Healthy Wealthy & Smart

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









All Episodes
Now displaying: Category: Episodes
Apr 22, 2019

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Laurie Seely on the show to discuss gut health.  Laurie is a Certified Health and Wellness Coach specializing in helping people repair their gut from Candida, IBS, and Heavy Metals Toxicity.

In this episode, we discuss:

-The number one question you should be asking your doctor at your next check up

-How you can assess the health of your stool

-Simple solutions to improve your gut health

-Laurie’s long journey to overcome Candida

-And so much more!



Laurie Seely Website

Laurie Seely Facebook

Young Living Parafree

Candida, IBS, and Heavy Metals Education Facebook Group



For more information on Laurie:

I’m a Functional Medicine Health Coach, a lover of Young Living Essential Oils, a mom to a beautiful little girl, and a professional opera singer, formerly in the chorus at the Lyric Opera of Chicago.

I suffered for years with IBS and all the horrible, embarrassing symptoms that came along with it, including a raging candida (yeast) overgrowth. Eeeeew!

With help from my health coach and the School of Applied Functional Medicine, I learned how to kill Candida and repair my gut. I am a health detective! Now I teach people how to kill Candida and repair their gut through workshops, group programs, essential oils, and 1-on-1 coaching.

Many of my clients find surprising side effects such as extra energy, clearer skin, fewer wrinkles, better digestion, less need for medications, lower blood sugar, and clearer thinking!


Laurie Seely


Read the full transcript below:

Karen Litzy:                   00:01                Hey Lori, welcome to the podcast. I am happy to have you on.

Laurie Seely:                 00:05                I'm so happy to be here. Thank you Karen.

Karen Litzy:                   00:08                Of course. And as we were talking about before we got on the air, the way that we were introduced to each other is through Christine Gallagher, who's a really wonderful business coach and she was part of my women in PT Summit, in our inaugural summit a couple of years ago. And so I just want to give a quick shout out to Christine for the hookup here.

Karen Litzy:                   00:31                She’s great. So now obviously in your bio I talked about the fact that you're a functional medicine health coach, but I have a feeling a lot of people aren't exactly sure what that is or what that means. So would you mind giving the listeners a little bit of background on to what that is exactly.

Laurie Seely:                 00:48                I got a certification as a health coach and then I continued at the school for Applied Functional Medicine and they offer another certification. And basically that's where I learned all my stuff. You learn about just really how to be a health detective because there are so many symptoms of dis-ease that a lot of doctors will label as an illness. And I was very interested in this kind of, it's not really medicine, but I was very interested in this kind of health detective work because I went through this whole thing myself with IBS and Candida and I still had a couple of pieces left to really, really find health for myself. And it was at this school that I've finally put in the last couple of pieces to make that happen. And so, in the process I became a functional medicine health coach. Isn't that cool? Now I help other people that had the same sort of problems that I once had.

Karen Litzy:                   02:08                Yeah. And I feel like oftentimes that's kind of the way life takes us, right? We kind of have these experiences and we figure them out for ourselves and then we try and delve a little bit deeper to widen the net and then help others. So I think it's great when you can kind of make that change. But a question, what were you doing before you were a health coach?

Laurie Seely:                 02:32                Well, I was an opera singer actually. I was singing fulltime in the chorus at the lyric opera of Chicago, which was really, really fun. And actually I just recently quit there. I was doing both at the same time for a while, which was a really difficult juggle. And I feel like this is where my heart lies and my passion now. So yeah, I was an opera singer.                 

Karen Litzy:                   03:12                What a career, what a career switch. Yeah. I love talking to people who have had different careers within their life because I always think like it gives people hope, you know? So if you're not doing exactly what you love right now, that there's hope, you may find that thing that kind of, like you said, gives you your passion. Right? Fantastic. All right, so now let's talk about the health coaching aspect of things. So let's say I'm one of your clients. I come to you and I've already been to my doctor or maybe I'm going to see my doctor. So what are some important questions that maybe doctors should be asking us that they're not? Maybe that, yeah, we're not delving into as much.

Laurie Seely:                 03:49                So I think that the number one most important question a doctor can ask you is what does your poop look like? And specifically, what does it look like and how often do you poop? Because that is your body's way of telling you when there's something wrong. I learned that functional medicine school that most dis ease begins in the gut. We don't say all because we just want to, you know, 99.9% of disease begins in the gut, I would say, right? And that's your first indication. That's your body telling you, hey, there's something wrong. You know? And so we need to be educated on our part. What poops should look like. Right. And I feel like this should be like on the commercials on TV instead of like, you know what pharmaceutical drug can help you with your IBS.

Laurie Seely:                 04:52                They should be telling us what our poop should look like so it doesn't have to go all the way to IBS. We can see right at the beginning, you know what, I'm pooping little marbles like that's, that was my problem for most of my life. Little marbles with occasional bouts of diarrhea and I went for close to 40 years not knowing that there was anything wrong. If one doctor had asked me what my poop looked like when I was say 12 years old and I was old enough to kind of tell him, well about nine times a day I'm pooping little balls. He'd be like, wow, there's something wrong with you. We need to figure out what it is. And I feel like there's so many people who are in the same boat, you know, it never would have gotten to candida for me. I had a yeast infection for a year, every single day. And if somebody had asked me at 12 years old, what does my poop look like? I just, I feel like it never would have gotten that bad. And I feel like there's so many other people in this world who are in the same boat, you know, and who are maybe at some sort of state of disease that really could have been kind of nipped in a bud years ago when it was much less.

Karen Litzy:                   06:05                Hmm. Yeah. And so if we're going there, right? We're going to talk about poop right now. We're in it, we're doing it.

Laurie Seely:                                         If you have a conversation with me long enough, it'll eventually go there.

Karen Litzy:                                           Yes. This is it. Obviously a very good question that your doctor should be asking, but now if people listening to this next time they go to their doctor, they can bring this up, correct?

Laurie Seely:                 06:33                Yeah, absolutely. And you want to be very clear because even doctors can mess up with this. You know, there was one chiropractor that I was at who asked, we sort of, we get treated in the same room, a bunch of us, and there was another client, they're getting treated at the same time. And she was making comments that kind of made the chiropractor and me kind of go to, sounds like you're constipated, but we didn't say that. And he asked her, how's your digestion?

Laurie Seely:                 07:04                She’s like oh, it's fine. And then he left the room and I said, what does your poop look like? How many times do you poop a day? And she said, Oh, I'm pooping like once every 10 days. Oh my God. Yeah. So I was like, wow. Like I didn't want to alarm her, but I sort of explained, you know, that it shouldn't be that way. So, that's the thing, when you talk to your doctor, like get gross, get like in it, tell them what it looks like, what it feels like, the texture, the smell, how long it takes to pass, because they need to know all of those things. And sometimes the doctor's going to get grossed out by that. And you know what, find a different one because you need to be able to talk about this stuff.

Karen Litzy:                   07:45                Okay. So let's talk about what it should look like. So there is a chart called the Bristol stool chart. So can you tell us what it is and what it should look like?

Laurie Seely:                 07:59                So on the chart it goes from number one to number seven. So number one is constipation and that's the tiny little balls. Number seven is diarrhea, that's watery stools. And number four is Nirvana poop. Like exactly what it's supposed to be like. It's like soft serve, ice cream texture. And it's not going to smell very much. It's going to be light brown in texture, easy to pass. We're talking one or two minutes and it's all gone all out and it leaves almost nothing to wipe. So that's the, the good stuff. And then they have, you know, the different levels in between one, four and seven also. So you can, you can Google that. There's like great illustrations online.

Karen Litzy:                   08:50                And so obviously if you're at a one or a seven, we pretty much know something's up, right? Yep. So four is perfect. What if you're at three or a five? I mean, are these things to be worried about?

Laurie Seely:                 08:56                I honestly, I don't think so. If you're at a three or a five, it's probably not your norm. If that makes sense. Like you want to look at where, where is it usually? Right? What is your pattern? If you have a couple of days with a little bit of stress and suddenly you're pooping tiny little balls, but then you get back to a number four after that, you're good. It was the stress you got over it. Right. Do a little yoga, some deep breathing, you'll be fine. Same thing happens with diarrhea. You know, a lot of people get stressed diarrhea. So if that's a temporary thing and it's due to stress that's temporary, then you're fine.

Laurie Seely:                 09:49                If it's happening all the time, then you need to know that, yeah, it's a problem and you need to do some detective work there and that's time to do a stool test or to do any number of blood tests for parasites and stuff like that. So that's time when you want to, you want to find out what's causing it. A lot of times like, okay, so I went to my gastroenterologist, I said, I have IBS, I'm constipated all the time. Sometimes I have diarrhea. I told her the whole story and she said, we don't know what causes IBS.

Laurie Seely:                 10:24                So that's another indication that you need a new doctor. So that's what I did. I got a new doctor because there are so many things that cause IBS and that's time to just find yourself a health detective and figure it out. There's a great test from the Meridian Valley lab called a comprehensive stool analysis and Parasitology times three. So that will tell you all of the expected beneficial flora that you want in there. It'll measure imbalanced flora. Any flora that's dysbiotic or like out of crazy, out of balance. So you know exactly really what's supposed to be there. It's also going to measure how much yeast you have in there because everybody pretty much has yeast in their digestive tract. It's just when it gets overgrown and it's bad. And then it also measures like mucus and then it checks for parasites and it's a three day test.

Laurie Seely:                 11:26                So if you find a doctor that gave you a stool test and it's just from one bowel movement, that's not a good enough test. If it finds something cool, then you got lucky. But it's good to test over the period of at least three days. There are some stool tests that go up to six days. So the reason for that is that the bacteria and the parasites and the candida, it all travels in groups like in clumps, they like to stick together like a school of fish, right? And from one bowel movement you could be full of parasites and in one bowel movement you pass a whole bunch that doesn't have any parasites in it because they were hanging out somewhere else in your colon. So that's why you want to test over three days. So then you have a pretty good chance that if there's any parasites in there, you've found them.

Karen Litzy:                   12:27                Yeah, that makes sense to me. And now let's say you do this test and something is positive. Where do you go from there?

Laurie Seely:                                         Well, there's a lot of things you can do about that. It depends on your doctor. He might give you a pharmaceutical antiparasitic drug to take, which can be effective and there's the possibility that it's not effective as well. You always want to retest. What I do with my clients is I use a product from young living essential oil as it's the best thing that I've found so far, the most effective and it's called para free and it's full of various essential oils and all. So, other ingredients that are known to support intestinal health and are, I can't say that they're known to kill things because it hasn't been approved by the FDA, but I've seen in my practice and in my own body and in my mother's body, that it clears up parasites.

Karen Litzy:                   15:29                So now let's say you do this comprehensive stool analysis and you find something, it's treated either by your physician with the pharmaceutical or through the essential oils, but I guess it's probably important to note that with the essential oils that like you said, they're not FDA approved and they're not studied or tested. It's just more like anecdotal stuff.

Laurie Seely:                 16:01                There are many case studies and actually it seems like from the case studies that the para free is actually more useful.

Karen Litzy:                   16:14                Well it would probably behoove someone to do some research on that because it's hard to I think get buy in from a lot of people when something isn't well-researched. That's a word I was going to say, test it. But research is probably better. Probably a better way to put that. So, you know, at least someone will, we'll do that to help people make a better decision.

Laurie Seely:                 16:50                Right. Well, here's a thing, the reason why they're not FDA approved is not because the FDA looked into it and disapproved them. It's because the FDA doesn't want to waste their time on something that can't be patented because they're natural ingredients in there. They're not synthetic versions of natural ingredients it’s the actual natural ingredient. And so those things can't be patented and they can't, you know, companies can't make money off of that. And so the FDA doesn't want to use their funding on that.

Karen Litzy:                   17:23                Right. Yeah. Well hopefully someone can do like a nice comparative study between that and a pharmaceutical and see what works and what doesn't.

Laurie Seely:                 17:34                I think one of the issues that pharmaceuticals are usually aimed at just one thing. And the para free has been useful in treating a wide range of parasites. So it's like throwing a huge blanket on it. You Kill Them all. But you're right. You're right. It'd be nice if it were more widely publicized.

Karen Litzy:                   18:05                All right. Now let's say we talked about this a little bit. Let's say you're on the one of the Bristol stool chart, which means that you're constipated and everyone at some point in their life has been, and we know it's not comfortable, so how can we relieve this?

Laurie Seely:                 18:29                So there's a couple of different ways. It depends on what's causing it. So before doing a stool test, I would try, what I'm going to tell you now, I would first look at how much water are you drinking every day. So the rule of thumb for how much water you should be drinking is you see how many pounds you weigh, divide that by two. And that's how many ounces of water you should be drinking every day. So if you weigh 140, you should be drinking at least 70 ounces of water per day. Right? Now there's a lot of people who are already doing that, but there are a lot of people for whom that would be quite a bit of water. That's really what we need to be doing because, the number one and the Bristol stool chart is an indication that your stool is dehydrated and you're still maybe dehydrated just because you're not drinking enough water, it's possible that the muscles along your colon aren’t functioning absolutely properly and that you're just moving along slowly because there's not enough water in your stool.

Laurie Seely:                 19:36                So that's the simplest fix. Right? And then also if you do that and you find that it doesn't fix it or it improves it, now you're still drinking more water. Another thing to do is consider that maybe you don't have enough magnesium intake. So a lot of us don't have enough magnesium just because we're not getting it anymore from the fruits and vegetables because of modern day farming practices. It's not in the soil. So if it's not in the soil, can't be in the vegetables and that's where we're supposed to be getting our magnesium from. So we use supplements. So there's, the form of magnesium that helps to stimulate the bowels is called magnesium citrate. And so you just see, you try taking some magnesium citrate and there's a very easy way to figure out how much of that you need.

Laurie Seely:                 20:32                You want to get the powdered version because it's easier to lower or raise your intake right then like taking a capsule. And so you start with half a teaspoon of magnesium citrate. And you do that for about three days because it takes a while for it to build up in our bodies. And if after about three days you're not moving along the way you want to be, then you raise it by another half teaspoon and you just keep doing that in three day intervals like that until you're where you want to be. And it's possible that you might go up a little too far and have diarrhea and then you know, for sure that half a teaspoon or less than that is what you need.

Karen Litzy:                   21:17                Right, right. Yeah. So it's a little bit of trial and error there, but I get it.

Laurie Seely:                 21:22                I mean that if you're trying to do things naturally, that's how it is.

Karen Litzy:                   21:27                Yeah, for sure. Okay. So we've got lack of water, lack of magnesium. Anything else that can contribute?

Laurie Seely:                 21:35                Well, we always say we should have more fiber. Right? And that could be part of it as well. So you want to make sure that you're eating enough vegetables because I never recommend a person to get their fiber from things like shredded wheat or bread or things like that. But that's what we see in the media, right? We see like, oh, have your high fiber bread and that's going to help you. Well, wheat actually can irritate the colon. Whether you have a sensitivity to it or not because of the way that it's being produced nowadays. It's a very common irritant. And so that could be, I mean, maybe you're eating bread and that's your problem, right? So if you feel like maybe it's a fiber issue, then the way to get fibers through vegetables and I'm talking about like spinach, Kale, leafy Greens.

Karen Litzy:                   22:34                Yeah. So that makes sense. So you want to start having more water, kind of eating a little bit healthier and things may even out for you. Okay, great. So is there anything else with constipation that we didn't go over about kind of how to relieve it or what might be causing it?

Laurie Seely:                 22:55                Well, those are the places that I would start. And if you don't make any headway there, then got to find yourself a health detective, I think.

Karen Litzy:                   23:07                Yeah. Yeah. All right. Sounds good. Now you made mention of this earlier, but, and I know it's part of your history and kind of why you became a health coach, but talk a little bit about Candida and what it was like for you for 10 plus years.

Laurie Seely:                 23:28                So, my whole life, this whole thing with my digestion just kept getting worse. I didn't even know that I had a problem. I was unaware of it. That's why I'm here. Like educating people about it, bringing it into the light. Eventually I started having like three to six or more yeast infections every single year, which I also didn't know, but that's considered frequent for yeast infections. And then eventually, this is a little while after I had my daughter. My immune system just tanked and so did my thyroid and I had a yeast infection for every day for an entire year. I remember spending a week at Disney with an itch that I couldn't scratch. It was just horrible. So that's when I finally, I took the plunge. I was googling the whole time, like, there's probably a good 10 years that I was like, why am I getting so many yeast infections?

Laurie Seely:                 24:32                And I would Google that and it would come up as a candida, you know, a systemic candida infection. I was like, no, no, no. It couldn't be that, because then I of course googled the remedy for that. And it just seemed like so hard and such a problem to go through that I was like, no, it's gotta be something else. It can't be that. So when I finally admitted it, I mean, that was the first day of the rest of my life, you know? And, I started my journey to health

Karen Litzy:                   25:11                So aside from having the recurrent and constant yeast infections, was there anything else that you noticed that maybe you ignored?

Laurie Seely:                 25:20                Yes. Looking back, I started to have, when I wasn't constipated, I was having far more urgent diarrhea, which actually led to like public accidents. Very, very embarrassing. And I got some allergies that I had always had some allergies, but it was just so bad that I was seeing an allergist and I was using Flonase and other steroid nasal sprays. And of course that was just making my problem worse because steroids actually kill gut bacteria and that was the root of my problem. And then after that allergies then more yeast infections. That was I think the allergies and the more frequent diarrhea that I didn't put it together. I didn't understand.

Karen Litzy:                   26:19                Yeah. And that always seems to be the way because especially when you're in it, it's kind of like hard to connect all those dots, right? Because you're just trying to take care of the symptoms.

Laurie Seely:                 26:30                I was constantly putting band aids on symptoms, not realizing that they had a common cause. And sinus infections also. Yeast kinda likes to live in the warm, wet areas and sinuses are a really good place for them to take up shop. And I had that problem too.

Karen Litzy:                   26:50                Gosh. What a way to go through life.

Laurie Seely:                                         Yeah. Yeah. And you know, there's so many people who are really experiencing this all the time still and also haven't connected the dots, you know.

Karen Litzy:                                           Well, you know, hopefully you can raise a little bit more awareness for people and have them be a little more aware of how they poop yes. And what it looks like and the consistency and this smell and all that stuff so that hopefully we can, cause you know, what you put in your body's got to come out, right? So, I think it's important that we pay attention to what our body is doing because like you said, our bodies are pretty good at telling us when things are wrong. When things are out of homeostasis and if checking your poop, that seems pretty easy to me so then you could say, oh, this doesn't seem right. Maybe I should call my doctor about this.

Laurie Seely:                                         Exactly. Yes, exactly. Just have to pay attention.

Karen Litzy:                                           Yes, we have to pay attention. Well, now is there anything that maybe we didn't cover that you feel like who I really want your listeners to know this.

Laurie Seely:                 28:21                I think we got everything.

