at least for me, I don't know this is, this is, h gift that I have is I start reading between the lines. Umnd actually I'm kind of diverting for a moment. A lot of times when I work with people, I don't do it over zoom. We don't do video. Umecause when you look somebody in the eye, sometimes it's hard to be a hundred percent truthful, you know, or again, you kind of fall into the, the external competence trap. Umnd so we do it all over the phone or, you know, with the video off so that I can really deeply listen.

Speaker 2 (13:09):

And what I'll do is, you know, if there's a belief in there for example, I was working with somebody the other day and she shared, you know, while we were talking about her personal life. And and she was like, you know, if I kind of keep having these, these, if I close the door on this relationship, I'm probably actually going to have to do a lot of hard work on myself to pick up the pieces. And what I asked her was, well, well, is that true? That working on yourself has to be hard.

Speaker 1 (13:47):

And when

Speaker 2 (13:47):

We, I call it, like, we've got to, we've got to go. I like going down the rabbit hole with somebody of like, really being like, why, why are we fearful about this? Like, let's, let's talk about it. Let's get to the root and let's shine the light on what, what the narrative is with this overthinking piece. Once we shine the light on it, half of the work is done because we've brought in awareness. And whenever you bring in awareness works time.

Speaker 1 (14:18):

Absolutely. Yeah. And it's, it's, you know, that you're right. Being able to listen and listen well is a gift, but it's also something luckily that can be practiced and can be worked upon as physical therapists. I think a lot of us, a lot of us are pretty good at listening. But when you work with, like you said, that chronic pain population, you really get, I think, a lot more in tune to what the person is saying. And you also learn how to ask those questions to draw out more thoughts.

Speaker 2 (14:54):

Absolutely. Yes. And here's the interesting thing that I've found. Okay. and, and I, a lot of this comes from like archetypes and youngian psychology is we have different aspects of our, of our psyche and of our personalities. Right. And a lot of times what you'll find is we learn these skills, we practice these skills professionally, but when it comes to the, behind the scenes for ourselves, we're almost like different people. I had a client the other day, you know, she is a director and has, has a large, very well-known board behind her. And and she's like, you know, if the board was to be a fly on the wall and kind of experience my personal life, they they'd be like what, you're not even the same person. Because suddenly things become matters of the heart. They're no longer again, the, the head, you know, so professionally relating people through this very well yet, we're not really sometimes having that, that advisor, that best friend, that we didn't even know we needed behind the scenes to help us hash out our own stumbling blocks. And that's where I think in, in leadership and entrepreneurship and being a CEO of, you know, your business and your life and trying to be healthy, wealthy, and smart, I think that's, we need that now.

Speaker 1 (16:22):

And why do you think that's so hard

Speaker 2 (16:24):

To,

Speaker 1 (16:27):

To confide in others of, you know, it's, it's a lot easier to say, Oh, you know, I, I didn't have any new patients this month. So, you know, I really w what do you think, how can I help? How can I get more patients? That's easy, right. To talk about our business and, and to talk about our our professional life. But why do you think it's so hard for people to confide in others on a more personal level?

Speaker 2 (16:55):

Hmm. I love this question. I really love it. Of course, I'm sure it's very multifactorial. I find that I don't, you know, I don't have any research on this, but I find that if you start looking back even into it and not like massively, but you start looking back into childhood, you know, where a lot of habitual patterns are formed and thought patterns are formed. A lot of times you'll see, you'll see trends there, but, you know, one vein of research shows that about half of all CEOs, those at the top are experiencing loneliness and loneliness in the sense that, you know, there has to be a level of healthy ego and confidence, right? B core confidence or confidence in order to want to succeed. You know, all sorts of people are teaching us out there and showing us that, you know, you gotta have some grit, you gotta have some resiliency if you wanna play this game.

Speaker 2 (18:01):

And it is a game. And so, you know, there there's factors of like, you can't trust everyone, right. If you have team members underneath of you traditionally that's really changing, I think, but traditionally we're taught, you know, you don't mix business and personal life. You don't do that. That's a no, no. Now you'll see that changing. And that's continuing to change because you know, many psychologists are beginning to study really resiliency and entrepreneurship and, and understanding more specifically how they're tied together, because it's, th that's really just a new field of, of understanding. He can't trust people, you know, and I think many have experienced, again, maybe it was in the past or more recently you know, you do share some of those personal moments and it might come back to bite you or suddenly the, the inner critic and other thought thought in the brain comes up and says, Ooh, that was not a good idea. You're probably that is going to backfire. You know, that could make you look weak. So I think it's very multifactorial.

Speaker 1 (19:16):

And I guess this is kind of where having someone, you know, outside of your direct business to have as a resource and to help you as a coach I guess I would, I'm assuming that that's where coaching comes into play, because you can kind of be that person to sort of help with the personal and the professional, because I can only assume that they're closely related.

Speaker 2 (19:44):

Right. They are way more closely related than people realize. And your professional self that like the way you act professionally is often different than the way you act and your personal life. Like, can you, can you relate to that?

Speaker 1 (20:02):

Yeah, of course. Okay.

Speaker 2 (20:05):

And so, you know, cause I, I, yeah, same thing for me too, but I'm always interested, you know, in what, what somebody, his answer would be.

Speaker 1 (20:12):

Yeah, no, there's, there's no question that, that we're a little different in our personal life than in our professional life. And, you know, it's funny to say, because I was having thoughts around that yesterday. Because you know, we're all human, right? Every once in a while, like we screw something up, we say something we didn't want to say we regretted afterwards. And yet you're vilified for being a human being. You're vilified for saying something that, yeah, like maybe what you said, wasn't the best thing to say, but you take ownership over it. You say, Hey, listen. Like, yeah. I mean, I, you know, I let my emotions get the best of me, which never ever happens in my professional life. Right. Right. In my professional life never happens. And yet all of a sudden you're demoted in the eyes of so many people, but all you did was you were just a human being and you said something, or you wrote something that you later like, ah, I can't believe I did that. And because it's not a podcast, we can't go back and edit it out. So I think that there is this, this weird kind of, if you start to melt the two together, you're going to be screwed.

Speaker 2 (21:33):

Yeah. It's a way or another, it's a belief. Absolutely. And I think that we need guidance to blend them appropriately, you know, because the answer is not, well, you'll see this as a marketing strategy now. Right. Where it's like, okay, show the behind the scenes and show yourself and be yourself and dah, dah, dah. Well, I think that there's always a, a middle ground to all of that, that we need to be aiming for. And again, it has to feel true to you, you know, like you have to get back into a state of checking in with yourself and not checking in with the head and the thoughts of like, okay, is this an alignment for me? And so, you know, in a lot of cases when you're blood, when you're, I like drawing on the professional self, like let's say, I might say, okay, what would professional dr.

Speaker 2 (22:23):

Litzy do when we're talking about something personal, because that's how the, the, the two aspects of you can really start blending together and start working together as a team and be like an integrated, whole healthy, beautiful person, right. Uwho can stay true to your individual values? You know, we get to like explore what those individual values are and being true to those,uin, in order to make it work for us, I've ever really cool example of a client who,ushe's in the hospital system and I'm pretty high up. And she was offered. We had been working for, I don't know, probably three to six months or something we'd been, she had been, and we were mostly working in the personal field, you know, but of course the professional always, always blends in. And she had been offered this incredible opportunity to lead this team.

Speaker 2 (23:25):

This was just in addition to her goals that she already professionally had for the year. And as she sat with that, and as I sat with that with her, she realized, you know, if this had been last year, I would have said yes to that. And I'm very flattered, but the truth is, is if I say yes to that, then all that I'm doing to take care of myself so that I can show up to meet my professional goals is actually going to be derailed. And so at that moment, it wasn't in alignment for her. And what was even better about that was then she was able to go to her boss and to communicate that I call it like, you know, communicating from the core, but communicate that not from up in the head like, Oh, no, I wonder what I'm doing. I hope, you know, hope I'm not really screwing this up, communicating it with authenticity, with crowdedness, with strength, right. With empowerment. And, you know, her superior was like best decision you ever made. I really appreciate it. Really championed to her now, how awesome would that be if we could have more of that in our small businesses and in all of our workplaces and all of our organizations,

Speaker 1 (24:43):

I mean, that's an ideal situation when the ideal situation, but I think it's hard when you're constantly kind of seeking out success and seeking to be quote unquote the best at what you do and to get that recognition and to build your business and to make more money. So you can live the lifestyle that you want to live and provide for your family or your friends or whomever is in your, your world. But how does, how does making these decisions, like you said, these sort of more grounded decisions where, where they are emotional versus making these decisions as strictly like pros and cons, like an intellectual pro and con list, you know what I mean? So how do you, how do you coach people in that tug of war?

Speaker 2 (25:41):

I hope I can answer the question of how do you coach people, because sometimes you just have to see it, you know, and experience it. But you know if you look, if you talk to anyone in the financial world, the stock market is emotional emotions drive everything. That's true. Right. And you know, if we're the faster, we're aware of that, the more tapped in that, that we're going to be. And so that's actually, what's happening is a, is a lot of times where we're making these leadership decisions, we're making these personal decisions when we're in a state of emotion. And often when we're, you know, emotions are coming from thoughts, right. You know, you know, the, the, the little wheel starts going and then suddenly, you know, we have these emotions with us. A lot of times you don't even know what the sensation is in the body, because we're, again, we're kind of more of in the head.

Speaker 2 (26:36):

And so when you can access, and what I do is often just really helping somebody with very challenging. Like I prefer the challenging situations, you know, where it's like, okay, why do I keep getting into this relationship? Why do I keep not, you know, being able to climb the ladder? Why is it I can't get, get know fit in the self-care pieces of it. And when we get to the root of it, a lot of times it's because things are happening in an emotional realm. And we've got to be aware of that, go down the rabbit hole of the actual, like fear and worry. And why, like, why are we responding the way we're responding? Why are we doing that? And then once you get to that, then you can actually get to the clarity piece where you get the clouds and the, you know, the fog out from your face. Right. You can go, okay, pro this con this dah, dah, dah, dah. Okay. Now I've got my marching orders go. And I, I don't know about you, but I like marching orders. I like to know the next step.

Speaker 1 (27:37):

Yeah, absolutely. And, and I think, you know, a lot of people who are in leadership positions or who are going out to be that entrepreneur, their dreams, like you are a type a person. I think you are a lot of just pros and cons. But I do think that the emotional segment of things does have to come into play because if your pros and cons from a very sort of robotic sense is, is okay, I guess, but then how is it going to make you feel, how is it going to affect your life? Are you going to be happy with your decision? Are you doing something because you feel pressure to do it because you have to do it, quote unquote. So I think being able to tap into that core confidence in that and your core values in order to help you make decisions is important. So it's like, I don't want to be on either pole, like purely emotional, purely cerebral, but you want to have, you want to be able to kind of get in there and go down that rabbit hole, which is not easy and takes a lot of self-awareness.

Speaker 2 (28:44):

Yes, no, it does. And that's why it usually takes a guide. Yeah, exactly. It really does. It takes a guide and you know, again, kind of that core confidence model that was not created by me, but having self-efficacy hope, optimism and resiliency, you know, these are things with, with a lot of difficult situations that, that our, our brain just has not been able to figure out the answer to. We tend to go down on the scale of those things, right? We're not trusting ourselves efficacy. We're not feeling very hopeful about it now, fascinatingly enough, you know, those that are fixers and types day and, and, and leaders if we can't fix something, if we don't know the solution to it, we're going to avoid it

Speaker 1 (29:25):

Totally a hundred percent. So it was easier and it's so much easier.

Speaker 2 (29:30):

We are to, to help and to show up for others and to fix the things that we know we can fix. And so again, then you see an imbalance and often times it's with the most challenging things that dealing with, again, personally, or professionally that we don't want to talk about. One of my clients, the other day was sharing,uyou know, this situation just resolved, but she was like, you know, I have been sitting on this,uspace like this, this land and space for the last 10 years. And I didn't know what to do with it. Now, when we got to the root of it, it was actually extremely emotional because she's in a family owned business. And it was something that a family member prior to her set up and, you know, really loved. And so it, it, it, it was way too. She couldn't make the decision because of the emotions connected with it. Uyou know, but she was like, I've been sitting on this forever and just avoiding it because I don't know what to do. So I can think of 50,000 other things to spend my time doing. You know, you can fix the kids, you can fix your friends, you can bring it into your professional career. And then meanwhile, some of the, you know, the other aspects are, are, are missing.

Speaker 1 (30:44):

I know I, when I get into those, those bouts of, Oh God, I can, I like will. And it's what I'm doing right now, which is why, when you said that you could do so, so many things to avoid. I'm like redoing my bookshelves, I'm doing some shredding of papers. I'm like crazy with the home edit. And now everything's in a rainbow, you know, I've got a lot of plastic bins hanging out everywhere. That's what I do when I'm trying to like, avoid looking at deeply at other things, you know? So that's what I've been doing for the past couple of weeks is I have been like cleaning out. Like my doorman was like, are you moving? I was like, Nope, not moving. Just, just finding stuff to do around the apartment.

Speaker 2 (31:30):

Exactly. Just being a great, you know, leader in the liver of life.

Speaker 1 (31:35):

Yeah, exactly. Cause I'm like, well, you know, if you come home to a nice clean apartment, it's better for your head. You can concentrate more when, you know, I probably need to go dig a little deeper and see, why am I doing all of this? And I know it's not just from watching the home edit, although it's a nice show. I'm sure it goes a little deeper.

Speaker 2 (31:56):

Well, it does, you know, and I'm glad you brought that up, you know, your, your personal situation, because I think that that helps all of us so much, you know, it's always nice to know when we're not alone. Right. And but you know, one of the biggest things that I've found in doing this work for as long as I have is people say to me, yeah. You know, I just, you know, everything you do sounds really great. Like that sounds awesome. It sounds like it really be helpful for me. And like, I don't really think I will, but I don't really think I want to go there. Uand we think, again, we think it's going to be hard, right? Like I was mentioning the client, the client earlier,u

Speaker 3 (32:40):

I have found that,

Speaker 2 (32:44):

And I think this is just my personality, but it's like, we got to make this fun and we gotta make this. Or action-oriented we kinda got to get the show on the road. So it's like, you know, again, if, if we're, if we're trying to leave a legacy, if you're trying to, you know, be productive and not give up on the idea that we have, you know, have success, then we are in a state in our country and in the world where, where we, we, yes, we can all, you know, afford to sit down on the couch with the weighted blanket and the wine and the ice cream, you know, but, but I just don't believe that, that we can afford too much of that anymore. I really don't, you know, like I, I need, I really feel so strongly that like, I need everybody to be functioning at a high level and it, it can be fun.

Speaker 2 (33:40):

It doesn't have to be like, Oh gosh, I'm, I'm, doesn't have to be so stressful. Yeah. Or like annoying, you know what I mean? Like, nobody really wants to like, look at themselves and see their shortcomings. And it's not about that. Like anybody that's trying to tell you it's about that. Th that's probably just perfectionist behavior showing up. It's not about that. It's about like, you've got to tap into your greatness. And when I say your greatness, meaning like just our essence, like our purpose of being here on earth, like something greater than ourselves, we've got to tap into that. We've gotten away from that. You know, that, that radical act of self-love that that's not just let me go draw a bubble bath. You know, that that is radically like, you know, we're all beautiful and we're here to share something great.

Speaker 2 (34:37):

One of the, one of the most upsetting thing, NGS, m don't know if you've ever experienced this, but, you know, as a physical therapist, when somebody has, host a limb or their pelvic floor is not working and they're upset with, you know, they have prolapse and they're like, Ugh, Ugh, this uterus, or, you know, gosh, my arm just looks awful. Now that pains me to my soul because I'm like, Oh, you know, like, gosh, your body has done so many miraculous things. I understand. And I empathize why you feel that way, but it, it makes me sad. And one of the things that has made me sad and being, you know, an advisor and a best friend to, you know, leaders who didn't even know if they needed that. Um,e of the things that makes me sad is when somebody comes to me and they're willing to just for a second share, I don't know if I can keep doing this anymore.

Speaker 2 (35:35):

I've thought about just giving it all up and going back to a simpler way of life and the same sort of thing. It makes me sad. Cause it's like, no, no, no, no, no, we don't. We don't have to do that. Like, you know, you, we don't have to, we just have to find some balance, right? Like you said, we don't need to be on one extreme. We don't need to be on the other extreme. We need to be somewhere in the middle and finding that is like super, super small finite changes. It's not the giant crazy things that changes that we like to make in our lives that we, you know, we think are going to be the solution. Yeah.

Speaker 1 (36:10):

I, I agree a hundred percent. And I think on that note, because I could keep talking about this all day. It's sadly, I don't know if the listeners want to listen to it all day. I'll do. I think they might. But I feel like we could keep going on and on here. But that being said before we wrap things up, just a couple of other things, number one, what, what are some of the big takeaways, or if there's one in particular takeaway that you want the listeners to leave this conversation with?

Speaker 4 (36:46):

Wow.

Speaker 2 (36:47):

I wasn't prepared for that. Dr. Lindsay. There is what I would say. The big takeaway that I really hope everybody understands is that when we get out of our head a little more often and start listening to the messages of the body, start listening to the messages of within then we really activate that core confidence. We step into a more effective way of leading and living and that's available to everybody and it's time to take it. Beautiful.

Speaker 1 (37:26):

That's a beautiful takeaway. Now you're welcome. And then of course, the last question that I ask everyone is knowing where you are now in your life and in your career, what advice would you give to yourself right out of PT school, a newbie.

Speaker 2 (37:42):

Ooh. Oh, this is, this is a fun one. So when I was in PT school, I knew PT was going to be a jump jumping off point for me. Ubut I, I didn't feel confident in that. And so honestly, what I would have said to myself then is, you know, yeah, you're a little bit of a fish.

Speaker 1 (38:06):

Yeah. You're doing things a little bit differently

Speaker 2 (38:08):

And it's okay. Just own, own your worst, keeping you which I'm sure I've always been doing, you know, but, but really telling myself that and gifting that to myself, that it's okay. It all starts lining up just one step at one step at a time.

Speaker 1 (38:25):

Awesome. And where can people find you? So social media or what's the best way? Yeah. So the best to get in touch with you,

Speaker 2 (38:36):

There are just so many ways to get, to get in touch with me. Of course social media let's see Facebook and Instagram is dr. Sarah Smith official. I'm also on LinkedIn, dr. Sarah Smith. It is Sara without an H. Usually people always are putting an H on my name, which is like,

Speaker 1 (38:52):

Denise is a Sara without an H. So I am very well aware of it.

Speaker 2 (38:56):

Thank you. And then www dot dr. Sara, D R dr. Sarah smith.com awesome. And website.

Speaker 1 (39:06):

Perfect. And we will have all of those links up at the podcast website podcast at healthy, wealthy, smart.com under this episode. And you saw, you also have an activate core confidence workbook that dr. Sara has so generously given as a free gift. So if you go to www.dot dr. Sarah smith.com/core hyphen confidence, did I get it right? You did. Perfect. And again, that will also be in the show notes, if you want your free gift from dr. Sarah, which is very generous. Thank you very much for all of the listeners, go and grab it from the show notes. So Sarah, thanks so much. Like I said, I could talk about this forever. It'll turn into a therapy session and that's not what you're doing here. I will not take advantage of you in that way.

Speaker 2 (39:57):

We can, we can do it at that.

Speaker 1 (40:03):

Thank you so much for coming on and sharing all of your knowledge. I appreciate it.

Speaker 2 (40:07):

Oh, you're so welcome. Thank you for having me.

Speaker 1 (40:09):

Of course. And everyone listening. Thanks 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 twitterinstagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

 

 

Nov 5, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Smith, PT, DPT to discuss how women can cultivate their core confidence. Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically, women who wear many hats and desire to leave a legacy with less burnout and greater personal joy. 

In this episode, we discuss:

 

-How women focus attention on external approval and achievements/external successes.

 

-Why we need to be connected, aware and in tune with our pelvis.

 

-Messages the pelvis (and body) may be giving us that we are missing

 

-Core Confidence-what it is. why it is so important

 

-How does reducing urgency in daily life payoff- how the mental affects the physical body.

 

-How mental and spiritual Core Confidence and awareness of our Core can affect physical core strength.

 

Resources: 

 

Dr. Sarah’s Facebook

 

Dr. Sarah’s Instagram

 

Dr. Sarah’s LinkedIN

 

Activate Your Core Confidence Workbook

 

Discover Your Joy Coaching Session w/ Dr. Sarah

 

A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. 

 

More Information about Dr. Smith:

Dr. Sara Smith specializes in assisting female leaders, healers & creatives re-activate their Core Confidence. Specifically women who wear many hats and desire to leave a legacy with less burnout and greater personal joy. 

Her unique approach focuses on connecting women back to their Core which holds authenticity, choice and immediate solutions so one can thrive both personally and professionally in all life situations.

This activation is vital so that women leading their families, communities and companies can stay fully present in all situations in order to

  • Communicate & interact authentically and calmly
  • Finally feel their private life & success matches their professional success with greater freedom, confidence, peace, focus and direction.
  • Flow through daily tasks and commitments with more focus, ease and an organized plan
  • Improve physical strength & major health gains
  • Live Wild & Bright- meaning! connected to our true, authentic, soul calling

She has blended her professional expertise as a Doctor of Physical Therapy- specializing in Women’s Health and Chronic Pain Management, Certified Yoga Instructor & Certified Wellness & Life Coach. With every personal & group experience Dr. Sara Smith offers, she is dedicated to the goal of assisting women of all ages to step back into their Core Confidence.

 

Read the Full Transcript below:

Speaker 1 (00:01):

Hey, Sarah, welcome to the podcast. I'm happy to have you on,

Speaker 2 (00:04):

Thank you so much for having me, dr. Litzy. It's glad to be here.

Speaker 1 (00:08):

Yeah. And so obviously I'm a physical therapist as are you, you have specialized in pelvic health and women's health, and then you have also kind of made that transition for at least part of your career into coaching, mainly other women from around the world. So before we get into the meat of the interview, I would love for you to share with the audience a little bit about your sort of career trajectory.

Speaker 2 (00:40):

Absolutely. Yes. So it's a, it's a little professional and it's a little personal, so it's the story tends to track with a little bit of both. I also went and got my yoga certification and that was actually the first thing that I did after physical therapy, you know, from, from physical therapy. A lot of that came because you know, in our profession we have a high turnaround and burnout ratio there at times. And I was a chronic fixer and helper and I was good at what I was doing to the point where I, you know, anybody came in and I was ready to, you know, help them with their issue. And so I went to my first yoga class, really just to chill myself out, get a little bit grounded and get, get real. And then from there it really almost overnight, it, it drastically shifted the way I was showing up and treating my patients at the time.

Speaker 2 (01:42):

I realized that kind of less was more, I realized that it was more important for me to listen instead of coming in with a plan and, you know, my own action sheet and really meeting people where, where we were, I think I was always empathetic, but it, it really enhanced that. And on top of that, I stopped getting sick. I was averaging, you know, a sinus infection once a month and just burned out already and young because I didn't want to, you know, you didn't want to fail having that syndrome. So really yoga kind of came first and then that solidified me for a while. I kept into the physical therapy world. I've always lived in rural areas in Virginia and I was on the Eastern shore of Virginia and I'm an only child. So I do like to be the only one doing something I like to be a little special.

Speaker 2 (02:40):

And, and so I realized nobody in the area was doing pelvic floor work. I had in all of my internships had some sort of connection to pelvic floor and women's health work. So I, I learned about it. I kind of knew about it. I didn't know if that was something that I wanted to get into. But I knew that it was a niche in the area that I was in. And so it was when I got into pelvic floor physical therapy work that I really professionally started to see this and, and chronic pain management has always been something that I just love helping people that have been to lots of therapists, physical therapists, and in there need assistance with that. But I was just seeing this mind body connection. I was seeing how with all of these individuals, and for some reason, I just happened to be working with a lot of leaders, professionals, directors, CEOs, you know, it just was kind of happening that way.

Speaker 2 (03:41):

Even some like rockstars lawyers, I don't know, Olympic swimmers, all these different people and stress was also happening mentally. You know, there were things going on either in their personal life or their professional life. That just seemed to be kind of also coming into what I was noticing in their physical body. So I was learning about it personally and just my own interest. And then I also was seeing it professionally and I was seeing when I started incorporating some of the yoga, you know, some of the mindfulness based practices and stress management breathing that I was getting better results. And I just am a result junkie. You know, I'm not interested in putting a patch on something. I want somebody to come back to me six or seven or 10 years later and be like, I'm still using what you did. So there was that.

Speaker 2 (04:34):

And then on top of that what I got into pelvic floor therapy, my started having children and my, our, our first child who's now seven was we found out at a very young age that he had an ultra rare genetic mutation. So it was de Novo. It wasn't for my husband or myself and severe speech apraxia. So I started getting, you know, deep into the world of executive functioning and,ureally learning more and more about kind of, I always loved the nervous system, but, you know, I became even more fascinated with how to manage that,uand, and work with it. And so that, those two things kind of happening simultaneously are what brought me into, into coaching. Umnd specifically working with female leaders, hecause that, I don't know, that's just like a deep within personal mission is I feel like women are here to make a major contribution.

Speaker 2 (05:42):

I feel like the time, the time is ripe, the time is now. But we've learned and write in it in a great way. We've learned from a very male dominated structure,uwhich doesn't always work for women. And,uit can, it definitely works. It's not that it's, you know, not working, but there, there are some things that need to slightly shift and,uI'm just, I really want to be able to contribute to women, being able to be in these leadership roles and do it without as much burnout do it without as much self-sacrificing,ufamily sacrificing community sacrificing. Uso yeah.

Speaker 1 (06:32):

Awesome. Well, thanks for that. Thanks for kind of letting the listeners get a little bit deeper into kind of who you are and why you do what you do, because it all leads into our discussion today. And it's, it's really all about as you say, why we need to be connected, why we need to be aware and in tune with our pelvis. So as a physical therapist, we can all agree that yes, we need to be in tune with that area. Everyone has a pelvis, everyone has that musculature and, and the functions of but coming from, I think your unique perspective of both physical therapist and coach and looking really beyond just the pelvic floor, which we should all be doing anyway. So, so give us your take on why we need to be connected.

Speaker 2 (07:25):

Yeah. You know, I've seen in, in the realm of success, leadership, entrepreneurship anybody who's, who's type a you know, th there's a lot of overthinking long to do lists. There's a lot of being up in our head, you know, w where do we go next? And I say, we, because this, you know, I've, you're only a great teacher if you've been there yourself, right. And, and are still in the depths of it. And so, you know, we th there's lots, that's constantly swirling up in our head, but we also know, and, and, you know, a variety of different resource research sources have shown us this, that we can't access all of the solutions to our biggest professional, personal life challenges. If we're in constant thinking mode all day long, not to mention, you know, roughly 80% of all thoughts are habitually negative, which is not very helpful for solving problems. And so the reason that I am so drawn to what I call, you know, well, it's not just me calling it a core confidence and getting people specifically into their pelvis and back into their body is, is reducing the overthinking so that we can access again, creativity, focus, productivity, you know, improved, sleep, stress, relieving, you know, hormone responses. You know, I could, I could go on and on.

Speaker 1 (09:01):

Yeah. And so you brought up the, the the words, core confidence. So can you explain what, what does that mean? Because I have a feeling it may mean a couple of different things to a couple of different people, but in the work that you do in helping people become more productive, improve their leadership, improve their life, what does that, what does core confidence?

Speaker 2 (09:28):

Yeah. I love how you said that, you know, it means something to, there's lots of different ways to describe it in there. There really is. You know, to me, and also the, the clients that I've worked with for many, many years now, it means freedom. It means expansiveness. It means seeking joy. It means effectively, you know, being effective at what they do. Meanings means also having more energy core confidence really is being able to go within yourself and access that wellspring of inner wisdom really access your, your yes or no. And a lot of times, and this is, this is actually comes from, from those in the research field. Core confidence also is a mixture of self-efficacy of hope of optimism and resilience. External confidence. I don't think we should be talking about core confidence without also touching on external confidence and external confidence is what the majority of us learn to, to seek after.

Speaker 2 (10:43):

And we're constantly seeking after it. The external confidence is, you know, does dr. [inaudible] Like me, or, you know, what I should be doing right now, or, you know, these are the, the, the dreams that, that others are doing. So this marketing strategy has worked for them. This app has worked for them, let me do this, let me, you know, follow this meal plan. And so, you know, we're constantly as humans chasing others, things that have worked for them. And, and we're very often, again, not realizing we're up in our head and we're not really checking in with the, the little voice that's like, that's kind of a waste of time.

Speaker 1 (11:32):

Yeah, totally. I, I always find that it's so much easier to look for that external validation and get our confidence from that external validation, then what we do than what we think we are doing. Does that make sense? Solutely yeah, so I, I mean, and, and we're all human and all humans fall into that trap. So can you kind of give us an example of how you might work with someone to help develop this core confidence and help to bring in more joy and help get them a little more grounded into themselves? Are there any sort of exercises or things that you do with people that you can give this as an example? Yeah,

Speaker 2 (12:15):

That's a, that's a great you know, I I'd say one of the main tips that I, that is probably ended up being my, my signature Sarah move,uhas been really, you know, so listening to somebody, I really love deep listening. I mean, I think when you start listening to someone, at least for me, I don't know this is, this is, h gift that I have is I start reading between the lines. Umnd actually I'm kind of diverting for a moment. A lot of times when I work with people, I don't do it over zoom. We don't do video. Umecause when you look somebody in the eye, sometimes it's hard to be a hundred percent truthful, you know, or again, you kind of fall into the, the external competence trap. Umnd so we do it all over the phone or, you know, with the video off so that I can really deeply listen.

Speaker 2 (13:09):

And what I'll do is, you know, if there's a belief in there for example, I was working with somebody the other day and she shared, you know, while we were talking about her personal life. And and she was like, you know, if I kind of keep having these, these, if I close the door on this relationship, I'm probably actually going to have to do a lot of hard work on myself to pick up the pieces. And what I asked her was, well, well, is that true? That working on yourself has to be hard.

Speaker 1 (13:47):

And when

Speaker 2 (13:47):

We, I call it, like, we've got to, we've got to go. I like going down the rabbit hole with somebody of like, really being like, why, why are we fearful about this? Like, let's, let's talk about it. Let's get to the root and let's shine the light on what, what the narrative is with this overthinking piece. Once we shine the light on it, half of the work is done because we've brought in awareness. And whenever you bring in awareness works time.

Speaker 1 (14:18):

Absolutely. Yeah. And it's, it's, you know, that you're right. Being able to listen and listen well is a gift, but it's also something luckily that can be practiced and can be worked upon as physical therapists. I think a lot of us, a lot of us are pretty good at listening. But when you work with, like you said, that chronic pain population, you really get, I think, a lot more in tune to what the person is saying. And you also learn how to ask those questions to draw out more thoughts.

Speaker 2 (14:54):

Absolutely. Yes. And here's the interesting thing that I've found. Okay. and, and I, a lot of this comes from like archetypes and youngian psychology is we have different aspects of our, of our psyche and of our personalities. Right. And a lot of times what you'll find is we learn these skills, we practice these skills professionally, but when it comes to the, behind the scenes for ourselves, we're almost like different people. I had a client the other day, you know, she is a director and has, has a large, very well-known board behind her. And and she's like, you know, if the board was to be a fly on the wall and kind of experience my personal life, they they'd be like what, you're not even the same person. Because suddenly things become matters of the heart. They're no longer again, the, the head, you know, so professionally relating people through this very well yet, we're not really sometimes having that, that advisor, that best friend, that we didn't even know we needed behind the scenes to help us hash out our own stumbling blocks. And that's where I think in, in leadership and entrepreneurship and being a CEO of, you know, your business and your life and trying to be healthy, wealthy, and smart, I think that's, we need that now.

Speaker 1 (16:22):

And why do you think that's so hard

Speaker 2 (16:24):

To,

Speaker 1 (16:27):

To confide in others of, you know, it's, it's a lot easier to say, Oh, you know, I, I didn't have any new patients this month. So, you know, I really w what do you think, how can I help? How can I get more patients? That's easy, right. To talk about our business and, and to talk about our our professional life. But why do you think it's so hard for people to confide in others on a more personal level?

Speaker 2 (16:55):

Hmm. I love this question. I really love it. Of course, I'm sure it's very multifactorial. I find that I don't, you know, I don't have any research on this, but I find that if you start looking back even into it and not like massively, but you start looking back into childhood, you know, where a lot of habitual patterns are formed and thought patterns are formed. A lot of times you'll see, you'll see trends there, but, you know, one vein of research shows that about half of all CEOs, those at the top are experiencing loneliness and loneliness in the sense that, you know, there has to be a level of healthy ego and confidence, right? B core confidence or confidence in order to want to succeed. You know, all sorts of people are teaching us out there and showing us that, you know, you gotta have some grit, you gotta have some resiliency if you wanna play this game.

Speaker 2 (18:01):

And it is a game. And so, you know, there there's factors of like, you can't trust everyone, right. If you have team members underneath of you traditionally that's really changing, I think, but traditionally we're taught, you know, you don't mix business and personal life. You don't do that. That's a no, no. Now you'll see that changing. And that's continuing to change because you know, many psychologists are beginning to study really resiliency and entrepreneurship and, and understanding more specifically how they're tied together, because it's, th that's really just a new field of, of understanding. He can't trust people, you know, and I think many have experienced, again, maybe it was in the past or more recently you know, you do share some of those personal moments and it might come back to bite you or suddenly the, the inner critic and other thought thought in the brain comes up and says, Ooh, that was not a good idea. You're probably that is going to backfire. You know, that could make you look weak. So I think it's very multifactorial.

Speaker 1 (19:16):

And I guess this is kind of where having someone, you know, outside of your direct business to have as a resource and to help you as a coach I guess I would, I'm assuming that that's where coaching comes into play, because you can kind of be that person to sort of help with the personal and the professional, because I can only assume that they're closely related.

Speaker 2 (19:44):

Right. They are way more closely related than people realize. And your professional self that like the way you act professionally is often different than the way you act and your personal life. Like, can you, can you relate to that?

Speaker 1 (20:02):

Yeah, of course. Okay.

Speaker 2 (20:05):

And so, you know, cause I, I, yeah, same thing for me too, but I'm always interested, you know, in what, what somebody, his answer would be.

Speaker 1 (20:12):

Yeah, no, there's, there's no question that, that we're a little different in our personal life than in our professional life. And, you know, it's funny to say, because I was having thoughts around that yesterday. Because you know, we're all human, right? Every once in a while, like we screw something up, we say something we didn't want to say we regretted afterwards. And yet you're vilified for being a human being. You're vilified for saying something that, yeah, like maybe what you said, wasn't the best thing to say, but you take ownership over it. You say, Hey, listen. Like, yeah. I mean, I, you know, I let my emotions get the best of me, which never ever happens in my professional life. Right. Right. In my professional life never happens. And yet all of a sudden you're demoted in the eyes of so many people, but all you did was you were just a human being and you said something, or you wrote something that you later like, ah, I can't believe I did that. And because it's not a podcast, we can't go back and edit it out. So I think that there is this, this weird kind of, if you start to melt the two together, you're going to be screwed.

Speaker 2 (21:33):

Yeah. It's a way or another, it's a belief. Absolutely. And I think that we need guidance to blend them appropriately, you know, because the answer is not, well, you'll see this as a marketing strategy now. Right. Where it's like, okay, show the behind the scenes and show yourself and be yourself and dah, dah, dah. Well, I think that there's always a, a middle ground to all of that, that we need to be aiming for. And again, it has to feel true to you, you know, like you have to get back into a state of checking in with yourself and not checking in with the head and the thoughts of like, okay, is this an alignment for me? And so, you know, in a lot of cases when you're blood, when you're, I like drawing on the professional self, like let's say, I might say, okay, what would professional dr.

Speaker 2 (22:23):

Litzy do when we're talking about something personal, because that's how the, the, the two aspects of you can really start blending together and start working together as a team and be like an integrated, whole healthy, beautiful person, right. Uwho can stay true to your individual values? You know, we get to like explore what those individual values are and being true to those,uin, in order to make it work for us, I've ever really cool example of a client who,ushe's in the hospital system and I'm pretty high up. And she was offered. We had been working for, I don't know, probably three to six months or something we'd been, she had been, and we were mostly working in the personal field, you know, but of course the professional always, always blends in. And she had been offered this incredible opportunity to lead this team.

Speaker 2 (23:25):

This was just in addition to her goals that she already professionally had for the year. And as she sat with that, and as I sat with that with her, she realized, you know, if this had been last year, I would have said yes to that. And I'm very flattered, but the truth is, is if I say yes to that, then all that I'm doing to take care of myself so that I can show up to meet my professional goals is actually going to be derailed. And so at that moment, it wasn't in alignment for her. And what was even better about that was then she was able to go to her boss and to communicate that I call it like, you know, communicating from the core, but communicate that not from up in the head like, Oh, no, I wonder what I'm doing. I hope, you know, hope I'm not really screwing this up, communicating it with authenticity, with crowdedness, with strength, right. With empowerment. And, you know, her superior was like best decision you ever made. I really appreciate it. Really championed to her now, how awesome would that be if we could have more of that in our small businesses and in all of our workplaces and all of our organizations,

Speaker 1 (24:43):

I mean, that's an ideal situation when the ideal situation, but I think it's hard when you're constantly kind of seeking out success and seeking to be quote unquote the best at what you do and to get that recognition and to build your business and to make more money. So you can live the lifestyle that you want to live and provide for your family or your friends or whomever is in your, your world. But how does, how does making these decisions, like you said, these sort of more grounded decisions where, where they are emotional versus making these decisions as strictly like pros and cons, like an intellectual pro and con list, you know what I mean? So how do you, how do you coach people in that tug of war?

Speaker 2 (25:41):

I hope I can answer the question of how do you coach people, because sometimes you just have to see it, you know, and experience it. But you know if you look, if you talk to anyone in the financial world, the stock market is emotional emotions drive everything. That's true. Right. And you know, if we're the faster, we're aware of that, the more tapped in that, that we're going to be. And so that's actually, what's happening is a, is a lot of times where we're making these leadership decisions, we're making these personal decisions when we're in a state of emotion. And often when we're, you know, emotions are coming from thoughts, right. You know, you know, the, the, the little wheel starts going and then suddenly, you know, we have these emotions with us. A lot of times you don't even know what the sensation is in the body, because we're, again, we're kind of more of in the head.

Speaker 2 (26:36):

And so when you can access, and what I do is often just really helping somebody with very challenging. Like I prefer the challenging situations, you know, where it's like, okay, why do I keep getting into this relationship? Why do I keep not, you know, being able to climb the ladder? Why is it I can't get, get know fit in the self-care pieces of it. And when we get to the root of it, a lot of times it's because things are happening in an emotional realm. And we've got to be aware of that, go down the rabbit hole of the actual, like fear and worry. And why, like, why are we responding the way we're responding? Why are we doing that? And then once you get to that, then you can actually get to the clarity piece where you get the clouds and the, you know, the fog out from your face. Right. You can go, okay, pro this con this dah, dah, dah, dah. Okay. Now I've got my marching orders go. And I, I don't know about you, but I like marching orders. I like to know the next step.

Speaker 1 (27:37):

Yeah, absolutely. And, and I think, you know, a lot of people who are in leadership positions or who are going out to be that entrepreneur, their dreams, like you are a type a person. I think you are a lot of just pros and cons. But I do think that the emotional segment of things does have to come into play because if your pros and cons from a very sort of robotic sense is, is okay, I guess, but then how is it going to make you feel, how is it going to affect your life? Are you going to be happy with your decision? Are you doing something because you feel pressure to do it because you have to do it, quote unquote. So I think being able to tap into that core confidence in that and your core values in order to help you make decisions is important. So it's like, I don't want to be on either pole, like purely emotional, purely cerebral, but you want to have, you want to be able to kind of get in there and go down that rabbit hole, which is not easy and takes a lot of self-awareness.

Speaker 2 (28:44):

Yes, no, it does. And that's why it usually takes a guide. Yeah, exactly. It really does. It takes a guide and you know, again, kind of that core confidence model that was not created by me, but having self-efficacy hope, optimism and resiliency, you know, these are things with, with a lot of difficult situations that, that our, our brain just has not been able to figure out the answer to. We tend to go down on the scale of those things, right? We're not trusting ourselves efficacy. We're not feeling very hopeful about it now, fascinatingly enough, you know, those that are fixers and types day and, and, and leaders if we can't fix something, if we don't know the solution to it, we're going to avoid it

Speaker 1 (29:25):

Totally a hundred percent. So it was easier and it's so much easier.

Speaker 2 (29:30):

We are to, to help and to show up for others and to fix the things that we know we can fix. And so again, then you see an imbalance and often times it's with the most challenging things that dealing with, again, personally, or professionally that we don't want to talk about. One of my clients, the other day was sharing,uyou know, this situation just resolved, but she was like, you know, I have been sitting on this,uspace like this, this land and space for the last 10 years. And I didn't know what to do with it. Now, when we got to the root of it, it was actually extremely emotional because she's in a family owned business. And it was something that a family member prior to her set up and, you know, really loved. And so it, it, it, it was way too. She couldn't make the decision because of the emotions connected with it. Uyou know, but she was like, I've been sitting on this forever and just avoiding it because I don't know what to do. So I can think of 50,000 other things to spend my time doing. You know, you can fix the kids, you can fix your friends, you can bring it into your professional career. And then meanwhile, some of the, you know, the other aspects are, are, are missing.

Speaker 1 (30:44):

I know I, when I get into those, those bouts of, Oh God, I can, I like will. And it's what I'm doing right now, which is why, when you said that you could do so, so many things to avoid. I'm like redoing my bookshelves, I'm doing some shredding of papers. I'm like crazy with the home edit. And now everything's in a rainbow, you know, I've got a lot of plastic bins hanging out everywhere. That's what I do when I'm trying to like, avoid looking at deeply at other things, you know? So that's what I've been doing for the past couple of weeks is I have been like cleaning out. Like my doorman was like, are you moving? I was like, Nope, not moving. Just, just finding stuff to do around the apartment.

Speaker 2 (31:30):

Exactly. Just being a great, you know, leader in the liver of life.

Speaker 1 (31:35):

Yeah, exactly. Cause I'm like, well, you know, if you come home to a nice clean apartment, it's better for your head. You can concentrate more when, you know, I probably need to go dig a little deeper and see, why am I doing all of this? And I know it's not just from watching the home edit, although it's a nice show. I'm sure it goes a little deeper.

Speaker 2 (31:56):

Well, it does, you know, and I'm glad you brought that up, you know, your, your personal situation, because I think that that helps all of us so much, you know, it's always nice to know when we're not alone. Right. And but you know, one of the biggest things that I've found in doing this work for as long as I have is people say to me, yeah. You know, I just, you know, everything you do sounds really great. Like that sounds awesome. It sounds like it really be helpful for me. And like, I don't really think I will, but I don't really think I want to go there. Uand we think, again, we think it's going to be hard, right? Like I was mentioning the client, the client earlier,u

Speaker 3 (32:40):

I have found that,

Speaker 2 (32:44):

And I think this is just my personality, but it's like, we got to make this fun and we gotta make this. Or action-oriented we kinda got to get the show on the road. So it's like, you know, again, if, if we're, if we're trying to leave a legacy, if you're trying to, you know, be productive and not give up on the idea that we have, you know, have success, then we are in a state in our country and in the world where, where we, we, yes, we can all, you know, afford to sit down on the couch with the weighted blanket and the wine and the ice cream, you know, but, but I just don't believe that, that we can afford too much of that anymore. I really don't, you know, like I, I need, I really feel so strongly that like, I need everybody to be functioning at a high level and it, it can be fun.

Speaker 2 (33:40):

It doesn't have to be like, Oh gosh, I'm, I'm, doesn't have to be so stressful. Yeah. Or like annoying, you know what I mean? Like, nobody really wants to like, look at themselves and see their shortcomings. And it's not about that. Like anybody that's trying to tell you it's about that. Th that's probably just perfectionist behavior showing up. It's not about that. It's about like, you've got to tap into your greatness. And when I say your greatness, meaning like just our essence, like our purpose of being here on earth, like something greater than ourselves, we've got to tap into that. We've gotten away from that. You know, that, that radical act of self-love that that's not just let me go draw a bubble bath. You know, that that is radically like, you know, we're all beautiful and we're here to share something great.

Speaker 2 (34:37):

One of the, one of the most upsetting thing, NGS, m don't know if you've ever experienced this, but, you know, as a physical therapist, when somebody has, host a limb or their pelvic floor is not working and they're upset with, you know, they have prolapse and they're like, Ugh, Ugh, this uterus, or, you know, gosh, my arm just looks awful. Now that pains me to my soul because I'm like, Oh, you know, like, gosh, your body has done so many miraculous things. I understand. And I empathize why you feel that way, but it, it makes me sad. And one of the things that has made me sad and being, you know, an advisor and a best friend to, you know, leaders who didn't even know if they needed that. Um,e of the things that makes me sad is when somebody comes to me and they're willing to just for a second share, I don't know if I can keep doing this anymore.

Speaker 2 (35:35):

I've thought about just giving it all up and going back to a simpler way of life and the same sort of thing. It makes me sad. Cause it's like, no, no, no, no, no, we don't. We don't have to do that. Like, you know, you, we don't have to, we just have to find some balance, right? Like you said, we don't need to be on one extreme. We don't need to be on the other extreme. We need to be somewhere in the middle and finding that is like super, super small finite changes. It's not the giant crazy things that changes that we like to make in our lives that we, you know, we think are going to be the solution. Yeah.

Speaker 1 (36:10):

I, I agree a hundred percent. And I think on that note, because I could keep talking about this all day. It's sadly, I don't know if the listeners want to listen to it all day. I'll do. I think they might. But I feel like we could keep going on and on here. But that being said before we wrap things up, just a couple of other things, number one, what, what are some of the big takeaways, or if there's one in particular takeaway that you want the listeners to leave this conversation with?

Speaker 4 (36:46):

Wow.

Speaker 2 (36:47):

I wasn't prepared for that. Dr. Lindsay. There is what I would say. The big takeaway that I really hope everybody understands is that when we get out of our head a little more often and start listening to the messages of the body, start listening to the messages of within then we really activate that core confidence. We step into a more effective way of leading and living and that's available to everybody and it's time to take it. Beautiful.

Speaker 1 (37:26):

That's a beautiful takeaway. Now you're welcome. And then of course, the last question that I ask everyone is knowing where you are now in your life and in your career, what advice would you give to yourself right out of PT school, a newbie.

Speaker 2 (37:42):

Ooh. Oh, this is, this is a fun one. So when I was in PT school, I knew PT was going to be a jump jumping off point for me. Ubut I, I didn't feel confident in that. And so honestly, what I would have said to myself then is, you know, yeah, you're a little bit of a fish.

Speaker 1 (38:06):

Yeah. You're doing things a little bit differently

Speaker 2 (38:08):

And it's okay. Just own, own your worst, keeping you which I'm sure I've always been doing, you know, but, but really telling myself that and gifting that to myself, that it's okay. It all starts lining up just one step at one step at a time.

Speaker 1 (38:25):

Awesome. And where can people find you? So social media or what's the best way? Yeah. So the best to get in touch with you,

Speaker 2 (38:36):

There are just so many ways to get, to get in touch with me. Of course social media let's see Facebook and Instagram is dr. Sarah Smith official. I'm also on LinkedIn, dr. Sarah Smith. It is Sara without an H. Usually people always are putting an H on my name, which is like,

Speaker 1 (38:52):

Denise is a Sara without an H. So I am very well aware of it.

Speaker 2 (38:56):

Thank you. And then www dot dr. Sara, D R dr. Sarah smith.com awesome. And website.

Speaker 1 (39:06):

Perfect. And we will have all of those links up at the podcast website podcast at healthy, wealthy, smart.com under this episode. And you saw, you also have an activate core confidence workbook that dr. Sara has so generously given as a free gift. So if you go to www.dot dr. Sarah smith.com/core hyphen confidence, did I get it right? You did. Perfect. And again, that will also be in the show notes, if you want your free gift from dr. Sarah, which is very generous. Thank you very much for all of the listeners, go and grab it from the show notes. So Sarah, thanks so much. Like I said, I could talk about this forever. It'll turn into a therapy session and that's not what you're doing here. I will not take advantage of you in that way.

Speaker 2 (39:57):

We can, we can do it at that.

Speaker 1 (40:03):

Thank you so much for coming on and sharing all of your knowledge. I appreciate it.

Speaker 2 (40:07):

Oh, you're so welcome. Thank you for having me.

Speaker 1 (40:09):

Of course. And everyone listening. Thanks 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 twitterinstagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

 

 

Oct 26, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Helene Darmanin, PT, DPT, CSCS to the program to talk about physical therapy during and after pregnancy. Dr. Helene Darmanin is an orthopedic and pelvic health physical therapist with over a decade of experience facilitating healthy, empowering movement for her clients as a PT, and fitness and pilates instructor. Inspired by her own motherhood and ardent feminism, she specializes in preparing and healing pregnant and postpartum mamas.

In this episode, we discuss:

- Helene's experience with miscarriage, pregnancy, birth, postpartum

- Body positivity in pregnancy and postpartum and how it can optimize outcomes

- American College of Obstetrics and Gynecology guidelines for exercise while pregnant

- Reasons to go to PT when pregnant 

- Reasons to go to PT postpartum 

- And much more! 

Resources: 

When & Why To See A Pelvic Floor Physical Therapist

10 Ways to Love your Body

Helene's website

Helene's Instagram

Helene's LinkedIn

Helene's Facebook 

Danford Works 

A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. 

More Information about Dr. Darmanin: 

I am an orthopedic and pelvic health physical therapist who specializes in preparing and healing new and expectant mothers. I am currently seeing clients virtually through Danford Works, and am also the creator of Quarantoned, body-positive HIIT at home.

I practice guilt-free PT—physical therapy which fits easily into your day and improves your quality of movement and life. Research has shown that exercise and patient education are the two most effective interventions for positive long-term outcomes, and these can both be offered successfully virtually.

I have over a decade of experience facilitating healthy, strong movement in my clients' everyday lives. I have a Doctorate of Physical Therapy from New York University, and a Bachelors in Exercise Science from Smith College, and am a Certified Strength and Conditioning Specialist, and a Kane School-certified pilates mat instructor. I give workshops and webinars about fitness, pelvic health, and being guilt-free in your pursuit of wellness; I am published in peer-reviewed journals, blogs, and have presented at national conferences. Most importantly, I am a proud mama to my one year old son, and my calico cat.

Read the Full Transcript below:

Speaker 1 (00:01):

Hey, Helene, welcome to the podcast. I am thrilled to have you on welcome.

Speaker 2 (00:06):

Thanks so much, Karen. I'm so grateful to be here.

Speaker 1 (00:09):

And so today we're going to be talking about pelvic health or women's health after pregnancy, during pregnancy, which, you know, a lot of longtime listeners of this show will know that I've had a lot of episodes on this, but I'm particularly excited about this one, Helene, because you're going to, I think, bravely share a little bit about your story about your birthing experience and, and your experience with your body and how it changes and continues to change even after. So I'm just going to throw it to you and just kind of let you tell your side of the story. Thanks.

Speaker 2 (00:48):

Yeah, I know that in my, I have a my son is about to be one on Monday in just six days. So I know that in my time, since I gave birth or while I was pregnant hearing other women's stories always helped me to not, not feel alone, even though I knew what to expect because I specialized in pregnancy and postpartum long before I got pregnant. So I am really excited to share some of my story. The biggest, the biggest thing that, that happened when we first started trying to get pregnant was when we were trying to conceive and we got that positive pregnancy test. We were so excited. But then, and I remember, cause it was Thanksgiving. And all my family was so, so, so excited cause we shared right away. Cause I figured no matter what happened, I wanted to have the support of my loved ones.

Speaker 2 (01:43):

A few days after Thanksgiving, I started to have some bleeding and I started to have some cramping and it, it was before I had even gone for my first prenatal visit with my OB. And when I showed up for my first prenatal visit, she said, congratulations. I said, I'm pretty sure I'm having a miscarriage right now. And, and sure enough I did miscarry at about seven weeks which is early enough that some people don't even call it a miscarriage. It can be called a chemical pregnancy. My OB was incredible. And she said to me, they say, when it's this early, that you shouldn't be comforted because it was probably a chromosomal abnormality. And you know, it, it just naturally aborted itself. She said, but that didn't help me when I had two miscarriages. So I, I feel you that meant the world to me.

Speaker 2 (02:36):

Cause it was, it was it was a hard thing because we wanted the pregnancy so badly. And then actually I had a lot of trouble with continuing to bleed. And then I ended up needing an emergency DNC because I had a blood clot that was actually blocking the full shedding of the uterus. So that was, you know, in the midst of all the, the sadness, it was also scary and confusing. But I was really fortunate. I had some great practitioners and made it through, made it through. Okay. And then actually we were really lucky because we were able to conceive then the first month that we were allowed to start trying again, I had to get my normal period back, which took about six weeks and then we were able to start trying again. So I feel really fortunate that we were able to do that. And that time I texted my OB right away, I actually used progesterone depositories, which are really uncomfortable. They're like frozen popsicles of progesterone that you have to insert vaginally every night. There's really mixed evidence about them. There's nothing very conclusive, but my OB was like, it'll make you feel like you're doing something at bare minimum. You'll get that great placebo effect.

Speaker 1 (03:50):

And w what does it, what is the reasoning around using that?

Speaker 2 (03:55):

So there's some thought that the fetus won't implant, if the progesterone levels are too low, so you're causing a local increase in progesterone to help facilitate the fetus implanting. Got it.

Speaker 1 (04:06):

Got it. Okay. So sadly, you had a miscarriage, which, you know, for a lot of people listening to this, now, if you follow social media, we were talking about this before Chrissy Tiegen and John legend were very, very open about their miscarriage, which, which happened. I don't know how many months along she was, but enough. And that the comments were, Oh my gosh, I'm so glad you're, you're talking about this. No one talks about this. Women are so ashamed of it. Couples can be ashamed of it. Did you go through any of those feelings or was it like, okay, this happened full steam ahead. Let's keep trying, you know what I mean? I think you've got like both ends of the spectrum. Yeah,

Speaker 2 (04:51):

Yeah, yeah. I think I was somewhere middle of the road. I think I feel very fortunate that I'm was my awesome support network and my great care that I had from my OB and my acupuncturist to who I saw who helped me recover that I, I didn't feel guilty. I didn't feel like some I've I've heard people talk about feeling like their bodies had failed. But I did feel a lot of sadness. I didn't necessarily share right away, except for, with my very close circle. But I've certainly never kept it a secret. I've never felt like it was a shameful secret. And I I've always wanted to share it in case it does help someone else who has that experience, because as it turns out, the more I talked about it, the more women who I talked to said, Oh, yeah, that happened to me. Oh, that happened to me. Yeah. In fact, a lot of, a lot of my friends were like, I feel like over 30, the first one is like a trial run. And like, you kind of, a lot of women, their pregnancy was that chemical pregnancy or miscarriage.

Speaker 1 (06:01):

Yeah. So all of a sudden you're not quite so alone. Yes. Oh my goodness. Yeah. So, so now let's talk. So you get pregnant. So let's talk about your pregnancy, the birth postpartum, because all of this, part of your story, we're going to be tying into things that the listeners can do if they're in any of those phases.

Speaker 2 (06:24):

Yep, absolutely. So I was really lucky during the first trimester. I didn't have too much morning sickness, some slight nausea that usually eating a croissant helped. Unfortunately it was always a croissant. Well,

Speaker 1 (06:36):

Lucky you. Yeah. And

Speaker 2 (06:39):

But I was exhausted a hundred percent of the time. My first trimester, like I have always been super energetic. I've been a fitness instructor, like for my whole adult life. And I just wanted to sleep where I was standing all the time. So exercising was really difficult, which was hard for me because it's such a part of my life. And I would like put on an episode of Outlander and get on a stationary bike and be like, as long as your legs are moving, it counts. It's exercise, you know, was like no resistance on the bike. And that would be, I would get to my 30 minutes and counted as a win. So that, that was the first trimester. Second trimester is, was pretty awesome. That's kind of where it's at. Cause you're starting to show, which is fun. And then and energy levels come back up, but you're not like a whale yet, which is great.

Speaker 2 (07:32):

Well, by the end of the second trimester, when I was starting to get kind of big, then I started to have a very typical pregnancy symptoms of back pain. Interestingly my back pain was the worst kind of at that transition between the second and third trimesters. And then by the end of the third trimester kind of disappeared. My body kind of figured out how to be that size. I felt like I also had extreme swelling in my hands and feet. So I was wearing compression socks wearing wrist splints at night while I was having a lot of risk banks. I was actively working as a physical therapist on my feet and manually treating patients. So that was, that was hard to handle. I tried a cortisone shot, actually. I tried PT, of course. And then I tried a cortisone shot and none of that really helped. I had pretty bad carpal tunnel until I gave birth. And, and it would just like my hands and feet looked like little sausages, which was really pretty funny. And, and by the end of the third trimester, I was again, really tired, but I managed to work until I was 38 and a half weeks pregnant. On my feet demonstrating exercises, even though I gained well over the recommended amount and I gained 47 pounds, which interestingly was exactly what my mother gained with both her pregnancies

Speaker 1 (08:51):

Beard. And so what is the recommended? Isn't it like 20 to 35 or six 25

Speaker 2 (08:56):

To 35 is the midline though. The most recent American college of obstetrics and gynecology recommendation is anywhere from 11 to 40. So there's a little more acknowledgement that now there's a broader range that can be considered normal. Got it.

Speaker 1 (09:09):

Okay. Great. And so I think it's also, it's also good to note that what you were feeling back, pain, swelling, these are all, like you said, these are pretty typical, right? It's not outside the realm of, of normal to have these symptoms when you're pregnant. Right. Okay. So then you go in, you give birth. Yup. Yup. So,

Speaker 2 (09:30):

So I I had one day of false labor, which was very frustrating. I wanted that kid out by 39 weeks. I was like, Nope, done out. And then a week later I went into real labor. I had a doula, I was just ready to have my vaginal unmedicated birth. That's what I always wanted. I got to the hospital and luckily I was six centimeters dilated, which is when they consider active labor is starting. So they were able to keep me at the hospital, but Oh my goodness, was I tired? I started having contractions on a Friday, late morning, went into the hospital by about 3:00 AM, Saturday morning. I had gotten maybe three hours of sleep. My duals recommended that I sleep more and I was, and of course that's what I recommend to all my clients. And I was like, no, no, no, I don't need to sleep. I'm going to keep walking cause that'll help my labor progress. So I walked around my block 1 million times. And so by the time I got to the hospital, I was so tired. That's mostly what I remember is just being exhausted. And I had, you know, I advise on changing positions during labor and, and how to best facilitate things. And my doula was like, let's get on hands and knees. And I was like, Nope,

Speaker 3 (10:45):

Not moving. I am not moving.

Speaker 2 (10:49):

And then actually did have some complications during labor where my son had a cord wrapped around his shoulder. So every time I would push the cord would become compressed and his heart rate would drop. But my actually it wasn't my OB. I went in just after she got off call that night at midnight. And I got into the hospital at 3:00 AM. And let the OB who delivered me was sent Hastick. She was really, really fantastic and knew that I was really committed to having an unmedicated vaginal birth. So there was never a moment where she was not where she was considering anything else. She just kept kept me charging. And I ended up giving birth in exactly the position I didn't want to, which is lithotomy position. So on my back with my niece, Fred and doing directed bowel salvia breathing, which I also didn't want to do.

Speaker 2 (11:39):

Cause both of those things increase the likelihood of vaginal tearing. But it was the only way that we were going to get that kid safely out with his heart rate dropping. And, and we did, as she was, she was able to cut his before he was fully out and were able to get him delivered vaginally on medicated and safely. So that was, that was quite an experience. And it was really funny actually, my husband was like, yeah, like that's how you do it. You, you unmedicated. And he like, we're all these sissies who need, who need epidurals. And my doula was like, no, no, no, no, no, no. You don't understand. 90% of women in New York city get epidurals. Like your wife is nuts. So I was like, yeah, you don't get to judge. That's not an experience you'll ever have.

Speaker 4 (12:29):

Exactly. yeah. So it was, it was,

Speaker 2 (12:35):

It was a roller coaster and then I still didn't sleep because I was so excited about having my son. And so that was really like a crazy up and down day then that Saturday when he was born that morning. Yeah.

Speaker 1 (12:51):

Wow. That's dramatic. That's a lot of, that's a lot of drama for, for one birth. But it's, it's also, I mean, I can, I can imagine the relief of having him born safely and there you are, you're in the hospital, you take your baby home, you know, you're, you've been teaching other women on how to work with their postpartum bodies for a long time, but now let's talk about you get home and, you know, a couple of weeks go by and you have the, we all talk about the dad bod, but you know, there's like you have like the mummy tummy or the mom bod. So how do you, what advice do you have for people to kind of stay body positive during this whole period, whether it be during the pregnancy postpartum and, and what, what being body positive can do for you?

Speaker 2 (13:50):

Yeah. so I have always been an advocate of body positivity and this was the time in my life where I felt like it really paid off. In general, I think that body positivity creates this cycle of self-care where if you take care of yourself, then you feel good about yourself. And if you feel good about yourself, then you're more likely to take good care of yourself. And it becomes a very positive spiral. So I've often used that with my clients and and it was definitely my turn to use it for myself. I was a ballet dancer, so I definitely have had an awareness of body image for most of my life. When I was pregnant, I, I kept, I felt like when I was pregnant, it wasn't as hard to have positive body image because everyone was just telling you how beautiful you are and you're glowing.

Speaker 2 (14:43):

And it's so exciting and the thrill so you get a lot of positive reinforcement from outside, but I feel like a lot of that ends after you give birth. In fact, just, I was, we were just talking about the New York times in her words newsletter today was a mom who was talking about her experiences postpartum and saying that a lot of times, even if you had a complicated birth that you were in a lot of pain, people say, Oh, well, at least the baby's healthy and they completely brushed aside the mother and her experience and her symptoms. And I'm very much of the thought that, yes, it's wonderful, the baby safe and healthy, but in order to be a good parent and effective caregiver, you need to put on your own oxygen mask first. So starting to take good care of yourself and feeling good about yourself is going to make you a better parent in my opinion.

Speaker 2 (15:40):

Plus it's just it, regardless of your status as a parent, it's important for especially women because we're often ignored in this regard to feel good about ourselves. So in terms of staying body positive after I gave birth, I actually strangely I found it very helpful to spend some time like with my body and kind of noticing the changes. So I took a little longer in the shower where I w I would kind of be grateful to different parts of my body while I was showering, like, wow, thanks to my stomach that was able to stretch and hold my son, like thank you to my breasts that are able to produce breast milk and nourish my son. We did have a lot of struggles with breastfeeding. So I was very grateful when we got it down, Pat. And you know, I've got rid of a lot of clothing because anything that was squeezing me or making me feel uncomfortable you know, instead of trying to squeeze back into my old clothes where every time I would shift or move, I would feel like the pinching of my old jeans or you know, like the bra cutting into my sides.

Speaker 2 (16:52):

I got rid of all of that, unless I really thought it was realistic that in which case I put it aside and I didn't even look at it. I lived in leggings and nursing tops for at least three months because it was comfortable. So I wasn't constantly reminded that I was a different shape that I wasn't it wasn't my old body. And I, and then I started moving pretty early in my recovery. I was discharged with the hospital with the very old school instructions of you know, wait six to eight weeks before you start exercising. And then about three weeks I was losing my mind and I was like, Hey, wait a minute. I can give medical advice too. And I can exercise under my own medical supervision. So I I started exercising. I started really gently. And, but there's even, there's at least one study.

Speaker 2 (17:46):

I believe there are a couple studies that have shown that even one bout of exercise increase, improves your body image. So getting moving and feeling like I was in control of my body and really starting to feel what it was capable of for myself, not just feeling what it was capable of in terms of giving birth to a human, which was also incredible. But, but starting that again, feel like, Oh, look, I can lift this weight. I can do this movement. And, and all the positive feelings that come from exercise definitely also helped.

Speaker 1 (18:21):

Yeah. And, and kind of again, taking agency over your, over your body. And I really love the, you know, giving yourself a little extra love in the shower. I think that's great advice for anyone, if you had birth, if you gave birth or not, you know, sometimes just getting older things change, you know, and being able to acknowledge that things change and that's okay. And you're still, you know, in love with everything that you have. I love that. That's great advice. So now you talked about exercising. You sort of went back about three weeks after, but let's talk about exercising while pregnant. So there can college of obstetrics and gynecology. They put out guidelines on exercise. So do you want to kind of fill us in on maybe what those guidelines are so that if there are women out there listening that are pregnant at the moment, they can have a better idea of what they can and can't do.

Speaker 2 (19:20):

Absolutely. I'm really excited about them actually, because there are new ones this year that are much more forward thinking in their recommendations. So there has been a lot of fear-mongering about exercising while you're pregnant in the past. And this year, the recommendations are that virtually everyone can exercise while they're pregnant, whether you exercise before you were pregnant or not. They do recommend that everyone obtain a medical clearance first with a, with a thorough exam to talk about any possible medical complications that could arise from exercising. But you know, there used to be the wisdom used to be that if you didn't exercise before you couldn't start, while you were pregnant and they have completely changed that and they, even to the point where if you are an athlete or someone who regularly exercise at high intensity, they say that you can continue to do that through the third trimester safely.

Speaker 2 (20:20):

And they recommend exercise because it actually decreases the incidence of diabetes, of gestational diabetes and other blood pressure complications while pregnant like three clamps SIA. It decreases the likelihood of pre of giving birth preterm and decreases actually the incidents of low birth weight, interestingly, and it also decreases recovery time postpartum. So it improves postpartum outcomes kind of sets you up for success, especially during time where you might not have time or might not be able to exercise yet right after giving birth. And it actually increases the likelihood of having a vaginal birth. So if that's something you desire, exercise can help you get there. And it decreases the likelihood of postpartum depressive disorders. So those endorphins that you get while you're exercising kind of carry through to the postpartum period. Well, that's a lot of positives for exercising while pregnant. Are there any sort of big no-nos and on that,

Speaker 1 (21:18):

No, we're going to take a quick break to hear from our sponsor and be right back. This episode is brought to you by net health, helping you maintain strong relationships with your patients. The redox patient portal provides secure line of communication between you and your patients conduct virtual visits and have follow-up conversations with your patients via secure messaging. When it's convenient for you, patients have 24 seven secure on-demand access to their therapy, health information without phone calls and voice messages, video conferencing for telehealth, secure messaging, shared documents and photos and view health information, and appointments to learn more, contact them@redocatnethealth.com.

Speaker 2 (22:05):

A lot of it's on an individual basis and getting assessed by a PT who specializes is a great idea to see if you're able to still engage your transversus abdominis and see what positions might be best for you. If they do continue to recommend that you don't stay supine on your back for longer than two to three minutes, past 20 weeks of pregnancy, because you can become hypotensive because of the weight of the fetus on your on your blood supply. And they also recommend that you, they also really emphasize staying well hydrated. And if you're doing anything vigorous for more than 45 minutes to really make sure you have adequate calorie intake before maybe during and after to avoid hypoglycemia, which is not uncommon in pregnancy with my clients, I still recommend avoiding isometric exercises. So planks are awesome.

Speaker 2 (23:01):

Just make them dynamic somehow to help the body regulate the blood pressure, because it's just a lot of demand if you're holding a position and you're holding that tone in the muscles and you're trying to support a fetus it, it helps a little bit to keep those muscle pumps helping the blood pressure regulate. Besides that it's, it's on a very individual basis. It's what you're familiar with. It's how your pregnancy has been progressing. So it's really a good idea to talk to somebody. Okay. And speaking about talking to somebody, everybody who listens knows I'm a physical therapist, you're a physical therapist. So let's talk about reasons why women should go to a physical therapist when they're pregnant. I mean, it doesn't have to mean you, it doesn't mean you have to go every week of your entire pregnancy, but talk about why

Speaker 1 (23:47):

Every woman should be seeing a physical therapist when they are pregnant. Yes. Period.

Speaker 2 (23:53):

I love that. Yes, they should. So in the same guidelines this year, Aycock says that back pain has an incidence of about 60% in pregnancy, but that's extremely under-reported because most women just consider it a normal part of being pregnant. So I think back pain in pregnancy is pretty much universal. So that's one great reason to go to PT because it can help alleviate that back pain. And I did see a physical therapist myself when I was pregnant to help with the back pain. Also if you're having experienced experiencing things like sciatica wrist pain, which I had one kind of wrist pain while I was pregnant, different kind of risk pain after I gave birth, partly just because of the increase in fluid in the body. But then also changing joint mechanics because your ligaments are looser. If you have pelvic pain or pubic synthesis dysfunction, which you would know, cause your doctor would tell you, or you'd have a lot of fat in the front of your pelvis or even sprained ankles have a higher incidence in women who are pregnant. Because again, if those joint changes but also

Speaker 1 (24:57):

If you are having the perfect

Speaker 2 (25:00):

And see, which would be amazing and you have no pain whatsoever, you're that miracle person you can still help prepare for giving birth. There are PTs who specialize in helping with things like breathing, breathing techniques, preparing your pelvic floor muscles, and it might be a simple consultation. One time, two time to get some advice on, on what you can do to help yourself prepare. And also if you have any history of injuries or any current pain, then also PTs can help advise on what positions might be good for you and they can help coordinate with your OB or your midwife, whoever your burning professional is.

Speaker 1 (25:36):

Absolutely. And now all great reasons. Now let's talk about after you give birth the fourth trimester, right? So Aycock has came out with these guidelines about the fourth trimester. So first, can you tell us what the fourth trimester is for those who are not aware and then how, what is the physical therapist's role in the postpartum period?

Speaker 2 (25:57):

Absolutely. So fourth trimester kind of a tongue in cheek, a way of describing a three months after giving birth. Because the idea is that you're still, your body is still changing and your baby is also still changing a lot. There's some thought that when we were primates, our babies would have just dated for longer and come out further along, but our heads became too large and that's why babies started to be born earlier and earlier. So that's part of the reason that human babies are so vulnerable when they're born, as opposed to other species, like, you know, drafts who like pop out and run away from their mothers. And meanwhile, our kids can't, can't see, or

Speaker 1 (26:40):

Little blobs on my back. They're adorable blabs, but yeah,

Speaker 2 (26:44):

They, they can't do anything. So and one thing I hear a lot about the fourth trimester is women trying to get their bodies back which I need to bounce back quickly. I think it's just so depressing because, because you're not going back, why would we ever want to go backwards in your life? So why not take your body forwards with you? I love that. And, and you know what I, I will say just personally, like I, I gained, like I said, 47 pounds while I was pregnant. I have since lost all 47 pounds. I am still breastfeeding though. So we'll see what happens, but I am shaped totally differently than I was. And it's, it's not a good thing or a bad thing, at least to me, like it's just different. My body is totally different now. And that's, that's okay.

Speaker 2 (27:38):

You know, I, I'm really excited about what it can do. I love being a mom, so that's really important, but anyway, and physical therapy in the world of physical therapies. So again, it's a lot of similar reasons, usually back pain, but that can be again from a, it can be from how you gave birth. It can be from if you're, especially if you're still breastfeeding, you still have a lot of those quote unquote pregnancy hormones that cause the ligaments to be a little bit more flexible. Plus if you're breastfeeding the way that you're holding your child also if you're even just picking the kid up and down and getting on and off the floor and changing diapers, which can like, by the time they can turn over, sometimes it's like a circus you know, that that can cause back pain, wrist pain.

Speaker 2 (28:30):

And then of course you have your pelvic recovery, which I, for the first week, I, I don't think I was thinking about myself very much, but every once in a while I would realize that I felt like my vagina was on fire and sitting was horrible. It was the worst thing ever. I remember going, we were taking my son to his pediatrician, visit his first pediatrician visit. And I was sitting in the car like sideways on one butt cheek to try to avoid putting my perinatal area on the seat because it was so uncomfortable. So that, you know, that's normal for the first week, unfortunately even if you've had a Syrian birth that can you still have that huge change in, in your pelvis after it, no longer has this weight on it. And you have all these hormones released, so it could still be very uncomfortable and tender in your perinatal area.