Karen Litzy:                                           All right, well then I have one last question for you and it's a question 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, let's say right out of school, or maybe in your case when you first started getting into the opera world?

Laurie Seely:                 29:05                Oh, well this is, yes. Advice that I wish I'd had. Just keep trying get used to hearing no.

Laurie Seely:                 29:20                Because in the opera world we deal with a lot of rejection. There's a lot of auditions and you might get out of, I don't know, 20 auditions, you might get one job. So I really would have liked to start to hear that, to know that it was normal. You have all these auditions and just get one job, you know? But I have a very stick-to-it-ness sort of nature to me and I rolled with it.

Karen Litzy:                   29:52                Gosh, I'm sure so many people have been in your boat many times over and would have loved to have had that advice. And now you have, which I'm very grateful for, something for the listeners. So what is a Freebie for people?

Laurie Seely:                 30:10                So I have a seven step program that I use with my clients to help them get over candida and repair their gut. And I have a blog post on my website that goes through those seven steps. And it also has a very handy downloadable checklist that you can use as you're going through the program.

Laurie Seely:                 30:42                So, and it also has a very nice list of Anti-candida foods, foods that are allowed and not allowed on the anti-Candida, a diet that is very handy to print out and just hang in your kitchen so that you can check it every once in a while and see what kind of recipes you want to make for yourself. Because when you're doing the Anti Candida Diet, it can be very difficult and very depressing to try and figure out what there is that you can eat without feeding your candy jar. So for anybody who sort of was thinking, oh, that might be me, I don't know, you can go to my website and check out that post. And there's so many other posts on there about IBS and Candida and food sensitivities and all that stuff. You can go down quite a worm hole on my website.

Karen Litzy:                   31:33                Perfect. And we'll have the link to the seven steps to kill Candida checklist. We will have the link to that in the show notes over at so you can one click and it'll take you there. And where can people find you?

Laurie Seely:                 31:55                I am at and I'm also on Facebook at Laurie Seely functional medicine health coach. And I also have a group on Facebook called Candida Ibs and heavy metals education group.

Karen Litzy:                   32:14                Awesome. And again, we'll have all the links to that. So if you have questions you want to get in touch with Laurie, you can pop over to her website. If you weren't writing all this down, you can go to the podcast website, click onto it and it'll take you right there. So Laurie, thank you so much for coming on and talking to us about poop which is a first for me on the podcast.

Laurie Seely:                                         So that's awesome. I'm so glad I get my bad for you.

Karen Litzy:                                           It was at first. And hopefully people, no pun intended, got a lot out of this. So Lori, thanks so much for coming on and everyone else, 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 iTunes!

Apr 18, 2019

LIVE on the Third World Congress of Sports Physical Therapy Facebook page, I welcome Professor Ewa Roos to discuss the GLA:D Program. Professor Roos is an internationally leading researcher and change agent in the field of musculoskeletal health. She has been able to both produce high-impact clinical research and translate that research into clinical tools that are easily and effectively implemented in hospitals, primary care clinics and even community settings in municipalities.

In this episode, we discuss:

-The three components that make up the GLA:D program

-Are GLA:D exercises superior to performing any other form of exercise?

-The benefits of participating in group therapy

-A sneak preview into Professor Roo’s talk at the World Congress of Sports Physical Therapy

-And so much more!



3rd World Congress of Sports Physical Therapy

GLA:D Program

Ewa Roos


For more information on Professor Roos:

Professor Roos has a passion for advancing the frontiers of knowledge in muscle and joint health to improve the quality of life of those with musculoskeletal disease and to improve health care delivery for these conditions. Her focus is on patient involvement, non-surgical and surgical treatments and clinical care pathways.

A decade ago Professor Roos and colleagues started to investigate the evidence underpinning the outcomes from arthroscopic knee surgery. When they found very little evidence to support the ever-increasing frequency of these surgical procedures, they started investigation of the efficacy of arthroscopic surgery compared with sham surgery or structured exercises through a series of high quality randomised controlled trials performed in collaboration with Danish and Norwegian orthopaedic surgeons and physiotherapists. To the surprise of many and the concern of some, the results of these and other research projects have found that arthroscopic surgery for the degenerative knee is no better than sham surgery or non-surgical treatments for improving pain and loss of function.

Professor Roos is an internationally leading researcher and change agent in the field of musculoskeletal health. She has been able to both produce high-impact clinical research and translate that research into clinical tools that are easily and effectively implemented in hospitals, primary care clinics and even community settings in municipalities. She has also served as an expert on clinical guideline committees for osteoarthritis (Sweden and Norway 2003, Sweden 2012, 2017--, Osteoarthritis Research Society International 2014, China 2017), knee osteoarthritis (Denmark 2012) and meniscus pathology (Denmark 2015), thereby impacting the delivery of clinical care in the Nordic countries and worldwide.

One of the principal outcomes from her research has been the development of the Good Life with osteoArthritis in Denmark (GLA:D®) project for people with knee and hip pain. The GLA:D® project is an outstanding example of how to successfully implement evidence-based clinical guidelines in primary health care practice and municipalities. Its underlying principles focus on patient education, patient empowerment, exercises and self-management. Since 2013, more than 1000 clinicians nationwide have been trained in delivering GLA:D® care to about 30,000 patients, who report remarkable improvements in health in terms of less pain, less disability, consumption of less pain medication, increase in physical activity, reduced sick leave and return to work ( The GLA:D® project now serves as a template for establishing similar initiatives in other countries including Canada (2015), Australia (2016) and China (2017).

Professor Roos’ research unit at University of Southern Denmark now has 20 members, attracting international recognition for its involvement in evidence-based medicine, development of patient-reported outcome measures and pioneering research in the field of joint injury, osteoarthritis and the role of surgery and exercise in treatment.

Professor Roos plays an active role in breaking down the barriers between disciplines and forging interdisciplinary teams to collaborate on addressing key research questions of common interest. She is open-minded and inclusive, welcoming the opportunity to work with other disciplines and professional groups - a trait not always found in academia – to ensure the highest standards and the best possible outcomes for people suffering from musculoskeletal disease. To this end, she has been integral to the creation of the new Center for Health in Muscles and Joints at the University of Southern Denmark, which aims to become the leading institution in Denmark for information exchange, interdisciplinary research and innovation in the domain of musculoskeletal health.

Professor Roos has published many articles in lay language targeting patients with osteoarthritis, often in collaboration with the Swedish and Danish Rheumatism Associations and she has made hundreds of appearances in printed and electronic media and TV. She takes every opportunity to increase political awareness of the impact of muscle and joint disease for the individual and the society and the proven benefits of physical activity for those with these conditions in Denmark and internationally, to raise its visibility through public debate, and to advocate for its recognition as a public health priority to offer treatment of muscle and joint disease equal to that of other chronic diseases including heart disease and diabetes.

In 2014, her contribution to public health was recognised when she won the OARSI (Osteoarthritis Research Society International) Clinical Research Award for her “outstanding work in exercise as prevention and treatment of joint pain, joint injury and osteoarthritis”. This is the first time this highly competitive award was given to someone other than a medical doctor and to a Danish researcher. In addition, in 2014, she was awarded the Queen Ingrid of Denmark’s prize for outstanding arthritis research by Queen Margrethe II of Denmark, and the Danish Rheumatism Association (Gigtforeningen).

Professor Roos is the author of 205 peer-reviewed publications. She has published in high impact journals such as the New England Journal of Medicine, the British Medical Journal and The Lancet. Her work has been cited in total 10952 times with 1 paper cited more than 1100 times and 23 additional papers cited more than 100 times. Her h-index is 54 (January 2018). She has supervised 21 PhD theses to completion with her students having professional backgrounds in medicine, physiotherapy, nursing and sports. Four of her PhD students have received awards and/or prestigious post-doctoral funding from the Swedish or Danish Medical Research Councils.

Her success in attracting project funding is testament to the value that funders place on her research. In total, she has attained over 27 million SEK, 10 million DKK, 0.6 million AUD, 0.8 million CAD, 0.9 million USD and 4.2 million Euro as applicant or co-applicant since 2005.


Read the full transcript below:

Karen Litzy:                   00:00                My name is Karen Litzy. I'm a physio therapist. I'm based in New York City and I am so happy to be on the Third World Congress of Sports Physical Therapy Facebook page interviewing Professor Ewa Roos. And we are going to talk a little bit about her background and the GLA:D program and a sneak peek at what she's going to be speaking about at the Third World Congress, which is October 3rd through the fifth in Vancouver, Canada. So Professor Roos, thank you so much for taking the time out and joining us today on this Facebook live.

Ewa Roos:                     00:44                Thank you. It's very exciting to meet you Karen.

Karen Litzy:                   00:47                Yes. And for all of you who are on watching, if you have questions, we can see them. So feel free to put questions in as we get a little bit more into the conversation. But before we get to the meat of what our interview is about, can you talk a little bit more about yourself?

Ewa Roos:                                             Okay. So what do you want to know?

Karen Litzy:                                           Well, let's talk about how long you've been a physio therapist and kind of what led you into the work that you're doing now.

Ewa Roos:                     01:16                Okay. So I've been a physiotherapist since I graduated back in 1981. So that's a really long time ago. And the reason why I moved into this area was because I was very much involved in sports. I went to a sports high school and I competed on the national team in my sport, which is something called orienteering when you're running in the forest with the use of a map and a compass. And I got an obvious injury and suddenly I couldn't run as much as I wanted to run. And I visited a number of sports medicine doctors and they actually can’t tell me either and that built up some frustration and eventually actually have surgery for these overuse injuries. That was not very smart either. So that really sparked my interest and then my career. And then getting a degree in physical therapy was the fastest way of getting to work with what I wanted to work with Sports medicine.

Karen Litzy:                   02:21                And what took you from that, from getting your degree to where you are now? Professor, researcher.

Ewa Roos:                     02:28                When I think back I realized that I had aspirations of becoming a researcher already as a kid. I published my first paper back in the 80s. But it didn't really take off until I found a very good supervisor in the mid nineties and that's good advice, I think. Find yourself a good supervisor.

Karen Litzy:                   02:57                And so you’ve been conducting research in that since the 80s. And can you tell everyone where you currently are working?

Ewa Roos:                     03:05                So I'm working at University of Southern Denmark.

Karen Litzy:                   03:09                And that takes me into the GLA:D program. So before we start talking more about it, can you let the listeners know what does GLA:D stand for?

Ewa Roos:                     03:22                So GLA:D stands for good life with osteoarthritis in Denmark.

Karen Litzy:                   03:26                And when did this program start?

Ewa Roos:                     03:30                So I think I would like to start by saying that while I am a researcher, GLA:D is not really a research because GLA:D came out of the frustration I felt knowing about all the evidence that was out there and sitting on clinical guideline committees in Sweden, Norway, Denmark, China and globally. And we could see that all guideline committees, they're recommended patient education, exercise and weight loss if you were overweight as first line treatment for osteoarthritis. And there were lots of money spent on these clinical guidelines, but nothing changed in clinical practice because of these guidelines. So GLA:D actually came out of pure frustration and we realized that something needs to be done to help clinicians implement these clinical guidelines into their practice. That was the beginning of the GLA:D program and that was in 2013.

Karen Litzy:                   04:41                Okay, so it's yourself, Soren Skou. Yes, I pronounced that correctly.

Ewa Roos:                     04:48                Soren Skou was my PhD student at that time. And Soren is a very young, smart, energetic young man and the combination of the two of us was really good to make things happen.

Karen Litzy:                   05:05                Okay. So before we get into, and we'll talk about some of the discussions on social media regarding the GLA:D program in a little bit, but before we get into that, can you talk a little bit more about what is involved in the program and how it works?

Ewa Roos:                     05:23                Okay, so the whole aim is really to improve quality of care for patients with osteoarthritis and to do so we use three components. The first is that we educate clinicians in Denmark, it's mostly physiotherapist. It could basically also be other clinicians who have the sufficient background and knowledge about osteoarthritis and knowledge about exercise as treatment. So we have a two day course to educate about osteoarthritis and about delivery of exercises. That's the first component. The second component is then what these clinicians deliver in the clinical practice. So that is patient education and exercise therapy, which is group based and supervised by a clinician built on evidence. And the third very important component is that we evaluate the outcomes with an electronic registry. But I would again like to point out that this is not per se a research project because this is uncontrolled and this is real life. This is what happens across a nation.

Karen Litzy:                   06:46                I think it's important to note that this is not like a randomized controlled trial, you’re collecting the data that you are finding from clinicians, from actual patients sort of in the trenches so to speak.

Ewa Roos:                     06:59                Yes. So if you run most controlled trial, everything is very much controlled. That's not the case when you do it in real life clinical practice, but GLA:D it's a minimum, it's a core package of patient education and a 12 exercise sessions. But as a clinician you're always the one who determine what your specific patient need. So you have to deliver the patient education and you have to deliver the exercise, but you are absolutely free to add whatever you think your patient may need. They may need manual therapy to improve the range of motion of the joint or something else. That is absolutely fine. You can also send them to a dietician if you think that would be beneficial for them, et cetera.

Karen Litzy:                   07:53                And so sorry for that. We may hear horns and sirens because I'm in New York City, so I apologize everyone. So as far as the program is concerned, so it's not like a clinical practice guideline but rather a full program. So I guess my question is if clinical practice GLA:D guidelines weren't being followed, how do we know that the program is going to be something that's sustainable and followed? Do you know what I mean? Like if therapists were like I'm not following these clinical practice guidelines.

Ewa Roos:                     08:31                So, I’m not really sure I understand your question. But, so I think that's probably why to be able to answer that or respond to that question I would say that it's basically that we can see that clinicians want to take the courses and we can see that they actually register patients in the registry and we can evaluate the outcome. And that's a very good way of measuring the quality of what's being delivered. We can see how many sessions they have attended, for example, and things like that.

Karen Litzy:                   09:06                Yeah, yeah, exactly. So if I'm a clinician, so if I'm looking at it from the clinician standpoint, for me, it gives me some accountability. Right? So it's like, of course we're always accountable to our patients and should be to ourselves. But it's always good to know that you're being held accountable and being held to a certain standard for your patient in order to kind of be part of the program, if you will. And I think that's important because otherwise, I mean, human beings, right? We get lazy and we're not following things as best as we should. So I think that's an important component of the program.

Ewa Roos:                     09:55                I would say that the longer we go on, the greater is the part that has to do with quality assurance.

Karen Litzy:                   10:03                Absolutely. Yeah. And so, you know, let's get into some of these discussions on social media now that we have a better idea of what the program is, so some of the discussions are regarding whether the GLA:D program is superior to performing other forms of exercise. But what are your thoughts on this?

Ewa Roos:                     10:24                Yeah. Okay. So when you do a research study, the primary outcome can be pain relief. And if you look at randomized control trials and if you look at the effect that you find from different exercise program, there are no studies showing that one type of exercise is superior to another program when it comes to pain relief. So when the neuro muscular exercise program that we used in GLA:D is being compared to other exercise program, we can say it's similarly effective, but it's not more effective than other exercise programs. But what is interesting is that we can see that when we deliver it in clinical practice, one of the thing is that we're able to teach it to physiotherapists with very different backgrounds. You know, we have taught more than thousand physiotherapists in Denmark and some of them are real musculoskeletal experts, but some are not.

Ewa Roos:                     11:28                And just being able to teach a program to clinicians with very varying background that is in itself, something that requires a good framework for the program. I think. So that is one aspect and then we can see that we're actually able to have about 25% pain relief directly after program. So we can kind of duplicate the findings that we have in randomized controlled trials. But what I think is even more important is that we can maintain that improvement at one year. And that is something that we don't always see in randomized controlled trials actually. So in some regards it looks like we're doing better than in the randomized controlled trials. And this is not a research project. So I can't tell you why I can just say that the clinical findings are really good and encouraging because it looks like there must be some kind of a better understanding of the disease from the patient's perspective. And there are some indications that there are some lifestyle changes. One third for example, report that they have increased their physical activity level. We can see that one out of three stop taking painkillers and we can see that there is a lot less sick leave, especially among the knee OA patients at one year.

Karen Litzy:                   12:58                And do you feel that, at least in Denmark, I'm assuming if a thousand therapists have gotten through this, this is a pretty recognized program in the country. So do you feel like patients have more buy in so to speak because it is a recognized program?

Ewa Roos:                     13:17                That's a very interesting question. And my feeling is that there was more buy in from patients, from clinicians and from those referring to the program that is general practitioners and orthopedic surgeons. What the general practitioners tell me is that they really like to refer to program where they know the content of what is being delivered. They don't really like to refer to a physical therapy as a black box treatment that they don't really know what is going to be delivered. And I guess to some extent they may be right because there has been delivered passive treatments for which there is really no evidence in these patients.

Karen Litzy:                   14:07                And the other thing that I find interesting about the program is that it's in a group setting. So you have a lot of people together in one group and I also wonder does that also foster, first of all, it's a nice sense of community, you have a support group. Again, accountability on the patients. If it makes them more accountable, they’re doing their exercises, right? And they've got the support.

Ewa Roos:                     14:36                Yeah. You can see that when you go and audit the clinics that you can kind of see the interplay between the patients. And there was some kind of positive peer pressure, you know. And for example, we do some exercises on the floor very deliberately and there may be older patients who come in and say, I cannot get down on the floor because I haven't been on the floor for the last 10 years. You know? And the physio can say, well that's fine, you don't have to, you know. But after a few sessions, that person will be on the floor, not with the help of the physio, but inspired by the other patients and as some kind of side effect, you know, they're also learn how to get up with the help of a chair and they get less fear of falling because they know they can get up again.

Karen Litzy:                   15:22                Right. And I look at that as such a positive for the program, but also for the patient, the individual patient, because then they're more likely to do the exercises. I’m sure part of it is they're doing exercises on their own. I would assume it's not just twice a week or however many times a week you're coming into the program.

Ewa Roos:                     15:44                So what we told them actually is that this is twice a week. And we do not require them to do anything at home if they want to, sure they can do it. But there is no requirement of home exercises. And I think that makes it maybe, but this is pure speculation, a better experience because you feel sure if you're more secure about what you do, you have someone to hold your hand because it's painful to start exercising when you have osteoarthritis and you ask your body to do things you haven't done for a long time. And many people get anxious if they should exercise at home and they also feel bad conscience if they don't do it. So actually I think it seems to be a better experience to tell people do this twice a week. We know it will be better if I did it three times a week. But we also know that for most people it's not possible to squeeze that into their daily life. So it's a very pragmatic decision to say twice a week because that is what most people can do. It's not the best, but it is pragmatic.

Karen Litzy:                   16:55                And do you find that your class attendance is always very high? Meaning are there a lot of dropouts?

Ewa Roos:                     17:04                Yeah. So if we look at the last annual report that I have access to was from 2017 we are about cleaning of the data for 2018 but that was nearly about 30,000 patients. And we can see that eight out of 10 patients have completed at least 10 supervised sessions. That is very good, I think.

Karen Litzy:                   17:27                Very good. Yeah. Because you know, people always say exercises are great, but if you’re not going to do it it’s not going to make any bit of a change. Now is there anything else about the GLA:D program that you'd like to talk about and let everyone know about before we talked more about what you're going to be speaking about at the conference?

Ewa Roos:                     17:53                So I think it's important to say that the GLA:D program would not be the success it is if it didn't have the buy in from the clinicians and that the clinicians wouldn't feel that it really supports their clinical practice. And because it's the clinicians who take ownership of the program and it's them who kind of market it in their local areas, it's them who inform the general practitioners. So GLA:D is really more of a grass root movement or bottom up initiative or whatever you would like to call it. We actually had no, or very, very little funding to get this whole thing started. We actually only had funding to set up an electronic registry. That was it. The rest was just pure frustration, hard work and wonderful support by all the clinicians who have embarked on this and they feel that it really eases their daily practice and it has also made it possible for them to attract new patients. So it's actually been a good business for them in that sense.

Karen Litzy:                   19:06                Yeah, and I also liked that you mentioned earlier that if you've got a patient taking part in the GLA:D program, that it doesn't mean that you're not perhaps seeing them for one on one therapy as well.

Ewa Roos:                     19:19                So GLA:D, it's a framework, you know, and there are some core things that you have to deliver, but if you would like to deliver extra things on that because you are the clinician, you're the only one that knows the patient. I think that's really, really important to stress. And I think this pragmatic approach and this flexible approach is part of the success. And that may come because we have all worked for very long in the clinic and know what it's like to be in the clinic and we know that it needs to work. So for example, if it was a research project, we also do functional tests. Like we look at walking speed and chair stands just for example. And if you did that in a research project, you would do three attempt, you know, but we don't do that. We only do one attempt because that is what you can do in clinical practice. So, we have tried to do everything in a way that we evaluate the outcome. We can check the quality, but we've done it with minimum resources on the therapist.

Karen Litzy:                   20:38                And oftentimes that's what it's like when you're in a clinic.

Ewa Roos:                     20:41                You need to make your ends meet during the daily work because else you won't do it.

Karen Litzy:                   20:51                Exactly. Exactly. And I think it's also worth mentioning that the GLA:D program is not only in Denmark, it's also in let me see if I can remember Australia, China, Canada.

Ewa Roos:                     21:07                Yes. This year in April, Switzerland will come on board. In November in New Zealand will come on board.

Karen Litzy:                   21:16                Great. And the thing that I found really interesting is in China is that it's physicians who are running the program, their orthopedic surgeons, which is in your head, you think, well, that was interesting. It's competition, so to speak. But I think it's, I think that's great. And hopefully in other countries, hopefully you guys will expand in other countries in the near future as well. All right, so let's get to what you're going to be speaking about at the Third World Congress of sport physical therapy. So can you give us a little preview?

Ewa Roos:                     21:55                Okay. So we haven't been talking much about research. We've been talking about implementing clinical guidelines in clinical practice. But I think I have been so fortunate that I actually grew up academic department of Orthopedics and that has put me in a position that I've had many close collaborations with orthopedic surgeons and we have across professions then been interested in surgery and exercise therapy as treatment for different kinds of problems, mostly knee problems. So, over the years I have been involved in randomized controlled trials where we have compared surgery to exercise for an acute ACL tear in the young active populations, for a meniscal tear in the middle aged population and for severe osteoarthritis in people that we have provided with nonsurgical treatment, comprehensive package and then randomized them to have a total knee replacement in addition or not. So I will talk about the outcomes of these trials and I will talk about how you as a clinician can use these results in a shared decision making with your patients.

Karen Litzy:                   23:20                And I think that's so important, having that shared decision making, being honest with your patients and giving them all points of view so that they can then make the decision that’s best for them.

Ewa Roos:                     23:31                Yes, because there are pros and cons with different treatment strategies and there is not one treatment strategy that fits all patients, but I think it's really good if patients can get informed so they're able to make a treatment decision that is right for them.

Karen Litzy:                   23:52                Well I am definitely looking forward to that and you know, as we speak, I am seeing and a 12 year old girl who had an ACL tear with subsequent surgery, and I see a lot of ACL patients. So that is something that I always try and give, you know, all views so that they can make the best decision. And sometimes that involves being the quote unquote bad guy.

Ewa Roos:                                             What do you mean by bad guy?

Karen Litzy:                                           Well, not bad guy, but sometimes telling them things that they don't want to hear saying to the patient because you're trying to give them all points of view and sometimes patients don't want to see all points of view. I think oftentimes, and this has been my experience with patients is they want to hear the point of view that is going to confirm what they've already decided without hearing all the points of view

Ewa Roos:                                             Confirmation bias.

Karen Litzy:                                           Right. And so sometimes you have to if you want to be open and honest with your patient and give them all of the information that they can take with them to make that decision. Sometimes you have to tell them things that maybe they're not wanting to accept.

Ewa Roos:                     25:15                It would be very beneficial if we could develop educational packages or educational tools for young patients as well. Just as we have for osteoarthritis patients. That will be really beneficial. But it's a hard nut to crack because when you're young, you think you're invincible and your perspective is not very long. You want things to happen here now or yesterday would have been even better.

Karen Litzy:                   25:43                Well, I'm definitely looking forward to that because I'm always looking for better ways to communicate with my patients and really to be able to give them all of the information they need. So I am definitely looking forward to your talk.  And we've got a couple of comments that I'll just read. All right. I am going to not say this person's name right, but Meredith Gosh, I hope I said that correctly. She said, your work is incredible. Your work is incredible. You truly make the world a better place. So proud to know you. Hope to see you soon.

Karen Litzy:                   26:47                And then another one from Jay F Esqulare who is part of the world Congress, said you're a pioneer in the world of physio therapy, knee injuries, osteoarthritis and rehab programs such as GLA:D, so amazing to have you at SPC 2019. So, hopefully, everyone who is listening will now be a little bit more curious. Will want to come to Vancouver to listen to your great talk. So again, it's Vancouver October 3rd through the fifth of this year, 2019 in Vancouver. All the information is right here on the Facebook page. So you can go and click on the link on the Facebook page and we'll even put it underneath this video. And if it's okay with Professor Roos, we can also maybe put some links to the GLA:D program as well.

Ewa Roos:                     27:50                You can link to GLA:D Canada and GLA:D Australia and you will find information in English. That might also be a good thing.

Karen Litzy:                   27:57                Awesome. Yeah, that would probably be great, we're going to be in Canada even better. So in English.

Ewa Roos:                     28:03                If you link to GLA:D Switzerland, you will also get information in French, German, and Italian.

Karen Litzy:                   28:10                Awesome. So we've got a lot of languages covered there which is wonderful. So Professor Roos thank you so much for taking the time out of your day today and coming on, and I look forward to seeing you in Vancouver in a couple of months.

Ewa Roos:                     28:24                Nice talking to you Karen.

Karen Litzy:                   28:27                Thanks so much. Bye everybody. Thanks so much for coming on and we'll see you in a couple of weeks with another interview.


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

Apr 15, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Robin Meyers on the show to discuss fear.  Robin Joy Meyers is an international speaker, fear strategist, molecular geneticist and radio show host.  She educates and empowers women who are thought leaders, executives and entrepreneurs. Robin specializes in implementing strategies to harness the positive power of fear to their advantage through executive coaching, workshops, and speaking engagements.

In this episode, we discuss:

-The science behind the fear response

-Why self-awareness is key to harnessing the power of fear

-Recognizing the positive and negative side of fear

-How Robin transitioned her career throughout different periods in her life

-And so much more!



Robin Meyers Website

Robin Meyers Instagram

Robin Meyers Twitter

Robin Meyers Facebook

Robin Meyers LinkedIn


For more information on Robin:

Robin Joy Meyers is an international speaker, fear strategist and molecular geneticist.

She founded Navigate2Empower to educate and empower women who are thought leaders, executives and entrepreneurs, on how to harness the positive power of fear to their advantage.  Robin specializes in implementing strategies for self-awareness, mindset and leadership through executive coaching, workshops, and speaking engagements.

As a molecular geneticist, Robin discovered the TUB36 gene, a gene that affects the wing formation of fruit flies. She is also the host of the popular radio show, Activate Bold Choices, and is best-selling author of “Alone but Not Lonely” and “The Art of Unlearning.” 


Read the full transcript below:

Karen Litzy:                   00:01                Hey Robin, welcome to the podcast. I am happy to have you on. All right, so we've got a lot to talk about here. Just given your bio, we've got a lot to dive into. So the first thing I am so curious about is what is a molecular geneticist and how did you get into that field?

Robin Meyers:                                      Yeah, I have an eclectic background. I know I got into molecular genetics actually really because I didn't get into med school. I thought I was going to go to med school and I didn't get accepted in the states. And of course my parents were like, you're not going out of the country. I was like, okay. Although now looking back could have been fun. So I went to, I got accepted into Case Western reserve in Cleveland, Ohio and sounded like a great program. So I went and became a molecular geneticist down the road.

Karen Litzy:                                           And what does a molecular geneticists do exactly?

Robin Meyers:                                      You spend quite a lot of time in the lab. I actually was in a lab working with fruit flies. So in a lab with a lot of fruit flies, killed many of them a lot on research. So I was on research specifically looking for genes that had to do with flight.

Robin Meyers:              01:34                So lots of DNA work and I'm not talking about, I'm talking old school, so now I'm going to date myself. Old school, 1986 to 89 where you know, the DNA plates were big glass plates that had to be poured. That was the hardest part I think.

Karen Litzy:                                           I mean it's pretty amazing because now you know, we hear a lot in the news about women in stem, science, technology, education, medicine. So we hear a lot about women in stem and how the push is to get more women involved in these professions. So you were involved in this profession in a time where I have to think there weren't a lot of women there.

Robin Meyers:                                      Well interestingly enough, I never really put that together until recently in my life that maybe I was a pioneer. I don't know.

Robin Meyers:              02:34                I was too shy and quiet then to even think about that. But, it's true. There really weren't, and it was really on the forefront because when I graduated it was just the beginning of the human genome project and all of the human genetics. You know, my first job was with the French Anderson Group who was part of that genome project. And one of my companies that I started working for was the first DNA purification columns, like the disposable kind. And it really was on the forefront. So kinda cool.

Karen Litzy:                                           No, I think it's amazing. I think that this is the coolest thing. And, and when I was reading through your bio, I feel like, so just for context, Robin and I have known each other for well over a year now, right? Maybe year and a half, two years, I'm not quite sure. But I remember reading her bio thinking, well, I didn't know any of this.

Karen Litzy:                   03:28                I didn’t know you discovered a gene. I did not know any of this. And I just think it's like so cool that here you were and I will say a pioneer in the fields of stem. And I just wanted to highlight that for people so that, you know, they know that you’re coming from this sort of, I would think analytical data driven background.

Robin Meyers:                                      I really am actually, you know, and it's funny how for me as I developed, I always thought of my science and my master's degree was kind of just a stepping stone into whatever that next step was of my life. But dots do connect, you know, and when you start to own it, you do see these patterns. I did, I discovered a gene. And it's funny, it wasn't until recently, even in the salon when it was like you did what?

Robin Meyers:              04:25                And the ironic part is the gene, it's still called TUB36 because it's on the chromosome region of 36 in fruit flies has to deal with the wing formation, for fight or flight for flying like dystrophy and working with fear and that whole concept, it's like, it's just kind of weird and ironic and exciting and just interesting.

Karen Litzy:                                           Yeah, it's really interesting. And so let's get into now this other part of your life and your career, which is a fear strategist. So the same question as what is the molecular geneticist I have for what the heck is a fear of strategist.

Robin Meyers:                                      So I've taken over owning fear strategy because, you know, I became a coach, you know, after I left my graduate degree and became a wife and a mother and went through that phase of my life, and other jobs, I really started to figure out who I was and finding my own voice and dealing with my own fears and things like that.

Robin Meyers:              05:38                And so I worked with women giving themselves permission to look outside the box and working in transitions really. And so I've been every kind of transitional kind of coach to life strategists. And when it comes down to it, as I've owned the molecular genetic side and the science of fear, I was like, I'm a fear strategist. Like really what it is, is being able to understand that fear is real. And I think that's really where my message is right now. Like, if I can get the world to understand the science of fear, that it's not just this thing that should stop us in our tracks. Yes, it's limiting beliefs, but we can work through that. And I think when people hear the science of it and realize that it does work to our advantage, it creates a whole different conversation in this world.

Robin Meyers:              06:35                So it makes people stop and say, what is that? Instead of like, you're just another coach. But there is the science. So it kind of for me kind of stirs up the science and to be able to say, let me tell you, let me explain my science background to you.

Karen Litzy:                                           Yeah. So let's talk about the science of fear. So what is it about fear? What happens with them? I'm assuming that's what happens within our bodies, when we have that feeling of fear. So could you tell the listeners a little bit more, give us a background on what is the science.

Robin Meyers:                                      Okay. So it's totally fascinating. So the science is, you know, our brains so anyone in science will understand this, that you know, our brain is the most complicated organ in our body. Our emotions basically are lit up from different regions of our brains working together in combination and lighting up and igniting. The fear response is in combination of five areas that light up.

Robin Meyers:              07:41                And that's the amygdala, the sensory cortex, the Thalamus, the hypothalamus and hippocampus, all those areas. When a fear response comes they have to work together to produce that next step for the fear. Now the interesting thing is as all of that coordinates together, the Amygdala, which is like the size of a cashew, not only decodes your emotions, but it stores the imprint of every fear of every response from pre verbal stages throughout your entire life. Like every single thing, if you think of it like a tattoo, like you keep getting a tattoo with every single thing every fall, every emotion, every emotion associated with fear is another tattoo. And I don't think people actually realize, it's almost like if you could kind of tell me all about your life and actions that have happened. And I could sit there with a stamp, an ink pad, and just stamp a piece of paper and like you could physically see how many imprints you have.

Robin Meyers:              08:53                It's fascinating because not only do imprints start storing prior to you even realizing it, and that's more so because our parents impose their imprints of fear on us, but every little thing for the good and the bed. So there's a whole pattern of evolution that happens.

Karen Litzy:                                           First of all, I love the metaphor of the tattoo imprinting in the Amygdala. I love that. I'm going to start using that with patients who have chronic and persisting pain. I love it. Thank you. And it takes me back to, you know, as you know, Robin, I have a long history with chronic pain and a lot of that was centered. What kind of made the pain worse or prolonged would be fear avoidance behaviors. So I can't do that. It's going to hurt my neck. I don't want to do that it's going to hurt my neck.

Karen Litzy:                   09:55                I can't sleep. It's going to hurt my neck. So now I look back and think of that day when that pain first happened, I woke up and couldn't get out of bed. So much pain. And the thing that I guess I didn't connect until right now was how fearful I was. How fearful I was laying in bed not being able to move. So can you imagine the size of that Tattoo in my amygdala?

Robin Meyers:                                      Yeah, exactly. Exactly. So the idea is to take it one step further is to realize what those imprints are and remove the ones that aren't serving you. And you know, that's easier said than done. It's not easy. No, no, no. I'm not saying any of this is easy, but there's some that have been imposed that you really can't put your finger on it.

Robin Meyers:              10:52                Right? And then there's some that you've had an accident or something that you can put your finger on it, but it's not serving you. And then there's some deeper wounds that you really have to work through. But if you can start removing the ones that totally aren't serving you and actually work through it so it makes you the more you've worked through it. What I find with my clients, with myself, just people I deal with, it makes you live much more presently and actively and it takes courage. I always say it’s actively moving through the action with the conscious courageous presence because you have to be present and it is, it takes a lot of courage, no doubt.

Karen Litzy:                                           And how do you start working through some of these things? Like can you give the listeners, I don't know, one or two tips or exercises that they might be able to start doing today if they realize they have a fear that might be holding them back.

Robin Meyers:              11:54                So the biggest thing really is self awareness. It's really taking the time for you to understand who are you and just you forget kind of the noise of what your responsibilities are. If you've got, you know, spouse, dog, kids, whatever stage of life you're in and everyone has a different stage. So, and just to tell your listeners I had three kids and now 22, 24, 27. So I've been through a lot. Trust me. So I get it all. But whatever stage you're at, I only say build in five minutes every morning just to be in your own thoughts. And ask yourself, what do you need? You know, it really does come down to self awareness and saying, these are my non negotiables for me only for me. And you're going to find that you become very aware of people that work in your life, things that work in your life, conversations and what's acceptable.

Robin Meyers:              12:57                Once you start doing that, you're able to kind of start peeling away and going after things that have held you back. You know, the other side of this conversation is that our brain, as brilliant as it is and everyone's brain is, is great at keeping us in the patterns that it's been given. So a lot of that is reprogramming and there's ways to actually get into your subconscious and reprogram. But it is reprogramming. So it's baby steps and sometimes it's two steps forward and three steps back. And it's being very gentle with yourself and not beating yourself up and saying, okay, tomorrow's another day, but it's just breaking into a new pattern.

Karen Litzy:                                           And those patterns I agree in the brain can be so deeply set, deeply set from childhood into adolescence, into adulthood. Like you said, whenever a stage in life that you're in.

Karen Litzy:                   14:01                And you know, again, I go back to this population of people with pain, which is a huge population across the world. It's a $1 billion industry and that's just back pain, forget about every other kind of pain. So I think being able to work with someone to maybe tap into some of these patterns that we have developed, I think can really help people perhaps make sense of some of their pain, help overcome some aspects of that pain. I can say anecdotally from myself, so an n of one that being able to do that for myself was really helpful, I felt was for me the next step that needed to happen.

Robin Meyers:                                      I totally agree with you. It's sometimes like those patterns of talking yourself like, but if I get out of bed I might hurt. But if you don't get out of bed and you don't try, will you hurt? What is that risk?

Karen Litzy:                   15:13                Looking at the risk reward there. Right, right.

Robin Meyers:                                      I'll go back to a story if you don't mind. When I was 11, I think I was 11 I used to ride horses. I don't even know if I was good at it, but I used to ride horses. I had a really bad accident and I broke my back in three places. I ended up being fine. Actually it ended up being a blessing in disguise because I had a horrible scoliosis that they discovered. But I was in a back brace and possible surgeries and you know, initially it was like, is she going to walk? And things like that. It was a nine month recovery, but, and I was 11, so I think it, as much as it affected me, my parents really obviously dealt with it.

Robin Meyers:              16:01                Fast forward to my daughter being 10 years old and we lived in the countryside of outside of DC in Virginia where horses are Galore. She wanted to ride horses. I actually didn't think twice about it. It was a local farm. It was around the corner. I would take her, I would watch got her all the safety equipment. My father happened to call me, my mom had already died and my father had called me and didn't call me often. And instead of like, hi, how are you today? He just ripped into me. He just, you know, his, the first thing out of his mouth was, I'm so disappointed. Are you stupid? And I was like, oh well those are triggers to my childhood. Hello father. But when I sat, now when I process it, I understand in a way where he was coming from and I said, she's fine.