Speaker 2 (29:25):

But yeah, that, that brings me to another point. Scars are big thing that should be treated. You would treat a scar from any other surgery or massive injury. So I don't know why it's not routine to refer for scar therapy after if you've had any vaginal tearing with giving birth or if you've had a cesarean birth those scars that can really cause a change in function. They're not as elastic as the tissue around them. And that excessive tissue that's there can disrupt the function and cause a lot of discomfort. So I had grade two vaginal tearing because of my birth experience. And I, I saw a PT myself to have my scar tissue manually worked on and work on some release techniques from my pelvic floor, which was super tense because it was trying to hold everything together during that postpartum phase. So I'm not, and that also for me, I had pain with penetrative sex after, you know, you go to the opiate and they're like, yup, healed, done. Yeah. You know, go back to doing whatever you want. And I was, I was terrified of resuming sexual intercourse and I'm very grateful for my PT who helped me figure out how to comfortably and safely get back to, to having sex. Yeah.

Speaker 1 (30:52):

You know, all these things, like you said, like so many women are experiencing these things and I think it's so important to just vocalize that and put that out into the universe so that women could be like, Oh, wait a second. Oh, I can go to a PT and they can help with that. Or I can go to PT and they can help with incontinence afterwards, or they can help, you know, like you said, have sex with my husband or my partner afterwards. I mean, wow, this is revolutionary for a lot of women, you know, to know that this resource exists. And you just have to find that physical therapist, preferably one who is trained in pelvic health and who understands understands the pelvis in a more intimate way. And, and that doesn't necessarily mean that they're, your therapist has to be a woman. There are also men who specialize in pelvic health as well. So I want to give a shout out to all of our colleagues doing that around the country as well.

Speaker 2 (31:50):

Yeah. Oh, go ahead. Sorry. I was just gonna say you know, also there are PTs who have been trained in helping support breastfeeding in terms of what positions to use treating clog ducks, or even just education on you know, effective techniques. There's also pelvic organ prolapse and incontinence, as you mentioned, which can happen regardless of if you've had a child or not. And that can also be treated with physical therapy. Again, some incontinence after giving birth is actually normal for up to a month or two, but if you're still leaking after that, then you should definitely seek help. And again, even, even like you said, it was pregnancy like why every pregnant woman should get PT. Everyone should get some advice, professional advice on how to safely return to movement, whatever movement you want to do, whether it's, you know a yoga class or a couple of group fitness classes or going back to playing a sport. And that's, that's something where we that's something we specialize in is movement. Yeah.

Speaker 1 (32:51):

And, and in many countries it's, everyone goes to standard care. It's a standard of care, you know, and, and hopefully now that these are part of the guidelines by a cog, that that is something that will become a standard of care. You know, I interviewed dr. Camila Phillips, who is an OB GYN at Lenox Hill and she recommends all of her patients to see a PT and I love it. And that was awesome. Brilliant. But I don't know. She might be in the minority. I'm not sure I think she is, but, you know, experience. Yeah. But I just, I just love that she is so forward-thinking, and, and for women to know that you have all of these resources, it's so empowering to kind of help you back, get back to not get back to, but help you move forward. I love that. I almost say get back to, well, get back to doing what you like to do. Yeah, yeah, exactly. Get back to doing what you like to do and whether that be any kind of movement or running or, or a high intensity sports, you know, just because you have a child doesn't mean that, that you can't return to the things you were doing before. And I think that's where the PT comes in.

Speaker 2 (34:03):

Absolutely. And with the help of my PT and like my own expertise at like five months, I was back to boxing and high intensity interval training. And I will tell you though, the first time I tried to do a jump after giving birth, I mean, I don't, I don't remember how long postpartum I was, maybe three or four months. I was like, Oh my God, I am an elephant. Like, I just felt like I had no pep, no spring whatsoever. I felt like every time I landed, I was like sod. It took a good few months for me to feel like I had my, my spring back, my like pep in my step.

Speaker 1 (34:36):

Yeah. Yeah. And, and again, you know, this is, I think this is all great for people to hear. Like we don't, I think women don't give birth and then, you know, go back to like walking the Victoria secret runway show like Heidi Clume, you know, like it's, that's not normal. No, do that like four weeks after you give birth, not normal. Like that is an exceptional human being there who has very good genetics, I'm assuming. And also it's her job.

Speaker 2 (35:04):

Yes. And a lot of expensive support

Speaker 1 (35:07):

And a lot of expensive support that us average Joe's just do not have. Nope. Don't have it. All right. So Helene, what would you like to leave the listeners with, if you could leave them with, you know, your, your top tip or your takeaways from this? From our discussion here,

Speaker 2 (35:27):

That's a tough one because there's so many good tidbits in there. Yeah, I think my top tip is, is just to love, love where you are. I would love your body, where it is, love it for what it's done, love it for what it can do right now. And, and get some help if you need help loving it. If you need help you know, getting it to do what you wanted to do, there is so much help available. It's just a matter of finding it, which shouldn't be as difficult as it is, but it is there. Yeah.

Speaker 1 (36:01):

Fabulous. And now last question that I ask everyone, given where you are now in your life and in your career, what advice would you give yourself as a new grad fresh out of physical therapy?

Speaker 2 (36:15):

Cool. Well, I would say trust your intuition. My program was very into evidence-based physical therapy, which is awesome and everything should be grounded in evidence, but never forget that clinical expertise in clinical experiences, also a level of evidence.

Speaker 1 (36:36):

And I've heard that many times from people on the show.

Speaker 2 (36:40):

Sure. You have that. I've heard it. I've heard it on your show too.

Speaker 1 (36:43):

Yeah. Many times. Well now, where can people find you? Where can people get in touch with you if they have questions or they want to know what you're up to.

Speaker 2 (36:50):

Ah, great question. I'm on Instagram at Halloween B underscore PT. That's the best place to find me I'm currently practicing at Danford works. And so you can find me there or I would love to hear from anybody via email, it's HD the pt@gmail.com. Perfect.

Speaker 1 (37:10):

And we will have all of those links in the show notes for this episode at podcast at healthy, wealthy, smart.com. So if you didn't have a pen on you, you didn't write it all down. Don't worry. One click will take you to everything Helene. And I will say she also on her Instagram account, really great exercises, advice, and support. So if you're looking for for that, then definitely follow her on Instagram because you give a lot of great XYZ and support, especially for women throughout an after pregnancy. So definitely give her a follow on Instagram. So Helene, thank you so much for coming on. This was wonderful. And thank you for sharing your story because I know it's not easy. Thanks, Tara and everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

 

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Oct 22, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Haag to talk about exercise and urinary incontinence. This interview was part of the JOSPT Asks interview series. Sarah is the co-owner of Entropy Physiotherapy and Wellness in Chicago. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010.

In this episode, we discuss:

  • The prevalence of urinary incontinence
  • Is urinary incontinence normal
  • Pelvic floor exercises
  • Pelvic floor exam for the non-pelvic health PT
  • Sports specific pelvic health dysfunction
  • And much more

Resources: 

Entropy Physiotherapy and Wellness

JOSPT Facebook Page

JOSPT Journal Page 

More Information about Dr. Haag: 

Dr. Sarah HaggSarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010.  Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a  Registered Yoga Teacher.

Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.

Read the full transcript below: 

Read the Full Transcript below: 

Speaker 1 (00:06:25):

So, and hopefully it doesn't want to lose what we're doing here. We'll see. Okay. Going live now. Okay. Welcome everyone to JLS. PT asks hello and welcome to the listeners. This is Joe SPT asks the weekly chat where you, the audience get your questions answered. My name is Claire Arden. I'm the editor in chief of Joe SPT. And it's really great to be chatting with you this week, before we get to our guest. I'd like to say a big thanks for the terrific feedback that we've had since launching [inaudible] a week ago. We really appreciate your feedback. So please let us know if there's a guest that you'd like to hear from, or if you have some ideas for the show today, we're in for a very special treat because not only are we joined by dr. Sarah hake from entropy physio, but guest hosting [inaudible] asks today is dr. Karen Litzy who you might know from the healthy, wealthy and smart podcast. Dr. Lexi is also a new Yorker. And I think I can speak for many of us when I say that New York has been front of mind recently with the coronavirus pandemic. And I'd like to extend our very best wishes to everyone in New York where we're thinking of you. So I'm going to throw to Karen now. We're, I'm really looking forward to chat today on pelvic floor incontinence and exercise over to you, Karen.

Speaker 1 (00:08:25):

Hi everyone, Claire. Thank you so much. I really appreciate your giving me the opportunity to be part of J O S P T asks live stream. So I'm very excited about this and I'm also very excited to talk with dr. Sarah Hagar. Sarah is an educator, a clinician, and an author. She is also co-owner of entropy wellness and our physiotherapy and wellness in Chicago, Illinois, and is also a good

Speaker 2 (00:08:56):

Friend of mine. So it's really a an honor for me to be on here. So Sarah, welcome. Thank you so much. I was really excited that all this came together so beautifully. Yes. And, and again like Claire had mentioned, we're all experiencing some pretty unprecedented times at the moment. And the hope of these J O S P T asks live streams is to continue to create that sense of community among all of us, even though we can't be with each other in person, but we can at least do this virtually. And as Claire said, last week, we want to acknowledge our frontline healthcare workers and colleagues across the world for their dedication and care to those in need. And again, like Claire said before, a special shout out to my New York city colleagues, we are they are really working like no other.

Speaker 2 (00:09:52):

And I also want to acknowledge not just our healthcare colleagues and workers, but the scientists, the grocery store workers, the truck drivers the pharmacist, police, firefighter paramedics, they're all working at full capacity to keep the wheels turning around the world. So I just want to acknowledge them as well and thank them for all of their hard work during this time. Okay. So, like Claire said today, we're going to be talking about the pelvic floor, which is something Sarah loves to talk about because what I also, I also failed to mention is she is a certified pelvic health practitioner. So through the American physical therapy association. So she is perfectly positioned to take us through. And as a lot of, you know, we had, you had the opportunity to go onto Slido to ask questions. You can still do that. Even throughout this talk, just use the code pelvic that's P E L V I C, and ask some questions.

Speaker 2 (00:10:57):

So we do have a lot of questions. I don't know if we're going to get to all of them. So if we don't then certainly post them in the Facebook chat and maybe Sarah can find those questions in the chat below. And we'll try and get to those questions after the recording has finished. All right, Sarah. So like I said, lots of questions and the way the questions were, were written out, kind of corresponds quite well with maybe how you would see a patient in the clinic. So let's start with the patient comes into your clinic. They sit down in front of you. Let's talk about the words we would use in that initial evaluation. So I'll throw it over to you. Okay. So being a pelvic health therapist, obviously most people when they're coming to females, Things that happen in the pelvis, I like to acknowledge it, that there's a lot of things happening in the past. So I have

Speaker 1 (00:11:54):

Them tell me kind of what are the things that have been bothering them or what are the things that have been happening that indicate something might be going on? Like if something's hurting, if they're experiencing incontinence, any bowel issues, any sexual dysfunction. And, and I kind of go from there. So if the talk that's the title of the talk today includes incontinence. Continence is a super common issue that let's see in general might pop in. And if you would bother to ask there's actually, I think it's like one out of two people over 60 are experiencing incontinence of some kind. The answer is going to be yes, some, so you can start asking more questions. But starting out with what, what is bothering them is really what I like to start with. Then the next thing we need to know is after we vet that issue or that priority list of things that are bothering them in the pelvis, and it's not uncommon actually to have.

Speaker 1 (00:13:00):

So let's say they start with a discussion of incontinence. I still actually ask about sexual function, any pain issues, any bowel issues, just based on the innervation of the various, the anatomical arrangement of everything. It's not uncommon to have more than one issue, but those other issues might not be bothersome enough to mention. So it's kind of nice to get that full picture. Then the next thing we really want art. So there are times I've met women who come in and they're like, Oh yeah, you know, I have incontinence. And you're like, okay. So when did it start now? Like 25 years ago. Okay. Do you remember what happened then? Typically it was a baby, but sometimes these women will notice that their incontinence didn't happen to like four or five years after the baby. Hmm. So that's information, that's very help if they say my baby that was born six weeks ago, our interventions and expectations are going to be very different than someone who's been having incontinence for 25 years.

Speaker 1 (00:14:05):

So again, knowing how it started and when it happens, when the issues are happening, I just kind of let them, it's like a free text box on a form. Like just, they can tell me so much more excuse me. And when we are talking about things, we, I do talk anatomy. So when it comes to incontinence, I talk about the bladder and the detrusor, the smooth muscle around the bladder, the basically the hose that takes the urine from the bladder to the outside world. I do talk about the vagina and the vulva and the difference between the two. And then actually we do talk about like the anus and the anal sphincters and how all of that is is all there together and supported by the pelvic floor.

Speaker 1 (00:14:54):

Cause that's in physical therapy, it's going to be something with that pelvic floor or something. Drought, does it need to be more, more pelvic floor focused or does it need to be behaviorally focused, which is the case sometimes, or is it that kind of finding that perfect Venn diagram of both for those issues that the person's having? And let's say you're in a part of the world. One of the questions was what if you're I think this question came from Asia and they said, what if you're in part of the world where you have to be a little bit, maybe more sensitive around even the words that you use. I know we had gotten a question a couple of years ago about a woman in the Southern part of the United States that was from very conservative area. And do we even use these words with these patients?

Speaker 1 (00:15:48):

So what is your response to that? My response is that as healthcare providers, we are responsible, I think for educating people and using appropriate words and making sure people understand the anatomy like where things are and what they're supposed to be doing. However, definitely when I'm having this conversation with someone I want them to feel at ease. So like I will use the Ana vagina anus, anal sphincters Volvo, not, it's not a vagina, it's a Volvo it's on the outside. But then if they use different terms to refer to the anatomy, we're discussing, I'm happy to code, switch over to what they're most comfortable with because they need to be comfortable. But I think as, as again, healthcare practitioners, if we're not comfortable with the area, we're not going to make them feel very comfortable about discussing those issues. Right.

Speaker 1 (00:16:43):

And that makes a lot of sense. Thank you for that. So now let's say you, the person kind of told you what's going on and let's, let's talk about when you're taking the history for women with incontinence, especially after pregnancy, are there key questions you like to ask? Yes. So my, my gals that I'm seeing, especially when they're relatively relatively early in the postpartum period, are the things I'm interested in is did they experience this incontinence during their pregnancy? And did they have issues before pregnancy? And then also if this is not their first, tell me about the first birth or the, or the first two birth. So the first three birth to really get an idea of is this a new issue or is this kind of an ongoing marked by so kind of getting a bigger picture of it.

Speaker 1 (00:17:49):

And then also that most recent birth we want to know, was it vaginal? Was it C-section with vaginal birth? If there's instrumentation use, so if they needed to use forceps or a vacuum that increases the likelihood that the pelvic floor went over, went under a bit of trauma and possibly that resulted in a larger lab. And even if there isn't muscles, it's understandable that things might work well, if it's really small and if it's still healing you know, different, different things like that. So understanding the, kind of like the recent birth story, as well as their bladder story going back. So you've met first baby or before that first baby so that we know where, where we're starting from. And the, the reason why I do that is because again, if it's a longterm issue, we have to acknowledge the most recent event and also understand there was something else happening that, that we need to kind of look at.

Speaker 1 (00:18:58):

So would I expect it all to magically go away? No, I wouldn't. There's probably something else we need to figure out, but if it's like, Nope, this onset happened birth of my baby three months ago, it's been happening since then three months is, seems like forever and is also no time whatsoever. It took 10 months to make the baby. So it's you know, if you tear your hamstring, we're expecting you to start feeling better in three months, but you're probably not back to your peak performance. So where are we in that? And sometimes time will cure things. Things will continue to heal, but also that would be a time like how good are things working? Is there something else going on that maybe we could facilitate or have them reach continence a bit sooner. Okay, great. And do you also ask questions around if there was any trauma to the area?

Speaker 1 (00:19:56):

So if this birth was for example, the product of, of a rape or of some other type of trauma, is that a question that you ask or do you, is that something that you hope they bring up? It's, that's honestly for me and my practice, something, I try to leave all of the doors wide open for them to, to share that in my experience you know, I've worked places where it is on it's on the questionnaire that they fill out from the front desk and they'll circle no to, to any sort of trauma in the past.

Speaker 1 (00:20:34):

Yeah. They just, they don't want to circle yes. On that form. So and also I kind of treat everybody like they might have something in their past, right. So very nonjudgmental, very safe place, always making them as comfortable in a safe as possible. And I will say that there's anything I can do to make you feel more comfortable and more safe. We can do that. And if you don't feel safe and comfortable, we're not doing this w we're going to do something else. Cause you're right. That it's always one of those lingering things. And the statistics on abuse and, and rape are horrifying to the point where, again, in my practice, I kind of assume that everybody has the possibility of having something in their past. Okay, great. Thank you. And now another question that's shifting gears. Another question that came up that I think is definitely worthy of an answer is what outcome measures or tools might you use with with your incontinence patients? So with incontinence, honestly, my favorite is like an oldie buddy, but a goodie, like just, it's an IC, it's the international continents questionnaire where it's, I think it's five or six questions. Just simple. Like how often does this happen? When does it happen?

Speaker 1 (00:21:58):

There's a couple of other outcome measures that do cover, like your bladder is not empty. Are you having feelings of pressure in your lower abdomen? It gets into some bowel and more genital function. Can you repeat that? Cause it kind of froze up for a second. So could you repeat the name of that outcome tool as it relates to the bladder and output? Oh, sorry. I see. IQ is one and then, but like I see IQ vs which renal symptoms, right? So there are, there's a lot of different forms out there. Another one that will gather up information about a whole bunch of things in the pelvis is the pelvic floor distress bins questions about bowel function, bladder function, sexual function discomfort from pressure or pain. So that can give you a bigger picture. I'll be honest. Sometimes my, the people in my clinic they're coming in, and even though I will ask the questions about those things, when they get the, the questionnaire with all of these things that they're like, this doesn't apply to me. I'm like, well, that's great that it doesn't apply to you, but they don't love filling, filling it out. So sometimes what I will go with is actually just the pale.

Speaker 1 (00:23:24):

Can you say that again? Please help me. Oh yeah. Oh, so sorry. The patient's specific functional scale where, where the patient says, this is what I want to have happen. And we kind of figured out where they are talk about what would need to happen to get them there, but it's them telling what better. Right. Cause I've had people actually score perfect on some of these outcome measures, but they're still in my office. So it's like, Oh, I'm so patient specific is one of my one of my kind of go tos. And then there's actually a couple of, most of these pelvic questionnaires finding one that you like is really helpful because, because there's so many and they really all or discomfort. So if you have a really good ability to take a really good history, some of the questions on that outcome measure end up being a bit redundant.

Speaker 1 (00:24:26):

So I like, and you know the questions on there, make sure people are filling them out. You look at them before you ask them all the questions that they just filled out on the form for you. Yes. Good. Very good advice. So then the patient doesn't feel like they're just being piled on with question after question and cause that can make people feel uncomfortable when maybe they're already a little uncomfortable coming to see someone for, for whatever their problem or dysfunction is. So that's a really good point. And now here's a question that came up a couple of times, you know, we're talking about incontinence, we're talking about women, we're talking about pregnancy. What about men? So is this pelvic floor dysfunction? Is this incontinence a women only problem? Or can it be an everybody problem? So it very much can be an everybody problem. Incontinence in particular for men, the rates for that are much lower. And typically the men are either much older or they are they've undergone frustrate removal for prostate cancer.

Speaker 1 (00:25:33):

Fleur plays a role in getting them to be dry or at least dryer. And then it's like the pelvic floor is not working right. That can result in pain. It can result in constipation. It can result in sexual dysfunction. It can result in bladder issues. So it's, so yes, men can have all of those things. In fact, last night we had a great talk in our mentorship group at entropy about hard flacid syndrome. So this is a syndrome with men where everything is normal when they go get, get tested, no no infections, no cancers, no tumors, no trauma that they can recall. And, but the penis is not able to become functional and direct. And with a lot of these men, we're finding that it's more of a pelvic floor dysfunction issue, or at least they respond to pelvic floor interventions.

Speaker 1 (00:26:30):

So having a pelvic floor that does what it's supposed to, which is contract and relax and help you do the things you want to do. If, if we can help people make sure that they're doing that can resolve a lot of issues and because men have pelvic floors, they can sometimes have pelvic floor dysfunction. Okay, great. Yeah. That was a very popular question. Is this a woman only thing? So thank you for clearing up that mystery for everyone. Okay. So in going through your evaluation, you've, you've asked all your questions, you're getting ready for your objective exam. What do you do if you're a clinician who does not do internal work, is there a way to test these pelvic floor muscles and to do things without having to do internal work? My answer for that question is yes, there are things that you can do because even though I do do internal exams, I have people who come to see me who are like, no, we're not doing that.

Speaker 1 (00:27:31):

So, so where can we start? And so the first one is pants on and me not even touching you pelvic floor, I wouldn't really call it an assessment or self report. So even just sitting here, if you, if you were to call me up and and this actually goes into, I think another question that was on Slido about pelvic floor cues. So there is actually then it seems more research on how to get a mail to contract this pelvic floor then actually females. But I would ask you like like this is one that my friend Julie, we would use. So like if you're sitting there and you just sit up nice and tall, if you pretend you're trying to pick up a Ruby with your PA with your vagina is not on the outside, but imagine like there's just a Ruby on the chair and you'd like to pick it up with no hands, breathe in and breathe out and let it go. So then I would go, did you feel anything and you should have felt something happen or not. So if, if you did it, would you mind telling me what you built? You're asking me, Oh my goodness. Oh yes. I did feel something. So I did feel like I could pick the Ruby up and hold it and drop it.

Speaker 1 (00:29:04):

Excellent. And that's, and that, that drop is key. Excellent. So what I would say is this is like like a plus, like a, I can't confirm or deny you that you did it correctly, but I like, I would have watched you hold your, like she holding my breath. Is she getting taller? Cause she's using her glutes. Did she just do a crunch? When she tried to do this, I can see external things happening that would indicate you're might be working too hard or you might be doing something completely wrong. So then we'll get into, I mean, you said, yes. I felt like I pick up the Ruby, but if it's like, Hmm, I felt stuffed, but I'm not really sure we would use our words because they've already said no to hands to figure that out. But again, I can't confirm it. People are they're okay with that.

Speaker 1 (00:29:48):

And I'm like, and if what we're doing based on the information you gave me, isn't changing, we might go to step two. If you can send in step two is actually something, any orthopedic therapist honestly, should not feel too crazy doing. So if anyone has ever palpated the origin of the hamstring, so where is the origin of the hamstring facial tuberosity? If you go just medial to that along the inside part get, don't go square in the middle. That's where everyone gets a little nervous and a little tense, but if you just Pell paid around that issue, tuberosity it's pretty awesome. If you have a, a friend or a colleague who's willing to let this happen is you ask them to do a poll of our different cues with that in a little bit. You say that again, ask them to do what to contract the pelvic floor.

Speaker 1 (00:30:44):

Okay. And again, figuring out the right words so that they know what you're talking about. We can talk about that in a minute, but if they do a pelvic floor contraction, you're going to feel kind of like the bulging tension build, right there may be pushing your fingers. You should feel it kind of gather under your fingers. It shouldn't like push your fingers away, but then you can be like, well, you could test their hamstring and see that you're not on the hamstring and you can have them squeeze your glutes and you can kind of feel the differences. The pelvic floor is just there at the bottom of the pelvis. So you can palpate externally, even through BlueJeans is a bit of a challenge, but if they're in you know, like their workout shorts for yoga pants, it's actually very, very simple. And, and honestly, as long as you explained to them what you're doing and what you're checking for, it's no different than palpating the issue of tuberosity for any other reason.

Speaker 1 (00:31:36):

And with that, I tell them that I can, it's more like a plus minus, so I can tell that you contracted and that you let go. That's all I can tell. So I can't tell you how strong you are, how good your relaxation Wells, how long you could hold it for any of those things. And then I tell them with an internal exam, we would get a lot of information we could, we can test left to, right? We can, I could give you more of like a muscle grade. So like that zero to five scale be use for other muscles. We can use that for the pelvic floor. I can get a much better sense of your relaxation and see how was that going and I can even offer some assistance. So so we have two really good options for no touching.

Speaker 1 (00:32:19):

And then just as long as we understand the information we might gain from an internal exam, we can, we can, the information we gathered from the first two ways, isn't sufficient to make a change for them. And then as let's say, the non pelvic health therapist, which there might be several who are gonna watch this, when do we say, you know, something? I think it's time that we refer you to a pelvic health therapist, because I do think given what you've said to me and you know, maybe we did step one and two here of your exams. I think that you need a little bit more. So when do, when is that decision made to reach the point of, they have a bother that I don't know how to address so we can actually go to like the pelvic organ prolapse. So pelvic organ prolapse is, is when the support for either the bladder, the uterus, or even the rectum starts to be less supportive and things can kind of start to fall into the vaginal wall and can give a feeling of like pressure in with activity the sensation can get.

Speaker 1 (00:33:39):

So then we have two options, which is more support from below with perhaps a stronger meatier pelvic floor by like working it out to hypertrophy. So like if, if I had someone who had that feeling when they were running and we tried a couple are lifting weights, let's go lifting weights. No, like I feel it once I get to like a 200 pound deadlift. Okay, well, let's see how you're lifting when you're doing 150 and let's take a look at what you're doing at 200 in fresh with your mechanics or what's happening. And if there's something that is in your wheelhouse where you're like, well, can you try this breath? Or can you try it this way and see if that feeling goes away? I'm good with that. And if the, that the person who's having issue is good with that. Awesome. But if you're trying stuff or the incontinence is not changing, send them to a pelvic floor therapist, because what we love to do is we can check it out.

Speaker 1 (00:34:41):

We're going to check it out. We're going to give some suggestions. And then my, the end of every one of those visits that I get from my, from my orthopedic or sports colleagues is I'm like, excellent. So you're going to work on this, keep doing what you're doing. Cause another really common thing is like, is I don't really believe that they can make a lot of these things worse doing the things that they're doing. And by that, I mean, they can become more simple MADEC, but in many cases you're not actually making the situation worse. So if the symptoms seem to be not getting better or even getting worse, doing the things they're doing, they go come back to the pelvic floor therapist. And then that pelvic floor therapist also has a responsibility that the things I'm asking them to do, isn't helping them get there.

Speaker 1 (00:35:29):

You can try something a little more intense, still not helping. Then that's when I actually would refer for females, especially with like pelvic pressure. So Euro gynecologist for an assessment in that regard. Yeah. So I think I heard a couple of really important things there. And that's one, if you are the sports therapist or the orthopedic physiotherapist, and you have someone that needs pelvic health support, you can refer them to the pelvic health therapist and you can continue seeing them doing the things you're doing. So just because they're having incontinence or they're having some pressure, let's say it's a pelvis, pelvic organ prolapse. It doesn't mean stop doing everything you're doing.

Speaker 3 (00:36:12):

Okay.

Speaker 1 (00:36:15):

Correct. Okay. Yeah. It may mean modify what you're doing. Stop some of what you're doing, listen to the pelvic floor therapist. And I'm also seeing, well now we're, aren't we this great cause we're creating great team around this, around this person to help support them in their goals. So one doesn't negate the other. Absolutely correct. And I, and I think too often even, even within the PT world is people start to get kind of territorial. But it's not about what each one of us is doing. It's that person. Right. so telling them to stop doing something, especially if it's something they love it seems like a bad start. It's like, okay, let's take a look at this. Tell me what you are doing. Tell me what you want to be doing. Tell me what's happening when you do that. And let's see if we can change it.

Speaker 1 (00:37:02):

Cause like I said, like the, the other, that being something they're going to make worse and worse and worse is if symptoms get worse and worse and worse, but they're not causing damage, they're not causing, I mean, what they're doing and say leaking a bit. Got it. And now I'm going to take a slight detour here because you had mentioned pelvic organ prolapse. You had mentioned, there comes a time when, if that pressure is not relieving, you've tried a lot of different things. You would refer them to a urogynecologist now several years ago. They're so you're, you're a gynecologist. One of their treatments might be surgery. So there was pelvic mesh sweats. It's hard to say pelvic mesh surgery that years ago made some people better and made some people far, far worse with, with some very serious ramifications. So can you talk about that pelvic mesh mesh surgery and where we are now?

Speaker 1 (00:38:04):

Oh, the last bit cut out a little bit. So the pelvic mess, mess surgery and, and Oh, the most important part and kind of where we are now versus maybe where we were, let's say a decade ago or so. Awesome. Yeah. So, so the pelvic mesh situation certainly here, I think it's not a universal problem. I think it's a United States problem is if you're at home during the day, like most of us are now you will see law commercials, lawyers looking for your business to discuss the mesh situation on what's happening is there was there were, it was mesh erosion and the resulting fact that that was a lot of pain because they couldn't just take it all out. And it was several women suffered and are still sad.

Speaker 3 (00:38:55):

Mmm.

Speaker 1 (00:38:55):

But that was from a particular type of surgery with a particular type of surgical kit, which thankfully has, was removed completely from the market and isn't being used anymore and mesh surgeries, I would say at least for the last five to 10 years, haven't haven't been using that and mesh surgeries are being done with great success in resolving symptoms. So I think it's important that if a woman isn't responding

Speaker 3 (00:39:27):

Yeah.

Speaker 1 (00:39:30):

Well changing their breath or making a pelvic floor or changing how they're doing things is to have that discussion with the Euro gynecologist because they do have nonsurgical options for super mild prolapse. There are some even like over the counter options you can buy like poise has one where it's just a little bit of support that helps you. Actually not leak because if you're having too much movement of the urethra, it can cause stress or it can be contributing to stress incontinence. But so there's some over the counter things or there's something called a pessary, which I think about it. Like I'm like a tent pole, but it's not a pole. It's a circle don't worry or a square or a donut. There's so many different shapes, but it's basically something you put in the vagina and that you can take out of the vagina that just kind of holds everything back up where it belongs, so it can work better.

Speaker 1 (00:40:21):

And that it's not awesome. But there are also people who are like due to hand dexterity, or just due to a general discomfort with the idea of putting things in their vagina and living them there that they're like, no, I'd rather just have this be fixed. So, so there are, it's not just surgery is not your only option. There are lots of options and it just depends on where you want to go. But with the surgery, if that's what's being recommended for a woman, I really do. Some women aren't worried at all. They've heard about the mash, but they're sure it won't happen to them, but there are when we're still avoiding surgery, even with significant syndromes, because they're worried about the mesh situation. And I would still encourage those women to at least discuss us, to see if that surgeon can, can educate them and give them enough confidence before they move forward with the surgery.

Speaker 1 (00:41:18):

Because the worst thing I think is when I had one patient actually put it off for years. Not, not just because of the mesh because of a lot of issues, but the first time the doctor recommended it, she had a grade four prolapse. Like that means when things come all the way out. And she it was so bad. Like she couldn't use the pastory okay, so she needed it, but she avoided it until she was ready and had the answers that made her feel confident in that having the surgery was the right thing to do. So it might take some time and the doctor, the surgeon really should, and most of them that I've met are more than happy to make sure that the patient has all the information they need and understand the risk factors, the potential benefits before they move forward.

Speaker 2 (00:42:03):

Excellent. Thank you so much for that indulging that slight detour. Okay. Let's get into intervention. So there are lots of questions on Slido about it, about different kinds of interventions. And so let's start with lot of, lot of questions about transverse abdominis activation. So there is one question here from Shan. Tall said studies in patients with specific low back pain do not recommend adding transverse abdominis activation because of protective muscle spasm. What about urinary incontinence in combination? What do you do? So there is a lot on transfer subdominant as you saw in Slido. So I'll throw it over to you and, and you can give us all your share your knowledge.

Speaker 1 (00:42:55):

Okay, well, let's all do this together. So I don't know how many people are watching, but if we just sit up nice and tall and I'm going to give a different cue for the pelvic floor. So what I want you to squeeze, like you don't want to urinate, like you want to stop the stream of urine. Okay. So as we're pulling that in anything else other than the underneath contract, what did you feel Karen?

Speaker 2 (00:43:24):

Well, I did feel my TA contract. I felt that lower abdominal muscle wall started to pull in.

Speaker 1 (00:43:32):

Yes. So, so the, the way I explain it is that the pelvic floor and the trans versus are the best is to friends. And this makes sense when you think about when you remember the fact that the pelvic floor, isn't just there regarding like bowel bladder and sexual function. It's one of our posture muscles. So if we're totally like, like slacked out and our abs are off and all of that, our pelvic floor is pretty turned off as well. And then if I get a little bit taller and like, so I'm not really clenching anything. Right. But this is like stuff working like it should, my pelvic floor is a little more on, but not, I'm not acting. It's just but then I could like, right, if I'm gonna, if I'm expecting to hit, or if I'm going to push into something, I can tend to set up more and handle more force into the system.

Speaker 1 (00:44:21):

So I like to think about it in those in those three ways, because the pelvic floor, isn't just hanging out, down there and complete isolation it's, it's part of a system. And so in my personal, like emotional approach to interventions is I don't want them to be too complicated. So if I can get someone to contract their pelvic floor, continue to breathe and let go of that pelvic floor, then we start thinking about what else are you feeling? Cause I don't know that there's any evidence that says if I just work my transverses all the time, my pelvic floor will automatically come along for the ride. So a great quote. I heard Karrie both speak once at a combined sections meeting and she goes, your biceps turn on. When you take a walk, it's not a good bicep exercise. So just the fact we're getting activity in the pelvic floor when we're working other muscles, what's supposed to work. And also if you want to strengthen that muscle, you're going to need to work out that muscle.

Speaker 1 (00:45:26):

And that makes a lot of sense and something that people had a lot of questions around where we're kind of queuing for these different exercises. And I really love the can. You've made it several times comparisons to other muscles in the body. So can you talk about maybe what kind of queuing you might use to have someone on? I can't believe I'm going to say this turn on and I use that in quotes because that's what you see in, in a lot of like mainstream publications for, for layman. So it might be something that our patients may see when they come in. So how do you cue that? To, to turn on the pelvic floor? So honestly I will usually start with floor and I do if I'm able to do a public floor exam, that's usually, again, a lot more information for me, but I'm like, okay, so do that now.

Speaker 1 (00:46:27):

And I watched them do it or I feel them do it and I'd be like, Oh, okay. What did you, what did you feel move? And I start there. And then I always say it's a little bit, like I get dropped into a country and I'm not sure what language people are speaking. So sometimes excuse me, one of the first cues that I learned was like, so squeeze, like you don't want to pass gas. Okay. So everybody let's try that. So sitting squeeze, like you don't care and you got taller. So I think you did some glutes.

Speaker 1 (00:47:00):

It's like, OK. So like lift, lift your anal sphincter up and in, but activating mostly the back part. So if you're having fecal issues, maybe that's a good place to start, but most people are having issues a little further front. So then we moved to the, can you pick a upper with your, with your Lavia? I had a, I learned the best things for my patients. One woman said it's like, I'm shutting the church doors. So if you imagine the Lavia being churched doors, we're going to close them up. And that, that gives a slightly different feeling. Them then squeezing the anal sphincter. Now, if you get up to squeeze, like you don't want to like pee your pants, like you want to stop the stream of urine. That will activate more in the front of the pelvis. Look, men who are like if it gets stopped the flow of urine, I wouldn't be here.

Speaker 1 (00:47:57):

So what else do you get? What's really cool is in the male literature. So this is a study done by Paul Hodges is he found that what activated the anterior part and the urinary sphincter, this rioted urinary speaker, sphincter the most for men. What a penis or pull your penis in to your body now for women. So when I was at a chorus and it's like, so let's, let's think of like other cues and other words, but even if, so, I don't have a penis this fall that probably don't have a penis. Even if you don't have a penis, I want you to do that in your brain, shorten the penis and pull it in.

Speaker 1 (00:48:42):

And did you feel anything happen? Cause we do have things that are now analogous to the male penis, if you are are a female. So I'll sometimes use that. Like I know it sounds stupid, but pretend to draw on your penis and it works and it does feel more anterior for a lot of people. So I'll kind of just, I'll kind of see what's, like I said, sometimes it's like the 42nd way of doing it that I've asked them to do where they're like, Oh, that, and you're like yeah. So then also just another, it's a little bit of like a little bit of a tangent, but so as you're sitting, so if you're, if you're sitting I want you to pick the cue that speaks most to your pelvic floor, and I want you to slouch really, really slouch, and actually to give yourself that cue and just pay attention to what you're feeling. So when you squeeze, give yourself that cue, breathe in and breath out and then let go, we should have felt a contraction, a little hole and a let go. Now, the reason why I say breathe in and breathe out is if you breathe in and out, that's about five seconds and also you were breathing. Cause another thing people love to do when they're trying to contract their pelvic floors, just basically suck it in.

Speaker 1 (00:50:10):

And so that's, that's not great, but we want to feel the contraction and we want to feel it, let go. And that's super important. I think that was another question on the Slido is that yes. For any muscle we're working, you should be able to contract it and let it go. There's not a muscle in our body where I just keep it contracted. It's going to do much. It might look great. Eventually, but like I couldn't get my coat on, like getting a drink of water would be a little weird. It's not very functional muscles have to relax so that they can contract. So that's a big, yes, it's just as important that the contraction pelvic floor that cue and we felt where it happened, not tall, like, like you're sitting out at a restaurant and you just saw someone looking at you and you're like, Oh, what are they looking at? And then you're going to do the exact same cue and you're gonna breathe in and breathe out and let it go.

Speaker 1 (00:51:07):

And then did it feel different than menu or slouch that it did it change position? I feel like Karen's Miami. It feels different. Now what I want you to do is if you can, depending on how you're sitting really give me like an anterior pelvic tilt, really happy puppy and then do the exact same thing and then let it go. And so again, some more EMG work from, from Paul Hodges is that when you're in a posterior pelvic tilt, you tend to activate the posterior portion more, which is fine. And if you're not having problems in the front, if you're having problems activating and maintaining continence in the front, actually increasing that lordosis can favor the front a bit. So this is, that's really awesome when people can feel that difference. Because I want you to think about, if you start to leak on your fourth mile of a half marathon, there's no way, no matter how awesome you are, but you're going to be able to squeeze your pelvic floor for the rest of that race.

Speaker 1 (00:52:15):

Like there's just, there's no way. But sometimes if, because remember your pelvic floor is still doing its thing while you're running is if you're like, well, hold on, when you're at your fourth mile, are you starting to get tired or hopefully not if it's a half marathon, but you know, like is something changing and how you're using your body. And can you, when you get to that point, remember to stay tall or lift your tail a little bit, or is there a cue or something they can change that will help them favor the front instead of going about four steps with the contracted pelvic floor and then losing it anyway. So there's, there's a lot of different ways you can actually make that your intervention for the issue you're having and then let's just get it functional. Perfect. And since you brought up running a question that's been, got, gotten a couple of likes on Slido is how would you approach return to running after pregnancy?

Speaker 1 (00:53:15):

Do you have any tips on criteria for progress, timeframe and a recreational runner versus a full time athlete? Because I would think the majority of physiotherapists around the world are seeing the recreational runner versus the professional or full time athlete. So first, how would you approach return to running any tips for progress? So that's going to be after pregnancy, sorry. After pregnancy. Yeah. So this is where I was really excited. So just last year I'm going to say her name wrong, but Tom goom Gran Donnely and Emma Brockwell published returned to running postnatal guidelines for health professionals managing this population. And the reason why I was super excited is because even though it was just published last year, it's the first one. There was definitely a lot of emotion and feelings about, about women getting back into sport after having a baby, but to be perfectly Frank, there's very few actual solid guidelines for recreational or others.

Speaker 1 (00:54:30):

So I have not personally had a child, but I will tell you of all the women I've seen over the years, basically doctors are like, it's been six weeks ease back into it, see how it goes. I'm not really even mentioning if you have a problem come back so we can figure it out. It's just kind of like good luck with that. And as a result, what happens is a lot of women don't get back into exercise or they get back into exercise and and kind of freak themselves out because stuff feels different. So to get back to the question of what do I do, actually this this guide from Tom and team really, really helpful. I think, and, and it's just basically it's it does have a series of exercises that I've actually started to use with my postpartum moms to go like, look, if you can do these things without feeling heaviness, you're good.

Speaker 1 (00:55:30):

You're good to start easing back into your running program, but get up, get walking because I'm going to post Sandy Hilton and like, you can't rest this better, like just waiting, isn't going to make it all go away. But it can also be deceiving because again, with polo, you don't feel that heaviness and you don't leak. And so I'm just going to stay right here where everything is fine. So that's obviously not a good option longterm option for a lot of reasons. So, so what do I do? I do look at the patient's goals, their previous running history, and if they're having any options I recently had a patient who she was runner exercise or sr after baby number two for a bit, some feeling of happiness that got completely better, baby number three came along. So I saw her a bit while she was pregnant because she got, I think two thirds of the way through pregnancy before she started to feel that heaviness. Again, she was still running,

Speaker 1 (00:56:38):

Tried to see if we could change that feeling while she was running. And she could until about the, when did she start? I think she didn't stop running to her 35th week, which is pretty impressive. But then she wanted to do a half marathon. I think it was just three months postpartum. Right. So this is like going from having baby to running 13. You think that a lot of people would probably feel that was too soon, too much too fast, but she was able to do it completely symptom-free. So as she was training and she was really fast, she was timing it so that she could get back in time to breastfeed. Like I was like, Oh my gosh, like I, that would disqualify me. Like, there's no way I could run fast enough to make that happen. But she was able to, to work it out where she could perform at her level without symptoms. And I was really happy that I was able to support her in that she did all the hard work. For general people recreational, where you a runner before, or is this completely new and are you having any symptoms and is there any thing you're worried about? Again, a lot of women are worried about giving.

Speaker 1 (00:57:53):

It's actually really hard to perhaps to give yourself one baby babies are a great way to do it. But that's like the risk factors I look up for something else a couple of years ago, I haven't looked recently, but like you really have any prolonged lifting. So not like your CrossFit three days a week, but like your, your physical labor for eight, eight hours, 10 hours a day every day could eventually do it also having babies. So like once you get to every baby increases your risk of pelvic organ prolapse, which makes good sense. And that, and that is what it is. So kind of looking at what are their risk factors, are there any, and letting them know that if they feel it more, it doesn't mean they made it worse. They just made it more symptomatic. Got it. Great.

Speaker 1 (00:58:40):

All right. So we have time for maybe one or two more questions, and then I'm going to throw back to Claire. Cause we're coming up onto an hour here, maybe time for one more it's so w what am I going to ask? I think I'm going to go with the gymnasts I work with all believe it's normal to leak a little urine during training or competition. And this is something we talk about a lot. It might be common, but is it normal? You already gave me the answer. What is it, Karen? No, no, no. And so, yeah, so the, the short answer for that is no. Or I agree with the question where it is very, very, very common, and it is still, I would say, not to leak urine. Unfortunately, so there's any researchers out there who want to get together.

Speaker 1 (00:59:26):

Let me know. We haven't, we have information on athletes and incontinence, but mostly it's prevalent that it happens a lot and gymnastics and dancing and volleyball. There's, there's even some swimmers who have it, right? So there's, there's incontinence across the spectrum, which basically tells me, yep. People have incontinence. Some of the some of the sports are more likely to have urgent continents. A lot of them though, we're looking at stress incontinence, however, for none of the athletes, have, we really had a great study that says, this is what we're finding. We're thinking, this is the cause of this incontinence. And we certainly haven't gotten to the point where it's like, and this is what we should be doing for these women in particular. So I'm, I'm pretty curious as to what we would have to do as, as a profession, as, as a team with researchers to figure out what do we need to look at in these athletes, especially the female athletes, because most of these are also they've never had babies, right? So a lot of these athletes are the liberos. And so we can't, we can't blame them. There's something with how things are working. That seemed to be the situation it's not necessarily trauma or anything like that. So what do we need to look at? What do we think is happening? Can we measure it and assess it? And then can we get an intervention?

Speaker 1 (01:00:56):

My brain, obviously, something isn't working as well as it could. So could something like that improve their performance, even I don't, I don't know. I'd like to think so. Yeah. That would be distinct study. Yeah. But we ultimately don't know. So if anyone has any ideas for studies or doing studies, let me know, because I can't wait to read them. But I think maybe the first step is to let coaches and parents and young gymnast know very common. Don't be ashamed. Don't let it stop you from doing what you want to do. But also don't just ignore it. Maybe we can figure this out.

Speaker 2 (01:01:30):

All right. One more question with a short answer, if you can. So, and I'm going to ask this question because I feel like the person who posted this I think posted this in earnest. So that's why I'm asking, this is the last question. So a female patient age, 20 years still bedwetting from her childhood, otherwise she is normal, no incontinence. So other than this, just while sleeping, she tends to urinate any thoughts on this or any place you can direct this.

Speaker 1 (01:02:04):

Yeah. So I did, I was like, Oh, great question. And I did actually do a little research for this specific question. There's a lot of reasons why nocturnal enuresis, which is what bedwetting is called in the literature happens. And I think it's really important. So I don't know what kind of tests or studies this person has had done or what other issues they may be having. So things like sleep apnea is is something that could be related if there's any medications, any sort of diuretics, any kind of sleeping medications. Again, the fact it's kind of carried on since childhood, I, I would really wonder about how, how is the bladder functioning? The fact that it's working fine throughout the day makes me wonder what's changing at night. And I did find a study where it talked about when they look compared adolescents or adults who were bedwetting to people who weren't, they did have like detrusor overactivity. So like basically like an overactive bladder that they could see on the testing. So I would, I would really encourage this person to find a urologist that they trust if they haven't already and really to maybe investigate some of those other, other factors that could be contributing so that they can get some better sleep and not have that problem anymore.

Speaker 2 (01:03:28):

Excellent. Excellent. Oh, okay. Claire says we can go for one more question. So I'm going to listen to the boss here.

Speaker 1 (01:03:36):

And, Oh boy, are you ready? Because this is a question that did kind of get a lot of thumbs up. Okay. So we spoke about

Speaker 2 (01:03:44):

Briefly before we started.

Speaker 1 (01:03:47):

So let's see treatment of nonspecific, pelvic girdle pain, not related to pregnancy, which strategy with no susceptive pain mechanisms and which strategy with non nociceptive pain mechanisms would you incorporate with this patient? Okay. So I would say in the clinic, it's, it can be pretty hard. Like, I don't know how I would distinguish being nociceptive and non nociceptive or what even like non nociceptive might be if we're talking more central issues or stuff like that. I don't, I don't know. But honestly I would just look at, so in Kathleen's Luca has a great book about looking at the different types of pain or the different categories of pain and the most effective medications for it. Right. So we're really good in pharmacology. Like if you had this inflammatory process and, and inflammatory and anti-inflammatory should help, if you're having neuropathic pain, you want a drug that addresses that when we get into like physical therapy interventions, what's really cool is exercise is in all the categories.

Speaker 1 (01:04:59):

And it's one of the things we have the best evidence for. So regardless of pelvic girdle pain in pregnancy or not pregnancy, and regardless of how it may have been labeled by somebody else is I would, I would mostly want to know when did the pain start? Is there anything that makes it better? Anything that makes it worse and see if I could find a movement or change something for that person. Or that made me sound like I was going to do a whole lot of work. If I could find something for that person to change for themselves to have that hurt less and have the I tend, I would tend to keep it simple, mostly cause in the clinic again, we could do a lot of special tests that might say, Oh, Nope, they definitely hurt there, but it's still, if we're looking at what's going to be an effective intervention, that that patient is going to tell me what that is.

Speaker 1 (01:05:54):

Sorry. It would help a fire mute myself. So looks like we have time for one more. And I, I really, Claire was not clarity did not pop up yet. So we've got time for one more and then we're going to work. We're wrapping it up. I promise stroke patients, dementia patient. We just got the no go. Yes, no, it's a super short answer if you want Claire super short answer. Okay. So stroke dementia patients with urinary incontinence, any useful ideas for the rehab program? Yes, but not get an idea of their bladder habits, their bowel habits, their fluid intake. Because a lot of that's going to end up being outside caregiver help with the, with the stroke, it's much different. It depends on the severity and where it is and all of that. But for people with dementia is if you just get that, like if you can prompt them or take them to the toilet, a lot of the times that will take care of the incontinence.

Speaker 1 (01:06:48):

It's not a matter of like Cagle exercises. It's more management. All right, Sarah, thank you so much. I'm going to throw it back over to Claire to wrap things up. Thank you both for a wonderful and insightful discussion. Sarah and Karen. So many practical tips and pointers for the clinician, especially I was loving learning about all of the things that I could take to the clinic. So I hope our audience find those practical tips really helpful as always the link to this live chat will stay up on our Facebook page and we'll share it across our other social media channels. Don't forget. You can also follow us on Twitter. We're at Dow SPT. You can also follow us here on Facebook. Please share this chat with your friends, with family colleagues, anyone who you think might find it helpful. And if you like JSP T asks, please be sure to tell people about it at that what we're doing so they can find this here, please join us.

Speaker 1 (01:07:46):

Next week when we host our special guest professor Laurie from the university of Southern California, Larry is going to be answering questions on managing shoulder pain. We'll be here, live on Wednesday next week. So Wednesday, April the eighth at 9:00 AM Pacific. So that's noon. If you're on the East coast of the U S it's 5:00 PM. If you're in the UK and at 6:00 PM, if you're in Europe, before we sign off for the evening, there's also really important campaign that I'd like to draw your attention to. And it's one that we at Joe SPT supporting and it's get us PPE. So we're supporting this organization in their quest to buy as much a, to buy much needed personal protective equipment for frontline health workers who are helping us all in the fight against the coronavirus pandemic. So if you'd like to support, get us PPE, please visit their website, www dot, get us ppe.org, G E T U S P p.org as always. Thanks so much for joining us on this stale SPT asks live chat, and we'll speak to you next week. Bye.

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

Oct 22, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Sarah Haag to talk about exercise and urinary incontinence. This interview was part of the JOSPT Asks interview series. Sarah is the co-owner of Entropy Physiotherapy and Wellness in Chicago. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010.

In this episode, we discuss:

  • The prevalence of urinary incontinence
  • Is urinary incontinence normal
  • Pelvic floor exercises
  • Pelvic floor exam for the non-pelvic health PT
  • Sports specific pelvic health dysfunction
  • And much more

Resources: 

Entropy Physiotherapy and Wellness

JOSPT Facebook Page

JOSPT Journal Page 

More Information about Dr. Haag: 

Dr. Sarah HaggSarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010.  Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a  Registered Yoga Teacher.

Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.

Read the full transcript below: 

Read the Full Transcript below: 

Speaker 1 (00:06:25):

So, and hopefully it doesn't want to lose what we're doing here. We'll see. Okay. Going live now. Okay. Welcome everyone to JLS. PT asks hello and welcome to the listeners. This is Joe SPT asks the weekly chat where you, the audience get your questions answered. My name is Claire Arden. I'm the editor in chief of Joe SPT. And it's really great to be chatting with you this week, before we get to our guest. I'd like to say a big thanks for the terrific feedback that we've had since launching [inaudible] a week ago. We really appreciate your feedback. So please let us know if there's a guest that you'd like to hear from, or if you have some ideas for the show today, we're in for a very special treat because not only are we joined by dr. Sarah hake from entropy physio, but guest hosting [inaudible] asks today is dr. Karen Litzy who you might know from the healthy, wealthy and smart podcast. Dr. Lexi is also a new Yorker. And I think I can speak for many of us when I say that New York has been front of mind recently with the coronavirus pandemic. And I'd like to extend our very best wishes to everyone in New York where we're thinking of you. So I'm going to throw to Karen now. We're, I'm really looking forward to chat today on pelvic floor incontinence and exercise over to you, Karen.

Speaker 1 (00:08:25):

Hi everyone, Claire. Thank you so much. I really appreciate your giving me the opportunity to be part of J O S P T asks live stream. So I'm very excited about this and I'm also very excited to talk with dr. Sarah Hagar. Sarah is an educator, a clinician, and an author. She is also co-owner of entropy wellness and our physiotherapy and wellness in Chicago, Illinois, and is also a good

Speaker 2 (00:08:56):

Friend of mine. So it's really a an honor for me to be on here. So Sarah, welcome. Thank you so much. I was really excited that all this came together so beautifully. Yes. And, and again like Claire had mentioned, we're all experiencing some pretty unprecedented times at the moment. And the hope of these J O S P T asks live streams is to continue to create that sense of community among all of us, even though we can't be with each other in person, but we can at least do this virtually. And as Claire said, last week, we want to acknowledge our frontline healthcare workers and colleagues across the world for their dedication and care to those in need. And again, like Claire said before, a special shout out to my New York city colleagues, we are they are really working like no other.

Speaker 2 (00:09:52):

And I also want to acknowledge not just our healthcare colleagues and workers, but the scientists, the grocery store workers, the truck drivers the pharmacist, police, firefighter paramedics, they're all working at full capacity to keep the wheels turning around the world. So I just want to acknowledge them as well and thank them for all of their hard work during this time. Okay. So, like Claire said today, we're going to be talking about the pelvic floor, which is something Sarah loves to talk about because what I also, I also failed to mention is she is a certified pelvic health practitioner. So through the American physical therapy association. So she is perfectly positioned to take us through. And as a lot of, you know, we had, you had the opportunity to go onto Slido to ask questions. You can still do that. Even throughout this talk, just use the code pelvic that's P E L V I C, and ask some questions.

Speaker 2 (00:10:57):

So we do have a lot of questions. I don't know if we're going to get to all of them. So if we don't then certainly post them in the Facebook chat and maybe Sarah can find those questions in the chat below. And we'll try and get to those questions after the recording has finished. All right, Sarah. So like I said, lots of questions and the way the questions were, were written out, kind of corresponds quite well with maybe how you would see a patient in the clinic. So let's start with the patient comes into your clinic. They sit down in front of you. Let's talk about the words we would use in that initial evaluation. So I'll throw it over to you. Okay. So being a pelvic health therapist, obviously most people when they're coming to females, Things that happen in the pelvis, I like to acknowledge it, that there's a lot of things happening in the past. So I have

Speaker 1 (00:11:54):

Them tell me kind of what are the things that have been bothering them or what are the things that have been happening that indicate something might be going on? Like if something's hurting, if they're experiencing incontinence, any bowel issues, any sexual dysfunction. And, and I kind of go from there. So if the talk that's the title of the talk today includes incontinence. Continence is a super common issue that let's see in general might pop in. And if you would bother to ask there's actually, I think it's like one out of two people over 60 are experiencing incontinence of some kind. The answer is going to be yes, some, so you can start asking more questions. But starting out with what, what is bothering them is really what I like to start with. Then the next thing we need to know is after we vet that issue or that priority list of things that are bothering them in the pelvis, and it's not uncommon actually to have.

Speaker 1 (00:13:00):

So let's say they start with a discussion of incontinence. I still actually ask about sexual function, any pain issues, any bowel issues, just based on the innervation of the various, the anatomical arrangement of everything. It's not uncommon to have more than one issue, but those other issues might not be bothersome enough to mention. So it's kind of nice to get that full picture. Then the next thing we really want art. So there are times I've met women who come in and they're like, Oh yeah, you know, I have incontinence. And you're like, okay. So when did it start now? Like 25 years ago. Okay. Do you remember what happened then? Typically it was a baby, but sometimes these women will notice that their incontinence didn't happen to like four or five years after the baby. Hmm. So that's information, that's very help if they say my baby that was born six weeks ago, our interventions and expectations are going to be very different than someone who's been having incontinence for 25 years.

Speaker 1 (00:14:05):

So again, knowing how it started and when it happens, when the issues are happening, I just kind of let them, it's like a free text box on a form. Like just, they can tell me so much more excuse me. And when we are talking about things, we, I do talk anatomy. So when it comes to incontinence, I talk about the bladder and the detrusor, the smooth muscle around the bladder, the basically the hose that takes the urine from the bladder to the outside world. I do talk about the vagina and the vulva and the difference between the two. And then actually we do talk about like the anus and the anal sphincters and how all of that is is all there together and supported by the pelvic floor.

Speaker 1 (00:14:54):

Cause that's in physical therapy, it's going to be something with that pelvic floor or something. Drought, does it need to be more, more pelvic floor focused or does it need to be behaviorally focused, which is the case sometimes, or is it that kind of finding that perfect Venn diagram of both for those issues that the person's having? And let's say you're in a part of the world. One of the questions was what if you're I think this question came from Asia and they said, what if you're in part of the world where you have to be a little bit, maybe more sensitive around even the words that you use. I know we had gotten a question a couple of years ago about a woman in the Southern part of the United States that was from very conservative area. And do we even use these words with these patients?

Speaker 1 (00:15:48):

So what is your response to that? My response is that as healthcare providers, we are responsible, I think for educating people and using appropriate words and making sure people understand the anatomy like where things are and what they're supposed to be doing. However, definitely when I'm having this conversation with someone I want them to feel at ease. So like I will use the Ana vagina anus, anal sphincters Volvo, not, it's not a vagina, it's a Volvo it's on the outside. But then if they use different terms to refer to the anatomy, we're discussing, I'm happy to code, switch over to what they're most comfortable with because they need to be comfortable. But I think as, as again, healthcare practitioners, if we're not comfortable with the area, we're not going to make them feel very comfortable about discussing those issues. Right.

Speaker 1 (00:16:43):

And that makes a lot of sense. Thank you for that. So now let's say you, the person kind of told you what's going on and let's, let's talk about when you're taking the history for women with incontinence, especially after pregnancy, are there key questions you like to ask? Yes. So my, my gals that I'm seeing, especially when they're relatively relatively early in the postpartum period, are the things I'm interested in is did they experience this incontinence during their pregnancy? And did they have issues before pregnancy? And then also if this is not their first, tell me about the first birth or the, or the first two birth. So the first three birth to really get an idea of is this a new issue or is this kind of an ongoing marked by so kind of getting a bigger picture of it.

Speaker 1 (00:17:49):

And then also that most recent birth we want to know, was it vaginal? Was it C-section with vaginal birth? If there's instrumentation use, so if they needed to use forceps or a vacuum that increases the likelihood that the pelvic floor went over, went under a bit of trauma and possibly that resulted in a larger lab. And even if there isn't muscles, it's understandable that things might work well, if it's really small and if it's still healing you know, different, different things like that. So understanding the, kind of like the recent birth story, as well as their bladder story going back. So you've met first baby or before that first baby so that we know where, where we're starting from. And the, the reason why I do that is because again, if it's a longterm issue, we have to acknowledge the most recent event and also understand there was something else happening that, that we need to kind of look at.

Speaker 1 (00:18:58):

So would I expect it all to magically go away? No, I wouldn't. There's probably something else we need to figure out, but if it's like, Nope, this onset happened birth of my baby three months ago, it's been happening since then three months is, seems like forever and is also no time whatsoever. It took 10 months to make the baby. So it's you know, if you tear your hamstring, we're expecting you to start feeling better in three months, but you're probably not back to your peak performance. So where are we in that? And sometimes time will cure things. Things will continue to heal, but also that would be a time like how good are things working? Is there something else going on that maybe we could facilitate or have them reach continence a bit sooner. Okay, great. And do you also ask questions around if there was any trauma to the area?

Speaker 1 (00:19:56):

So if this birth was for example, the product of, of a rape or of some other type of trauma, is that a question that you ask or do you, is that something that you hope they bring up? It's, that's honestly for me and my practice, something, I try to leave all of the doors wide open for them to, to share that in my experience you know, I've worked places where it is on it's on the questionnaire that they fill out from the front desk and they'll circle no to, to any sort of trauma in the past.

Speaker 1 (00:20:34):

Yeah. They just, they don't want to circle yes. On that form. So and also I kind of treat everybody like they might have something in their past, right. So very nonjudgmental, very safe place, always making them as comfortable in a safe as possible. And I will say that there's anything I can do to make you feel more comfortable and more safe. We can do that. And if you don't feel safe and comfortable, we're not doing this w we're going to do something else. Cause you're right. That it's always one of those lingering things. And the statistics on abuse and, and rape are horrifying to the point where, again, in my practice, I kind of assume that everybody has the possibility of having something in their past. Okay, great. Thank you. And now another question that's shifting gears. Another question that came up that I think is definitely worthy of an answer is what outcome measures or tools might you use with with your incontinence patients? So with incontinence, honestly, my favorite is like an oldie buddy, but a goodie, like just, it's an IC, it's the international continents questionnaire where it's, I think it's five or six questions. Just simple. Like how often does this happen? When does it happen?

Speaker 1 (00:21:58):

There's a couple of other outcome measures that do cover, like your bladder is not empty. Are you having feelings of pressure in your lower abdomen? It gets into some bowel and more genital function. Can you repeat that? Cause it kind of froze up for a second. So could you repeat the name of that outcome tool as it relates to the bladder and output? Oh, sorry. I see. IQ is one and then, but like I see IQ vs which renal symptoms, right? So there are, there's a lot of different forms out there. Another one that will gather up information about a whole bunch of things in the pelvis is the pelvic floor distress bins questions about bowel function, bladder function, sexual function discomfort from pressure or pain. So that can give you a bigger picture. I'll be honest. Sometimes my, the people in my clinic they're coming in, and even though I will ask the questions about those things, when they get the, the questionnaire with all of these things that they're like, this doesn't apply to me. I'm like, well, that's great that it doesn't apply to you, but they don't love filling, filling it out. So sometimes what I will go with is actually just the pale.

Speaker 1 (00:23:24):

Can you say that again? Please help me. Oh yeah. Oh, so sorry. The patient's specific functional scale where, where the patient says, this is what I want to have happen. And we kind of figured out where they are talk about what would need to happen to get them there, but it's them telling what better. Right. Cause I've had people actually score perfect on some of these outcome measures, but they're still in my office. So it's like, Oh, I'm so patient specific is one of my one of my kind of go tos. And then there's actually a couple of, most of these pelvic questionnaires finding one that you like is really helpful because, because there's so many and they really all or discomfort. So if you have a really good ability to take a really good history, some of the questions on that outcome measure end up being a bit redundant.

Speaker 1 (00:24:26):

So I like, and you know the questions on there, make sure people are filling them out. You look at them before you ask them all the questions that they just filled out on the form for you. Yes. Good. Very good advice. So then the patient doesn't feel like they're just being piled on with question after question and cause that can make people feel uncomfortable when maybe they're already a little uncomfortable coming to see someone for, for whatever their problem or dysfunction is. So that's a really good point. And now here's a question that came up a couple of times, you know, we're talking about incontinence, we're talking about women, we're talking about pregnancy. What about men? So is this pelvic floor dysfunction? Is this incontinence a women only problem? Or can it be an everybody problem? So it very much can be an everybody problem. Incontinence in particular for men, the rates for that are much lower. And typically the men are either much older or they are they've undergone frustrate removal for prostate cancer.

Speaker 1 (00:25:33):

Fleur plays a role in getting them to be dry or at least dryer. And then it's like the pelvic floor is not working right. That can result in pain. It can result in constipation. It can result in sexual dysfunction. It can result in bladder issues. So it's, so yes, men can have all of those things. In fact, last night we had a great talk in our mentorship group at entropy about hard flacid syndrome. So this is a syndrome with men where everything is normal when they go get, get tested, no no infections, no cancers, no tumors, no trauma that they can recall. And, but the penis is not able to become functional and direct. And with a lot of these men, we're finding that it's more of a pelvic floor dysfunction issue, or at least they respond to pelvic floor interventions.

Speaker 1 (00:26:30):

So having a pelvic floor that does what it's supposed to, which is contract and relax and help you do the things you want to do. If, if we can help people make sure that they're doing that can resolve a lot of issues and because men have pelvic floors, they can sometimes have pelvic floor dysfunction. Okay, great. Yeah. That was a very popular question. Is this a woman only thing? So thank you for clearing up that mystery for everyone. Okay. So in going through your evaluation, you've, you've asked all your questions, you're getting ready for your objective exam. What do you do if you're a clinician who does not do internal work, is there a way to test these pelvic floor muscles and to do things without having to do internal work? My answer for that question is yes, there are things that you can do because even though I do do internal exams, I have people who come to see me who are like, no, we're not doing that.

Speaker 1 (00:27:31):

So, so where can we start? And so the first one is pants on and me not even touching you pelvic floor, I wouldn't really call it an assessment or self report. So even just sitting here, if you, if you were to call me up and and this actually goes into, I think another question that was on Slido about pelvic floor cues. So there is actually then it seems more research on how to get a mail to contract this pelvic floor then actually females. But I would ask you like like this is one that my friend Julie, we would use. So like if you're sitting there and you just sit up nice and tall, if you pretend you're trying to pick up a Ruby with your PA with your vagina is not on the outside, but imagine like there's just a Ruby on the chair and you'd like to pick it up with no hands, breathe in and breathe out and let it go. So then I would go, did you feel anything and you should have felt something happen or not. So if, if you did it, would you mind telling me what you built? You're asking me, Oh my goodness. Oh yes. I did feel something. So I did feel like I could pick the Ruby up and hold it and drop it.

Speaker 1 (00:29:04):

Excellent. And that's, and that, that drop is key. Excellent. So what I would say is this is like like a plus, like a, I can't confirm or deny you that you did it correctly, but I like, I would have watched you hold your, like she holding my breath. Is she getting taller? Cause she's using her glutes. Did she just do a crunch? When she tried to do this, I can see external things happening that would indicate you're might be working too hard or you might be doing something completely wrong. So then we'll get into, I mean, you said, yes. I felt like I pick up the Ruby, but if it's like, Hmm, I felt stuffed, but I'm not really sure we would use our words because they've already said no to hands to figure that out. But again, I can't confirm it. People are they're okay with that.

Speaker 1 (00:29:48):

And I'm like, and if what we're doing based on the information you gave me, isn't changing, we might go to step two. If you can send in step two is actually something, any orthopedic therapist honestly, should not feel too crazy doing. So if anyone has ever palpated the origin of the hamstring, so where is the origin of the hamstring facial tuberosity? If you go just medial to that along the inside part get, don't go square in the middle. That's where everyone gets a little nervous and a little tense, but if you just Pell paid around that issue, tuberosity it's pretty awesome. If you have a, a friend or a colleague who's willing to let this happen is you ask them to do a poll of our different cues with that in a little bit. You say that again, ask them to do what to contract the pelvic floor.

Speaker 1 (00:30:44):

Okay. And again, figuring out the right words so that they know what you're talking about. We can talk about that in a minute, but if they do a pelvic floor contraction, you're going to feel kind of like the bulging tension build, right there may be pushing your fingers. You should feel it kind of gather under your fingers. It shouldn't like push your fingers away, but then you can be like, well, you could test their hamstring and see that you're not on the hamstring and you can have them squeeze your glutes and you can kind of feel the differences. The pelvic floor is just there at the bottom of the pelvis. So you can palpate externally, even through BlueJeans is a bit of a challenge, but if they're in you know, like their workout shorts for yoga pants, it's actually very, very simple. And, and honestly, as long as you explained to them what you're doing and what you're checking for, it's no different than palpating the issue of tuberosity for any other reason.

Speaker 1 (00:31:36):

And with that, I tell them that I can, it's more like a plus minus, so I can tell that you contracted and that you let go. That's all I can tell. So I can't tell you how strong you are, how good your relaxation Wells, how long you could hold it for any of those things. And then I tell them with an internal exam, we would get a lot of information we could, we can test left to, right? We can, I could give you more of like a muscle grade. So like that zero to five scale be use for other muscles. We can use that for the pelvic floor. I can get a much better sense of your relaxation and see how was that going and I can even offer some assistance. So so we have two really good options for no touching.

Speaker 1 (00:32:19):

And then just as long as we understand the information we might gain from an internal exam, we can, we can, the information we gathered from the first two ways, isn't sufficient to make a change for them. And then as let's say, the non pelvic health therapist, which there might be several who are gonna watch this, when do we say, you know, something? I think it's time that we refer you to a pelvic health therapist, because I do think given what you've said to me and you know, maybe we did step one and two here of your exams. I think that you need a little bit more. So when do, when is that decision made to reach the point of, they have a bother that I don't know how to address so we can actually go to like the pelvic organ prolapse. So pelvic organ prolapse is, is when the support for either the bladder, the uterus, or even the rectum starts to be less supportive and things can kind of start to fall into the vaginal wall and can give a feeling of like pressure in with activity the sensation can get.

Speaker 1 (00:33:39):

So then we have two options, which is more support from below with perhaps a stronger meatier pelvic floor by like working it out to hypertrophy. So like if, if I had someone who had that feeling when they were running and we tried a couple are lifting weights, let's go lifting weights. No, like I feel it once I get to like a 200 pound deadlift. Okay, well, let's see how you're lifting when you're doing 150 and let's take a look at what you're doing at 200 in fresh with your mechanics or what's happening. And if there's something that is in your wheelhouse where you're like, well, can you try this breath? Or can you try it this way and see if that feeling goes away? I'm good with that. And if the, that the person who's having issue is good with that. Awesome. But if you're trying stuff or the incontinence is not changing, send them to a pelvic floor therapist, because what we love to do is we can check it out.

Speaker 1 (00:34:41):

We're going to check it out. We're going to give some suggestions. And then my, the end of every one of those visits that I get from my, from my orthopedic or sports colleagues is I'm like, excellent. So you're going to work on this, keep doing what you're doing. Cause another really common thing is like, is I don't really believe that they can make a lot of these things worse doing the things that they're doing. And by that, I mean, they can become more simple MADEC, but in many cases you're not actually making the situation worse. So if the symptoms seem to be not getting better or even getting worse, doing the things they're doing, they go come back to the pelvic floor therapist. And then that pelvic floor therapist also has a responsibility that the things I'm asking them to do, isn't helping them get there.

Speaker 1 (00:35:29):

You can try something a little more intense, still not helping. Then that's when I actually would refer for females, especially with like pelvic pressure. So Euro gynecologist for an assessment in that regard. Yeah. So I think I heard a couple of really important things there. And that's one, if you are the sports therapist or the orthopedic physiotherapist, and you have someone that needs pelvic health support, you can refer them to the pelvic health therapist and you can continue seeing them doing the things you're doing. So just because they're having incontinence or they're having some pressure, let's say it's a pelvis, pelvic organ prolapse. It doesn't mean stop doing everything you're doing.

Speaker 3 (00:36:12):

Okay.

Speaker 1 (00:36:15):

Correct. Okay. Yeah. It may mean modify what you're doing. Stop some of what you're doing, listen to the pelvic floor therapist. And I'm also seeing, well now we're, aren't we this great cause we're creating great team around this, around this person to help support them in their goals. So one doesn't negate the other. Absolutely correct. And I, and I think too often even, even within the PT world is people start to get kind of territorial. But it's not about what each one of us is doing. It's that person. Right. so telling them to stop doing something, especially if it's something they love it seems like a bad start. It's like, okay, let's take a look at this. Tell me what you are doing. Tell me what you want to be doing. Tell me what's happening when you do that. And let's see if we can change it.

Speaker 1 (00:37:02):

Cause like I said, like the, the other, that being something they're going to make worse and worse and worse is if symptoms get worse and worse and worse, but they're not causing damage, they're not causing, I mean, what they're doing and say leaking a bit. Got it. And now I'm going to take a slight detour here because you had mentioned pelvic organ prolapse. You had mentioned, there comes a time when, if that pressure is not relieving, you've tried a lot of different things. You would refer them to a urogynecologist now several years ago. They're so you're, you're a gynecologist. One of their treatments might be surgery. So there was pelvic mesh sweats. It's hard to say pelvic mesh surgery that years ago made some people better and made some people far, far worse with, with some very serious ramifications. So can you talk about that pelvic mesh mesh surgery and where we are now?

Speaker 1 (00:38:04):

Oh, the last bit cut out a little bit. So the pelvic mess, mess surgery and, and Oh, the most important part and kind of where we are now versus maybe where we were, let's say a decade ago or so. Awesome. Yeah. So, so the pelvic mesh situation certainly here, I think it's not a universal problem. I think it's a United States problem is if you're at home during the day, like most of us are now you will see law commercials, lawyers looking for your business to discuss the mesh situation on what's happening is there was there were, it was mesh erosion and the resulting fact that that was a lot of pain because they couldn't just take it all out. And it was several women suffered and are still sad.

Speaker 3 (00:38:55):

Mmm.