Robin Meyers:              16:53                I had an accident and I understand your thoughts. So for me, I honestly had to make a conscious decision to say, I could have easily said, you're not going to ride because I had this accident and I'm afraid for you versus processing. Listen, it was an accident. Logically it was an accident. I'm going to be there. We have all the possible safety stuff. Is there a possibility of an accident? Yes. Is there the probability? I don't know, but why am I going to not let you try something because of what happened to me. So that's an easy imprint to get rid of. Right. But it's just an example of making a real conscious choice to say, I'm going to cut that cord right there and not let that pass on. Because if I let it pass on, then she at some stage in her life would either say, I've always wanted to do this and I'm going to try it, or I'm never going to try it, but I wanted to do this.

Karen Litzy:                   17:57                Yeah. And you are able to kind of change that imprint. You cut that fear, but your father couldn't.

Robin Meyers:                                      No, he couldn't. He was furious. Oh, he was so mad. And that's coming probably for him of a place of fear.

Karen Litzy:                                           Right. I'm sure when that accident happened to you, your parents must have been beyond scared.

Robin Meyers:                                      I'm sure. I'm sure. And for them, you know, they obviously had to drive to every doctor's appointment and all of that and every ounce of pain I felt probably was as bad, if not worse for them. Right. As a parent. So. Sure. So I get it.

Karen Litzy:                                           Yeah. Yeah, I get that as well. And I think that's a really great example for the listeners of how you can start to change these imprints or tattoos that have taken hold in your brain to allow you to move forward in the PT World.

Karen Litzy:                   18:55                And this is probably in more worlds than PT, but we call that graded exposure to activity. So for instance, for me, I'll give an example. I felt I couldn't carry anything because it would hurt my neck. So I carried nothing around New York City, a place where you have to walk everywhere and groceries and things. I was like, I can't carry anything. So I always get everything delivered until, until the one day. I spoke with a physical therapist from Australia, David Butler, and he said, well, why don't you just go to the grocery store and put like, I don't know, a loaf of bread and a bag of snacks in it would be so light and just carry it home and see what happens. Right. And so that's what I did and I got home. I was like, okay, that felt pretty good.

Karen Litzy:                   19:49                And then each time I went I would add one or two more things to the bag. So gradually exposing myself to the activity that I was fearful of doing. Until now I can carry, I'm like a pack mule, you know, running around New York City. But if he had not encouraged me and helped me to see that I was doing a disservice to myself through fear, I don't know where I would be today. And I'm assuming that's what the kind of work that you do with your clients is helping them to see the fears that are holding them back.

Robin Meyers:                                      Right, absolutely. So I try and work with everyone to see, to acknowledge what it is. And you have to acknowledge it, right? I mean it's something, but once you peel back that layer of it, is it logical or illogical?

Robin Meyers:              20:46                Did something happen or did something not happen? And then what is the origin of it? And, with the groceries, how do you start working through it? Because when you become more present and you start learning about you and like using you as an example, right? You learned that you are stronger than you thought, it didn't hurt and now instead of holding yourself back. So you did move through it and you actively were aware of your surroundings and how you felt. There's actually a genetic disorder called Urbach-Wiethe disease, and it's a mutation where people cannot feel fear. It's very rare. It's like 400 people in the world or something and its parts. It's not just in the Amygdala, it's parts of certain regions of that combination of the brain. I don't know the other regions, but like that harden and kind of waste away.

Robin Meyers:              21:50                But now that wouldn't work to your advantage. Right. I mean you want to have that element of awareness and I think that's what fear needs to be looked at like a positive awareness of listening to yourself.

Karen Litzy:                                           Yeah. And I think oftentimes when you're coming from a place of fear, you're in it so to speak, it's really hard to acknowledge that because do people feel like acknowledging that is acknowledging a weakness that they might have?

Robin Meyers:                                      Exactly. And that's where the conversation needs to shift. Because I think when people realize that the science of fear exists, like the diagnosis is, it's not if you have it or not. Everybody has fear. Right. So if we want to talk like, you know, as practitioners, the diagnosis is you have it.  The prescription is you have a choice on how you react to it.

Karen Litzy:                                           Yeah, for sure. You definitely have it. We all have fear and how that fear manifests itself. Now in the beginning you said it could be good or bad. So how could fear be good? Cause I think we always associate with fear being bad.

Robin Meyers:                                      Right? And that's what has to change. That's the conversation that needs to shift because I think there's an element of fear that's good. I really do. I think it needs to work to your advantage. You know, I honestly think that it makes you stop and think.

Robin Meyers:              23:29                Now again, there's different levels of people's fears, right? So I don't think in an half hour or an hour we're going to be able to like solve the world's problems. It's good because it makes you actively move through the action of fear. So if you can take that imprint in that tattoo and look at it and say, answer the question, what is it? Identify what is it? Why am I afraid of this? Why? Why is this going to hold me back logically? Why is this going to hold me back.

Karen Litzy:                                           Logically? See but that's the hard part. When you have fear, it's hard to get that logic, right?

Robin Meyers:                                      And that's the whole part though of almost, you have to reverse the brain, your brain function and trick your own brain because your brain is going to keep you set in that fear based negative side. But we need to do is switch that whole paradigm to the positive side.

Robin Meyers:              24:36                So I was at a course for a workshop that I did and I was one of the facilitators and the last part was this trapeze for some reason I don't like heights, I've never fallen, but just not my thing. Like I'm not going to jump out of an airplane anytime that like it's not enjoyable for me. I don't ever see doing that. But this trapeze, and this was like a pretty rustic course by the way, climb up this 40 foot tree that had the little pegs in it. Yeah, turn around on a very small perch and jump, you know, like four feet out to catch the trapeze bar. I sat there for a while looking at it as most of the people were going and I'm like, I think I'm good for the day. And then I'm like, you really got to go do it. Like why not now? You're totally harnessed in right. So logically I'm harnessed. There's no reason why I shouldn't, my body on the other hand is like, I'm shaking like a leaf. I know I can't get hurt.

Robin Meyers:              25:42                Just do it. Like you have to trust yourself to just go do it. I ended up climbing up this tree. Of course when you get up to the top of the perch, I was turned around and hugging the tree. Yeah, I could see that. Yeah. Yeah. And like the guy below is like, okay, turn around. And I was like, yeah, give me a second. I'll be there in a moment and you know, go to the edge. Then they're like, just jump. And I was like, Eh, okay. You know, and you'd have to pause. But again, it's that logic and your brain playing games with you. But again, I'm standing in a harness where I know I'm not going to do a face plant onto the ground. So I took a deep breath, right. And eventually walk to the edge and put my arms in front.

Robin Meyers:              26:31                I actually caught the trapeze. Thank God that would have been embarrassing. But I trusted myself, you know, again, will I ever jump out of a plane. No. Cause that's not enjoyable to me.

Karen Litzy:                                           Like there are limits to where you can push yourself. And if it's not like Marie Kondo says, if it's not going to bring you joy, then you don’t have to do it right.

Robin Meyers:                                      But, I did it and it was a point, it was more proving to my own self that I could take that leap of trust. So that's where I think it's really getting in tune and in touch with yourself that you can understand fear working for you and not against you and really using it to move you forward in life. You know, I remember when I first started coaching, one of my first instructors said, when you're excited about something and you're fearful of something, like that's a great combination. And I've always really, it's always proven true to me and I've always believed it. Because it's kind of like not proceed with caution. It's just be aware. It's just that self awareness, you know, listen to yourself, trust yourself. But go for it.

Karen Litzy:                                           And I think that's great advice. Listen, trust and go for it. Yeah. I mean, why not? Because what's the worst that can happen? You fail.

Karen Litzy:                   28:07                And that's okay too. Right? Okay. I failed plenty of times. Oh my goodness. If you never failed in life, what have you been doing with yourself? Right. So I totally get that. And now, so you went from, like I said, molecular geneticist to fear strategist, coach. How did you make that transition? I think this is a great question because there are a lot of people who work in healthcare, very science based who are like, hmm, maybe I'm ready to make that leap, but I just have no idea what to do.

Robin Meyers:                                      It's a great question. So my transition took many years and let me cut it short for everybody else in the world. So obviously I was younger and did my molecular genetics training and jobs, and then I took a stint of time to raise a family and then I went back into the workforce smaller jobs.

Robin Meyers:              29:18                I always taught. I ended up finding, I taught biology and stuff like that. So I kept my science going. I'm not into research in my later years, but I kept it going and then realized that I never really gave myself permission to be me and to use my voice and my strengths. And so that's when I started to kind of look towards the coaching program. And especially working with professionals and women professionals. I think overall, but all professionals allowing themselves to think outside the box. And in saying that, you know, and this comes down to the whole fear thing, we're always told that you know, you're either left sided, your brains left side or right side, right, were dominant in one side or the other. So I really don't believe that. I feel like when you give yourself permission to really learn who you are, there's a great synergy that can happen and you can combine both sides of your brain and that's when you really start listening to yourself.

Robin Meyers:              30:29                So, even if you're in a science based world or something, you know, for me, my greatest strength right now is really connecting the dots back into the molecular genetics of fear and being able to bring a whole different angle and discussion and awareness, that I would not be able to. And I don't think many people can have the discussion that I'm having with it cause they just don't have that. So I think it's great to be able to combine your sciences and whatever creative side that you want to.

Karen Litzy:                                           Yeah. So don't throw away the science part, use it, use it to your advantage, use everything you've learned to help others.

Robin Meyers:                                      Absolutely. There are ways to connect the dots. And I mean, like you and I, you were saying, you know what, we've known each other a couple years and it wasn't until recently that I either admitted it or if you guys found out that I was a gene finder.

Karen Litzy:                                           Now knowing that it makes so much more sense for what you do now.

Karen Litzy:                   31:47                Now I'm like, oh, now I, yes, this makes perfect sense. It just comes back full circle as to that. I think the natural progression for you in your career and you know what was next for you. To me it all makes sense.

Robin Meyers:                                      Yeah, it makes sense to me now too. It really is coming full circle. And I was actually just having a conversation. Someone's like, you know, you're kind of been in this business for several years now. And I'm like, actually I feel like I'm new. I almost feel like I've started over again just because I finally allowed myself to Mesh the worlds together. And that's what I would say is, you know, you don't have to stay science in the left brain and whatever the creative is the other side, you can mesh it and at whatever stage of life you're at, you know, if there's something that really excites you in that other world, find the time.

Robin Meyers:              32:44                And even if it's once a month or once a week, you know, find something in that other element that you want to explore it.

Karen Litzy:                                           Yeah, absolutely. Great Advice. And, now that takes me to the last question that I ask everyone, but I feel like you might've just answered it, but I'm going to ask it anyway. Knowing where you are now in your life and in your career, what advice would you give yourself as a new Grad, as the molecular geneticist fresh out of college and Grad School?

Robin Meyers:                                      Well I was very much an introvert, so maybe be a little more outspoken. But to allow things to happen and not think that it had to be one way only. I walked that line, like if it wasn't going to be something, just molecular genetics, then I had to leave the field.

Robin Meyers:              33:43                You know what I mean? And I think if I knew what I know now, although again, it all works full circle, I would have realized like you can think outside the box and I think that's what makes us all unique and you know, whatever your background is, you're bringing a very special element to the conversation. So think outside the box. And that's where I would have said to myself, you know, don't stop being creative just because you're taking one path.

Karen Litzy:                                           And, I think that's great advice for anyone, but especially for women in the stem profession. I think that's really great advice. And now where can people find more about you? And if they have any questions where are you?

Robin Meyers:                                      The best way to find me is just to go to my website, which is And from there you can get on my calendar.

Robin Meyers:              34:43                I'm always happy to set up a discovery call with anybody if you want to have just a chat for 40 minutes and you have questions, things about what I'm doing and where I'm traveling and busy speaking with the fearless women's summit right now, all over the US.  And I'm taking a group only of 10 women to Italy in October for a retreat of giving yourself permission to be you. So yeah, just go to my website because that's the easiest way to find me.

Karen Litzy:                                           Awesome. Well, that sounds pretty amazing and thank you so much for coming on and sharing all of this information on fear with myself and with the listeners, and I can tell you, I said I'm totally using that tattoo thing. I think that's brilliant. So thanks for that. I'll give you credit for sure. I will credit you for that. Thank you so much for coming on. I appreciate it.

Robin Meyers:                                      Thanks, Karen. It's been a blast. Thank you.

Karen Litzy:                                           And everyone out there. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.



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

Apr 11, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Mark Merolli, Ann Green and Professor Catherine Dean. In this episode we discuss our upcoming focused symposium at the World Confederation for Physical Therapy Congress in Geneva Switzerland on Sunday May 12th at 4:00 PM. The title of our symposium is Education: Technology and Informatics.


In this episode, we discuss:

- The why behind our focused symposium.

- Current global entry standards for physiotherapy in relation to digital health technology and informatics.

- How technology affects the world of physiotherapy and are we preparing new graduates to meet those demands

- A sneak peek into the specifics of our talk.

- What we hope the symposium and discussions in Geneva will lead to.

_ And much more!




WCPT Congress 2019

Professor Catherine Dean Twitter

Ann Green Twitter

Dr. Mark Merolli Twitter  


For more information on Mark Meroli:


Dr. Merolli is Physiotherapist (musculoskeletal) and Certified Health Informatician. For many years now, he has been a leading voice on all matters technology in physiotherapy. He has global reputation for his expertise in digital health and informatics, which has led to his involvement and consultation on this area across several WCPT and member organization events and initiatives. He has presented on digital health at several recent APA, and WCPT conferences, run workshops, written articles for member magazines, and been interviewed on podcasts to discuss these areas. His research interests include how technology is engaging patients to be more active participants in their own health management and how we can ensure the digital preparedness of future health professionals.


For more information on Ann Green:


Ann Green MSc, FCSP, FHEA is Head of Life Sciences at Coventry University. Ann is a Fellow of the Chartered Society of Physiotherapy, awarded for her contribution to education, research and policy. Throughout her career Ann has worked in higher education and has developed physiotherapy programmes in the UK and internationally. She has been active within professional accreditation, physiotherapy educational policy and worked for the UK health regulator, the HCPC, in programme approval and international registration. Ann’s research outputs span 20 years with her earliest publication about admission and progression trends in undergraduate programmes and her recent publications relating to postgraduate physiotherapy education and the development of the individual, the profession and careers. She has been invited to speak internationally on advancing physiotherapy practice. Her current research with an international team, is on social media and its role in global physiotherapy professional networks. Ann is one of the co-founders of the Big Physio Survey, an open access resource which enables physiotherapists from across the world, to share case studies online, which forms a global repository to showcase our rich and diverse profession.


For more information on Catherine Dean:


Professor Catherine Dean is a physiotherapist with a full-time academic appointment with teaching research and administrative responsibilities. In 2011 Professor Dean moved to Macquarie University in a key appointment for the University’s expansion in health and medicine. She was appointed the inaugural Head of the Department of Health Professions and has established NSW’s first professional entry Doctor of Physiotherapy (DPT) degree.  The Macquarie DPT includes advanced physiotherapy skills, business management, leadership, policy and advocacy units as well as completion of a research project.  In 2014, she received the Executive Dean’s Service Award for engaging students and the community in establishing the Discipline of Physiotherapy and in 2015 led the DPT teaching team which was awarded the Faculty of Medicine and Health Sciences excellence in teaching award.  In 2017, she was appointed Deputy Dean of The Faculty of Medicine and Health Sciences. Prior to her Macquarie University appointment, Professor Dean worked as an academic with teaching, administrative and research responsibilities at the University of Sydney for 20 years. Her research interests are developing and testing of rehabilitation strategies to increase activity and participation after stroke, translating evidence into practice and clinical education. She has published in leading journals such as Stroke, Archives of Physical Medicine and Rehabilitation and Pain. She has been awarded over $5.8 million in grants for research and education. Professor Catherine Dean’s research has changed physiotherapy practice in stroke rehabilitation. Professor Dean’s research findings have been integrated into national and international clinical practice guidelines, such as the NHMRC-approved Clinical Guidelines on the Management of Stroke and featured on the Canadian Stroke Network StrokeEngine site.



Read the full transcript below:


Karen Litzy:                   00:01                Hello everyone and welcome to the podcast. I want to welcome Mark back onto the podcast and Anne and Catherine, welcome for the first time. I'm so happy to have you all on this episode. And for all the listeners, what we're going to be talking about is our focused symposium that is going to be taking place at WCPT in Geneva May 10th through the 13th for the WCPT meeting. And our symposium is education, technology and informatics, and it is Sunday, May 12th at 4:00. So if you are going to be in Geneva, you're going to want to come to this focused symposium. Now, this all sort of started with Mark, so I'm going to throw it to you first as to so you could tell the listeners why you wanted to even put this focused symposium together.

Mark Merolli:                00:58                Thanks for doing this again. And I'm actually really excited that actually got you on some part of this wider team, uh, to, to be part of this focusing posing in Geneva. And it's great to be on your podcast again. Uh, but you're right, when we last spoke on the podcast, we talked I think more broadly about just the impact that technology,  the wider discipline of informatics is having on the physio profession, future trends, disrupters, et cetera. And I think obviously for no uncertain terms that work has continued and that impact continues to grow. But one of the things that, you know, obviously, are very near physio educator for some time now. And I think working in that space of, um, health informatics, um, digital health, uh, so, you know, the intersection of technology and healthcare, I think one of the things that's been really readily apparent to me for some time now is need.

Mark Merolli:                02:02                Um, and to ask ourselves the question as to where this all fits into the way we educate our future physical therapists, physiotherapists. So I thought when calls for abstracts came along and sessions for WCPT, that it would be very topical, um, for WCPT and the wider profession to embrace the idea of, you know, let, let's have a look at, at current ways we educate university students, um, in this space? Have a look at perhaps where technology features in what we teach, where it should feature, where it can feature. Um, and I was just really glad to see the WCPT thought this was equally worthy. Um, I'll debate, um, and put it up as a focus symposium for us. Uh, and the speakers on, on the symposium, the panel yourself, uh, your entrepreneurial self. Um, and, and Ann Green will have known for a very long time as a physio educator in the UK.

Mark Merolli:                03:04                Um, and Catherine, uh, over here in Australia as well, who's a very innovative forward thinking educator who's one of the few people I know who's pushed to this stuff for many, many years before this was really a debate. Uh, I thought you were all pretty much perfect, um, example of people that could help push this topic and discuss it. So that was the motivation from my end. Um, I think it's one thing for you and I to talk about technology in the profession but a very different but complimentary themes to talk about how this all fits in education. Um, cause I think in no uncertain terms, we either don't do it, um, we don't know how to do it or we do it quite ad hoc for the most part. Um, so it would be really, really nice to discuss at WCPT, we're hoping to get along as many people as possible as to how we might actually go forward with this and see informatics, technology, digital healthcare starts to become a more sort of interwoven thread in the way we're trying to future proof this profession. So I'm really looking forward to doing this with all of you. So thanks for, thanks for spreading the word for us I guess.