Speaker 1 (00:38:55):

But that was from a particular type of surgery with a particular type of surgical kit, which thankfully has, was removed completely from the market and isn't being used anymore and mesh surgeries, I would say at least for the last five to 10 years, haven't haven't been using that and mesh surgeries are being done with great success in resolving symptoms. So I think it's important that if a woman isn't responding

Speaker 3 (00:39:27):

Yeah.

Speaker 1 (00:39:30):

Well changing their breath or making a pelvic floor or changing how they're doing things is to have that discussion with the Euro gynecologist because they do have nonsurgical options for super mild prolapse. There are some even like over the counter options you can buy like poise has one where it's just a little bit of support that helps you. Actually not leak because if you're having too much movement of the urethra, it can cause stress or it can be contributing to stress incontinence. But so there's some over the counter things or there's something called a pessary, which I think about it. Like I'm like a tent pole, but it's not a pole. It's a circle don't worry or a square or a donut. There's so many different shapes, but it's basically something you put in the vagina and that you can take out of the vagina that just kind of holds everything back up where it belongs, so it can work better.

Speaker 1 (00:40:21):

And that it's not awesome. But there are also people who are like due to hand dexterity, or just due to a general discomfort with the idea of putting things in their vagina and living them there that they're like, no, I'd rather just have this be fixed. So, so there are, it's not just surgery is not your only option. There are lots of options and it just depends on where you want to go. But with the surgery, if that's what's being recommended for a woman, I really do. Some women aren't worried at all. They've heard about the mash, but they're sure it won't happen to them, but there are when we're still avoiding surgery, even with significant syndromes, because they're worried about the mesh situation. And I would still encourage those women to at least discuss us, to see if that surgeon can, can educate them and give them enough confidence before they move forward with the surgery.

Speaker 1 (00:41:18):

Because the worst thing I think is when I had one patient actually put it off for years. Not, not just because of the mesh because of a lot of issues, but the first time the doctor recommended it, she had a grade four prolapse. Like that means when things come all the way out. And she it was so bad. Like she couldn't use the pastory okay, so she needed it, but she avoided it until she was ready and had the answers that made her feel confident in that having the surgery was the right thing to do. So it might take some time and the doctor, the surgeon really should, and most of them that I've met are more than happy to make sure that the patient has all the information they need and understand the risk factors, the potential benefits before they move forward.

Speaker 2 (00:42:03):

Excellent. Thank you so much for that indulging that slight detour. Okay. Let's get into intervention. So there are lots of questions on Slido about it, about different kinds of interventions. And so let's start with lot of, lot of questions about transverse abdominis activation. So there is one question here from Shan. Tall said studies in patients with specific low back pain do not recommend adding transverse abdominis activation because of protective muscle spasm. What about urinary incontinence in combination? What do you do? So there is a lot on transfer subdominant as you saw in Slido. So I'll throw it over to you and, and you can give us all your share your knowledge.

Speaker 1 (00:42:55):

Okay, well, let's all do this together. So I don't know how many people are watching, but if we just sit up nice and tall and I'm going to give a different cue for the pelvic floor. So what I want you to squeeze, like you don't want to urinate, like you want to stop the stream of urine. Okay. So as we're pulling that in anything else other than the underneath contract, what did you feel Karen?

Speaker 2 (00:43:24):

Well, I did feel my TA contract. I felt that lower abdominal muscle wall started to pull in.

Speaker 1 (00:43:32):

Yes. So, so the, the way I explain it is that the pelvic floor and the trans versus are the best is to friends. And this makes sense when you think about when you remember the fact that the pelvic floor, isn't just there regarding like bowel bladder and sexual function. It's one of our posture muscles. So if we're totally like, like slacked out and our abs are off and all of that, our pelvic floor is pretty turned off as well. And then if I get a little bit taller and like, so I'm not really clenching anything. Right. But this is like stuff working like it should, my pelvic floor is a little more on, but not, I'm not acting. It's just but then I could like, right, if I'm gonna, if I'm expecting to hit, or if I'm going to push into something, I can tend to set up more and handle more force into the system.

Speaker 1 (00:44:21):

So I like to think about it in those in those three ways, because the pelvic floor, isn't just hanging out, down there and complete isolation it's, it's part of a system. And so in my personal, like emotional approach to interventions is I don't want them to be too complicated. So if I can get someone to contract their pelvic floor, continue to breathe and let go of that pelvic floor, then we start thinking about what else are you feeling? Cause I don't know that there's any evidence that says if I just work my transverses all the time, my pelvic floor will automatically come along for the ride. So a great quote. I heard Karrie both speak once at a combined sections meeting and she goes, your biceps turn on. When you take a walk, it's not a good bicep exercise. So just the fact we're getting activity in the pelvic floor when we're working other muscles, what's supposed to work. And also if you want to strengthen that muscle, you're going to need to work out that muscle.

Speaker 1 (00:45:26):

And that makes a lot of sense and something that people had a lot of questions around where we're kind of queuing for these different exercises. And I really love the can. You've made it several times comparisons to other muscles in the body. So can you talk about maybe what kind of queuing you might use to have someone on? I can't believe I'm going to say this turn on and I use that in quotes because that's what you see in, in a lot of like mainstream publications for, for layman. So it might be something that our patients may see when they come in. So how do you cue that? To, to turn on the pelvic floor? So honestly I will usually start with floor and I do if I'm able to do a public floor exam, that's usually, again, a lot more information for me, but I'm like, okay, so do that now.

Speaker 1 (00:46:27):

And I watched them do it or I feel them do it and I'd be like, Oh, okay. What did you, what did you feel move? And I start there. And then I always say it's a little bit, like I get dropped into a country and I'm not sure what language people are speaking. So sometimes excuse me, one of the first cues that I learned was like, so squeeze, like you don't want to pass gas. Okay. So everybody let's try that. So sitting squeeze, like you don't care and you got taller. So I think you did some glutes.

Speaker 1 (00:47:00):

It's like, OK. So like lift, lift your anal sphincter up and in, but activating mostly the back part. So if you're having fecal issues, maybe that's a good place to start, but most people are having issues a little further front. So then we moved to the, can you pick a upper with your, with your Lavia? I had a, I learned the best things for my patients. One woman said it's like, I'm shutting the church doors. So if you imagine the Lavia being churched doors, we're going to close them up. And that, that gives a slightly different feeling. Them then squeezing the anal sphincter. Now, if you get up to squeeze, like you don't want to like pee your pants, like you want to stop the stream of urine. That will activate more in the front of the pelvis. Look, men who are like if it gets stopped the flow of urine, I wouldn't be here.

Speaker 1 (00:47:57):

So what else do you get? What's really cool is in the male literature. So this is a study done by Paul Hodges is he found that what activated the anterior part and the urinary sphincter, this rioted urinary speaker, sphincter the most for men. What a penis or pull your penis in to your body now for women. So when I was at a chorus and it's like, so let's, let's think of like other cues and other words, but even if, so, I don't have a penis this fall that probably don't have a penis. Even if you don't have a penis, I want you to do that in your brain, shorten the penis and pull it in.

Speaker 1 (00:48:42):

And did you feel anything happen? Cause we do have things that are now analogous to the male penis, if you are are a female. So I'll sometimes use that. Like I know it sounds stupid, but pretend to draw on your penis and it works and it does feel more anterior for a lot of people. So I'll kind of just, I'll kind of see what's, like I said, sometimes it's like the 42nd way of doing it that I've asked them to do where they're like, Oh, that, and you're like yeah. So then also just another, it's a little bit of like a little bit of a tangent, but so as you're sitting, so if you're, if you're sitting I want you to pick the cue that speaks most to your pelvic floor, and I want you to slouch really, really slouch, and actually to give yourself that cue and just pay attention to what you're feeling. So when you squeeze, give yourself that cue, breathe in and breath out and then let go, we should have felt a contraction, a little hole and a let go. Now, the reason why I say breathe in and breathe out is if you breathe in and out, that's about five seconds and also you were breathing. Cause another thing people love to do when they're trying to contract their pelvic floors, just basically suck it in.

Speaker 1 (00:50:10):

And so that's, that's not great, but we want to feel the contraction and we want to feel it, let go. And that's super important. I think that was another question on the Slido is that yes. For any muscle we're working, you should be able to contract it and let it go. There's not a muscle in our body where I just keep it contracted. It's going to do much. It might look great. Eventually, but like I couldn't get my coat on, like getting a drink of water would be a little weird. It's not very functional muscles have to relax so that they can contract. So that's a big, yes, it's just as important that the contraction pelvic floor that cue and we felt where it happened, not tall, like, like you're sitting out at a restaurant and you just saw someone looking at you and you're like, Oh, what are they looking at? And then you're going to do the exact same cue and you're gonna breathe in and breathe out and let it go.

Speaker 1 (00:51:07):

And then did it feel different than menu or slouch that it did it change position? I feel like Karen's Miami. It feels different. Now what I want you to do is if you can, depending on how you're sitting really give me like an anterior pelvic tilt, really happy puppy and then do the exact same thing and then let it go. And so again, some more EMG work from, from Paul Hodges is that when you're in a posterior pelvic tilt, you tend to activate the posterior portion more, which is fine. And if you're not having problems in the front, if you're having problems activating and maintaining continence in the front, actually increasing that lordosis can favor the front a bit. So this is, that's really awesome when people can feel that difference. Because I want you to think about, if you start to leak on your fourth mile of a half marathon, there's no way, no matter how awesome you are, but you're going to be able to squeeze your pelvic floor for the rest of that race.

Speaker 1 (00:52:15):

Like there's just, there's no way. But sometimes if, because remember your pelvic floor is still doing its thing while you're running is if you're like, well, hold on, when you're at your fourth mile, are you starting to get tired or hopefully not if it's a half marathon, but you know, like is something changing and how you're using your body. And can you, when you get to that point, remember to stay tall or lift your tail a little bit, or is there a cue or something they can change that will help them favor the front instead of going about four steps with the contracted pelvic floor and then losing it anyway. So there's, there's a lot of different ways you can actually make that your intervention for the issue you're having and then let's just get it functional. Perfect. And since you brought up running a question that's been, got, gotten a couple of likes on Slido is how would you approach return to running after pregnancy?

Speaker 1 (00:53:15):

Do you have any tips on criteria for progress, timeframe and a recreational runner versus a full time athlete? Because I would think the majority of physiotherapists around the world are seeing the recreational runner versus the professional or full time athlete. So first, how would you approach return to running any tips for progress? So that's going to be after pregnancy, sorry. After pregnancy. Yeah. So this is where I was really excited. So just last year I'm going to say her name wrong, but Tom goom Gran Donnely and Emma Brockwell published returned to running postnatal guidelines for health professionals managing this population. And the reason why I was super excited is because even though it was just published last year, it's the first one. There was definitely a lot of emotion and feelings about, about women getting back into sport after having a baby, but to be perfectly Frank, there's very few actual solid guidelines for recreational or others.

Speaker 1 (00:54:30):

So I have not personally had a child, but I will tell you of all the women I've seen over the years, basically doctors are like, it's been six weeks ease back into it, see how it goes. I'm not really even mentioning if you have a problem come back so we can figure it out. It's just kind of like good luck with that. And as a result, what happens is a lot of women don't get back into exercise or they get back into exercise and and kind of freak themselves out because stuff feels different. So to get back to the question of what do I do, actually this this guide from Tom and team really, really helpful. I think, and, and it's just basically it's it does have a series of exercises that I've actually started to use with my postpartum moms to go like, look, if you can do these things without feeling heaviness, you're good.

Speaker 1 (00:55:30):

You're good to start easing back into your running program, but get up, get walking because I'm going to post Sandy Hilton and like, you can't rest this better, like just waiting, isn't going to make it all go away. But it can also be deceiving because again, with polo, you don't feel that heaviness and you don't leak. And so I'm just going to stay right here where everything is fine. So that's obviously not a good option longterm option for a lot of reasons. So, so what do I do? I do look at the patient's goals, their previous running history, and if they're having any options I recently had a patient who she was runner exercise or sr after baby number two for a bit, some feeling of happiness that got completely better, baby number three came along. So I saw her a bit while she was pregnant because she got, I think two thirds of the way through pregnancy before she started to feel that heaviness. Again, she was still running,

Speaker 1 (00:56:38):

Tried to see if we could change that feeling while she was running. And she could until about the, when did she start? I think she didn't stop running to her 35th week, which is pretty impressive. But then she wanted to do a half marathon. I think it was just three months postpartum. Right. So this is like going from having baby to running 13. You think that a lot of people would probably feel that was too soon, too much too fast, but she was able to do it completely symptom-free. So as she was training and she was really fast, she was timing it so that she could get back in time to breastfeed. Like I was like, Oh my gosh, like I, that would disqualify me. Like, there's no way I could run fast enough to make that happen. But she was able to, to work it out where she could perform at her level without symptoms. And I was really happy that I was able to support her in that she did all the hard work. For general people recreational, where you a runner before, or is this completely new and are you having any symptoms and is there any thing you're worried about? Again, a lot of women are worried about giving.

Speaker 1 (00:57:53):

It's actually really hard to perhaps to give yourself one baby babies are a great way to do it. But that's like the risk factors I look up for something else a couple of years ago, I haven't looked recently, but like you really have any prolonged lifting. So not like your CrossFit three days a week, but like your, your physical labor for eight, eight hours, 10 hours a day every day could eventually do it also having babies. So like once you get to every baby increases your risk of pelvic organ prolapse, which makes good sense. And that, and that is what it is. So kind of looking at what are their risk factors, are there any, and letting them know that if they feel it more, it doesn't mean they made it worse. They just made it more symptomatic. Got it. Great.

Speaker 1 (00:58:40):

All right. So we have time for maybe one or two more questions, and then I'm going to throw back to Claire. Cause we're coming up onto an hour here, maybe time for one more it's so w what am I going to ask? I think I'm going to go with the gymnasts I work with all believe it's normal to leak a little urine during training or competition. And this is something we talk about a lot. It might be common, but is it normal? You already gave me the answer. What is it, Karen? No, no, no. And so, yeah, so the, the short answer for that is no. Or I agree with the question where it is very, very, very common, and it is still, I would say, not to leak urine. Unfortunately, so there's any researchers out there who want to get together.

Speaker 1 (00:59:26):

Let me know. We haven't, we have information on athletes and incontinence, but mostly it's prevalent that it happens a lot and gymnastics and dancing and volleyball. There's, there's even some swimmers who have it, right? So there's, there's incontinence across the spectrum, which basically tells me, yep. People have incontinence. Some of the some of the sports are more likely to have urgent continents. A lot of them though, we're looking at stress incontinence, however, for none of the athletes, have, we really had a great study that says, this is what we're finding. We're thinking, this is the cause of this incontinence. And we certainly haven't gotten to the point where it's like, and this is what we should be doing for these women in particular. So I'm, I'm pretty curious as to what we would have to do as, as a profession, as, as a team with researchers to figure out what do we need to look at in these athletes, especially the female athletes, because most of these are also they've never had babies, right? So a lot of these athletes are the liberos. And so we can't, we can't blame them. There's something with how things are working. That seemed to be the situation it's not necessarily trauma or anything like that. So what do we need to look at? What do we think is happening? Can we measure it and assess it? And then can we get an intervention?

Speaker 1 (01:00:56):

My brain, obviously, something isn't working as well as it could. So could something like that improve their performance, even I don't, I don't know. I'd like to think so. Yeah. That would be distinct study. Yeah. But we ultimately don't know. So if anyone has any ideas for studies or doing studies, let me know, because I can't wait to read them. But I think maybe the first step is to let coaches and parents and young gymnast know very common. Don't be ashamed. Don't let it stop you from doing what you want to do. But also don't just ignore it. Maybe we can figure this out.

Speaker 2 (01:01:30):

All right. One more question with a short answer, if you can. So, and I'm going to ask this question because I feel like the person who posted this I think posted this in earnest. So that's why I'm asking, this is the last question. So a female patient age, 20 years still bedwetting from her childhood, otherwise she is normal, no incontinence. So other than this, just while sleeping, she tends to urinate any thoughts on this or any place you can direct this.

Speaker 1 (01:02:04):

Yeah. So I did, I was like, Oh, great question. And I did actually do a little research for this specific question. There's a lot of reasons why nocturnal enuresis, which is what bedwetting is called in the literature happens. And I think it's really important. So I don't know what kind of tests or studies this person has had done or what other issues they may be having. So things like sleep apnea is is something that could be related if there's any medications, any sort of diuretics, any kind of sleeping medications. Again, the fact it's kind of carried on since childhood, I, I would really wonder about how, how is the bladder functioning? The fact that it's working fine throughout the day makes me wonder what's changing at night. And I did find a study where it talked about when they look compared adolescents or adults who were bedwetting to people who weren't, they did have like detrusor overactivity. So like basically like an overactive bladder that they could see on the testing. So I would, I would really encourage this person to find a urologist that they trust if they haven't already and really to maybe investigate some of those other, other factors that could be contributing so that they can get some better sleep and not have that problem anymore.

Speaker 2 (01:03:28):

Excellent. Excellent. Oh, okay. Claire says we can go for one more question. So I'm going to listen to the boss here.

Speaker 1 (01:03:36):

And, Oh boy, are you ready? Because this is a question that did kind of get a lot of thumbs up. Okay. So we spoke about

Speaker 2 (01:03:44):

Briefly before we started.

Speaker 1 (01:03:47):

So let's see treatment of nonspecific, pelvic girdle pain, not related to pregnancy, which strategy with no susceptive pain mechanisms and which strategy with non nociceptive pain mechanisms would you incorporate with this patient? Okay. So I would say in the clinic, it's, it can be pretty hard. Like, I don't know how I would distinguish being nociceptive and non nociceptive or what even like non nociceptive might be if we're talking more central issues or stuff like that. I don't, I don't know. But honestly I would just look at, so in Kathleen's Luca has a great book about looking at the different types of pain or the different categories of pain and the most effective medications for it. Right. So we're really good in pharmacology. Like if you had this inflammatory process and, and inflammatory and anti-inflammatory should help, if you're having neuropathic pain, you want a drug that addresses that when we get into like physical therapy interventions, what's really cool is exercise is in all the categories.

Speaker 1 (01:04:59):

And it's one of the things we have the best evidence for. So regardless of pelvic girdle pain in pregnancy or not pregnancy, and regardless of how it may have been labeled by somebody else is I would, I would mostly want to know when did the pain start? Is there anything that makes it better? Anything that makes it worse and see if I could find a movement or change something for that person. Or that made me sound like I was going to do a whole lot of work. If I could find something for that person to change for themselves to have that hurt less and have the I tend, I would tend to keep it simple, mostly cause in the clinic again, we could do a lot of special tests that might say, Oh, Nope, they definitely hurt there, but it's still, if we're looking at what's going to be an effective intervention, that that patient is going to tell me what that is.

Speaker 1 (01:05:54):

Sorry. It would help a fire mute myself. So looks like we have time for one more. And I, I really, Claire was not clarity did not pop up yet. So we've got time for one more and then we're going to work. We're wrapping it up. I promise stroke patients, dementia patient. We just got the no go. Yes, no, it's a super short answer if you want Claire super short answer. Okay. So stroke dementia patients with urinary incontinence, any useful ideas for the rehab program? Yes, but not get an idea of their bladder habits, their bowel habits, their fluid intake. Because a lot of that's going to end up being outside caregiver help with the, with the stroke, it's much different. It depends on the severity and where it is and all of that. But for people with dementia is if you just get that, like if you can prompt them or take them to the toilet, a lot of the times that will take care of the incontinence.

Speaker 1 (01:06:48):

It's not a matter of like Cagle exercises. It's more management. All right, Sarah, thank you so much. I'm going to throw it back over to Claire to wrap things up. Thank you both for a wonderful and insightful discussion. Sarah and Karen. So many practical tips and pointers for the clinician, especially I was loving learning about all of the things that I could take to the clinic. So I hope our audience find those practical tips really helpful as always the link to this live chat will stay up on our Facebook page and we'll share it across our other social media channels. Don't forget. You can also follow us on Twitter. We're at Dow SPT. You can also follow us here on Facebook. Please share this chat with your friends, with family colleagues, anyone who you think might find it helpful. And if you like JSP T asks, please be sure to tell people about it at that what we're doing so they can find this here, please join us.

Speaker 1 (01:07:46):

Next week when we host our special guest professor Laurie from the university of Southern California, Larry is going to be answering questions on managing shoulder pain. We'll be here, live on Wednesday next week. So Wednesday, April the eighth at 9:00 AM Pacific. So that's noon. If you're on the East coast of the U S it's 5:00 PM. If you're in the UK and at 6:00 PM, if you're in Europe, before we sign off for the evening, there's also really important campaign that I'd like to draw your attention to. And it's one that we at Joe SPT supporting and it's get us PPE. So we're supporting this organization in their quest to buy as much a, to buy much needed personal protective equipment for frontline health workers who are helping us all in the fight against the coronavirus pandemic. So if you'd like to support, get us PPE, please visit their website, www dot, get us ppe.org, G E T U S P p.org as always. Thanks so much for joining us on this stale SPT asks live chat, and we'll speak to you next week. Bye.

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

Oct 5, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Leigh Hurst on the show to discuss breast cancer awareness.  Leigh Hurst is a breast cancer survivor and the founder of the Feel Your Boobies® Foundation, which she started to educate young women (under 40) by reminding them to "feel their boobies" - a call to action that can save their life. Feel Your Boobies® is one of the largest followed breast cancer awareness foundations on Facebook and has inspired women all over the world to feel for lumps starting before they are formally screened for breast cancer. And, most importantly, it has directly resulted in countless women finding lumps early and giving them a better shot at living a full, meaningful life after their diagnosis. The Feel Your Boobies® Foundation has been featured in The New York Times, New York Daily News, and other national publications. At one point, Feel Your Boobies® was the largest cause on Facebook, with more than 1 million supporters.

In this episode, we discuss:

-Leigh’s experience advocating for her own breast cancer diagnosis

-The story behind the Feel Your Boobies Foundation

-Why women need to prioritize self-care

-The voices of breast cancer survivors in the book Say Something Big

-And so much more!

Resources

Leigh Hurst Website

Say Something Big Book

Say Something Big Facebook

Say Something Big Instagram

Feel Your Boobies Website

Feel Your Boobies Facebook

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Feel Your Boobies Instagram   

 

A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. 

 

For more information Leigh:

 

LEIGH HURST is a breast cancer survivor and the founder of the Feel Your Boobies®

Foundation, which she started educate young women (under 40) by reminding them to

feel their boobies - a call to action that can save their life. Feel Your Boobies® is one of

the largest followed breast cancer awareness foundations on Facebook and has inspired

women all over the world to feel for lumps starting before they are formally screened for

breast cancer. And, most importantly, it has directly resulted in countless women finding

lumps early and giving them a better shot at living a full, meaningful life after their

diagnosis. The Feel Your Boobies® Foundation has been featured in The New York Times,

New York Daily News, and other national publications. At one point, Feel Your Boobies®

was the largest cause on Facebook, with more than 1 million supporters.

Hurst is also the author of the new book, Say Something Big: Feel Your Boobies, Find Your

Voice. Stories About Little Lumps Inspiring Big Change (Oct. 2020)

Beyond her work with Feel Your Boobies®, Leigh regularly speaks to audiences large and

small, sharing her own personal journey and inspiring others to “Say Something Big”

amidst life’s hurdles and hardships. She resides in Pennsylvania with her family.

Feel Your Boobies® uses innovation around media to reach women across the world with

their important message.

For more information, visit www.leighhurst.com or www.feelyourboobies.com, and connect

with Leigh on Instagram, Facebook, and LinkedIn.

 

 

Read the full transcript below:

Karen Litzy (00:01):

Hi, Leigh, welcome to the podcast. I'm happy to have you on.

Leigh Hurst (00:05):

Thanks for having me, happy to be here.

Karen Litzy (00:07):

Yeah. And now we're in the month of October. And for those of people who don't know October is breast cancer awareness month. And in the past, I've had shows about breast cancer during the month of October, but this is the first time I am speaking to a breast cancer survivor. So thank you so much for coming on and sharing your story because I know it's going to be so helpful for other women and men listening to this podcast. So before we kind of get into everything, I'm going to just throw it over to you so that you can just kind of tell your story how old you were when you were diagnosed. How did you find out? So I'll send it over to you.

Leigh Hurst (00:51):

Okay, cool. Thank you. So I was officially diagnosed when I was 33 that I had felt the lump for some time leading up to the actual diagnosis. So I think I was probably around 30 or 31 when I started to notice the lump. And I was living in New York city at the time and I was a marathon runner. So really health conscious, certainly educated about my health felt very kind of plugged into that kind of thing. And for a little while, I didn't really think much about it. I just thought it was, you know, something no big deal. I really small breasts. So I felt like when I'd go to the doctors, I'd let them sort of do their exam of my breasts and they would never notice it until I would point it out. So I would literally take their hand, put it on my boob and say, this kind of feels a little different to me.

Leigh Hurst (01:39):

I don't know if you notice it or not. It's like a ridge on the outer side of my left breast and then they would feel it and then they would say, I don't really think that's anything to worry about. I had no family history, so I wasn't exceptionally worried about it. Although, as I know now, that's not necessarily a primary risk factor. It is, but most women diagnosed don't have a family history. So I was pacified about that for a while. You know, that kind of went on for maybe a year or two. I eventually decided to sort of simplify my life and I moved out in New York city. I was in a really kind of super corporate job, traveled a lot for my work on a weekly basis. And I was just trying to find ways to sort of step out of that.

Leigh Hurst (02:20):

And so I moved back to central PA, which is where I live now. I'm kinda got set up on a house was back near my family and it came time for my annual exam. And I went again to the doctors and again, it wasn't noticed, but I mentioned it and it was the first time someone's like, Oh, she probably should just get a mammogram. It can't hurt to sort of just see if it's something or not. So that's how it started and ended up having the mammogram showed some areas of concern, took me right in and did an ultrasound and eventually at the biopsy a couple of weeks later and it did turn out to be cancer. So that was 2004. And you know, needless to say, I was very concerned because I knew I had had the lump for quite some time, so I wasn't sure what to expect, but it didn't turn out to be stage one, so early stage breast cancer.

Leigh Hurst (03:09):

And so, yeah, that's kinda how it started with, you know, finding out that I had a lump and went through treatment. I decided to have a lumpectomy, the lump was small stage one had no lymph node involvement. So that was good. And I did do chemotherapy because I was young. So they suggested that because of being premenopausal and being so young at the time, it was some preventative. So I did chemotherapy than I did seven weeks of daily radiation treatment to the lump site. And then I took five years of a pill called Tamoxifen, which is estrogen reducing medicine at the time they were still prescribing it for five years. I believe now the regimen is 10 years. But so the actual treatment itself was about six months start to finish. And then it was the five years of the Tamoxifen following that.

Karen Litzy (03:59):

And at the age of 33, you must have been kind of shocked. Right. Cause it's not something that we hear a lot of, you know, like even to get a mammogram, they don't suggest getting a mammogram until you're 40.

Leigh Hurst (04:15):

Correct. Yeah. And you know, it was, you know, looking back on it, I remember thinking, gosh, I never talked about breast cancer, never talked about it. I didn't know anybody who had had it. I'm not even really sure. I knew anybody who’s mother that had had it. So I was really taken aback by that when I was diagnosed and I was single at the time really hadn't thought about having a family quite yet. You know, I was living in the city, it was very common to still be kind of doing your thing. And so there are other issues that came up other than of course the life or death issue with breast cancer. There were the other possibilities of losing your fertility through chemo. Certainly that's a possibility certain decisions that you might be faced with can also, you know, if you decide to remove any of your female organs, ovaries, whatever, to minimize your risk, of course, those are big decisions when you haven't started a family yet.

Leigh Hurst (05:08):

And I wasn't really sure I was going up, but I didn't want that choice to be taken away from me. I didn't want it to be something that I couldn't do at a later date. So yeah, it was, it was shocking. And you know, out of that, I really started to like, think about why didn't I talk about this? Why didn't I think about this? And so that's kind of how the feel your boobies idea came about is that I just made some t-shirts for friends. Cause I would joke around during my treatment, I was actually still running and I didn't get sick. So I was really happy about that. And I just made sure that said, feel your boobies for fun. I'd always wanted to make t-shirts. I was kinda crafty kind of thing, you know, hobbies on the side.

Leigh Hurst (05:47):

And so my friend and I mocked up a tee shirt and I got a hundred made, put a website up, my background's in technology based learning. So I was kind of techie and I'm just send it around to my friends that had lived in the cities where I had moved after grad school. And I started selling shirts to people. I didn't know, very quickly, it just kind of went viral. I was getting checks in the mail from people. I had no idea who they were. And so, you know, that whole idea of, of using a message, like feel your boobies, which is lighthearted, but very pointed in terms of what it's trying to get you to do. Made me think about, you know, is this really creating behavior change? Is this creating a meaningful dialogue among a population of women like me that never really talked about it before? Or if they did, it was the third serious town and it was about their mother or it was in the context of a doctor's office. And so to that accidental t-shirt, that was just a hobby sort of evolved in time into something that took over my life quite honestly, and quickly I had to figure out what I was doing with it. So that's how the foundation itself came to be.

Karen Litzy (06:53):

Yeah. It's amazing. The things that happen to you that can just do a 180 and change your life. Right. So you could have had this diagnosis and then just went on and got a job and just went on your way. Right. But instead you were like, wait a second, like I'm young, I never talked about this. There's gotta be other people out there just like me. So how can I reach them?

Leigh Hurst (07:15):

Right, right. Sort of back fitting it. Right. Because I didn't create the tee shirt with that in mind, but I watched it happen. And that started to make sense to me with my background in behavior theory and that kind of thing. And so I kind of ran with it and, you know, we were able to support ourselves for quite some time just through t-shirt sales. So fortuitously, unlike other nonprofits that you know, have to submit for grants and you know, really the funding side of it is the tricky part. We were fortunate in those early days the t-shirt sales themselves allowed us to do a lot of creative things through social media before that was a standard way of spreading our message. And so we really tried to leverage the idea of media and the peer to peer sharing because what I saw when somebody would wear the tee shirts, like a happy hour or a cookout was I was watching like a 20 something talk to another 20 something or a guy even who might say your shirt says feel your boobies.

Leigh Hurst (08:16):

Can I feel your boobies? And then they would say, it's not about that. It's about breast cancer. Or you got to feel your boobs to see if you find a lump. And to me that was a productive conversation. It was somebody articulating something very simple, but in a playful and a more friendly and lighthearted way than trying to impart stats or other types of things that I think a lot of campaigns do, or certainly they have the aesthetic and the sensibility that feels like it's for an older woman. So you may relate to it because you're trying to just be proactive and educate yourself about health. But the messaging itself is not really created for you. It's not created for the younger population, the style of the images, the style of the graphics, and even the use of the channel that you use to spread it.

Leigh Hurst (09:01):

Right? So a tee shirts, just one way you can not, but you can do that in many other ways. You know, we flew aerial banners up and down the Jersey shore in the summertime on all the very populated beaches. And I'm thinking of these young women that are like dragging themselves out to the beach after going out Friday night. And they see a, you know aerial banner and they say, Oh my God, that says feel your boobies. And I'm like, that's wonderful. That's a great way to kind of intersect with them where they are in a way that they can relate to. And, you know, it's created testimonials from women that say, that's why they found their lumps. So very proud of the campaign. And eventually I went on and left my corporate career and ran the foundation full time. So it really wouldn't do that 180 for me, that you mentioned about changing your life. It was definitely that for me.

Karen Litzy (09:50):

Yeah. So we can definitely see how your life has changed after diagnosis, but what are the big lessons that you learned?

Leigh Hurst (10:00):

Well, you know, I definitely learned I'm type A, very much of an ambitious overachiever and, you know,

Karen Litzy (10:06):

Well, I mean, you were in New York city in a corporate job, we get it, that came across.

Leigh Hurst (10:12):

Right. And so you kind of like play these scripts out in your head. Like I really should slow down this. Isn't really how I want to spend my time. I'm really too busy. I wish I could make more time for X and part of my move home quite honestly, before breast cancer was in an effort to sort of really operationalize some of that stuff to sort of extract myself out of the environment that wasn't really fueling me anymore. It was draining me. And so, you know, earlier in my career, there's coast to coast flights on a Monday morning to get to a meeting on time. That was exciting. And as I got older, I'm kind of like, I don't really want to do that anymore. I don't care how much money I make. I don't want to be on a plane. I want to be involved in the place that I live.

Leigh Hurst (10:55):

And so my move was in part to get that going right, to really start to be outside more to, you know, I decided to go part time cause I kept my job in New York city. So I didn't need the amount of money I was making where I lived anymore. But I didn't truly step out like that until breast cancer came. And then I quite honestly, I got depressed at the end of my treatment, I got depressed and I took three months off work. I called it my be nice to me times. So I like got weekly massages. I went to get therapy because I felt like I needed to sort of sort through some things, you know, I felt like I should be getting back to normal, but nothing about my life felt normal. Everything had changed, you know, whether or not.

Leigh Hurst (11:39):

So I think during that time is when I started to realize what it meant to say no, that you can say no and not give a reason. And that having lots and lots of friends, which I had is great, but having a lot or having fewer really good friends became more important to me. People that I could really keep in touch with and have meaningful conversations. And my family quite honestly, too, was a big part of that. So I would say that that was the biggest thing slowing down. And I still struggle with that because that's not my genetic makeup. My genetic makeup is to, you know, attack a problem, and make a change and go through something like breast cancer, trying to get back to normal is tricky because you really can't change the future. You never know if it's going to come back.

Leigh Hurst (12:26):

That's just a fact with breast cancer. And so I think learning to live with the ambiguity of not knowing, you know, and accepting that, truly accepting that that kind of translates out into other parts of your life, where you can, if you really allow yourself to sit in that space, you can apply that to other uncomfortable things that come up, right. Things that happen with your job or relationships or other things that make you feel anxious. Like you want to make a change or you want a resolution immediately. I think I have a better sense of pause around that where I trust that in time things will sort themselves out and I will have a greater sense of peace around whatever it is. I'm stressing about things that came out of that period of time in my life. Yeah. That's so powerful. I don't do it well by the way, but I work at it all the time.

Karen Litzy (13:19):

Well, I mean, I think the fact that you were able to identify that as, Hey, listen, this is something that I know I need to work on. And of course we're all a work in progress. Nothing's perfect. But to just be able to recognize that and say, I need to make a change. Like this is too much, that's so powerful. And then to be able to kind of leave the city, move to central PA and say, I know I'm doing this for me. And that was even before the diagnosis. So you were already, you know, heading in that direction. And I also really appreciate that. You said at the end of treatment that you were depressed, that you were unsure, you know, because I think oftentimes when people see breast cancer survivors or they hear from, or just looking at a picture, let's say, right, it's a person smiling or it's I beat it, or, but you don't really get into the background of that.

Leigh Hurst (14:22):

I talk about the mental health side all the time, because I think it is something that's not discussed as much as it should be and not everybody gets depressed, but I do think everybody has down days. Of course, I mean, when you're struggling with something that's life or death and that happens at different times for different people. For me, I was fight or flight during the treatment. For me, it was like a project, right. I knew I had a plan and I had to do it. And the tricky part for me was when I entered into that gray space where I was kind of released from all of that care. And I had to make sense of my life on a day to day basis, be my own cheerleader, quiet those voices in my head that would raise all those scary thoughts and realize that this was going to be forever. You know, like you can't let this consume you. And you know, being brave enough to say I'm depressed. I wasn't brave enough to say that right away. You know, I went into therapy, very hesitantly feeling like, what do you have to be upset about? It was stage one, you got through it, shouldn't you be happy with it?

Karen Litzy (15:22):

That self-defeating language, right? There's someone worse off than you.

Leigh Hurst (15:27):

Right? So therefore you can't feel any sort of emotion around your own words is not true and very dangerous by the way. And so, you know, I really try to bring that up when I speak to women who are going through it or who have gone through it, who I sense might be struggling with a little bit of that, because there's so much, and it's different for everybody. If you might be balancing kids, I wasn't, but it might be balancing kids, little children and trying to mask what you're going through to keep them from being afraid. And so that you're hiding your own emotions for some period of time, or same thing goes for spouses that can have issues. So finding a place where you can be truly honest with your own feelings and dealing with that is I think really important because it delays your ability to heal. If you don't find your way.

Karen Litzy (16:18):

You have to say to yourself, okay, this is the situation and I need to live with this. What's the best way I can move forward. Right. We discussed that a lot with people who have like chronic pain. So the pain may never go away, but can you get to a point where you're still doing all the things you want to do, but in order to do that, you kind of have to accept it.

Leigh Hurst (16:48):

Yeah. And the way you choose to do that, whatever steps you take to make that possible in your life. The biggest thing for me was realizing that other people don't have to get it right. Like if I had a choice, things that make me able to have good days or days that I need to step out for a little bit, I don't have, I shouldn't have to worry, or I can't worry if that makes sense to somebody else, because the only thing I can do is reconcile within myself. What makes me the best version of me, the fullest version of me, for the people that need me. And the way I choose to do that is probably not going to be the same as the way someone else chooses to do that, or should it yeah. Nor should it be. Right. So looking for affirmation about those decisions outside of yourself is a real challenge. You know, if you're a pleaser or you're, you know, sometimes you just gotta bone up and do what you have to do, right. You always just satisfy your needs. But the times when you have choices to flake out on plan that you just don't feel up for, or push something that you thought you should do today to tomorrow those things are okay to do, and you don't need someone else to tell you they're okay.

Karen Litzy (18:01):

Right, right. It comes down to like giving yourself the permission and the grace and the ability to do what you need. Like you said, to do what you need to do in the moment at that time, that's going to be best for you. That's going to allow you to show up fully as the person you need to be.

Leigh Hurst (18:20):

Right. Yeah. That makes total sense. I thought it was a great way of putting it as like self care is not the same as selfish. So making those choices, you have to be, you know, polite, honest, a good person when you're doing all of those things, but taking care of yourself, the self care part of it is not being selfish. It's about being in touch with what makes you the good person that you are.

Karen Litzy (18:46):

Right. And I think also being able to communicate that to someone maybe it's your partner or your spouse or your children or work, I think the way you go about communicating, that makes all the difference, right. Because there's a difference between, listen, right now, maybe you might have felt, you know, I just need to be by myself for a couple of hours, you know, that's what's best for me, but if you don't communicate that properly or if you just flake out and go stout on people like that is not that that's how you, you create a lot of friction. Right. So what advice would you give to people if they do have to make these decisions to do what's best for them? What's the best kind of language? Cause I know you're very good at communication and all that other stuff.

Leigh Hurst (19:38):

So I have two small children. I had kids after breast cancer and I'm a single mom now. And I was since they were very little good friends with their father and all of that, but still, you know, being I'm 50 now, but I was 40 and 42 when I had them. And so, you know, the loss of independence around raising two children alone when you're used to like literally flying coast to coast, you know, rewind five years. And it was like, the world was at your feet. So I found myself becoming extremely protective of my space when they were not with me. And, you know, so I was very cautious about making plans. And I would just be honest about that if it was a weekend that I didn't have them and somebody invited me to go away for example, Oh, we're having a girl's weekend.

Leigh Hurst (20:24):

We're going to go to a winery. Do you want to come? And I would say, well, I might, I might want to come if you need a commitment though. I can't commit because a lot of times when the kids go away, I just like to have some quiet time to myself. I don't like to come back from a weekend and be tired. So I would, I mean, that's just being honest, you know, some things, those are, it's not as easy as something like that, but you know, I think with work where there's deadlines and it's a little trickier to push things off I've gotten better at prioritizing where I'll say it has not really in it today. I know I said I would have this by two o'clock is it possible I could have it tomorrow by maybe 10. So I'm not telling them all the inner workings of what's going on in my brain, but I'm floating the idea that I'd like to shift the priority around because I think it would work better for my mental state. You know, so those are just some ideas for how I do it.

Karen Litzy (21:20):

Yeah. That's great. That's great. Thanks for sharing that. And now what I'd also like to talk about is your book. So you're about to release, well, this will be out the first weekend of October. So the book should hopefully be out by then, right? They will be. Okay. Perfect. So say something big, feel your boobies, find your voice stories about little lumps, inspiring, big change. So first of all, congratulations, because writing a book is no joke. So tell us a little bit about why you wrote the book and what's in it.

Leigh Hurst (21:57):

So I wanted to write this book for quite some time. You know, I do a lot of speaking and people often say, Oh, your story is so inspiring about how you just created something and then you ran with it and you saved lives. And now you have this big foundation. And I do realize that that's inspirational, but I kind of tire of my own story over time. So every time I would sit down and try to write about it, I was like, Oh my gosh. But what I found inspirational enough to get me going this time. And it was really an honor of our 15th anniversary, which was last year. I was hoping to have it done by them, but that's the 15th anniversary of the foundation. And it was also my anniversary from breast cancer is the same as the foundations university.

Leigh Hurst (22:39):

So I started writing it back then and the way I got inspired to really get into it was as I started writing about my own story, I was things were coming to mind about these other women that I had met over time through my path, as you know, being very involved in the breast cancer community and quite honestly, their stories while different were very similar. So they were young when they were diagnosed, they found their own lump and they made some sort of change that was remarkable that they hadn't really pivoted from one path to another and really in an effort to give back. And so, as I started seeing that sort of common thread through some other women that I respected, I thought, well, what if I wove their stories into mine? And so, you know, our stories are different. So how I felt it, this part of the journey, you know, when I found the lump, the way I found it is different than the way one of the other women found it and how I felt during chemo is a lot different than the way some other people felt during chemo.

Leigh Hurst (23:38):

So if I can weave their stories in to mine, then it will relate to so many more people because can kind of say, Oh, I really relate to Leigh. When she was deciding if she wanted to have a mastectomy or lumpectomy, but I really, really related to Holly during chemo, cause I'm really struggling with it. And she struggled with it too. And so there's lots of tidbits of inspiration and advice that come out of all of these stories. And so after each chapter, I write a little piece that's called big lessons from little lumps. And it's basically trying to suss out the things that I felt were common through each of the women's stories at each stage of the breast cancer journey. And then of course at the end, you know, they've all sort of found their voice. They've started their own nonprofits, where they started a company to create underwear, lingerie line that's meant to make you feel sexy, even if you've had your breast removed.

Leigh Hurst (24:35):

And that was because that particular survivor did not feel sexy after she was diagnosed and had surgery and she was a designer. So she decided to do that. And so I just found great inspiration and listening to their stories and trying to weave them into mine. And, really at the end of the entire book, what I found were basically three ideas that I saw across all the women that I think can relate to anybody that's going through any sort of difficult time, not just breast cancer. And one of them was that I really noticed that each woman found a frame for their situation that really focused on the idea of looking forward into the future versus looking only backwards and only wishing they could redo it differently. Right? Like being sad about what had happened. They all had those emotions, but the way they ultimately framed things was with the idea of looking forward.

Leigh Hurst (25:31):

Then each of them also talked a lot about finding a passion, something that really, you know, gave them those goosebumps or that feeling you get in your stomach when you're doing something right. And that is what they chose to spend their time on. And they really made an effort to strip anything out of their life that got in the way of them being able to focus on that type of activity. And then the thing that we talked about earlier, but the third thing is that they all recognize that change is continuous, right? It's not like you flip a switch and say, I'm going to make this change, or I'm going to start fuel your movies. And all of a sudden I'm happy because I started a nonprofit and it does good things. I mean, it has all the same challenges that a normal job has.

Leigh Hurst (26:11):

So change is truly this continuous thing, but because of the passion and they're focused on the future, they were able to realize that, sure, there's going to be some bad days throughout this process, but nothing is going to get in the way of my path to create this change towards the way I really want to live my life. And I found that so powerful when I saw that kind of trend throughout each woman. And I really think a lot of people will benefit from watching how each of them kind of, you know, injected that into their own lives.

Karen Litzy (26:44):

And isn't it amazing how storytelling creates such great learning moments, right? I think that's the way to do it. People they remember the stories, they think it's digestible, they internalize it. Like you said, what someone may not relate to you, but they may relate to someone else in the book. And it's those stories that weave through that come up with these great themes that anyone can relate to. So I just always think that I'm such a huge fan of storytelling and storytelling makes things real and relatable.

Leigh Hurst (27:16):

And I think that's an important way. It's one of the things we try to do with the foundation too, is when we do provide messaging or things, we try to really make it relatable. And that we're telling a story about someone who is real, someone who was young when they were diagnosed. So when you say that looks like me, I can relate to that. I also think women who are brave enough to share their story and I, by no means think it's wrong to not share your story. I think you're a private person and that's how you heal, then that's what you should pay attention to. But for those who choose to, and they don't always realize they've chosen to one of the women in the books that she never talked about it. The first time she was diagnosed, she was 26 and she was embarrassed.

Leigh Hurst (27:56):

And then she unfortunately was rediagnosed nine years later with metastatic cancer at 45, which means it's terminal. And at that point she really became braver to start talking about it and she realized how much strength she got from sharing her story. And so I think when women put their stories out there they have no idea how many people they touch when they do it, because no one's gonna necessarily walk up to you and say, I really respect that. You said that, or I want you to know that that really made a change in my life that day, but it does. It does. And it goes beyond what you will ever actually know.

Karen Litzy (28:32):

Absolutely. Yeah. And I love that sort of women pushing other women forward and building them up and paying it forward. It's just such a lovely, a lovely lesson for anyone. But as we all know, you know, the power of women in groups is very powerful.

Leigh Hurst (28:52):

Unstoppable. Exactly.

Karen Litzy (28:54):

Exactly. That's better unstoppable. Yes, absolutely. And so before we kind of wrap things up, what I would love from you is what would you like the audience to sort of take away from maybe from your experience or from our talk today? Cause I know that you do and you also, I also want to point out that you also talked to a lot of young people, college students, things like that, right?

Leigh Hurst (29:18):

Yeah, I do. I do. Yeah. So one of the aspects of our campaign in the past has been what we call our college outreach program, which we provided free materials to college health centers nationally through sororities and women's centers and so forth. And that was in an effort to get our message out to the college campuses. And we've also started running a media campaign which we did last year called are you doing it was a minority outreach campaign focused on young African American women in low income areas. African American women have a higher, are diagnosed at an earlier age than white women. And once they're diagnosed, they have a higher mortality rate as well. And so it's a very important audience to target. And so we funded a campaign that leveraged billboards, bus shelters, bus wraps, as well as targeted digital outreach to that demographic of women specifically to spread the message and that incorporated five local survivors, real survivors who were diagnosed at a young age, we did a photo shoot, shot a video with them.

Leigh Hurst (30:22):

And we shared that through all the channels that I mentioned, but we got over 6.2 million impressions with that campaign. Amazing. Very amazing. So, yeah. So we reach out to that younger population, like you mentioned in a lot of different ways, but I mean, I think if you asked me what the one thing is, I want someone to take away is that, you know, it sounds cliche, but I really do believe that one voice matters. I feel like the ripple effect from one person's passion and when one person's devotion to an idea can really make a difference and they don't have to be big actions. The things that you choose to do, don't have to necessarily change the world, but you can start small. And the actions that you choose, the words that you choose and how you choose to navigate your life, I think affects other people. And this book really showed me that in the smallest of ways, people can have the biggest impact in their communities and in other people's lives. And that's, I think that's a really great lesson for anybody to take away.

Karen Litzy (31:24):

Absolutely. And now if people want to get in touch with you, where can they find you? Where can they find the book?

Leigh Hurst (31:31):

So the book will be available on Amazon. Starting October 1st, I believe. You can read more about the book leighhurst.com. You can follow the book on Facebook, which is, say something big as well and Instagram to say something big. So those are all the channels. And then of course, if you're interested in feel your boobies and the work that we do, the Facebook pages you know, at feelyourboobies on Facebook, Instagram, and Twitter, and our website is feelyourboobies.com.

Karen Litzy (32:08):

Awesome. And we'll get all of those links. So for everyone, if you don't have something to take it down, or you're not right in front of the computer, we'll have all of the links. You can go to podcast.healthywealthysmart.com. And we'll have a quick link to everything that Leigh mentioned today throughout the podcast. So not to worry, everything will be right there. So Leigh, thank you so much for sharing your story. I just know, like you said, even if one person hears this and they say, Oh, well maybe I will feel my boobies, mission accomplished. Well, thank you so much for sharing your story and coming on the podcast. I appreciate it. And everyone out there 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 Apple Podcasts

Sep 28, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Sandy Hilton, David Butler and Bronnie Thompson on the show to discuss persistent pain during COVID-19. 

In this episode, we discuss:

-Shifting current healthcare curriculum to better educate clinicians on persistent pain

-Can passive modalities empower people to pursue more active treatment options?

-How to create more SIMS during the COVID-19 pandemic

-Can telehealth appointments adequately address persistent pain?

-And so much more!

 

Resources:

International Association for the Study of Pain Website

Factfulness Book

David Butler Twitter

Sandy Hilton Twitter

Bronnie Thompson Twitter

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

                                                                    

For more information Bronnie:

I trained as an occupational therapist, and graduated in 1984. Since then I’ve continued study at postgraduate level and my papers have included business skills, ergonomics, mental health therapies, and psychology. I completed by Masters in Psychology in 1999, and started my PhD in 2007. I’ve now finished my thesis (yay!) and can call myself Dr, or as my kids call me, Dr Mum.

 

I have a passion to help people experiencing chronic health problems achieve their potential. I have worked in the field of chronic pain management, helping people develop ‘self management’ skills for 20 years. Many of the skills are directly applicable to people with other health conditions.

 

My way of working: collaboratively – all people have limitations and vulnerabilities – as well as strengths and potential. I use a cognitive and behavioural approach – therapy isn’t helpful unless there are visible changes! I don’t use this approach exclusively, because it is necessary to ‘borrow’ at times from other approaches, but I encourage ongoing evaluation of everything that is put forward as ‘therapy’. I’m especially drawn to what’s known as third wave CBT, things like mindfulness, ACT (Acceptance and Commitment Therapy) and occupation.

 

I’m also an educator. I take this role very seriously – it is as important to health care as research and clinical skill. I offer an active knowledge of the latest research, integrated with current clinical practice, and communicated to clinicians working directly with people experiencing chronic ill health. I’m a Senior Lecturer in the Department of Orthopaedic surgery & Musculoskeletal Medicine at the University of Otago Christchurch Health Sciences.

 

I also offer courses, training and supervision for therapists working with people experiencing chronic ill health.

 

For more information Sandy:

Sandy graduated from Pacific University (Oregon) in 1988 with a Master of Science in Physical Therapy and a Doctor of Physical Therapy degree from Des Moines University in December 2013. She has worked in multiple settings across the US with neurologic and orthopaedic emphasis combining these with a focus in pelvic rehabilitation for pain and dysfunction since 1995. Sandy teaches Health Professionals and Community Education classes on returning to function following back and pelvic pain, has assisted with Myofascial Release education, and co-teaches Advanced Level Male Pelvic Floor Evaluation and Treatment. Sandy’s clinical interest is chronic pain with a particular interest in complex pelvic pain disorders for men and women. Sandy is the co-host of Pain Science and Sensibility, a podcast on the application of research into the clinic.

 

For more information on David:

Understanding and Explaining Pain are David’s passions, and he has a reputation for being able to talk about pain sciences in a way that everyone can understand. David is a physiotherapist, an educationalist, researcher and clinician. He pioneered the establishment of NOI in the early 1990’s. David is an Adjunct Associate Professor at the University of South Australia and an honoured lifetime member of the Australian Physiotherapy Association.

 

Among many publications, his texts include Mobilisation of the Nervous System 1991 The Sensitive Nervous System (2000), and with Lorimer Moseley –  Explain Pain (2003, 2013), The Graded Motor Imagery Handbook (2012), The Explain Pain Handbook: Protectometer (2015) and in 2017, Explain Pain Supercharged. His doctoral studies and current focus are around adult conceptual change, the linguistics of pain and pain story telling. Food, wine and fishing are also research interests.

 

Read the full transcript below:

Karen Litzy (00:00:23):

Hello everyone. And thank you for joining us today for this webinar. For those of you who are here live, you got to hear a little bit of pre-conversation which is great. And of course in that pre-conversation we were talking about all the things happening in the world today, specifically here in the United States with a lot of unrest and protests for very, very good reasons, in my opinion. And so we just want to acknowledge that and that we see it and that we are trying to learn, and we are doing our best to be allies to our fellow healthcare workers and citizens across the country and across the world for all of the other countries who have been showing solidarity. So I'm Karen Litzy, I'm going to be sort of moderating this panel of minds and I'm going to now go round and just have each of them say a little bit about themselves. So Sandy I’ll start with you.

 

Sandy Hilton:

Okay. Hi, I'm Sandy Hilton. I'm a physiotherapist here in Chicago, Illinois with Sarah Haag. We have entropy physiotherapy and our clinic is predominantly working with pain. It's like a hundred percent of my case load is people in pain and about 80% of that is pelvic pain in particular. But I still see, you know, the rest of humans.

David Butler (00:01:49):

Hi, I'm David Butler from Adelaide Australia. I'm a physio, although I'm completely a professional and I believe everybody has the exact same role in treating pain. I'm trying to hire, but I can't retire. And then in world, our changing knowledge and our changing potential just keeps me, keeps me on track. So yeah, any sort of pain I'm happy to talk about.

Bronnie Thompson (00:02:16):

I’m Bronnie Thompson, I'm an occupational therapist by original training with some psychology thrown in, and I'm an educator and clinician as well, but a teeny tiny bit of research, but not much. And I'm a painiac and quite proud of it actually.

 

Karen Litzy:

Excellent. So again, everyone, like I said, if you have questions as we go along, please feel free to put them in the Q and a part. And I will be looking at that as we're going through now, like I said, we've got some questions ahead of time, but before we get to some of the questions that some of the listeners and viewers have wanted to ask, I also want to just quickly acknowledge that we've got a bit of a mixed audience, so we've got healthcare practitioners and clinicians and we've also got people living with pain.

Karen Litzy (00:03:11):

And so as a clinician for me, it's a great opportunity. I think to address people in pain who maybe don't have the access or the ability to kind of get this information that's in their town or where they're living. So I am really, I'm really looking forward to this discussion, especially for those people that are watching that are living with persistent pain. So the first question I'm going to ask is and I'll ask this of all of you. If you were to give a piece of advice to a new professional or a healthcare professional that is sort of newly working with people with persistent pain, what would that piece of advice be?

Sandy Hilton (00:04:11):

I'm in Chicago. I'm just going to take it. I really like to stress, especially to students that, you know, we get this concept that the longer you've been in the field, the better you are at it. And, I think that maybe we make different mistakes, but everyone is learning this. And there's so much about pain that we're learning. And so if you're just starting in, I don't know that you might have an easier time because you have less bad habits to get rid of and can start with some of the better newer research and avoid some of the mistakes we made.

Bronnie Thompson (00:04:50):

So she's doing the popcorn approach. She looks at me. And so I think my advice would be, listen, listen very carefully to what people tell you and trust that they're telling you your experience. Don't try and read stuff into it, just listen and reflect, show that you're listening by reflecting what you've heard. So you can give that you've understood one another, because it's really easy to come out of school with all of this knowledge packed up and your brain thinking, Oh, I've got to do an info dump just like that. And it's not that great for the person, stop and listen.

David Butler (00:05:37):

They are lovely comments. I'd add. I would welcome anybody to the most new and exciting area of health. And there is a true pain revolution out there. And I would say to anybody, when you come in to just lift your expectation of outcome or what, might've been five or 10 years ago, because the clinical trials and our knowledge of the potential for humans to change is just increasing so dramatically. And I say, now we can say think treatment, not necessarily management because for many people recovery or some form of recovery is on the cards and what's leading the charge is the talking and the movement therapies. It's not the drug therapies for chronic pain. And, I just like to reflect as an older therapist now, patients who maybe 10, 15 years ago with maybe complex post pain surgery or Phantom limbs or complex regional pain syndrome would have thought, and I can't really help here. Now we welcome them through the door and you can get such pleasure, pleasure from treating these people no matter how long they've had the problem.

Karen Litzy (00:06:48):

Great. And, I would echo what Bronnie said is, you know, really listen and also believe, you know, they're giving you their experience. So try and take your bias out of it and believe what they're telling you and try not to talk them out of it because you see this quite a bit of, Oh, I have pain with this. And well, do you really have pain with that? Or is your pain really that much? And as the patient, it's very frustrating to have someone try and tell you what your pain is. So I'm looking at it from the person who has lived with the really chronic and at times debilitating neck pain is just listen, which is good. Believe them, and try not to talk people out of their experiences because it's very frustrating and it's very sort of dehumanizing for the patient, you know?

Karen Litzy (00:07:54):

And when I look back at when I first met David and went up to him at an APTA event and said, would you like to be on my podcast? And he said, yeah, sure, but I'm going to New York. I said, Oh, well, that's great. Cause that's where I live. And so then he met me at my, where I was working at the time and spent two hours with me. And I just, after that felt like, Whoa, like this is the first time that someone really listened and didn't interrupt and believed what I was saying and really set me on a path that just changed my life. Like, I don't know where I would be, had I not had that encounter with David. I think it was like 2011 or 2012. And so I always reflect on that and try and be that person, because I know what it felt like.

Karen Litzy (00:08:45):

And then when someone does come in and, and gives you their full attention and their time and their understanding, and then says, well, challenges your beliefs in a positive way, it was something for me that, you know, and I've talked about it many times that just completely changed my pain and my life. And so, you know, try and be that person is what I would say to people.

 

Bronnie Thompson:

It's like, we've got to remember that people with pain and I live with fibromyalgia, those of you that don't know that's my reality, it's our experience and what it's like to live without pain. You know, what it feels like to know the things that sit at off things that settle it down and our relationship to it, to that pain and conditions. We come in with a whole lot of knowledge about other people and what we've seen. So we are experts and a whole lot of stuff, but what we're not experiencing as this person's life, their experience via what they're wanting from us even, what's important to them. And that's where when we meet and we can kind of share the hidden paradigms things that we don't know about each other, then we've got a chance to make a huge change and that as we know, I just feel so good about what I do. I just love it. I'm such a pain geek.

Sandy Hilton (00:10:09):

And I think the pain science or the science of pain really gives as a clinician, a lot of comfort to the listen to them, believe them, you don't have to prove it. You don't have to go. And like they say, I hurt here. You don't have to go poke it to reproduce the symptoms to believe it. And that's how I was taught of you have to reproduce the symptoms so that you can document that it's true. And it was like, that's a giant piece of unnecessary that we don't even have to do anymore, which really saves us a lot of time, not to mention establishing that trust and not being one more person. That's poked them in the sore spot. But, that's the thing that I was taught in school.

Bronnie Thompson (00:10:58):

So the question is, do you think that all chronic pain patients were not treated particularly when they were having the first or second episodes of their acute pain or are they in any way destined to become chronic pain patients? Well, my story is I hurt my back. I was what, 21, 22, doing a tango with the patient and a doorway patient was bigger than me. I landed on the floor on my back and I had all the best evidence based treatment at the time, maybe not, maybe not all the ultrasound, but you know, they didn't lie. They're really and relax a bit.

Bronnie Thompson (00:11:48):

But I didn't recover. I was then seeing the Auckland regional pain Center with amazing dr. Mike Butler, who is a rheumatologist and founded, and basically was one of the first in this initiations of bringing the international association for the study of pain to New Zealand, good friend of Patrick Wall knew her stuff very well. Gave me the book the challenge of pain to read. So essentially an explain pain paradigm back in the eighties, I know pain pretty well. My pain has not gone away. So there are some people who will not have a complete recovery of all of their pain, but because none of our treatments provide a hundred percent abolition of pain and actually I'm comfortable with it. I live with the pain and it gives me some stuff that some other people don't have access to. I know what it's like to have every bit of my body feeling really rotten.

Bronnie Thompson (00:12:53):

At the same time. I'm not limited by my pain. And I think sometimes we look at pain removal is that end goal. But I think our end goal is to help people live full, productive, satisfying, joyful and enriched lives. And some people will bring the pain along with them and many people won’t have to and that's amazing. Let's let the person make that decision about what is the most important outcome. But yeah, sometimes we can do all the right things, but if you have a spinal cord injury and you've got a smashed up spine, probability is that at the moment, our technology doesn't give us a solution. We can help, but we can't always take it all away.

 

Karen Litzy:

David, what are your thoughts on that, that sort of movement from acute pain to chronic pain? You know, what are your feelings on that is, is like you said, are you destined to have it are I know, cause I get this question a lot from people like, well, you know, it started out with like an ankle sprain or it started out with a knee sprain and now it's turned into this. So did I do something wrong or was something not done?

David Butler (00:14:12):

I think you’re not destined to have it, but I think our treatment or therapies and the politics of treating acute pain probably gets in the way. And I also think if someone's hurt their back or any part of their body bad enough to see a health professional, the data is that 50 or 60 or 70% will have a recurrence in the following year. Now most health professionals think a recurrence is a reinjury, but if they really explored what happened, that reoccurance probably happened at a time when they would look at down and flat the immune system's a bit out of balance and they might've just done something simple, lifted up and picked something we would now from pain science, reconceptualize that as well, that's quite good. It's your body testing yourself out like a fire alarm with all the stuff you've been through in the past. It's no wonder your brain. Wouldn't want to play it again to check out how your systems are working, but that just simple piece of knowledge and usually should check to make sure nothing serious has gone on because you check and you can normally say, well, that should ease in a couple of days. That's an example of a little bit of knowledge dampening down. They don't have to go through the old acute process again of more, x-rays more tests, more power.

David Butler (00:15:31):

I think if that's correct, that observation was seen for many years, it could save governments Billions.

Bronnie Thompson (00:15:37):

Oh, absolutely. We've got a great thing. The language we use don't we, is it an injury or is it just a cranky body?

David Butler (00:15:46):

That whole linguistics? And for me and my treatment, you're now a physio by trade. I feel it says important to help someone change the story, to have a story, to take their experience out into society and let it go. That to me is as important as having healthy movement, although they obviously like go together.

Sandy Hilton (00:16:07):

I was gonna say that the saving of money for systems, for sure, but also the saving of time for people and the saving in our healthcare system. Every test you go do is going to cost you a lot of money. And, that time that it takes to get it in a time away from work and family and the concern of what the test results will be. If we can divert them wisely to not do that when it's not really indicated, that's just so good.

 

Bronnie Thompson:

Yeah. And then I also for, you know, I've had a test now I'm going to wait for the results and now I'm going to wait for what are they going to do as a result of those results? And then, Oh, it's the same. And it just feels very demoralizing to people. And I think that's something we need to think about with make the decision about when and we to stop doing investigations often. That's the sense of the clinician worrying that something, are they going to sue me? It’s not a good way to practice.

 

Karen Litzy:

Yeah. here's another, we'll do this from Louise. She says, picking up on something David had said earlier, how do we move towards being more, a professional? How do we move the pain industry toward this goal? Excellent question Louise.

David Butler (00:17:51):

There's a lot of answers to it, but a couple would be, I think you just got a quite badly out there would know sports trainers who could deliver an equally good management strategy to some physios, to some doctors, et cetera, right? This pain thing is across all spectrums, which is why the national pain society meetings are so good. And why everybody there is usually humbled and talks to all the other professionals because they realize the thing we're dealing with is quite hard. And we need all the help that that's a weekend get, but it ultimately comes back to provision of pain education throughout all the professions and that pain education should be similar amongst all the professions it's not happening yet. We've tried pushing it, but it's not out there. And it's incredible considering the cost of pain is to the world is higher than cancer and lung diseases together.

Karen Litzy (00:18:51):

Yeah. The burden of care is trillions of dollars across the world. And, you know, even in the United States, I think the burden of care of back pain is third behind heart disease, diabetes. And then it was like all cancers put together, which, you know, and then it was back pain. So, and, and even I was in Sri Lanka a couple of years ago and I did a talk on pain and I wanted to know what the burden of disease of back pain was in Sri Lanka. And it was number two. So it's not like this is unusual even across different, completely different cultural and socioeconomic countries. And, you know, David kind of what you said, picks up on a question that we got from Pete Moore. And he said, why isn't it mandatory that pain self management and coaching skills isn't taught in medical schools? Is it because there isn't expertise to teach it? Well, I mean, David's right here. He's semi retired.

David Butler (00:19:58):

Why isn’t that mandatory? That's a big, big question. I would say that the change is happening. Change is happening. I would say that at least half of the lectures or talks I give now are to medical professionals and out of my own profession or even more than half. So yeah, change is happening, but it's incredibly slow. It needs a bloody revolution, quite frankly. A complete reframing of the problem and awareness that this problem that we can do something about it and awareness that there's so much research about it let's just get out and do it now.

Sandy Hilton (00:20:40):

The international association for the study of pains curriculum and interdisciplinary curriculum would be a nice place to start. And I know some schools here in the States are using it in different disciplines to try and get at least a baseline.

 

Bronnie Thompson:

The way we do it as the core for the post grad program, that I am the academic coordinator for it. Doesn't that sound like a tiny, tiny faculty. But anyway the other thing that we know is that looking at the number of hours of pain, education, Elizabeth, Shipton, who's just about completed. If she hasn't already completed her PhD, looking at medical education and the amount, the number of hours of pain, it's something like 20 over an entire education for six to six or more years. In fact, veterinarians get more time learning about pain then we do then doctors medical practitioners do, which suggests something kind of weird going on there.

Bronnie Thompson (00:21:50):

So I think that's one of the reasons that it's seen as a not a sexy thing to know about and pain is seen as a sign of, or a symptom of something else. So if we treat that something else in pain will just disappear, but people carry the meaning and interpretation in their understanding with them forever. We don't unlearn that stuff. So it makes it very difficult, I think for clinicians to know what to do. Because they're also thinking of pain is the sign of something else not is a problem in its own, right? Persistent pain is a really a problem in its own right.

Karen Litzy (00:22:29):

Yeah. And wouldn't it be nice if we were all on the same page or in the same book? I wouldn't even say the same chapter, but maybe in the same book, across different healthcare practitioners, whether that be the nurse, the nurse practitioner, the clinical nurse specialist, the physician, the psychologist, the therapist, physical therapist, it would be so nice if we were all at least in the same book, because then when your patient goes to all these people and they hear a million different things, it's really confusing. I think it's very, very difficult for them to get a good grasp on their pain. If they're told by one practitioner, Oh, see, on this MRI, it's that little part of your disc. And that's what it is. So we just have to take that disc out or put it back in or give a shot to this.

Karen Litzy (00:23:25):

And, and then you go to someone else and they say, well, you know, you've had this pain for a couple of years, so, you know, it may not be what's on your scan. And then the patient's like, who am I supposed to believe? What am I going to do? And, and you don't blame the patient for that. I mean, that's, you'd feel this that's the way I, you know, I had herniated discs and I say, you just get a couple of epidurals and the pain goes away and then it didn't. And I was like, Oh, okay, now there's so my head, I was thinking, well, now there's really something wrong.

 

Sandy Hilton:

That's the problem. Because yeah, if you think it's the thing you did that helped you or didn't help you, then you lose that internal control.

Karen Litzy (00:24:13):

Yeah, yeah. Yeah. So I think, I think it's a great question and, and hopefully that's a big shift, but maybe it'll start to turn with the help of like the international association for the study of pain and some curriculum that can maybe be slowly entered or David can just go teach it virtually from different medical schools, just throwing it out. There is no pressure, no pressure. Okay. Speaking of modalities, we had a question. This is from someone with pain and it's what can be the appropriate regimen for usefulness of tens, for acute and chronic cervical and lumbar pain of nerve origin. So Bronnie, I know that you had said you had a little bit of input on this area, so why don't we start with you? And then we'll kind of go around the horn, if you will.

Bronnie Thompson (00:25:24):

I think of it in a similar way to any, any treatment, really, you need to try it and see whether it fits in your life. So if you are happy and tens feels good and you can carry it with you and you can tuck it in your pocket and you can do what you want to do. Why not just is, I would say the same about a drug. If you try a drug and it helps you and it feels good and you can cut the side effects, there's nothing wrong with it. Cause we're not the person living life. It's more to think about it in a population. How effective does this? And my experience with tens is that for some people it does help and it gives a bit of medium, like a couple of hours relief, but often it doesn't give long sustained relief and you have to carry this thing around. That's prone to breaking down and running out of batteries, right when you need it. So to me, it's agency, but then I put the person who's got the pain and the driving seat at all times to say, how would this fit in your life? Do you think you want to try this one out? It's noninvasive it's side effects. Some people don't like the experience and sometimes the sticky pads are a bit yuck on your skin, but you know, that's more bad. So yeah, that's my, my take on it.

David Butler (00:26:44):

I haven't used it for 40 years after the second world war. When you start to stop, when they, I was friendly with the guy who invented it and I'm thinking it'd be happy pet we'll would be happy to, with these comments that I agree with what Bonnie said. Absolutely. I would also say that, hi, wow, you have got something there which can change your pain by scrambling some of the impulses coming in. You can change it, let's add some other things which can change the impulses coming in or going out as well. So let's use that. Let's get you building something, maybe something repetitive or something contextual or something as well. So you you've shown change you're on the track. So I would use it as a big positive to push them on keep using it, but on the biggest things.

Sandy Hilton (00:27:32):

Yeah, the advantage is it's. So it's gotten so inexpensive. So for something that has minimal to no side effects and has the potential of helping them to move again, which I think is always the thing that we're aiming for. It's not very expensive. But now like several hundred dollars, right? You can order it online. Now you don't even need a prescription or approval or anything like that.

Karen Litzy (00:27:59):

Yeah. Yeah. That's true. And something that I think is also important is, you know, you'll have people say, Oh, those passive modalities, that's passive. You know, I had a conversation with Laura Rathbone Muirs. Is that how you say the last name? I think that's right. Laura. And we were talking about this sort of passive versus active therapies and, you know, her take on, it was more from that if they're doing these passive modalities, they're giving away their control. And, she said something that really struck and, kind of what the three of you have just reinforced is that no, they still have that locus of control. Cause they're making that conscious effort, that conscious choice to try this, even though it's a passive modality, they still made the choice to use it.

Karen Litzy (00:29:03):

And I think that coupled with what David said, Hey, this made a difference. Maybe there's some other things that can make a difference that I think that I don't think they're losing that locus of control, or I don't think that they're losing they're reliant on passivity, right.

 

Sandy Hilton:

When they have their own unit and they're not coming into the clinic to have it put on you. And you lie there on the bed while you do it.

 

Bronnie Thompson:

It's something that you have out in the world. It's not different to sticking a cold compress on your forehead when you're feeling a bit sick, you know, we did it. That's just another thing that we can do. So I see it as a really not a bad thing. And it is in the context, you know, if you can do stuff while you've got it on, then it's the hold up problem, as long as you like.

 

Karen Litzy:

Great, great. Yeah. As long as you like it. Exactly. Yep. Okay. so we've got another question that we got ahead of time and then there's some questions in the queue. So one of the questions that we got ahead of time was how do we explain pain responses like McKenzie central sensitization phenomenon in modern pain science understanding.

David Butler (00:30:35):

I'd answer that broadly by saying that the definition that we've used and shared with the public in the clinical sense is that we humans hurt when our brains weigh the world. And judge consciously subconsciously that there's more danger out there than safety. We hurt equally. We don't hurt when there's more safety out there, then danger. So somebody who's in a clinic and is bending in any way and it eases pain. There will never be one reason for it. So it might just be, that might just be the clinic. It might be the receptionist. It might be all adding up. It might be the movement. They might've done one movement. And so, Oh, I can do that. And then all safety away, we go again, the next movement helps within that mix. There may be something structural. You've done to tissues in the back and elsewhere that might have eased the nociceptors that barrage up. But by answer will always be that when pain changes, it's multiple things are coming together, contributing to them. And they'll never never just be related to nociception.

Sandy Hilton (00:31:49):

I have to say this to say, I am not McKenzie certified. So this is my interpretation of that. I like the concept of you can do a movement. That's going to help you feel better. And we're going to teach you how to do that throughout the day. Maybe as a little buffer to give you more room, to challenge yourself a little more knowing that you'll have a recovery. And I just pick that part and use that.

 

Bronnie Thompson:

I heard the story of how it all came about and it, and it's you know, it's an observation that sometimes movement in one direction bigger than another. And that's cool. It's like, you're all saying, let's make this little envelope a little bigger and play with those movements because we're beasts of movement.