Karen Litzy:                   04:18                Yeah, and I mean I'm really looking, I've learned so much just from listening to the three of you, so I can guarantee if you're in Geneva you are going to learn a lot with this focused symposium. So, Ann let me throw it to you now and can you give us a little snippet as to what your part of this symposium is going to focus on?

Ann Green:                                           Okay. Well Hello Karen. I'm really pleased to be part of this podcast and join this panel. So as Mark said, it had been an educator for a long time. I've involved with a professional body in setting curriculum guidelines. I've involved with statutory bodies. Um, and I suppose that's the obvious point when, when you saw when you forming curriculum. So it was really interesting to have a look what the UK is doing and then have conversations with, with Catherine, Mark about Australia and yourself about at the U.S. and what we all found was that there are, are a few guidelines.

Ann Green:                   05:19                And so I'm really interesting to discuss with everybody in the audience. Is that a good thing? Is that a liberating or should there be more guidelines? Um, I've previously been involved with Mark and do this research around social media and it's interesting that a number of guidelines appeared from all corners once physios became very active on social media. So it would be interesting to know, um, what we can learn from that. Uh, and whether it's professions, accrediting bodies, individuals we should be guiding or letting people freely develop and uh, and see what happens.

Karen Litzy:                                           And do you feel like looking at those guidelines for social media, which like you said, I think we can all agree that probably most, uh, physical therapy governing bodies of countries around the world have some sort of guidance on social media that came way after people were using. So yes.

Karen Litzy:                   06:21                So it's one of those kind of, are we asking for permission or asking for forgiveness and, and I think that's where guidelines around informatics can be kind of interesting because you want to know, are we asking for permission or are we doing things like wild west? It, that's a definitely a US thing. Um, uh, is it going to be like the wild west out there as more informatics and more technology get involved in the profession where then people have to ask for forgiveness for certain breaches of let's say privacy or things like that?

Ann Green:                                           Yeah, I suppose, I think what we did learn from social media and the guidelines, the teeth essentially came round to good professional behavior. Um, uh, maybe mmm. Maybe in terms of going forward with how people are using technology, um, in health cat, it will perhaps be framed around, you know, the sort of common standards that we have for professional behavior, respecting patients, privacy, um, and um, and using evidence.

Karen Litzy:                                            Yeah, absolutely. And now, Cath, can you talk a little bit more about what you're going to be sharing a in Geneva with this symposium?

Catherine Dean:            07:37                Oh yeah. Thanks Karen. I'm, hi, I'm Catherine. I'm, I'm an educator. For a long time in 2011, I changed university and I had the opportunity to develop a physio therapy program from scratch from a green field, which is a, I've never worked so hard in my life, but it's very exciting. Um, when I came to the knee university, I really wanted to ensure that our graduates, it was future proofed and future focus. So I knew I had to embrace technology and, and um, health informatics. I wasn't quite sure how to do it. Um, I was very fortunate to  meet Mark at a conference who helped me out. And I really want to share at the conference a little bit about what I did, what worked and what didn't. Uh, um, the lessons I've learned it you learn a lot from the errors as you make and hopefully I can stop some other people making some of my errors. Um, but I'm really interested in what other people have done because there's still lots to solve. And how do we actually adequately prepared, um, the future professionals for practicing a ever increasing digital world. So be there Sunday, May 12th at 4:00 PM Geneva.

Karen Litzy:                   08:45                And what, what do you feel like from your perspective and with the students that you've worked with in the past and are currently working with, what do you feel the biggest, I guess, barrier to, having these students be, whether it be, cause they seem to be proficient in technology, right? What is it that is maybe the biggest barrier about using this within the practice of physical therapy?

Catherine Dean:            09:14                I think it probably intersects a little bit with what Anne said. I think, well, they often proficient in using their technology. They perhaps don't understand the ramifications around privacy issues. Uh, and then I think some of the other issues is it's around professional behavior. Again, uh, your, your, your digital profile is, it is, it reflects the profession as well. So you need to think about, um, adequate oh, standards and provisional by, but I also think while they can be really good at technology and make flashy things, sometimes the content still misses the critical analytical skills that are needed. So, um, I, in some ways it's just another format for communicating and it has its own challenges about that. What you do communicate has to be accurate and evidence based.

Karen Litzy:                   10:08                Yeah, for sure. And Mark Your, you know, your goal in putting this panel together is to really spark conversation and to get people interested in informatics. But one thing we didn't talk about in this podcast yet is, and it's a question I get every time I say, oh, I'm doing this focus symposium on informatics. It's what's informatics?

Mark Merolli:                10:32                We haven't had to refer people back to the other podcast episode. I don't remember look in no uncertain terms. When we talk about informatics, we're, we're really talking about information science, um, and is an essentially where technology plays a role in how we improve use of inflammation in healthcare. So, you know, we were covering everything from the way we collect health information, store it, uh, analyze it and then essentially put it into practice. It's about making healthcare safer, more efficient, more evidence based, you know, improving essentially the quality of health information using technology. If I can put it in a nutshell. Ready for if Karen, if I could probably just echo Cath sentiments. Really it's um, I agree 110% with what she said, but part of the other reason for having this topic and the symposium, I think yes, we are all passionate advocates but this is also an exercise in supporting, uh, our colleagues, uh, and the wider physio profession as well.

Mark Merolli:                11:33                Um, and much like implementing technology into practice, whether that be a small practice or a hospital. Um, you know, technology requires a big change management exercise. And one of the, you know, we were just talking about the barriers here. One of the barriers is also the confidence and the skillset and the that are actual educators and workforce clinical supervisors have to support this too. Um, so one of the things I'm very passionate about and part of the reason for getting the word out there here is that, you know, we actually need to consider the existing work force, the audience of this symposium, our colleagues, the other educators who are expected to teach these students these themes but may not also be all at 100% confident themselves. So I think that's probably one of the other barriers and considerations that I'd like to throw into the debate as well. Um, how we can support the existing workforce.

Karen Litzy:                   12:30                And I think that's important. And I think part of what I guess I should say what I'm going to talk about during this symposium as well. Um, but, uh, I think what I'm going to be speaking of, I'm coming at this from a practice owner, from a practicing clinician. So I'm served, people are wondering what I'm doing on this panel of academics because I am not an academic. I'm not in, I'm not teaching in a university. Um, but I am coming at it from the point of view of the practice owner, the practicing physical, the practicing physical therapist and the point of view as someone who may be hiring these students as they come out of school and, and supervising the students. And so I think from a practice standpoint, I mean I'm really looking for, uh, graduates who at least bare minimum have an idea of what informatics are.

Karen Litzy:                   13:30                Um, kind of what we use. Mark you just said, but I'm also looking at how can we use technology to make my practice run a little bit more smoothly. And that can be an electronic medical proficiency and electronic medical records, understanding how electronic medical records  work and why they're there. Um, and again, the safety and privacy around that. And also using technology with my patients, whether that be an APP or a wearable, how it's like, yeah, anybody can use an app or a wearable, but to marks, uh, I think other passion, you know, big data sets and things like that. Yeah, anybody can do that. But then what do you do with the data you're collecting? It's got to go somewhere. You have to understand how to use that in order to help improve your patients' journey with you and also your practice as a whole.

Karen Litzy:                   14:24                So that's kind of where I'm coming from. A little bit more of the, how can this all be applied in the real world with real patients and real businesses, whether that business be a large hospital, which is going to be way different than what I do. Um, and in some respects, large hospital systems maybe have better data collection. I don't know. I'm just throwing that out there cause they have more resources at their fingertips. So I would, I'm looking forward to are the people who are sitting in the audience to kind of get, Hey, this is what I use for my practice. So kind of sharing best practices amongst people from all over the world I think can really go a long way in supporting each other. Like you said, mark, kind of bringing it back full circle. Yup.

Mark Merolli:                15:07                They symposia are very collaborative and that's the whole point of these. Um, you know, we're, we're hoping to not talk too much, uh, outside of audience discussion. Uh, I think we're at a very unique opportunities to point with this topic. Uh, and I think that, you know, as a collective and WCPT has always been a great forum for that to really shape this debate. Um, and actually create some state of, of, you know, guidance going forward. I, and again, like Cath has said in, in our discussions a lot, um, guidance is one thing, but you know, creativities in hello. Um, we actually hope that some of the ideas come from the room and come from the session.

Karen Litzy:                   15:48                And so let me ask you all the same question before we wrap things up here. And that is your pie in the sky view of this symposium. What would be the best outcome you can hope to achieve at the end of this two hour symposium? Right? Two hours. Yeah. Okay. So what would be your, your best outcome for this two hours symposium? So any one of you can kind of take it first?

Ann Green:                                           Um, I'll, I'll go first. Okay, go ahead. Well, I'd like people to think that the time went really fast and they wish their discussion and debates could've gone on longer and that they will continue those debates at the conference and the each person we'll go back

Ann Green:                   16:39                and say, I am going to get involved. I am going to effect change in my own region,

Ann Green:                   16:45                in my own area with the people that I'm interacting with.

Karen LitzyL                                          Awesome. Mark Cath. Either one want to,

Catherine Dean:            16:53                for me, I would like to connect with people who had some bright ideas they have tried and had success with and I'm really happy to to just have a network of academics that are really trying to work on this so you can actually have a kind of a community of practice where you can share your ideas and share what's gone worked well and what hasn't. And and um, look, they'll always be local contextual factors, but there's probably lots to share and, and, and some good ideas if we can get together in a, in a virtual environment. Yep.

Mark Merolli:                17:30                Yeah, it looks similar to me. I think what I'd love to say is very much the way that the whole social media landscape ramped up, um, on the back of WCPT congress is, I, I've loved after this congress, you know, educators far and wide start to actually talk about this stuff, starts to try and think of ways, um, to bring this into professional development and university curricula and that um, technology, digital healthcare informatics stays, you know, high on the, you know, WCPT annual member organization agenda. Um, and we sort of see it as a regular feature at conferences and et Cetera. So from this day forth, the type of thing.

Karen Litzy:                   18:10                Yeah. And I think that's all great news. I would say I would hope to kind of meet other clinicians and practice owners who may be, can again collaborate and be the driver for a lot of the technology that we're seeing in every day use that can then be brought back to maybe local universities and to say to them, hey, listen, this is what we're seeing in practice. This is what needs to be taught to your students. And then see if we can have that collaboration between the academics and the clinicians, which I think is, is sorely lacking in our profession as a whole. That's just my opinion. Um, but I definitely feel like having great collaborations between the academics and the fulltime clinicians can just drive the practice forward in, in a way that will make us more innovative and creative and, and quite frankly, a happier profession. Um, so that would be my sort of pie in the sky view is to really get a lot of cross pollination between all of us

Karen Litzy:                   19:21                So. All right, one more time. I'm going to thank Mark and thank Ann thank Cath for coming onto the podcast today and for being great partners, uh, in what will definitely be a really fun and interactive symposium. Again, it's edge, it's called education, technology and informatics and it's Sunday, May 12th at 4:00 PM, and that is at the WCPT conference in Geneva, Switzerland. So if you're there, come by, um, and sit down, share your thoughts, make sure you're coming. We want you to come armed with your thoughts on informatics, what you're doing, what worked, what didn't, so that we can have a really robust conversation within the room. So guys, thank you so much for coming on and I look forward to seeing all of you in, in real life,

Karen Litzy :                  20:16                Geneva.

Karen Litzy:                   20:21                Yes, bye bye. Thanks 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 iTunes!


Apr 8, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Jason Falvey on the show to discuss healthcare fake news.  Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT.  Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness.

In this episode, we discuss:

-The definition of fake news as it relates to healthcare and medical disinformation

-What Jason recommends you do when you encounter articles with a high comment to retweet ratio

-How you can avoid falling trap to your biases by crowdsourcing to interpretate literature

-The importance of seeking information not affirmation

-And so much more!



NY Times Fight Fake News

Why Healthcare Professionals Should Speak Out Against False Beliefs

Jason Falvey Twitter

Jason Falvey Yale


The Outcomes Summit, use the discount code: LITZY

For more information on Jason:

Dr. Jason Falvey is a physical therapist working as a post-doctoral research fellow at Yale University in New Haven, CT. He holds a bachelors degree in English, and a doctor of physical therapy degree from Husson University in Bangor, Maine and a PhD in Rehabilitation Science from the University of Colorado, Anschutz Medical Campus.  He is also a board-certified geriatric clinical specialist. Jason’s research interests focus on improving post-acute care quality and outcomes for older adults recovering from major medical events, such as surgery or critical illness. To date, Jason has authored or co-authored 18 peer reviewed papers in widely read rehabilitation journals.


Read the full transcript below:

Karen Litzy:                   00:01                Hey Jason, welcome back to the podcast. I'm happy to have you back on even though we're not talking about what we usually talk about when you're on these podcasts and we have our specials with Sandy Hilton and Sarah Haag but I think this is still a really great topic and I'm happy to have you on to dive into it.

Jason Falvey:                 00:24                It’s great to be back and I have been excited to present this topic for a couple of months. While it’s no sex podcast part five I think we can definitely got come up with some interesting points for the audience.

Karen Litzy:                   00:37                Yeah, I think so too. And so everyone today we are talking about fake news as it relates to health care. Because I know a lot of you that are listening are in the healthcare world and if you're not, this is also a great way for you to kind of understand that everything that you read on social media isn't true gasp, right. So, Jason, let's talk about first, what in your opinion, is the definition of fake news as it relates to healthcare and let's say medical disinformation?

Jason Falvey:                 01:19                Yeah, I like the term medical disinformation because fakes news is not nearly as common in medicine, you know, as far as the falsified information. But medical disinformation is much more common than people may realize. The context is most of the hundred shared articles of last year, over 50% of them are of poor evidence quality when experts have actually rated that. So when I talk about fake news and medical disinformation, I'm really kind of breaking it down to a handful of categories. So there's fake news that's rare, but it does happen that's false or completely inflammatory, you know, that is completely falsified data, or completely false claims that are created to either scare somebody into making different health care decisions or drive them towards a curative product that may be your marketing. So that’s not common, but that definitely is out there. I think the more common pieces of fake news and medical disinformation are hyperbolic and intentional.

Jason Falvey:                 02:34                So the splashy headline that says Bacon Causes Cancer, you know, where people are putting that headline so it’s clicked on and read when the real story behind a lot of that evidence is substantially more nuanced. And then there's also hyperbolic and unintentional where a well meaning university employee publishes a press release on investigators article and misstates or over-interprets the conclusions to be much broader, more sweeping than they are suggesting that a drug cures cancer or Alzheimer when really it was affective in early stage studies for one particular protein in a mouse model. So those are the three definitions I tend to stick with, but really it's medical information that's not fully accurate, that’s shared widely and may influence healthcare decision making.

Karen Litzy:                   03:32                When we talk about these flashy headlines and this medical disinformation whether intentional or unintentional, as healthcare professionals, sometimes we're responsible for sharing that. It's not just the lay public. Right. So when you look at these headlines and you read through let's say a press release, is that where it ends? Do you say to yourself, yeah, this sounds good. I'm going to share it.

Jason Falvey:                 04:05                I think that should be the focus of what we talk about today and that is how do we as health care providers recognize fake news? How do we kind of avoid unintentionally sharing it and how do we avoid intentionally sharing it? So I think my guiding principle for all of these things, for any healthcare professional, it's Hippocratic oath, it's do no harm. And then health care beyond what we do with patients and beyond the hands on care that we provide sharing misinformation, whether intentionally or unintentionally has the potential to cause harm. Patients for going standard of care treatment and in lieu of an alternative medicine or unproven other therapy that may actually cause their health to decline, you know, or causing them to participate in a treatment that is unlikely to benefit them and causes harm both financially or time and potentially health care harm. So I think Hippocratic oath above all else should really drive our decision making and the impetus for why we should care about this. And the other guideline I use is I really want patients and providers both to be looking at social media and healthcare information that they're sharing and really make sure that they're seeking information, not affirmation. So they're seeking to broaden or challenge their pre held assumptions and not just share things, read things and kind of propagates a worldview that just affirms that are already firmly held biases to harm a patient.

Karen Litzy:                   05:58                Okay. Yeah, but so you mean we can't cherry pick things to confirm our own biases to make ourselves look better? Is that what you're trying to say here?

Jason Falvey:                 06:16                Yeah, that sounds like a terrible polarizing thing to say, but I'm really going to stand by that I think and just say I really don't think we should be cherry picking evidence and just sharing evidence that is fully supporting our world view. We may have a brand to keep, you know, I don't think I would widely share studies that I think are well done that maybe say physical therapy isn't as helpful as other things, but I certainly would acknowledge that they exist. I don't think I would market them heavily, but I certainly wouldn't ignore them or basically say that they're not accurate either. But I think we have to be really careful, especially when we're talking about vulnerable patient populations, thinking about patients with dementia or patients with cancer who are really hanging on hope that there's something medically that can be done that's outside of what's already been offered to them and kind of have a cure. And I think it's really important that we choose our language and we choose what we share, how we share, and the quality of what we share very carefully.

Karen Litzy:                   07:29                Well, and you know, that goes back to do no harm. And I think goes back to being an ethical person because when you look at these vulnerable populations, like you said, the elderly people with possibly terminal diseases, people with chronic pain, these are people who are looking for things that they feel they have not gotten that will fix them. Right? And so that's where snake oil salesmen come in. That's where people sort of touting that they have this great flashy thing that isn't supported with evidence, but it sounds really, really good. And so how do we as healthcare professionals combat that without looking combative and turning off those people that we actually want to help?

Jason Falvey:                 08:22                Yeah. How do we combat that information without unintentionally propagating it either. I think when we evaluate information, I think one of the things I really encourage is time, take time to think about the information, take time to research the primary source of that information. Take time to recognize if there is potentially both sides of an issue. So outside of things like, you know, vaccinations causing autism, which is a clearly manufactured result. If you follow back the evidence or if you go ahead and follow back evidence about infant chiropractic work. But I guess generally falsified or highly, highly, highly biased to the point where there really isn't a pro side, but a lot of medical things have a potential pro and con side. So I think it's important to recognize the nuance and carefully layout reasons one why you disagree with something and two the rationale methodologically, not just your opinion of kind of how you came to that conclusion.

Jason Falvey:                 09:42                But I think you have to do that without validating what you think is a very poor quality or highly biased or dangerous source to share. If, for example, you saw a tweet about the harms of vaccination and it may be, it was for your older adult population getting the chicken pox vaccine and it caused them Alzheimer's, you know, caused them to get dementia. Let's say you just saw a story like that. Which is not true. How do you, you know, how do you combat that? Some people would just retweet it with a really dismissive comment, like this is garbage. Don't listen to them. Well then doing that, and I'm guilty of this in the past as well, we've actually unintentionally propagated that information. Right now I have not very many followers, so 2000 followers all of a sudden see that and potentially one more retweets it and then another 2000 people. So I unintentionally exposed 4,000 people. Even if I'm dismissing that information, I've lent it credibility by sharing yet.

Jason Falvey:                 10:51                I think what I have to do is write something about the study, not actually link or validate in some way and not unintentionally spread fake news. And there's not an easy way to do that. So I think you really have to toe the line between not sharing the primary sources, potentially providing that provider of fake news, financial revenue from clicks, which is a lot of times what they want. Or providing a really misguided researcher, a clinician validation that their technique is not loved by the general medical population because they're jealous of his success, you know, something that they can take it the other way to spin it as a positive for their business.

Karen Litzy:                   11:39                Right. And because if you're re tweeting this and clicking on it and retweeting it, you're giving it life, which is what they want. That's what we don't want to do.

Jason Falvey:                 11:52                Right. And I think that's one of the ways that propaganda is designed right from the early days of using propaganda as a war tool. It was shared not just for people that believed in it heavily. It was shared in outrage and passed along and whispered about which served the exact same purpose. So really it's hard to discipline ourselves in a really, like we see something, we feel like we immediately have to react on social media and immediately have to comment on it. And I've been guilty of sharing articles that are either satire and actually taking them seriously, which has happened once in a fatigue non-caffeinated state. And also information or studies, which I think in hindsight probably weren't high quality or perhaps overstated its conclusions. My own articles have had overstated conclusions written and press releases that weren't by me or interpretation of written press releases that are perhaps more definitive than I would have wanted, you know, not fake news, but certainly unintentionally declarative about the quality and strength of the evidence versus, you know, the hypothesis generating evidence that it was.

Karen Litzy:                   13:16                Yeah, absolutely. You sort of alluded to one way as healthcare providers that we can combat the fake news or the medical disinformation and that's taking time to read the source if it's a press release, to read the article, to maybe look at the methodology and to see how would rate this study? So that's one way we can combat it, which takes time. And like you said, on social media, people often react quickly because it's emotional. So maybe we need to take a deep breath and then take a moment and think about what we want to do. Do we want to share this misinformation or do we want to read it and come up with maybe another way to share more positive information? What else can we do as healthcare providers to get around this fake news?

Jason Falvey:                 14:14                When we encounter something that we think is fake news or unintentionally or intentionally hyperbolic to the point where we think it's harmful to patients. And I think that's the line I draw. If I think that potentially sharing or engaging with this information in any way which propagate information that's harmful to patients. I generally take a little extra caution. And one of the things I look at, you know, I see in politically or in health care news, if I see a that goes out that has a really high comments or retweet ratio. So there's this term ratioed and it's not scientific and it's not peer reviewed. But I find that the good starting point when you see a tweet from a government official or a healthcare provider, healthcare related source, and there's more than double the amount of comments, then there is retweets and the likes.

Jason Falvey:                 15:18                It makes me go and do a little bit more investigation. You know, sometimes those comments are positive and way to go. And sometimes there's a lot of skepticism or criticism of the findings or people really, you know, offering some real insight into some of the problems in methodologically or otherwise. And often a well done methodological study can be completely blown out of the water on Twitter by a very poorly written headlines. Right. We should care about storylines, not just headlines. And one of the ways we do that, looking at comments, retweets, and the likes, looking at that ratio and look at the source, right? Who's retweeting? And so I pay attention to that because most fake news on the Internet is actually propagated by bots. So there's a very high percentage of fake news that was propagated by automated accounts that are automatically set up to capture certain hashtags or certain language and amplify it.

Jason Falvey:                 16:23                You know, if you're a political audience would know that that's how the Russians basically designed the misinformation campaign to influence the 2016 election using bots to amplify certain messages. Well, that happens to a lesser extent in health care. There are certain pockets, you know, of health care professionals, and there may be some in our profession that provide certain treatments. There may be some in other alternative medicine professions, there may be some in mainstream medical professions that are physicians or nurses who use their medical expertise and propagate information about medical techniques like abortion or vaccines in a way that makes them seem more credible. So I look at who's retweeting what the population of people are retweeting is, who the person the primary sources coming from. Right. You said if it's a summary of an article from a press release or somebody's blog, like I want to go and find that primary source and then also look at the bias of the person who may be interpreting that information for me if they're a credible source.

Karen Litzy:                   17:40                Yeah. And I think you also want to keep in mind those hot button issues may have more misinformation about them. Like you said, vaccines, abortions, these are hot button issues, right? So you have to I think take a more examining eye to some of these hot button issues then with others. That's not to say that other issues in health care do not have as much misinformation surrounding them. But when you're talking about things that are really emotional for people, I think that's when you have to also take a good editing eye to some of this information being put out there.

Jason Falvey:                 18:26                Looking at the source of information is one thing you can see. Cleveland clinic has accidentally posted fake news before where they put in like a really positive result from an innovative experimental therapy for cancer. And they put it in a brain scan and said this person had a miraculous results forgetting to mention that they also were receiving the standard care and this additional therapy would, they didn't know if that was the cause or if it was just a normal reaction to the normal care. But then all of a sudden you created a demand for something that is at best maybe ineffective and at worse, we don't know if it's harmful. By having a high visibility site, your responsibility for news is even higher. So I think that's an important piece. Like know who's tweeting it, but then go back and make sure you have the whole story. If it sounds too good to be true.

Jason Falvey:                 19:38                This is the humanities education that a lot of PT students have complained that they've had to take history and literature and policy courses throughout their undergraduate degrees and some have suggested streamlining education to really eliminate those things. My counter argument is those skills you learned from critical thinking and critical reading and analysis and understanding of historical context and how to read hyperbole, how to read marketing and different kinds of language really with a critical eye, you tend to develop a radar for when you're suspicious of information and when you want to go and look a little deeper, even if it's from what you view as a pretty credible source.

Karen Litzy:                   20:27                Yeah, absolutely. So we've got taking your time really looking at not only the source of the article but who's re tweeting it and that retweet to comment ratio. Is there anything else that we should be doing as healthcare professionals to make sure that we're not propagating this misinformation?

Jason Falvey:                 20:54                Another thing I think would be really helpful is crowd sourcing, right? So most of us are networked on social media with a lot of other really knowledgeable professionals. You know, I know that on my Twitter feed alone, half the people are probably smarter than me.

Karen Litzy:                   21:10                Oh, I don’t know about that.

Jason Falvey:                 21:14                But that's intentional, right? Like I want to be in a community of really intelligent people who think about issues critically, who may have different opinions than me. And I could say, I just read a study about Xyz and the conclusion seems flawed. Who would want to, you know, and maybe I don't name the article, maybe I don't put a link to it. I just put the tweet and throw out a few names and say, Hey, I would love if some of my community would like to take a look at this and tell me what they think. Right. If I'm on the borderline of whether or not I think this is legitimate or I asked somebody in the profession, you know, lean on them to really make sure that I'm taking that extra step to not share information that is influencing medical decisions in a negative way.

Jason Falvey:                 22:03                And I teach my patients these same strategies, right when I'm talking to patients and caregivers who are googling information, WebMDing, looking at blogs, and I've had patients with significant neurological illnesses that are terminal. And one of the places I've practiced, and I won't name that place if it's a relatively rare disease, but this person searched the literature and she was very well educated person, searched the literature high and low for a cure for her neurodegenerative disease and found one that was highly controversial. Probably harmful. And she invested thousands of dollars and hundreds of hours of travel over three months for something that was not beneficial while she was askewing typical medical care. So you know, that kind of taught me how to teach patients, not just how to look for information, right? That's part of the problem. But how to evaluate information, how to triangulate information to make sure that the reference that they found is supported by expert opinion and maybe other articles and making sure that there's a critical mass of support for this particular treatment before they really make a major alteration to their course.

Jason Falvey:                 23:21                A single article about a vitamin supplement that might help that has little harm. You know, that may be something that I don't intervene on, but somebody who's thinking about making massive changes to their medical routine, whether it has directly to do with Rehab or not. I encourage people to look at the literature critically and I use the word triangulation and I draw it out. I'm just like, you should be able to verify this information should be similar between these three things. Right? And if they tell me that they've done that and they found those three things, I'm more comfortable, even if I disagree, at least I've done my diligence to make sure they looked at the issue in a robust way and not fallen victim to something that was purely a single tweet or Facebook post of medical disinformation.

Karen Litzy:                   24:15                That's a shame. And I think it's important that you brought up that as healthcare professionals, we should be talking to our patients about this and we should be teaching them stuff. Glad that you went through that. Yes, we should be teaching them what to look for. If we can have a more educated patient base and a more educated base of health care professionals that high in the sky view. Of course the amount of misinformation may be less.

Jason Falvey:                 24:45                Yeah. And I think there are certain countries that have done a lot of work. Norway for example, has done a lot of work from a country perspective on educating citizenry on medical and you know, general disinformation, both political and medical and teaching, how to recognize it. Giving a lot of the same strategies we've talked about of really time and a little bit of additional resource and that solves so many of the problems. If you don't change some of these decision making process and they still are firm believers in the medical information at that point then you go to some of the other strategies, you know, more targeted intervention. But I think as a general population strategy, those are great places to start and really just, I tell patients all the time, I am going to be telling you seek information, not affirmation.

Jason Falvey:                 25:45                If you have a friend who told you about this treatment, you need to remember that everybody responds individually, the medications and treatments and you know, cause I think we've all had patients that say my friend got this therapy and their knee got better, really inappropriate for that patient. But it's really hard to walk that back, you know, from just your professional opinion. So teaching them how to look for information and letting them look for it on their own instead of providing it to them I have found is sometimes a helpful strategy because it feels like I'm not forcing my view on them. At the end of the day you can rest knowing that you put tools in people's hands, you know, health care providers or patients teach them how to do these things. I mean, but it does take some effort on their part too.

Jason Falvey:                 26:37                You definitely have to want to read these things carefully and you have to have the mindset that you don't want to just look for information that validates what you already believe. And I've seen this, you know, I don't like to pick on dry needling, but I definitely have seen people who are very strong believers in dry needling, just cherry pick evidence that supports their worldview, without recognizing that there's a lot more nuance to that discussion. And I'm not anti or pro dry needling. I'm pro information. Looking carefully and realizing that there are patients who do benefit from it, but it is certainly not a blanket treatment that everybody should be using and it's a tool in your bag, like everything. So, I think it's really important to just have that seek information, not affirmation. If I can say something a few times on this podcast that will be what it is.

Karen Litzy:                   27:40                Well, and then my next question would be, after having this great conversation, is there anything we missed and is there anything that you really want people to stick in people's minds, which I think you just said it, but I'll ask the question anyway.

Jason Falvey:                 27:55                Yeah. And I think the other thing is like, when you are a healthcare professional, I think investing money in like high quality sources or whatever source. For me, I tend to read a newspaper in New York Times or Washington Post. I have a subscription to it. I try to support that kind of, you know, to provide financial resources to a place that I trust to provide good information because that is positive reinforcement, right? I try not to provide positive financial rewards to places that are providing this information. And you do that by clicking on their articles, right? You read a headline and it's like vaccines cause autism study says, and I clicked on that headline, I’ve unintentionally propagated and supported financially that fake news provider who now is incentivized to create more fake news. So I think it takes a lot of discipline to not fall victim to our need to read everything.

Jason Falvey:                 29:02                And you know, sometimes we have to think about the greater good is not clicking on that article. Shutting it down, blocking that news source or whatever, if you really feel like it's egregious enough and not engaging with it. Creating polarization. Polarization is what creates ratings on television. Polarization is what creates ratings on radio, polarization is what gets people to download podcasts and things that are highly controversial. Polarization, you know, sells books, right? The top selling books on New York Times bestseller lists are generally, there's political books that exist, sometimes multiple political books that are on that list from different points of view. So I think it's really important that we don't support agregious, you know, fake news providers or fake healthcare news providers and don't engage with them on Twitter because that's giving them a form of a positive attention. Even if you're criticizing their work, that they can go ahead and leverage to share more.

Karen Litzy:                   30:13                Yeah, I thank you for all that great information. And hopefully the listeners can really take this in and understand that what we do on social media has ramifications one to our profession and two to the people we serve. So before we leave, I have a last question and normally I ask people, what advice would you give to yourself as a new Grad? But I'm going to ask you, what advice would you give to yourself as a new Grad physical therapist in light of fake news?

Jason Falvey:                 30:50                Oh, that's a great question. Beyond the sentence I said of seek information not affirmation, which I think is helpful for research and beyond, I think one of the things I would tell myself as a new Grad physical therapist in this era is I would be incredibly thankful for my English education, my bachelor's degree in English, all of the humanities and critical thinking classes that I took and all of the writing that I did because trust me, I wrote enough papers as an undergraduate that probably could have qualified this fake news cause I didn't really read the books very carefully and really had some made up opinions about what I thought was happening. So I think I can recognize the difference in that writing now. And I would tell myself, be appreciative of the education in humanities and the historical context that you've gained and use those skills. Don't forget about them. They are valuable parts of your tool bag. They are not direct patient care skills, but there among the most critical soft skills you can obtain to really do a good service to your patients and teaching them how to use those skills and taking healthcare into their own hands.

Karen Litzy:                   32:13                Awesome. Well, thank you so much. This was a great discussion. I'm glad we finally got to do this. Where can people find you if they want more info or to ask you questions?

Jason Falvey:                 32:26                Yeah, so I am listed on the Yale site, I am not officially representing Yale now just to put that out there, but my email address is on the Yale division of geriatrics site. I'm also on Twitter at @JRayFalvey and I'm sure you'll put that in your show notes. Those are the two things. And hold me accountable. Do you see me sharing something that you think is not a great source of information? Tell me about it. Right. And I think holding each other accountable is part of this process and doing that in a professional way is all the better.

Karen Litzy:                   33:07                Thanks again for coming on. 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 iTunes!

Apr 4, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Peter Fabricant on the show to discuss pediatric ACL injuries. Dr. Peter Fabricant is an orthopedic surgeon specializing in pediatric and adolescent orthopedic surgery. His clinical expertise is in sports medicine and trauma surgery of the knee, hip, shoulder, elbow, and ankle.

In this episode, we discuss:

-How to determine if a patient should have non-surgical treatment or surgical treatment following ACL injury

-Rehabilitation considerations following Physeal-Sparing ACL Reconstruction Surgery

-Setting realistic expectations for return to sport with the pediatric population

-And so much more!



HSS Peter Fabricant


For more information on Dr. Fabricant:

Dr. Peter Fabricant is an orthopedic surgeon specializing in pediatric and adolescent orthopedic surgery. His clinical expertise is in sports medicine and trauma surgery of the knee, hip, shoulder, elbow, and ankle.

Dr. Fabricant completed his undergraduate studies at the University of Rochester, graduating with honors. He then attended Yale University School of Medicine. During his orthopedic surgery residency training at Hospital for Special Surgery, Dr. Fabricant earned a Master of Public Health Degree from Columbia University, and won several awards for excellence in patient care and innovation in patient safety.

Following residency, Dr. Fabricant completed two fellowships: first in pediatric orthopedic surgery at The Children's Hospital of Philadelphia and the second in sports medicine at Boston Children's Hospital. This afforded him the unique opportunity to study with renowned mentors at both institutions, including Dr. Lyle Micheli, Dr. Mininder Kocher, and Dr. Theodore Ganley, in order to compile additional subspecialty training uniquely focused on the care of children and adolescents with sports-related injuries. He has cared for athletes and performers at all levels, including the Boston Ballet, Babson College, the International Skating Union World Figure Skating Championships, and the Boston Marathon.

Dr. Fabricant is an accomplished researcher, with over 100 peer-reviewed publications and 15 book chapters in circulation. He has received multiple institutional, national, and international awards for clinical research, including the Herodicus Award (AOSSM), the Excellence in Research Award (AOSSM), and the Promising Career Award (PRiSM Society), among others. Dr. Fabricant currently serves on several research and education committees in two international professional societies (POSNA and PRiSM). He is a member of several pediatric orthopedic and sports medicine research consortiums, through which he participates in cutting-edge multicenter clinical research studies with many of the most prolific researchers in pediatric and adolescent sports medicine.

He also serves on the editorial boards of Clinical Orthopaedics and Related Research (CORR) and the Journal of ISAKOS, on the Peer Review Committee for the Orthopaedic Research and education Foundation (OREF), and as a reviewer for several academic orthopaedic journals including the Journal of Bone and Joint Surgery (JBJS), the American Journal of Sports Medicine (AJSM), and the Bone & Joint Journal (BJJ).

Dr. Fabricant understands the physical and emotional complexities of injuries in youth and adolescent athletes. Sports and recreational activities provide social, emotional, and physical development, leadership skills, and encouragement for children to work as a part of a team with their peers. Dr. Fabricant has dedicated himself to addressing sports injuries in the context of all of these important issues and strives to return his patients back to their sports and activities as quickly and as safely possible, while minimizing the risk of future injury and prioritizing their long-term health and well-being.


Read the full transcript below:

Karen Litzy:                   00:00                Hi Dr. Fabricant Welcome to the Healthy Wealthy and Smart Podcast. I am so excited to have you on today to talk about pediatric ACL injuries.

Karen Litzy:                   00:13                So we're just going to kind of jump right into it because I know our time is limited here so the reason that I wanted to do this is because I have a patient now with an ACL tear who had surgery and there seemed to be a lot of questions in the rehab world around this population. So after a confirmed ACL tear in a pediatric patient can you take us through your decision making process as to whether or not that patient will have non-surgical treatment which would mean high quality rehab or ACL reconstruction plus rehab.

Dr. Fabricant:                00:53                Yeah that's a really great question. So historically kids who still had you know growth remaining who had open growth plates would kind of be held off until they were fully grown and then have an ACL reconstruction then. But we know that that's not the ideal thing to do just because they have an unstable knee they can develop cartilage and meniscus injuries that might not be repairable once they reach the maturity but there are a subset of patients who tend to do pretty well without surgery and with high quality rehab alone. And so typically when I'm evaluating a patient the ones that tend to do well with high quality rehab alone would be typically younger patients. So kids who are like under 14 years old and kids who have non full thickness ACL tear. So like a partial ACL tear like a 50 percent tear.

Dr. Fabricant:                01:49                And so kids who are young and who have you know a 50 percent partial tear their ACL who have rotational stability of their knee so their knee doesn't kind of rotate during things like a pivot shift examination. Those are kids who tend to do pretty well without surgery with a period of protected weight bearing bracing and high quality rehab. When I'm seeing kids who are either older and or have a full thickness ACL tear with a really unstable knee those tend to be the kids who we recommend surgery for especially if they're involved in cutting or pivoting sports jumping or landing sports things like that. So that's basically how I approach it in general.