Bronnie Thompson (00:32:50):

We just forget that sometimes we think we've got to do it one way. And you know, I can't tell my plumbers who crawl under houses. Look, you've got to carry things the way, you know, the proper safe handling thing. And I wasn't, I was the same safe handling advisors like me. But you know, there's so many ways that we can do movements and why can't we celebrate that? And the explanation, sometimes we come up with really interesting hypotheses that don't stand the test of time. And I suspect it might be some of the things that have happened with the McKenzie approach. It's same time. What McKenzie did that very few people were doing at the time was saying, you can do something for yourself that as we are the gold ones, that's what changed.

David Butler (00:33:40):

Bronnie, what's really helped us to start the shift away from poking the sore bit, come on, do it yourself. And, and I always give great credit to Robin McKenzie for that shift in life.

Sandy Hilton (00:33:53):

Yeah. And an expectation that it's going to get better. Right.

David Butler (00:34:00):

You think that’s showing something in the clinic that helps. Wow. Let's ride let's rock.

Karen Litzy (00:34:07):

Yeah. And oftentimes I think patients are surprised. Do you ever notice that Sandy, like, or David, or, you know, when you're working with patients, they're like, Oh, Oh, that does feel better. And they're just sort of taken aback by, Oh, wait a second. That does feel better and it's okay. I can do it. Yeah. And then you give them the permission to do so. And like you said, is it's certainly not one single thing that makes the change. But I think everything that you guys just said are probably the tip of the iceberg of all of the events surrounding that day, that time, that movement, that can make a change in that person. And I think that's really important to remember. That's what I sort of picked up from the three of you.

 

Bronnie Thompson:

But the stories like that kind of convenient ways of, for us to think that we know what we're doing, but actually within what this person by what this person feels and how they experience it. And the context we provide us safety, security. And I'm going to look after you, that's, you know, changes, motivations about how important something is and how confident you are that you can do it. We can provide the rationale important part. The person ultimately drives that. So we can also provide that sense of safety and that I'm here. I'm going to hang around while you do this stuff. Let's play with it. Let's experiment. And if we can take that experiment, sort of notion of playing with different movements in, we've got a lot more opportunity for people in the real world to take that with them. We can't do that. Or forgive people are prescribed. You will do this movement. And this way perfectly I salute, but the old back schools, Oh, I know scary, And they did get people seeing the other people were moving. And that's a good thing that we can take from it. It's always good and not so good about every approach.

Karen Litzy (00:35:11):

Now I have a question for David and then out to the group, but you know, we've been talking about Sims and dims and safeties and dangers. And so for people who maybe have no idea what we're talking about, when we're talking about Sims and dims, can you give a quick overview of what the Sims and dims, what that is so that people understand that jargon that we're using?

David Butler (00:36:40):

Okay, it's a model we use. There's lots of other similar models out there. So basically based on neuro tag theory, the notion of a network that there's danger danger in me networks out there, and there's safety in me networks, rather simple, structured thinking here, and we've looked at these this has emerged due to the awareness, the pain science that we have a network in our brain. But me as an old therapist, when the brain mapping world came in and we realized, hang on pain, isn't just a little nest up there. There could be thousands of areas of the brain ignited indeed the whole body ignited in a pain experience. And one of the most liberating bits of information for me and my whole professional career, because what it meant was that many things influence a pain experience and a stress experience, move experience lab experience, and many things can be brought in to actually try and change it.

David Butler (00:37:39):

And all of a sudden means that everything matters. So this is where dims danger in me, safety sims in me, it was just a way to collect them. So an example of a dim with categorize them could be things you hear, see, smell, taste, and touch. So for one person, it could be the smell of something burning or looking at something or hearing something noise. The things you do could be a dim. It could be just doing nothing, but then there's Sims, gradually exercising, gradual exposure seems in things you hear, see, smell, taste, and touch could be going out. One of my most common exercises I now give somebody is to go down to our local market and find four different smells, four different things to taste, four different things to touch. And then they'll say, why should I do that? Because you can sculpt new safety pathways in your brain, which will flatten out some of them, some of the pathways they're linked to pain and it comes to of the things you say important.

David Butler (00:38:37):

You know, I can't, I'm stuffed, I'm finished. I got mom's knees. We try and change that language too. I can, I will. I've got new flight plans. I can see the future, the people you meet, the places you're with. So it's a way of categorizing all those things in life into either danger or safety, we try for therapy, we try and remove the dangerous. It is often via education. What does that mean? And we try and help them find safety and health professionals out there are good at finding danger, but we're not used to getting out there and finding those liberating safety things. And of course the DIMS SIMS thing. It's also closely linked in, we believe to immune balance. So the more dims you have, the more inflammatory broad immune system, the more sims you have, you move more towards the analgesics or the safety. And so it's the way to collect them. It's a way to collect as we try and unpack and unpack a patient's story listing to it within to unpack it and then to re-pack it again with them in a different way. Did that make sense?

Karen Litzy (00:39:49):

Absolutely. Yes. I think that made very good sense. And I believe you, there is a question on it, but I believe you answered it in that explanation. It says, have you had patients that cannot find Sims or it's difficult to identify and if so, how can you teach them what a SIM is? But I think you just answered that question in that explanation.

David Butler (00:40:11):

Once they get it. They're on their way. And we send people on SIM hunting homework. So for example, the same might be places you go, okay, if you can get out, just walk in the park or walk somewhere, then power up the SIM by feeling the grass, touching the box, spelling something. And we pair it up by letting them know that if you do that, your immune system gets such a healthy blast, that it can also help dampen down some of the pain response.

Bronnie Thompson (00:40:39):

And with regard to our current situation, sort of around the world COVID-19 and all the subsequent stuff. And also the situations in the U S at the moment, is it any wonder that lots of people are feeling quite sore because we’re eating this barrage of messages to us. And so I would argue that at the moment it might be worthwhile if you're a bit vulnerable to getting fired up with the stuff said, it's a good idea to ration, how much time you're spend looking at the stuff, not to remain ignorant, but to balance it with those other things that feel good, that make you feel treasured and loved and committed. And for me, it's often spending some time in my studio, walking the dog, going outside, doing something in nature. And there is some really good research showing that if you're out in the green world nature, that there is something that our body's really relish, kind of makes sense to me.

Sandy Hilton (00:41:42):

So taking that concept into what's going on right now, there's been a challenge clinically of the things that helped people balance that out, got taken away from them. Yeah. So it was a complicated it still is. It was a complicated thing where it wasn't your choice to stop going to the swimming pool because it made you happy and it gave you exercise and balance this out. Someone closed the pool and told you, you couldn't go. And so there's all different layers of loss in that and lost expectations and loss of empowerment and all of these things. So we have had to help people rediscover things that they could access that could be those positives. And that's been hard and really working my muscles of how to help people find joy or pleasure or happiness or safety in an unsafe environment to really get that on a micro level when you've lost the things that used to be there. And, it's been like a lot, but you can do it. It just takes concentration.

David Butler (00:42:57):

An important thing. That's so important. I think a question for therapists health professionals should be a sane question should be, you know, what's your worldview at the moment. And I would ask that, and it's usually not good, but I chat and have a chat. And actually I'd like to take people through some graphs that the world is not as bad as it really is. And if you look at I've been reading a book by Hans Rosling called factfulness. And really over time, our world is getting better. There's less childhood diseases, a whole range of things, getting better, bad, and bad things, getting better. This is a hiccup. This, for example, I had a musician recently and I had a graph I could show her that say that there's now 22,000 playable guitars to a million people in the world. But 12 years ago, there was only 5,000. All right, this is just one little thing. All right, cool. There's a lot of stats that show that our world is improving, you know, children dying, amount of science, a whole range of things. And this hiccup we have that I'm hopeful humanity can get, can get through, but just a little message I pass on is therapy.

Bronnie Thompson (00:44:13):

Even though we can't do stuff, we can't access places. What can't be taken away as our memory of being there. So it's really easy to take a moment to back a memory that feels good to say, actually, you can't take that one away from me. I might not be physically getting there, but I can remember it, feel those same feelings. And then being mindful.

 

Sandy Hilton:

This is funny because if you look at Bronnie's background, that's one of the memories I've been using. When I lost the lakefront, I was like, okay, I'm just going to sit there and pretend that I'm not at that beach by that pier. So it's, it's fabulous. And even pictures or recordings of things that you've done before is like, okay, now there is still good stuff. I might not have it right here, but they're still good stuff. So that's really funny. As soon as I saw the picture, I'm like, yeah. And gratitude and just, yeah.

Bronnie Thompson (00:45:05):

The other thing as well, we've always got something that we can be grateful for all that. It might feel trite, you know, I'm living in winter, but I've got a roof over my head. I can have a damn fine cup of coffee and probably a nice craft. I'll at the end of the day, these are things that I can do and can have any way. So we can create the sense of safety insecurity inside ourselves without necessarily having to experience it.

David Butler (00:45:38):

Right. Just a quick comment. I would share that with patients who can't get out are saying the things you do when you're still can be as important as the things you do when you move. Right? So let's explore. If you can't do things, you can still really work you yourself with the things you do. And you're still calm. The introspection reading, thinking, contemplation memory enhancement, go through the photo album, et cetera. And I'd also like to always say to someone to link that in that is a very, very healthy thing to do to your neuro immune complex.

Karen Litzy (00:46:13):

And that sort of brings, I think we answered this question. This was from a woman who is living with chronic pain and at high risk with COVID-19. So how do we get past the fear of going out where people are crowding areas to get the exercise we need to maintain our fitness and muscle tone to reduce our pain. She said, even though I'm doing exercises and stretching, I've lost the ability to walk unaided on uneven grounds through weeks of lockdown. And the hydrotherapy pool is closed. She said, she knows, I need to get out and walk more, but shopping centers, which are the best place to find level floors are out. And a lot of places that she used to go are now very crowded because people are, don't have the access to gyms and things like that. Are health professionals able to suggest options when she lives in a hilly area with only a few but all uneven footpaths or sidewalks. And she has a small house.

Sandy Hilton (00:47:18):

That's the kind of thing that we've been doing since it's like, okay, let's problem solve this out. Because yeah, you have your carefully set way to get through this and then it's disrupted.

 

Bronnie Thompson:

Yeah, boy, I like having lots of options for movement opportunities. So we don't think of my exercise, but we think of how can I have some movement today and bring that sense of, we are alike to be like, if I can imagine I'm walking along the beach while I'm standing and doing something and, you know, doing the dishes or watching TV or something that still can bring some of those same neuro tags it's same illusion, imaginary stuff activating in my brain. And that is a really, really important thing because we can't always the weather can be horrible, especially if you're in Christchurch and you can't go out for a walk.

Bronnie Thompson (00:48:27):

Yeah. But you know, we can think novelty is really good. So maybe this is a really neat opportunity to try some play. And I've been watching some of the stuff that our two chiropractor friends do with you put, let's put, at least try some obstacle courses and the house so that it's not we're not thinking of it as exercise. And I've got, do three sets of 10, please physios change that. Let's do something that feels like a bit of fun. There's some very cool inside activities that are supposed to be for kids. I haven't grown up yet. I'm still a baby.

Sandy Hilton (00:49:16):

Yeah. A lot of balance and things like that you inside that would help when you have your paths back outside. Yeah, yeah.

 

Karen Litzy:

Yeah. Great. And then sticking with since we're talking about this time of COVID where some places are still in lockdown, some places are opening up. Bronnie and David are in an area of the world where they have very, very few cases, very, very few cases, Sandy and I are in a part of the world where we have a lot more than one. So what a lot of practitioners have had to do is we've had to move to tele-health. And so one of the questions David Pulter, I believe, as I hope I'm saying his name correctly is do we perceive that our ability to be empathetic and offer effective pain education is somehow diminished by a tele-health consult. So are we missing that? Not being in person.

 

Sandy Hilton:

I have found it equally possible in person or telehealth cause you're still making that connection. We do miss stuff. We can't read the microexpressions in people as easily. So we as therapists have to work harder, but for the person on the other end, think about what the alternative is.

Sandy Hilton (00:50:46):

And it's been really cool for the people with pelvic pain, that every single time they've gone to a physio it's been painful. And on tele-health it's the first time she has been able to talk to someone about all of her bits and pieces without being afraid that it's going to hurt because there was no way to see somebody inside somebody's home.

 

Bronnie Thompson:

You get to know something more about me. I've met more pets than ever thought. It was wonderful. This is a privilege that occupational therapists have had for a long time. And I'm so pleased that other other clinicians are getting that same opportunity, because we know so much more about a person when we can see the environment that they live with. That's just fantastic, but it's harder.

David Butler (00:51:39):

I find I've come back into clinical practice. I thought I was going to retire because I wanted to go, but also doing it. I was hopeless at first, but I'm really enjoying it. And I actually believe, I actually believe for the kind of therapies we're doing it's equal or better than face to face. Ideally, I think I'd like to have one face to face or maybe two but then to continue on with the tele health, particularly for people are in rural areas and it's almost no this kind of therapy was coming anyway, but the COVID has hastened it. So I found myself getting anecdotally here a much more emotional, closer, quicker link to patients by the screen. They were in a safe place. They're in their house. That's number one. They're not in a clinic you're there. And you can actually look at that face in the screen, as we're doing now, I'm looking at your faces, maybe one or two feet away, and I'm just keep looking at you.

David Butler (00:52:46):

And there's this connection, which is there. And there's also these other elements it brings in like, you start at 10 o'clock and you finish at 10:45. So there's open and closure, which isn't really there in some of the, in some of the clinics, the difficulty I'm having with it though is I was never in face-to-face practice a very good note taker. I used to make notes at the end. I was talking too much, but what you have to do here, my suggestion with face to face is you really need to plan and make your notes straight after. What did I tell that one on the screen, last clinical context, to sort of remind you of all the little juicy bits that we've got in the interaction. So it's really, for me, it's coming back to curriculum and mind you, I'm glad I'm not doing dry needling or just manipulating it with the talking therapy, but my suggestion is to have the habit curriculum.

David Butler (00:53:44):

So I've got my key target concepts. I know that I've addressed them in that particular session in the next session. I know I've gone back and I've done teach them the self reflection as well. Then to come back to see if I can get it all, or if I've translated my knowledge into something functional or some change. So I'm really, I'm really loving it. And I think there's something rather new and special with this, with this interaction. But maybe that's just me as a physio who sort of used to the more physical stuff. Maybe this is something more natural to the psychologist, its perhaps, but I'm with it.

Bronnie Thompson (00:54:22):

I’ve been doing the group stuff. And I found that has been, I've seen, I like it because they don't have to go and travel someplace. It does mean that we can offer it to people who otherwise can't get here. You know, they can't seek people, especially rural parts of New Zealand, low broadband is not that great in many parts as well. So it gets that it's an opportunity. I'd like to see the availability of it as an option. So we can use like we do with our therapies, we pick and choose the right approach or the right piece at the right time and the right place that doesn't have to be one or the other, like you said, you could see him a couple of times in person and then a couple tele-health and then maybe they come back again and then you do mix and match.

 

Karen Litzy:

We have time for one more question here, maybe two. So David, this was one you might be able to answer it really quickly. As a practitioner, what is the utility of straight leg raise slump and prone knee bend test and the assessment of chronic back pain. Is it still relevant?

David Butler (00:55:38):

Oh gosh. Oh gosh. I'm going to dodge that question and would say it, it would depend on the client who comes in so I think those neurodynamic tests, which I still do. I think the main principle from them is you're testing movement. You're not testing a damaged tissue and anytime you're doing a physical examination, the deeper thing is the patient is testing you. You're not testing them. So what that patient, what that patient offers back in terms of movement or pain responses or whatever, depends on so many things. I might however, have a client and they are out there who do have maybe a specific stickiness or something or something catchy, whatever that may well, the scar around it might well be polarized by action, where I might spend a little bit more time taking a closer look at it. Now that might be relevant. Someone might have, for example, someone might come out of hospital and have had a needle next to the IV drip, next to their musculocutaneous or radial sensory nerve there where it's really worthwhile. Let's explore all the tissues here and see that that nerve can move or slide or glide. But in the second case, I'd made a clinical decision that we probably have issues out in the tissues, which are with a closer evaluation. That's a really broad answer.

Karen Litzy (00:57:11):

I think it's a tough question to answer because it, sorry, got a cat behind me. I felt my chair moving and I was like, what's going on? Just a large cat. So last question. So how to manage tele-health when the patients may be kind of embarrassed of their house or context or spaces or family it's very common in low socioeconomic patients. So they may not want to turn on their camera.

 

Sandy Hilton:

Yeah. I've had that shaking well, and I've had people in their car or very clearly like I'm kind of angled cause there's a lot going on in my house and I don't have a green screen. So where it's like, and there's just a wall behind me and it's one of the reasons like I'll talk to him ahead of time of if I'm in the clinic, it's clearly the clinic, but I'll tell them I'm at my house.

Sandy Hilton (00:58:12):

Cause of COVID. So, you know, no judgment, you're going to see a wall and probably a cat and just kind of be up front in the beginning of this as a thing, I've had people that start with the phone on or turn it off or whatever, you just, you roll with it. But I have those conversations ahead of time, before we even do the call.

 

Bronnie Thompson:

It's about creating a safe space for people. You know, if somebody feels, you know, was not having the video, it won't be that long before. I hope we've got some rapport and it feels better. I'm just, I'm doing a bit of a chuckle because the reason I've got my green screen behind me as my silversmith studio, which has an absolute shambles because it's a creative space. So I'm just disguising it because it's works.

David Butler (00:59:07):

There is something about delivering a story of some talking in the patient's room and there's cupboard doors open and you're looking in their cupboard at the same time. And you know, looking at that, then I just look at that thing. We’re safe here.

Karen Litzy (00:59:26):

Well, listen, this has been an hour. Thank you so much. I just want to ask one more question or not even a question, more like a statement from all of you that, what would you like the people who are listening and they're, like I said, there were clinicians, there were non-clinicians on here. And I think from the comments that we're seeing in the chat is very valuable and very helpful. So what do you want to leave people with?

 

Sandy Hilton:

I'm gonna echo how I started. We're learning more every single week. I'd say, day but I'm not reading that often. So even if you've gone or you've treated someone and you couldn't quite figure out a way to help them, don't give up because there's more information and more understanding and more ways to get to this all the time. And I don't think you're stuck if you hurt.

David Butler (01:00:26):

I'd like to mirror those comments, explore the power of tele health, lift your expectations of outcome for those patients, people who are suffering and in pain, who are listening for those who are getting into pain treatment there's a science revolution and a real power in that revolution behind what you do. So just go for it.

Bronnie Thompson (01:00:52):

I think don't be hung up on with the pain changes or not, be hung up on does this person connect with me. We create trust. Am I listening? Can I be a witness? Can I be there for you? Because out of that will come this other stuff. There are some people whose pain doesn't get better. It doesn't go away. And that's a reality, but it doesn't mean that you have to be imprisoned or trapped by your pain. That means you develop a different relationship with your pain. And I think that's a lot of what we are doing is creating this chance to have some wiggle room, to begin to live life. That's what I'm looking for.

Karen Litzy (01:01:53):

Beautiful. Well, you guys thank you so much. And for everyone that is here listening, I just want to say thank you so much for giving up an hour of your time. I know that time is valuable, so I just want to thank you all and to Bronnie and to David and to Sandy. Thank you. Thank you. Thank you. And kind of on the fly. So I just want to thank you so much and to everyone. I guess the thing that I would leave people with is, if you're a clinician or if you are a patient, the best thing that you can do, if you are in pain is reach out to someone who might be able to help you, find a mentor, find a clinician, ask around Google, do whatever you can try and find someone who like Bronnie and David and Sandy I'll echo everything. You said that number one first and foremost, you connect with and that you feel safe with. You want them to be your super SIM, you know, like Sandy's my super SIM.

Karen Litzy (01:02:48):

So you want them to be your super SIM. And, if you can find that person, that clinician just know that that there can be help, you know, whether you're struggling as the clinician to understand your patients or your the patient struggling to find the clinician, I think help is out there. You just have to make sure that you be proactive and search for it. Cause usually they're not going to come knock on your door. So everybody thank you so much for showing up. Thank you, everyone who is on the call and to everyone who is watching this on the playback I hope you enjoyed it. If you have any questions, you can find us we're on social media and various websites and things like that. So we're not hard to find.

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 Apple Podcasts

Sep 24, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Eric Miller on the show to discuss how to maximize the value of your physical therapy practice.  Eric Miller has been in the financial planning industry for over 20 years. He is the Co-Owner of Econologics Financial Advisors and the Chief Financial Advisor. He has a degree from Capital University and is a Registered Financial Consultant® and licensed insurance agent. He takes pride in helping practice owners become the financial heroes of their own stories and has taken this passion to over 600 families in the past decade.

In this episode, we discuss:

-How to maximize the value of your practice

-The business systems that add the most value and are most attractive to potential buyers

-Financial considerations when planning your exit strategy

-Simple strategies to minimize your tax bill every year

-And so much more!

Resources:

Econologics Financial Advisors Website

Econologics Financial Advisors Youtube

Eric Miller LinkedIn

Econologics Financial Advisors Facebook

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

                                                                    

For more information Eric:

Eric Miller has been in the financial planning industry for over 20 years. He is the Co-Owner of Econologics Financial Advisors and the Chief Financial Advisor. He has a degree from Capital University and is a Registered Financial Consultant® and licensed insurance agent. He takes pride in helping practice owners become the financial heroes of their own stories and has taken this passion to over 600 families in the past decade. During this time, he’s had over 15,000 conversations with practice owners regarding money, investing, practice expansion, practice transitions, taxes, asset protection, estate planning, and helping them shape their financial attitude toward abundance. Econologics Financial Advisors is an Inc. 5000 honoree for 2019 as one of the fastest growing companies in the US.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey, Eric, welcome to the podcast. I am happy to have you on.

Eric Miller (00:05):

Well, thanks, Karen. I'm really excited to be here. Yeah.

Karen Litzy (00:08):

Before we get into our talk on, you know, how to maximize the value of our practice, in your bio, I read that you're a registered financial consultant. So can you explain to the listeners what that is and maybe how that differs from a financial advisor, an accountant? What is the differentiation there?

Eric Miller (00:31):

No problem there. So I think when people hear that I'm a financial advisor, I mean, people kind of have the same impression that all financial advisors are alike, so to speak. And that's not always the case. You know, there's some financial advisors that specialize in working with you know, ministers and teachers and all different kinds of professions. I just happened to work with private practice owners. Now, as far as am I licensed to do what I do in the financial world, there's something called being a fiduciary. And when you're a fiduciary, that basically means that you have to do what's in the best interest of your client, not all financial advisors adhere to that standard. What's called a registered investment advisor and we're held to that standard under the SEC guidelines. And then as a registered financial consultants, it's a designation that I picked up along the way. And it just basically, you know, there's certain criteria that you have to use to be able to get to that designation that's system.

Karen Litzy (01:41):

Got it. Yeah. So, you know, we were talking before we went on and it's kind of like if you're in the physical therapy world, which I am, and you go on to become, you know, like a clinical specialist in orthopedics or a clinical specialist and in pediatrics, it's like going on for a little bit extra education and certification and what you do is that right? Okay. That's exactly correct. Perfect. Perfect. All right. So now let's get into the meat of this interview. So today we're going to be talking about how to maximize the value of your practice, perhaps plan for an exit of that eventually. And we're going to weave in some critical tax strategies that you might be able to use to save you money. So no one likes to leave money on the table. No one likes to feel like a dope because they didn't know what they were doing. So, let's start with maximizing the value of your practice. So first, what does that even mean?

Eric Miller (02:42):

That's a great place to start because I think people automatically assume that when I say maximizing your practice value, it's just about money, right? It's just about, Oh, the, you know, what's the enterprise value of my business. And then that leads into, Oh my gosh, he's going to talk about like profit and loss and EBITDA and all these really technical terms. But in my viewpoint maximizing practice value. Isn't just about money. It's about the other parts of owning a business that you get value for like time, right? Like you would want to build a business that gives you a lot of time. You'd want to build a business that gives you great relationships with either your employees or recognition from your community. So when I say, if you're trying to maximize the value of your practice, it's not just about the money.

Eric Miller (03:31):

It's about all of those other things, because you know, you look at it, most people that own a private practice that is your largest investment. You know, it's like the thing that provides the most cash flow to your household, and it is an investment and anybody that's owned a business for any period of time knows that it's something that you have to care for. And that you have to make sure that you're treating like an investment and putting in the time and the money to make sure that you get the most value out of it. That's our definition for that.

Karen Litzy (04:04):

Yeah, absolutely. So how can we as practice owners then maximize the value of our practice. If let's say in the event, we want to sell it, we want to exit our practice in whatever way we want that exit to happen.

Eric Miller (04:21):

There's definitely some key areas like, yeah, you have to kind of assume the viewpoint of a buyer. Like if I'm going to buy your practice, Karen, like what are some of the things that I would like to see in place that would allow me to give you, you know, top dollar for it. And I think number one is your personnel organized? Okay, do you have organized personnel? Do people have job descriptions? Do they know what they're doing? Do they know who to report to? So, you know, I think that that is that's key because obviously if you have people in your organization that are aligned and are all kind of working together, you know, you're going to have a really powerful organization. If you can do that, if you don't, then you're going to have, you know, this scattered business that everyone's kind of doing their own thing and that's not good.

Eric Miller (05:13):

So that's certainly one thing. And then of course, just having good stable systems that are built in your business so that there's procedures that people have, that they can follow. You know, there should be an organization chart somewhere where people know like who's in charge of what I think that's going to all add value to your business. Certainly if you look at like the facility, what's the facility look like, is it in good shape? You know, do you have, if you lease the building, do you have a good lease on it? You know, is there new carpeting is, I mean, is it a nice place where people feel safe to come to, you know, certainly a buyer's going to think about that. And then I think from an income standpoint, obviously you have to be solvent.

Eric Miller (05:57):

You certainly don't want to have a lot of, you know, outstanding accounts receivable out there. You want to make sure your books are up to date and current, you don't owe any back taxes on the practice. You have multiple income streams in the business that you like multiple services that you provide because no one wants to be reliant upon one of anything. So I think those are all, some really key areas that if you can get those things in shape and you can get them systematized, you're really going to have something that someone else would want and they would value. And they're going to pay you a much higher amount for that.

Karen Litzy (06:33):

Yeah, that makes sense. So what I'm hearing is you really want to have an organization that's sort of a well oiled machine where people know why they're coming to work. They know what they're doing once they get there and reasonably happy at their jobs, if not very happy at their job.

Eric Miller (06:52):

Yeah. And I think that you're exactly right. And I think the key as the person that's in charge of it is that you have to know what your role is in that business. So I think a lot of people that are in private practice, and maybe you can attest to this when you first started out, you're just trying to make things happen and go, right. And, you know, as you go on, you kind of realize, look, I'm not just a practitioner, I'm also an owner and I'm an executive and those are completely different roles. And I think over time, if you can really make sure that you understand that those three roles are separate and that you have to make sure you master them to that degree, or at least hire someone that can do those things, that that's really going to create you a valuable practice, you know?

Karen Litzy (07:41):

And I mean, when you first start out, like I work with a lot of like first time entrepreneurs, you are the owner, the therapist, the executive, the marketer, the pay, you know, you're everything, right? So, so let's say you have a practice like that, where maybe you are a single owner practice, right. Or maybe you have one person part time person. So you don't have this sort of robust, huge practice. Can you sell that?

Eric Miller (08:12):

Well, you can, you can sell anything. It's just as a matter of how much you're going to get for it. So, again, looking from the buyer's perspective, he wants to buy something. That's not dependent upon one person. He wants something that's going to be basically, he can assume that there's free cashflow there. That is going to be worthwhile to him as an investment. So if you have like a single doctor practice or you're a single practitioner, I mean, you can certainly sell it. It's just not going to go for a very high, multiple, see, most of the practices that we're talking about, you know, are going to sell for maybe like a one to two times earnings. Whereas if you get a bigger organization that has, you know, seven, eight, nine, 12, 20 PTs on staff, there's executives in the office, it's going to go for a much higher, multiple could go as high as eight to 10 of your earnings. So it is, it is that kind of a game, but that's, you know, that's the journey.

Karen Litzy (09:08):

Right? And, you know, you had said you want to have a lot of systems in place, in your opinion, what are the most valuable or most important systems to have in place within your business? Looking at it from a value standpoint?

Eric Miller (09:23):

I think definitely having a good financial system is really key because look at what, you know, a lot of businesses, business owners, don't like to confront the finance part of their business, and that's why they don't have much in reserves. And, you know, they're always kind of struggling for, gosh, I can't make payroll this week. And it's just a constant battle when you don't have good financial systems in place, because they're just, they're not paying attention to their money lines. And unfortunately, when it comes to your practice, that that is the most important thing is keeping that practice solvent, which means that there's more money coming in than what's going out. So that personally, I think that's the most important. Some people would say a marketing system is really key because let's face it. If you don't have more patients coming in and buyers definitely going to want to see that he's going to want to see that you are, you have a system in place where you're constantly getting new patients in the door. Right. And then, you know, I think a good quality control system is, is really, really key. Because if people aren't, you know, getting better and you don't diagnose that quickly of, you know, why aren't people getting better because that's what you do as a physical therapist, your job is to get people pain-free, you know, or reduce their pain. So I think that's a pretty key area too.

Karen Litzy (10:42):

Nice. Yeah. I just had this conversation about the importance of a financial system. Cause I sort of switched my financial system within my practice around, over the last couple of years and it's made such a huge difference. You know, I started looking at the financial system in percentages sort of going off of Mike McCollough, the book profit first. And so, yeah. So how much stays in the business? How much goes to me as an owner, how much goes to taxes? How much goes to profit, how much goes, and then making sure that when that money comes in, it is automatically divided up into those percentages and it's made a huge difference.

Eric Miller (11:22):

That's so awesome to hear it, does it because you've instilled control over your money right now. Right. And when you look at like what's a barrier for a lot of practice owners is that they don't feel like they have control over their money. Right. And, when you start putting in good control, it's kind of like when you're adjusting somebody or you're getting someone to feel better, right. You have to kind of put control in on that person. Like, I need you to do this and move here and do that. It's the same thing with your money. You have to kind of allocate it so that you know, your expenses are you channel your money to places where it needs to go to handle whatever expense that would be. Certainly, you know, you're yourself. I think, you know, is the most important person that you need to pay first.

Karen Litzy (12:07):

Well, that's what profit first says. No, it's true. Like, and once I started doing that, it made everything just lighter. So now like quarterly taxes are coming up September 15th or depending on when this airs that might've just been that September 15th date. And I remember like years ago, I'd be like, Oh my gosh, I don't know how, how do I not have them now? I'm like, Oh, totally fine, my money's where it's supposed to be. I am good. Like, this is exactly where it needs to be.

Eric Miller (12:43):

That actually is kind of like an underlying goal and purpose that I have is I, you know, people always ask like, what's the product of a financial advisor and people think it's, you know, Hey, you know, you made me 20 or 30% or you know, helped me save in taxes. Not really, you know, I like people to feel relaxed about their financial condition and just what you explained to me right there. You're definitely much more relaxed about your condition now because you have control over it and it doesn't control you. That's really awesome.

Karen Litzy (13:13):

Yeah. And it's a little stressful at first because it's different and it's a change. So I always tell people if you're starting out now start off this way. And Holy cow you'll be so much easier. Everything is just, I feel so much easier. Yeah, just a sense of ease that I now know, like, yes, I have money set aside for this. It's already paid, like it's basically already paid for.

Eric Miller (13:39):

That's it that's right. But it also does another thing too. It does make you look at and say, you know what, maybe I'm not making enough money in my business because I can't cover some of these other things. And I think that's the most important thing that people have to realize. And I'll go off on a little tangent here, but there's really two basic rules of, for me, income and expenses. The first one is that just get used to the fact that your business will try to spend every dollar that it makes. And then some, and, and that's not just for a business, that's like a government or any household or organization just, it's just going to try to spend every dollar that it makes. And then some, but at the same time, it will also make the exact amount of money.

Eric Miller (14:25):

It thinks it needs to make to survive. So when I say that, people are like, what does that mean? I'm like, well, look, you know, if you know that you have expenses coming up, somehow miraculously, the business does make enough to cover it. Doesn't it? It's just like, it's just, that's the way it is. So the trick to it is simply to make sure that your reserves and your profit and your taxes are just part of what the business thinks it needs to make to survive. And if you can get that in as what you said as part of that profit first book, I think that's what he's talking about is that it sets the right income target for what the business really needs to make, because that's the biggest outpoint that I usually see with, with practice owners is that I'll ask them, Hey, what's your income target? They'll say, well, you know, I need to make $30,000 a month to pay my bills. And I'm like, well, no, that's not what you need. You actually need 45. If you want to include your profits and building up reserves and paying your taxes that they're operating on a wrong income target. So I think that's really key is to make sure you're operating on the right number.

Karen Litzy (15:30):

Right. So don't underestimate it completely because I think oftentimes people will just look at, well, this is my rent. These are my utilities. This is my payroll. If you're paying people and these are, you know, overhead costs that maybe we have to pay, you know, phone bills, things like that. And that's it. And they're like, okay, so that's all I have to make.

Eric Miller (15:55):

That's right. And that's where their demand for income is. But, and if, but if they put in, Hey, I need another $10,000 a month for myself. I need another 5,000 for taxes. I need another because I want to make sure I have reserves. So if I have to shut down for another month, I can handle that. Right. You start putting all those things in. Now the number changes from Oh, 35, I need to make 50. Oh, right. Okay. Well, that's fine. How many more patients do I need to see a week? Right. To be able to make that number, it just gets them, you know, being a problem solver now, as opposed to like, I can't do anything about it kind of mode.

Karen Litzy (16:32):

Yeah. And I do that. Like people always ask me, well, how many patients, you know, do you usually see a week? And I said, well, it's not, how many do I usually see it's this is what I need to see to make X amount of money per week. So that I know per month, this is what I'm making. And my costs are a little bit lower because I have a mobile practice. So I'm not paying a lease on a brick and mortar facility, but I still have to pay my own rent for my apartment. And I still got to eat. You know, these are all the things that you have to put in. So it's not just, what does the business need, especially if you're a solo preneur, what do you need to survive?

Eric Miller (17:12):

Yeah. And I think this is where a lot of people, yeah. A lot, a lot of practice owners and entrepreneurs gets, think that their business is more important than their household. And you know, I'm under the, you know, our philosophy, our viewpoint is that your household is like a parent company. Okay. You think about this, you look at all the big corporations out there and you know, people have opinions of them, but they do understand money pretty well. And they certainly understand that let's take Facebook. For example, Facebook owns, I don't know if you do this, like 83 other companies and they're the parent company to all of those other companies, but everything flows to the parent company. Okay. We're your households, no different, you know, you own, you have a, let's say you own a house, a business, maybe a piece of real estate 401k plan, the bank account. Right. Those are all assets of the household. So you really, you know, once you start treating your household, like the parent company, then you set up the system so that, you know, your household you're meeting the goals and purposes of the household people. I think they don't do that. They don't take care of themselves like they should.

Karen Litzy (18:19):

Yeah, no, I think that's great advice. Thank you for that. Alright. So we've got those financial marketing quality control systems, obviously three very important systems and we can go on and on and systems. That's a whole other conversation. So we will take those and people can run with them as, as sort of prioritizing their systems. So now we've got, we've got all of our systems in place. We've especially our financial system. So how do we plan? Let's say we're getting towards the end of our treating career, whatever your clinical career, whenever that may come. And it may come at different times for different people. How do we efficiently plan for an exit? What do we do?

Eric Miller (19:05):

As far as like getting the business ready to exit out.

Karen Litzy (19:09):

Yeah. Like let's say, let's say you're getting ready to kind of exit out of your business. Now we know that maybe you can try and sell it. Or what if you're just like, this is the business is done. You're just done. What do you do?

Eric Miller (19:24):

Yeah. Well, I mean, I think the first thing you gotta realize, you gotta look at your own financial readiness. Like, can you afford it? You know? I mean, I think a lot of people, they get into a position where they're tired, they get exhausted, right. Because they've been doing things for themselves or I'm sorry, just for the business. And then they just get burnt out, you know? Well, you know, burnout, you know, what burnout is, it has nothing to do with that. It's just that you don't have a bright enough future in front of you. That's what burnout comes from. Right. And I can see why a lot of practice owners getting that conditions. Like I just keep doing the same thing every day and I can't see a bright future for me, so I might as well just sell the thing. Okay.

Eric Miller (20:06):

So the first thing that I do is just, I try to rehabilitate, like, do you remember why you decided that you wanted to be a business owner? Do you remember like what the purpose was? And if you can revitalize that, I think you can get that person back on track, but look at the end of the day, if you don't want to do it anymore and you want to sell your business, then you know, certainly, you know, hiring a broker can help. Certainly finding someone or just finding another PT that, you know, in the area that would be willing to take, you know you know, sell, you can sell the business to, for Goodwill or it's not going to be very high price, but certainly you can find someone that would be willing to buy practice for some costs. Right. That may just not be very much. Right.

Karen Litzy (20:52):

And then what, if you were ready to just wrap it up, you don't want to sell it. Are there things that one needs to think about as they wind it down?

Eric Miller (21:02):

You mean just like, just close it down?

Karen Litzy (21:04):

You're closing it down. You're moving on to greener pastures, if you will. So you decided to close it down. Are there any financial considerations that one has to think about in that scenario?

Eric Miller (21:16):

Well, you know, certainly look at how much money that you make from your business. Even, you know, money that through the cashflow that you make, it's sometimes a lot more significant than what people think. And certainly you can own the business. You can just, I mean, if you're a physical therapist, you can just go work for somebody else if you want to. But you know, I think people just have to realize that, that their business does provide them a pretty good living and they just have to analyze that and say, do I have enough to replace that? Or can I go to work for somebody else and replace that income? You know, it's certainly not a good thing to do. You know, there's seven different ways to exit out of business. And that's one of them just shutting it down. It's probably the most, it's the worst way to do it, but I know that it does happen.

Karen Litzy (22:05):

Yeah. Yeah. What are the other ways you could just name them? We don't have to go into detail.

Eric Miller (22:13):

So you can die with your boots on, you can close it down. You can sell to an associate. Okay. You can sell to a competitor. Okay. You can sell to private equity. Okay. You can gift the practice to somebody else. Okay. Or you can have your employees buy it through, what's called a Aesop plan. Those are the seven ways that you can exit out of your practice. Okay. Great. What happens with most practice owners is they either sell to an associate to a private equity group, the size of the practice.

Karen Litzy (22:54):

Yeah. Yeah. And so now let's talk about taxes.

Eric Miller (23:03):

Yes. So, Oh, taxes. Hey guys, when you could see your eyes got big.

Karen Litzy (23:07):

Who likes to pay taxes, right. Nobody likes to do it, but we all do it because we need, we need the services that they provide. Right. So let's talk about some tax strategies that might be able to save us some time.

Eric Miller (23:21):

Yeah. Yeah. I think the first thing on taxes is that you have to realize that your accountant may or may not understand the tax code completely. And it sounds really weird because everyone assumes that they have an accountant, Hey, he's going to try to minimize my taxes. That's not really what their goal is. Their goal is to make sure that you are compliant, that you file your taxes on time. They're not necessarily doing tax planning for you. They're not trying to minimize your taxes. Okay. So I think that's the first thing is that you really have to make sure you're working with an accountant that has the viewpoint that I want to try to minimize this tax bill as much as I can, because it won't happen by itself. You have to be proactive. You cannot take a passive role in minimizing your taxes, or you're just going to end up paying the most.

Eric Miller (24:09):

Okay. The tax codes, 3 million words, and, you know, no one's going to know every single passage of it. That being said, there are definitely some strategies out there that you can utilize. One that is that I've been talked about a lot is that you can actually rent your house out for 14 days out of the year and you can collect that money completely tax free. And you're probably thinking like, well, how, how would that benefit me? So where this came about was that in a, I don't know what year it was, but if you've ever heard of the masters golf tournament, there's a lot of, there's a lot of guys that have big houses there and on the golf course and they rent their houses out for thousands and thousands of dollars. Okay, well, legally they can collect all of that money, completely tax free.

Eric Miller (25:08):

Okay. Because the IRS code says, you can rent your house out 14 days out of the year and get that money complete tax free. And you probably thinking, how do I take advantage of that? Well, if you own a business, your business can rent your house out for 14 days out of the year. And as long as you have a legitimate meeting at your house, maybe you have with a key executive or even with yourself, right. You have an executive meeting at your house and you document that, then you can rent, you can have the business pay for that. Okay. It's a business expense. And then you get that personally. And as long as you do it correctly, you can get that money completely tax free. All right. That would be certainly one strategy you can use. It's called the, it's called the Augusta rule. You can look it up online and, and certainly there's. Yeah, yeah. That's where it came from. That's one and, you know, right there, 14 days, let's say that it's a thousand dollars, that'd be $14,000 that you could expense out in your business. And then you can get that personally. Oh, you have to do it right. You have to have a legitimate meeting. You have to like

Karen Litzy (26:14):

Say it's $10,000 a night.

Eric Miller (26:17):

I don't know. In New York, you may be able to write.

Karen Litzy (26:20):

I don't know. That might be a stretch too.

Eric Miller (26:22):

If you needed to rent out like a hotel or a restaurant, that's what you would need to do. You need to go get like an estimate like of where you would normally hold that meeting just for documentation purposes, but like anything else it can be done. You just have to follow through and have documentation, you know? And I just have the accountant guide you on how to do that. That's certainly that's one that would be, you know, 14, 15,000. So if people have kids, they can put their kids on payroll and they can, you know, show them that would be another deduction that you can use. You know, there's certainly a lot more, I could probably go on all night. But you know, I think another thing that people can do is just look at how they take their income.

Eric Miller (27:06):

Like you own a business, right? And most physical therapists are escorts. And you know, a lot of accounts will tell them to take bigger salaries than what they actually need to be taking. Right? So you can actually adjust your salary downs as long as it's a reasonable compensation and then take more an owner draws. That's going to help minimize the Medicare tax as well. So it really just boils down to, you know, finding the right information, finding a right advisor that can help you and, you know, provide tax deductions that your accountant can work with to minimize it. It can happen like you should, it's your responsibility. And I say this a lot. It's like, I've never read anywhere where it's my responsibility to maximum fund the IRS. Right? Like I know I have to pay taxes. I get that. But there's no one that said that I have to like pay, you know an ungodly amount of tax. But that's the way the IRS works. They just assume that your money is their money and you have to be proactive to show them otherwise.

Karen Litzy (28:11):

Yeah. I know this year when I paid my taxes, when I did my taxes for 2019, I was so excited. Cause I only owed like $309 after doing my estimated quarterly taxes, which I thought, well, this is great because I'm not giving them more throughout the year. And in fact I was almost like, spot on. That's pretty good. Yeah. That was pretty good. Because like, you don't want to, like, I understand when people get refunds, but if you got a refund, that means that you gave them more than was necessary throughout the year. Correct. Right. Yeah.

Eric Miller (28:53):

So it is something that you have to stay on top of because as your business grows, you know, your tax liability personally is going to be higher. So you really have to make sure you stay in good communication with your accounts. Like you should be talking to them every quarter, especially now recently where I think a lot of people have gotten the PPP loan. And if you, you know, if that gets forgiven well, you know, physical therapists didn't really shut down. I mean, some of them did, but you were still collecting money. So you know, you may have, you really have to make sure that you're not going to have a tax problem for 2020, it could happen. So just, you know, just getting in communication with your accountant. I think that that will help.

Karen Litzy (29:32):

Yeah. During the PPP loan phase and covert, I was thinking, I was talking to my accountant like literally every other day. Yeah. I'm like, does this make sense? Should I do this? Should we do this? Should I do this? Can I do this? Does this, is this the right form? Do I feel, and I did get a PPP loan because in New York, you know, we were done, like when I say shut down, like shut down, nothing, you know? And eventually I started doing more telehealth visits, but in the beginning it was quite scary. And so I said, you know, I better apply for a loan and, and I did get it. And now they haven't even asked, we haven't even filled out the forgiveness paperwork yet, but now I'm in contact with him like weekly, like, is this the right form? Did I fill this out? Right? Is this the right documentation I need? And he's like, yes, yes, yes. You're all good. So now when the time comes, I'll be able to get that in really quick.

Eric Miller (30:27):

Yeah. And it won't be a problem and you know, you'll have your attention on other things that'll help expand and that's good. And then that's just, that's not my experience. Most practice owners, they kind of don't confront it, they ignore it. And then it becomes a bigger problem down the line. And that's really needless. Right.

Karen Litzy (30:44):

I think that's how I used to be, but I have now been rehabilitated financially. So yeah, this was great. Now, what are in your opinion, what are the key messages that you would like the listeners to kind of take away from this conversation?

Eric Miller (31:02):

Well, I mean, you know, for me look, I mean, you can, regardless of what your financial condition is, like, you can do something about it. Right. And I think that's always been a pretty key, you know, philosophical viewpoint that I have. Like, I don't think that there's such thing as an unwinnable game and I know that even things get a little murky and they get a little dark and you know, sometimes you don't really see, you know, the future as bright as it could be, but if you just kind of like, just do one thing right. And complete that cycle of action and then go onto the next, then I think that starts to create more freedom for yourself. Like people get overwhelmed so fast. Right. And there's like, there's so many different things to do, especially financially. Right. That they just, they don't just do what's in front of them while they're doing it. Like just complete one thing at a time. And then you can go on to the next one. Right. Like do the next thing and then go on to the next one. And then to me, that's the key to success, right? There is, is getting interested in something that you don't want to do. Right. And completing it. And I think once you do that, you'll start to see a much brighter future, better things happening to you.

Karen Litzy (32:14):

Yeah. Great, great advice. Thank you so much. And before we get going, I'm going to ask you the same question that I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to your younger self?

Eric Miller (32:29):

I would simply tell myself that there are destructive and constructive actions that you can do in life, right. And that those destructive actions, while they may appear fun at the time will certainly prevent you from getting to your potential and leading the life that you want to lead. Right. I know we're all young. We all kind of make stupid mistakes and that's just part of the learning curve. But I would certainly tell myself, you know, your personal ethics is really part of your survival, right? And to the degree that you kind of keep yourself in good shape morally, and you do the right thing better things are gonna happen to you in your life. It's going to create more abundance for you. And I would tell myself that is just make sure you pay attention and do the right thing more often than you do the wrong thing.

Karen Litzy (33:22):

Excellent. And now, where can people find you on social media website?

Eric Miller (33:27):

Yeah. So if you want to go for a wealthforpts.com wealthforpts.com, you can download a free ebook that we have. You can certainly go to our website www.econologicsfinancialadvisors.com And then we have a YouTube channel, www.econologicsfinancialadvisors.com. And those would be three places that you can go to connect with us.

Karen Litzy (33:48):

Perfect. And all of that will be at the show notes at podcast.healthywealthysmart.com under this episode. So one click will take you to everything. So Eric, thank you so much. This was great. I was taking copious notes and you know, every time I have these conversations, I'm always thinking to myself, Hey, what do I need to do? What do I need to act on? And you know, a lot of the conversations that I've had with folks like yourself, accountants, even on this program and in my own personal life have just really been so valuable. So I thank you so much for taking the time out today. Thank you and everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

 

 

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Sep 14, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Stephanie Weyrauch on the show to discuss budgeting.  An active member of the national physical therapy community, Stephanie has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Stephanie is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership.

In this episode, we discuss:

-Stephanie’s experience paying off student loans and still enjoying her lifestyle

-The budgeting tools you need to manage your expenses

-Why an accountability partner can help keep your budgetary goals on track

-How to incorporate pro bono work into your practice

-And so much more!

Resources:

Stephanie Weyrauch Instagram

Stephanie Weyrauch Twitter

Stephanie Weyrauch Facebook

Email: sweyrauchpt@gmail.com

Dave Ramsey’s Complete Guide to Money - Hardcover Book

The Total Money Makeover

Dave Ramsey Podcast

Every Dollar App

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

 

For more information on Stephanie:

Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.

 

Read the full transcript below:

Karen Litzy (00:00):

We are the facebook group so we'll be checking the comments regularly, but just know that we will be checking and we'll probably be a couple seconds behind you guys. So if you are on and you are watching throughout any point in our talk today about setting a budget definitely write your comments down like questions. Whether for me mostly directed to Stephanie and we will get to those questions as well throughout the talk or throughout this very informative talk. I was saying before we went on the air that I'm really excited to listen to this because I have always been impressed with the way that Stephanie and her husband Deland have been able to create their life and their budget, and it's still full and they get to do the things they want to do and go where they want to go all while maintaining a budget and all while they both have student loans.

Karen Litzy (01:07):

So what I'll do first is it's for people in the group who aren't familiar with you, Stephanie just talk a little bit more about yourself and then we'll talk about how you set your budget and what kind of framework you follow.

 

Stephanie Weyrauch:

Well, thanks Karen, for having me on, I'm really excited to talk about this because I'm running a budget as something that was really hard for me to do for a long time. I wasn't really raised to think about money growing up. So it's not, when I went through PT school, I just got my student loans and spent my money as I saw fit. And didn't really think about my money. So I'm Stephanie, Weyrauch, I'm a physical therapist here in Orange, Connecticut. I work at a private practice called physical therapy and sports medicine centers.

Stephanie Weyrauch (01:55):

And I do a little bit of consulting work privately through four different companies to try to help with occupational medicine and try to prevent any type of work injuries that happened in the workplace. So that's kinda my background a little bit, but when I went to, when I graduated from PT school and went to my first job, and at the time I was working in Minnesota, my student loans were becoming due and my husband is a physician. So he has a lot of student loans as well. So at the time total, we had pretty close to $300,000 in student loans. So quite a bit. And when my student loans were coming due and my boss hands me this little application for my 401k and like all these other very adult things, I just, I panicked. And I was like, I don't even know what a 401k is.

Stephanie Weyrauch (02:44):

I don't know how to pay my student loans. My husband was in medical school at the time. So I was the only one working. And my boss was just like, hold on. He's like, it's okay. I can help you. And so he handed me this book called the total money makeover by Dave Ramsey. And I read it and it changed my life. It changed the way that I thought about money. It changed the way that I handled money and it really empowered me to pay off my student loans and to not be afraid of debt to basically conquer it. So that's kind of the background behind it in the book. And also on his podcast, the Dave Ramsey show, he talks about how to manage a budget and how to set up a budget and how to stick to a budget. So the app that I use is called every dollar it's free.

Stephanie Weyrauch (03:30):

You can download it on, you can download it on Apple or Android, it kind of looks like this. So you can kind of set up, you can put in how much money you make and also what your expenses are for the month. Basically, it's very easy to use. You can use it on your phone or your computer. And so I started using that at the time, we were a one income household. I did pick up an extra job in a skilled nursing facility because my goal was, I didn't want to accumulate any more debt. So my goal was to try to make enough money and save enough money that we could pay for my husband's last year of medical school, which he went to an instate school. So his tuition was $25,000, which is very cheap, I think, by medical school standards.

Stephanie Weyrauch (04:19):

And we were able to cashflow that entire year of medical school, just off of the extra job that I was working at the skilled nursing facility. So every month, basically what I do is I go into the app before the month starts, I put in how much money I'm expected to make. Now, one of the things that happens when you're in private practice, especially if you're starting out is you may not know exactly how much you're going to make. And so it's hard to put in your budget like, Oh, I'm going to make, let's say, as Karen was talking about in the last course, you know, paying yourself by, let's say by biweekly or by month bi-monthly I'm gonna make $2,000 this next two weeks. Like you can't necessarily do that in Dave Ramsey's book. He has a sheet that you can use that lays out how you can do a budget based off of an income that fluctuates.

Stephanie Weyrauch (05:11):

I've never had a fluctuating income, so I've never used it, but he talks all about that in his book. And it's very easy to follow because he also talks about that if you are in debt and you're trying to pay off your debt, there's a certain amount, certain things you need to pay first. So food, shelter, lights, those are like the main things that you need to make sure that you focus on first. And then also the next thing would be like clothing. If let's say you're, you need to buy clothing. For some reason, I have really don't buy a lot of clothes. So I don't necessarily have to worry about that. And then after that is, comes your debt and any other miscellaneous things. So in this budget, you set up your income. If you were planning on giving any of your money away and like doing some charitable giving, that's something that he puts in there.

Stephanie Weyrauch (06:02):

If you're saving any money, there's a section for that. So then you can set aside how much money you want to save. And then for housing in my budget, I have my rent electricity. I put my cell phone cause that's my phone bill in there, my internet, and then my laundry. So those are like the five budget items that I have in there. And then in that month I set how much money I'm going to spend. And he thinks of a budget, not necessarily as a restriction, but permission for you to spend your money. So like throughout the month, if let's say your needs change, you can kind of rearrange how much money you're putting aside. So let's say for transportation, I need, let's say I'm taking my car. Cause I'm going to drive to a couple of patients’ houses. But this month, most of my patients are within a two mile radius of me.

Stephanie Weyrauch (06:53):

They're not far away, so I don't have to drive as much. So at the beginning of the month, I thought maybe I have to drive more. So let's say I set a hundred dollars for my gas and auto budget, and now I'm realizing I don't need that much. So what I could do with that is let's say I only need $50. So that extra 50, that I'm saving, I could potentially move to, let's say my savings, or if I have debt that I need to pay, I can move it down towards my debt. So you're giving yourself permission to spend that much money per month. The next item line item is food. So I've had groceries. And then I have, we have a section for restaurants. So if we want to eat out now with the pandemic, one of the things that was kind of nice about the pandemic is we weren't eating out nearly as much, but our grocery bill went like way up.

Stephanie Weyrauch (07:38):

So I noticed that we've been spending a ton more money on groceries. And I think it's mostly because food has gone up. So I had to adjust our budget based on that. Now this month we're, you know, things are starting to open up a little bit more here in Connecticut and Deland and I really haven't been able to go out and eat very much. And so now we're trying to put a little bit more money towards our restaurant budget because we want to enjoy that experience since we haven't had it for so long. So typically I set aside maybe $150 a month for restaurants, but this month we doubled that just because we haven't hardly eaten out at all in so long. So again, it's permission to use your money in the way that you think is going to be good for that month.

Stephanie Weyrauch (08:27):

And then there's a section for lifestyle. So I put like my subscriptions in there. So my Peloton subscription and my Netflix subscription, and then I have a vacation with my mom, hopefully coming up. And so I've been, you know, find some hotels and stuff for that. So I've been putting that under that, and then this one's going to be big if you're in private practice insurance and taxes. So there's another section for that. So if you have your, let's say it's the month where you have to pay your quarterly taxes, or let's say, instead of saving all this money and doing it in one month, you divide it up into three months. Well then you can kind of equally divide that four month, and then that way you're not forgetting to pay it. And then of course the last line item is debt. And so how much money you're going to be spending towards your debt that month.

Stephanie Weyrauch (09:20):

And then what happens is it will take, it'll give you like a picture and a graph of how much you're spending. So let's see if I can bring that up. So, so basically this is my debt and how much I spend this, this past 12 months on different things. So you can see that most of what I've been spending has been on my debt is debt, the green light, this light green color, this big one, that's all how much money that I've spent on debt this year, so far this year. So, you know, Karen had mentioned the other day that deal and I paid a lot on debt and we have, since I've been on this budget, I have been dedicated to becoming debt free.

Stephanie Weyrauch (10:09):

And our goal has been to be debt free in a total of seven years. So right now we're in year four of that. And within those four years, we've paid off $150,000 in debt, which is a lot. And that includes the cashflowing of Deland’s medical school, plus our move that we had to cash flow from North Dakota to here in Connecticut. So I'm not saying it's easy, like I'm not saying I live a luxurious life at all, but I would say that I definitely, like Karen said, I'm able to like go, I'm able to go well before the pandemic, I'm able to go to New York city, like once a month and see Karen and like hang out with my friends. But I plan for that every month. And if something comes up where I'm not able to do that, then I just have to make sure that I don't do it.

Stephanie Weyrauch (11:00):

And so it takes discipline, which you're all in private practice and you've started your private practice. So you obviously are all disciplined individuals. I will say that when you're managing a budget too, it always helps to have a partner who will keep you accountable. I am a spender and Deland is a saver. And so if I had my choice, I would probably go over our budget every month. But Deland is very good at saying now, Stephanie, do you really need that. And I fortunately must admit many times no. So having an accountability partner is really important. If you're in a private practice, that accountability partner can be your spouse or your partner, or it can be your business partner, or it could be a trusted friend. So having maybe you guys are both managing budgets at the same time and you can kind of be each other's encourager.

Stephanie Weyrauch (11:53):

So that is something that's how I run our budget. It is definitely, I definitely don't live a very luxurious lifestyle, but I wouldn't say that I'm just sitting at home, eating ramen noodles all the time either. So I'm able to put most of the money that we spend every month goes towards debt. So probably half of our budget each month goes towards debt, but that's just because we are dedicated to making sure that we become debt free within the next four years. So, yeah. And, and there may be people on here who have no debt and don't awesome. Right? And so that part of the budget and the app, I mean, how wonderful, if you don't have student loan debt, maybe you have credit card debt, and you're putting something towards that each month. But I think if you don't have, if you're past the student loans or you didn't have to have, you didn't have to take out any student loans, then you can certainly take that money that would go to debt.

Stephanie Weyrauch (12:57):

It would be substantially smaller if we're just talking about credit cards and you could say, you know, I'm going to dedicate it to XYZ. Now what happens? Oh, quick question. So what was the Dave Ramsey book? I put two books. One was the total money makeover and the other's complete guide to money. I put them both in the comments section here, but where was the one that said he had like that's total money makeover. Okay. The total variable with the variable income. Yep. That's at the very back of it. And you can just copy and I mean, I'm sure that there's a copy of it too, on the internet. You could Google it and it's palatable.

 

Karen Litzy:

Okay, great. Yeah. I think that for me, I look at, you know, this I'm taking care of your budget. I think a big part of it is writing everything down, right? It's the same way when we say to our patients to keep a journal or an exercise log, or if you've ever done weight Watchers, you have to write everything that you eat using weight Watchers. This is kind of the same thing. It sounds like this app, and you're really having to write everything down each month is definitely keeps you accountable, but also gets you into the habit of doing it.

Stephanie Weyrauch (13:44):

Yes. I definitely agree with that. And you know, the other thing too, that Dave Ramsey talks about in his book is he has these specific baby steps that you work towards to building wealth. So obviously I think all of our goals, some days to be financially stable and successful, right? So even utilizing his principles towards your business, I think is really important, especially because look at what happened to us during this pandemic.

Stephanie Weyrauch (14:34):

I mean, 80% of Americans are living paycheck to paycheck, and a lot of us needed PPP loans. And like some people's businesses just weren't prepared for this. So in his book, he talks about like having a small saving, like emergency funds, you know, paying off debt so that you can become debt free would be the next step after that. And then saving three to six months of expenses. And, you know, after this pandemic, one of the things I think I've learned is having that six months expenses saved is like so important and notice that it's six months of expenses, not six months of your monthly budget, but expenses. So then when you have an emergency, like something that you just can't even control, like you feel more in control, you're able to maybe provide more for your employees, or if you, you know, or even your help your patients out a little bit more pay your bills.

Stephanie Weyrauch (15:31):

And then the last three steps, which if you're a business owner, I mean, it's pay for kids' college, which you don't have to worry about that as a business owner, but pay off your mortgage. So if you have a brick and mortar practice paying that off, and then the last one would be to give charitable giving. And if there's one thing I think this will therapist are really good at it's giving to charity, i.e. giving out our services for free sometimes. So, I mean, at that point, when you're in that point in the baby steps, like you hypothetically are set enough that potentially you could do some pro bono work with your business, which would then put your business on the map as being a very solid community practice as well. So, I mean, I think a lot of the day to day principles that he talks about in the total money maker, that's meant for day to day stuff could easily be applied to business.

Karen Litzy (16:21):

Yeah. And I'm glad that you brought up the pro bono because the question that Gina had was, how do you decide on that pro bono? How does that fit into the budget? What kind of a sliding scale do you use and how do you do that? If you are a private practice, what kind of sliding scale are you using and how do you decide what to charge? And, you know, I say like I have a real Frank discussion with the individual patient. And if they say, you know, listen, I really need the help. If they were referred to me from another therapist who they were seeing using their insurance. And they say, you know, so-and-so says, you're the best person. You're best equipped for this. This is what I can afford. Can you do it? And because my business is at that point now where I don't, I can, I'm able to offer that kind of service.

Karen Litzy (17:11):

Then I say, yes, I can do it for this price. You know? So that's kind of how, and it's also depends on like, if the person, if I have to travel an hour and a half to get there and an hour and a half back, then it might not be best. Which in which case, I'm happy to find them, someone that will work for them. So I think when you're looking at the pro bono costs, if you're traveling to patients, you have to look at your travel time. You have to look at how that's going to cut into your overall budgeting and your overall key performance indicators, which we'll have a whole other talk about KPIs. But I think the bottom line is you have to know how much does your business need per month to be able to do everything you just said, right Stephanie.

Karen Litzy (17:57):

To be able to keep the lights on, to have shelter. So how much does your business need each month just in expenses? Have you met that goal, then? How are you able to pay for your insurance and your taxes, which I would say go into just the sheer expense of running the business. Yes. I would agree with that too. So that's the sheer expense of running the business. Do you need another new fancy gym equipment or this, that, and the other thing? No. Right. So if you can forego that to maybe help someone else at a pro bono rate or at a reduced rate, then my inclination is to forgo the fancy new treadmill and to treat the person that needs it. So I think how you decide what that pro bono rate is, I think depends on the person in front of you.

Karen Litzy (18:51):

And you could say, you know, you can ask, ask around and just say, Hey, listen, this is what other physical therapy practices are doing. This is what I'm comfortable with. This is what the least amount I can charge so that I break even. And I think people understand that. So I think when you're thinking about what's the lowest charge you can give to someone that would be it, or you can go perfectly free. If you can say, you know, I can treat, I can do one session free per week, and I'm still, you know, in the green and I'm not in the red, then go for it, you know, but I think you have to know how much you can make to keep your company in the green, and then you can decide, well, this would be my lowest pro bono charge.

Karen Litzy (19:37):

And then if someone comes in, who's really, really of need, or you're volunteering through an organization or something like that, where you're treating someone for free, then, you know, I think in my opinion, I think that's the best way to go about it. I'm sure there's some legal aspects around that. But from what I can tell in speaking with lawyers, they say, it's your rate. You know, you just have to be clear about what it is. You, Stephanie, where are you where you are? Do you have a pro bono rate?

 

Stephanie Weyrauch:

Yeah, so typically our pro bono rate is like $40 per session is what we'll do, but we are flexible. I mean, again, our practice, luckily my boss, he's been an amazing leader throughout all of this. We didn't have to fully lay off any of our physical therapists and we have five physical therapists, but we were very strategic with how we worked and when we worked.

Stephanie Weyrauch (20:30):

And so we've had that freedom from kind of how we've been running our practice to allow for us to sometimes even treat patients where they pay like $10 for a session. So, I mean, it varies from situation to situation. Things that we consider is how dedicated is the patient? Is this a patient that's actually going to come to therapy? Or is this a patient that's going to flake out on us because we don't want to save them a spot and then they not show up consistently also we've had instances where we've had maybe some where we've thought the insurance was one thing and it came out somewhere else. And so we ended up using the visits that we were given and the insurance company won't give them any more visits, which is a mistake on our part. So we always want to do, we always want to do right with any mistakes that we make.

Stephanie Weyrauch (21:21):

That is another thing that we'll consider, or sometimes if we have a Medicare patient that can't afford their copay, you know, we'll exchange services and other ways, you know, whether it be like they come in and maybe fix something in our clinic. And then we exchange that with our services, bartering, bartering. Yeah. So, we've been able to be flexible. But again, we built up our practice enough. We've been in business now for over eight years and we're a well established in the community that we are able to do that if you're starting out, you may not be able to do it right away, but you can work up towards that as you start to manage your money and start to make a profit.

Karen Litzy (22:12):

Yeah, yeah. Yeah. Thanks for that example. And I think that you'll find that in most physical therapy practices, they have a pro bono rate. They work with people they're flexible. Every practice I've ever been in the owners have been super flexible because in the end, we're all in the business of getting people better. And sometimes that business, maybe doesn't yield a profit of $200 per person. Maybe sometimes it's 10, but if our business is to get people better, then that's what we want to do. And I will also say this just because that person let's say your patient needs that pro bono care, they can't, it doesn't mean that they don't know people who they will scream to the rooftops of how wonderful you are and how great you were and how easy you were to work with too. A lot of their friends or to their communities. And then all of a sudden you're bringing in more business because you did a good thing.

Karen Litzy (23:05):

So don't discount that. And perhaps, you know, that person can be the stellar Google review you need, they can be that video testimonial on your website. They can be that written testimonial on Yelp or on your website. So these are all ways to like, incorporate your pro bono services by saying, Hey, listen, we're happy to do this. If you're pleased with your service, if you feel better, we would love for you to put up a thing on Google or put up a review on Google or Yelp or on our website, if you're comfortable doing that. Right. I totally agree with that. That's another great way. So that's right. It's the same thing as, like I said what would the other night talking about lead magnets, put something out there that people can use. They then give you their email. And all of a sudden you've made this really fruitful transaction for the both of you.

Karen Litzy (24:00):

And that's what that pro bono type of situation can do. So just always think there's always ways to leverage a visit that has nothing to do with money. That's right. So, all right. So Stephanie, let's talk about if you would like to sort of wrap it up on the big budget issues that people need to be aware of. And I also put just so people know, I also put every dollar, the app in the comments as well.

 

Stephanie Weyrauch:

Perfect. So I would say that the first thing that you need to know is you need to stick with the budget. I mean, there's no point having a budget and you don't stick with it. Accountability partner, I think is key. Having somebody there that will keep you accountable. I mean, you're in private practice. You're probably a very accountable person, but it's still good to have somebody there that asks that says, do you really need that this month?

Stephanie Weyrauch (25:02):

Or are you sure that this is what you want to spend on this specific line item? So having the accountability, I think is the key and sticking to your budget is the absolute key. I think that if you allow yourself to go over your budget and you're like, Oh, it's just one month that develops bad habits. You just gotta break all your bad habits right now. And that budget is like your gospel. You need to have a monthly budget meeting with your staff. If you have a staff, if you don't have a staff, it's just you with your accountability partner and say, this is what I'm going to spend. You know, I have a little bit of extra money that I can spend it on. What, what should I spend it on? Should I spend it on my charity work?

Stephanie Weyrauch (25:48):

Should I spend it on my debt? Should I spend it on getting new equipment and have that accountability partner help you with those decisions? If you want somebody to help you, but at least they can be there to basically ask you those questions of is this really necessary? I think if you can stick to your budget, you will feel so much better about your business. You will be less stressed. Like Karen said, you will feel like you've been like you, you have all this extra money because you know where all your money is. And the reason that the every dollar app is called every dollar is because you give every dollar a name. You don't have any extra money floating around in your budget. You put it where it goes for that month. The other thing is, is that to think of the budget as permission to spend money versus being super strict with it.

Stephanie Weyrauch (26:41):

So you still have the bulk amount of money that you're spending that you, that you have for the month. But, you know, if you notice again, like let's say you don't have to drive as much, you can take that extra money that you would typically spend driving and put it towards a different line item, but just make sure that your budget always adds up to all these total $0. You have nothing left. Everything is going to something in the budget and it has a name. Your budget is your baby. You would not name your baby nothing. Well, no, I'm just kidding.

Karen Litzy (27:26):

Yeah, no, I think that's a really great point. And even if that money is savings, right, it goes, it has a name. So nothing thing, I'm just going to leave it in the bank. It's going somewhere every month. I love that. All right. So we have stick with it. Don't break it, give it a name, anything else? And just accountability partners. Yeah. All right. Well, this was great, Stephanie, and I hope that people this gives everyone an idea of having a good starting point, downloading the app, maybe reading the book. Like I said again, to repeat the name of the book, the total money makeover by Dave Ramsey, and every dollar.com or every dollar app. And in there, it also has in the book, like Stephanie said, it also has information for people who don't have that steady every two week paycheck. But if you're an entrepreneur, it gives you ways in order to kind of work around that as well.

Stephanie Weyrauch (28:27):

And if you do end up, if you guys are podcast listeners, and if you download the Dave Ramsey show podcast, a lot of his podcasts focuses on entrepreneurship and on business ownership. And so he has a lot of really great advice on running a business and budgeting for business. The budget that I talked about is more, it can be both used as a personal budget or a business budget, but he does talk a lot about business ownership in his podcast as well. So I would definitely recommend checking that out. If you have extra time and want something to play in the background, it's a good podcast to listen to in the background. You don't have to sit there and like learn from it. It's just kind of there. And he's a pretty entertaining guy. Yeah. I took one of his it was like a longer course a couple of years ago. So I still have all of the materials and everything like that. So yeah, he's very entertaining and he knows what he's doing and it works.

Stephanie Weyrauch (29:15):

And I will say, you know, you can have a personal budget and a business budget. You don't have to have just one. You can have personal, you can have business and then you'll know exactly where literally every dollar in your business and every dollar in your personal life is going. And like I said, on our talk, you know, after reading profit first from Mike, I just found it amazing of like, yeah, I know now where every dollar is going to. So now that I know where every dollar is going to my big buckets, I can now use this to see where it goes to the very last dollar.

 

Karen Litzy:

Right. Yeah. And like I said, when you do a budget, it's amazing how much extra money you have. And you're like, wow, I didn't know. I had all this money. What was I spending on before?

Stephanie Weyrauch (30:03):

Right. What kind of nonsense was I doing before?

 

Karen Litzy:

Yeah. That's one thing that I have to tell you after instituting profit first, I was like, the hell was I doing like, seriously? What was I doing before? Because I have so much more money in savings. I don't have to worry about paying taxes. Everything's awesome. Like, what was I doing? I can't explain it, but now it's like, yeah, now I get it. Now I understand. And I feel like you know, like you said, Oh, this is a grownup thing. Oh yeah. So I was like adulting hardcore when I learned this. So I think that's great. And now Steph, before we jump off, where can people reach out to you or find you social media if they have questions?

 

Stephanie Weyrauch:

So I'm on Facebook. Stephanie Weyrauch. Or you can find me on Instagram or Twitter at theSteph21 and I'm available on any of those platforms.

 

Karen Litzy:

Perfect. Well, thank you so much. And everyone, thanks for indulging us, at least here in the Northeast on a very rainy, very rainy Saturday to talk about setting your budget, sticking to your budget and creating more wealth from the money you're already taking in. So Stephanie, thank you so much. And everyone, thanks so much for listening.

 

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Sep 7, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Adam Culvenor on the show to discuss ACL injury. Dr. Adam Culvenor is a physiotherapist, leader of the Knee Injury and Osteoarthritis Research Group and Senior Research Fellow within the La Trobe Sport and Exercise Medicine Research Centre in Melbourne, Australia. Adam’s research focusses on the outcomes of anterior cruciate ligament (ACL) injuries, in particular the prevention and management of early knee osteoarthritis in young adults following ACL injury and reconstruction.

In this episode, we discuss:

-The short-term and long-term burdens following ACL injury

-Why patient rapport is integral to effective treatment post-ACL injury

-Optimal loading strategies for non-surgical and post-surgical cases

-The latest research on prevention for early-onset osteoarthritis

-And so much more!

 

Resources:

Adam Culvenor Twitter

La Trobe SEMRC Twitter

Email: A.Culvenor@latrobe.edu.au

La Trobe Adam Culvenor

La Trobe University Blog

For knee injuries, surgery may not be the best option  

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

 

For more information on Adam:

Dr. Adam Culvenor is a physiotherapist, leader of the Knee Injury and Osteoarthritis Research Group and Senior Research Fellow within the La Trobe Sport and Exercise Medicine Research Centre in Melbourne, Australia. Adam’s research focusses on the outcomes of anterior cruciate ligament (ACL) injuries, in particular the prevention and management of early knee osteoarthritis in young adults following ACL injury and reconstruction. His work has identified important clinical and biomechanical risk factors for post-traumatic osteoarthritis, and he is currently testing novel osteoarthritis prevention strategies in young adults following injury in a world-first clinical trial. He has published over 60 peer-reviewed articles in international journals.