Karen Litzy:                   02:34                And so let's talk about the surgical procedures because there are several surgical procedures one can do on a pediatric ACL patient taking into account the growth plate damage. How do you decide which surgical procedure to do with this population?

Dr. Fabricant:                02:57                I think that's a great question too. So I kind of think about these kids in three groups.

Dr. Fabricant:                03:04                Let's go from kind of oldest to youngest so the oldest type of kid is the kid who either has growth plates that are closed or near closed or they have very little growth remaining let's say like less than six months of growth remaining. Those are kids that I kind of think about a little more like adults. But then within that within kind of specific to your question the kids who have open growth plates. The question I ask myself are kind of are these kind of the youngest kids like prepubescent kids. So those are kids with greater than 2 years of growth remaining.  In girls, those who haven't had started having their periods yet. In boys and girls kids who really haven't had a growth spurt or who are kind of prepubescent.

Dr. Fabricant:                03:53                There's kind of that group and then there's the pubescent kids who are between let's say two years of growth remaining and six months of growth remaining you know in girls let's say they've had their periods for a year, in boys they may have already showed some signs of puberty or of their growth spurt. So those are kind of the pubescent kids even though they have growth remaining and so in thinking about a reconstruction technique I try to figure out are they in the prepubescent group or the pubescent group. And then there are a couple of different described surgical procedures in each but in broad generalities the prepubescent group you need to really avoid the growth plate completely and so that can be done either with techniques where you do drill tunnels in the bone but you confine it to the epiphysis of the bone or the area that's kind of away from the growth plate or you can do a procedure where you're not drilling any tunnels which would be like the IT Band ACL procedure and that those both can protect the growth plate and they're both been well described and then in the kids who are pubescent who have growth remaining but maybe not so much growth remaining those kids you typically can drill tunnels in the bone but you just need to use a graft that's made of soft tissue because if you take let's say a bone plug from a graft and fix it across the growth plate that can inhibit their growth and cause a limb length deformity limb length discrepancy or like an angular deformity of the limb.

Dr. Fabricant:                05:31                So that's kind of how I think about the two groups that still have growth remaining and taking surgical procedures.

Karen Litzy:                                           And does the activity of the child come into play when deciding on which procedure to do or is it really just their kind of bony anatomy and age.

Dr. Fabricant:                                        Yeah it's mostly their age and skeletal maturity and their developmental maturity. The sports sometimes come into play when you're deciding whether or not to do a reconstruction but once you kind of made the decision to do a reconstruction you know which technique you choose is typically chosen based on their skeletal maturity.

Karen Litzy:                   06:11                Got it got it. And then you sort of alluded to this a little bit earlier talking about the meniscus but why is the health of the meniscus so important in the pediatric ACL patients.

Karen Litzy:                   06:22                So from what I've read it seems like if there is a bucket handle tear or other repairable meniscus injury surgery is really warranted. Why is that?  

Dr. Fabricant:                06:42                So if there's the meniscus is pretty precious tissue and it's really the shock absorber of the knee but it also provides secondary stability to the knee, nourishment of the joint. It provides congruence between the femur and the tibia and so it's really important to try to save as much meniscal tissue as possible and then these kids obviously have quite a long life ahead of them and many have a long athletic career ahead of them. So you definitely want to save as much meniscus as possible so if there is a large unstable meniscus tear and the knee remains unstable it's likely to continue to degenerate whereas if you go and stabilize the knee and fix the meniscus you have the best chance at preserving that tissue and getting it to heal.

Karen Litzy:                   07:20                Yeah that makes sense. And now for a lot of my listeners who are physical therapists this is sort of the money question right.

Karen Litzy:                   07:27                What are the most important considerations for rehab after these physeal-sparing ACL reconstruction surgeries?

Dr. Fabricant:                07:36                So it's interesting there's not like a really strong evidence base about like specific things with rehab but I would tell you that kind of the way that I approach it and kind in in broad generalities typically the first six weeks are where there's the biggest difference depending on how the procedure goes. So if if it's let's say a procedure where you're drilling tunnels and fixing it with implants you know those kids can tend to weightbear relatively soon the implants tend to confer a lot of stability to the graft and allow the body to heal the graft. If there's a meniscus repair at the time of surgery, I tend to protect the weight bearing for a total of six weeks just to let the meniscus heal and in the kids who end up getting the IT Band ACL because there are no tunnels drilled in the bone and therefore there's no like screws holding the graft in place and the graft tends to be fixed to the periosteum of the bone or the skin around the bone with heavy duty suture.

Dr. Fabricant:                08:39                Those kids I tend to protect for six weeks regardless of if they've had a meniscus tear repaired just because I want to make sure they've started to have some biologic healing of the graft before I let them really bear full weight. So for me the first six weeks are kind of the most critical portion where if I've done a IT Band ACL and I'm kind of relying on suture for fixation I tend to protect their weight bearing a little longer but once they hit about six weeks for me at least the rehab tends to progress the same whereas essentially all kids are kind of started to wean off crutches by six weeks starting to work on strengthening and then for me I tend to let kids start to jog around 12 weeks and from there on it's pretty similar rehab to the adult rehab.

Karen Litzy:                   09:24                So why with the ACL reconstruction using the IT band, why is no lunging a precaution with this population.

Dr. Fabricant:                09:37                When I was in training I had some of my mentors would say that they found that kids who load the knee from a flexed position after any ACL reconstruction tend to kind of flare the knee up especially in the early phase and so I tend to tell kids to avoid you know deep lunges and squats early on. So that's just something that I do I don't know that there's a lot of great evidence for that but it seems to have worked for some of my mentors and so I've kind of adopted it into my practice as well.

Karen Litzy:                   10:13                Got it. Got it yeah. Because I read that out of Boston right. And OK so that makes a lot of sense because I often wondered.

Karen Litzy:                   10:24                Well they can jog and run but they can't squat or they can't lunge. And is that obviously to protect the knee and is that also to maybe protect secondary problems like patellar tendinopathy or something like that.

Dr. Fabricant:                10:38                You know right after surgery there is a bit of inflammation going on in the knee and so certainly doing like deep squats and lunges can increase the risk of further inflammation.

Dr. Fabricant:                10:50                But I really do like squats like leg presses that go down to about 90 degrees of knee flexion. I really find it helps strengthen the knee without inflaming it too much. But you know the physical therapist that we work with tend to do that and the patients do pretty well and they end up building it pretty quickly.

Karen Litzy:                   11:12                That makes sense. And now let's talk to a lot of these kids want to return to sport. I mean you're working with kids all the time as you know their attention spans are a little short and they're all really excited to get back to sport A.S.A.P. but according to the IOC consensus on pediatric ACL they recommend waiting twelve months to return to sport. So what is your thought on that?

Dr. Fabricant:                11:43                Yeah I would say the short answer is I agree with that completely. I typically mentally prepare kids for a year to return to play.

Dr. Fabricant:                11:53                I think that you know there's really three things you need in order to successfully return back to sports safely. So one is the anatomy which is really the job of the surgeon and reconstructing the anatomy. The other is you know strength and balance and coordination which is a team effort between the physical therapist and the patient and the surgeon as well. And then the third thing is just time. So it just takes about a year for the graft to incorporate and mature and remodel and kind of be biologically ready. And I think that's the hardest part about this surgery is really kind of keeping the kids engaged for a full year. I think kids sometimes hear about some professional athletes who get back to sports sooner than a year and so they feel like they want to get back sooner than a year.

Dr. Fabricant:                12:39                But I typically tell families you know a couple of things. First off the average time to return to sport, even in professional athletes like in the NFL is about eleven months. So even in pro athletes who have no job other than to rehab their knee you know they don't have chores and schoolwork and things like that that it's still about a year and that's an average. So while they might hear you know on the news about people who get back after six or eight months there's also people who don't get back for 14 or 16 or 18 months. And so even professional athletes it takes about a year and then the other thing is that kids are really even higher risk than professional athletes because typically you know if there's something about the child's anatomy or their physiology or how they're moving

Dr. Fabricant:                13:24                That puts them at such high risk that they're gonna tear their ACL when they're 11, 12, 13, 15 years old. They're at higher risk patient than the guy or gal who goes through you know high school and college and professional sports before tearing their ACL. They've made it through let's say 30 years of life before tearing their ACL. So I tend to try to kind of work with kids and families and say you know look you're a higher risk than a professional athlete for one and two you know all they do all day is rehab and it still takes them a year to get back to sports. So I tend to agree with the one year recommendation. I tend to let kids just because they're itching to get back. I tend to let them do some light practice with their team at the beginning of the following season. So for instance if a kid injures themselves midway through a soccer football season in the fall you know usually it's around nine or 10 months till the next beginning of the next season I say that they can do some kind of non contact practice with their team just so they can stay involved. But I do agree with the one year before they're really kind of on the field or the court competing with other kids.

Karen Litzy:                   14:33                Yeah and I'm so glad that you brought up what they see on TV and what they hear or see on social media because that's something that's so pervasive amongst a lot of these kids and they think someone else did it. They should be able to do it too. So I thank you for that. And I think that advice to tell the parents and to keep reiterating that to the patient to the pediatric patient is so important because boy they just want to every day. Well when can I do this. Well when can I do that and being able to keep them like you said motivated but realistic expectations and being honest is a challenge.

Dr. Fabricant:                15:14                Yeah you're totally right. I think that even setting expectations before surgery you know they kind of forget you know when their knee starts feeling pretty good around three or six months but you know I think the other important thing is that you know what they hear on TV and in social media tends to be the exceptions to the rule rather than the average.

Dr. Fabricant:                15:31                So they hear about the person who gets back to sports at six or seven months but they don't necessarily hear about the people who take a year and a half to get back to sports in the pros or who don't make it back to sports in the pros. So I think you know also telling them they're probably getting a bit of a biased view when a lot of these kind of news outlets kind of sensationalize people who are getting that quickly they think it's the norm when actually it's the exception.

Karen Litzy:                   15:54                Absolutely. I just had this conversation the other day about what a bell curve is and how some people are on one side some people are on the other but most people are in the middle.

Karen Litzy:                   16:04                And to really keep that in mind when you see these big extremes so now is there anything else that you would like to add as far as let's say speaking to physical therapists or people who are going to be working with your patients. Anything else you would like to add as far as the pediatric ACL patient is concerned.

Dr. Fabricant:                16:27                Not not really. I think we really kind of touched upon all the important topics. I think it's just important to understand a lot of people are really beginning to realize that you know kids aren't just small adults and they have their own unique considerations both with the surgery and in the rehab and in the kind of mental preparedness for sports. And so I always really enjoy working with therapists who enjoy working with kids and engaging kids because it's not just that the surgery and even the exercises are different it's the whole kind of mindset and the approach. And so when the whole team is on the same page it's always really rewarding.

Karen Litzy:                   17:09                Awesome well thank you so much for taking the time out. And where can people find more about you if they would like to know more about you and what you do and have any questions.

Dr. Fabricant:                17:18                Yes so I practice at the Hospital for Special Surgery so they can go to the hospital for special surgeries Web site which is a they can look me up on that Web site or they can Google search my name at HSS and we're here and happy to take care of our youth athletes who get injured.

Karen Litzy:                   17:39                Awesome. Well thank you so much and everyone else. Thank you so much for listening. Have a great couple of days and stay healthy wealthy and smart.



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


Mar 30, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Nikki Kimball on her experiences as a female distance runner.  Nikki Kimball is an American distance runner specializing in the Ultramarathon. She is also a physical therapist in Bozeman, Montana.

In this episode, we discuss:

-Nikki’s journey to becoming a long-distance running athlete

-The societal health and wellness ramifications of running

-How Nikki’s experience as a physical therapist has shaped her running journey

-Gender differences, both physical and financial, in competitive running

-And so much more!



Shannon Sepulveda Website

Shannon Sepulveda Facebook


Trail Sisters

Nikki Kimball Instagram



For more information on Nikki:

Nikki Kimball (born May 23, 1971) is an American distance runner specializing in the Ultramarathon. She ran her first 100-mile race at the Western States 100 Mile Endurance Run in 2004, and was the female winner. She was the winning female at Western States again in 2006 and 2007, becoming only the third woman to win Western States three times. In 2014, she won the Marathon Des Sables multi-stage endurance race on her first attempt. Prior to running, her main sport was cross-country skiing. She was crewed at the 2007 Western States by U.S. Senator Max Baucus of Montana, where Kimball lives. She lives in Bozeman, Montana.

For more information on Shannon:

Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.


Read the full transcript below:

Shannon Sepulveda:      00:00:00           Hello and welcome to the Healthy, Wealthy and Smart Podcast. I am your guest host, Shannon Sepulveda, and I am here with Nikki Kimball. Hi Nikki. So Nikki, can you tell us a bit about you and what you do?

Nikki Kimball:                                        What I do? My favorite subject, I am a physical therapist here in Bozeman and I also coach running, ultra marathon running. And I got into that because I've been an ultra marathon race or professional racer for almost two decades. And that's kind of what I do.

Shannon Sepulveda:                              So in the ultra marathon running world, when you say Nikki Kimball, people are like, oh, Nikki Kimball. And I feel like, so Nikki is a very accomplished ultra marathoner for those of you who don't know who Nikki is. So we are very, very fortunate to have her here on the podcast. So how did you get into ultra running? Because back then it seemed like it's not as popular as it is now.

Nikki Kimball:                00:01:01           No, I don't think it is, but there were still, you know, a boatload of us. I mean there are thousands of us who absolutely loved this sport and we, you know, there wasn't much money at it or anything like that. It wasn't very popular. But I think a lot of cross country skiers come into it sort of organically because of the training we do for cross country skiing is essentially ultra marathon training, which is kind of funny because the women don't get to race very far. The longest they can do is 30K at the Olympics. It's pretty pathetic. But regardless, we always trained with the guys anyway. So we would do these four or five hour run hike things in the woods. And so it was kind of doing it anyway.

Nikki Kimball:                00:01:50           And in graduate school I raced a lot of 5K's, 10K's, half marathons, marathons, just kind of wherever. Cause I had a store team that sponsored me and they'd pay all my race entry fees. And so I just go do fun things. And it just like sort of saved me through Grad school because it had gave me this other thing besides studying all the time. And it made me sort of mentally clearer. I just loved it and I'm just like running makes me happy. It just makes sense to go out and run and run and run. And so yeah, at the time it wasn't super, it wasn't mainstream popular, but those of us who did it loved it. Did it all the time.

Shannon Sepulveda:                              So you grew up Nordic skiing?

Nikki Kimball:                00:02:41           Yes, in high school. I grew up in a town called Chittenden in Vermont, so south central Vermont town and I grew up skiing. My brother was four years older, so he was skier and the Bill Koch Youth Ski League is this big, big thing then. I don't know if it still is, but there would be these races for kids and because I mean the kids who would be racing, you know, from eight years old on, they kind of knew what they were doing, but they had to do something for like the little brothers and sisters. So they'd have these races, they called Lollipop races because you get a lollipop at the end and you might go 100 meters maybe holding your parent's hand. But I believe I was three when I first did this. I basically learned how to ski and walk at the same time, I'm sure.

Nikki Kimball:                00:03:31           And so yeah, I mean I just don't remember life without competition, without endurance sports.

Shannon Sepulveda:                              And then did you race in college?

Nikki Kimball:                                        And I raced at Williams College, so all four years, so division one racing. Then, partway through college I decided to switch to biathlon. So my senior year I had to keep my rifle at a professor's house cause they weren't too keen on having rifles on campus. And so I raced a couple of years in biathlon hoping for the ‘98 Olympics and I raced through ‘94.

Shannon Sepulveda:                              Oh Wow. So how is biathlon different from cross country skiing, like endurance wise. What do you think?

Nikki Kimball:                                        Similar, really similar. I mean, it's just adding this sort of cognitive piece to it. I mean to go from skiing as hard as you can to shooting clean for five rounds is, it just requires a whole different skillset.

Nikki Kimball:                00:04:37           Of patience and humility and cognition. I mean, looking at where the wind is and deciding you know, how to change your sites on your rifle, by this, you know, it's just an extra layer. And I loved that.

Shannon Sepulveda:                              Do you feel like that has influenced your ultra racing at all? Like part of it?

Nikki Kimball:                                        Probably not a ton. I mean, I think the calmness needed to do well in biathlon in the humility is super helpful. So those two things are good because if you're racing a hundred miles, something is going to go wrong and running. You don't have perfect races when you're beyond 20 hours, you just don't. And so having, you know, biathlon does teach a bit of that, sort of humility but also ability to change with the changing situation. You might come into the range and the wind's coming from a completely different direction than it was when you, when you cited your rifle in and you have to deal with that.

Nikki Kimball:                00:05:48           And similarly, an ultra marathon is very common that you come into an aid station and the bag of stuff that you wanted there isn't, or your crew isn't there or something that you expect isn't there. And so that ability to think during the race and make changes to your plan during the race is definitely something is common between the ultra running and biathlon.

Shannon Sepulveda:                              Cool. So then when you say graduate school, do you mean physical therapy? And so how did you get into running, cause it sounds like that's where the transition went into ultra running, is that right? Or where the transition to competitive running?

Nikki Kimball:                                        Yeah, absolutely. Because I threw 94, I was ski racer, which is sort of a different body type also, more muscular and a lot more upper body mass.  So, you know, through 94, ski racing was the only thing I really wanted to do. And I also was kind of I hadn't raced anything long in running, so I wasn't very, and I wasn't good.

Nikki Kimball:                00:06:57           I was fantastic for the middle of the back. I hadn't really realized that I had any ability in running because my abilities not in running, it's in enduring. I always qualified for nationals in D1 skiing. And there was definitely something I wasn't good at. Actually in 94, after a really successful year of biathlon doing well at Olympic trials, I wasn't expecting to make the team because I can shoot very well. Did very well at nationals. And then I ended up getting very sick with depression, losing about 20 pounds and I couldn't even run three miles. Like I couldn't, I couldn't do anything.

Nikki Kimball:                00:07:55           I was just sleeping. All I did. And when I went to Grad School, I came in with a completely different body. I mean I lost all my muscle, and really  I was in Philadelphia, so I'm like, well, what can I do? So running was the thing I could do and this was way before most psychiatrists and counselors were thinking that exercise was important for running. But I sort of knew it, you know, I just knew that I could think better, I could function better, all of those things, everything better when I'm exercising. And so it was sort of natural for me to just my daily dose of endorphins that is just critical to me. Even having normal brain function. It would be like I'd have to run an hour a day just to stay sane.

Nikki Kimball:                00:08:49           So then I went to graduate school and I'm in Philadelphia and I go and do this 5K race and I win it, and I'm like, what the heck? I am not a runner. This is crazy. And then the store team picks me up and then we just started running longer and longer and more and more trails and you know, so it wasn't something I never set out to be a good ultra marathon runner. It just sort of, it just was what I did anyway. And then I realized it was a support.