Adam has worked in teaching and research at universities in Australia, Norway and Austria and is a graduate of Harvard Medical School’s Global Clinical Research Program. His research has been awarded American Journal of Sports Medicine most outstanding paper 2016, Australian Physiotherapy Association Best New Investigator 2013 & 2017 in musculoskeletal and sports research, and Sports Medicine Australia best Clinical Sports Medicine paper 2019.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey, Adam, welcome to the podcast. I'm so happy you're here. And I'm excited to talk about ACL injuries with you. So welcome.

Adam Culvenor (00:08):

Thanks very much for having me, Karen. It's great to be here and chat.

Karen Litzy (00:11):

So now the bulk of your research is in ACL injuries and not the mechanism of injuries for ACLs, but what happens after that injury? So before we get into, and we'll talk about the burden of ACL and optimal treatment and osteoarthritis and why that happens. But what I would love to know is why are you interested in this subject matter? Sort of, why did you make this kind of the centerpiece of your research?

Adam Culvenor (00:43):

It's a good, good question. So about 10 years ago, also, now I had done a couple of years of clinical practice as a physiotherapist in Melbourne where I'm based and was interested in pursuing a bit more of the research line into ACLs because we had a patient come to myself and one of my colleagues who was a young guy, about 35 years old, who had a very active, healthy life up to that point, he'd suffered an ACL injury about when he was 20 years old, he was about 35. Now it had a number of issues. He'd got back to sport without any problems, but then now about, you know, 10 to 15 years later, started having some pain, unable to do the things he normally would love to do. Couldn't go back and play anymore.

Adam Culvenor (01:33):

Sport couldn't start, couldn't really play with his kids. He'd seen an orthopedic surgeon, he'd had an Arthroscope, had a bit of a cleanup now going back to the surgeon and he was really in want of a knee replacement because he could no longer do the things that he wanted. And the surgeon basically said to him, you're too young to have a knee replacement go and see, Adam and Tom, our colleague. And so what we can do, and that really opened our eyes from a clinical perspective about these types of patients and this particular young guy had on x-ray most of his changes were actually in his patellofemoral joint. So in the patella and the trochlea, and that really set my mind up to go and look into the literature in this space and see what's out there in terms of not only osteoarthritis in these young people. And clearly it was very burdensome to this young guy, but also why are we seeing this in the patella femoral joint in particular and why is it causing so many problems? And so that really set us off for my PhD, about 10 years ago, looking into these medium to longterm outcomes, ultimately trying to help these people get back to do the things they wanted to do without the pain and the symptoms that come with osteoarthritis a lot of the time.

Karen Litzy (02:48):

Yeah. Oh, great story, that's a shame 35 years old. Gosh, that's so young. I can understand why that would really peak your interest because you don't want to see these patients coming into you or when you do see them, you want to be able to help them with the best evidence and best things that you can. So you had mentioned in your explanation there as to why this subject interests you, is that there is this sort of burden after having this ACL injury. So could you talk a little bit more about the burden of an ACL injury and subsequent surgery?

Adam Culvenor (03:27):

Sure. So I'm sure it goes through a lot of people's minds, as soon as they hear that pop or click, that if they know they've had an ACL injury, that's the initial burden is, you know, that worry of, I can no longer play sport. And often if you do go and have a reconstruction surgery, it's often the nine, 10, 12 months of extensive rehabilitation, as we know, and not going back to sport that often people find a lot of personal satisfaction and get a lot of mental health benefit from playing sport and from their peer involvement and social interaction. So it's that initial burden of the extended period out of sport. Some people do really well with great rehab. They can get back to their sport. They want to play at back to the same level of performance, but there's a certain percentage at about 50% of people we know in the evidence will develop longer term, not only persistent symptoms from a patient reported outcome perspective, but also ongoing functional limitations.

Adam Culvenor (04:26):

And ultimately the development of osteoarthritis be that on radiographs, on x-rays. And some of our work is which we can go into a little bit more detail in a moment is looking at the earlier changes on some more sensitive imaging like MRI to try and detect these types of people who might be more at risk of developing longer term changes. So as I said, some people do really well following an ACL injury, but rehab only, or surgery. And we can chat about the differences in the treatment options later as well, but about 50% of people at the moment. And the evidence suggests that they will have osteoarthritis within about 10 years of their ACL injury. So if we think of the typical patient is, you know, the adolescent or the young 20 year old patient playing sport, they rupture their knee only 10 years, 15 years down the track.

Adam Culvenor (05:16):

They're still only 30, 35. That young gentleman I spoke to earlier. And they've got a knee of essentially that looks like on imaging of a knee of a typical 70 or 80 year old. And we know that imaging findings on x-ray don't necessarily match up particularly well with what we see clinically. So that's not necessarily, you know, a sign that they're definitely going to have functional limitations on symptoms, but it certainly increases the risk of that happening. And that burden at a time when people often have really important family commitments and young family commitments work commitments, and they often still want to be active in participating in sport. And so when you bring all of those in to a knee that might not be has have recovered as well, following an ACL injury, you might still have some muscle weakness if that wasn't addressed initially and create the picture of more of a persistent pain problem, then you start getting into being quite a burdensome condition that we say these types of patients clinically come back in often five, 10 years following their injury.

Karen Litzy (06:20):

Yeah. And I can imagine along with that, persistent pain comes decreased activity, decreased movement, and we all know all of the sort of cascade of events that can happen when you're not getting an exercise. You're not getting in movement. You know, then you have risk of obesity, risk of diabetes mental health issues. So all of that stuff can kind of stem from, you know, this burden of an ACL, which, you know, for a lot of people, I don't think that even would flash in their mind when you're looking at a 20 something year old who just tore their ACL, because we know that population who does tear are usually pretty athletic.

Adam Culvenor (07:03):

Exactly. And that's the thing prior to their injury. They're often very healthy and, you know, never seen a doctor or never been to hospital before and having the ACL injury can often be that initial. Unfortunately, you know, the cascade where you become less physically active in, might not be able to get back to the sport. You really want to start putting on weight. And that increases the risk of all of these other conditions, as you've just said. And I think there was a recent article a research paper actually showing that having an ACL injury increased your risk of a cardiovascular disease by about 50% longer term. So for me, that was a real wake up. This knee is not just a knee, it's actually affecting the whole person. Exact reasons you just mentioned that it can spiral into, you know, less physically activity, the pain putting on and then being the increased risk of all of the comorbid conditions as well.

Karen Litzy (07:55):

Exactly. And now, so you mentioned a couple of minutes ago about treatment. So you could have surgery, you can not have surgery. So can you talk a little bit as to what the optimal treatment is after an ACL and how one comes to that decision, whether you're the clinician or you're the patient, how does that work?

Adam Culvenor (08:18):

And that's the $64 question. And so I can have extreme of the spectrum. You can have one end, you can have everyone has surgery. The other end is no one has surgery and the truth probably lies somewhere in the middle. So if we look to what the evidence suggests in the literature, there's very little high quality evidence comparing the two treatment options. There's really only one, what we call randomized control trial. That's compared about 120 people. Who've had an acute ACL injury and they were either allocated to having early surgery. So a couple of months of having the injury and then an extensive rehabilitation period I've nine months or so, and then the other group. So exactly the same rehabilitation. The only thing is they didn't have the surgery. And so the only difference between these two groups of patients was the surgery or not.

Adam Culvenor (09:15):

Now the group who didn't have the surgery initially could have the option of having surgery later on if they had ongoing problems or symptoms, or desired to have the surgery later on, and they could cross over to the surgery arm. And what this study showed is initially this was published back in 2010 now. So we've not done this for over a decade, is that there's very little differences both at two years after surgery five years. And I think that the authors are about to publish their 10 year outcomes, but certainly the two and five year Mark, there's very little differences, whether you have surgery or not, in terms of pain symptoms, strength returned to sport the need to have more surgery, quality of life, and indeed radiographic knee osteoarthritis. So I was fortunate enough during my time in Europe, conducting a research fellowship recently to work with this group of researchers based in Sweden.

Adam Culvenor (10:07):

And we looked at the MRI outcomes in this population, as I said earlier, trying to identify people maybe earlier in the process initially after that ACL injury, to see if we can identify those more at risk of longer term problems, which might present opportunities to intervene a little bit earlier to stop that cascade of negativity and what we found really, interestingly, when we looked at the cartilage on MRI between the time of injury to two years and to five years, is it the group that had early surgery actually had more cartilage loss compared to the group that didn't have surgery and you sort of asked, well, why might that be? Because, and I think I haven't had an ACL reconstruction, I'm injuring myself, but I know from colleagues and working clinically that the ACL surgeries is almost a secondary trauma. Like you're going in there, you're drilling tunnels, you arthroscopically opening the joint.

Adam Culvenor (11:04):

You come out of surgery, having a very angry, hot red, swollen knee. And so I think that whole cascade of inflammation can soften the cartilage, can create a knee that's not particularly happy. And then when you go and potentially, you know, put that knee through load, maybe going back to sport and whatnot, then that might actually be related to the development of osteoarthritis more so than if you don't have the reconstruction. And so we've actually done a little bit more work on the return to sport type of thing. And, thankfully in a group with ACL reconstruction, it doesn't seem to increase the risk of osteoarthritis if you do go back to sport. So that doesn't seem to be the main things. That's a good thing for patients knowing that if you've had an injury or reconstruction, you can go back to sport knowing that you're not going to put your knee at more risk, but it's probably more the inflammatory markers, the secondary trauma of that that's reconstruction surgery that increases the risk even longer term as well.

Adam Culvenor (12:03):

So I think what I always tell my patients is that you should always trial a non-operative period. First, you can always go and have surgery later. And I think, I always say, you need to prove to me that your knee is unstable. So some people can do really well without having surgery because their neuromuscular and muscle systems can compensate for that ruptured ACL and the mechanical instability, the neuromuscular system, the humans are very clever. They can really compensate quite well, and they feel you don't need the ACL. If you're only going to perhaps not go back to that high level pivoting sport, where you put your knee at high stress, a lot of the time, then if you just want to run straight lines and play with the kids, then you're likely not needing to have the reconstruction. If for instance, you try a really intensive, progressive rehab strengthening program and you're starting to run, or you're starting to get back into a bit of sport and your knee starts to become unstable at that point at the level that you want to get back to, then that sort of probably instigates the conversation.

Adam Culvenor (13:12):

Well, maybe your knees actually not able to overcome the structural instability to the level of activity that you want to achieve. Maybe let's have the discussion of a reconstruction as a potential option, but always get them. You need to prove that your knee's unstable by going through this rehab and putting yourself through these activities. But it's not going to do well without surgery because we know that the outcomes that are quite similar for the majority of people if you have early surgery or even delayed surgery and doing a period of rehab, irrespective of whether you go and have surgery or not, will be beneficial, if you do go and have surgery. So that prehab, if you like. So that's, I think it's my take home is it's probably actually just educating the patient to empower them with the evidence because they're the ones ultimately that need to make the decision. And so presenting them with all the best available evidence and guiding them for the initial rehab stage often can change their mind that they need surgery once they realized they were actually doing quite well without it.

Karen Litzy (14:17):

And when you're saying to the patient, let's do a trial for a non-operative phase, so that you can prove to me that this knee is unstable. What kind of length of time are you talking about for that rehab process and knowing that it's going to vary person to person obviously.

Adam Culvenor (14:37):

Oh, of course, of course. So I think a period of two to three months is sufficient to provide an intensive strengthening program. Let the knees settle down initially and then actually start you know, within the first month and even two months getting them to start really loading their knee. That's the thing, if you actually don't have surgery and actually responds a lot quicker because you don't have any of the graft morbidity, you're not taking out some of the hamstring or the patellar tendon. There's no real reason why we need to be conservative about you know tearing a hamstring or whatever that might be cause of the graft or rupturing the graft because you haven't had the graft reconstructed. So it's different for everyone because different people will respond differently, but actually there's no real hard and fast rule with this because you need to rehab them to get them to a point where they're starting to do the activities that they want to get back to.

Adam Culvenor (15:37):

And at any point in that step ladder of increased physical activity demands that they might fail or start having, you know, severe giving way episodes. Then that's the point that you might have that conversation with someone, but if you're running and you start giving Y and these people want to go back and play elite football, then clearly maybe you're not getting, being able to run without a stable knee. You're probably not going to be able to play football with that with a stable knee. Then that might be the point where you revisit, you're running no problems and you tried playing football and it starts giving way, but really you actually just want to run, right? Playing football is just something you tried, but didn't really want to do. Then you probably don't need the structural stability. If you just want to run off another thing, I like to set a patient's, is it like a seatbelt?

Adam Culvenor (16:28):

Is it, we all wear a seat belt when we drive, but very rarely do we have a crack and we rely on that seatbelt to keep us safe. So if you're someone who walks around and might run, then the ACL is a bit like a seatbelt, is that you actually don't need that seatbelt on because you're not having a crack. You're not putting the need through that real pivoting type movement to rely on it. So unless you're going to go back to a high level sport and, you know, put your knee through those pivoting jarring mechanisms of movement, then you probably don't need that seat belt. You don't need that ACL to protect the knee. Does that make sense? Yeah,

Karen Litzy (17:06):

That's perfect. That's really great. And it sounds to me like when, if you're the clinician working with this patient during, let's say this non-operative trial period where they have to prove, again, the instability, every single person is different. So what you're going to be looking at is different meaning, right? So if I just want to be able to play with my kids, I wasn't a runner before I don't really need to run. I just want to ride a bike or, you know, you want to put people through the things that they want to be able to do. And that would kind of be the way you would test for that instability. But are you also using sort of standardized tests when it comes to seeing if people have the stability in the knee?

Adam Culvenor (17:54):

Exactly. so it's really a goal based discussion with the patient come. The desires of the return to activity comes is driven by the patient. And as clinicians, you know, it's good to have that discussion to then work out, you know, what level do we need to get at, but certainly there's a number of standardized clinical tests and really great patient reported outcomes that we can use with these patients. So the very common ones are the strength tests. So if you have the resources, you know, a dynamometer, an isokinetic dynamometer in the clinic to look at the three range of quads and hamstrings strengths and making, you know, the criteria we typically use in the literature is meeting 90% of the strength compared to your uninjured side. Now, there's obviously some pros and cons about doing that.

Adam Culvenor (18:44):

And the other tests are typically hop tests. So single leg hop, as far as you can, with a balanced landing site, decide hop tests. There's a number of different tests we can use to try and assess the stability, the functional stability and confidence of the knee. Having said that though, we've actually just done some work I've led by Brooke Patterson here as part of our team, looking at the limb symmetry index, which is the ACL rate constructively comparing to the, I mean, delayed and what we found sort of between one and five years after their reconstruction is that often the non-injured leg isn't that healthy gold standard cause that often deteriorates because it's a period of an activity, you be back playing the sport you’re back to. So that's sort of the crisis in capacity. So it's not that reference standard that we should necessarily be comparing our rate constructed.

Adam Culvenor (19:44):

And so there's been a couple of other bits and pieces that people have looked at alternatives to this type of measurement. And whether it's, if you have say someone initially after injury, it's a great opportunity to start doing these tests is actually the estimated pre-injury capacity. So to estimate that it's best to try and do it as soon after injury as possible, given that patients might have some fear and confidence, you know, respect that obviously, but actually trying to do a hop test quite early before that other leg has the chance to start decreasing in capacity because often the limb symmetry index overestimates, what the reconstructive legs capacity actually is. And so they're the functional type of measures that I think we should be using in this patient population, not only to assess outcomes, but also patients get in my experience really like seeing their improvements and getting feedback about having, going along their journey totally. And then an objective test of strength or a hop test they can see right in front of their eyes, how far they're hopping and if they are improving and if they're not, then why not have that conversation. And so that can be great for adherence motivation because this journey of a rehab, irrespective of whether you have a reconstruction or not, can be quite long and tedious, it can be boring. You're sitting there doing strength exercises, you know, any type of motivation to get people to continue is going to be beneficial.

Karen Litzy (21:14):

It's always, one of the biggest complaints is, gosh, these exercises, when do we get to the X, Y, Z, you know, that you see on, on Instagram or on YouTube. And I was like, you know, you're a month in buddy. This is it.

Adam Culvenor (21:28):

Exactly. And I think as physios and the evidence suggests that, we're very good at doing the early stage of the rehab because patients are probably more compliant at that point as well. But there's evidence actually coming out of Australia that less than 5% of people who have had an ACL reconstruction, so less than 5% actually go through a period of rehab beyond six months and include and return to sport type training. So I think whether it be a lack of understanding from a clinician standpoint, or also that, you know, financial and motivational points of view from the patient after six months of like, I've had enough, I'm out, I've good enough. I don't need that extra, you know, icing on the cake to get back to sport. They tend to drop off. And that's when not having that really high level agility capacity returned to school at top training, you increase the risk of re rupture. And that obviously is a devastating impact for these patients and increases the risk of longer term negative outcomes as well.

Karen Litzy (22:27):

Yeah. And I know here in the United States, not so much in other parts of the world, but insurance will oftentimes cut people off at three or four months.

Adam Culvenor (22:36):

Okay. So it's different everywhere. Yeah.

Karen Litzy (22:38):

So it's like, okay, so the person can walk and run and then, then what do they do? You know what I mean? So it kind of depends on your clinic model and things like that. But I mean, I've been lucky enough that I've been able to stay with my patients for 12, 13 months and upward. So it's been really great to be there the week they are out of the OR to getting them on the field and actually doing things that are going to, you know, mimic their soccer, their football place. So, but it's, yeah, there's so many obstacles. It seems.

Adam Culvenor (23:25):

Totally. And I think there's some really great evidence coming from Scandinavia that for every month that you delay the return to sport up to nine months, it actually reduces your injury risk by 50% that's mind blowing for me. So not only, you know, it was it from a rehab point of view, but actually from a range, point of view, having that nine months will actually you know, reduce your risk substantially of re rupturing when you do go back to sport. And I think that is why it's so heavily on people's minds when they're first going back to sport. That fear that's a huge impact psychologically for these types of patients. And I think often an ACL injury can happen. So innocuously, like you've done this movement a thousand times at training before, so why this time and that fear of, Oh, it wasn't a major blow when I first did it, like it wasn't someone running across and really hitting my knee. It was, I was on my own. And so what's stopping that from happening again. And that's that, I think that feeds into the fear of what could happen anytime again. Yeah. So I think I often try and say to patients while you injured your ACL, initially let's get your knee back to better than it was before you injured it, to prevent it from happening again. Because once we know once you have one injury, the biggest risk factor. So the biggest risk factor for a second injury is having a first.

Karen Litzy (24:51):

Exactly, exactly. And I've quoted that that study of that nine months reducing 50%, especially when you're working with kids who think I'm fine. Now I can walk. And I was like, listen, this, and you have to have that conversation with the child and with the parents. And once the parents hear that, they're like, okay, like we get it. Even though her physician was onboard, like you're not playing until you're one year out from surgery. I mean, wherever it is on the same page, but it's hard to keep. It's hard to keep everyone on the same page, but being able to use the literature and say, listen, I'll send you the study here it is.

Adam Culvenor (25:34):

When actually pulling it's actually for some people it's not in needing to encourage them, it's actually needing them to pull them back. That's where your education and clinical reasoning and discussions with patients will differ quite a bit is that some people are so gung ho in their rehab and they just want to get back to sport. You actually have to, as I said, pull them back, whereas the opposite might be true for some alpha people. So it's really interesting how different people respond differently to this type of quite devastating injury.

Karen Litzy (26:03):

Right. And how they respond, how you can use, like you mentioned the study of Scandinavia, how we can use that study with both of those extremes of people, right? So the people who are afraid and the people who are gung ho, so again, it's having this good rapport with your patient and their other stakeholders to kind of get them through safely through their rehab. But now we talked about it earlier on and that's osteoarthritis. So 50% of people will develop some sort of osteoarthritic changes in their knee. So what do we do about that? Are there prevention strategies? What can we do?

Adam Culvenor (26:54):

So this is something that we've been looking at for a few years now and obviously you know, we'd love to be able to have a treatment to stop this from happening, but we're not actually there yet. There's a lot of really nice longitudinal studies investigating risk factors for the increase prevalence of osteoarthritis in this population. And there's a number of risk factors that we can start informing how we might treat these people initially as well. So the number one risk factor is having a combined injury with a meniscus tear or a cartilage lesion. So if you have not only an ACL injury and very rarely, is it just an ACL injury, it can often be combined with a meniscus tear, cartilage lesion, bone marrow lesion, et cetera. So that more severe sort of type of injury will automatically put you at risk longer term of having osteoarthritis.

Adam Culvenor (27:46):

That's not that exciting because as clinicians, we can't do much about that. It's not really modifiable. So we're really trying to identify some factors that might be modifiable that we can address. So things like BMI being overweight, we know increases the risk of osteoarthritis longer term not only after injury, but in people of older age who have the traumatic type of osteoarthritis what's coming emerging from the literature more and more is the quadriceps weakness. So quadriceps in particular the muscle weakness in that muscle and also the functional impairments. So we talked about hop tests and in a balance in your muscle control a little bit earlier. So they're actually starting to become more and more prominent as risk factors for the medium and longterm outcomes for osteoarthritis. So we've just published a paper in the British journal of sports medicine, which looked at this exact question.

Adam Culvenor (28:44):

So do functional outcomes. So typical tests, we might use to clear someone to return to sports, a hop tests and strength tests. Do these actually have a relationship with future osteoarthritis? And what we found is, so this is a one year we tested them. And then at five years we measured their osteoarthritis on MRI. So quite sensitive measure of osteoarthritis, but also an X ray. And what we found is we combine a lot of these tests together into a test battery. So side to side hop test, single leg forward hop test. If you have a poor outcome at one year in these tests, then you're more likely to develop osteoarthritis at five years down the track. And so there's other studies that show quite similar findings in this space as well, which is really, I mean, it's upsetting because they're more at risk of osteoarthritis, but it's quite encouraging as clinicians.

Adam Culvenor (29:34):

This is our forte. We can actually do something about it in the initial stages of rehab. And again, this can be a great education motivational tool to say on this test, you're not achieving at a level that you need to achieve. This is not only going to put you at risk of reinjury. The research shows that this is actually going to increase your risk of developing arthritis. And we need to be a little bit careful about how we inform our patients about this. Cause as I said, some people can be really fearful and terrified about reinjuring and worried about what it is going to look like. And so presenting them with, Oh, you're going to be, you're going to have arthritis in 10 years as well. Might not be quite the right moves to allay that fear at that point in that patient.

Adam Culvenor (30:16):

Whereas other people having a knowing that information can be really motivating to try and get them feedback to the best possible condition that it can be. So again, it's very personalized how we educate our patients, but I think it's really important to educate them along the journey about that increased risk of OA and encouragingly. There's some, some really positive signs that we might start to be able to modify that risk with some really great rehab, getting back to the strengths, getting back to improving function in our clinical work as well. So I think that's really, really exciting moving forward.

Karen Litzy (30:50):

And that's great news for physical therapists because this is where we live, so wow. We can really make a difference in someone's life by good comprehensive rehab within that first year after ACL injury. And again, that's, regardless of whether they have surgery or not, is that correct?

Adam Culvenor (31:08):

Exactly. Yep, exactly. And as I said earlier about the return to sports, so we've also done some research which should be published shortly, hopefully looking at the fact that again, encouragingly, if you have an ACL injury or reconstruction and then decide to go back to these pivoting type sports, some people say, well, you shouldn't go back to that. You know, the high impact sport, because that's going to put your knee at undue stress and you're going to have more arthritis longer term, is that what we've found is actually that's not the case. So we can be confident that we can give these people you know, the advice to go back to sport. If that's what they really want to, for their quality of life and mental health, they do drive a lot of social pleasure from playing sport. The good thing is, is if you have a great functional and strong knee, then that's not going to put your knee at further risk by going back to sport. Sure. It's going to perhaps increase your risk of re injury compared to sitting on the couch at home. I heard that from a lot of mental health and also physical health being physically active and involved in sport has so many more benefits to our general health as well.

Karen Litzy (32:11):

Absolutely. And now can we, if you don't mind talk about the patient that I think a lot of physiotherapists are going to see, and it's like the patient that you saw 15, 20 years after their ACL. So we're not, we're not seeing them one to five years, but now we're seeing them 10 to 15 to 20 years later. That's when a lot of people are going to come to us with knee pain. So what can we do for these patients? Do we want to look at these hop tests in these patients? Does that make a difference? What happens then? Cause that's a big bulk of our population.

Adam Culvenor (32:54):

You're exactly right. And it varies about again what their goals are, but often if they're 10 to 20 years down the track and they've got osteoarthritis, we can look to the literature in the osteopath writers field. And in that space, it's very, very compelling evidence that exercise therapy and education provides the strongest effect for pain and symptoms and function in this population. And so that's almost reassuring that it's quite similar to what we're seeing in the early post-operative or post-injury stage is that whatever level on the spectrum you are post-injury and the development of osteoarthritis, essentially your treatment's going to be quite similar where you're developing the strength that underlies everything that we do in day to day activities. And indeed, if we want to get back to sport and also the functional capacity, so ask for the, what they want to do, what they can't do because of their pain and symptoms and make it a really goal oriented treatment.

Adam Culvenor (33:54):

And I think it's really important to also ask them what physical therapy have they actually done. A lot of those people come to us and they've seen five different surgeons and they've got different opinions. And when you actually question them and interrogate them, they've actually never had a gym program or they've never done any strength training. And it's like, well, of course you're having a few problems. So let's start you from the very basics. And not, you know, not flare them up by going too hard, too fast, but actually educate them around the importance of strength and functional control that the knee will benefit a lot from that. As well as from a function symptomatic point of view and start building on their strength, capacity and functional capacity to be able to meet whatever goal that they want to get back to. So I don't see it as being a totally separate patient from the post-injury one to the osteoarthritic, it's on a spectrum. And a lot of the treatments going to be very similar in principle depending on what their goals and their goals might change over time. So the treatment can as well.

Karen Litzy (34:58):

Yeah. Yeah. Well, thank you for that. That's great. Now, can we talk about the study that you are currently undertaking at La Trobe University. So can you tell us a little bit more about that? What is it and what are your goals for it?

Adam Culvenor (35:18):

We're super excited. Pardon the pun. So this is a project that's really stemmed from over the last 10 years of our work. Looking at identifying those risk factors, as I've talked about earlier to then be able to get some funding. So we've got some funding from the Australian government health and medical research council to perform this really world first randomized control trial, to see if we can actually prevent early osteoarthritis and improve symptoms and function through an exercise therapy intervention. So in essence, we're going to get a whole lot of people, about 200 people who are one or two years following there ACL reconstruction. So they've had that initial period of rehab to get better. Cause some people do really well. We need to remember that, that some people do great following the injury and surgery and don't need more intervention longer term.

Adam Culvenor (36:14):

So we want to try and capture the ones that have some ongoing symptoms and functional impairments. Haven't got back to doing what they want to do at one year post op to two postop at a point where they should be able to do those things and because they are going in out by some of the research, that's just, those people are more at risk of developing longer term problems. So we want to capture those at high risk and we're going to separate them into two different groups. In our clinical trial. One group will get a really intensive physio therapist, led exercise therapy program. So a lot of strengthening, agility, neuromuscular control, education, around physical activity you know, loading of the knee return to sport. And then that's over a period of four months initially. And then the other group gets what we're trying to say is usual care.

Adam Culvenor (37:06):

So very little intervention, they get a little bit of education and some booklets with the types of exercises I could do if they want to essentially, which is what they'd probably get it from their GP or their surgeon. Similarly, am I going to then assess their needs and their general health and symptoms and function from baseline and that changes over four months. And then also look at the changes up to 18 months as well because the MRI is one of our main outcomes looking at early collagen changes, which is our osteoarthritis marker. And some of these can take a little while to show up. So if you have an MRI on one day and then go and have an MRI the next week, chances are, you're probably not going to see much difference. So we need that period of, you know, 12 to 18 months to be able to see an effect of our exercise therapy intervention.

Adam Culvenor (37:56):

Whereas the symptoms of function we're expecting to be able to improve quite a bit within the first four months, which is going to be the most intensive period. And so yeah, our hypothesis is yeah, is that there's really strong, intensive, progressive rehab program strengthening, getting nice knees back to better than what they were before is going to be beneficial for their symptoms, function, general health quality of life, but also hopefully be able to show that that's actually preventing the early changes that we see on MRI or indeed maybe slowing the changes. So we know that cartilage thickness decreases. So we have a loss of cartilage, bone marrow lesions can start developing also for small osteophytes and bony spurs can start developing over a course of one or two years. And so we want to see if there's a difference in the development of those features in the two different groups. So we are ready to hit, hit, go on this study and a little bit delighted with COVID effecting us at the moment as well. So we're really excited to get going on this study and hopefully be a really impactful research project, moving the field forward and empowering clinicians to say, we actually can make a difference in this space for these patients.

Karen Litzy (39:07):

Yeah. I love it. Well, I look forward to when you guys can actually get started and maybe 12 to 18 months from then. So it sounds like a great study. And like you said, it's something that can be so empowering for physical therapists or physiotherapists to then pass on to their patients and kind of transfer that power from the physio to the patient to give them a greater sense of wellbeing, which is exactly that's what we do, right. That's why we became PTs or physios. So before we sign off, I have a couple other things. Number one. What are your biggest sort of takeaway messages for the listeners?

Adam Culvenor (39:55):

So I think the biggest thing is probably when you first see the patient, whose had an acute ACL injury in front of you and they're devastated. They often might come into your rooms and have heard particularly here in Australia. Our media is very centric on if you've had an injury, you need reconstruction because the elite athletes tend to have the reconstruction and I want the best treatment. And therefore I need a reconstruction is actually having a conversation with them and saying, presenting them with the evidence as I spoke about earlier. And there's no problem trialing a period of non-operative management for a couple of months, because that's going to be a great help if you do go down and have surgery afterwards. And it's, I think the reality is that a lot of people given the opportunity to do is to not pretty, very happy, actually can change their mind over the course.

Adam Culvenor (40:45):

And I realized actually, my knees gone really well. I actually don't need to have surgery where I was. I thought I would. So that's instead of just going gung ho into surgery, I think the evidence is very clear that a period of non-operative management is beneficial. Most patients almost all. And then the second key take home for me is, is during a postoperative or post-injury rehabilitation is actually working these patients intensively and progressively, I think we tend to shy on the side of being a little bit cautious, particularly after they've had a reconstruction, we worry about the graft rupturing. And of course we have to respect the surgeons requests of what we need to do with the patient from a restriction standpoint. But I think there's evidence growing now that we can be a lot more intensive early on and progressive with our exercises and looking to the strengths and conditioning research like these guys are trained specifically to develop strength and conditioning programs.

Adam Culvenor (41:46):

And I think as physios where we're pretty good at it, some better than others. And I think meeting the American college of sports medicine, you know, criteria for strength gains is actually, you need to work really hard. You need to get sweaty, you need to actually be working at an intense level. And so unless we put our patients through that, those sort of levels of intensity, we're not going to see the best outcomes that these patients can then can achieve. So there my two take homes is I think try non-operative period of rehab initially and revisit that along the course of the program. And then don't be afraid to actually build a lot of strength in those people because that's going to be beneficial. So they short term prevent re injury and the longterm of preventing arthritis, likely down the track as well.

Karen Litzy (42:31):

Awesome. And then number two, next question is, and it's something I ask everyone knowing where you are now in your life and in your career, what advice would you give to yourself right out of a physiotherapy school?

Adam Culvenor (42:51):

Ooh, good question. I'd say don't worry so much about things. Things will work out. I think in the research I'll probably have my research hat on a little bit, is often clinicians who want to start in research or even researchers who want to continue in research is that the funding can be really you know, tricky and really competitive and can often make and break careers. But I think some general, you know, I'd tell myself is don't worry too much about that. Just link up with good people and strong mentors. So, and I think finding, I'm sure you've had other guests say this as well, but finding good people who can mentor you really well and put your interests or your goals in your career sort of forward to their collaborators. So you can meet new people and open doors.

Adam Culvenor (43:46):

I think I was always worried that it wasn't gonna be enough doors opening, but I've been really lucky in my career that I've been surrounded by a great team throughout and doors have inevitably even though I don't expect them to keep opening. And so having the being in the right place at the right time is important, but you can, you can help to create more instances of being in the right place and more instances of being in the right time by putting yourself out there and meeting new people and surrounding yourself with really good mentors.

Karen Litzy (44:20):

Great advice. And number three, last question. Where can people find you?

Adam Culvenor (44:25):

Peak pool can find me in my lantern at the moment I'm up? No. So I'm have a Twitter account @agculvenor. My profile's on the Latrobe sport and exercise medicine research center page at Latrobe university. So we have a blog at our research center with a lot of really nice impactful easy to digest, short blogs, short videos, infographics designed for clinicians designed for patients. So you can take them off the blog and give them to your patients so I can not recommend that resource highly enough. And then my email, feel free to email me. You can find that email address on the La Trobe website page as well.

Karen Litzy (45:13):

And, we'll have all the links to that at the show notes for this podcast over at podcast.healthywealthysmart.com. So we'll have a link to your Twitter and to your page at Latrobe and also to the blog. So people want to get those resources, they can, and we'll also put in links to the papers that we spoke about today so that people can go and kind of read those papers as well. So we can link up to all of that. So, Adam, thank you so much was a great conversation. I appreciate your time.

Adam Culvenor (45:44):

That's been fantastic. Thanks Karen.

Karen Litzy (45:46):

You're welcome. And everyone, thanks 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 Apple Podcasts!

Aug 31, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Michael Greiwe on the show to discuss telemedicine.  Dr. Michael Greiwe is a practicing orthopaedic surgeon with OrthoCincy, near Cincinnati, Ohio, and the founder of the OrthoLive and SpringHealthLive telemedicine platforms. The platforms allow medical practices to deliver telemedicine visits through real-time HIPAA compliant video conferencing between provider and patient increasing practice revenue, efficiency and patient satisfaction.

In this episode, we discuss:

-The benefits of telemedicine for both the patient and provider

-Choosing the right telemedicine platform for your practice

-How to meet patient privacy and compliance requirements

-Practical tips for a seamless telehealth visit

-And so much more!

 

Resources:

Ortho Live Website

Michael Greiwe LinkedIn

Michael Greiwe Twitter

Email: mikegreiwe@ortholive.com

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.   

For more information on Dr. Greiwe:

Dr. Michael Greiwe, M.D., is a surgeon by day and tech guru by night. He is a practicing orthopaedic surgeon with OrthoCincy, near Cincinnati, Ohio, and the founder of the OrthoLive and SpringHealthLive telemedicine platforms. The platforms allow medical practices to deliver telemedicine visits through real-time HIPAA compliant video conferencing between provider and patient increasing practice revenue, efficiency and patient satisfaction.

Dr. Greiwe is a nationally recognized expert on how telemedicine technology is changing the practice of medicine. TV news stations and podcasts across America have interviewed him about the future of telemedicine and how to use it to improve the patient experience.

He attended the University of Notre Dame, where he won the prestigious Knute Rockne Award for excellence in academics and athletics. He completed his Founder and CEO of OrthoLive orthopaedic surgery training at the University of Cincinnati Department of and SpringHealthLive Orthopaedic Surgery and Sports Medicine. In 2010, Dr. Greiwe completed his fellowship in shoulder, elbow and sports medicine at Columbia University, training with the head team physician for the New York Yankees, Dr. Christopher Ahmad.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey Dr. Greiwe, welcome to the podcast. I am so happy to have you on today to talk all about telemedicine.

Michael Greiwe (00:08):

Oh, thanks so much, Karen. I'm glad to be here. I really appreciate you having me on the show.

Karen Litzy (00:11):

Yeah. So for any of the long time listeners of this podcast, you know that back in March and April, when the covid pandemic hit, we talked a lot about tele-health. But I think it's great to sort of revisit that now that we're a couple of months in and perhaps more people are using telehealth at this time, then were back then. But what I want to know is Dr. Greiwe, did you just start using telehealth when the pandemic hit or were you more of an early adopter?

Michael Greiwe (00:42):

Yeah, thanks for the question. I kind of carrying out with sort of like an early adopter. You know, I started using telemedicine back when it really wasn't cool, I guess. It was like back in the 2016 time period. And I knew it was great for my patients cause they live pretty far away. I had patients that live like two or three hours away and they would drive and try to meet me. And then you know, I'd only see them for 15 minutes. I felt really bad about that. So I started using telemedicine and it's been a great thing for my practice. And then of course, you know, recent things changed everything and it's now exploded.

Karen Litzy (01:16):

Right. And like I said, in your bio is that you're an orthopedic surgeon. So one question that I think is probably good that you probably get asked all the time is how in the heck do you see someone for an orthopedic condition when you can't put your hands on them and kind of feel what's going on?

Michael Greiwe (01:37):

Yeah, that's a great question. I get it all the time. And it's one of those things where, you know, for me, and I'm sure for you as a physical therapist, you know, so much when you hear about the history of that patient. So like the history gives you probably 80 to 90% of what you need. And then the rest is sort of verifying things through, you know, a physical exam and there's certain things on video that you can kind of catch. So like if I have somebody with the rotator cuff problem, I can watch their arm move. And I just know that the rotator cuff is bothering them. And then I'll maybe order like an MRI or something along those lines sort of confirm. But ultimately for me, it's more about like, you know, I may have to see this patient in the office at a certain point in time, but I don't always have to do that. It's kind of like depends on what the history gives me.

Karen Litzy (02:22):

Yeah. And I agreed from a physical therapy standpoint. I get that question all the time is, well, how can you do physical therapy on someone if you can't, if you're not in the same room. And again, it comes down to listening to the patient. Like they will tell you everything you need to help treat them to help diagnose them. If you just listen in the beginning and then you can tailor your program accordingly. Now of course, like you said, there are times where you have to see the person in person, right. And sometimes that's the same with PT. So I think oftentimes when people think about tele-health, they just paint with a very broad stroke and they think, well, how can you do that? So what do you say to people who sort of have that mentality of all or nothing?

Michael Greiwe (03:13):

Yeah. I think if they experience it for their, you know, themselves, they can sort of see that, okay. You know, this really works and it works because, you know, if you have somebody on the other side that's engaging you and asking the right questions, you're going to eventually come to the right answer. You know, I've had patients with a frozen shoulder and I'm sure you've treated patients with frozen shoulder. It sort of have classic signs and symptoms. Sometimes the history isn't like exactly, they're just sort of out, well, you know, my shoulder has been hurting and it kind of came on over the last several months and now I can't really move my arm as well as I used to. Or maybe you might not hear that. You just hear like, well, it hurts all over all the time, but if you kind of ask some leading questions, you have the right examiner, you can find out the answer. And so I think that's really, the key is having the right person on the other side of the screen, you know, asking the right questions. I'm sure you do the same in your practice with physical therapy.

Karen Litzy (04:06):

Yeah, absolutely. And you know, when we're talking about our different practices and our businesses because of the COVID pandemic, a lot of places had to shut down there in person I'm in New York city. So talk about being shut down. So we were shut down quite early. Now other parts of the country are flaring up and there's a lot of uncertainty here. So when it comes to tele-health and our business, how can tele-health help our practices grow and help our businesses grow?

Michael Greiwe (04:41):

That's a great question. I think it's something that people are sort of finding out more and more about right now. I mean, there's so many ways to be able to utilize telemedicine in our practices to help it grow. I mean, first of all right now as an orthopedic surgeon, I see patients from around my area because of COVID in the situation we're in right now, they don't want to come into the office, you know, so they're looking online and they find, Oh, Dr. Greiwe has got an open slot to be able to be seen via telemedicine. So we're kind of advertising that at ortho Cinc, where I practice to say, Hey, anybody that might want to come in for telemedicine appointment, you can. And it just gives me access a lot better than it normally would to be able to see patients. And then I think there's other ways too.

Michael Greiwe (05:25):

So for instance you know, for physical therapists, you might work with employers for instance, or workplaces that need a physical therapist and you put like an iPad there to say, if you need a physical therapist, here's how I can help you, you know, call me or whatever through this device. And so there's just so many ways for us to do that inside ortho, specifically postoperative recheck appointments, they open up slots of time that, you know, you typically wouldn't have because it's a lot more efficient to see someone via telemedicine than it is in person. And you know, also there's a lot of downtime kind of between surgeries for us too, so that downtime can be utilized for telemedicine too. So there's a lot of ways we can sort of generate you know, revenue through that and kind of open up our practice a little bit more.

Karen Litzy (06:13):

And, what I found is I can actually help more people.

Michael Greiwe (06:17):

Oh yeah, absolutely. Because you could probably have group visits too. Right. You could have you know, on those group visits or are you talking about just sort of more you know, area? Yeah.

Karen Litzy (06:29):

Like you were saying before we went on is sometimes you have people have to drive two to three hours to see you. Right. You know, that's really, that can be really difficult. So imagine if you have, you know, this really aching shoulder pain and you have to drive two hours.

Michael Greiwe (06:45):

Right. Absolutely. You're absolutely right. I think what helps, what helps you is, you know, with telemedicine, you've got the reach to be able to see somebody that's five hours away or even across the country that's heard about you or, you know, maybe they know that you have certain techniques that they like. I sort of developed like a posterior shoulder replacement where it's kind of a muscle sparing approach to the shoulder. And so I have people come from like California, Texas, Montana, you know, and now I can kind of see them postoperatively and preoperatively with telemedicine. So it's a really nice, it's a nice tool from that standpoint too.

Karen Litzy (07:19):

Yeah. That's great. Yeah. So you could see them preoperatively, if they're across the country, they come in, you do the surgery and then you can then see them postoperative. So they don't have to stick around by you for six weeks.

Michael Greiwe (07:33):

Right. So I'll have him stay for the first week and then we'll have the incision to make sure everything's looking good. Take x-rays and then they'll go back home and then I'll check in with them every four or five weeks, they'll be doing physical therapy kind of in their local area. Or of course I could refer them to you to remote therapy, but yeah. So that's how they do it currently is they go back home, they work and they get their motion back. And then we'll check in again, virtual.

Karen Litzy (07:57):

Now how about prescribing medications? Is that something that you can do via tele? How does that work?

Michael Greiwe (08:03):

Yeah, it still works pretty well via telemedicine, but I don't really do any like schedule three narcotics, you know, things like that. We don't do, but you know, anti-inflammatories, you know you know, if somebody has had some nausea like Zofran or, you know, things of that nature are pretty easy to prescribe and we still prescribe and have the same prescribing practice that we do in person, it's just, I get a little bit more wary and I think it's prudent to be more wary about, you know, narcotic prescriptions and things like that, especially in the world that we live in right now. We've gotta be very careful about that. So, we're super careful with that, but I think most of the other prescriptions are totally they're okay to do.

Karen Litzy (08:46):

And how about this is a question that I get sometimes is what about privacy and compliance and making sure that meeting all those standards. So how can we ensure that we're doing that as a healthcare practitioner on tele-health?

Michael Greiwe (09:04):

That's a great question. I think, you know, it is very important, obviously. So HIPAA compliance is what it's sort of called as you know, and it's what everybody's sort of, doesn't like to have to worry about, but it's very important for our patients, right? I mean, it's, people are very much in tune with their privacy. Data privacy is becoming like a really big thing right now, but really people's healthcare privacy and their you know, their medical privacy is very, very important. So the telehealth platform that you choose, you have to make sure that that is HIPAA compliant. And that means end to end encryption. That means like the data that starts out, you know, it's carried through the internet and it's encrypted and then wherever it's housed, it's also encrypted there too, so that no one can sort of get to that information. I think that's really critical, very important for our patients and most of the platforms they will advertise whether or not they're HIPAA compliant. And you want to know kind of how many you know, what type of bit encryption they are and things like that when you look at platforms.

Karen Litzy (10:06):

What was that last thing you said?

Michael Greiwe (10:09):

Yeah, it's sort of like, as the information is traveling across the internet there's sort of, you know, bytes of information, right? And so the amount of encryption can be sort of leveled up so that, you know, basically you can have like 64 bit encryption, or you could have 264 bit encryption there's certain levels. And so it takes, it's like a string of numbers. And so that string of numbers is how much it would take to crack the code essentially. So 256 bit encryption is like, you know, a massive amount of code breaking has to happen to catch that while it's traveling through, you know, the inner web.

Karen Litzy (10:50):

Well, no, that's really good because I think that's something that if people are choosing a platform, it's definitely something that as a provider you want to be looking at.

Michael Greiwe (11:00):

Absolutely. It's very important, you know, and most providers are pretty in tune with that, but right now, like, you know, they're allowing telemedicine to occur on FaceTime and some other platforms.

Karen Litzy (11:12):

Now FaceTime is not HIPAA compliant.

Michael Greiwe (11:17):

Yeah. So we don't want to really be using that right now. And there are some providers out there that are doing it, maybe just for ease of use and because the pandemic it's happened. But ultimately what we really need to make sure is that we don't use those platforms. Those platforms are not safe, not secure.

Karen Litzy (11:35):

Are there any other sort of things that you want to watch out for when you're let's say, well, first we'll start with looking at different tele-health platforms. So what are the things that you want to be looking for? And if you have any advice on a do's and don'ts, while you're actually in your tele-health session, I know some of them seem like, should be common sense, but you never know. So let's go with, what should you look at first? What should you be looking at in your telehealth platform?

Michael Greiwe (12:11):

It's a great question. I think the first thing that's really important for patients is making sure that, you know, the HIPAA compliance there, we covered that, right? So HIPAA compliance, probably number one, number two is, does this platform allow you to, you know, keep a schedule? So one of the most frustrating things as a provider of telemedicine is, and this is what I found out many, many years ago is that there is no schedule. You know, you have to send the invitation to the patient. The patient sort of says, yes, I'd like to do this. And then, you know, they link up eventually, but what you really want us to be able to schedule the appointments, that way you can move from one person to the next, and you're not really leaving a screen and trying to come back and forth just from an efficiency standpoint.

Michael Greiwe (12:53):

It's not very efficient to do that. Another thing that's important, I think is being able to chat with your patient. Sometimes it's important to be able to have a conversation. And it's also important to answer questions. And so being able to have kind of a text based chat that's secure as well, that might be, you know, maybe they can send you a picture. Maybe you can send them a video. Maybe you can send them sort of a document that gives them some exercises or what have you. And that's really important too. But I think one of the other things I was gonna mention is consenting. A lot of platforms don't have consent and of course that's part of the law. You have to consent that patient for telemedicine before you have a visit in most of the States, I think 45 of the States, you have to have a consent. So very important for the consent process to happen also. And that allows you to have a legal telemedicine appointment.

Karen Litzy (13:44):

And that consent process. Can that be in your initial paperwork? So if you're onboarding someone and, you have, I mean, we've all been to the doctor's office, you have to fill out a million different forms, right? So same thing with PT. So can that consent to tele-health be in that onboarding or does it have to be every time you connect for a telehealth visit, do they have to consent every single time?

Michael Greiwe (14:11):

That's a great question. And it's really just a onetime consent, so it doesn't have to be, you know, every time. So if they just come to your office first time, you're going to maybe have him sign some paperwork that says consent to telemedicine, and that's fine. You're good to go. But in the case where you have a new patient, it's very important to make sure that you have that consent process. And so for us and what we do at ortho live and spring health live, we just have them sign off one time that they agree to telemedicine. And then we assume every time they visit the platform, they know what they're doing and they've already agreed to it.

Karen Litzy (14:44):

Yeah. Yeah. Cause I have woo. You just gave me a little sigh of relief cause I have it again as part of my onboarding paperwork that people are consenting to their telehealth visits, but I don't do it every single time for each visit.

Michael Greiwe (15:00):

Right. Then I think it's just sorta like the billing practices in your practice too. And that people sign off that they're okay with billing and that they just do it once they're not signing it every time that they come back, it applies similarly to telemedicine.

Karen Litzy (15:12):

Got it. Got it. Okay. So those are the things you want to look at when you're kind of shopping around for a platform. Now let's talk about some things that you want to have in mind as the healthcare practitioner during your telehealth visit with your patient on the other end.

Michael Greiwe (15:30):

Yeah. It's a really good question. So the first thing is if you're going to use a phone, you know, and sometimes you're using a phone because you might be on the go or maybe your platform only allows you to have a phone it's really important to make sure that you don't like hold the phone, like right underneath your nose. Because it sort of gives you like kind of the up the nose shot a little bit. So I always tell people, you know, prop your phone up in front of you, like on your keyboard, maybe that's a really good place for it. Or if you're using a laptop, obviously like your face is kind of directly in front of that camera. And it just gives you more of a conversational type of appearance to your patient rather than you're not like talking straight down to them.

Michael Greiwe (16:06):

I think that's important. The other thing to sort of test out is just make sure that like, you know, when you move your right arm, like your right arm is like going up in the correct location in the camera. So you're not off to the side, you know of the camera when you're trying to show them kind of what you expect, I imagine for physical therapy and you can answer this, you know, too, I imagine for physical therapy that you may have to be seen, like your full body may need to be seen at some point in time.

Karen Litzy (16:33):

Yeah. Yeah. You definitely need like a decent amount of space so that you can lay down on the ground. You can come up to kneeling, you're standing you're so yeah, for physical therapy, you do need a good amount of space. So it comes down to finding those spaces, whether it's in your home or your office, where you can kind of get the right angle and good lighting.

Michael Greiwe (16:54):

Right. That's great. I think that's really important. You know, for your listeners on the physical therapy and for us, it's also being able to screen share too. If you can screen share, then you can show x-rays MRIs, things like that. And just getting tests sent out. Like I know for my practice, you know, we had a lot of physicians go live as soon as COVID hit and nobody had practiced. And so it was disaster on the first day, it was like, you know, it was like Groundhog day. And like no one knew what they were doing. And I was running around different pods trying to help everybody. But it's important to practice just like we would never go to surgery, not practicing what we're doing, you know, you practice to on your side to make sure that everything's working properly, your camera, your audio and all of that.

Karen Litzy (17:36):

Yeah. Do a couple dry runs with friends and family, make sure it's working well. Yeah, that's excellent advice. And now what do let's say, physicians or therapists what do they need to do now to kind of quickly adapt to this telehealth? Because from like, I look at, it's such old hat now, but I've been doing it since March. So now you have other parts of the country who are sort of trailed behind New York city. So they're in lockdown maybe for the first time and they really need to start adapting quickly. So what advice do you give to those practitioners?

Michael Greiwe (18:12):

Well, you know, providers of medical services always have a hard time with change, right? I think that's like one of the tenants of being a type a personality, the personality that ends up getting into medical practices or, you know, we're very particular. So we don't like to change. That's the first thing to recognize. And, and so there's going to be bumps in the road and they're just going to be hurdles. And I think it's really important to just understand like, Hey, you got to sort of roll with the punches a little bit, understand is not usually too difficult. We just need to kind of figure out what your plan of attack is going to be. Are you going to see tele-health patients in the morning and then see your regular, you know business in the afternoon, if you're completely shut down, how are you going to adapt to that? How are you going to get the word out? Are you going to be able to market this really, really important for you to make sure you kind of figure all that out on paper before just sorta like saying, yeah, I'm going to buy this telehealth cloud from when we get rolling, you know, it's like let's plan an attack and how we're going to be seen and how we're going to be able to see patients. I think that's really, really important.

Karen Litzy (19:12):

Yeah. Makes sense. And now let's talk about the platforms. Let's talk about the platforms that you're involved with and how you got involved. So there's ortho live and spring health live, right? So how are you an orthopedic surgeon with all of the work that surrounds that and then sort of this tech person entrepreneur on the side. So you must have some spectacular time management skills.

Michael Greiwe (19:44):

Well, I've got a very forgiving wife. I know that that's number one. But you know, it is like a it's a wonderful thing for me because I really enjoy doing kind of creative things. Things that might help my patients and telemedicine was one of those things I think really was, was a great thing for my patients ultimately. But for me, telemedicine was a way for my patients to be helped in a way that we couldn't really help them through anything else. And so there wasn't a great solution. So I decided to found ortho live about three years ago, that was 2016. And it was only because I was looking around to try to find a solution for patients and for providers that was really efficient and that worked really smoothly. But what I found was that really didn't exist and it was really hard to find the right solution.

Michael Greiwe (20:32):

And so I decided to create it after speaking with a CEO of a telemedicine company out in the California area, he kind of runs a lot of the video for MD live and some of the other larger companies. And he said, Mike, you know, this is a great idea. You ought to kind of through on your vision to do this for orthopedics. And so I did that with ortho live and it's been really successful and I kind of knew what we needed. We just, you know, we didn't have the efficiency in a way to be able to see patients in a streamlined fashion. So we created that within orthopedics, which I knew very well. And then we kind of branched out and now we're offering services to other specialties and subspecialties as well with spring health live.

Karen Litzy (21:11):

And within these platforms, do you have ways to do objective measurements within these platforms? Cause I know some do some don't so how does this, how does this work let's say from an orthopedic standpoint.

Michael Greiwe (21:27):

Yeah. So I mean, if you want true objective measurements we have to kind of integrate with braces and things like that. So, you know, we're like a smartphone application. And so we do have API APIs that can integrate and take in information like that. It's not something that, you know, orthopedic surgeons really use on a daily basis. I would see that more for physical therapists. So we kind of have the ability to integrate with you know, applications that give you range of motion and actual discrete data. I think that's really important because it does give you some actual feedback on a day to day basis, how a patient's doing. But from an ortho standpoint, we don't really need those, like the discrete data points we just sorta need to see, okay, well, how was that patient performing?

Michael Greiwe (22:09):

Are they having difficulties still, you know, moving their knee, let's see you bend your knee. And if it's not really going as well as we want, we know we need to up the physical therapy, we need some more intensity there. And it's more of a good stall for us. Less on the discrete hard numbers, but with therapy, I feel like it is really important to have that feedback to say on a day to day basis that patient's not doing well, how can we help them? Do we need to intervene sooner? So maybe that's what you're getting at, but, but yeah, we have the ability to kind of feed that information back into our platform.

Karen Litzy (22:39):

Yeah. Yeah. That's cool. Because a lot of times it's, you know, you could say, well, if 180 degrees of shoulder elevation is considered full, it looks like maybe they're at 75% or they're at 50%. So, but it's hard to get those, like you said, very discrete numbers because we can't measure it. Right. So having the ability to kind of integrate applications to be able to do that, I think is it can be really helpful. Although I, yeah, I guess sort of postsurgical when the patient is perhaps limited to X amount of degrees of movement, I think is where that comes in really handy.

Michael Greiwe (23:21):

Right. Right. And we have them sort of stand kind of at the side and like watch for inflection and things like that. So I think we get, you know, to within probably five to 10 degrees, but if you're looking for exact degrees, that's where those programs, which, you know, you can strap like an iPhone to your leg now and like move your knee. And it measures range of motion through like some little track pads and things like that. And there's ways to, to really effectively get that, that motion and understand what's happening with the patient and recovery, which is nice. And so we've allowed the ability to integrate those types of applications to our platform, which is cool.

Karen Litzy (23:56):

Yeah. That's really cool. I was working with some developers based in Israel who have an app for gait. And so you put it in your pocket and what it does is it can tell you the excursion of your hip range of motion from flexion through extension pairing side to side, your stance time steps per minute all sorts of stuff. I think there's up to like seven or eight discrete measurements, which is super cool. So again, in times like this, this is where the technology 10 years ago didn't exist.

Michael Greiwe (24:33):

Yes. A hundred percent.

Karen Litzy (24:36):

Having that now is allowing healthcare professionals to continue to help their patients during this pandemic.

Michael Greiwe (24:46):

No question. I was speaking with a group that has some special socks that like will measure stride length and things like that. So they know when a person may be like, you know, unsteady with their gait when they might be a fall risk which I think is a great, it's a great thing. And so, you know, understanding when patients may need some therapy to try to help with balance is critical. I mean, falls are a multibillion dollar issue in the United States today. And if we kind of cut down on falls, it's a great, great opportunity. And so we're, I think we're leveraging little things like, you know, from a data standpoint to be able to improve population health. I think it's great. Yeah.

Karen Litzy (25:26):

And where do you see telemedicine moving in the future? The pandemics over is everybody just gonna wrap it up and call it quits? Or what, where do you see that moving towards in the future?

Michael Greiwe (25:39):

No, I think telemedicine is here to stay Karen, I think you know, so-called genies out of the bottle, you know, there's a lot of great things that have happened with telemedicine recently. I think it's here to stay. We're gonna end up seeing telemedicine continue to spike. It was on the rise. Even before the pandemic, we were seeing multi millions of patients that were being seen every year. It was doubling every year. And now it's like, I mean, I think it's gone up by 10 X. So there's going to be a lot more telemedicine, I think, in people's future.

Karen Litzy (26:10):

Yeah. And as we were discussing before we came on the air hopefully the providers of insurance will also agree with that and say, we are going to continue paying for these because look at the advantages it's giving look at the money we're saving because of this. Cause like you said, if you can have a telemedicine visit with someone and it prevents a fall, which is a multibillion dollar industry, would you rather pay the $2-300? Whatever it, I don't know how much it is or have that person hospitalized for hundreds of thousands.

Michael Greiwe (26:48):

You're absolutely right. And so if there's any, you know, any of the insurance industry listening is very, very critical that we continue with telemedicine for their patients. And it's so beneficial, not only in protecting them during this time period, you know, we definitely don't want to let them go out of the house or 70 year old patients that are potentially sick and I'll really you know, it's for their safety and it's also for the benefit of the patient. I mean, it's way more convenient for them. And so I think without a doubt, it is so important to make sure that our legislature continues to support telemedicine and telemedicine billing.

Karen Litzy (27:25):

Absolutely fingers crossed fingers crossed that that happened. So I'm with you on that. Alright. Now, before we start to wrap things up, is there anything that we didn't cover or anything that you want the listeners to sort of walk away with from our discussion on telemedicine?

Michael Greiwe (27:43):

Oh, I think the main thing is, is that, you know, there's a lot of great people out there trying to provide health care. And many of them are trying this, you know, as a new you know, thing for them in their practices. And I think supporting them in that is important. I think everybody inside their local community is really trying to do things via telemedicine now and they weren't doing that before. And so being flexible, I think with those providers, I think is important, but I also think that telemedicine is here to stay. It's one of these things where there's so much benefit on both the provider and the patient's end that it'll just continue to be here and be a part of society and medical care going forward.

Karen Litzy (28:20):

Yeah, absolutely. And now I have one question left and it's a question I ask everyone, and that's given where you are now in your life and in your career. What advice would you give to yourself as a fresh medical school graduate?

Michael Greiwe (28:36):

That's a good question. I love this question. I think for me, I was such a you know, a worrier, like I was, I was always worried about, you know, what was I going to be good enough? Was I going to be smart enough? And you know, I always knew that I believed in myself, but I didn't trust myself back in those days enough to know that I was going to be okay. And I think the thing to remember is like, you know, you went into this medical profession for a reason you want to take good care of patients. You got to believe that, you know, you're a hard worker and you're going to continue to do as best you can to take good care of people. And you're not, you know, even a few fail it's okay. I think failure is it's okay to fail. I think that's another thing that I would tell myself to, because I was so worried about failing that I wasn't willing to like branch out and take risks. But I've learned that now. And I think if I could go back, I'd tell myself, don't worry about failure. Just you're gonna be fine. Just keep working hard.

Karen Litzy (29:36):

Great, excellent advice. And now where can people find out more about you more about ortho and spring health live?

Michael Greiwe (29:43):

Great. Yeah. Well, they can actually look at our website. So our website is www.ortholive.com and then www.springhealthlive.com. So for me, I can be reached at mikegreiwe@ortholive.com. That's my email address and I'll be happy to respond.

Karen Litzy (30:08):

Perfect. And just so everyone knows, we'll have all of those links in the show notes under this episode at podcast.healthywealthysmart.com. So Dr. Greiwe, we thank you so much for coming on. And, and like I said, I've spoken about tele-health before, but it was way back when this started. So it's great to get more information out there for people to know that it's not just something that we're doing during the COVID pandemic, but that this is something that can be incorporated into your practice. It can help your business, help your patients. So thank you so much.

Michael Greiwe (30:43):

Oh, thank you, Karen. I was glad to be here. Appreciate it

Karen Litzy (30:45):

Anytime. And everyone. 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 Apple Podcasts!

Aug 24, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Dr. Michael Weinper speaks with guest host Dr. Stephanie Weyrauch about the American Physical Therapy Association's Vision 2020. Passed by the House of Delegates in 2000, Vision 2020 was APTA's plan for the future of physical therapy. In his 2000 Dicus Award speech, Dr. Weinper discussed his predictions of where the profession would be in 2020. Dr. Weinper and Dr. Weyrauch revisit the elements of Vision 2020 and analyze whether our profession has accomplished a vision of the future set twenty years earlier.

In this episode, we discuss:

-How has the physical therapy profession evolved since the drafting of Vision 2020?

-The student loan debt to income ratio

-Advocacy efforts to achieve full direct access in all of the States

-The importance of lifelong learning and evidence-based practice

-And so much more!

 

Resources:

Stephanie Weyrauch Instagram

Stephanie Weyrauch Twitter

Stephanie Weyrauch Facebook

Email: sweyrauchpt@gmail.com

APTA Website

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

 

For more information on Dr. Weinper:

Michael Weinper, PT, DPT, MPH, cofounded the company in 1985 with his partner, Fred Rothenberg, a former executive at Blue Cross of California. A physical therapist with more than 40 years of experience in clinical practice, management consulting, administration, and program development, Weinper is also a principal in Progressive Physical Therapy, a private practice, with four locations in Southern California.

Weinper received a Bachelor of Arts degree in Industrial Psychology and a Bachelor of Science degree in Health Science (physical therapy) from California State University, Northridge. He received a certificate in physical therapy from that institution in conjunction with UCLA Hospitals and Clinics. Weinper later received his Master of Public Health degree (M.P.H.) from UCLA in Health Services Administration and his Doctorate in Physical Therapy from the EIM Institute for Health Professions in Louisville, KY.

Weinper has been active in the American Physical Therapy Association (APTA). He has served as a member of the APTA’s Task Force on Physician Ownership of Physical Therapy Services, as a member of its Committee on Physical Therapy Practice, as the association’s chairperson on its Task Force on Reimbursement, on the Board of Directors for APTA’s California Chapter and national Private Practice Section, and as trustee of the APTA Congressional Action Committee (now known as PT-PAC). Weinper received the prestigious Robert G. Dicus Award from the Private Practice Section of the APTA in 2000, and he received the Charles Harker Policy Maker Award from the APTA Health Policy and Administration Section in 2011.

On behalf of the state of California, Weinper has served as a member of the Physical Therapy Subcommittee of the Division of Industrial Accidents, now known as the Division of Workers’ Compensation. He also has served as an expert to the Medical Board of California, where among his activities he has appeared on behalf of the People in insurance fraud trials. He has provided expert witness testimony on behalf of more than 20 insurance companies.

A former associate professor of health science at California State University, Northridge, Weinper is a frequent presenter for various professional associations including the National Managed Healthcare Conference, the American Medical Care and Review Association, and the APTA. He has authored many articles for both physical therapy and insurance industry publications.

For more information on Stephanie:

Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.

 

Read the full transcript below:

Stephanie Weyrauch (00:00:01):

Hello everyone. And welcome to the healthy, wealthy and smart podcast. I'm your guest host Stephanie Weyrauch and I am interviewing Mike Weinper who's the president and CEO of physical therapy provider network or PTPN as it's better known and also a private practice owner for progressive physical therapy in California. The reason that I wanted to talk to Mike today, as he won the Robert G Dicus award for the private practice section back in 2000, and he has been an instrumental person in practice, leadership, innovation, legislative, and political issues, healthcare reform, and a number of other areas where he's really had the opportunity to champion innovation and leadership. And one of the things that, you know, we know it's 2020, and obviously vision 2020 has something that has happened in the APTA was written back in 2000 and in Mike's Dicus award speech, he talked a little bit about where he thought the profession would be in 2020, in 2000. And so I'm really interested in kind of his take on where we are today. So Mike, welcome to the healthy, wealthy and smart podcast. And tell us a little bit about yourself.

Michael Weinper (00:01:21):

Well, thanks Stephanie, for the very nice introduction and it's a pleasure and an honor to be with you today. At some level, I’m considered by some, to be a dinosaur, having gotten my Dicus ward 20 years ago, and now long in my career, I'm just celebrating my 50th anniversary as a PT. So I hope that some people won't tune out just because of that. Maybe if nothing else, they can see me as a history lesson, any event, I can tell you that back in 1992 the California chapter of APTA now called California PT association created a long range planning task force that I was honored to serve on. And in that task force where a lot of leaders in the profession in California names that were household names, then probably names and most people would not know now, but our plan was to draft a long range vision.

Michael Weinper (00:02:21):

If you will, a crystal ball of what things would look like some 18 years later in 2010, kind of looking back, it's interesting to look at and we created, I believe 18 different points that would be goals if you will, of the association and the primary aspects of that working document, which was called PT 2010 by the California association. I'm sure if you were interested, you could look it up or get a copy of it. Then later became the working document for APTA called PT 2020. And since we are now in 2020, I wish we would have known then what we know now, because things have dramatically changed in many ways, but in other ways they have not. And so I guess I could give you some of the ideas we envisioned back in 1992, if you'd like, and then we can take it from there.

Michael Weinper (00:03:23):

So in that document, we said that PTs would be able to evaluate and diagnose conditions that's true today, perform specialized treatment procedures and work in teams with physical therapists and PT assistants. So all that did come true. Next, the PTs would be able to initiate services subsequent to their own evaluation diagnosis without referral from or diagnosis by another practitioner. And that in 2000 that had not yet been accomplished, but we, now we know we have independence and practice almost every state with regard to our licensure. In most therapists are, would be in independent press configurations with other therapists, maybe who would work in a hospital. In other words, there would be an opportunity to be clinically specialized in it with a board certification, which we now know has really grown quite a bit.

Michael Weinper (00:04:25):

And they would be sought out. These specialists would be sought out by consuming public and third party payers. Not as much. I don't think our profession has reached to the public well enough to get the public, to understand what a board certification really means and what it takes to become a board certified specialist in our profession, but I'm progressing for a moment. Anyway. So then we said that PTs would be able to be involved in the continuum of care from the hospital to the home, to the private practice. In other words, PTs would have hospital-based privileges and they would be able to go there. And then if the patient were home, many of them would be able to then go to the patient's home and treat them there and then follow them up in the office. And so that was another kind of idea we had way back then.

Michael Weinper (00:05:21):

So it would be basically following the patient through the episode of care from beginning to discharge and obviously getting them ambulatory and functional. We also said that this is a good one that PTs would become diagnosticians. And more importantly that we would be at the entry point in healthcare which wasn't the case in 2000, but in now in some places, it is that therapists are in fact these musculoskeletal specialists would be a cause we can do it musculoskeletal evaluation or diagnosis many states now recognize that. And some insurance companies have recognized that we can be an entry point into the system, which I believe going forward, it's going to become much more prominent because of the higher cost of care. And actually Stephanie, the difficulty we all experienced when we try to refer a patient to a specialist, state, an orthopedist or a neurologist to do an evaluation so we can follow the patient.

Michael Weinper (00:06:18):

We find that it can take several weeks for that patient to get in, to see the physician, whereas they can usually get in to see us in a few days. So I think that's something that we will see more of in the future, but back then we had it as a dream, but not a reality. We also said that at that time, that instead of 24 weeks of internship that were experienced by PT graduates back in those years, we thought internships would last one year. Now that I don't think there's a, but we have in fact seen fellowships and other levels of work where therapists are really going into specialization so that they in fact can do things over a year's period of time and then becoming sort of like specialists. So those were sort of the, kind of, I think the basic things that would be of importance today.

Michael Weinper (00:07:15):

We did also, this was a very important one. We identified that in the year 2010 PT would be a doctorate profession. That was what our key points of doctorate and profession. And lo and behold now our entry level is what a DPT, a doctorate. I'm very proud to say that I went back and got my DPT a little over 10 years ago. I talked back in 1982, and I certainly wanted to walk the walk before 2010. So cause that was our benchmark was 2010. So with that in mind I think it's important to realize that we have become doctoral people. In other words, we are now at a level of sophistication with our education and hopefully some research that gives the PT of today a much broader view of a patient, their wellness or their disability, and gives them better tools, which the function do the evaluation or assessment of the patient, and then follow up with treatment compared to how things were back when I graduated in 1969.

Michael Weinper (00:08:31):

So and I found that when I got my DPT that I learned quite a bit. I learned some of the things I learned actually were more on how to think differently than I had thought previously. And I will tell you that some of the things that I learned that were most valuable to me was how other people think so studying with other transitional DPT candidates gave me an opportunity for me because I was the oldest person in my class. Gave me an opportunity to hear people think and how they process, how they analyze and how they come to the decisions they do. And then how do they communicate it? I like to think I'm a good communicator, but oftentimes I get really wrapped up or wound up and, you know, I go off on a tangent and I probably go down the rabbit hole and maybe other people in today's world are much more succinct.

Michael Weinper (00:09:31):

And to the point also I can tell you that I was privileged back in 1975 to get my MPH at UCLA and the school of public health there. And I learned a lot about things that are important today, including epidemiology, which we now know is at the forefront of everybody's thinking and infection control and making for safe environments, which was only very basically touched in my DPT program. But one of the things that I really enjoyed was the differential diagnosis courses I took and the radiological courses I took that gave me a much broader sense for things that I'd studied back previously, or maybe taken some content courses, but went into much more depth and listening to other people discuss those kinds of things. So that's how things were back then. I can tell you also that insurance companies were perceived to be able to give PTs a lot more latitude. And it's only been in recent years that many insurance coverage industry to pay for PT. That's independent of physician referral. We're still working with Medicare on that. You and I know all the snow and I think the day will come that the feds will start to get a little wiser and realize the cost benefit of the PT being an entry point into the system.

Stephanie Weyrauch (00:10:58):

I think that that's a really great overview of kind of what you guys envisioned back in the early nineties and kind of correlating that with vision 2020. So the APTA vision 2020 and a couple elements that made that basically encompassed a lot of what you said. So autonomous physical therapist practice was one of them, direct access, evidence based practice, doctor physical therapy and lifelong education PPS as practitioners of choice and professionalism. So those were when the house of delegates discussed this, those were the main themes that they were looking for. So keeping those themes in mind, let's maybe start by talking about the doctorate of physical therapy. I mean, that was something that you were obviously very proud of. You will talk the talk, you walk the walk. So what do you think? Well, studies have been shown the DPT student debt now varies between 85,000 and 150,000. Okay. Do you think based off of what we're seeing today, as far as student debt, do you think that today's DPT is a good return on investment? And do you think that the salary for the physical therapist has kept up with the increases in training and inflation?

Michael Weinper (00:12:14):

Well, I'm very happy to hear you raised this question because it's a question that I not only think about a lot. I talked about a lot with my colleagues and I also talked with students who are becoming PTs and people have gone into residencies for a year post-doctoral now for purposes of gaining a better outlook on things. And I must tell you that when we gave thought to the idea of PT being a doctoral profession, never in our wildest dreams, did we think about the cost benefit aspects of it as it relates to educational costs back then costs were not inexpensive. You should teach part time at USC and Cal state university Northridge. And I remember students used to complain about the cost of education back then, but it was nothing as compared to today. So to get to your point, I am sad to say that we have not grown our income levels for PT to the level that they should be given the doctoral training that we received.

Michael Weinper (00:13:29):

And the depth that usually goes with that, unless you've got some kind of a rich uncle or a greatness scholarship, having said that most PTs coming out with a lot of debt, and then they find themselves in jobs that they don't want to do. Let me just elaborate a little bit on that. PTs in private practice is considered by many to be the desired venue in which to work because patients are coming to you. You have all kinds of equipment and resources and hopefully a nice facility to work in. And the patients for all intents and purposes are ambulatory or said differently. You're not going to be ambulating a patient in a hospital hallway and have something happen to your shoe. If you can get my drift in any event, it seems that most PTs that come out of school today are struggling with where they want to work versus where they have to work and where they have to often work or those places that pay more because they're less desirable.

Michael Weinper (00:14:35):

So as the desirability quotient increases, the unfortunately the salary decreases because of in part supply and demand. And also to a greater extent because insurance companies are not reimbursing PTs in private setting, like they are in the hospital, for example. So if I go to work in the hospital, I can make a lot more right out of school than if I go to work for an independent therapist in the same community. On the same side, I can go to work for a home health agency, not have this desirable of a work environment. Have you seen changes from patient to patient, but make better money, but then again, have other costs of doing business. And I think at the end of the day, those who do home health, and I don't mean to criticize those of you who do, but if you look at your cost of doing business and take that away from your income, you find that your true income is much less than you thought it was going to be.

Michael Weinper (00:15:30):

Whether it's wear and tear on your car, gasoline insurance, you have to carry on your own, whatever it may be, equipment you might have to buy and so on. So it seems to me that the desirability of where you'd like to work and the pay ratio is a universally, but proportionate with that in mind, it's a function of insurance companies, and this is where I really go down a rabbit hole. And that is why are PTs and private practice paid less? And the answer is because PTs in private practice accept less, they have an, I am very secure, experienced on this. Having started PTPN 35 years ago, a managed care company for PTs in private practice. And we have always advocated for higher reimbursement. And in fact, we Protestant have been successful in getting a higher reimbursement for PT and practices that are in our organization.

Michael Weinper (00:16:30):

Then PTs were in the community who are not in our organization. However, because PTs are willing to accept whatever insurance company pays. In other words, they don't want to lose business. They accept fees. They're much lower than they should. And that has driven down the value of PT in the mind of the insurer and that's led to lower salaries. And so to get to the end of this thought, PTs coming out of school, don't get proportion of the kind of income they should with a doctorate. And let's contrast that for just a moment to a PA, a PA has less training than we do. They will usually get a master's degree. They work in a physician's office, but the way that they can bill under the physician's license gives them much better reimbursement. It makes them more valuable to the physician and therefore their income is oftentimes much greater even out of school, you know, apples to apples. Then we get as a PT out of school.

Stephanie Weyrauch (00:17:31):

Yeah. I think you make a lot of really great points there. I mean, the doctor, the DPT was obviously great as far as, you know, gaining direct access, being more autonomous, but you know, the cost of education has obviously sky rocketing it. So based on, you know, your ideas, what do you think that the private practice section can do to help guide new graduates through the uncertainties of student debt?

Michael Weinper (00:17:57):

Wow. there's a lot of things that come to mind. First of all, we, as a profession have to be better educated to know when to say, no, that's a K N O W and N O in the same sentence. Know when to say no. In other words, if insurance companies are offering rates that are below what it costs us to business or below what we think we should be reimbursed, we need to learn to say no to them and walk away from that business. Maybe it's better to see fewer patients and make more money and be able to compensate our staff better than to take every insurance contract that comes down the road that pays less than it costs you to run your business. Those in private practice who might be listening to this podcast are shaking their heads affirmatively I'm sure because they get it.

Michael Weinper (00:18:47):

Those who are not in private practice probably don't understand what I just said. I don't need that it was criticism, but I think that at the educational level, during your basic education it's therapists need to learn more about socioeconomics as it relates to our profession. Supply demand economics certainly, and cost of doing business are key points. In years past for APTA taught courses on economics made easy for PTs because many of us come out of school even today without very much in the way of business knowledge or knowing much about economics. And once you learn more about that, things become much clearer and it makes it easier to make decisions that are in the best interest of our profession. So I think the PPS can, it does from time to time try its best to educate us on how to be better managers, if you will.

Michael Weinper (00:19:51):

And that includes things like the economics. But I think we, as a profession need to be top of mind with economics and learn how to advocate more as a group, as a profession, not just individuals because insurance companies will not look, listen to individuals. They will disappear to larger groups. To that point, larger groups get better reimbursement. So that point hospitals being really affiliated with one another or powerful entity as an association get better reimbursement. So I think that getting PTs together to understand I know APTA has advocated for many years better reimbursement. I worked with APTA in different retreats for payers. So there was a way to bring together a summit, a payer summit, they call it where they bring together many insurance companies. Actually I did one in Connecticut where you are cause that's a sort of a hodgepodge or location of many insurance companies.

Michael Weinper (00:20:55):

So we had several speakers who knew a lot about reimbursement, including Helene furan, a dear friend of mine and others who would speak to insurers about what is PT? What does a PT do? How do we evaluate patients? What does it cost to run a business to give these payers a better understanding, but remind you be reminded. These were not big association meetings. We brought peers together. So we might have 25 or 30 people in a room, some of whom which were larger decision makers than others, but when it came right down to it, we didn't have the ability to follow up with them and push them down the road to where they would be accepting of what we do. So we today, the cost benefit of coming to PT, I'm sad to say is very disappointing. It takes you a long time to work off your debt. Hopefully in the future, our government will see fit that people in professions like ours need to have better forgiveness of their debt in return for doing public service for the public we serve.

Stephanie Weyrauch (00:22:06):

Yeah. I think that you make a great point about the fact that we as private practitioners need to walk away from some of these more measly reimbursement contracts. And you know, one of the things that we hear a lot with incoming graduates is that there are a lot of private practices that have very high volume. And one of the reasons that they have low job satisfaction is because they're seeing so many patients. So I think that you make a really great point in saying that, you know, maybe it's better that we take fewer insurance companies, see fewer patients, but get paid more because now you're eliminating that burnout and that poor job satisfaction and allowing that new professional, or, you know, even if it's a veteran physical therapist, make the money that they actually deserve with the training that they have.

Michael Weinper (00:22:58):

Exactly right. And that's why we need to really advocate politically. And that's why the PT PAC is a very important thing to be involved with because we, as a profession can be heard through advocacy many, many years ago, I was one of the early trustees of what we used to call APTCAC American physical therapy, congressional action committee, which now PTPAC. And I always used to say, and I consider you to say today, if every PT would just give $25 to political action, how much more strength we could have because we live in a world where legislators listen to those who support them, support them with votes and support them financially so they can get folks important that we do get to legislators.

Michael Weinper (00:23:54):

We have a lot of people in Congress who are friends and have been our friends for many years, but we need more. And when things come up like budgetary cuts of Medicare, where they talk about an 8% reduction in Medicare reimbursement coming in next January, which I hope goes away. I think it will go away. I pray it would go away. But if it doesn't, I mean, think about that. You're getting a reduction in your reimbursement, which is not that great today. And they're going to reduce it even more. What's that gonna do to salaries? It's not going to help the PTs in private practice. And this is something that I think many people who are not in private practice, the students podcast may or may not, may not believe, but it has to be true.

Michael Weinper (00:24:40):

I've spoken to hundreds of PTs in private practice over the years. And I think many people would be appalled or shocked at least to realize that many people who own private practices do not make a lot of money. I spoke to a PT just last week here in Southern California, who was impacted by the rallies that were going on with black lives matter. And unfortunately, during that time, there was some looting and pillage went on by some bad actors, if you will, not people who were affiliated with the rallies themselves, but people who took advantage of that and broke into places and solving fuel and burn places. We all heard about that here in Southern California was one of those places in other parts of the country, the same thing that held true, that PT, when I talked to them and was trying to do what I could do to help them rebuild their practice. Cause your practice had been broken into and everything taken.

Michael Weinper (00:25:42):

I asked this individual if they would be willing to share with me how much they make per year. This person said to me, under $80,000

Michael Weinper (00:25:58):

And I pause for a second. And since not only for the problems they were experiencing because of the looting and stuffed up to their office, but for the fact that even under good times, they weren't making a lot of money and they were working hard. They're working 10, 12 hours a day, sometimes on weekends. That is because they were in a situation where their cost of doing business is almost as high as what they would receive in payment.

Michael Weinper (00:26:24):

And we know that owners of businesses get what's ever left over after paying all the other bills, including salaries and benefits and rent and all the other things that come to mind. And it's not uncommon to find people who own their own practices, who do not make a lot of money and you have to take a lot of risks. So it's one of these things that we need Congress to better understand that it's important to support physical therapy as a profession, because we are a very valid and important aspect of the health care continuum that if we aren't there the cost of care will go up because rehabilitation, I believe, and I'm sure you believe decreases overall cost of care. So getting Congress to vote that in and to budget more money for us and Medicare, and then hopefully getting insurance companies to understand that not every therapist is going to do things on the low ball side of it, but really are going to hold out for a higher compensation that they're entitled to.

Michael Weinper (00:27:36):

They're going to be more inclined more and as a parent more it's my idea that therapists should be able to own practices to be able to pay their staff more. I've always said, Stephanie, that I wish I could pay every therapist that works in our practice, $150,000. I think they're easily worth it, but it's a function of what we get paid. And I can tell you that, you know, my own practice, progressive PT my income hasn't gone up in over 10 years and I don't make, you know, I don't make a lot of money in it, but it's because I get what's left over after we pay everybody. I feel that we've got to give our employees reasonable compensation for what they do. And we don't use a lot of extenders. We don't do a lot of things that are in the realm of I'm doing it on the cheap side as many people do.

Stephanie Weyrauch (00:28:31):

Yeah. I think that your points about advocacy are really important because I know APTA has been working on that 8% cut. You haven't written to your Congressman. I definitely encourage those of you listening to this podcast today to log onto APTA’s website, whether you're a member or not and write a letter to your Congressman, it really only takes three seconds. Additionally, there has also been a legislation that has gone forward with trying to increase the loan forgiveness for DPT students. APTA is always trying to get us to have pay, be paid more so that advocacy piece is really important. So that kind of brings me into the next pillar or the next element of vision 2020 and that's full direct access. So we do have at the some form of direct access in all 50 States right now, however, there are three States where the direct access is extremely limited, where you basically can only do a wellness evaluation without a doctor's referral. And then there are about 27 States where you have direct access with basically limitations or rules attached to it. And a lot of those have to do with say diagnosis or with different interventions like dry needling or electrical stimulation. Those types of things. So kind of along that route, how can PPS ensure that we get full direct access in each state? What are some things that the association can do and that physical therapists can do?

Michael Weinper (00:30:04):

That's a wonderful question. And I think the answer is create stronger advocates in each state because what you're talking now is not about federal legislation, but state legislation. In other words, each licensing act is governed by the state legislature. So having a good group of PTs who can rally and lobby, if you will, or have a lobbyist, if there is a big enough state to meet with members of the state legislature to express how important it is in an effort to control costs in healthcare, to give therapists more clinical rights and abilities, that's where it starts. Once you get that, then you can get insurance companies to start to buy in because they realize that is legal in that given state. I have seen this happen throughout my career that has been slow to come. We've been shooting for direct access. And at the same time also trying to eliminate the need for there to be physician intervention in certain musculoskeletal situations where we now are trained as diagnosticians to be able to evaluate and treat these things.

Michael Weinper (00:31:17):

It's my hope in the future that we get the opportunity from a licensure standpoint to order x-rays, to order lab work and things like that, to where we can have more information at our fingertips, but then to have to refer out. But only where it's appropriate, where we're adequately trained to do that. You have to teach legislators what is PT and what is the benefits of PT and what are the cost savings that insurance companies, the public. And we all save by giving the opportunity for patients to be strong entry points into the healthcare field. It's certainly fond for us to evaluate patient. And in some States you can do, like you said, dry needling. I live in a state, California doesn't even allow dry needling. I have people in my practice who teach dry needling to therapists around the company because he used to do that where they worked in other States, very frustrating for them, extremely frustrating for me, but it takes legislation.

Michael Weinper (00:32:25):

It takes talks. It takes contributions to your local state PAC, and most of them have it now. And to be involved in APTA, I think is key that so many PTs I call nine to fivers. They come in and they do their nine to five and go home and they forget about their profession. People like you and others who are dedicated to making this a better profession for PTs of the future, not to mention the public that receives our care are the ones that make things happen. And so being more involved in our field through volunteerism obviously is key, I think, to change and too many of us look to the other guy to do it, whether it's writing a letter to your congressmen, or there's going to meeting with a state legislator, whether it's inviting your local state representatives into your practices, see who you are and what you do.

Michael Weinper (00:33:27):

All of the things bode well for growing our practice. And too few of us, unfortunately do that. We don't realize that it starts fortunately with regulations and what we can do and how we can do it. So the quest, if you will, or request, I should say would be that we as a profession, get more involved in our association because the association is the focal point for getting the information to legislators. It's our association that has the greatest credibility. And I can tell you that one of the reasons I went back and got my DPT was that I saw that when I would testify on a bill in Sacramento here, there would be people with a doctorate, not necessarily in our field, but just doctorates, so would speak against what we were doing it. And I would get up there and I would have 40 years of experience, and we have a master of public health degree then on my doctorate.

Michael Weinper (00:34:26):

And I were always, and I would like to think I had good presentation and good preparation and knew the facts. And yet it was those who had doctorates that were, or had the title doctor who were paid more attention to now, we as PTs have that title. And now we're sort of in a level playing field with other professions, from the term being entitled a doctor. And with that credibility, we need now to take more action, we need to spend more time trying to create change in my Dicus talk back in 2000, I said that people were afraid of change and it's true. And even today they're afraid of change and we all like the status quo, but the reality is we need as a profession to embrace change because with change comes progress and we need to progress as a field of profession. If you think about things it takes a village if say and certainly in our professional, it's no different, we have to be part of that village. We can't just be part of the tribe. We need to be active leaders of our village.

Stephanie Weyrauch (00:35:43):

Yeah. And I think, you know, if you look back at where we were with direct access 20 years ago, I mean, obviously we're in a much better state than where we were, but some of the resources that I know PPS has for people with their fighting, the direct access is they do offer grants to state associations if they're doing any type of lobbying. So if you haven't applied to one of those, it's a pretty hefty amount of money. It's like five or $10,000, which that goes a long way when you're paying the lobbyists to do the work for you. You know, they also have a key contacts program and they offer resources for practitioners that if you do invite a legislature in a legislator into your practice, or you are trying to advocate for a bill, like they provide all that information for you on their website and on the APTA action app.

Stephanie Weyrauch (00:36:29):

So, I mean, PPS does have resources out there that we can utilize to try to continue in our fight with direct access. And I mean, yes, we're in a much better place than where we were 20 years ago, but like you said, change takes time. And as a, you know, as a young professional, I definitely would love to see change happen even faster. So you know, the more people we can get together and build that village, the faster it's going to happen in your Dicus speech, you also talked about how you envisioned that physical therapist will be evaluating and diagnosing conditions, performing specialized treatment procedures and working with the PTA team. And then you also envision that there would be no referral needed by another practitioner. And I know you've kind of covered this a little bit, but give us an idea of where we are, where we're at with this prediction and what you think the future holds. Because as you know, a lot of these direct access bills that we have still restrict our ability to quote unquote diagnose conditions or even perform specific procedures. So kind of give us an idea of where we are compared to 2000 and where you see us going in the future.

Michael Weinper (00:37:41):

Well we are obviously light years ahead of where we were in 2000, just by hearing what you described to helping things in what I predicted. And I think from the standpoint of going forward, we need to be cognizant of the fact that we can change things if we put some effort to, and in other words, so many therapists don't do things because I think I hear people say, Oh, it doesn't make a difference, or they'll say somebody else will do it. And the truth is that we all need to be more involved. And I'm one of those key contacts and have been for many, many years. I can only tell you that how rewarding it is to invite a legislator or even somebody who works in their office, into your office, into your practice, to visit with you, see what you do, talk to you, the things that are your barriers to growth and barriers to doing for patients, what we should be doing and should have been doing for many years.

Michael Weinper (00:38:46):

And I think it's more important to understand what you can't do versus what you can do. And you only learn that by going to stage or talking to people in other States who have full privileges to do those things and have that true autonomy. So I think that by attending association meetings, for example, PPS is a great example or CSM when it comes back. And, and I say this, not just going to the meetings, but talking to people, not just your friends, but talking to people you don't know, but from other States where you might know there's a lot more progress, ask them what they did and how they did it, or talk to the leadership in those States, in those state associations and ask them, how did they accomplish what they accomplished? Because it takes a lot of work and there's a lot of resistance by other professions, physicians be it chiropractors, osteopaths, even dentists from time to time resist, having us grow to where we should grow.

Michael Weinper (00:39:53):

And the key again is educating the public, what we do. So when you're treating them, let them know what you can do, what you can't do all because of the laws, even though you might be trained to do these things. And sometimes the best advocacy doesn't come from ourselves. It comes from the people we serve our patients. So getting people to write letters to their members of the legislature is very important. But I think getting more people to stand up, write letters, attend hearings in your state Capitol become more involved, become more aware of the benefits you can create, not only for the professional, but certainly for yourselves as well. And that's one of the reasons that I've been very involved in APTA throughout my career was I felt that I had the ability to change things if I would only work at it.

Michael Weinper (00:40:47):

And I was very blessed. You haven't brought it up, but Bob Dicus for who the Dicus award is named obviously was one of my mentors. When I was a student, I got to meet Bob. He was already very deep in his ALS disease in Georgia. He was fully wheelchair bound and tied to a respirator, but that man had so much knowledge. He was one of the first private practitioners. And one should only go to the PPS website and learn more about Bob and what a great man he was and what a visionary he was for our profession. As a matter of fact, just to digress for a moment, he is the one who created the ALS society nationally. He was the inventor of that. He had a second professional. He was in, he was a motion picture producer in his later years when he couldn’t be a PT, he went into motion pictures.

Michael Weinper (00:41:48):

A lot of them had to do with rehabilitation and things that we do. They weren't necessarily featured like Sims, but he got involved in that kind of communication. So it always goes to the fact that I think some of the best PTs are the ones who are best able to communicate with their patients, with the public, with our legislator. Sure. Those are the PTs who really do the best, because if you're good with your patients in communicating, you're able to motivate them to do the right thing. Right. And communication is something that we need to study more perhaps in school. I teach a lecture on communicating with different generations because as I become part of the older generation and looking at the younger people, I see how you and others in your generation and younger generations communicate with one another as much different than what my experience is.

Michael Weinper (00:42:43):

I grew up with our computers. I remember the very first calculators. We were not what I was going through school in high school. We used an Abacus and a slide rule. And then going forward, we used a Texas instruments brand calculator, which was very expensive and very elementary looking back at it. That's an idea of technology when technology and communication are, I think are very interwoven. In other words, as technology increases, communication becomes dependent on that technology. And we tend to communicate less with one another or said differently. I can see my son-in-law and daughter at our house, sit on the couch, waiting for dinner, remake, and what are they doing? They're texting. And I said, who are you texting to talk to them? Wait, what answer? Just speaking with one another. And that's just the world we live in. And then all the little acronyms, all these simple things that you know are, are part of the lexicon today.

Michael Weinper (00:43:56):

Today's younger people, older people don't necessarily know. And when treating an older patient, it's key that you speak to them in a communication form that they're going to understand. And don't assume they understand. I mean, you're saying just because you're saying it, and the same is true for older therapists like myself, talking to younger people, you have to motivate them in a different way. Young people want it. Now they want things quickly. They're used to getting information quickly. You go with something up on Google and get an instant answer on something. Whereas back in my day an encyclopedia sales person used to knock on our door, trying to sell my family a big set of 30 books of encyclopedia. We were tell much to us what we needed for today's knowledge. And I don't think those people around anymore. If at all. If you wanted an encyclopedia, you've got it.

Michael Weinper (00:44:50):

Just look up something in Google or another search engine, and you've got instant. You got too many answers. Sometimes you get different answers for the same question, but with all that in mind, communication is key to success. And we as service need to communicate better, not only with our patients with one another, with our legislators and with the public in general, and to that point, having better PR public wise. And I think APTA is trying to do that. Now that we're into our hundredth year, starting there as your celebration or Centennial celebration. I think you're going to see a lot more information going out to the public, through electronic media and social media, to where we gain a higher visibility with the public.

Michael Weinper (00:45:38):

I had the TV on the other night, I was watching a game show and one of the contestants was a PT. And he was a young PTA until that. And he didn't want a whole bunch of them. I think it was, I believe the show was a wheel of fortune actually, which I don't watch too often, but it was on. And I've heard the word physical therapist. It's just like you, whatever you heard that word somewhere. Even as sitting in a restaurant, you hear somebody talking about their PT, your ears perk up and you sort of start to eavesdrop a bit. And we as a profession don't hear that word in the public as much as we hear about doctors or other things. So I think the public needs a better awareness of who we are and feel comfortable talking to us. And we need to feel comfortable talking to them and educating more about who we are for. They haven't needed to see us.

Stephanie Weyrauch (00:46:26):

I think you make some really good points about the communication aspect and that kind of leads into the next element of vision 2020, which is us being practitioners of choice. So in kind of going off of that with communication, it's too bad Bob Dicus, isn't around anymore to make the next hit healthcare drama on physical therapists. I mean, how many physical therapists and healthcare dramas do you see walking patients or stretching patients? You know, it's never really, they're never main characters in, you know, like Chicago med or Grey’s, you know.

Michael Weinper (00:47:05):

Anytime I see a PT portrayed in these situations. I cringe because first of all, they're wearing, and I hate to say this cause I'm going to probably, I'm going to take an issue with some of you they're wearing scrubs. I don't think I don't scrubs when I grew up were for people working in surgery. Now everybody wears scrubs. So you go to the grocery store. People were in scrubs. They, I think people not even in healthcare wear scrubs sometimes, but I think we should look more professional. We should be more professional and the public will respect us better if we act more professional. And so there are some times PTs who are brought in on dramas to be a technical advisor. I have been in that position before twice, and I have talked to directors and producers about what they need to show.

Michael Weinper (00:48:05):

And I can only tell you that what you tell them to do and what they end up doing sometimes is different because maybe they don't have the right equipment or the character. They thought they already lined up costumes for their characters. It becomes very frustrating, but getting in on the front end and getting the public to understand who we are, hopefully through drama and maybe through, you know, like I say, public service announcements or ads on TV where we're portrayed better or having the opportunity. Many of you are in smaller cities and towns, your local newspapers and television are hungry for local news. And you may be doing something you don't need to think second thought about, but it's newsworthy. Maybe you just purchased a very important piece of equipment to help with ambulation or suspension or something technical electronically to create new opportunities to treat patients your local TV stations would love to demonstrate, come to your clinic, film you doing that and have it as a segment on their TV show.

Michael Weinper (00:49:21):

And many of us don't even think about that. So and I, again, even in Los Angeles market, I've had the opportunity to do that a couple of times. And it can be a little bit overwhelming, a little bit scary, but you know, something at the end of the day, you feel really good about it and how you come across is much better than you perceived. You are going to come across when you're getting ready to do it. So don't be shy, but reach out to your local media and try to get them interested in what you do, because what you do, what I do is very newsworthy and very important for the public.

Stephanie Weyrauch (00:49:52):

Yeah. And you know, obviously people are following what the media says and listening to the media. So, I mean, the media is, has been a very powerful force that you can utilize to spread the gospel of physical therapy so that we can become the providers, the practitioners of choice, for the musculoskeletal system. And so the people actually know that PT means physical therapist and not like personal trainer or part time, people actually know what it means in your speech. You also stated that PTs would be recognized by payers as diagnosticians an entry point into the healthcare system. And I know you've talked, you you've touched on this a little bit, but how do payers recognize physical therapists and how do today's payers recognize us compared to back in 2000? Where are we at with that?

Michael Weinper (00:50:43):

Well, back in 2000, and even in day sense, payers felt we needed to be treating only under a physician's referral. If you looked at insurance policies that you might have, or if you spoke with payers, they would say that PT was a covered service when provided or the auspices of a physician referral or diagnosis today. Many of those policies from the same payers do not have that language. So because of the direct access laws and because of therapists and given States talking to their insurance companies, the payers they've educated them to where certain payers are starting to realize the benefits of PT first. And let's just take substance abuse and chronic pain. We know as musculoskeletal experts, there are lots of things that we can do for the patient to avoid surgery, to avoid downstream costs like expensive imaging that may be unnecessary. We can certainly get the patients treated properly and get them in a mindset to where pain is not top of their mind. I have a book sitting right behind me on my bookshelf. It's called explain pain. Are you familiar with this book?

Stephanie Weyrauch (00:52:13):

Oh yeah, that's a very familiar book.

Michael Weinper (00:52:16):

Okay. And this was a very good book for people to read. It's the authors are David Butler and Lorimer Moseley, and they're down in Australia, but they talk about dealing with the mental side of pain, the cognitive side of pain, if you will, and how to best creature patients in deemphasize of pain and emphasize wellness or health. And we need to do more of that as practitioners. And as we can educate our insurance companies, that by sending the patient to PT for four or five, six visits, we can avoid surgery, many cases, what is a cost benefit to the insurance company? Their insurance companies listen to money. And I know this from my experience for many years of working with many of them speak with probably too many insurance companies to not only remember, but to count. And they are driven by dollars and they do not put enough emphasis on times in their underwriting to allow PTs to do the things we do.

Stephanie Weyrauch (00:53:26):

Yeah.

Michael Weinper (00:53:28):

Shortsighted because they ended up then forcing patients to go to a physician first, wait, several days or weeks to see the physician where the patients only getting more deconditioned. And rather than just seeing us first, and we have the opportunity and the knowledge on doing things that get the patient out of the problem or fixing the problem, if you will, from a nonsurgical standpoint. So insurance companies in some cases have become much more enlightened and other cases are still in the dark ages. And those who allow us to treat without referral and pay us for what we're worth are the more enlightened ones, some insurance companies that I've dealt with now in recent years are paying for outcomes. There's concept of paper for pay for performance or P for P. I like to call P fro. It's really not what you do, the process of what you do, but really the outcome that you get.

Michael Weinper (00:54:27):

So if you can get a great outcome with fewer visits, then insurance company should be willing to pay you more because you reduce their costs. And, not only of what you did in terms of your crew cough, but in terms of what would otherwise cost them to treat the patient going forward. So I like to pay to pay for outcomes Peterborough, and that's why we, as a profession, need to do more in the way of outcome measurement, whatever tool we use and be able to communicate to the payment payer community, the benefits of what I do. So I'm going to go back now to the mid seventies again, when I got my master's degree we learned even back then that the definition of quality in healthcare was composed of three things. And the author of that was a fellow who's no longer with us.

Michael Weinper (00:55:22):

His name was Avitas Donabedin. He was a physician. He was very involved with the new England journal of medicine, D O N A B E D I N, if you want to look it up and Donabedinn even back then said that quality health healthcare was three things structure, which is where you do it and what you use in terms of equipment process, what you do okay. And outcome, or the results. So we all have been able to measure it structure, and we were able to mission measure the process where you, but not enough of us over my career have been able to truly prove that what they did was a benefit. And I think that that's one of those things that we have to focus more on proving the benefit of PT two outcomes or said differently because of what we do, patients get better quicker.

Stephanie Weyrauch (00:56:16):

And that leads us really nicely into the next element of vision 2020, and that's evidence based practice. So obviously APTA has done a lot over the years to try to improve how we're measuring outcomes. So you have the outcomes registry CoStar was created. If you look at how much the literature has been put out for, if you search, if you search up physical therapy, even in Google, it's, you know, an exponential growth since even 2000 and even the larger growth. If you think about it from even the 1970s, when outcomes were first described. So, I mean, this is something that, you know, we've been working on for a long time. I think that obviously it's come a long ways, but we still have confirmation bias in our literature. We still have group practice that people are practicing. We have treatment fads that really don't have a lot of evidence behind them. And we have practice variation that continues to affect our outcomes and affect our profession. How can PPS help offset this? How can we continue to go forward to mitigate some of these things that are occurring?

Michael Weinper (00:57:24):

Well, that's a $64 question, as we used to say my hero. I think it's important that we need to, you talked earlier about one of the goals of PT, 2020 is lifelong learning. And I see too many people in our profession who don't come to meetings of the profession, whether it's a local meeting in your area, whether it's a state conference whether it's CSM or PPS meetings, too many of our colleagues never go, or maybe they went as a student cause their school paid for them or somehow or another they're were to go. And they never ever go. If you think about people, you went to school with Stephanie, you never see them again. And you wonder, how are they getting their education? One of the things that has occurred a dream the last 15 years I would say is the requirement by States that each PT in order to continue, their licensure must have continuing education, a certain amount.

Michael Weinper (00:58:35):

And it varies state by state, as we know, and what things have to be parts of that, continuing education, again, vary by state by state, but at least we're being forced now as a profession to continue our learning. Having said that, and having taught in different venues in different ways. I can tell you, there are people who are serious learners, and there are people who we call lazy learners. The lazy learners are those who will buy the cheap level CEU kind of stuff, and do a quick read on something and take a test and not really spend the time to investigate what was being offered. And maybe some of the quality of that they're learning is really not up to date either. Versus those of us who will go to con ed meetings, we'll do things online. Now there's a lot of opportunity. PBS shows a lot of things out ABQ has a lot of things.

Michael Weinper (00:59:35):

I'm a member of the orthopedic session section and the oncology section. They have lots of stuff going on that, yeah, there's too much of it. There's just like there's like education overload. So you have to be selective, but do choose things that I think will be beneficial to you. And that are evidence-based. So it brings back to the evidence based part because too often I've heard people get up at meetings and start to talk about things. And then when challenged on what's the word, what's the basis of your comments? They sort of stammered. And they said they gave answers that weren't really appropriate. So we do need more focus on, on lifelong, which we’re mandated to do, but some people take the easy way out. You know, people, we all have people we know who will take the high road and others who take the low road and the low road may be the easier road that may not be the get to the right end.

Michael Weinper (01:00:29):

So we want to challenge ourselves to learn more each day. And I can tell you that when I went back and got my DPT, I thought it would be fairly easy. And some of the things that I was exposed to, I'd already learned in my master's level, but I can tell you a lot of things that I learned were new concepts that I had never even thought about. And that goes to the idea of this lifelong learning and evidence based practice you learn, most of you learned in school all about evidence-based theory and practice, and some of you embraced it very well and other views sort of gone a different path. So I would say, take a step back and look at the research that's coming out. There's all kinds of journals. And that's another thing that I have to digress on a moment.

Michael Weinper (01:01:17):

And that is, here's a question for each of you, how many journals or publications that are healthcare oriented, do you read or subscribed to, if you say only PT, then I think you're making a big mistake because there's so much literature and so many things that are appropriate for what we do in our field. And to validate what we do in other journals and research is being done that we miss the boat by not looking at it at other professional journals or other modes of information, or even attending meetings for physicians and so on. I used to specialize in the treatment of hand injuries. And so I would go to the society for hand search and they actually had a PT sub, a PTO to see subset of that that my friend, dr. Susan Mike Clovis, was very involved in and she got me involved and I would listen to physicians.

Michael Weinper (01:02:18):

We collegial meetings where PTs and physicians would interact to try and come up with the best ideas. And many of us don't really have any contact with physicians, except when we're talking to them in the halls of the hospital or when we're going out to market them, or we're trying to take lunch to them. We don't talk really about concepts and about theory. And what do you base this upon? And what can we do to learn more about the benefits of what we do? And that gets us to the idea of each of us having the challenge to do some research, research is fascinating. It doesn't pay a lot, but you can still do research in your clinic. You can be parts of research projects. If you just look for them, is they're out there to take advantage of. And if you do that, it opens your eyes so much more.

Stephanie Weyrauch (01:03:09):

And I think a lot of the things that you've touched on kind of goes with the last element of vision 2020 and that's professionalism. So when the house of delegates originally defined what professionalism means in vision 2020, it's that we as physical therapists and physical therapist assistants are consistently demonstrating core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability by working with other professionals to optimize health and wellness in individuals and in communities. So obviously one of the bigger focus is of APTA has been this optimizing society or optimizing movement to impact society. And we've been kind of taking more of a population health kind of perspective, trying to get out of the silo, physical therapy and move more into the interdisciplinary healthcare, healthcare, professional realm. Where would you say we are? As far as our professionalism goes in 2020, compared to where we were in 2000?

Michael Weinper (01:04:15):

Oh boy, I think many of us have because of our increased education, gotten more credibility with the medical profession. They tend to listen to us more rather than just seeing us as a technical entity or a technician versus a professional. Although I can tell you still today, physicians oftentimes don't see the benefit that we do even orthopedist. And we have come a long way in some with so many physicians, but we've missed the boat with others. I think it's critical than medical stuff, schools, especially if you're doing an orthopedic residency, that's a resident spend time with a PT. I was in a well known physician, internationally known physicians office recently with my wife who, when she had her shoulder surgery. And he has no to fellows at all times. And occasionally a PT will visit and come in and, and be there not to get paid, but just to talk and work with the physicians, educate the physicians and the younger ones, the fellows who are going to be out there real soon in their own practice.

Michael Weinper (01:05:34):

We need to do a better job of educating physicians. I said that a little bit earlier, but I really mean it. We can do it when they're in school, when they're doing their fellowships, we can invite them into our practices. We can go to doctor's offices and shadow them much more than we do. We can go into surgery with physicians and talk to them while they're there doing their procedure, learning why they're doing their procedure. And sometimes a light bulb will go on in your head say, Oh, I get that. And that's, I think there's something I could do a little bit differently with like, with your patients when I'm treating them by seeing what you're doing surgically and listening to what your concepts are. So I think there's a lot more collegial realism of that goes to being a professional. And to that point, if you don't see yourself as a professional others, aren't going to see you as fun and too many of us lose track of the fact that we are in it.

Michael Weinper (01:06:27):

When you say it's a profession, a profession requires one of the key points of any profession is that you learn, you keep current and you give back to society. And giving back to society means more than just treating people. It means educating the population, doing things from a wellness standpoint or avoidance of injury. I guess going back to my public health days where one of the key things is getting people not to have to see you clinically as a post op or whatever, but helping people to avoid surgery and do things the proper way. Ergonomics for example, is a good, good use of our skills and what we've learned as I sit up in my chair properly. And we doing things that people just don't think about. And when we break away from just being the PT, treating person and branch out to media with other professions, talking to them about what are their challenges, what can we do to help though, or thinking about things we can do to help them communicating better in collegially at different levels. Then we go a long way towards not only building those relationships, but most importantly, helping the patients we serve. So it's one thing to say your profession. That's another thing to give back to society and find different ways to give back

Stephanie Weyrauch (01:07:55):

What, you know, from this conversation. Obviously we've come a long way since 2000, we've achieved many things that vision 2020 set out to achieve, but we still have a lot that we yet need to achieve. So kind of on that note, Mike, you know, what is a clinical Pearl that you can kind of leave all of us with? What is some advice you could give a young graduate or somebody new in the profession that maybe you wish you would've known when you were coming out of school?

Michael Weinper (01:08:29):

Oh, that that's an easy question to answer because I oftentimes get asked by younger PTs, how did I become successful? I say very simply through volunteerism, volunteering your time to help your profession and help those we serve, whether it's going to a health fair and educating the public, you ever done that fascinating what they don't know and how the aha moments you see in the public. When you spend two minutes with them screening students preseason athletic screening, another great opportunity to follow tourism positions you're working with, Oh, that's how you do that. That's how you measure that. I didn't realize that. And that's another idea, again, of getting involved, getting I talked earlier about legislation, getting involved in legislation, getting involved in your association is what I think makes you successful. And to that point, I think that the best jobs of PTs get are not the ones they see through a Craigslist or three C on the association.

Michael Weinper (01:09:41):

Advertisements is from talking to other therapists, word of mouth learning, where are the best jobs to be had. And the only way to do that is not staying in your little house if you will, but getting out and talking to the PTs. That's like I said earlier, getting to know other PTs there's this PT pub nights that I see around the country, what a great idea I've gone to them. And they're actually fun. I stood out in the rain. They had an outdoor one here in Southern California, and you don't get a lot of rain here, but that particular night, we all were standing outside of this venue drinking our beverages of choice, getting soaked, but having a good time. And it's very memorable and getting to know other people and volunteering just goes a long, long way. I think, to learning more and learning what needs to be done, if you could learn what needs to be done and then not put it on somebody else, but say, I'm going to take responsibility again, getting back to I'm a professional.

Michael Weinper (01:10:43):

I need to be professionally responsible. I need to be the one who does this. I know you're one of those people. I'm preaching to the choir. Stephanie, when I say this and you know exactly what I'm talking about, but so many people who might be listening to a podcast like this, don't quite follow it. So my challenge to each of you would be get involved in your profession and spend a little time here and there, away from family away from work away from your social activities and back to your profession. That's part of being a professional. And as you give back, the more time you give the more you get. And I like to leave this thought with people. And that is for all the thousands of hours, I guess, at this stage of my career, I have given to my profession, whether it was the local district or my chapter or the national association or the private practice section or other sections I've been involved with or doing things in the public realm, getting involved in I was involved in a college board. So people got to know me as a PT and as an individual and get to know more about PT, getting involved in society, rather than just going home at night, turning on the TV, or turn on your computer or playing games, getting more involved with people and trying to do good things for the public benefits you directly.

Stephanie Weyrauch (01:12:11):

There were some wise words spoken by a true visionary of our profession. So thank you so much. And thank you for all of those who listened to this episode of the healthy, wealthy, and smart podcast and I'm your guest host Stephanie Weyrauch. And I hope that you stay healthy, wealthy, and smart.

 

 

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Aug 24, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Dr. Michael Weinper speaks with guest host Dr. Stephanie Weyrauch about the American Physical Therapy Association's Vision 2020. Passed by the House of Delegates in 2000, Vision 2020 was APTA's plan for the future of physical therapy. In his 2000 Dicus Award speech, Dr. Weinper discussed his predictions of where the profession would be in 2020. Dr. Weinper and Dr. Weyrauch revisit the elements of Vision 2020 and analyze whether our profession has accomplished a vision of the future set twenty years earlier.

In this episode, we discuss:

-How has the physical therapy profession evolved since the drafting of Vision 2020?

-The student loan debt to income ratio

-Advocacy efforts to achieve full direct access in all of the States

-The importance of lifelong learning and evidence-based practice

-And so much more!

 

Resources:

Stephanie Weyrauch Instagram

Stephanie Weyrauch Twitter

Stephanie Weyrauch Facebook

Email: sweyrauchpt@gmail.com

APTA Website

 

A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!

 

For more information on Dr. Weinper:

Michael Weinper, PT, DPT, MPH, cofounded the company in 1985 with his partner, Fred Rothenberg, a former executive at Blue Cross of California. A physical therapist with more than 40 years of experience in clinical practice, management consulting, administration, and program development, Weinper is also a principal in Progressive Physical Therapy, a private practice, with four locations in Southern California.

Weinper received a Bachelor of Arts degree in Industrial Psychology and a Bachelor of Science degree in Health Science (physical therapy) from California State University, Northridge. He received a certificate in physical therapy from that institution in conjunction with UCLA Hospitals and Clinics. Weinper later received his Master of Public Health degree (M.P.H.) from UCLA in Health Services Administration and his Doctorate in Physical Therapy from the EIM Institute for Health Professions in Louisville, KY.

Weinper has been active in the American Physical Therapy Association (APTA). He has served as a member of the APTA’s Task Force on Physician Ownership of Physical Therapy Services, as a member of its Committee on Physical Therapy Practice, as the association’s chairperson on its Task Force on Reimbursement, on the Board of Directors for APTA’s California Chapter and national Private Practice Section, and as trustee of the APTA Congressional Action Committee (now known as PT-PAC). Weinper received the prestigious Robert G. Dicus Award from the Private Practice Section of the APTA in 2000, and he received the Charles Harker Policy Maker Award from the APTA Health Policy and Administration Section in 2011.

On behalf of the state of California, Weinper has served as a member of the Physical Therapy Subcommittee of the Division of Industrial Accidents, now known as the Division of Workers’ Compensation. He also has served as an expert to the Medical Board of California, where among his activities he has appeared on behalf of the People in insurance fraud trials. He has provided expert witness testimony on behalf of more than 20 insurance companies.

A former associate professor of health science at California State University, Northridge, Weinper is a frequent presenter for various professional associations including the National Managed Healthcare Conference, the American Medical Care and Review Association, and the APTA. He has authored many articles for both physical therapy and insurance industry publications.

For more information on Stephanie:

Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.

 

Read the full transcript below:

Stephanie Weyrauch (00:00:01):

Hello everyone. And welcome to the healthy, wealthy and smart podcast. I'm your guest host Stephanie Weyrauch and I am interviewing Mike Weinper who's the president and CEO of physical therapy provider network or PTPN as it's better known and also a private practice owner for progressive physical therapy in California. The reason that I wanted to talk to Mike today, as he won the Robert G Dicus award for the private practice section back in 2000, and he has been an instrumental person in practice, leadership, innovation, legislative, and political issues, healthcare reform, and a number of other areas where he's really had the opportunity to champion innovation and leadership. And one of the things that, you know, we know it's 2020, and obviously vision 2020 has something that has happened in the APTA was written back in 2000 and in Mike's Dicus award speech, he talked a little bit about where he thought the profession would be in 2020, in 2000. And so I'm really interested in kind of his take on where we are today. So Mike, welcome to the healthy, wealthy and smart podcast. And tell us a little bit about yourself.

Michael Weinper (00:01:21):

Well, thanks Stephanie, for the very nice introduction and it's a pleasure and an honor to be with you today. At some level, I’m considered by some, to be a dinosaur, having gotten my Dicus ward 20 years ago, and now long in my career, I'm just celebrating my 50th anniversary as a PT. So I hope that some people won't tune out just because of that. Maybe if nothing else, they can see me as a history lesson, any event, I can tell you that back in 1992 the California chapter of APTA now called California PT association created a long range planning task force that I was honored to serve on. And in that task force where a lot of leaders in the profession in California names that were household names, then probably names and most people would not know now, but our plan was to draft a long range vision.

Michael Weinper (00:02:21):

If you will, a crystal ball of what things would look like some 18 years later in 2010, kind of looking back, it's interesting to look at and we created, I believe 18 different points that would be goals if you will, of the association and the primary aspects of that working document, which was called PT 2010 by the California association. I'm sure if you were interested, you could look it up or get a copy of it. Then later became the working document for APTA called PT 2020. And since we are now in 2020, I wish we would have known then what we know now, because things have dramatically changed in many ways, but in other ways they have not. And so I guess I could give you some of the ideas we envisioned back in 1992, if you'd like, and then we can take it from there.

Michael Weinper (00:03:23):

So in that document, we said that PTs would be able to evaluate and diagnose conditions that's true today, perform specialized treatment procedures and work in teams with physical therapists and PT assistants. So all that did come true. Next, the PTs would be able to initiate services subsequent to their own evaluation diagnosis without referral from or diagnosis by another practitioner. And that in 2000 that had not yet been accomplished, but we, now we know we have independence and practice almost every state with regard to our licensure. In most therapists are, would be in independent press configurations with other therapists, maybe who would work in a hospital. In other words, there would be an opportunity to be clinically specialized in it with a board certification, which we now know has really grown quite a bit.

Michael Weinper (00:04:25):

And they would be sought out. These specialists would be sought out by consuming public and third party payers. Not as much. I don't think our profession has reached to the public well enough to get the public, to understand what a board certification really means and what it takes to become a board certified specialist in our profession, but I'm progressing for a moment. Anyway. So then we said that PTs would be able to be involved in the continuum of care from the hospital to the home, to the private practice. In other words, PTs would have hospital-based privileges and they would be able to go there. And then if the patient were home, many of them would be able to then go to the patient's home and treat them there and then follow them up in the office. And so that was another kind of idea we had way back then.

Michael Weinper (00:05:21):

So it would be basically following the patient through the episode of care from beginning to discharge and obviously getting them ambulatory and functional. We also said that this is a good one that PTs would become diagnosticians. And more importantly that we would be at the entry point in healthcare which wasn't the case in 2000, but in now in some places, it is that therapists are in fact these musculoskeletal specialists would be a cause we can do it musculoskeletal evaluation or diagnosis many states now recognize that. And some insurance companies have recognized that we can be an entry point into the system, which I believe going forward, it's going to become much more prominent because of the higher cost of care. And actually Stephanie, the difficulty we all experienced when we try to refer a patient to a specialist, state, an orthopedist or a neurologist to do an evaluation so we can follow the patient.

Michael Weinper (00:06:18):

We find that it can take several weeks for that patient to get in, to see the physician, whereas they can usually get in to see us in a few days. So I think that's something that we will see more of in the future, but back then we had it as a dream, but not a reality. We also said that at that time, that instead of 24 weeks of internship that were experienced by PT graduates back in those years, we thought internships would last one year. Now that I don't think there's a, but we have in fact seen fellowships and other levels of work where therapists are really going into specialization so that they in fact can do things over a year's period of time and then becoming sort of like specialists. So those were sort of the, kind of, I think the basic things that would be of importance today.

Michael Weinper (00:07:15):

We did also, this was a very important one. We identified that in the year 2010 PT would be a doctorate profession. That was what our key points of doctorate and profession. And lo and behold now our entry level is what a DPT, a doctorate. I'm very proud to say that I went back and got my DPT a little over 10 years ago. I talked back in 1982, and I certainly wanted to walk the walk before 2010. So cause that was our benchmark was 2010. So with that in mind I think it's important to realize that we have become doctoral people. In other words, we are now at a level of sophistication with our education and hopefully some research that gives the PT of today a much broader view of a patient, their wellness or their disability, and gives them better tools, which the function do the evaluation or assessment of the patient, and then follow up with treatment compared to how things were back when I graduated in 1969.

Michael Weinper (00:08:31):

So and I found that when I got my DPT that I learned quite a bit. I learned some of the things I learned actually were more on how to think differently than I had thought previously. And I will tell you that some of the things that I learned that were most valuable to me was how other people think so studying with other transitional DPT candidates gave me an opportunity for me because I was the oldest person in my class. Gave me an opportunity to hear people think and how they process, how they analyze and how they come to the decisions they do. And then how do they communicate it? I like to think I'm a good communicator, but oftentimes I get really wrapped up or wound up and, you know, I go off on a tangent and I probably go down the rabbit hole and maybe other people in today's world are much more succinct.

Michael Weinper (00:09:31):

And to the point also I can tell you that I was privileged back in 1975 to get my MPH at UCLA and the school of public health there. And I learned a lot about things that are important today, including epidemiology, which we now know is at the forefront of everybody's thinking and infection control and making for safe environments, which was only very basically touched in my DPT program. But one of the things that I really enjoyed was the differential diagnosis courses I took and the radiological courses I took that gave me a much broader sense for things that I'd studied back previously, or maybe taken some content courses, but went into much more depth and listening to other people discuss those kinds of things. So that's how things were back then. I can tell you also that insurance companies were perceived to be able to give PTs a lot more latitude. And it's only been in recent years that many insurance coverage industry to pay for PT. That's independent of physician referral. We're still working with Medicare on that. You and I know all the snow and I think the day will come that the feds will start to get a little wiser and realize the cost benefit of the PT being an entry point into the system.

Stephanie Weyrauch (00:10:58):

I think that that's a really great overview of kind of what you guys envisioned back in the early nineties and kind of correlating that with vision 2020. So the APTA vision 2020 and a couple elements that made that basically encompassed a lot of what you said. So autonomous physical therapist practice was one of them, direct access, evidence based practice, doctor physical therapy and lifelong education PPS as practitioners of choice and professionalism. So those were when the house of delegates discussed this, those were the main themes that they were looking for. So keeping those themes in mind, let's maybe start by talking about the doctorate of physical therapy. I mean, that was something that you were obviously very proud of. You will talk the talk, you walk the walk. So what do you think? Well, studies have been shown the DPT student debt now varies between 85,000 and 150,000. Okay. Do you think based off of what we're seeing today, as far as student debt, do you think that today's DPT is a good return on investment? And do you think that the salary for the physical therapist has kept up with the increases in training and inflation?

Michael Weinper (00:12:14):

Well, I'm very happy to hear you raised this question because it's a question that I not only think about a lot. I talked about a lot with my colleagues and I also talked with students who are becoming PTs and people have gone into residencies for a year post-doctoral now for purposes of gaining a better outlook on things. And I must tell you that when we gave thought to the idea of PT being a doctoral profession, never in our wildest dreams, did we think about the cost benefit aspects of it as it relates to educational costs back then costs were not inexpensive. You should teach part time at USC and Cal state university Northridge. And I remember students used to complain about the cost of education back then, but it was nothing as compared to today. So to get to your point, I am sad to say that we have not grown our income levels for PT to the level that they should be given the doctoral training that we received.

Michael Weinper (00:13:29):

And the depth that usually goes with that, unless you've got some kind of a rich uncle or a greatness scholarship, having said that most PTs coming out with a lot of debt, and then they find themselves in jobs that they don't want to do. Let me just elaborate a little bit on that. PTs in private practice is considered by many to be the desired venue in which to work because patients are coming to you. You have all kinds of equipment and resources and hopefully a nice facility to work in. And the patients for all intents and purposes are ambulatory or said differently. You're not going to be ambulating a patient in a hospital hallway and have something happen to your shoe. If you can get my drift in any event, it seems that most PTs that come out of school today are struggling with where they want to work versus where they have to work and where they have to often work or those places that pay more because they're less desirable.

Michael Weinper (00:14:35):

So as the desirability quotient increases, the unfortunately the salary decreases because of in part supply and demand. And also to a greater extent because insurance companies are not reimbursing PTs in private setting, like they are in the hospital, for example. So if I go to work in the hospital, I can make a lot more right out of school than if I go to work for an independent therapist in the same community. On the same side, I can go to work for a home health agency, not have this desirable of a work environment. Have you seen changes from patient to patient, but make better money, but then again, have other costs of doing business. And I think at the end of the day, those who do home health, and I don't mean to criticize those of you who do, but if you look at your cost of doing business and take that away from your income, you find that your true income is much less than you thought it was going to be.

Michael Weinper (00:15:30):

Whether it's wear and tear on your car, gasoline insurance, you have to carry on your own, whatever it may be, equipment you might have to buy and so on. So it seems to me that the desirability of where you'd like to work and the pay ratio is a universally, but proportionate with that in mind, it's a function of insurance companies, and this is where I really go down a rabbit hole. And that is why are PTs and private practice paid less? And the answer is because PTs in private practice accept less, they have an, I am very secure, experienced on this. Having started PTPN 35 years ago, a managed care company for PTs in private practice. And we have always advocated for higher reimbursement. And in fact, we Protestant have been successful in getting a higher reimbursement for PT and practices that are in our organization.

Michael Weinper (00:16:30):

Then PTs were in the community who are not in our organization. However, because PTs are willing to accept whatever insurance company pays. In other words, they don't want to lose business. They accept fees. They're much lower than they should. And that has driven down the value of PT in the mind of the insurer and that's led to lower salaries. And so to get to the end of this thought, PTs coming out of school, don't get proportion of the kind of income they should with a doctorate. And let's contrast that for just a moment to a PA, a PA has less training than we do. They will usually get a master's degree. They work in a physician's office, but the way that they can bill under the physician's license gives them much better reimbursement. It makes them more valuable to the physician and therefore their income is oftentimes much greater even out of school, you know, apples to apples. Then we get as a PT out of school.

Stephanie Weyrauch (00:17:31):

Yeah. I think you make a lot of really great points there. I mean, the doctor, the DPT was obviously great as far as, you know, gaining direct access, being more autonomous, but you know, the cost of education has obviously sky rocketing it. So based on, you know, your ideas, what do you think that the private practice section can do to help guide new graduates through the uncertainties of student debt?

Michael Weinper (00:17:57):

Wow. there's a lot of things that come to mind. First of all, we, as a profession have to be better educated to know when to say, no, that's a K N O W and N O in the same sentence. Know when to say no. In other words, if insurance companies are offering rates that are below what it costs us to business or below what we think we should be reimbursed, we need to learn to say no to them and walk away from that business. Maybe it's better to see fewer patients and make more money and be able to compensate our staff better than to take every insurance contract that comes down the road that pays less than it costs you to run your business. Those in private practice who might be listening to this podcast are shaking their heads affirmatively I'm sure because they get it.

Michael Weinper (00:18:47):

Those who are not in private practice probably don't understand what I just said. I don't need that it was criticism, but I think that at the educational level, during your basic education it's therapists need to learn more about socioeconomics as it relates to our profession. Supply demand economics certainly, and cost of doing business are key points. In years past for APTA taught courses on economics made easy for PTs because many of us come out of school even today without very much in the way of business knowledge or knowing much about economics. And once you learn more about that, things become much clearer and it makes it easier to make decisions that are in the best interest of our profession. So I think the PPS can, it does from time to time try its best to educate us on how to be better managers, if you will.

Michael Weinper (00:19:51):

And that includes things like the economics. But I think we, as a profession need to be top of mind with economics and learn how to advocate more as a group, as a profession, not just individuals because insurance companies will not look, listen to individuals. They will disappear to larger groups. To that point, larger groups get better reimbursement. So that point hospitals being really affiliated with one another or powerful entity as an association get better reimbursement. So I think that getting PTs together to understand I know APTA has advocated for many years better reimbursement. I worked with APTA in different retreats for payers. So there was a way to bring together a summit, a payer summit, they call it where they bring together many insurance companies. Actually I did one in Connecticut where you are cause that's a sort of a hodgepodge or location of many insurance companies.

Michael Weinper (00:20:55):

So we had several speakers who knew a lot about reimbursement, including Helene furan, a dear friend of mine and others who would speak to insurers about what is PT? What does a PT do? How do we evaluate patients? What does it cost to run a business to give these payers a better understanding, but remind you be reminded. These were not big association meetings. We brought peers together. So we might have 25 or 30 people in a room, some of whom which were larger decision makers than others, but when it came right down to it, we didn't have the ability to follow up with them and push them down the road to where they would be accepting of what we do. So we today, the cost benefit of coming to PT, I'm sad to say is very disappointing. It takes you a long time to work off your debt. Hopefully in the future, our government will see fit that people in professions like ours need to have better forgiveness of their debt in return for doing public service for the public we serve.

Stephanie Weyrauch (00:22:06):

Yeah. I think that you make a great point about the fact that we as private practitioners need to walk away from some of these more measly reimbursement contracts. And you know, one of the things that we hear a lot with incoming graduates is that there are a lot of private practices that have very high volume. And one of the reasons that they have low job satisfaction is because they're seeing so many patients. So I think that you make a really great point in saying that, you know, maybe it's better that we take fewer insurance companies, see fewer patients, but get paid more because now you're eliminating that burnout and that poor job satisfaction and allowing that new professional, or, you know, even if it's a veteran physical therapist, make the money that they actually deserve with the training that they have.

Michael Weinper (00:22:58):

Exactly right. And that's why we need to really advocate politically. And that's why the PT PAC is a very important thing to be involved with because we, as a profession can be heard through advocacy many, many years ago, I was one of the early trustees of what we used to call APTCAC American physical therapy, congressional action committee, which now PTPAC. And I always used to say, and I consider you to say today, if every PT would just give $25 to political action, how much more strength we could have because we live in a world where legislators listen to those who support them, support them with votes and support them financially so they can get folks important that we do get to legislators.

Michael Weinper (00:23:54):

We have a lot of people in Congress who are friends and have been our friends for many years, but we need more. And when things come up like budgetary cuts of Medicare, where they talk about an 8% reduction in Medicare reimbursement coming in next January, which I hope goes away. I think it will go away. I pray it would go away. But if it doesn't, I mean, think about that. You're getting a reduction in your reimbursement, which is not that great today. And they're going to reduce it even more. What's that gonna do to salaries? It's not going to help the PTs in private practice. And this is something that I think many people who are not in private practice, the students podcast may or may not, may not believe, but it has to be true.

Michael Weinper (00:24:40):

I've spoken to hundreds of PTs in private practice over the years. And I think many people would be appalled or shocked at least to realize that many people who own private practices do not make a lot of money. I spoke to a PT just last week here in Southern California, who was impacted by the rallies that were going on with black lives matter. And unfortunately, during that time, there was some looting and pillage went on by some bad actors, if you will, not people who were affiliated with the rallies themselves, but people who took advantage of that and broke into places and solving fuel and burn places. We all heard about that here in Southern California was one of those places in other parts of the country, the same thing that held true, that PT, when I talked to them and was trying to do what I could do to help them rebuild their practice. Cause your practice had been broken into and everything taken.

Michael Weinper (00:25:42):

I asked this individual if they would be willing to share with me how much they make per year. This person said to me, under $80,000

Michael Weinper (00:25:58):

And I pause for a second. And since not only for the problems they were experiencing because of the looting and stuffed up to their office, but for the fact that even under good times, they weren't making a lot of money and they were working hard. They're working 10, 12 hours a day, sometimes on weekends. That is because they were in a situation where their cost of doing business is almost as high as what they would receive in payment.

Michael Weinper (00:26:24):

And we know that owners of businesses get what's ever left over after paying all the other bills, including salaries and benefits and rent and all the other things that come to mind. And it's not uncommon to find people who own their own practices, who do not make a lot of money and you have to take a lot of risks. So it's one of these things that we need Congress to better understand that it's important to support physical therapy as a profession, because we are a very valid and important aspect of the health care continuum that if we aren't there the cost of care will go up because rehabilitation, I believe, and I'm sure you believe decreases overall cost of care. So getting Congress to vote that in and to budget more money for us and Medicare, and then hopefully getting insurance companies to understand that not every therapist is going to do things on the low ball side of it, but really are going to hold out for a higher compensation that they're entitled to.

Michael Weinper (00:27:36):

They're going to be more inclined more and as a parent more it's my idea that therapists should be able to own practices to be able to pay their staff more. I've always said, Stephanie, that I wish I could pay every therapist that works in our practice, $150,000. I think they're easily worth it, but it's a function of what we get paid. And I can tell you that, you know, my own practice, progressive PT my income hasn't gone up in over 10 years and I don't make, you know, I don't make a lot of money in it, but it's because I get what's left over after we pay everybody. I feel that we've got to give our employees reasonable compensation for what they do. And we don't use a lot of extenders. We don't do a lot of things that are in the realm of I'm doing it on the cheap side as many people do.

Stephanie Weyrauch (00:28:31):

Yeah. I think that your points about advocacy are really important because I know APTA has been working on that 8% cut. You haven't written to your Congressman. I definitely encourage those of you listening to this podcast today to log onto APTA’s website, whether you're a member or not and write a letter to your Congressman, it really only takes three seconds. Additionally, there has also been a legislation that has gone forward with trying to increase the loan forgiveness for DPT students. APTA is always trying to get us to have pay, be paid more so that advocacy piece is really important. So that kind of brings me into the next pillar or the next element of vision 2020 and that's full direct access. So we do have at the some form of direct access in all 50 States right now, however, there are three States where the direct access is extremely limited, where you basically can only do a wellness evaluation without a doctor's referral. And then there are about 27 States where you have direct access with basically limitations or rules attached to it. And a lot of those have to do with say diagnosis or with different interventions like dry needling or electrical stimulation. Those types of things. So kind of along that route, how can PPS ensure that we get full direct access in each state? What are some things that the association can do and that physical therapists can do?

Michael Weinper (00:30:04):

That's a wonderful question. And I think the answer is create stronger advocates in each state because what you're talking now is not about federal legislation, but state legislation. In other words, each licensing act is governed by the state legislature. So having a good group of PTs who can rally and lobby, if you will, or have a lobbyist, if there is a big enough state to meet with members of the state legislature to express how important it is in an effort to control costs in healthcare, to give therapists more clinical rights and abilities, that's where it starts. Once you get that, then you can get insurance companies to start to buy in because they realize that is legal in that given state. I have seen this happen throughout my career that has been slow to come. We've been shooting for direct access. And at the same time also trying to eliminate the need for there to be physician intervention in certain musculoskeletal situations where we now are trained as diagnosticians to be able to evaluate and treat these things.

Michael Weinper (00:31:17):

It's my hope in the future that we get the opportunity from a licensure standpoint to order x-rays, to order lab work and things like that, to where we can have more information at our fingertips, but then to have to refer out. But only where it's appropriate, where we're adequately trained to do that. You have to teach legislators what is PT and what is the benefits of PT and what are the cost savings that insurance companies, the public. And we all save by giving the opportunity for patients to be strong entry points into the healthcare field. It's certainly fond for us to evaluate patient. And in some States you can do, like you said, dry needling. I live in a state, California doesn't even allow dry needling. I have people in my practice who teach dry needling to therapists around the company because he used to do that where they worked in other States, very frustrating for them, extremely frustrating for me, but it takes legislation.

Michael Weinper (00:32:25):

It takes talks. It takes contributions to your local state PAC, and most of them have it now. And to be involved in APTA, I think is key that so many PTs I call nine to fivers. They come in and they do their nine to five and go home and they forget about their profession. People like you and others who are dedicated to making this a better profession for PTs of the future, not to mention the public that receives our care are the ones that make things happen. And so being more involved in our field through volunteerism obviously is key, I think, to change and too many of us look to the other guy to do it, whether it's writing a letter to your congressmen, or there's going to meeting with a state legislator, whether it's inviting your local state representatives into your practices, see who you are and what you do.

Michael Weinper (00:33:27):

All of the things bode well for growing our practice. And too few of us, unfortunately do that. We don't realize that it starts fortunately with regulations and what we can do and how we can do it. So the quest, if you will, or request, I should say would be that we as a profession, get more involved in our association because the association is the focal point for getting the information to legislators. It's our association that has the greatest credibility. And I can tell you that one of the reasons I went back and got my DPT was that I saw that when I would testify on a bill in Sacramento here, there would be people with a doctorate, not necessarily in our field, but just doctorates, so would speak against what we were doing it. And I would get up there and I would have 40 years of experience, and we have a master of public health degree then on my doctorate.

Michael Weinper (00:34:26):

And I were always, and I would like to think I had good presentation and good preparation and knew the facts. And yet it was those who had doctorates that were, or had the title doctor who were paid more attention to now, we as PTs have that title. And now we're sort of in a level playing field with other professions, from the term being entitled a doctor. And with that credibility, we need now to take more action, we need to spend more time trying to create change in my Dicus talk back in 2000, I said that people were afraid of change and it's true. And even today they're afraid of change and we all like the status quo, but the reality is we need as a profession to embrace change because with change comes progress and we need to progress as a field of profession. If you think about things it takes a village if say and certainly in our professional, it's no different, we have to be part of that village. We can't just be part of the tribe. We need to be active leaders of our village.

Stephanie Weyrauch (00:35:43):

Yeah. And I think, you know, if you look back at where we were with direct access 20 years ago, I mean, obviously we're in a much better state than where we were, but some of the resources that I know PPS has for people with their fighting, the direct access is they do offer grants to state associations if they're doing any type of lobbying. So if you haven't applied to one of those, it's a pretty hefty amount of money. It's like five or $10,000, which that goes a long way when you're paying the lobbyists to do the work for you. You know, they also have a key contacts program and they offer resources for practitioners that if you do invite a legislature in a legislator into your practice, or you are trying to advocate for a bill, like they provide all that information for you on their website and on the APTA action app.

Stephanie Weyrauch (00:36:29):

So, I mean, PPS does have resources out there that we can utilize to try to continue in our fight with direct access. And I mean, yes, we're in a much better place than where we were 20 years ago, but like you said, change takes time. And as a, you know, as a young professional, I definitely would love to see change happen even faster. So you know, the more people we can get together and build that village, the faster it's going to happen in your Dicus speech, you also talked about how you envisioned that physical therapist will be evaluating and diagnosing conditions, performing specialized treatment procedures and working with the PTA team. And then you also envision that there would be no referral needed by another practitioner. And I know you've kind of covered this a little bit, but give us an idea of where we are, where we're at with this prediction and what you think the future holds. Because as you know, a lot of these direct access bills that we have still restrict our ability to quote unquote diagnose conditions or even perform specific procedures. So kind of give us an idea of where we are compared to 2000 and where you see us going in the future.

Michael Weinper (00:37:41):

Well we are obviously light years ahead of where we were in 2000, just by hearing what you described to helping things in what I predicted. And I think from the standpoint of going forward, we need to be cognizant of the fact that we can change things if we put some effort to, and in other words, so many therapists don't do things because I think I hear people say, Oh, it doesn't make a difference, or they'll say somebody else will do it. And the truth is that we all need to be more involved. And I'm one of those key contacts and have been for many, many years. I can only tell you that how rewarding it is to invite a legislator or even somebody who works in their office, into your office, into your practice, to visit with you, see what you do, talk to you, the things that are your barriers to growth and barriers to doing for patients, what we should be doing and should have been doing for many years.

Michael Weinper (00:38:46):

And I think it's more important to understand what you can't do versus what you can do. And you only learn that by going to stage or talking to people in other States who have full privileges to do those things and have that true autonomy. So I think that by attending association meetings, for example, PPS is a great example or CSM when it comes back. And, and I say this, not just going to the meetings, but talking to people, not just your friends, but talking to people you don't know, but from other States where you might know there's a lot more progress, ask them what they did and how they did it, or talk to the leadership in those States, in those state associations and ask them, how did they accomplish what they accomplished? Because it takes a lot of work and there's a lot of resistance by other professions, physicians be it chiropractors, osteopaths, even dentists from time to time resist, having us grow to where we should grow.

Michael Weinper (00:39:53):

And the key again is educating the public, what we do. So when you're treating them, let them know what you can do, what you can't do all because of the laws, even though you might be trained to do these things. And sometimes the best advocacy doesn't come from ourselves. It comes from the people we serve our patients. So getting people to write letters to their members of the legislature is very important. But I think getting more people to stand up, write letters, attend hearings in your state Capitol become more involved, become more aware of the benefits you can create, not only for the professional, but certainly for yourselves as well. And that's one of the reasons that I've been very involved in APTA throughout my career was I felt that I had the ability to change things if I would only work at it.

Michael Weinper (00:40:47):

And I was very blessed. You haven't brought it up, but Bob Dicus for who the Dicus award is named obviously was one of my mentors. When I was a student, I got to meet Bob. He was already very deep in his ALS disease in Georgia. He was fully wheelchair bound and tied to a respirator, but that man had so much knowledge. He was one of the first private practitioners. And one should only go to the PPS website and learn more about Bob and what a great man he was and what a visionary he was for our profession. As a matter of fact, just to digress for a moment, he is the one who created the ALS society nationally. He was the inventor of that. He had a second professional. He was in, he was a motion picture producer in his later years when he couldn’t be a PT, he went into motion pictures.

Michael Weinper (00:41:48):

A lot of them had to do with rehabilitation and things that we do. They weren't necessarily featured like Sims, but he got involved in that kind of communication. So it always goes to the fact that I think some of the best PTs are the ones who are best able to communicate with their patients, with the public, with our legislator. Sure. Those are the PTs who really do the best, because if you're good with your patients in communicating, you're able to motivate them to do the right thing. Right. And communication is something that we need to study more perhaps in school. I teach a lecture on communicating with different generations because as I become part of the older generation and looking at the younger people, I see how you and others in your generation and younger generations communicate with one another as much different than what my experience is.

Michael Weinper (00:42:43):

I grew up with our computers. I remember the very first calculators. We were not what I was going through school in high school. We used an Abacus and a slide rule. And then going forward, we used a Texas instruments brand calculator, which was very expensive and very elementary looking back at it. That's an idea of technology when technology and communication are, I think are very interwoven. In other words, as technology increases, communication becomes dependent on that technology. And we tend to communicate less with one another or said differently. I can see my son-in-law and daughter at our house, sit on the couch, waiting for dinner, remake, and what are they doing? They're texting. And I said, who are you texting to talk to them? Wait, what answer? Just speaking with one another. And that's just the world we live in. And then all the little acronyms, all these simple things that you know are, are part of the lexicon today.

Michael Weinper (00:43:56):

Today's younger people, older people don't necessarily know. And when treating an older patient, it's key that you speak to them in a communication form that they're going to understand. And don't assume they understand. I mean, you're saying just because you're saying it, and the same is true for older therapists like myself, talking to younger people, you have to motivate them in a different way. Young people want it. Now they want things quickly. They're used to getting information quickly. You go with something up on Google and get an instant answer on something. Whereas back in my day an encyclopedia sales person used to knock on our door, trying to sell my family a big set of 30 books of encyclopedia. We were tell much to us what we needed for today's knowledge. And I don't think those people around anymore. If at all. If you wanted an encyclopedia, you've got it.

Michael Weinper (00:44:50):

Just look up something in Google or another search engine, and you've got instant. You got too many answers. Sometimes you get different answers for the same question, but with all that in mind, communication is key to success. And we as service need to communicate better, not only with our patients with one another, with our legislators and with the public in general, and to that point, having better PR public wise. And I think APTA is trying to do that. Now that we're into our hundredth year, starting there as your celebration or Centennial celebration. I think you're going to see a lot more information going out to the public, through electronic media and social media, to where we gain a higher visibility with the public.

Michael Weinper (00:45:38):

I had the TV on the other night, I was watching a game show and one of the contestants was a PT. And he was a young PTA until that. And he didn't want a whole bunch of them. I think it was, I believe the show was a wheel of fortune actually, which I don't watch too often, but it was on. And I've heard the word physical therapist. It's just like you, whatever you heard that word somewhere. Even as sitting in a restaurant, you hear somebody talking about their PT, your ears perk up and you sort of start to eavesdrop a bit. And we as a profession don't hear that word in the public as much as we hear about doctors or other things. So I think the public needs a better awareness of who we are and feel comfortable talking to us. And we need to feel comfortable talking to them and educating more about who we are for. They haven't needed to see us.

Stephanie Weyrauch (00:46:26):

I think you make some really good points about the communication aspect and that kind of leads into the next element of vision 2020, which is us being practitioners of choice. So in kind of going off of that with communication, it's too bad Bob Dicus, isn't around anymore to make the next hit healthcare drama on physical therapists. I mean, how many physical therapists and healthcare dramas do you see walking patients or stretching patients? You know, it's never really, they're never main characters in, you know, like Chicago med or Grey’s, you know.

Michael Weinper (00:47:05):

Anytime I see a PT portrayed in these situations. I cringe because first of all, they're wearing, and I hate to say this cause I'm going to probably, I'm going to take an issue with some of you they're wearing scrubs. I don't think I don't scrubs when I grew up were for people working in surgery. Now everybody wears scrubs. So you go to the grocery store. People were in scrubs. They, I think people not even in healthcare wear scrubs sometimes, but I think we should look more professional. We should be more professional and the public will respect us better if we act more professional. And so there are some times PTs who are brought in on dramas to be a technical advisor. I have been in that position before twice, and I have talked to directors and producers about what they need to show.

Michael Weinper (00:48:05):

And I can only tell you that what you tell them to do and what they end up doing sometimes is different because maybe they don't have the right equipment or the character. They thought they already lined up costumes for their characters. It becomes very frustrating, but getting in on the front end and getting the public to understand who we are, hopefully through drama and maybe through, you know, like I say, public service announcements or ads on TV where we're portrayed better or having the opportunity. Many of you are in smaller cities and towns, your local newspapers and television are hungry for local news. And you may be doing something you don't need to think second thought about, but it's newsworthy. Maybe you just purchased a very important piece of equipment to help with ambulation or suspension or something technical electronically to create new opportunities to treat patients your local TV stations would love to demonstrate, come to your clinic, film you doing that and have it as a segment on their TV show.

Michael Weinper (00:49:21):

And many of us don't even think about that. So and I, again, even in Los Angeles market, I've had the opportunity to do that a couple of times. And it can be a little bit overwhelming, a little bit scary, but you know, something at the end of the day, you feel really good about it and how you come across is much better than you perceived. You are going to come across when you're getting ready to do it. So don't be shy, but reach out to your local media and try to get them interested in what you do, because what you do, what I do is very newsworthy and very important for the public.

Stephanie Weyrauch (00:49:52):

Yeah. And you know, obviously people are following what the media says and listening to the media. So, I mean, the media is, has been a very powerful force that you can utilize to spread the gospel of physical therapy so that we can become the providers, the practitioners of choice, for the musculoskeletal system. And so the people actually know that PT means physical therapist and not like personal trainer or part time, people actually know what it means in your speech. You also stated that PTs would be recognized by payers as diagnosticians an entry point into the healthcare system. And I know you've talked, you you've touched on this a little bit, but how do payers recognize physical therapists and how do today's payers recognize us compared to back in 2000? Where are we at with that?

Michael Weinper (00:50:43):

Well, back in 2000, and even in day sense, payers felt we needed to be treating only under a physician's referral. If you looked at insurance policies that you might have, or if you spoke with payers, they would say that PT was a covered service when provided or the auspices of a physician referral or diagnosis today. Many of those policies from the same payers do not have that language. So because of the direct access laws and because of therapists and given States talking to their insurance companies, the payers they've educated them to where certain payers are starting to realize the benefits of PT first. And let's just take substance abuse and chronic pain. We know as musculoskeletal experts, there are lots of things that we can do for the patient to avoid surgery, to avoid downstream costs like expensive imaging that may be unnecessary. We can certainly get the patients treated properly and get them in a mindset to where pain is not top of their mind. I have a book sitting right behind me on my bookshelf. It's called explain pain. Are you familiar with this book?

Stephanie Weyrauch (00:52:13):

Oh yeah, that's a very familiar book.

Michael Weinper (00:52:16):

Okay. And this was a very good book for people to read. It's the authors are David Butler and Lorimer Moseley, and they're down in Australia, but they talk about dealing with the mental side of pain, the cognitive side of pain, if you will, and how to best creature patients in deemphasize of pain and emphasize wellness or health. And we need to do more of that as practitioners. And as we can educate our insurance companies, that by sending the patient to PT for four or five, six visits, we can avoid surgery, many cases, what is a cost benefit to the insurance company? Their insurance companies listen to money. And I know this from my experience for many years of working with many of them speak with probably too many insurance companies to not only remember, but to count. And they are driven by dollars and they do not put enough emphasis on times in their underwriting to allow PTs to do the things we do.

Stephanie Weyrauch (00:53:26):

Yeah.

Michael Weinper (00:53:28):

Shortsighted because they ended up then forcing patients to go to a physician first, wait, several days or weeks to see the physician where the patients only getting more deconditioned. And rather than just seeing us first, and we have the opportunity and the knowledge on doing things that get the patient out of the problem or fixing the problem, if you will, from a nonsurgical standpoint. So insurance companies in some cases have become much more enlightened and other cases are still in the dark ages. And those who allow us to treat without referral and pay us for what we're worth are the more enlightened ones, some insurance companies that I've dealt with now in recent years are paying for outcomes. There's concept of paper for pay for performance or P for P. I like to call P fro. It's really not what you do, the process of what you do, but really the outcome that you get.

Michael Weinper (00:54:27):

So if you can get a great outcome with fewer visits, then insurance company should be willing to pay you more because you reduce their costs. And, not only of what you did in terms of your crew cough, but in terms of what would otherwise cost them to treat the patient going forward. So I like to pay to pay for outcomes Peterborough, and that's why we, as a profession, need to do more in the way of outcome measurement, whatever tool we use and be able to communicate to the payment payer community, the benefits of what I do. So I'm going to go back now to the mid seventies again, when I got my master's degree we learned even back then that the definition of quality in healthcare was composed of three things. And the author of that was a fellow who's no longer with us.

Michael Weinper (00:55:22):

His name was Avitas Donabedin. He was a physician. He was very involved with the new England journal of medicine, D O N A B E D I N, if you want to look it up and Donabedinn even back then said that quality health healthcare was three things structure, which is where you do it and what you use in terms of equipment process, what you do okay. And outcome, or the results. So we all have been able to measure it structure, and we were able to mission measure the process where you, but not enough of us over my career have been able to truly prove that what they did was a benefit. And I think that that's one of those things that we have to focus more on proving the benefit of PT two outcomes or said differently because of what we do, patients get better quicker.

Stephanie Weyrauch (00:56:16):

And that leads us really nicely into the next element of vision 2020, and that's evidence based practice. So obviously APTA has done a lot over the years to try to improve how we're measuring outcomes. So you have the outcomes registry CoStar was created. If you look at how much the literature has been put out for, if you search, if you search up physical therapy, even in Google, it's, you know, an exponential growth since even 2000 and even the larger growth. If you think about it from even the 1970s, when outcomes were first described. So, I mean, this is something that, you know, we've been working on for a long time. I think that obviously it's come a long ways, but we still have confirmation bias in our literature. We still have group practice that people are practicing. We have treatment fads that really don't have a lot of evidence behind them. And we have practice variation that continues to affect our outcomes and affect our profession. How can PPS help offset this? How can we continue to go forward to mitigate some of these things that are occurring?

Michael Weinper (00:57:24):

Well, that's a $64 question, as we used to say my hero. I think it's important that we need to, you talked earlier about one of the goals of PT, 2020 is lifelong learning. And I see too many people in our profession who don't come to meetings of the profession, whether it's a local meeting in your area, whether it's a state conference whether it's CSM or PPS meetings, too many of our colleagues never go, or maybe they went as a student cause their school paid for them or somehow or another they're were to go. And they never ever go. If you think about people, you went to school with Stephanie, you never see them again. And you wonder, how are they getting their education? One of the things that has occurred a dream the last 15 years I would say is the requirement by States that each PT in order to continue, their licensure must have continuing education, a certain amount.

Michael Weinper (00:58:35):

And it varies state by state, as we know, and what things have to be parts of that, continuing education, again, vary by state by state, but at least we're being forced now as a profession to continue our learning. Having said that, and having taught in different venues in different ways. I can tell you, there are people who are serious learners, and there are people who we call lazy learners. The lazy learners are those who will buy the cheap level CEU kind of stuff, and do a quick read on something and take a test and not really spend the time to investigate what was being offered. And maybe some of the quality of that they're learning is really not up to date either. Versus those of us who will go to con ed meetings, we'll do things online. Now there's a lot of opportunity. PBS shows a lot of things out ABQ has a lot of things.

Michael Weinper (00:59:35):

I'm a member of the orthopedic session section and the oncology section. They have lots of stuff going on that, yeah, there's too much of it. There's just like there's like education overload. So you have to be selective, but do choose things that I think will be beneficial to you. And that are evidence-based. So it brings back to the evidence based part because too often I've heard people get up at meetings and start to talk about things. And then when challenged on what's the word, what's the basis of your comments? They sort of stammered. And they said they gave answers that weren't really appropriate. So we do need more focus on, on lifelong, which we’re mandated to do, but some people take the easy way out. You know, people, we all have people we know who will take the high road and others who take the low road and the low road may be the easier road that may not be the get to the right end.

Michael Weinper (01:00:29):

So we want to challenge ourselves to learn more each day. And I can tell you that when I went back and got my DPT, I thought it would be fairly easy. And some of the things that I was exposed to, I'd already learned in my master's level, but I can tell you a lot of things that I learned were new concepts that I had never even thought about. And that goes to the idea of this lifelong learning and evidence based practice you learn, most of you learned in school all about evidence-based theory and practice, and some of you embraced it very well and other views sort of gone a different path. So I would say, take a step back and look at the research that's coming out. There's all kinds of journals. And that's another thing that I have to digress on a moment.

Michael Weinper (01:01:17):

And that is, here's a question for each of you, how many journals or publications that are healthcare oriented, do you read or subscribed to, if you say only PT, then I think you're making a big mistake because there's so much literature and so many things that are appropriate for what we do in our field. And to validate what we do in other journals and research is being done that we miss the boat by not looking at it at other professional journals or other modes of information, or even attending meetings for physicians and so on. I used to specialize in the treatment of hand injuries. And so I would go to the society for hand search and they actually had a PT sub, a PTO to see subset of that that my friend, dr. Susan Mike Clovis, was very involved in and she got me involved and I would listen to physicians.

Michael Weinper (01:02:18):

We collegial meetings where PTs and physicians would interact to try and come up with the best ideas. And many of us don't really have any contact with physicians, except when we're talking to them in the halls of the hospital or when we're going out to market them, or we're trying to take lunch to them. We don't talk really about concepts and about theory. And what do you base this upon? And what can we do to learn more about the benefits of what we do? And that gets us to the idea of each of us having the challenge to do some research, research is fascinating. It doesn't pay a lot, but you can still do research in your clinic. You can be parts of research projects. If you just look for them, is they're out there to take advantage of. And if you do that, it opens your eyes so much more.

Stephanie Weyrauch (01:03:09):

And I think a lot of the things that you've touched on kind of goes with the last element of vision 2020 and that's professionalism. So when the house of delegates originally defined what professionalism means in vision 2020, it's that we as physical therapists and physical therapist assistants are consistently demonstrating core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability by working with other professionals to optimize health and wellness in individuals and in communities. So obviously one of the bigger focus is of APTA has been this optimizing society or optimizing movement to impact society. And we've been kind of taking more of a population health kind of perspective, trying to get out of the silo, physical therapy and move more into the interdisciplinary healthcare, healthcare, professional realm. Where would you say we are? As far as our professionalism goes in 2020, compared to where we were in 2000?

Michael Weinper (01:04:15):

Oh boy, I think many of us have because of our increased education, gotten more credibility with the medical profession. They tend to listen to us more rather than just seeing us as a technical entity or a technician versus a professional. Although I can tell you still today, physicians oftentimes don't see the benefit that we do even orthopedist. And we have come a long way in some with so many physicians, but we've missed the boat with others. I think it's critical than medical stuff, schools, especially if you're doing an orthopedic residency, that's a resident spend time with a PT. I was in a well known physician, internationally known physicians office recently with my wife who, when she had her shoulder surgery. And he has no to fellows at all times. And occasionally a PT will visit and come in and, and be there not to get paid, but just to talk and work with the physicians, educate the physicians and the younger ones, the fellows who are going to be out there real soon in their own practice.

Michael Weinper (01:05:34):

We need to do a better job of educating physicians. I said that a little bit earlier, but I really mean it. We can do it when they're in school, when they're doing their fellowships, we can invite them into our practices. We can go to doctor's offices and shadow them much more than we do. We can go into surgery with physicians and talk to them while they're there doing their procedure, learning why they're doing their procedure. And sometimes a light bulb will go on in your head say, Oh, I get that. And that's, I think there's something I could do a little bit differently with like, with your patients when I'm treating them by seeing what you're doing surgically and listening to what your concepts are. So I think there's a lot more collegial realism of that goes to being a professional. And to that point, if you don't see yourself as a professional others, aren't going to see you as fun and too many of us lose track of the fact that we are in it.

Michael Weinper (01:06:27):

When you say it's a profession, a profession requires one of the key points of any profession is that you learn, you keep current and you give back to society. And giving back to society means more than just treating people. It means educating the population, doing things from a wellness standpoint or avoidance of injury. I guess going back to my public health days where one of the key things is getting people not to have to see you clinically as a post op or whatever, but helping people to avoid surgery and do things the proper way. Ergonomics for example, is a good, good use of our skills and what we've learned as I sit up in my chair properly. And we doing things that people just don't think about. And when we break away from just being the PT, treating person and branch out to media with other professions, talking to them about what are their challenges, what can we do to help though, or thinking about things we can do to help them communicating better in collegially at different levels. Then we go a long way towards not only building those relationships, but most importantly, helping the patients we serve. So it's one thing to say your profession. That's another thing to give back to society and find different ways to give back

Stephanie Weyrauch (01:07:55):

What, you know, from this conversation. Obviously we've come a long way since 2000, we've achieved many things that vision 2020 set out to achieve, but we still have a lot that we yet need to achieve. So kind of on that note, Mike, you know, what is a clinical Pearl that you can kind of leave all of us with? What is some advice you could give a young graduate or somebody new in the profession that maybe you wish you would've known when you were coming out of school?

Michael Weinper (01:08:29):

Oh, that that's an easy question to answer because I oftentimes get asked by younger PTs, how did I become successful? I say very simply through volunteerism, volunteering your time to help your profession and help those we serve, whether it's going to a health fair and educating the public, you ever done that fascinating what they don't know and how the aha moments you see in the public. When you spend two minutes with them screening students preseason athletic screening, another great opportunity to follow tourism positions you're working with, Oh, that's how you do that. That's how you measure that. I didn't realize that. And that's another idea, again, of getting involved, getting I talked earlier about legislation, getting involved in legislation, getting involved in your association is what I think makes you successful. And to that point, I think that the best jobs of PTs get are not the ones they see through a Craigslist or three C on the association.

Michael Weinper (01:09:41):

Advertisements is from talking to other therapists, word of mouth learning, where are the best jobs to be had. And the only way to do that is not staying in your little house if you will, but getting out and talking to the PTs. That's like I said earlier, getting to know other PTs there's this PT pub nights that I see around the country, what a great idea I've gone to them. And they're actually fun. I stood out in the rain. They had an outdoor one here in Southern California, and you don't get a lot of rain here, but that particular night, we all were standing outside of this venue drinking our beverages of choice, getting soaked, but having a good time. And it's very memorable and getting to know other people and volunteering just goes a long, long way. I think, to learning more and learning what needs to be done, if you could learn what needs to be done and then not put it on somebody else, but say, I'm going to take responsibility again, getting back to I'm a professional.

Michael Weinper (01:10:43):

I need to be professionally responsible. I need to be the one who does this. I know you're one of those people. I'm preaching to the choir. Stephanie, when I say this and you know exactly what I'm talking about, but so many people who might be listening to a podcast like this, don't quite follow it. So my challenge to each of you would be get involved in your profession and spend a little time here and there, away from family away from work away from your social activities and back to your profession. That's part of being a professional. And as you give back, the more time you give the more you get. And I like to leave this thought with people. And that is for all the thousands of hours, I guess, at this stage of my career, I have given to my profession, whether it was the local district or my chapter or the national association or the private practice section or other sections I've been involved with or doing things in the public realm, getting involved in I was involved in a college board. So people got to know me as a PT and as an individual and get to know more about PT, getting involved in society, rather than just going home at night, turning on the TV, or turn on your computer or playing games, getting more involved with people and trying to do good things for the public benefits you directly.

Stephanie Weyrauch (01:12:11):

There were some wise words spoken by a true visionary of our profession. So thank you so much. And thank you for all of those who listened to this episode of the healthy, wealthy, and smart podcast and I'm your guest host Stephanie Weyrauch. And I hope that you stay healthy, wealthy, and smart.

 

 

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Aug 17, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jamey Schrier on the show to discuss how to develop your dream private practice.  Jamey Schrier, P.T. is the Founder and Chief Executive Officer of Practice Freedom U, a business coaching and training company. He’s an executive business coach and leadership trainer.

In this episode, we discuss:

-Jamey’s entrepreneurial journey

-The importance of vision and giving yourself permission to imagine your dream practice

-How to generate revenue even during unprecedented times

-Why building a team of experts is necessary for you to grow your practice

-And so much more!

 

Resources:

Jamey Schrier Twitter

Jamey Schrier Instagram

The Practice Freedom Method Facebook

FREE GIFT

Practice Freedom Method Website

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

 

For more information on Jamey:

Jamey Schrier, P.T. is the Founder and Chief Executive Officer of Practice Freedom U, a business coaching and training company. He’s an executive business coach and leadership trainer. Founder of Lighthouse Leader®, Jamey helps physical therapy owners create self-managing practices that allows them the freedom they want and the income they deserve. He is the best-selling author of The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More, and Live Your Passion

A graduate of The University of Maryland Physical Therapy School, Jamey specialized in orthopedics and manual therapy. He was the sole owner of a multi-clinic practice for more than 15 years.

Jamey’s passions are basketball, tennis, golfing, and reading. He and his wife, Colleen, and there 2 kids live in Rockville, Maryland.

 

Read the full transcript below:

Karen Litzy (00:00):

Hey, Jamey, welcome back to the podcast. I'm happy to have you on again.

Jamey Schrier (00:05):

Karen. It's lovely to be here.

Karen Litzy (00:07):

Yes, no stranger to the podcast. That is for sure. And that's because we love having you on because you always give such good information to us PT business owners. So thanks for coming back now, you were a PT business owner yourself. People can go back and kind of listen to the past podcast that you did with us to get even a dive in a little bit deeper to your history and how you kind of went from a business owner to now coaching and mentoring in a training business. But can you give the cliff notes version for us now?

Jamey Schrier (00:45):

The cliff notes. That's how I got through school. Yes. Be happy to give the cliff notes. So I always wanted to have my own business ever since I was younger and went with my dad to his store. I thought it was the greatest thing. So when I got the opportunity to open up and put up my shingle, I went all for it. And I had my fiancé Colleen at the time. Now my wife who you have met, she was, yeah, she was my fabulous front desk. So it was a perfect scenario. Right? I was the quote, the doctor doing the treatments. It was the happy go lucky front desk. And it was a perfect scenario. And that lasted for a couple of years until we started to hire people until I said, honey, do you want to get married?

Jamey Schrier (01:35):

And she said, sure, boom. She left. She got 35 books on weddings. And she was like, not really there that much. So we had to actually grow a real business. Well, I really didn't know how to hire. I just assume everyone worked like I did everyone thought like I did. Everyone just did quote the right thing. And that's when a whole lot of stress and a whole lot of struggle started to happen, which caused me to create this sense of anxiety that I really didn't experience before. Definitely not as an employee, but I didn't experience for the first couple of years in business. So my hours started to increase. So not only that I have to do the treating and some of the other duties that I had to, but I also had to oversee them and all their stuff. So I took half of their job as well.

Jamey Schrier (02:23):

And about four years into it, a crazy thing happened, which I've shared before, but I will quickly share. It is my place burned down. We had a fire and it burned down and I was caught with these weird feelings of feeling relieved. Great. I don't have to go to work on Monday and feeling scared to death and feeling, Oh my God, what do I do now? Not just similar to what has happened with, COVID like, Oh my God, I wasn't prepared for this. What do I do now?

Jamey Schrier (03:00):

So after some soul searching, I realized, I don't know anything about how to build a business. I was a very good clinician. I thought being a good clinician was enough. It was not. So I spent the next nine years learning, trying, failing, learning again, trying and failing of how to build a business that can literally operate with a little bit of maintenance, but not me. They're doing all of it. And fortunately I figured it out and in January of 2013, I removed myself scared to death, but I did it anyways. Remove myself from the schedule no longer I was treating my team was handling it and my business shot up. So I got more time and I made more money and my team was great and my patients were happy and I was like, Oh my God. So I went on a webinar. I believe it was the private practice section webinars that they do. And I just shared my story. People reached out. And next thing you know, I was in the coaching business because they were asking me how I did it. And I've been doing that and being on a mission to help other practice owners try to build, grow their business for the last seven years.

Karen Litzy (04:11):

Awesome. And the name of your courses?

Jamey Schrier (04:19):

So the name of the company is Practice Freedom U, the letter U kind of playing off the university thing. And it is a really a business training and coaching firm. So we help the practice owners and we help their teams and grow and build the kind of business they like. So they can have the kind of life that they want.

Karen Litzy (04:40):

Awesome. And now you had mentioned in your story about when your practice burned down, you kind of weren't prepared for it. It's like kick in the guts. So the country, the world continues, not has been, but continues to live through the COVID-19 pandemic. A lot of clinics had to close. Some may still be closed as we tape this. I am in New York city. We are just reopening now. So as owners begin to reopen and restart, delivering their patient care, what are some of the not so obvious things that they should be aware of?

Jamey Schrier (05:23):

Yeah, that's a great question, Karen. What I learned in my experience when the place burned down and literally I had nothing to go back to, what was difficult about that was I was the only person going through that everyone else was just business as usual. And my initial instinct, because I am a high achiever because I am a doer was to do more like, okay, what do I got to do? What are we going to do? And it wasn't until maybe a couple days into it that I began to learn that, you know what me trying to do more me trying to be busy and filling up my day with just stuff. Even though I had no patience at all. And there was, by the way, there was no tele-health right. I mean, there wouldn't be telehealth right now if there wasn't a whole country, if it was just one person, the insurance companies wouldn't be changing all their rules.

Jamey Schrier (06:26):

So, but we didn't even have the technology for that. So what I did was I just started to sit and think and just sit with, well, okay, I'm going to rebuild this. If I'm going to rebuild this, what is it that I really want from this business? What wasn't working well. And I started to write out this, this idea, this outline of what I wanted the business to be. Now, mind you, I didn't know how I was going to get there. Right? I didn't know that, but the more I ask questions, the more I said, what would my business have to look like for me not to work 70 hours a week, which is what I was working, what would happen? What would my business have to be? If I didn't work the weekends, who would I need to hire ultimately to perhaps not have to treat or choose the people I want to treat.

Jamey Schrier (07:26):

So, as I started asking these questions and gave myself permission, love that word, I gave myself permission to imagine what it would look like. It started to create the outline. And this is exactly what I did and what I shared with other practice owners, what to do during this time. First of all, pause, acknowledge what the hell was going on right now, because it is unprecedented. I hate that word because everyone's saying it, but it is something that you are not prepared for. And it is something that everyone is going through. The people that are going to get through this and be better than they were before, or the people that are not trying to go back to where they were. It's the people that are pausing and saying what an opportunity to fix the things that were broken and to ultimately create what I want.

Jamey Schrier (08:21):

It doesn't mean it's going to happen today or even in a week, or even in a month, or even in six months. But it's something that can start to help you create the outcome you're looking for, which then causes you to focus on where do I work today, this week? Who should I keep? Who should possibly, I keep furloughed, right? If you're like me at the time I was treating for, you know, 12, 14 years, I was like, maybe you want to reduce your schedule. What would that have to look like to reduce your schedule? Because now's a great time to start searching for therapists. Cause they're out there. And then maybe you weren't as keen on some of the metrics you weren't as clear. Well, what a great time to start getting really organized. So I tell people the not so obvious things is for you to pause, reflect, and start to ask the question.

Jamey Schrier (09:21):

I love questions better than statements, but start to ask the questions. What would it look like in order to blank? What would it have to be? Who would I have to have in place? What technology we would have to be. You don't have to answer the questions. And that's the mistake that people make. They put all the pressure to have to answer them today because we are doers. We are problem solvers, give yourself a break, give yourself permission, just put them out there. And something interesting is going to happen. I know you and I have talked about this in the past. It's amazing how things start to happen. How people start to show up people that are like, wait a minute, fall into place. They start to fall in place. And it seems like this voodoo magic. It isn't, your mind will start to look for your subconscious mind will start to look for these and it could be right in front of you, but you never saw it before. It's kind of like, where's the salt honey, where's the darn salt. Then she comes in just right in front of you, your mind, wasn't seeing that. So that's kind of the things that I would initially suggest, and then that kind of guides you to. So what are the key elements that you have to do now, which I'm sure we can dive in.

Karen Litzy (10:34):

Yeah. So let's talk about that. So aside from the obvious safety of your staff and of your patients, that's clearly number one, right? And we want to make sure that when places reopened that that is number one priority. So putting that to the side, because that is hopefully a given for all physical therapy practice owners, right. If it's not, I think you need to go back and ask yourself some questions, but so that should be number one. I think the other thing that a lot of owners are struggling with is the lack of money, lack of revenue that you missed from your business, let's say over the past three months or so. So do you have any thoughts on how owners can build back that revenue?

Jamey Schrier (11:22):

Yeah. And that is from the people that I've spoken with the surveys we've done, I mean, that is the number one stressor. I mean, you would want to think it's safety it's to protection. Well, the thing that stresses us out is if we don't have any money, we don't have security and stability and we can't take care of our own family. And that stresses the living daylights out of us. Cause for many people, that's why we went into business to be able to have that control and freedom to create the lifestyle we want. So we know that the biggest stressor

Jamey Schrier (11:54):

Now, for many people, you have a PPP loan, you have maybe a EDIL loan. So it's important to get clear on what options you have find eventually. So some people are kind of coming out of that PPP loan, like the money's gone, they just reacted, they got the loan and they thought they were doing a good job by keeping their staff, even though their staff didn't do anything, except write some blogs and send out some YouTube videos, but it didn't generate anything. So you know, you have to look at what you have available. So that's number one, get your financials in check. So you know, for our business we brought in accountants, we brought in attorneys, I'm sure you know, Paul well so we brought in people and I know for me personally, when this happened, I reached out to experts in this area. I reached out to my accountant, to my financial advisor.

Karen Litzy (12:55):

Are you kidding me? I was on the phone with my accountant, like literally, almost every single day and emailing him several times a day and thank God for accountants, what gems.

Jamey Schrier (13:08):

Yeah. But you know, what's interesting, Karen, not everyone thinks like that. You see, we are rugged individualist at heart. What is this business? We struggled. We sacrificed, we studied, we got A's and that is not how you build your business. You need to be.

Karen Litzy (13:25):

Yeah. That's how I used to be. Now. I'm like could you help me with this, this, this, and this? I mean, because I don't, I'm not an account. I've never filled out. Like I got a PPP loan. I didn't know what I was doing. So I would take screenshots of everything, send it to him. And then he was like, put this number here, put this number here, put this number here. And I was like, did it digit to do? And guess what? It was approved. If I didn't have his help, I wouldn't have been able to do that. I have learned, I've seen the light.

Jamey Schrier (13:54):

Don't tell anyone. I did the same thing. I call my accountant very calmly. I said, Hey Greg, what should I do? He said, well, it makes no sense not to get the PPP loan. I mean, it's more or less going to be free money. Who knows what's going to end up happening with it. But go ahead and apply that. I said, great, can you have someone help me with that? Because if I don't feel like doing it and he's like, sure, yeah. So everyone's talking about PPP loan. Everyone's freaking out. I've had, I can't tell you how many dozens and dozens and dozens of conversations I've had with business owners. Because I asked him, I go, so who's on your team. Do you have an accountant, financial advisor, someone that understands this and they went, well, I have a friend or a neighbor that does my taxes. And I'm like, see there lies the problem because you don't look at your business as a team of people that are experts in different areas.

Jamey Schrier (14:52):

So if you're going to learn from this whole COVID thing, start building the experts in your business. So it doesn't fall on you to try to be the expert that you're not. And give yourself permission, Karen, like you did. And I did. I'm not the expert nor do I want to be. However, I do know enough to know that I need to talk to the accountant about this particular problem. Yeah. So talking to someone, even if it's your bookkeeper and start to design what you have available, because that is going to determine if you have literally no money available, then bringing back all your staff isn't feasible, right? It's just not going to happen. But if you have some money available, if you have some other loans, maybe you have equity in your house. Maybe you have some things, not that you're going to use it, but you have it there.

Jamey Schrier (15:46):

Then the next thing is, start to create the plan, have a plan. Now I typically teach what's called a 90 day sprint, right? 90 day sprint is what is the outcome? The number one outcome you want in the next 90 days, once you're clear on that outcome, let's say the outcome is I want to be a lot of outcomes for people. I know I want to be back up running the way we were before at the same level, it doesn't mean they're going to do it, but it's amazing how many people have believe it or not. It's amazing how many people have that. They are literally 80, 85% pre COVID and they just, you know, kind of reef officially grew up in a, you know, for six weeks ago. So it's amazing what happens when you put that scary goal out there. But the purpose of it is to just reverse engineer down to, so what has to happen this week?

Jamey Schrier (16:46):

What are the two or three things that have to happen this week for you to start moving towards that? So once you get clear on your financials, you got to start making decisions about your staff. The one thing I would be very weary of is diving back in. If you weren't that before, if you were not treating 40 hours a week, I would not knee jerk reaction to go back to that. The reason is this, I know it seems. Yeah, but if I do it, it's like free money because I'm not paying myself. Yes. That would seem to be the case, but it's not. It's actually going to cost you more money because your mind, your creative energy is all taken up by taking care of the patients in a very emotional setting, dealing with the notes and the insurances and all that. And you're not taking a step back and a 30,000 foot view and really seeing the different components of the business.

Jamey Schrier (17:50):

And if that happens, your natural response is going to be quick, impulsive decisions. Even you think you're a hundred percent sure of the decisions you can't trust yourself because of the emotional state that you're in. So if you've been a treater before, okay, if you want to go back to that fine, cause you still need to remove yourself at some point, even if it's cutting your schedule down, cause you need to look at things to run your business. So, but if you're not, take a survey of your staff, who's essential. Well, you need people that can generate money. I would choose the people that were the most productive before. COVID sounds obvious, but sometimes you kind of like so and so more, but even though they weren't a great therapist or not a producer and you make decisions like that, or you haven't really had numbers, you're not even sure what your metrics are.

Jamey Schrier (18:45):

We never really tracked productivity. I think this person was good. So look back at that. Or when, in doubt, who was sought after bring those people back. Now, if you're deciding on will Jamey, should it be full time or part time there's other models out there. I just got off a conversation with a guy that has a business around employment payment models. And he was talking about, you know, this model of shared risk is becoming more and more popular. So perhaps you do an hourly model. Perhaps you explore a shared risk model where the person gets maybe one third or 40% of their income and then they get targets and they make money based on that. You don't have to know what that is. You just have to know that someone is out there that knows what those options are. Your job is to go out there and find out about it and then share it with your staff.

Jamey Schrier (19:48):

So really getting clear on your team and who you need. I would absolutely bring a front desk back, obviously your billing and all that can be done from anywhere. And then the biggest thing is if you don't have patients in the door, none of this is going to matter. Your money will eventually run out. So I am a simple person, you know my stuff isn't rocket surgery. As one person once said it isn't rocket surgery. What was working before COVID hit? Like, what were you doing? I know most people will answer. I don't know. It was kind of word of mouth. I was kind of doing this. Like they weren't really clear on that. Well, first of all, moving forward, let's be really clear on that. What's working. What strategy was working. One of the most basic strategies you can use.

Jamey Schrier (20:39):

That's a human strategy is reach out to your people. If you haven't already, most people have reach out to your patients, reach out to the list of people, check in with them, see how they're doing. And they've been cooped up for months. I don't know about you, but I got problems all over the place. Cause I haven't been able to exercise the way I want I'm stress. Of course, stress goes to my back and my head shoulders, these people, it's not like COVID took their health. I mean, they still are human beings. They still have the same problems they did. If not worse, how can you help them? So approach it from, Hey, how are you feeling with all this? Well, my shoulder hurting, Hey, you know what? And then you just offered maybe a free consult. Then you do it either in person or through tele medicine.

Jamey Schrier (21:30):

Yeah. If you do that and you approach it genuinely like you want to help them, man, I've had people generate dozens and dozens of patients quickly. And I would put the people that are best on the phone that had the highest level of communication. Don't put someone that doesn't really like people that much, you know, like don't put that person on the phone. They're not going to like having that conversation. Same thing for your referral sources, same thing for your referral sources. And you know, can I share one strategy, marketing strategy, eight marketing strategy. And you and I were just talking about it right before this, you said, you know, I couldn't get half these people on my podcast and now what else are they doing? They're like, sure, I'll come and share all this stuff. Well, we have a simple strategy that is called an interview spotlight strategy.

Jamey Schrier (22:27):

And all you do, same thing. What we're doing here. You just reach out to a rep. We call them referral partners. But someone that oversees and has influence of your target audience, right? If you're going to do this, do it with someone that as you build a relationship can send you the kind of people you want and you offered to interview them and you choose the topic. That would be interesting to your audience, to your list of people. So do you specialize back pain? Are you a vestibular person? Are you pediatrics? Women's health doesn't really matter? And you say, Hey, I was you know, I was thinking we're starting in an interview. Spotlight interview love to interview you. It's all through zoom, 20 minutes, 30 minutes, whatever it is, we'll promote it to all of our people. So I'm sure you'll get some recognition and business out of it. And if you'd like, you could promote it to your people as well. And then you end up with marketing term leads, prospects as well. But what really happens is you start building a connection, a deeper connection with the referral source, who obviously is, you're going to be top of mind with them because you reached out and helped them. You weren't the person sucking on the teat did, give me, give me, you were actually providing something first.

Jamey Schrier (23:46):

One of my clients did this and he generated 50 cases, 50 in a very short period of time in New Hampshire, like massive town. And he said, this is like, I think it was like 52 people. Exactly. But he said, Jamey, this was easy. And it was fun. It was really a lot of fun. And because we're all used to zoom now, the technology is so easy to use. You just record it. Doesn't have to be video. You can do audio and you just save it and slap it in an email.

Karen Litzy (24:18):

Yeah. Yeah. That's a great marketing tip. Thank you for that. And just so people know it doesn't, you don't have to have a podcast to do that. You could just, like you said, save it, send it out to your list. Even if your list is five people or if it's 500 people just, you're just creating good content that people want to hear.

Jamey Schrier (24:40):

And you're meeting people, who's a great marketing, same and it can be used for anything. Always meet people where they are not where you want them to be. So if I was going to do this in New York and let's say reach out to some docs or reach out to some other people that may I'm like if you do with personal trainers or CrossFit or whatever your audience is, my approach in New York would be different than my approach in the Midwest. Of course, right now, the template's the same, but how you're going to do it, how you're going to, I mean, what you're going to talk about the content has to meet your people where they are. If you start talking about, Oh my God, we're opening up. Things are great. And all that. That's not going to land on a lot of people in New York.

Jamey Schrier (25:31):

So meet people where they are meet the doctor, meet the people, meet the other referral partners where they are and see how you can help start cultivating these relationships. And as your town opens up more and more and things get back to quote normal, whatever that is that bonding is what separates you. That's what keeps giving again. And again and again. So how many of these can you do? I mean, I know some people are doing like twice a month and they said, this is just fun and it's easy. And by the way, it does lead to other opportunities.

Karen Litzy (26:07):

Sure. Tell me about it.

Jamey Schrier (26:09):

I mean, your whole business is built on, you started this. You're like, I'm trying to figure this out and all of a sudden you've done. I don't know thousands of episodes. You've met all kinds of people. I know you used to travel around the world. So  this is a formula. And it's a really powerful formula. I'll tell you the hardest part about the whole thing.

Karen Litzy (26:31):

Yes, absolutely.

Jamey Schrier (26:35):

Passion. Don't let the little critic on your shoulder go, but you can’t do it. I think you need to be, you need to learn more about zoom. Just do it, just do it.

Karen Litzy (26:37):

Yeah. So yeah, it doesn't have to be perfect.

Jamey Schrier (26:49):

It better not be, if it's perfect. It's too late. You're not doing something that's rusty, not rusty, but like just rough around the edges and stuff. You've waited too long. You need to get what is called the minimum viable product up running and out. Then you learn from it and your fourth interview will be a hundred times better than your first. And there's nothing you can do about it. Yeah. So true. So how quickly can you get to the fourth interview?

Karen Litzy (27:19):

Yeah, that's great advice. And now as we kind of wrap things up here I know that as we were going through this conversation, one thing that struck out as like, you just can't do all of this stuff on your own. It's what I should say. You can, but it's really, really hard, right? Why would you, so having a mentor coach, is something that can be so helpful. So where can people get in contact with you if they feel like, okay, I've got this business, I'm ready for it to grow. I don't know what the hell I'm doing. So where can people find you and learn a little bit more about what you're doing and if you've got any free resources and things like that for people that would be helpful.

Jamey Schrier (28:12):

Sure. So I want to just real quick, I know we're coming up on time here, but I want to address real quick with the idea of the coach or a mentor. You know, a coach isn't the end all be all it. Isn't the person that has all the answers and all the solutions to your problem. The way I got into coaching was I resisted it because I was a rugged individualist. Who's smarter than most people who could figure it out. And eventually I started looking at my bank account, looking at the amount of stress I was dealing with and looking at how many hours I put in. And I said, these aren't the results I want. So whatever I think I am doing, it's not getting the results. So can I just swallow my pride and my ego and go ask for help.

Jamey Schrier (28:55):

And that is so hard for high-achieving individuals like ourselves. So if you are at the place where you're like, you know what, I want some guidance because to me, a coach is guiding you. It's a co collaborative effort. It's strategic thinking partners. If you want that person go and find the person that connects to at practice freedom U I built our company based in part of providing people that kind of business coach, that kind of guide that helped them through some of these problems. Cause it's hard to think of it. I've had a coach for over 14 years. I'll never not have a coach because I don't trust my own thinking because I don't know what, I don't know. So if you're interested in that, you can certainly reach out. You can check out our site, practicefreedomu.com.

Jamey Schrier (29:50):

You you can get my email from Karen, but one of the things that I thought would be a great thing for your audience is to give them a little insight on some of the things we talked about today and a lot more other things that I think are very appropriate in how to restart, rebuild, and build your business the right way. I did write a book called the practice freedom method and it's 12 chapters of various things from marketing to hiring, to financials a lot with my story and all the struggles I went through. I share all the crap that I went through. So you can learn from it and I wanted to give it to your people for free. You can download it immediately. It's the entire book, but feel free to just go through the chapters it's in digital form.

Jamey Schrier (30:42):

You just go to practicefreedomu.com/healthywealthysmart-podcast, and you'll just get it immediately. So that would probably be the first place that I would go. And if some of my stuff resonates and you want to have a conversation happy to do so, if not, I would just seriously, you know, consider getting a mentor, finding someone or even maybe a small mastermind group, just people you resonate that can think differently than you to help you through things that alone will take you down a better path, regardless of the specific strategy or tactic that you use.

Karen Litzy (31:21):

Right. Excellent advice. And thanks for the free book. And that'll also be on the podcast at podcast.healthywealthysmart.com under this episode. So one click and we'll take everybody right to that site. And now last question, knowing where you are now in your life and in your career, what advice would you give to your younger self? Say a young pup, right out of PT school?

Jamey Schrier (31:49):

Young Jamey Schrier that's scary. Cause I was one cocky son of a bitch. God, I knew it all. Fear is a part of this fear is a part of growth and it is never the right time. You will never feel like you're enough. And if I had to talk to myself before I would've told myself, swallow your frickin pride and start hanging around people that you want to be like, that you're in that you're impressed by something of what they're doing. Just be there, just be with them. And just soak up some of that. I didn't do that a ton. I had a little bit of an attitude towards that. I don't know why. I don't know where it came from, probably because I wanted to feel improved to myself. I wanted to do it on my own. And the reality I look back and I was like, God, that was the stupidest thing I ever did. So whatever your passion is, whether it's business and you want to do your own thing, whether it's side hustle, I know that. Or whether you just want to be the greatest therapist or clinician or researcher, just connect with other people. People are so awesome in giving and providing, but they're not going to do it without you coming to them.

Karen Litzy (33:10):

Yeah. They're usually not knocking on your door while you're on your couch watching TV.

Jamey Schrier (33:15):

They're not going to come to you and what the successful people out in the world. I don't just mean financial success. I mean success and happiness success and just who you are as a person, just your own wellbeing. All of those people have these groups, these connections, these people, they reach out to, they all do. They might not talk about it, but they all do. They all have coaches. They all have mentors. They all have people they connect with. And when you do that, it just makes this so much easier and so much more fun.

Karen Litzy (33:48):

Yeah, absolutely great advice. So Jamey, thank you so much for coming on and everyone again you could go to a podcast.healthywealthysmart.com to get the book or go to freedom practice U the letter freedompracticeu.com/healthywealthysmart-podcast for the book. And you can also find out more about Jamey, what Jamey's doing to help so many physical therapy business owners around the country. So Jamey, thanks so much for coming on again. I appreciate it.

Jamey Schrier (34:25):

Oh, thank you, Karen. Enjoyed it.

Karen Litzy (34:28):

Great. And everyone, 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 Apple Podcasts

Aug 10, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Erica Ballard on the show to discuss how to optimize your health and performance through nutrition.  Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules.

In this episode, we discuss:

-The impact of optimal nutrition on performance

-How to detect and remedy vitamin and mineral imbalances in your body

-Mindfulness strategies to cope with quarantine stressors

-And so much more!

 

Resources:

Erica Ballard Website

Erica Ballard Instagram

Erica Ballard LinkedIn

Pantry Essentials Playbook

The Lies We've Been Fed Podcast

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

 

For more information on Erica:

Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. Erica has her MS from Tufts University School of Medicine, got her CHC through the Institute for Integrative Nutrition, is a regular contributor to WTHR 13, and has been featured by Women’s Health, Lululemon, and the Young President’s Organization.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey, Erica, welcome to the podcast. I'm so happy to have you on. And now, before we get into the meat of our discussion, I would love for you to talk a little bit more about you so that the listeners kind of know how you got from point a to point B to where you are now.

 

Erica Ballard:

Sure. So for most of my life, I have been a public health practitioner. People pleasing go getting type of gal. And so because of that, I thought I knew what healthy was. And so I was always trying to get there through the traditional means of, you know drinking the shakes, eating the bars, following the guidelines. But the thing about it was I never actually looked or felt the way I wanted to, which was again, so confusing because rule following people, please are working in public health.

Erica Ballard (01:02):

You think that I would look the way that I wanted to given that I knew quote, unquote, exactly what to do because I had these huge desires to not only have the body I wanted and look like the women I saw on TV or magazines, but I also had this like deep desire to be happy. And I thought that health or fitness, because I equated the two at the time was the linchpin for me because externally I had everything that one would desire, but internally I felt unfulfilled. And so the only piece that was missing in my exterior, you know, look was my weight. And so I was like, okay, that's it. So I did what everyone does, who tries to get healthy? I like, I count calories. I followed all the rules. I tried to outrun every French fry or glass of wine that I would have, and I just couldn't get there.

Erica Ballard (01:57):

And that all changed though, when I moved from East coast to Indianapolis, which is where I'm originally from, I moved here and I went to the Institute for integrative nutrition, even though everyone said, don't do it because I got my master's at Tufts medical. I had still student loans, all those things. I was like, no, this is the thing. And it was like, it was the thing. It actually taught me that, you know, food sleep, stress. Those are the drivers of health. And when I figured that out, I went out and I tried to share this information with people. And when I did, they were like, no, that's not right. And so while I started to get results, I would hear them or I would hear society saying girl, no. And so then I would stop doing the thing that made me feel better.

Erica Ballard (02:46):

And it was this weird up thing that would happen until finally I decided now I'm the expert on me actually. And I'm going to let feeling good lead the way. And when that happened, it's like weight dropped. I was able to hold conversations and happy. My mom likes me again. Right? Like I wasn't the worst human being who was like constantly snapping and more. So I just figured out that, like I was in charge of my happiness. I was in charge of my health and I knew best. And so doing that journey is what has brought me here today to help not only continue to help myself, cause you never just arrive at health. Right. But also to help others who are really desperate to get healthy, do it because most of the people that I help are high performers are people that are willing to do the work and are just like, I am doing it, but I can't. And I'm like, I got you. I've been there. And so walk them through the things that they can do in order to really enjoy their lives while being healthy.

Karen Litzy (03:49):

That's incredible. And now let's talk about that. Cause I love that you work with kind of high performance people, high achievers, high performers feel like I'm the same way in New York. I don't know a lot of people in New York who aren't that way. I think that's part of living in that might be a requirement for living in New York city. But let's talk about how we can optimize our performance through food, right? I'm a physical therapist. So we're used to optimizing performance through strength, training, stretching, pro programs, plyometrics, but as a physical therapist, I also know that just what you said, sleep food are paramount to when it comes to being able to optimize your performance. So I'm just going to throw it over to you. And I would love to hear your take on what that means.

Erica Ballard (04:42):

Sure. So it was up to two things when I have this conversation because so many people will tell me all the time, Hey, I get so much done. Even though I don't eat the way I should or I'm drinking these Cokes or whatever it is. So like screw you Erica. And I'm like, listen, you're only in second gear. Like think about that. Like you're only in second gear, you get to fifth, you have to get your food. Right. And the first reason I think that I think it's so clear that we need to get our food right for this is Maslow's hierarchy of needs. So at the bottom of Maslow's hierarchy of needs is psychological and within psychological is food. So that means in order to get the self actualization, the top that, you know, essentially self fulfillment, you have to get the base, right? So without it, you just can't be. And if that's not enough, cause social science, isn't always enough for people. The hard data is starting to show that our brain and gut aren't connected. So we know that if what you put in your gut is not good, your brain will not function. And if your brain will not function appropriately or to the best of its ability, you can't optimize because a lot of your decisions are made with your brain.

Karen Litzy (05:47):

Right? Absolutely. Yeah. And, and you know, when we talk about that brain gut connection and you can correct me if I'm wrong, but we are really one of the bigger there is that Vagus, Am I correct? In that a hundred percent? Do you want to talk a little bit about that?

Erica Ballard (05:58):

Well, I think it's one. So for me, when I work with clients, I can, but where I always find it being interesting is that when I talk with people about how to get healthy every single time, I don't know, this is what happens to you when I get into the nuances. They're not, they're like, yeah, the Vagus nerve that matters, but I'm like, yeah. Breathing, putting things in making sure that like the fibers in your gut, they're all going up to your brain, making sure that that's, they're talking matters, but the nuances I have found people don't care as much about.

Karen Litzy (06:36):

I can definitely relate to that because I deal with a lot of people who have pain, more chronic pain. And so when I sort of go into kind of the neurophysiology behind pain, people like get it for a little bit, but then they just don't want to go that much deeper into the weeds with it. Like you said, like the nuances, but for the purposes of our discussion, I would like to, so let's pretend I'm like your ideal client and I'm like, Erica, tell me what does all this mean?

Erica Ballard (07:10):

So for me, when I look at our nervous systems and how they're connected, right, we have this nerve that literally runs through our body that connects these two entities and for it to be functioning appropriately, to make sure that the fibers around it actually work to make sure that it, all of the things that it's also then connected to work appropriately. It's really important that we put in foods and fibers and vitamins that our body need for those things to communicate and talk. And so what we typically do, right, is we're like, we'll put whatever it's in and it doesn't matter. And if I just drop weight, I'm going to be the healthiest version of myself. And it's like, no, you have, you have the Vagus nerve, you have your entire nervous system. You have your gut lining.

Erica Ballard (07:58):

You have these, like you have these different pieces within your body that need to appropriately absorb all of the nutrients in order to make sure that everything is communicating the way that they should. And so when I think about how to optimize and when I think about food and Vagus nerve and all of those pieces is I like where my head often goes is in order for these things to function appropriately, we need the right amount of nutrients and we need our body to be able to absorb them so that these things can talk. But we were like, we think that supplements work by themselves. And we think that vitamins and minerals work by themselves, but it's a payer to make sure the communication is appropriate.

Karen Litzy (08:45):

Okay. That makes sense. Yeah. And I think you do see a lot, I don't know about you, but I see a lot of people Hawking different kinds of supplements and vitamins and this and that. And then you hear research on none of it matters, right? Like, Oh, why take this? Why take that? Why take a multivitamin or take a plethora cocktail of vitamins that doesn't work. You should get it all from food anyway. So what do you say to that?

Erica Ballard (09:11):

So I think there is, I can understand where they're coming from. And I think that from a health perspective, if you're at the beginning and you're like, I'm trying to get healthy, I can't quite figure it out. Start with food nine times out of 10, or I would, should say eight times out of 10, start with food, making sure that you have of the highest quality items. But when I think about the importance, I used to really agree with that. But now I'm starting to understand the importance of supplementation or I have fully grasp it of supplementation because the soil in which our food grows does not have all the nutrients necessary for our body, for the plant to grow to the best of its ability and for our body then to take in all the nutrients that exist. Like as a society, we are magnesium deficient as a society. We are vitamin D deficient. And as a society, we tend to be omega-3 deficient and you can't often get enough magnesium through your food, especially if you're trying to make up and provide them in D like if you're in a Chicago or Boston or in New York, it is listen, it's cold outside. Like it is hard.

Erica Ballard (10:22):

To get those things in. So while I believe that food is medicine, I do believe often food is the first line of defense. If your thyroid isn't working appropriately, if you're in a lot of muscle pain, if you're not sleeping so well, those are, they're probably supplementations that you need to bring into your body to make sure that it's optimized. But, before going to experiment, I would always say consult with a practitioner or like PT health coach, like certified health coach doctor nurse practitioner, because you can't like you can't really OD per se, but you can get the wrong results from these supplements.

Karen Litzy (11:04):

And do you suggest people take blood work? Like if you're working with someone, do you suggest they get blood work taken so that you have a clearer picture or to see like, Oh wow, you really are deficient and XYZ. And then here's a way I can plan this.

Erica Ballard (11:19):

So when I work with people, what I always recommend is first start with your diet. So straight up, like most people are not eating enough vegetables. You know, if you're listening to you are like eat vegetables, try to also clean up your diet, take out where you can. And if you can organics pasture, raised grass fed really just up that quality and see what happens. But if you do that and in a month, you're not moving towards the results you want. Blood work, I think is, can be extremely helpful because like, for instance, going to like to the thyroid, the amount of hypothyroidism underdiagnosed in this country is, is pretty high. And when you also look at inflammation markers, even though you're eating a clean diet, like if we're having food, like we're eating things that we're intolerant to, maybe you can't get that exact number in, or that exact food item in the blood work.

Erica Ballard (12:14):

But I do think it helps really show same with magnesium, vitamin D cause there's different protocols, right? Based on different deficiencies that you have. And so to be able to task, versus just to think I provides a piece of mind that a lot of people want, especially going back to the high-performer piece, like your mind is always going, like you're going a thousand miles a minute, but if you can get paperwork that will show you what's happening and different ways to track, it can feel really nice. And it also can feel like an accomplishment.

 

Karen Litzy:

Yeah, I agree. And I think that it gives you, like you said, a goal to work for, to work towards maybe like, I know I'm like a big numbers person, so I really like to see the numbers. So for me, if I had like a blood test, let's say I was vitamin D deficient, which I am by the way. And then I was like, okay, well let me change my diet or let me take this supplement. And then I got another blood test in six months and it was better than I would be like, okay, this is a little bit more proof for me. This is what I needed. And it would encourage me to stay on that healthy path.

Erica Ballard (13:09):

Yeah. And I think there's nothing wrong with that. I think that that's why there's such beautiful things with all the tracking devices and blood work and the availability of multiple different types of blood work now to test all these different things, because what I always find, and this is neither good or bad, it just is. It's not a lot of folks are sicker than they know that they are. And because they're so used to feeling a certain way, they don't even know that they're in deficient levels or dysfunction.

Erica Ballard (14:00):

And so that blood work can also, as a practitioner help us show that there are different ways to feel better. Because going back to the vitamin D example, I mean, vitamin D was all the rage. And then it was then were told it was a crock of, you know, stuff. And then now it's coming back in and it's like, if we could just show here's where it should be, that was conventionally what we said. Right. And here's where we need to be. It just fosters an easier conversation.

Karen Litzy (14:53):

Yeah. I think you get better buy in, you get people like, Oh boy, I don't think it's, and I don't think it's meant to scare people, but it's just meant to be like, Hey, you know, something may be some of your symptoms. Maybe they're correlated with this. You know, it may not be causative, but maybe it can correlate and let's see if we can change some and see, Do you feel different? And then retest, it's just a test retest, right?

Erica Ballard (15:03):

It's yeah. And if one scientific method, if you will, I'm all for that. And I think when it comes to supplier minerals, nutrition, like nutrients, things like that, it's really helpful. I think the only place I would say, and I would be interested in what you think that it's not as wonderful as doing the test on yourself is food intolerance. Because I find that the best model or the best testing out there is 85% accurate. Whereas the gold standard I have historically found is to pull it from your diet for three to four weeks and then systematically add it back in. Which you can do anything for three weeks.

Karen Litzy (15:40):

Yeah. Yeah. And I've done that in the past. And it was definitely very, very helpful. Like I took things out of my diet for a month and it's felt a huge difference. I had some autoimmune issues after getting the flu shot. So I had an auto immune reaction to that and it was quite painful and it lasted nine months. Yeah, it's called erythema nodosum it looked like somebody kicked me in the shins 500 times of the steel toed boots. Like it was swollen and red and purple. And I remember I was at the time dating this guy that lived in Baltimore and it was on one leg and it was like over Christmas. So it was in between Christmas and new year's and it was on one leg. I was like, what? And I remember I showed his mom like, what, what do you think this is?

Karen Litzy (16:28):

And she's like, she used to be an EMT. And she was like, I feel like you should just see a doctor. I'm like, why? And she's like now. And so I just went to like a ready care place, you know, like a city MD. And they thought it was like a staph infection, which I was like, this is I've seen or cellulitis. I was like, listen, I've seen cellulitis this ain't it. And then the next day I woke up and was on the other leg and I'm in Baltimore. And I said to my boyfriend, like, we gotta go to the ER. He's like, I don't know where to go in Baltimore, Johns Hopkins, Johns Hopkins immediately. And I went in and the doctor said, I'm in the ER. And he looked and he's like, it's erythema nodosum. I was like, what he's like, did you have any, like, do you get any shots lately?

Karen Litzy (17:08):

I'm like, well, I got a flu shot a week ago. He's like, yeah, it's the flu shot. Don't ever get a flu shot again. I was like, okay. So that was over Christmas. And then it finally, all of the symptoms went away in September. And, what I changed in September is I did an elimination diet and took a whole bunch of stuff out. So I don't know what it was, but I mean, I mean, I stopped sugar, gluten caffeine, which I didn't drink anyway. Dairy, everything, like just took it all out. Yeah. And then within a month I was like, and even like my boyfriend, he's like, you're so much brighter and you're back yourself again. And so that auto-immune really like knocked me out quite a bit. And so I do agree there is something to that pulling stuff out of your diet and just see what happens. I mean, it's the easiest thing you can do, right. Doesn't cost any money.

Erica Ballard (18:06):

I mean, there's so many now alternatives and just the auto immune piece of it. I work with a lot of folks who have auto immune disorders and gluten. I mean, whether or not you have an intolerance or not gluten, for some reason always seems to aggravate these autoimmune diseases. And so we're disorders. And so when you pull that out for a few months, it doesn't mean it has to be gone forever, taking it out and then allowing yourself to see if it works or doesn't is huge. And like you, like, it's the sugar and the caffeine. I know it can be really tough for people, but the rest of the stuff there are alternatives for all.

Karen Litzy (18:39):

Yeah, absolutely. And I mean, I don't really have a lot of sugar and I don't drink caffeine anyway. So that was easy. The other thing was no alcohol also fine. I can handle that. You know, the gluten was a little hard in the beginning, but then like you said, like I just had gluten free bread and gluten-free POS I mean, it's so easy. It's not like I was like Jones and for tea, like a loaf of French bread or anything, you know? So for me, I felt like, Oh, this was super helpful. And I have not had the flu shot since.

Erica Ballard (19:09):

I wouldn't either if I had to.

Karen Litzy (19:11):

Horrible. Anyway, so we're talking about optimizing performance through food, right? And so I think the listeners can now get an appreciation for how food should be the first line of defense. Then move into if you need vitamins or supplementation or minerals and nutrients and when these work together, your brighter you're quicker. Like you said, you're moving from second gear to fifth gear.

Erica Ballard (19:37):

Yeah. And the thing that always it's interesting for people when they do this is they never knew that they could feel this good. And now it's what makes continuing it so much easier. It's both a mix of like, I feel this good. And then being quite honest is when you start to eat better, like take supplements, do those types of things. When you put in things that your body doesn't like, man, does it fight back? Like you just feel the pain, you feel the grogginess, you feel the lethargy and you don't do it anymore. Because a lot of times people will say, well, you're healthy. It's easy for you. And it's like, Oh, it's either I feel horrible. Or I take care of myself because I've done enough. I find that the body always is trying to talk with you. It's always communicating and it will slap you in the face. If it does, if you do something, it does not like, and most of us can't feel it because we've put it in such a stressed out state. So that it's always feeling so bad that like, it's just hanging on because we're in survival mode. But when you get into that parasympathetic nervous system, when you get into thriving, it will literally have as many communications and conversations as it can that you move in the best direction for you.

Karen Litzy (20:53):

Yeah. And it sounds to me like what you're saying is the body would prefer not to feel like shit.

Erica Ballard (21:03):

Yeah. That's exactly in a nutshell.

Karen Litzy (21:05):

Okay. All right. That's what I thought. Okay. So you brought up briefly, they're talking about stress. So let's talk about stress. I mean, we're still as we're recording this, I'm in New York city, we're still on lockdown. We're in the middle of a COVID pandemic. So stress is a real thing right now. And when we're stressed, I think that's when people are like, I'll take that piece of chocolate, I'll take this, you know, so what can we do to help overcome the stress without falling back on those cravings if you will.

Erica Ballard (21:39):

That's a really good question. And I heard something this morning that I think was brilliant. So I'm going to share it here is when we think about stress, the idea is just, how do you get back into the present moment and how do you get back in to finding joy? I mean, it sounds a little corny, but that is that's it. And so in quarantine, what can be really helpful is identifying things that you could do that you would do on your vacation at your house. So whether you take naps on vacations or you take long walks, or you listen to music in the morning, instead of a podcast, doing those things that transport you into a state of calm is really helpful. And we can do those things in our house. We just completely forgot that we could, because we're so used to only doing them when we're out there.

Erica Ballard (22:36):

So that's the first thing that just came to top of mind when you were, when you asked that question. And I think the other pieces are just looking for moments of not solitude seems like the wrong word right now. But moments of peace, because while some people are not at the office, we're there were so available now. And at least we had these cutoffs, right? You go into the office, you leave the office like, and that was that. Now everyone knows we're not going anywhere. So we're getting the emails, we're getting the texts, we're getting those things. And if we could work our way in defining moments where we can shut down, whether it's the walk without the phone, whether it's actually closing your computer and not opening it back up, putting your phone away for half an hour, those things are really gonna help bring you down. Even though we don't think that they do like you feel it in your body, like 15 and another phone, you kind of, you're able to sink down into that couch wherever you're at and just be.

Karen Litzy (23:40):

Yeah. And you know, I've been hearing that from a lot of my clients who I normally see patients in their homes. And so at this, right. Nobody wants somebody coming into their home and I don't blame them. But they're also working from home and what everyone's saying, they're like, you know, when I'm at work and we have a meeting, I get up from my desk, I walk to a boardroom, I sit down, I go to the bathroom, I talked to other people. I come back, I walk to work. I walk home from work. I go out for lunch. I come back in or at least I go to the kitchen and I come back to my office. And now I said, you know, I'll have a meeting from two to three. And they're like, Oh, you're available at three. We're gonna have another meeting from three to four.

Karen Litzy (24:20):

Oh, you're available from four to five. She's like, so all of a sudden my patient, she was like, I'm not leaving my computer. Whereas when I'm at work, I do. And I also have the opportunity to get fresh air, but now I'm 12 hours. I barely have time for lunch. And I'm just, and I heard that again and again and again, so you're right. It's that, that feeling of, we all have availability and for some people, their only option might be a five minute break, you know? Like they might not be able to take that half hour break if they've got people sort of like breathing down their throat. So do you have any advice for those people to do like a five minute break or a three minutes something to help at least ground them a little bit.

Erica Ballard (25:04):

Yeah. So there's two ways to do it depending on who you are as a person. So I think standing up planting your feet from on the ground and just breathing in and out in a really calm, amazing fashion and like feeling the breath go through you is just such a great way to literally move yourself into a very present state. The other way is to move your body, right. It depends on who you are and what you need. When I have five minutes between meetings, I'm not even going to hide it. Like I, right now, I'm here for the Jonas brothers. You can judge me all you want. I turn on the Jonas brothers and I like dance in my house. Cause those songs are only like three and a half minutes. So I will literally put it on and I will just dance around my house because a music makes me happy. But also it like moves. My body moves. My energy moves like that stagnation. And so whether it's squats for you going up and down the stairs dancing, whatever it is, it's just shaking off what was for what is. And I find that that is very helpful when you're chained to your desk for 12 hours on end.

Karen Litzy (26:10):

Great advice. Thank you so much. So now before we wrap things up, is there anything that we didn't touch upon or anything like, what is the thing that you want the listeners to leave this discussion with?

Erica Ballard (26:24):

I would say that if you want to get healthier and you're not where you want to be really taking a look at your food and at your stress and seeing which one is holding you back. Cause I pretty much guarantee it's probably one of the two and then make a few decisions and change as necessary.

Karen Litzy (26:49):

Excellent. And again, the good thing about this is that doesn't take a lot of money, may take some time, but it certainly is not something that's going to break the bank. And, and again, because we're in these uncertain times right now, you know, people might be a little less wary of like, Oh, do I have to, you know, go and leave my apartment or my home and go and do this and go and do that. But if there are easy ways, like you said, look at your food, look at your stress easy. Now, if you are the kind of person that needs someone to help walk you through it, that's where someone like you Erica would come in, you know, at being a health coach, like that's where you would come in to kind of not hold their hand, but be their coach and give them the game plan.

Erica Ballard (27:41):

Yeah. And, that is why if you do need help, I'm so huge on working with a practitioner because like at the beginning, it's an N of one, you are actually the unique snowflake you think you are. And so helping you figure out the right things for you in a safe space is really important because health is so personal and you get a lot of feels when he's searching to move, try to move in the direction you want to move. And so I do really believe people can do it on their own with a little bit of support from online programs and things like that. But if you can't, asking for help is the best thing you can do.

Karen Litzy (28:26):

Yeah. And I know you have a free resource for the listeners. It's the pantry playbook. Is that right? So do you want to talk a little bit about that? And just everyone knows, we'll have a link to that in the show notes at podcast.healthywealthysmart.com, but talk a little bit about it and where people could get.

Erica Ballard (28:43):

Sure. So I heard from clients all the time, I want meal prep, I want meal prep. I want meal prep. And I was like, no, you don't, they don't want it. But it's what they kept saying that they wanted. What they really wanted though, was they wanted it to be able to make really quick meals on the fly that tasted good because three days into the meal prep, if throughout all of their foods, they're sick of it. So I said enough, that's like, yeah. I mean, I don't like five day old food either. So I get it. And so what I did is, I was like, well, I don't ever meal prep. I don't. And so I was like, why don't I meal prep? Oh, cause I have everything I always need on hand all of the time.

Erica Ballard (29:25):

And so I went to my pantry and started to look at, and then think about all what my clients do and me, and they're there, the special needs that go on and was like, Oh, I can create a list that if you always have on hand, it's going to be faster to make healthy meals than it is to go out and get takeout, because these are our options, right? We meal prep, we get take out or we make it home. And if I can help you make a fast healthy meal at home that cuts the meal prep and cuts the time it would take to get takeout. It works. So I have that resource for them and it'll be at https://www.ericaballardhealth.com/pantry-essentials-playbook.

Karen Litzy (29:59):

Thank you so much. And now onto the last question that I ask everyone, knowing where you are now in your life and in your career, what advice would you give to yourself after college? Let's say grad school

Erica Ballard (30:12):

That I love this question and I really, really wish I knew this, that you can do it your way.

Karen Litzy (30:22):

Mm, powerful.

Erica Ballard (30:24):

It's just with health. Like you go into people's homes. Like I go into people's homes via camp, like what, like, you know, zoom, you can do this thing. You were away. So don't follow someone else's rules. If it doesn't feel good inside.

Karen Litzy (30:41):

Excellent advice. And where can people find you social media website?

Erica Ballard (30:47):

Okay. So I play a lot on Instagram. So it's at Erica Ballard health. I'm actually on LinkedIn quite a bit. Website is EricaBallardhealth.com. And I had a new podcast that's actually dropping on June 2nd called the lies we've been fed. And it's an eight part series that walks people through the lies that we have been fed about food to give them a path forward.

Karen Litzy (31:12):

Awesome. It sounds great. I look forward to listening and thank you so much for coming on. This was wonderful. Thank you and everyone. Thanks 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 Apple Podcasts!

Aug 10, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Erica Ballard on the show to discuss how to optimize your health and performance through nutrition.  Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules.

In this episode, we discuss:

-The impact of optimal nutrition on performance

-How to detect and remedy vitamin and mineral imbalances in your body

-Mindfulness strategies to cope with quarantine stressors

-And so much more!

 

Resources:

Erica Ballard Website

Erica Ballard Instagram

Erica Ballard LinkedIn

Pantry Essentials Playbook

The Lies We've Been Fed Podcast

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

 

For more information on Erica:

Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. Erica has her MS from Tufts University School of Medicine, got her CHC through the Institute for Integrative Nutrition, is a regular contributor to WTHR 13, and has been featured by Women’s Health, Lululemon, and the Young President’s Organization.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey, Erica, welcome to the podcast. I'm so happy to have you on. And now, before we get into the meat of our discussion, I would love for you to talk a little bit more about you so that the listeners kind of know how you got from point a to point B to where you are now.

 

Erica Ballard:

Sure. So for most of my life, I have been a public health practitioner. People pleasing go getting type of gal. And so because of that, I thought I knew what healthy was. And so I was always trying to get there through the traditional means of, you know drinking the shakes, eating the bars, following the guidelines. But the thing about it was I never actually looked or felt the way I wanted to, which was again, so confusing because rule following people, please are working in public health.

Erica Ballard (01:02):

You think that I would look the way that I wanted to given that I knew quote, unquote, exactly what to do because I had these huge desires to not only have the body I wanted and look like the women I saw on TV or magazines, but I also had this like deep desire to be happy. And I thought that health or fitness, because I equated the two at the time was the linchpin for me because externally I had everything that one would desire, but internally I felt unfulfilled. And so the only piece that was missing in my exterior, you know, look was my weight. And so I was like, okay, that's it. So I did what everyone does, who tries to get healthy? I like, I count calories. I followed all the rules. I tried to outrun every French fry or glass of wine that I would have, and I just couldn't get there.

Erica Ballard (01:57):

And that all changed though, when I moved from East coast to Indianapolis, which is where I'm originally from, I moved here and I went to the Institute for integrative nutrition, even though everyone said, don't do it because I got my master's at Tufts medical. I had still student loans, all those things. I was like, no, this is the thing. And it was like, it was the thing. It actually taught me that, you know, food sleep, stress. Those are the drivers of health. And when I figured that out, I went out and I tried to share this information with people. And when I did, they were like, no, that's not right. And so while I started to get results, I would hear them or I would hear society saying girl, no. And so then I would stop doing the thing that made me feel better.

Erica Ballard (02:46):

And it was this weird up thing that would happen until finally I decided now I'm the expert on me actually. And I'm going to let feeling good lead the way. And when that happened, it's like weight dropped. I was able to hold conversations and happy. My mom likes me again. Right? Like I wasn't the worst human being who was like constantly snapping and more. So I just figured out that, like I was in charge of my happiness. I was in charge of my health and I knew best. And so doing that journey is what has brought me here today to help not only continue to help myself, cause you never just arrive at health. Right. But also to help others who are really desperate to get healthy, do it because most of the people that I help are high performers are people that are willing to do the work and are just like, I am doing it, but I can't. And I'm like, I got you. I've been there. And so walk them through the things that they can do in order to really enjoy their lives while being healthy.

Karen Litzy (03:49):

That's incredible. And now let's talk about that. Cause I love that you work with kind of high performance people, high achievers, high performers feel like I'm the same way in New York. I don't know a lot of people in New York who aren't that way. I think that's part of living in that might be a requirement for living in New York city. But let's talk about how we can optimize our performance through food, right? I'm a physical therapist. So we're used to optimizing performance through strength, training, stretching, pro programs, plyometrics, but as a physical therapist, I also know that just what you said, sleep food are paramount to when it comes to being able to optimize your performance. So I'm just going to throw it over to you. And I would love to hear your take on what that means.

Erica Ballard (04:42):

Sure. So it was up to two things when I have this conversation because so many people will tell me all the time, Hey, I get so much done. Even though I don't eat the way I should or I'm drinking these Cokes or whatever it is. So like screw you Erica. And I'm like, listen, you're only in second gear. Like think about that. Like you're only in second gear, you get to fifth, you have to get your food. Right. And the first reason I think that I think it's so clear that we need to get our food right for this is Maslow's hierarchy of needs. So at the bottom of Maslow's hierarchy of needs is psychological and within psychological is food. So that means in order to get the self actualization, the top that, you know, essentially self fulfillment, you have to get the base, right? So without it, you just can't be. And if that's not enough, cause social science, isn't always enough for people. The hard data is starting to show that our brain and gut aren't connected. So we know that if what you put in your gut is not good, your brain will not function. And if your brain will not function appropriately or to the best of its ability, you can't optimize because a lot of your decisions are made with your brain.

Karen Litzy (05:47):

Right? Absolutely. Yeah. And, and you know, when we talk about that brain gut connection and you can correct me if I'm wrong, but we are really one of the bigger there is that Vagus, Am I correct? In that a hundred percent? Do you want to talk a little bit about that?

Erica Ballard (05:58):

Well, I think it's one. So for me, when I work with clients, I can, but where I always find it being interesting is that when I talk with people about how to get healthy every single time, I don't know, this is what happens to you when I get into the nuances. They're not, they're like, yeah, the Vagus nerve that matters, but I'm like, yeah. Breathing, putting things in making sure that like the fibers in your gut, they're all going up to your brain, making sure that that's, they're talking matters, but the nuances I have found people don't care as much about.

Karen Litzy (06:36):

I can definitely relate to that because I deal with a lot of people who have pain, more chronic pain. And so when I sort of go into kind of the neurophysiology behind pain, people like get it for a little bit, but then they just don't want to go that much deeper into the weeds with it. Like you said, like the nuances, but for the purposes of our discussion, I would like to, so let's pretend I'm like your ideal client and I'm like, Erica, tell me what does all this mean?

Erica Ballard (07:10):

So for me, when I look at our nervous systems and how they're connected, right, we have this nerve that literally runs through our body that connects these two entities and for it to be functioning appropriately, to make sure that the fibers around it actually work to make sure that it, all of the things that it's also then connected to work appropriately. It's really important that we put in foods and fibers and vitamins that our body need for those things to communicate and talk. And so what we typically do, right, is we're like, we'll put whatever it's in and it doesn't matter. And if I just drop weight, I'm going to be the healthiest version of myself. And it's like, no, you have, you have the Vagus nerve, you have your entire nervous system. You have your gut lining.

Erica Ballard (07:58):

You have these, like you have these different pieces within your body that need to appropriately absorb all of the nutrients in order to make sure that everything is communicating the way that they should. And so when I think about how to optimize and when I think about food and Vagus nerve and all of those pieces is I like where my head often goes is in order for these things to function appropriately, we need the right amount of nutrients and we need our body to be able to absorb them so that these things can talk. But we were like, we think that supplements work by themselves. And we think that vitamins and minerals work by themselves, but it's a payer to make sure the communication is appropriate.

Karen Litzy (08:45):

Okay. That makes sense. Yeah. And I think you do see a lot, I don't know about you, but I see a lot of people Hawking different kinds of supplements and vitamins and this and that. And then you hear research on none of it matters, right? Like, Oh, why take this? Why take that? Why take a multivitamin or take a plethora cocktail of vitamins that doesn't work. You should get it all from food anyway. So what do you say to that?

Erica Ballard (09:11):

So I think there is, I can understand where they're coming from. And I think that from a health perspective, if you're at the beginning and you're like, I'm trying to get healthy, I can't quite figure it out. Start with food nine times out of 10, or I would, should say eight times out of 10, start with food, making sure that you have of the highest quality items. But when I think about the importance, I used to really agree with that. But now I'm starting to understand the importance of supplementation or I have fully grasp it of supplementation because the soil in which our food grows does not have all the nutrients necessary for our body, for the plant to grow to the best of its ability and for our body then to take in all the nutrients that exist. Like as a society, we are magnesium deficient as a society. We are vitamin D deficient. And as a society, we tend to be omega-3 deficient and you can't often get enough magnesium through your food, especially if you're trying to make up and provide them in D like if you're in a Chicago or Boston or in New York, it is listen, it's cold outside. Like it is hard.

Erica Ballard (10:22):

To get those things in. So while I believe that food is medicine, I do believe often food is the first line of defense. If your thyroid isn't working appropriately, if you're in a lot of muscle pain, if you're not sleeping so well, those are, they're probably supplementations that you need to bring into your body to make sure that it's optimized. But, before going to experiment, I would always say consult with a practitioner or like PT health coach, like certified health coach doctor nurse practitioner, because you can't like you can't really OD per se, but you can get the wrong results from these supplements.

Karen Litzy (11:04):

And do you suggest people take blood work? Like if you're working with someone, do you suggest they get blood work taken so that you have a clearer picture or to see like, Oh wow, you really are deficient and XYZ. And then here's a way I can plan this.

Erica Ballard (11:19):

So when I work with people, what I always recommend is first start with your diet. So straight up, like most people are not eating enough vegetables. You know, if you're listening to you are like eat vegetables, try to also clean up your diet, take out where you can. And if you can organics pasture, raised grass fed really just up that quality and see what happens. But if you do that and in a month, you're not moving towards the results you want. Blood work, I think is, can be extremely helpful because like, for instance, going to like to the thyroid, the amount of hypothyroidism underdiagnosed in this country is, is pretty high. And when you also look at inflammation markers, even though you're eating a clean diet, like if we're having food, like we're eating things that we're intolerant to, maybe you can't get that exact number in, or that exact food item in the blood work.

Erica Ballard (12:14):

But I do think it helps really show same with magnesium, vitamin D cause there's different protocols, right? Based on different deficiencies that you have. And so to be able to task, versus just to think I provides a piece of mind that a lot of people want, especially going back to the high-performer piece, like your mind is always going, like you're going a thousand miles a minute, but if you can get paperwork that will show you what's happening and different ways to track, it can feel really nice. And it also can feel like an accomplishment.

 

Karen Litzy:

Yeah, I agree. And I think that it gives you, like you said, a goal to work for, to work towards maybe like, I know I'm like a big numbers person, so I really like to see the numbers. So for me, if I had like a blood test, let's say I was vitamin D deficient, which I am by the way. And then I was like, okay, well let me change my diet or let me take this supplement. And then I got another blood test in six months and it was better than I would be like, okay, this is a little bit more proof for me. This is what I needed. And it would encourage me to stay on that healthy path.

Erica Ballard (13:09):

Yeah. And I think there's nothing wrong with that. I think that that's why there's such beautiful things with all the tracking devices and blood work and the availability of multiple different types of blood work now to test all these different things, because what I always find, and this is neither good or bad, it just is. It's not a lot of folks are sicker than they know that they are. And because they're so used to feeling a certain way, they don't even know that they're in deficient levels or dysfunction.

Erica Ballard (14:00):

And so that blood work can also, as a practitioner help us show that there are different ways to feel better. Because going back to the vitamin D example, I mean, vitamin D was all the rage. And then it was then were told it was a crock of, you know, stuff. And then now it's coming back in and it's like, if we could just show here's where it should be, that was conventionally what we said. Right. And here's where we need to be. It just fosters an easier conversation.

Karen Litzy (14:53):

Yeah. I think you get better buy in, you get people like, Oh boy, I don't think it's, and I don't think it's meant to scare people, but it's just meant to be like, Hey, you know, something may be some of your symptoms. Maybe they're correlated with this. You know, it may not be causative, but maybe it can correlate and let's see if we can change some and see, Do you feel different? And then retest, it's just a test retest, right?

Erica Ballard (15:03):

It's yeah. And if one scientific method, if you will, I'm all for that. And I think when it comes to supplier minerals, nutrition, like nutrients, things like that, it's really helpful. I think the only place I would say, and I would be interested in what you think that it's not as wonderful as doing the test on yourself is food intolerance. Because I find that the best model or the best testing out there is 85% accurate. Whereas the gold standard I have historically found is to pull it from your diet for three to four weeks and then systematically add it back in. Which you can do anything for three weeks.

Karen Litzy (15:40):

Yeah. Yeah. And I've done that in the past. And it was definitely very, very helpful. Like I took things out of my diet for a month and it's felt a huge difference. I had some autoimmune issues after getting the flu shot. So I had an auto immune reaction to that and it was quite painful and it lasted nine months. Yeah, it's called erythema nodosum it looked like somebody kicked me in the shins 500 times of the steel toed boots. Like it was swollen and red and purple. And I remember I was at the time dating this guy that lived in Baltimore and it was on one leg and it was like over Christmas. So it was in between Christmas and new year's and it was on one leg. I was like, what? And I remember I showed his mom like, what, what do you think this is?

Karen Litzy (16:28):

And she's like, she used to be an EMT. And she was like, I feel like you should just see a doctor. I'm like, why? And she's like now. And so I just went to like a ready care place, you know, like a city MD. And they thought it was like a staph infection, which I was like, this is I've seen or cellulitis. I was like, listen, I've seen cellulitis this ain't it. And then the next day I woke up and was on the other leg and I'm in Baltimore. And I said to my boyfriend, like, we gotta go to the ER. He's like, I don't know where to go in Baltimore, Johns Hopkins, Johns Hopkins immediately. And I went in and the doctor said, I'm in the ER. And he looked and he's like, it's erythema nodosum. I was like, what he's like, did you have any, like, do you get any shots lately?

Karen Litzy (17:08):

I'm like, well, I got a flu shot a week ago. He's like, yeah, it's the flu shot. Don't ever get a flu shot again. I was like, okay. So that was over Christmas. And then it finally, all of the symptoms went away in September. And, what I changed in September is I did an elimination diet and took a whole bunch of stuff out. So I don't know what it was, but I mean, I mean, I stopped sugar, gluten caffeine, which I didn't drink anyway. Dairy, everything, like just took it all out. Yeah. And then within a month I was like, and even like my boyfriend, he's like, you're so much brighter and you're back yourself again. And so that auto-immune really like knocked me out quite a bit. And so I do agree there is something to that pulling stuff out of your diet and just see what happens. I mean, it's the easiest thing you can do, right. Doesn't cost any money.

Erica Ballard (18:06):

I mean, there's so many now alternatives and just the auto immune piece of it. I work with a lot of folks who have auto immune disorders and gluten. I mean, whether or not you have an intolerance or not gluten, for some reason always seems to aggravate these autoimmune diseases. And so we're disorders. And so when you pull that out for a few months, it doesn't mean it has to be gone forever, taking it out and then allowing yourself to see if it works or doesn't is huge. And like you, like, it's the sugar and the caffeine. I know it can be really tough for people, but the rest of the stuff there are alternatives for all.

Karen Litzy (18:39):

Yeah, absolutely. And I mean, I don't really have a lot of sugar and I don't drink caffeine anyway. So that was easy. The other thing was no alcohol also fine. I can handle that. You know, the gluten was a little hard in the beginning, but then like you said, like I just had gluten free bread and gluten-free POS I mean, it's so easy. It's not like I was like Jones and for tea, like a loaf of French bread or anything, you know? So for me, I felt like, Oh, this was super helpful. And I have not had the flu shot since.

Erica Ballard (19:09):

I wouldn't either if I had to.

Karen Litzy (19:11):

Horrible. Anyway, so we're talking about optimizing performance through food, right? And so I think the listeners can now get an appreciation for how food should be the first line of defense. Then move into if you need vitamins or supplementation or minerals and nutrients and when these work together, your brighter you're quicker. Like you said, you're moving from second gear to fifth gear.

Erica Ballard (19:37):

Yeah. And the thing that always it's interesting for people when they do this is they never knew that they could feel this good. And now it's what makes continuing it so much easier. It's both a mix of like, I feel this good. And then being quite honest is when you start to eat better, like take supplements, do those types of things. When you put in things that your body doesn't like, man, does it fight back? Like you just feel the pain, you feel the grogginess, you feel the lethargy and you don't do it anymore. Because a lot of times people will say, well, you're healthy. It's easy for you. And it's like, Oh, it's either I feel horrible. Or I take care of myself because I've done enough. I find that the body always is trying to talk with you. It's always communicating and it will slap you in the face. If it does, if you do something, it does not like, and most of us can't feel it because we've put it in such a stressed out state. So that it's always feeling so bad that like, it's just hanging on because we're in survival mode. But when you get into that parasympathetic nervous system, when you get into thriving, it will literally have as many communications and conversations as it can that you move in the best direction for you.

Karen Litzy (20:53):

Yeah. And it sounds to me like what you're saying is the body would prefer not to feel like shit.

Erica Ballard (21:03):

Yeah. That's exactly in a nutshell.

Karen Litzy (21:05):

Okay. All right. That's what I thought. Okay. So you brought up briefly, they're talking about stress. So let's talk about stress. I mean, we're still as we're recording this, I'm in New York city, we're still on lockdown. We're in the middle of a COVID pandemic. So stress is a real thing right now. And when we're stressed, I think that's when people are like, I'll take that piece of chocolate, I'll take this, you know, so what can we do to help overcome the stress without falling back on those cravings if you will.

Erica Ballard (21:39):

That's a really good question. And I heard something this morning that I think was brilliant. So I'm going to share it here is when we think about stress, the idea is just, how do you get back into the present moment and how do you get back in to finding joy? I mean, it sounds a little corny, but that is that's it. And so in quarantine, what can be really helpful is identifying things that you could do that you would do on your vacation at your house. So whether you take naps on vacations or you take long walks, or you listen to music in the morning, instead of a podcast, doing those things that transport you into a state of calm is really helpful. And we can do those things in our house. We just completely forgot that we could, because we're so used to only doing them when we're out there.

Erica Ballard (22:36):

So that's the first thing that just came to top of mind when you were, when you asked that question. And I think the other pieces are just looking for moments of not solitude seems like the wrong word right now. But moments of peace, because while some people are not at the office, we're there were so available now. And at least we had these cutoffs, right? You go into the office, you leave the office like, and that was that. Now everyone knows we're not going anywhere. So we're getting the emails, we're getting the texts, we're getting those things. And if we could work our way in defining moments where we can shut down, whether it's the walk without the phone, whether it's actually closing your computer and not opening it back up, putting your phone away for half an hour, those things are really gonna help bring you down. Even though we don't think that they do like you feel it in your body, like 15 and another phone, you kind of, you're able to sink down into that couch wherever you're at and just be.

Karen Litzy (23:40):

Yeah. And you know, I've been hearing that from a lot of my clients who I normally see patients in their homes. And so at this, right. Nobody wants somebody coming into their home and I don't blame them. But they're also working from home and what everyone's saying, they're like, you know, when I'm at work and we have a meeting, I get up from my desk, I walk to a boardroom, I sit down, I go to the bathroom, I talked to other people. I come back, I walk to work. I walk home from work. I go out for lunch. I come back in or at least I go to the kitchen and I come back to my office. And now I said, you know, I'll have a meeting from two to three. And they're like, Oh, you're available at three. We're gonna have another meeting from three to four.

Karen Litzy (24:20):

Oh, you're available from four to five. She's like, so all of a sudden my patient, she was like, I'm not leaving my computer. Whereas when I'm at work, I do. And I also have the opportunity to get fresh air, but now I'm 12 hours. I barely have time for lunch. And I'm just, and I heard that again and again and again, so you're right. It's that, that feeling of, we all have availability and for some people, their only option might be a five minute break, you know? Like they might not be able to take that half hour break if they've got people sort of like breathing down their throat. So do you have any advice for those people to do like a five minute break or a three minutes something to help at least ground them a little bit.

Erica Ballard (25:04):

Yeah. So there's two ways to do it depending on who you are as a person. So I think standing up planting your feet from on the ground and just breathing in and out in a really calm, amazing fashion and like feeling the breath go through you is just such a great way to literally move yourself into a very present state. The other way is to move your body, right. It depends on who you are and what you need. When I have five minutes between meetings, I'm not even going to hide it. Like I, right now, I'm here for the Jonas brothers. You can judge me all you want. I turn on the Jonas brothers and I like dance in my house. Cause those songs are only like three and a half minutes. So I will literally put it on and I will just dance around my house because a music makes me happy. But also it like moves. My body moves. My energy moves like that stagnation. And so whether it's squats for you going up and down the stairs dancing, whatever it is, it's just shaking off what was for what is. And I find that that is very helpful when you're chained to your desk for 12 hours on end.

Karen Litzy (26:10):

Great advice. Thank you so much. So now before we wrap things up, is there anything that we didn't touch upon or anything like, what is the thing that you want the listeners to leave this discussion with?

Erica Ballard (26:24):

I would say that if you want to get healthier and you're not where you want to be really taking a look at your food and at your stress and seeing which one is holding you back. Cause I pretty much guarantee it's probably one of the two and then make a few decisions and change as necessary.

Karen Litzy (26:49):

Excellent. And again, the good thing about this is that doesn't take a lot of money, may take some time, but it certainly is not something that's going to break the bank. And, and again, because we're in these uncertain times right now, you know, people might be a little less wary of like, Oh, do I have to, you know, go and leave my apartment or my home and go and do this and go and do that. But if there are easy ways, like you said, look at your food, look at your stress easy. Now, if you are the kind of person that needs someone to help walk you through it, that's where someone like you Erica would come in, you know, at being a health coach, like that's where you would come in to kind of not hold their hand, but be their coach and give them the game plan.

Erica Ballard (27:41):

Yeah. And, that is why if you do need help, I'm so huge on working with a practitioner because like at the beginning, it's an N of one, you are actually the unique snowflake you think you are. And so helping you figure out the right things for you in a safe space is really important because health is so personal and you get a lot of feels when he's searching to move, try to move in the direction you want to move. And so I do really believe people can do it on their own with a little bit of support from online programs and things like that. But if you can't, asking for help is the best thing you can do.

Karen Litzy (28:26):

Yeah. And I know you have a free resource for the listeners. It's the pantry playbook. Is that right? So do you want to talk a little bit about that? And just everyone knows, we'll have a link to that in the show notes at podcast.healthywealthysmart.com, but talk a little bit about it and where people could get.

Erica Ballard (28:43):

Sure. So I heard from clients all the time, I want meal prep, I want meal prep. I want meal prep. And I was like, no, you don't, they don't want it. But it's what they kept saying that they wanted. What they really wanted though, was they wanted it to be able to make really quick meals on the fly that tasted good because three days into the meal prep, if throughout all of their foods, they're sick of it. So I said enough, that's like, yeah. I mean, I don't like five day old food either. So I get it. And so what I did is, I was like, well, I don't ever meal prep. I don't. And so I was like, why don't I meal prep? Oh, cause I have everything I always need on hand all of the time.

Erica Ballard (29:25):

And so I went to my pantry and started to look at, and then think about all what my clients do and me, and they're there, the special needs that go on and was like, Oh, I can create a list that if you always have on hand, it's going to be faster to make healthy meals than it is to go out and get takeout, because these are our options, right? We meal prep, we get take out or we make it home. And if I can help you make a fast healthy meal at home that cuts the meal prep and cuts the time it would take to get takeout. It works. So I have that resource for them and it'll be at https://www.ericaballardhealth.com/pantry-essentials-playbook.

Karen Litzy (29:59):

Thank you so much. And now onto the last question that I ask everyone, knowing where you are now in your life and in your career, what advice would you give to yourself after college? Let's say grad school

Erica Ballard (30:12):

That I love this question and I really, really wish I knew this, that you can do it your way.

Karen Litzy (30:22):

Mm, powerful.

Erica Ballard (30:24):

It's just with health. Like you go into people's homes. Like I go into people's homes via camp, like what, like, you know, zoom, you can do this thing. You were away. So don't follow someone else's rules. If it doesn't feel good inside.

Karen Litzy (30:41):

Excellent advice. And where can people find you social media website?

Erica Ballard (30:47):

Okay. So I play a lot on Instagram. So it's at Erica Ballard health. I'm actually on LinkedIn quite a bit. Website is EricaBallardhealth.com. And I had a new podcast that's actually dropping on June 2nd called the lies we've been fed. And it's an eight part series that walks people through the lies that we have been fed about food to give them a path forward.

Karen Litzy (31:12):

Awesome. It sounds great. I look forward to listening and thank you so much for coming on. This was wonderful. Thank you and everyone. Thanks 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 Apple Podcasts!

Jul 27, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Kameelah Phillips on the show to discuss optimizing health during pregnancy.  Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate.  Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care.

In this episode, we discuss:

-The impacts of COVID-19 on pregnancy and post-partum

-Factors that impact the United States’ maternal mortality rates

-Six ways to optimize your health during pregnancy

-The importance of interprofessional collaboration

-And so much more!

 

Resources:

Calla Women's Health Website

Dr. Kameelah Phillips Instagram

Calla Women's Health Instagram

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

 

For more information on Dr. Phillips:

Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate.  Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care.

Dr. Phillips graduated from Stanford University with a degree in Human Biology with an emphasis in Women’s Health and Human Sexuality. After graduation, she worked at the San Francisco Department of Public Health in the AIDS office as a Research Assistant on HIV vaccine studies.  She relocated to Los Angeles to attend the University of Southern California Keck School of Medicine.

During medical school, she received numerous community service awards. She was privileged to travel to Ghana, Cuba, and Tanzania on health missions during this time. Upon completion of medical school, she attended a competitive OB/GYN residency at the New York University School of Medicine. She also served on an emergency medical mission in Port-au-Prince, Haiti to provide women’s health care during the 2010 earthquake. 

Dr. Phillips is an educator, mentor, and expert in women’s health issues.   She loves to help women and girls feel comfortable with their bodies, so that they can be aware of changes or new developments.  Her interests include Minority Women's Health and health care disparities, lactation, sexual and menopause medicine.  Dr. Phillips is a member of the International Board of Lactation Consultants and speaks Spanish. She enjoys teaching residents and medical students.

Her guilty pleasures include reality T.V.   As a Real World Alumnae, she has used this platform to travel nationwide to discuss domestic violence, smoking cessation, and other health-related issues.  She loves a good bargain, flowers, and deep-tissue massages.

You can follow her on Instagram @drkameelahsays

 

Read the full transcript below:

Karen Litzy (00:01):

Hi, Dr. Phillips, welcome to the podcast. I'm excited to have you on. And this is the first time I'm having an OB GYN on the program. I've had lots of physical therapists who work with women's health and pelvic health. So this is really exciting to get a different point of view on women's health and on pelvic health. And now, before we get into the meat of the interview, we are still living in a pandemic, COVID-19 is still here. It has not mysteriously disappeared or vanished. And so there are a lot of women who are getting pregnant, who are living through pregnancy at this time and who might be a little nervous, a little concerned about what can happen during their pregnancy is COVID affected. So what I would love for you is any advice for those pregnant women in the time of COVID?

Kameelah Phillips (00:58):

Yeah, absolutely. You know, one thing I really try and impress on patients that is absolutely unique to OB GYN is despite what's going on in the world, whatever chaos is going on, women still have babies women still go into labor. Women still take healthy babies home. So for us in particular we've made some minor, not, I shouldn't say minor there there's significant, we've made some changes in how we deliver care and the hospital setting, but for us, it's really been, you know, not so huge of a change because you know, hurricane Sandy earthquakes in Haiti, I've been through both of those, we still deliver excellent care to women. So one thing I would ask them to do is just really take a deep breath and while things are going on around us remember that their primary concern is to take care of themselves so that they can take care of their baby.

Kameelah Phillips (02:11):

I have told patients that a little bit of their OB care is changing. So we might have fewer visits, but really the important things we will always make sure that we hit the important time points and hallmarks of a pregnancy. So you won't miss anything. I've been telling them that labor and delivery has changed a little bit. And I think this changes pretty much coming across country, but whereas it used to be a time where, you know, extended family was welcome. It's important that they recognize now that only one or maybe two people will be allowed to be present for labor and delivery. And our hospital in particular, both moms and support family are being asked to wear a mask. We do check moms for coronavirus. We use the nasal swab. The extended family is not tested, but they're expected to keep their mask on.

Kameelah Phillips (03:16):

And most of the time our moms are coming back negative, but if they do come back positive, you know, we have a discussion and education with them as to what it's going to be like, knowing that they're now corona virus positive and going to be taking home a newborn. So we talk about those things. But for all intents and purposes, women are coming in. They're having healthy, safe deliveries, both C-sections and vaginal deliveries. Their hospital stay we've shortened a little bit in New York, we're going back to keeping women two days or four days, but other places in the country are, are shortening. The hospital stays in an effort to get women home safely and so that they can use hospital resources for the people that need them. But we're having healthy and safe deliveries. There was a panic, I think, amongst the pregnant community at the beginning of the pandemic, and everyone wanted to have a home delivery that still continues to not be the best response to this.

Kameelah Phillips (04:28):

It is still safest to deliver in a hospital or birthing center, certainly not at home to have best outcomes. We still recommend that women breastfeed that's the best way to feed your baby despite Corona virus, even if you were previously infected. And when women go home, I just ask them to be considerate of the new immune system in their house, right? So limiting visitors, washing their hands. If people come over, keeping them not being afraid to say, Hey, keep your face mask on while you're with the baby or around the baby. And really using the technology that we have to their benefit. So while it's not what we're used to, the grandparents meet their babies over FaceTime or zoom now. And that's not going to be forever, but you know, if you have people who are unable to quarantine and can guarantee that they're negative, I asked them to defer visiting.

Karen Litzy (05:29):

Yeah. Thank you. That's all really great advice. And I should have mentioned in the beginning that we are both located in New York city. And so right now it's different.

 

Kameelah Phillips:

Yeah. So obviously New York was the epicenter of the pandemic, certainly in the United States, if not the world at one point we have now our numbers have gone down, but the safety for the pregnant and new moms have, has not is right. Yeah. Right. So we are still on top of new infections, preventing infections in the hospital, the doctors, the nurses, the people who clean your rooms, we're all washing our hands, wearing gloves, keeping our mask on because it is our priority that you come in healthy and that you leave healthy.

Karen Litzy (06:33):

Yeah. Perfect. All right. Well, thank you for that. And hopefully if there's any pregnant moms or other healthcare practitioners that are working with pregnant women kind of give them a little bit more information to pass along or to kind of keep in their heads. So now let's switch gears slightly here. I'd love to talk about maternal mortality rates in the United States now in the United States. We know, unfortunately that we do have a very high maternal mortality rate amongst advanced countries, or what's the best word for that advanced countries? Is that the right developed countries, industrialized countries, like we know what you're talking about, you get it right. So the questions that I have are what populations are most effected. And then what, in your opinion, do you feel like needs to be done to improve those maternal mortality rates?

Kameelah Phillips (07:32):

I am firmly under the belief that we can as a nation, as a country walk and chew gum at the same time to make these rates better. So to answer your first part of your question we have plenty of data that show that black women, African American women in particular are most vulnerable during pregnancy labor and delivery. And postpartum times the rates of increased death can be anywhere from five to seven times higher than their white counterpart. And these rates are abysmal for a developed country to have such a discrepancy in healthcare is really saddening and frankly just discussing it's unacceptable. But there are other ethnic groups that are also at risk that, you know, we always talk about black and white and really this country is so diverse, but our native American population is also significantly affected by maternal mortality rates that are poor as well as Alaska.

Kameelah Phillips (08:57):

We always forget about Alaska. So African American women, native American women and Alaska women, and it's complicated. It is a combination of access to care. It's unfortunate that we seem like we're talking about the same things over and over, but access is a big issue. We live in the biggest city in the United States, but you know, Manhattan alone, what the Island of Manhattan has four hospitals there used to be more, there used to be more can you imagine? But some of our outlying communities that are more ethnically diverse or Latino or African American have far fewer hospitals. And certainly in those hospitals, the resources aren't comparable to anything that you would see in Manhattan. So along with, you know, access there's hospitals, there's doctors there's birthing centers, all of these are less often found in lower resource places.

Kameelah Phillips (10:06):

So access is a big one education both on the part of the health field and of patients themselves is a problem. I think we're starting to really get some traction on the African American population, helping them understand that this is a very critical time in their life. And so they have to be hypervigilant about blood pressure, weight gain, diabetes, all of things, all the things that can be triggers for issues in pregnancy. Those are the big things that stand out access and education.

 

Karen Litzy:

And do you also find that, and I find this in other aspects of healthcare especially when it comes to feeling pain that oftentimes women are not believed as much as men are. And, that is in other parts of healthcare, certainly true. Do you find that women maybe during pregnancy or even post pregnancy, like maybe that the day they gave birth, if they're there trying to explain things that are going on and perhaps they're not being believed and are just yeah brushed to the side so that I think is absolutely the case for a lot of the issues that women experience around the maternal period.

Kameelah Phillips (11:22):

And it's not limited to women. It also crosses ethnic and socioeconomic boundaries. We have a real issue and I'm part of the establishment, right? I'm part of the medical community. So I feel free to air up our dirty laundry, that we have a real issue with bias and medicine and we talk about racial bias and how that can impact black people. But we have a bias against women. We have a bias against women and, you know, she's being hysterical, she's being dramatic or pain's really not that big women in our discomfort in our needs are routinely downplayed and even by other women, because we've sort of ingrained in our head that, you know, women tend to be more dramatic, whatever.

Kameelah Phillips (12:30):

We downplay the needs of poor patients who come in, Oh, you know, she's just being loud for no reason or, Oh, that's just how they're. So this isn't just an issue of women. It goes across class, it goes across ethnicities. But for us, when we're pregnant, it has to be addressed and highlighted because when a woman is saying something isn't right. Something isn't right. And that should be taken seriously because in the postpartum period we get lucky a lot of times because women are generally young and healthy, but when things go bad in obstetrics, they happen quickly and then its big. So for example, if a woman was like, my bleeding is kind of heavy and say, maybe she just delivered a baby, a woman could easily lose one to two liters of blood in like a few minutes. So we had a really bad postpartum hemorrhage the other day. And I was like, this is impressive when you see what the body can do. Especially in labor, it happens quickly. And so it's incumbent upon us as healthcare providers to take women seriously.

Karen Litzy (13:27):

And then I would also think there is, and again, I don't know if this is true or not, but I know kind of where I come from more looking at the pain world and from my own experiences, as I personally would downplay my own pain. So as not to bother someone. Right. And do you feel like in the world of OB GYN, if you're going for pregnancy, like, do you have to kind of really educate those patients to say, listen, if you're feeling something doesn't feel right, like you need to speak up, right. Well, like you're bothering us. Have you encountered that?

 

Kameelah Phillips:

I have encountered that. And it's really incumbent upon all of us to relearn these narratives that we've picked up just growing up in the United States of like not being the complainer or not being the squeaky wheel, not rocking the boat. Like those all have negative connotations right.

Kameelah Phillips (14:47):

In the obstetric space. When you don't speak up, we can have really negative, horrible outcomes. So part of my experience with patients is to listen to what they're saying really repeat back what they're saying, like, okay, I hear you're having X, Y, and Z. Did I get that right? And if it's something that is quote unquote normal in the space of a, you know, a growing uterus or a growing body part of my job is to really provide education, to help them manage their expectations for what they should expect. Growing uterus, growing weight gain, swelling, what they should expect from their body. If it's the first time they've been pregnant or the sixth time they've been pregnant, you know, all the pregnancies are different. And if we have a clear understanding her giving me her complaint, me giving her feedback on what I think she's saying, and then giving her the anticipatory guidance, I think she needs, and we still have an issue. Then it's incumbent on me to escalate it and really make sure that there's nothing there that's going to hurt her.

Karen Litzy (16:01):

Yeah. Great. That's perfect. And I love the kind of handling of expectations and monitoring expectations because that goes such a long way when, especially if it's your first time or not, like you said, your first or your six times, but kind of knowing what to expect at certain times is very comforting. And so then as if you're the patient, then you can say, Oh, you know, she said, this might happen, but I'm not, you know, it's not happening or it's going above and beyond what she said. So maybe this is time that I reach out and contact my physician on this, there are times where you may need to reach out to your doctor. And so knowing when those times might be, is really helpful.

Kameelah Phillips (16:53):

Exactly. So when a woman leaves the office and you know, it'll be maybe a month before I see her again, I tell her, you know, this is what I think might happen. It's okay. If it doesn't happen to you, but in the next four weeks, you might expect, you know, your pants size to change general discomfort in this area. You might feel something fluttering in your belly, like giving her those points to look out for. And again, managing those expectations and I'll get a phone call, Hey, this is maybe more I'm having this. Plus this is this in the realm of normal. No, it's not come in. You know, we can really help women out by giving them education cause it's empowering. And it helps us do a better job taking care of you.

 

Karen Litzy:

Yeah. And it also keeps people away I would think from dr. Google or far down the rabbit hole of how many doctor Googles do you get?

Kameelah Phillips (18:17):

You know what, I can't anymore. Just so many doctor Google's with doctor said, I can't even more. Or my Facebook friend Sally said, Stay off. And it's funny cause when their partner comes with them, the partner inevitably just looks at him and like glares at them because they know that they're on Google or they're on these, you know, small chat rooms where everyone is on the T level 10 when the patient's issue is actually maybe a one or zero. And so it freaks her out. Yeah. I encourage patients to stay off of Google. Because yes, there are some times when it might answer your question, but really we're aiming for individualized personalized care and Google doesn't offer that to you. And so I really ask my patients to stay off of it. That's what their visits are for to write down the questions as they go. And honestly, it's so funny. They'll come in with like, say there's five questions just in the scope of time, given them the anticipatory guidance.

Kameelah Phillips (19:17):

Like by the time they actually get to the appointment, they may only have two questions because they're like, Oh yeah, she said that was going to happen. They know exactly, exactly. It helps to stay off Google.

 

Karen Litzy:

Yes, yes, yes, yes. And now I think we've touched a little bit, I think on this, but let's see if we can delve into this more and that are what are ways women can stay healthy throughout their pregnancy so that maybe it can contribute to a decrease in the maternal mortality rate, even if it's just chinking away at the tiny little bit, because like you said, it's a big bucket with a lot of stuff going into it. But if there are ways that women can, like you said, empower themselves to stay healthy and give themselves the best chance, what advice do you give to women to stay healthy?

Kameelah Phillips (20:04):

Yeah. So in thinking about this, I have six points that I usually share with patients. So I'll go over them really quickly. But my first point is to find a doctor that you trust. I'm really big on that. I'm really big on that. I tell people to find someone that they trust because inevitably, you know, most pregnancies are fine, but if we get into some mess, I need to know that you know that I am your advocate and I am on your side. And if you hesitate or you don't feel like you can trust me a hundred percent, I'm going to ask that you explore other op, find another doctor because I want you to the best experience possible. And I even say this with my GYN patients, like if I tell a patient, you know, I really think you need surgery for this.

Kameelah Phillips (20:56):

I don't sign them up for surgery that day. I've let them go into the world, do their due diligence, meet with three other doctors. And I promise you, I have not had a patient not come back because they trust me. So that's a big thing. Find someone you trust. I think it's really important that patients meet with their doctor frequently, meaning that you come to your visits, you got to show up, right? So we can get data from you like your blood pressure, your weight how you're feeling, checking the baby regularly, blood work, this data that we're collecting at every visit. And it might not sound like a lot 15 minutes, but it actually gives us a picture of where we're going with your health. So that's important. I asked my patients also to stay active and exercise. I am not sure why there's this misconception that you should be sedentary during pregnancy first trimester.

Kameelah Phillips (21:55):

I get it that progesterone knocks everyone out there on the couch. They can't, you know, they're nauseous. They don't want to, I get that. But for the most part, when you feel healthy in pregnancy, I need you take care of yourself. And that means exercise and eating healthy and patients are, Oh no, but the baby really wanted the chili cheese fries. No, no she didn't the baby requests. Yeah. Did she send you a text message to get that? So really encouraging, like if you would feed your six month old, you know, a Coke and chili cheese fries for lunch, that's a separate conversation, but you know, trying to do as best they can. In terms of staying active and eating healthy education is a big piece for me. Every time they leave, I'm like, okay, we're entering this phase. These are the major risks for this phase.

Kameelah Phillips (22:53):

So I need you to go home and look at this website and read two minutes about diabetes, cause you're doing your diabetic test and this is why it's important. Being flexible is huge. Patients, I think often have the misconception that physicians or that I control their pregnancy. And really, I see myself as just like a tour guide, ushering your baby safely into this world. And so it's important that they're flexible to whatever the results come back as whatever the ultrasounds tell us, however, the baby is behaving in labor, that they're flexible. In my industry, I'm not sure what the corollary will be with physical therapy, but people who come in with very strict demands as to how they expect their process to be are the main people who have complications as opposed to just letting us do our job, to get you guys to the finish line.

Kameelah Phillips (24:02):

So being flexible is really important. And then my last one is to not refuse life saving treatments. We were, it was in the, I told you the other day I had a postpartum hemorrhage and I might back of my head. I was like, this woman's going to bleed. So as we were pushing or when she got admitted, I was like, you know, this is the type of situation where I see XYZ happening and when XYZ happens and she lost all that blood. When I came to her about needing a blood transfusion, she was already on board to not refuse treatment that could possibly save her life. So not refusing like blood products or blood pressure management, those are increased surveillance. Those are the big things that hurt and cause women to lose their life. So really not refusing important treatment.

Karen Litzy (24:58):

Yeah. And I think thank you, those are great ways that women can stay healthy. And you know, as you were saying, they need to be flexible. And I always go back to movies where they show the woman going in and she's got a birth plan and it has to be this and it has to be this. And there's no flexibility around that. So I could see how that could be really dangerous if you're going in with that kind of a mindset of, you know, I have to have this baby without any drugs and have to have it vaginally. When in fact there might be some complications where that's just not possible and it's just not possible. And, or advised or safe.

Kameelah Phillips (26:00):

And again, we don't decide that, right. The baby's position, the mom's uterus, the pelvis, like all of these things that are outside of our control decide that we're just here to make sure you both come out on the other side. Okay. And I can't underscore that. Cannot underscore that. Like I don't have anywhere to be there's this misconception that doctors always have like tickets. So like I have to be at the opera tonight. No, we don't have anywhere to be we're here for your baby, but you know, we have to have some flexibility, like let us just do our job and we'll get you through this.

 

Karen Litzy:

Yeah. I think that's great. And then of course, I always love the third point, which is stay active and exercise and move during your pregnancy. And I think I'll give a quick plug for physical therapists. I think this is where physical therapists and women there are a lot of physical therapists who are pelvic health specialists and who work specifically with pregnant and postpartum women. And this is where I think we can actually maybe make an impact in that maternal mortality rate as physical therapists.

Kameelah Phillips (26:54):

Yeah. Yeah. I spent the first part of my career in a group dynamic and it was very hard for us to think outside the box with complimentary specialties that can help make this process of pregnancy, which is physically mindblowing. Like people, if you haven't necessarily been pregnant before or been in an intimate relationship with someone who's going through pregnancy, you can not imagine how physically difficult it is to have a baby. And so when I was bringing up the options of like physical therapy, no, no, no, she's fine. The body heals itself. I'm like, but it's not like, look at her walk. You know, I'm looking at her. Diane is like, like, let's think outside the box. So in my new practice, I'm making much more of an effort and actively establishing relationships with people that, okay, you're having this issue.

Kameelah Phillips (28:07):

Now let's connect with the physical therapist because you know, the hips give women the most trouble, the hips, maintaining flexibility labor and delivery, the act of pushing literally separates your pelvis. You know, it's not, of course you have issues with your pelvis afterwards. Lacerations, you know, women who undergo episiotomies that pelvic floor has literally hit the wall and back. So to not expect that pregnancy is a hundred percent, the most physical activity you can do with your body just really undermines and belittles the whole process. And so part of my process now is to send women to physical therapy, postpartum, even if it's just for one visit so they can have an idea of how to improve their core, how to keep their pelvic girdle in shape and engaged because most women have more than one kid.

Kameelah Phillips (29:11):

So that's a lot of, you know, trauma to the body. And we can do better. We know that it works, we know that it's available, but it's up to us to provide the education and the next steps for them to heal.

 

Karen Litzy:

Yeah. Well said, well said I love it. And now as we wind things up here what would be, what would you like the audience to take away from our discussion today?

Kameelah Phillips (30:29):

I think that it would be helpful to really understand that most doctors do their best to provide women with excellent obstetrical and Gynecological care. I think that a good doctor is really open to receiving information from other specialties in this case PT, physical therapy as modalities that can compliment what we offer. That's not in opposition to what we do so that if we could somehow strengthen the relationship between obstetrics and physical therapists, everyone would win. Like it's for all of us, the patient the obstetrician, the physical therapist the patient's family. It's, you know, pregnancy is the deal. It affects literally you physically, emotionally, psychologically, and sometimes the physical impact of sometimes a lot of times the physical impacts the emotional and the psychological and your sense of wellbeing and health is so impacted by like how you physically look and feel. And you guys have a direct, you know, you have the keys to helping us, you know, improve women physically. So if we could strengthen that relationship and not see it as so oppositional, I think it's a triple win for everyone.

 

Karen Litzy:

Yeah, I agree. And the last question I have is one that I ask everyone. And given where you are now in your life and in your career, what advice would you give to your younger self?

Kameelah Phillips (31:41):

So I'm out of residency 10 years, and I'm just starting my first private practice venture. And looking back, I probably should have done this five years ago. And yet I had a lot of other things going on. I was like birthing my own children and that kind of thing. But at the root of it, honestly, I was scared. I was scared of failing. I was scared of the unknown. I was scared of doing things that I'd never been taught before. Like formally I didn't consider myself an entrepreneur, all these like negatives, right? Negative, negative, never didn't have it. Shouldn't wouldn't, couldn't like, and I would give my younger self, like a kick in the butt to like, just get out there and you know, unless it seems so cliche, but you don't know unless you try. And when you're young, there's nothing to lose.

Kameelah Phillips (32:53):

Except the fear that's like this imaginary fear that's holding you back. It's a time to be brave and courageous and adventurous. And so I would probably give my younger self like the little push off the ledge the encouragement that I needed to have started this venture and experience earlier. And I would just tell her to be fearless. What do you got to lose? You can always, you know, move back in with your parents. That's what we're doing these days. Right. So like, why be afraid to fail like that just now it's so funny. Cause I think about it cause I'm in it now, but what did I have to lose? Nothing. Nothing. Yeah. Like time, but that would have been a learning, you know, you would have learned so willing to learn.

Kameelah Phillips (33:52):

So yeah, I would have jumped sooner.

 

Karen Litzy:

Excellent advice. Thank you for that. And now where can people find out about you about your new practice? Where are you on social media? Where can we find you?

Kameelah Phillips (34:57):

So on social media? My main page is drKameelahsays, my practice page is Callawomenshealth, like the flower. I love the like beautiful erotic nature of the calla lily. So that's my practice Calla women's health. I'm on the upper East side of Manhattan, but also available for telehealth visits, physical visits throughout coronavirus. I've been on the grind in this office. So taking new patients of course also happy to see them.

 

Karen Litzy:

And for everyone listening, we will have all of this information, one click straight to all of the practice and the social media at the podcast.healthywealthysmart.com. Under this episode, it'll all be in the show notes. So if you didn't get it, don't worry, you can get it that way. So thank you so much for coming on. This was a great episode and I think you've given a lot of wonderful advice to healthcare providers and to women who may be pregnant or want to be pregnant or maybe has already been pregnant. There's a lot of stuff here. So thank you so much. I appreciate it. 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 Apple Podcasts

Jul 20, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Susie Gronski on the show to discuss chronic pelvic pain syndrome in men. Dr. Susie Gronski, licensed doctor of physical therapy and board-certified pelvic rehabilitation practitioner, is the author of Pelvic Pain: The Ultimate Cock Block, an international teacher, and the creator of several programs that help men with pelvic pain get their pain-free life back.

 

In this episode, we discuss:

-What is chronic pelvic pain syndrome/chronic prostatitis

-Sociocultural barriers unique to men receiving pelvic pain care

-Male expectations and reservations during a pelvic health treatment session

-Strategies to increase patient self-efficacy

-And so much more!

 

Resources:

Susie Gronski Instagram

Susie Gronski Facebook

Susie Gronski Twitter

Treating Male Pelvic Pain Course for healthcare practitioners

Pelvic Pain: The Ultimate Cock Block Book

In Your Pants Podcast

Men's Online DIY program: use code painfree20 for $20 off!

One-on-One Intensive Program

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

 

 

For more information on Susie:

 Dr. Susie Gronski is a licensed doctor of physical therapy and a board certified pelvic rehabilitation practitioner. Simply put, she’s the doctor for ‘everything down there.’

Her passion is to make you feel comfortable about taboo subjects like sex and private parts. Social stigmas aren’t her thing. She provides real advice without the medical fluff, sorta' like a friend who knows the lowdown down below.

 

Dr. Susie is an author and the creator of a unique one-on-on intensive program helping men with pelvic pain become experts in treating themselves. Her enthusiasm for male pelvic health stretches internationally, teaching healthcare providers how to feel more confident serving people with dangly bits.

 

She’s determined to make sure you know you can get help for:

  • painful ejaculation
  • problems with the joystick
  • discomfort or pain during sex
  • controlling your pee

without needing to be embarrassed...

So whatever you want to call it, (penis, shlong or ding-dong), if you’ve got a problem ‘down there’, she’s the person to get to know. Dr. Susie is currently in private practice in Asheville, North Carolina specializing in men’s pelvic health. 

 

Follow her on Instagram, Facebook, Twitter, YouTube and listen to her podcast, In Your Pants, for expert pelvic health advice without the jargon. 

 

Read the full transcript below:

Karen Litzy (00:01):

Hi Susie, welcome to the podcast. I'm happy to have you on. And now as the listeners may know, I've had a lot of episodes about pelvic health, pelvic pain, but most of them were centered around female pelvic health and pelvic pain. And today, kind of excited to have you on Susie because today we're going to be talking about chronic pelvic pain in men. And I think this is a topic that is not spoken about a lot. I don't know if it's still considered taboo in many places. We'll talk about that today as we go through this podcast. But before we get into it, can you tell the listeners what is chronic pelvic pain syndrome or chronic prostatitis, which I don't know why I have a hard time saying that word and I'm looking at it and still have a hard time. But anyway, that's neither here nor there. That's my problem, not yours. So go ahead and just give us what is it?

Susie Gronski (00:52):

Well that's okay about the not able to say the word prostatitis because it is a bit of a misnomer when we're talking about male chronic pelvic pain syndrome. So it's okay. I wish that word wasn't used as frequently anyway to describe what we're going to be talking about. So the official definition that one might read in the literature is that chronic pelvic pain syndrome or chronic prostatitis is having recurring symptoms lasting more than three to six months without a known cause or pathology. And that typically results in sexual health issues, urinary complaints, and obviously a lot of worry to say the least. So that's the official definition of chronic pelvic pain syndrome.

Susie Gronski (01:46):

Now the NIH or the national Institute of health classifies, I put in bunny quotes here, prostatitis into four categories and briefly those categories are an acute bacteria prostatitis, chronic bacterial prostatitis, chronic non bacterial prostatitis, both inflammatory and non-inflammatory, which is the realm that physical therapist will work in. And then you have a category, interestingly enough, asymptomatic inflammatory prostatitis. And I think that's really important to stress that you can have quote unquote inflammation in the prostate, but you still have individuals who are asymptomatic. So when it comes to the word prostatitis and itself to describe male pelvic pain, I think it is a bit of a misnomer because a lot of cases are not bacterial related or infection related. And actually in fact 90 to 95% are not infection related or bacteria related. So I think we need to shift from using prostatitis as the main umbrella term.

Susie Gronski (02:52):

Because you know, it puts the blame on the prostate when we know that's not the sole cause or what we're dealing with in the long run.

 

Karen Litzy:

Got it. So that, that can be a little confusing for people. Cause I'm assuming if you're a man and you hear that diagnosis prostatitis that that's gotta be kind of unnerving to hear. Right? For one you don't know what it is.

 

Susie Gronski:

Yeah. It's like, well, and I don't want to stereotype, but I think when guys really hear prostate, anything, what's the first thing that might come to mind? Cancer, cancer. Right. And so now you're freaked out like what's wrong with my prostate? Am I going to have cancer? We know it's highly prevalent. And so yeah, I think it is a bit of a misnomer in terms of when you have pain down there especially without a known cause that leaves the fear of, well, they must be dismissing something.

Susie Gronski (03:50):

There must be something really seriously wrong that the doctors are not just finding.

 

Karen Litzy:

And what are some common symptoms? I know you mentioned a couple in the beginning there, but if you can kind of repeat those common symptoms that people may experience with chronic pelvic pain syndrome and is pain one of them. Yes. Right?

 

Susie Gronski:

Yes. Most often it is a sensation that is not typically pleasurable. It's painful. It may or may not be associated with urinary issues. In general. You'll have any sort of pain or discomfort in the abdominal or genital region. It could even be around the tailbone or even pain with sitting, sitting around, you know, around the sit bones in the groin. It may or may not be associated with sexual function. So for some men they might experience pain after completion or with an erection.

Susie Gronski (04:46):

They might feel pain with bowel movements. It might be testicular pain. It might be pain between the scrotum and the anus, typically known as the taint area. So there's a lot of overlapping symptoms that one might have. Again, everyone's so unique, but those are some of the common themes that one might hear in the pelvic health world.

 

Karen Litzy:

And so if you're experiencing these symptoms, let's say for more than a month, I mean, will people experiencing these symptoms for, let's say a couple of weeks before they go see a doctor or go to look up their symptoms and see what's going on?

 

Susie Gronski:

I think that varies on the person and their personality in terms of like their health and healthy behavior in terms of men health seeking behavior. We know that when you compare it to, for example, women, they don't tend to kind of seek out the help of doctors as women might do.

Susie Gronski (05:50):

Right. and I think that's across the board in terms of international standards as well in terms of the seeking behavior, health seeking behavior. I don't think I can have like a, I don't have a stat or factored on that, but I do think that men tend to kind of like watch and see what happens or you know, I think many of us do. Like if you feel something you're like, well that'll just pass. Right? I don't know if I gave an answer that fully. I just know that sometimes people wait and sometimes people go right away cause they're afraid or whatever the case may be. But I do think that the sooner that you can get reassurance for what you're experiencing in term, and I mean reassurance from not just take these antibiotics and come back and see me in six weeks, it should go away.

Susie Gronski (06:42):

Because that's typically what will happen when a guy will seek help. And I think the main one of the main barriers too is that where does a guy go get help from when something like this happens? Cause for females we have a gynecologist or a woman's doctor, right. But guys, like I know my husband just, he's like, I would have no idea where to even go. Who do I seek for help for this kind of thing. And so I think when we're talking about barriers for seeking help, that's one of them. I just don't know where do I go. And then you'll go to your primary care physician who may or may not be familiar with, you know, chronic pelvic pain or being able to differentiate, you know, whether it's an infection and what tests to do.

Susie Gronski (07:26):

A lot of times men are given antibiotics without even having diagnostic tests to see if there's an infection, which is unfortunate. And they'll do this for several rounds too. And so I think the longer that happens, the more that we're making the situation worse in terms of, you know, we know we've got microbiome, we'll plan to those pictures. Well it may or may not have been an infection that triggered this. We know the immune system plays a role in chronic pelvic pain. So, you know, I think having a well versed, fuzzy healthcare professional who can really help this person say, Hey, this is what could be happening. We know a multifactorial and multi-modal treatment approaches is very helpful for what you're going through and that, you know, these symptoms shouldn't last forever. Here go see a pelvic therapist if we know that's not happening.

Susie Gronski (08:23):

And I see guys several years later or years later before they even have an appropriate diagnosis, which I guess brings me to say that chronic pelvic pain syndrome is a diagnosis of exclusion. So, before they even come see or get a referral to see and see if they're lucky to get a pelvic health referral, they'll go through a lot of invasive tests. Cystoscopies colonoscopies. I mean, you name it. So I just think that by the time they do get the help, the right care that they need for the issues that they're experiencing, they've gone down a really dark rabbit hole by that point.

 

Karen Litzy:

Yeah, and that's sort of looking at, I mean, it's not that they're healthcare providers are intentionally doing them wrong, right? They just don't know. Right. So we're talking about, I guess this more traditional view of a medical process for men who are coming in. Having these complaints is saying, well, let's check this, this, this, this, this, and this. Like you said, a diagnosis of exclusion. And then years down the road they come to see you and I can't imagine, forget about their physical wellbeing. I can't imagine their mental and emotional wellbeing is doing all right either. And now the pelvic physical therapist has a whole lot of comorbidities to deal with.

Susie Gronski (09:21):

Absolutely. Absolutely. And with any type of persistent pain, not just chronic pelvic pain syndrome in men, but I think with any type of persistent pain, we really have to be looking at the psychological and sociological aspects of that person's experience. Because at this point now we're dealing with an emotionally driven process versus a purely nociceptive in nature. You know, it may have started that, but now we're dealing with this like this cat yarn, I don't have cats, but a kid, I know they like to play with yarn and you have this big ball of yarn that you're really just taking one strand out at a time to really unravel and everyone is so unique and very different.

Susie Gronski (10:30):

So yeah, I think that's where we're dropping the ball with getting quality pain care for these individuals. Number one, just getting rid of some of these barriers of a lack of education on the practitioners, you know, perspective of what do I do in this situation? Why do we need to have all these invasive tests done? In my opinion. I don't think we need to do that, but they're really not getting the referral to see qualified, you know, pelvic therapists who can really rule out, you know, biological triggers and even work with the psychological and sociological aspects of that person's experience. Just to, again, calm things down. And to reassure that person that things are going to be okay. And to that extent, I think this would be worth noting as well is some men do not have positive medical experiences in that they're not being validated, often being dismissed.

Susie Gronski (11:23):

And no one's really actually looking at their genitals. To this day, I still have men say it's all about just finger, finger in the butt, checking out the prostate, and no one's really addressing like, take a look at my testicles, look at my penis, like treat it like any other part of my body. And then you're then that kind of plays into the blame and shame of one's body. And just again, not knowing, no one's really looking at it. I want somebody to look at it to tell me I'm okay. And I think that's really being missed as well in those early encounters with medical providers. I think that's so important.

 

Karen Litzy:

And you know, you had touched on it a few minutes ago talking about not just what we see from a physical standpoint, but a socio cultural standpoint as well. So what are some common barriers that are unique to men from a sociocultural standpoint when receiving care for chronic pelvic pain?

Susie Gronski (12:25):

Well, the first one that I touched base upon as you said, was having an outlet to get medical care. So there isn't a, you know, male gynecologist per se for men. And so I think just having a lack of that awareness of where does a guy go get help for these types of things. Where would be the best physician, let's say for health urologist or urologist. But that isn't usually the first line of the encounter. It's usually an internist or primary care physician. And sometimes it could be even other healthcare professionals like a massage therapist or a chiropractor, an acupuncturist who's hearing these the symptoms or men feel comfortable enough with the trusted provider that they trust to talk about even what they're going through. Cause I think that brings me into the second, I think barrier is I think if I can say this, the masculine side of culture, right?

Susie Gronski (13:33):

Like, what should men like mentioned man up and not have these issues and what if something is going on down there? Like, you know, guys aren't really talking about their private parts in the locker room per se. And I speak, again, I'm speaking for the heterosexual male, but like, you know, I think it's just uncomfortable in terms of how the society that we live in to even have that conversation be brought up so that being one of the barriers is just, we're not really talking about sexual health issues and what could go wrong unless it's like, you know, erectile dysfunction. Right?

 

Karen Litzy:

Well, that's all over TV, so you can't miss that one. Right, exactly. Here's a pill for that. We know how to fix that. You know, you got Snoop dog talking about like male enhancement products, Pandora. Yeah. And I think, I think in terms of, you know, what are the conversations that we're having around men's health and really comes down to what's selling and what's not selling, unfortunately.

Susie Gronski (14:38):

But yeah, I think that that's one of the biggest barriers as well as just we're not talking about it outlets. There are no you know, taking a stand for men's health essentially. And the second thing too, or the third thing is when a guy has pain down there and they look it up on the internet, cause that'll probably the first thing we do. Absolutely dr Google will be first they're there and to get help, everything is women's health, women's pelvic health, a women's clinic, baby and mom, you know, like things like that that are coming up where that in itself is like, wow, this is a quote unquote woman's issue. Why am I having it? What does that mean for me? Because again, guys and everyone, I think unless something is going on down there, like we really don't talk about our pelvises or how things work and we're not taught, we're not really taught about like you know, what to expect and how things work and that you have actually pelvic muscles down there.

Susie Gronski (15:39):

So until you know, something goes South literally and then you have to like look things up and there's enough of crap out there to scare anybody. And so I think, you know, again, I think Google is helpful but it also can be harmful because we know, we know that anything can really shape someone's prognosis when they're seeking treatment and you have scary forums and you have people talking about how I'm living with this for several years. And then you have this person who's just starting to experience these symptoms, reading through these forums and looking at, you know, it could be cancer or it could be this or that. You know, it's like a life sentence. And that's really scary. And that I think is what part of the picture that takes things from acute to chronic in my opinion.

 

Karen Litzy (16:48):

Yeah. And you know, when people are involved in, and this isn't across the board, but oftentimes in those kinds of forums, it's people are writing about their experiences that have gone wrong, right? Or that you said, I've been experiencing this for years or I tried X, Y, and Z and it was horrible. So when you read those kinds of forums, cause I've gone on those, I think we, you know, a lot of healthcare practitioners should go on some of these forums to see what's being spoken about. But I've gone on them for like chronic neck pain and you're like, Oh my God, goodness. Right. This is, this is frightening. It's really scary. And so I can't even imagine someone going on there who is experiencing, like you said, some of the symptoms that you had mentioned before. Maybe they've been experiencing these symptoms for a couple of years or a couple of weeks and they look on these forums, they're like, Holy crap. Yeah. Like this is what my life is going to be now.

Susie Gronski (17:35):

Right. I mean that is really scary. Exactly. Exactly. And that we know, doesn't matter what body part we're dealing with, right. Tends to make the situation worse. Yes. Just cause of that. And so I think I'm a huge proponent of, I don't think I am a huge proponent of having good information knowledge. And like I said, reassurance for this group of people to say like, Hey, this isn't forever. This is what you can do about it. We can really work with this. It's more common than you think. And, it happens in this area, just like any other part of our body, you know there's muscles down there, there's nerves down there, there's everyday function that happens, like pooping, having sex, you know, all these things are quite normal. And I think just even experiencing some discomfort down there, just like you would have some back pain once in a blue moon is not, you know, something that needs to be perpetuated I think for many, many years.

Susie Gronski (18:41):

But I think we're talking about is that it's unfortunate because they will go down a rabbit hole of, well we've checked everything, we've done every scan under the sun and there's nothing that's showing up on scans. I just don't know what else I can do to help you. And then at that point the conversation is, well now it's all in your head and then, and I'm a goner. Like I'm doing. Yes, I'm doomed. Like and then, yeah. You know, when we talk about the interpersonal context of pain for that individual, it's am I going to be able to have a family, you know, if they don't have any, you know, or be in a relationship or to have kids or how about my job, I have to sit for my work. I can't do that. Or what about my sport that I want to play?

Susie Gronski (19:27):

Does that mean I can't do that anymore. I mean, there's so many like what ifs and uncertainty and that's one of the themes that men will talk about it's this uncertainty, this roller coaster ride of the symptoms that they experiences. It's fine, you know, one week and then it's terrible the other week and they just don't know what to expect because there's no rhyme or reason for it, for their triggers. And that's really, I think that's a really hard mental, yeah. How do I say that? Like a lack of words. It's really hard. Mentally. It is.

 

Karen Litzy:

Yeah. You know, you're absolutely right. And now let's say one of these guys they've been having these symptoms, they've gone to their doctor and miraculously their doctor said you need to go see a pelvic health therapist. Right. Yay. The doctors know what's up. So what are some reservations men might have before seeing that pelvic health therapist? And then we'll talk a little bit from the therapist background point of view after that. But let's talk about the men's point of view first.

Susie Gronski (20:26):

Yeah. So, the point of views that I'm going to be talking about are actually from the people that I've worked with. So I'm just reiterating or paraphrasing from their experience. But the number one thing is what is it? Cause the doctors aren't really telling them what to expect. So again, they'll go on to Google and they'll find like, you know, this is a woman's health issue and why am I going here? And you know, again that psychological aspects of I guess gender in general of what that means for me as a person. And that experience in itself might be one reservation.

Susie Gronski (21:17):

Like you know, this is a women's health issue. Like I don't want to go there. And so they might put that off. Which is common as well. I think the second thing is the actual procedure of having internal work or an internal examination. And this is one message I'd like to kind of get across to people is that you don't have to do internal work to get better. And I think there's this huge misunderstanding of like pelvic therapy being like, well, it's all about moving the genitals out of the way and just going for internal work and chasing trigger points. That's not really what it should be an in fact, I think unintentionally of course, I think that's more harm than good because we aren't really asking. Like if you ask the guy in front of you like is this something that you really like?

Susie Gronski (22:06):

First of all, what would be the purpose of doing internal work? Or even having that assessment, like why are you doing what you're doing? And number two is that in alignment with what that person wants, is that a goal of theirs? Is that functional for them? You know, why are we doing these things? Because we don't want, as for me, I'm speaking for myself, I don't want it to be another person to create medical trauma. I don't want to be that person that says, well this is what you need. When in fact like they're sitting up there on the table, you know, cringing and guarding and tensing. And I think it's funny for me, like it's not funny for the person on the table, but I think when they're pissed we'll say, Oh, you're really tight. You know, you're really tight.

Susie Gronski (22:51):

It's like, yeah, this is tightest I've ever seen. And I look at me and I'll tell my patients, cause they'll be told that. And I say, well, how did you feel on the table? Were you comfortable with what was going on? And they're like, no, you know, no. And I said, well, no wonder your muscles are tensing. And that would happen with anyone, you know, I'm like, but that doesn't mean that you're broken or that there's something wrong with you. And I think that's the message that's going across, not for every therapist. And I'm not speaking for every therapist, but it's just a theme that I see with men who come into my office who've had therapy in the past. And that's something that I think might be a huge reservation for someone seeking care as well, is having to have an internal assessment done.

Susie Gronski (23:36):

Although it is common, it doesn't have to happen. And if you're doing an internal, so now let's kind of go into the pelvic health therapist point of view. So this patient comes in, they've had chronic pelvic pain for, we'll say several months and why might you do internal work in or an internal assessment if the patient was okay with it, obviously. So what would a therapist be looking for? So if the person is agreeing to have this done, number one, I think it's, they want to have a thorough evaluation by a professional who works in this field. So that's reassurance. So you would do that because they're asking you to do that, to rule out whatever's putting their mind at ease, right? Again, if that's what they so, so want, I think that's the first thing that we're doing.

Susie Gronski (24:35):

Number two, if there's like pain with bowel movement or let's say that person's sexual preferences or pleasure has to do with anything anal that would also be applicable in order to just map out areas of tenders, tenderness, and then see if we can change that. So we're not, they're looking for golden nuggets, trigger points. We're there just to see, okay, can we change what you're feeling and can we give that person an experience of, Hey, it doesn't always have to hurt this way. And there are things that we can do to change things and essentially giving them back a sense of control of their own body. But I like to preface that it is a very awesome teaching opportunity for the person because you can say, well, how does it feel when somebody else touches you versus when you try to do this yourself and right then and there during the assessment, I will actually have, we'll compare, I'll say, okay, I want you to touch those areas at home and tell me what you feel.

Susie Gronski (25:39):

And then I'll say, if it's okay, I'm going to do the same thing and that might be my own individual hand. It might be hand over hand with that person's hand. It just depends on, you know, again, their comfort level. But essentially I'm just there to see if we can change their experience in their body and to prove that you don't have to hurt all the time and that things are changeable. So I love those moments. So that's the reason that I would do any internal work or any external work for that matter, is to see if we can change that person's experience in their body to create more safety and less danger. And so it makes sense. That's what I would do. So yeah, that's essentially why do that and it's not an hour long treatment session of you know, internal work.

Susie Gronski (26:31):

But, men do appreciate that you take the time to actually talk to them to address their body just like, or this part of their body just like any other part of their body. And that's a theme across every single man that I have worked with. I came into my office, you know, they'll say, I really appreciate how you just worked with me and worked with my intimate parts of my body but just considered it just like any other part of my body, like my nose. And they just felt like the sense of like they can feel vulnerable, they can be safe. They feel heard and validated because somebody is actually taking the time to work with them to ease their essential suffering around what it is they're experiencing.

 

Karen Litzy:

And I think that's really important. And so if you are working with a patient with this diagnosis and they are not comfortable with internal work, cause like you said, you don't have to do it. So what might be some other evaluative procedures you might do as the therapist to help this patient? Like you said, feel more comfortable in their body and get a better sense of understanding of what's happening.

Susie Gronski (27:45):

So the first thing is really just getting to know their story. So going back to giving them time to talk about what's going on for them. I think for men, having an outlet to be heard is really important because men don't typically kind of talk about these things. So once they know that you are accepting and you're there to offer that space for them to express themselves and the difficulty that they're going through with this, I think that's therapy right there. Just to give them that opportunity. So, having a supportive outlet. And the other thing is just if it's movement related, if it's an activity that they're having difficulty with, for example, sitting as a very common one. I have all sorts of like gadgets and toys in my office and I just bring some playfulness into the conversation.

Susie Gronski (28:39):

I have them sit on various different surfaces to see what would be something they like would actually explore, you know, again, I'm trying to see if we can violate the expectancy of, well, it always hurts and it's constant. I can't change anything. And so my role is really to see like can we change things and if we can, let's do more of that. So I try to bring a little fun into it. I try to incorporate like the passions, their hobbies that they once had done but have stopped since because of all this happening. Sometimes we don't even do any hands on work or any, even a formal assessment on the first day because we're really going through the story and we're reestablishing a sense of that person, a sense of what that person, who that person is. Because a lot of times you lose who you are.

Susie Gronski (29:38):

You know, when you have pain, persistent pain, you've gone through something. So life changing. So I think, you know, for me and for that person is establishing, well, what would life look like? What would life look like if this were no longer a problem? Who do you want to get back to being? And so I do vision boards. I'll do some sort of visioning exercise of where we can get to like the why, you know, why is this important for you? What do you want to get back to doing? How do you want to feel in your body? And then that becomes essentially the treatment plan or the plan of care. Anything that we can do to collaborate together in more of a coaching relationship to help you move forward, to attain I guess living in a way that you see yourself living, but also a values based type of approach.

Susie Gronski (30:28):

In terms of treatment. So I know that was like a mouthful, if it's the Bible, you know, I'm doing a bio-psycho-social approach, but I'm really, really having a being patient centered and patient led and I'm just there guiding them. So for some people it is really more of this, I need to figure out who I am, I need to start doing something. Well we figure that out before we go on the table. Cause there might be a lot of fear with that or they might have had certain traumas associated with, you know, medical experiences that may have had that may be negative. And so there might be a lot of reservation.

 

Karen Litzy:

And I think we as therapists need to recognize that that person might say yes, like yes, that's okay for you to do all these things like with touch. But we should also be responsible of actually paying attention to what their body is doing, what their autonomic nervous system is doing while you're touching them. Because they might say, yes, and I'm guilty of this too. I'll go for a massage and that person's touches firmer than I'd like. And they'll ask me, you know, how's my pressure? And I'll be like, Oh, it's good, it's good.

Susie Gronski (31:37):

That's my point. Exactly. That's what the person that you're working with is going through the same thing. And I think it takes a sort of a bit of a skill to recognize or to be more mindful of, you know what, this isn't necessary. I noticed that you're sweating a little bit more, that you're tensing up more. I see your facial expressions, what are your eyebrows doing? And then I'll say, you know, we don't have to do this. I don't think this is right. You know, your body is saying one thing and I know you, you know, I know intellectually, yes, they want it. They want to make you happy. They want to please you, they want to make you happy. And I think part of the treatment too is giving them permission. That's self-efficacy, that's giving them a sense of agency to make that decision for themselves.

Susie Gronski (32:21):

Do I want, you know, I want to be able to say no. You know, and I tell them right off the bat, you know, that may know I have a lot of tools in my toolbox and if we try something where you're willing to try something and it doesn't work for you, just let me know cause there's many other things that we can do and try out. It doesn't have to be this one size fits all, which we know never works. So yeah. Anyway, I guess in the long run it just depends on the person who is sitting in front of me and essentially what they're telling me they need. And they'll actually, I have a very long intake form, but it's more reflective, very open-ended. And so I'll know from that of like what they're telling me. It's just so it's this awesome cause you can see it like they actually write it out.

Susie Gronski (33:04):

Like this is what I need. So I think is happening. Great. Well I'm going to facilitate this process and we have a conversation around that.

 

Karen Litzy:

Yeah. And I think that's great. And I think it gives the listener, certainly other therapists listening have a better idea as to what a session treating someone, treating a man with chronic pelvic pain might look like. And now you had mentioned self-efficacy and we all know that as physical therapists one of our biggest jobs is to give people a sense of self efficacy and control over their body. So do you have any helpful strategies that you give to your patients for them to increase their self efficacy and to be able to manage their care when you're not there?

Susie Gronski (34:02):

Hmm. I love that question. So as you know, it probably depends on the person, but everything that we do together in a session, I make sure that they walk away with, well, here's what you can do for yourself. And it's really just a suggestion for them. I really want them to take it to experience it. So for example, I might say, you know, let's do some pleasure hunting. Probably if they've had experiences with you know, having an erection or participating in sexual activity, that was painful. We know that it's like all it takes is one time for things not to work and for things to be bad, to have a bad experience, to be worried about the next time and the next time and the next time. And unfortunately that's really strong for men and their, I guess their penis function, you know? And that's not uncommon to experience when you have pain down there. You know, the last thing you want to do is be like, yeah, I'm ready for sex. You know, it's a threat. Absolutely. and I think it's just educating, educating the person about like, this is completely normal what you're going through and it's common and it's not forever and let's see what we can do to start getting you to feel comfortable in your body again.

Susie Gronski (35:05):

And so, yeah, I think just having that kind of conversation, not being afraid to ask the questions and then asking them, well, what is it that you'd like to do or start with? Cause there's so many things we can do. What is it that you think is the most important thing to start with onto your recovery? Like I said, it could be sensory integration. So touching one's body, touching oneself and not being afraid and then having a recovery plan or a flare up plan. Cause we know that's common as well. So having some sort of structure around if I experienced this discomfort well what can I do next to help myself in this situation? Whether that's breath work a stretch you know, talking to a friend meditating, whatever it is for that person. Then we kind of put that into a plan to say, okay, next time, you know, if you try this cause you can't really, it's really hard to just, I think applied graded exposure techniques or graded activity to sexual function.

Susie Gronski (36:08):

Like you know, erections and having an orgasm and you're ejaculating. You can't like stop halfway. Like coming back from like, once you hit that climax, you know, and I think just letting them know that this is the process that happens in your body when you're having an erection and when you're ejaculating and here's what you can do to help yourself post. So, you know, I usually give things like recovery plan, but it's really collaborative with that person cause you know, everyone has their own way of living and their own lifestyle and whether or not it depends under relationship dynamics and sometimes we have to have a conversation around that. And then, you know, if any of those things are kind of coming into play, then we have to reach out to other, you know, a network of team members to help with all those dynamics that might be contributing to that person's experience.

Susie Gronski (37:01):

So, you know, like sex therapist or couples therapy or, you know, that sort of thing. So it just, you know, again, it depends on the person. So I actually want to do, I do want to make a comment about, you mentioned you know, so what is it that you give to your clients or to your patients? I think the other thing that I want to mention is that for therapists not to be afraid to address the genitals, this is one thing that I think is still common where female therapists will want to I think move male genitalia out of the way and just go to internal work. I think it's really important not to be afraid of, you know, addressing, we're touching a testicle or touching their penis. Because for them it's really important that you're doing that and then you're showing them what exactly, you know, showing them techniques or sensory integration techniques that you can do that they can do for themselves.

Susie Gronski (38:03):

So you don't have to do things. You're just showing them and then you're saying like, this is all completely normal or you know, or this is what we can work on. And having them experience, have an experience in their own body that's completely not sexually related at all. But I think as female therapists, we're afraid of like, well what if they have an erection right in front of me? You know, or like, and that's happened. You know, that does happen. I think that's one of the reservations is like, and speaking of reservations for the guy on the table, they're also afraid, maybe more so than you, that they're going to have an erection. Oh my gosh. You know, and then I always, I'm very candid about that too. I'm like, you know, we're touching parts of your body that have nerves and sense things and physiological reaction may occur.

Susie Gronski (38:47):

No big deal. If you need some time to yourself, I'll walk out of the room, you know? But you kind of address it before they even have a question about it. To put things at ease. So, sorry, I went on a tangent with that.

Karen Litzy (39:20):

I think that's important. That's really important to mention for sure. No, this is great. I mean, what great information. And so if you were to kind of take this conversation from let's say from the point of view of a man suffering from chronic pelvic pain syndrome, what would be your big takeaway for them?

Susie Gronski (39:23):

Big take away. How can I put this in one sentence? The big takeaway would be that this doesn't have to be forever. Like that this isn't permanent. That if there is something going on down there, don't be afraid to talk about it. I know you may not be surrounded by people who are very candid about talking about poop pee and sex. Like, you know, us as physical pelvic therapists. Anyway, we're so comfortable talking about that, that we forget that people, other people have reservations about talking about private parts. But yeah, not to be afraid to just, you know, reach out to a professional who understands what you're going through and who can relate to you because it doesn't have to be a lifelong sentence and a death sentence per se.

Susie Gronski (40:27):

You can get help for it and there's help for this. And yeah, I just, I guess that would be the main thing, just making, you know, having support and having that outlet for them to just be themselves and know that they're not alone.

 

Karen Litzy:

And what about to the physical therapist who, let's say you, if you are a pelvic health therapist, you're probably a little bit more informed about this, but what if you're not a pelvic health therapist and someone is coming to you with these symptoms, what advice would you give to them? I mean, outside of, I have some that I could refer you to, who is more well versed in the treatment of this, but what advice would you give to the physical therapist?

 

Susie Gronski:

You might be seeing a patient with chronic pelvic pain syndrome. I think just having more knowledge about what it is and what it isn't just as a practitioner so that you can have a conversation with this person who is experiencing pain because it in fact, you know, if the person you're working with has groin pain or the tailbone pain or sit bone pain, I think just being aware of like, there are other things that might be involved and asking questions, really not being afraid to ask questions.

Susie Gronski (41:48):

Maybe you put it in your questionnaire. I think there used to be Oswestry used to have a sex question in it. They took it out. So get the original one, keep the original one. But, yeah, just not being afraid to ask those questions and really just asking the person like, you know, I know asking permission without giving advice to, you know, just saying like, you know, I know a little bit about this. It's not within my scope, but how do you feel about having a consultation with a colleague of mine who works with men? Or who works in this field that can really help you out, we can really work together. It really is just opening up the conversation to say, Hey, you know, you're having these symptoms. There's something that we can do about it.

Susie Gronski (42:36):

It doesn't have to be, you know, it doesn't have to be like, well I don't know what to do for you, you know? Exactly, yeah. I think that's what it is. Like, you know, give them a resource or give them a website. There's so much free stuff out there. Like my website, I have all sorts of like blog posts and many others who work in this field have a lot of great literature on here's some things that you can do to just open up the conversation and what you can do to help yourself. So I think that's really the key. I think for PR professionals who are not pelvic health therapists but working with people who have pelvises that make a difference, you know, and you know they might be coming to you for low back pain but we know that low back pain and pelvic floor dysfunction and pelvic issues are correlated, highly correlated and in fact you know a lot of testicular pain can or can't originate because of low back issues and vice versa because of the connection there.

Susie Gronski (43:31):

And so just I think just having that conversation with your patients of saying like this is why it's all connected and this is what I think is what else is happening. How do you feel about getting, you know, getting a consult from so-and-so related to this because they might be, that person might be having many other struggles down there but not talking about it. Right. The first and foremost thing to do from a therapeutic perspective is let's have a conversation because we don't know what else might be going on for that person. And we can certainly be that gatekeeper, that liaison that says, Hey, I know I can get you to see so and so to help with these things issues. You don't have to just live with them.

 

Karen Litzy:

Yeah. Great. Great advice. Thank you so much. This was such a good conversation. I think from the standpoint of the therapist and the standpoint of a man maybe experiencing some of these chronic pelvic pain symptoms. Thank you so much. And now last question is one that I ask everyone and that's knowing where you are now in your life and your career, what advice would you give to yourself as a new graduate out of PT school?

Susie Gronski (44:52):

Oh, that's a good question. Okay. So what advice would I give myself as a new graduate from PT school? Hmm. You don't have to be so serious. I think that would be the advice of knowing that we're humans are all very different and we're built differently. And what we thought was once quote unquote true is always evolving and just use your own experiences to make those determinations. Like you don't always have to be, I don't know, taking word for word when everyone tells you, experience it for yourself and then make that decision.

Karen Litzy:

Excellent advice. So now let's talk about what you have coming up. So you've got podcasts, books, courses. So tell the audience where they can learn about what you're doing so that they can in turn help their patients or help themselves.

Susie Gronski (45:52):

Well, thank you for this opportunity to have a shameless plug. Here I am. Well, I'm currently working on the second edition or revised edition of my book, pelvic pain, the ultimate cock block, which is written for, you know, the average Joe who is suffering from pelvic pain. I have a podcast called in your pants that's also on YouTube. And I have several programs support programs for men who are suffering, who suffer from pelvic pain. Some are online DIY programs, others are support programs where myself and a psychologist and sex therapist have collaborated on. And I also have a course that I teach. It's called treating male pelvic pain eight bio-psycho-social approach. So I'm very busy. I have a lots of things go. It's awesome. But where can we find all of it on my website? drSusieg.com. I'm on Instagram @drSusieG. I'm also on Facebook and Twitter. Same handle.

Susie Gronski (46:54):

Awesome. Yeah, and we'll have the links to everything at podcast.healthywealthysmart.com under this episode. So one click will take you to all of Dr. Susie's really helpful information, whether you're the person living with a chronic pelvic pain syndrome or you're a health practitioner that wants to learn more. So Susie, thanks so much for coming on. This was great and I look forward to your revised book and all the fun stuff that you have coming out. So congrats. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.

 

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