Shannon Sepulveda:                              Yeah. That's really cool story. Awesome. So what was ultra running like when you started and how is it different now? Cause I mean, how long ago was that when you started?

Nikki Kimball:                00:09:38           I started in ‘99, 20 years ago. It was still very, very competitive at the top.  But the fields were not as deep. And there wasn't, you know, it was never talked about in runner's world, I don't think runner's world even knew what ultra running really was. And it didn't really need to create a magazine, but it was like runner's world is for sort of mainstream runners and getting people into running and it's fantastic for that. But ultra running was never something that would even be considered in, you know, for their audience. And I think that's really telling now. They know now they talk about ultra running and that kind of stuff. And ultra running is now becoming appealing to your general public. It’s just not something that's freaky anymore because it's in the running media.

Nikki Kimball:                00:10:32           Part of me wants to go back to the old ways where you raced and you had only water at the aid station.  The aid stations might be two hours apart and you want a belt buckle after you set a world record you know, it was great. Not that I ever set any world records, but, that's the trail runner part of me. But that was kind of Nice. It wasn't very commercial.  And now it is more so, but I'm also part of that. I mean I was in films about running several films about running. I was promoting, you know, Nike northface Hoko, which ever sponsor I had at the time. And  you know, kind of using my running to promote basic health and fitness things. And you know, I mean it just, I mean I definitely was heavily involved in media surrounding running, so the increase of popularity of running, I'm not innocent in that.

Shannon Sepulveda:                              I think it's awesome. I think it's really great because not everybody's going to be fast at a 5K and some people are really good. It's completely different. Being fast at a 5K is completely different than running a hundred miles. Yeah, it's totally different. And some people are really good at it and some people are not. And some people, the accomplishment of running just running 50 miles or 18 miles or whatever, will get them through, get them on a high for a whole year. I mean, the fact that they can do that. So I think that's amazing.

Nikki Kimball:                00:11:54           And it'll get them training for a whole year. Will get them healthier in an age in which sedentary lifestyles our biggest killer, or contributes to it anyway. We really need to make sports mainstream and running is so easy and it's something we don't need special equipment for, you can do it on any budget. And then you can still compete in it.

Shannon Sepulveda:                              But I mean, it's like if you were a baseball player, you can't just go play baseball games a lot of the time. But if you're a runner, you can always say, I'm going to sign up for x race and train for x race.

Nikki Kimball:                00:12:49           Yes. And so it’s the perfect lifestyle, lifetime sport and you can do it if you're running, you know, if you're running team, if you, let's say you want to do stuff with people, you're running team doesn't show up for a workout. You can do that work out on your own. You know, it can be as social or isolated as you want to be. And I think runners know that, you know, sometimes, you know, you and I are both physical therapists. Sometimes we have a whole day of patients. We want to go out and run the five, 10 whatever miles by ourselves because we're just, we need that break and not talk.  And then other times, you know, you want to go out with a group of 10 people and just, you know, just chat the whole way.

Nikki Kimball:                00:13:40           And I swear that if political leaders could do all of their work while running, things would actually work. I mean, cause I swear every, you know, every long run you go on, somebody comes up with an idea that just seems brilliant.

Shannon Sepulveda:                              Yeah. And you get to talk to people who believe different things and have actual conversations with people because there's nothing else to do, right. You're out in the woods for four hours and that's who you're with and you can talk about stuff and you're not checking your phone. And now I think it's great.

Nikki Kimball:                                        Yeah. And it's something that's so foreign to us in modern times. You know, we're always sort of plugged in and we're always hanging out with only others like us and running sort of takes all that away. Yeah, I really liked that.

Shannon Sepulveda:                              And I think, you know, even, you know when I get postpartum women in here and they want to run a 5K after they've had a baby and they're like, well I'm not really a competitive runner.

Nikki Kimball:                00:14:37           I just, I really want to run this 5K. And I'm like, that is awesome. I really want to run it in under 30 minutes. Well that's such a great goal. Like let's do that and it's attainable and it's great. It gives people a goal of something to do.  It doesn't have to be 100 miles, you know, like it doesn't, that’s the beautiful thing about running.

Nikki Kimball:                                        And I love about ultra and running in general is that different variations on running are becoming popular. Whether it's spartan racing or color runs or you know, like none of those events is going to attract every person, but it's going to attract somebody. And if somebody gets hooked because they like having paint balls thrown at them, like great, if that keeps that person from getting type two diabetes, I mean it's the cheapest medicine we can buy.

Shannon Sepulveda:                              Oh yeah. And I think that that's why it's so awesome being a physical therapist because we know how important exercise is and getting people back to that. So like they don't die and they don't get type two diabetes and they don't get heart disease.

Nikki Kimball:                00:16:01           And we're not rehabbing their total knee replacements because of obesity. You know? I mean they have a total knee replacements because they earned it.

Shannon Sepulveda:                              Yeah. I think it's so great just to be able to have, you know, running become more mainstream so it's more accepted and people are really excited about it. I mean, when you go to marathons and you see people of all shapes and sizes completing marathons, I think it's so cool and it's so different from what it was 20 years ago.

Nikki Kimball:                                        Absolutely. Absolutely. I mean, marathons didn't kind of include, they certainly didn't encourage and often didn't allow people to finish a marathon in six hours or more. And now we've got that in there just has to be a place in athletics for all adults because if this is the way we are going to stay healthy in a world that is more and more sedentary, then we need to make it fun because otherwise it's not going to be sustainable for most people. And you know, and we also need to have resources out there for people to do these sports.

Nikki Kimball:                00:16:56           And I just keep seeing more and more emphasis on building trails and on making shoulders on roads so that people can safely bike or run or whatever. I think the more these sports grow, the more people demand from their local government that we have trails, that we have safe places to work out. And play and do all those things that are just going to save us money in the end because we're all healthier.

Shannon Sepulveda:                              Yeah. No, I think it's great. So let's talk about how has being a physical therapist impacted your career?

Nikki Kimball:                                        Probably for the better and for worse. We over analyze everything exactly. I mean, and I'm sure you remember when your first a physical therapist and you're working in general orthopedics and you see people coming in and they're in their sixties and that's old to you because you're in your 20s and you're like, oh my gosh.

Nikki Kimball:                00:17:50           I have all these things that are going to happen to me. Yeah. So you start getting these ideas of things that happen with aging. So that's a little, that's actually probably good, a little cautionary tale there, but, for the first 18 years of my ultra running career, I never missed significant time from races, from any running injury. I mean, the races that I missed were mostly from direct trauma cause I fell off something or trail running is a little aggressive. And I also mountain bike and dirt bike and ski race and do all that. So you know, I definitely have had injuries, but they're usually direct trauma, not repetitive trauma. And I think PT has been the biggest factor in that. I mean also I just have good genetics. Having treated every running injury there is, I could see when one was coming up and I think that helped a lot.

Nikki Kimball:                00:18:44           Oh, I've got this little thing, Ooh, that's not just muscle soreness. That sounds more like, you know, it band and Oh, maybe I should have somebody look and see if my hip is strong or if I’m overstriding or whatever. And so I think, you know, running is a huge deal and running and prevention of an injury is so much more important than fixing it. And PT has given me the patience for that, you know, like, okay, I know I need to take a week and be water running now because I've worked with so many people who didn't do that and now they're out for four or five months.

Shannon Sepulveda:                              Do you see differences in injuries between ultra runners and like your recreational 5K’er?

Nikki Kimball:                00:19:35           Yes and no.  Your recreational 5K’er often it's their first year running and they're much more likely to get injured and injuries that are completely preventable. Just because they just sort of get into it without any guidance. Ultra runners first of all, probably have the genetics that allow them to run that long. So they're probably mechanically more, more ready to run ultras. And then some of the ultra running injuries we see are just like, they can be really serious because we can I think once we're out there racing, to be successful, you have to be able to put pain in a little box or just sort of deflect it. And you really don't, like when I was racing, I really didn't feel pain so much cause I could just sort of play in my head with it. And so you can get people who in ultra running who will go into a race with a stress fracture and it becomes a frank fracture.

Nikki Kimball:                00:20:35           And I've seen that with several ultra runners and you know, that's not your recreational 5K runner might get a stress fracture, but they'll probably actually going to go seek help while it's still a stress fracture and not going to let the bone actually break in half. So sometimes runners, ultra runners can be a little, aren't good at using pain as a guide. I think your recreational 5K runners going to come into when their knee starts hurting or their ankle starts hurting and they're gonna be like, Hey, something's funky here. And so I think those recreational 5K runners are much more likely to get injured, but their injury is also going to be much easier to manage. And ultra runners were all, I mean, most of us I think are addict to the sport and to running and to exercise. And you know, I just know how tempted I am to run if injured, you know, cause I have to work out or I'm just staring at the wall being brain dead. I mean, I really like without you know, at least a few times a week infusion of endorphins I don't function and I think a lot of our ultra runners are that way and we can so we basically go until something's really bad.

Shannon Sepulveda:      00:21:51           So I'm always interested in like the mental aspect of pain.So when you were like racing in your, you know, cross country racing biathlon you're like super anaerobic, like you gotta get over that governor in your head that says slow down. So that sort of mental capacity for pain versus I'm on Mile 90, I have pain everywhere. It seems like a different type of pain. Do you classify those as a different type of pain in your head or are they kind of the same?

Nikki Kimball:                00:22:20           I think in my head they're the same or similar. In ski racing I could always say, or in biathlon, well I'm going to lie down at the end of this kilometer to take a bunch of shots. So you know, you know that that pain is, is there, but I think I dealt with it mentally by, it's going to be over very quickly and it always was. So in that it's somewhat different but so in ultra running you have less intense pains but for a lot longer period of time. And so I don't get to say, oh well it's going to be over soon because this, now you have another four hours left. And I think that got me to the point where I would think of pain as this is just this neural sensation.

Nikki Kimball:                00:23:09           It's nothing more than that. There is no reason to put any emotion into this sensation that's coming in. I mean, I think part of what gives pain its power is fear of pain. And in an ultrathon you have long enough to think that you have to deal with pain in a different way. And if I can just take the power away by saying, okay, I have a nerve signal telling me that my hip hurts or my knee hurts. But that's all it is. It's just a neural signal. And because I think the anesthetic effect of our chemical changes when we run, we can do it. I mean I don't think I'm really tough about pain. Like if it's just, if we're just sitting here and you know, somebody hits me, it's going to hurt just as much, but while I'm running I can take so much more.

Nikki Kimball:                00:24:04           And as long as you don't fear it, it's just way, way easier to tolerate.

Shannon Sepulveda:                              It's so interesting cause it's like when I hear you talk, there's such similarities to chronic pain and like what we know about chronic pain and how as like PTs we treat chronic pain where it's like, you know, these are just neural sensations coming in. The brain controls where you are, what you're doing. Do I need to get out of here? You know, and how we gradually increase people's exposure to certain things to get them out of chronic pain. So when I hear you talk, that's like exactly what I think of. Like you think about it as a neural sensation, not, you know, this emotional response that you have to like give into.

Nikki Kimball:                                        Right, right. And you know, I think that ultra running can be a very good metaphor for life in many ways.

Nikki Kimball:                00:24:57           And that's one of the ways, and I think that medicine, both physical medicine, physical therapy plus medicine, human medicine are starting to research ultra running, which is incredible. And I think, I think we need to look at things like ultra running for managing chronic pain. We need to look at ultra running to see. But I think we need to do more and more research to find like what is it that benefiting here? I think it would be extraordinarily hard to thrive through chronic pain. I mean, we've both worked with so many people with chronic pain and it's really, really horrible. But if you can, you know, do you just give up? I mean there's no, we don't have like a pill form now, we don't have anything that will just kind of get rid of it right away.

Nikki Kimball:                00:25:56           Nothing. And so we have to be able to manage it. And I think ultra running is about managing stuff and so maybe somebody in medicine finds out what, you know, what factors allow us to thrive despite that pain, to win the race despite the pain that we're in. And certainly there's a lot of research out there on mental health. What is it, you know, we know there is, you know, six or eight different things that were changing when we're running that might affect our cognition and mental state. Like, you know, what is it we don't really know. But we know something about running is lessening the effects of depression and other mental illnesses and we know that is lessening the effects of some pains.

Nikki Kimball:                00:26:44           So it's just this brilliant area of untapped research or a research opportunity. I mean, there's so much out there and it's very much in its infancy. But you are seeing people being serious about running medicine now.

Shannon Sepulveda:                              Yeah. It's really interesting when I hear you say manage the pain because that's like when I have conversations with my patients that have had chronic pain for years. I have a conversation of like, this is chronic, we are going to manage it. You're going to have flare ups and you're going to manage it and it's gonna get better. But at some point you're going to have a flare up and it's going to be okay. And so when you think about managing versus curing, it's, I guess very similar to ultra running like it is, I'm in mile 80, I'm going to manage this, right, because I've got to finish it and it's going to flare up and I'm going to manage it and it's going to get better.

Nikki Kimball:                00:27:37           Yes, exactly. And I think this is where all types of medicine need to come together. I mean it's neuro, psych, it's mechanics, it's all of those things. Because how else are we going to let people live quality lives with chronic pain or mental illness, any of those kinds of things. And ultra running is sort of microcosm and like, it's like, yeah, like your whole, you know, it's like a lifetime. And, you know, 100 mile race. And so I think there are really important pieces of information in there that can be applied to our world in general.

Shannon Sepulveda:                              Yeah. That's so interesting. Okay. So the next thing I want to talk about is gender equity in ultra running are running in general. Both prize money, sponsorship, but also physiologically. So which one do you want to start with first? So to just talk about it, because I know you're a very good advocate for women and gender equity and this is a problem in many sports. So let's talk about the problem in ultra running.

Nikki Kimball:                00:28:52           It is, it is a problem and in many sports. I must say on the good side, just to start this out on a good note the changes through my lifetime and how women are treated in sport has been amazing. I mean, when I started racing in the 70s, you know, there were oftentimes, you know, races just for men or you know, the men would get prize money and the women wouldn't get any. And that was really, really common. We just sort of expected that.

Nikki Kimball:                00:29:42           And you know, all through high school and college, and this still happens unfortunately, you know, being a high level ski racer, the women, we would race 5K when the men would race 10K and you know, that stuff is still happening but getting better hopefully sometimes that's changing. And sometime in the 2000 odd you just really stopped seeing prize money be different. Because  prize money is so transparent and you know, there were still a few holdout races that would prize the men and wouldn't prize the women. And in Europe that was very common, which is kind of shocking to me. But many, many races, money for the men and you know, something cute for the women and the fights for gender equity already had enough traction behind them to finally, to really call out race directors who didn't prize equally.

Nikki Kimball:                00:30:52           And with the Internet and with everything being freely, with being able to get that information really easily from your computer, race directors would look really, really horrible at this point if they weren't prizing equally. And so the last 15 years has been pretty good that way. Then we have sponsorship. And most of our contracts tell us we aren't supposed to talk about how much we're getting paid. And that's a brilliant strategy by the marketing people for, on these big companies that sponsor runners because why pay a woman what she's worth when you can pay 12 times less? And that's not an unreasonable that actually I have seen that in order of magnitude difference between males and females, why pay or that isn't, you know, if your customers, when they go to buy that jacket, don't know that, you know, Sarah gets paid 5,000 a year and Joe gets paid 10,000 or a hundred thousand a year, why would we, you know, why would they pay that?

Nikki Kimball:                00:32:00           And I think that's the next area to go or to get down, get down to and really dig into hopefully the last one. There's still other subtle forms of sexism that happened, but this is still a major, major form of sexism that's happening. And I've thought through my professional career and then once I started trying to add up how much I would have made if I'd done the same thing as I did but be a male. And once I realized that I would probably have an extra house in the most expensive part of town, I decided to stop torturing myself. And so some sort of transparency there has to happen. But the other, the subtle stuff, some athlete contracts give you bonuses for getting their logo in print media or on television or all those things will still look through the sports pages in any local paper.

Nikki Kimball:                00:32:58           And they're still often, you know, eight pictures of men compared to one picture of a woman. Or, you know, even if it's two men to each woman in the sports pages, that's money we're not getting because you know, you're not in the picture. I won the race. But the guy's winner gets in there and you still look at Wikipedia. If you look up Wikipedia or any of those race sites or running sites. They'll often have, you know, they'll talk about a race and they'll say, you know, the course record is held by, and it's always the guy. I also have the course record, right. But so then again, the men gets so much more promotion from media and all of that.

Nikki Kimball:                00:33:46           And then that gets the sponsor's thinking that they have a better return on investment from the men because the men are like, look, here's what you know, here are all the newspaper articles I was in, magazine articles I was in. So those more subtle types of sexism are harder to fight. And I think some of us are doing it. Gina Lucrezi is an ultra runner and very solid alternative, but also really great supporter of women's ultra running and has started a company called trail sisters that is huge and just getting bigger and bigger and it is to address some of these issues and also address other physiological issues that women have to fight, have to face. These things are happening. It's just not as fast as I'd like.

Shannon Sepulveda:      00:34:41           I know it's so hard. I mean, I feel like the same thing happens even with like small companies and like they've just had to like fight tooth and now just to even like get, you know, compared to Nike or something like that, just even get themselves and they're a running company for women, but, no matter what it seems like we're fighting an uphill battle.

Nikki Kimball:                                        Yes, we are. And you know, I remember it just a few years ago, I had a couple of women runners I was treating and I was like, Oh, you know, we get into the talk about sponsorship money. And I'm like, well, they've got to be doing better than I did. And you know, both of them were like, yeah, we're about 25% of what the men were.

Nikki Kimball:                00:35:29           I'm like, well, that's better than I did at my worst. At least they're not getting one 10th, but yet again, it's still, it's not okay.

Shannon Sepulveda:                              It's not. Okay. And so what do you think we can do?

Nikki Kimball:                                        I think we talk, we keep open dialogue. We support people like Gina who have trail sisters. We support brands like Oiselle who are trying to make a difference. And I think that each of us you know, each female athlete is one cog in the machine of getting female athletics taken seriously. I mean there was a time when women weren't allowed to run a marathon because our uterus would fall out, which makes a lot of sense as a women's health specialist. It's gross when it happens. But each of us just does her part to make it a little bit more fair.

Nikki Kimball:                00:36:30           The unfortunate thing is each of us doing our part makes us less sponsorable. Cause if I'm out there whining about the sponsors treating me poorly versus my male counterparts, they're not going to want to sponsor me. But at this point, it doesn't matter  I'm past my professional career anyway. But I do know I probably could have been more quiet and you know, tried to look cute and race that way and because you need and probably that would have been better for sponsorship. Cause you definitely notice that the women getting on covers of magazines, it's not necessarily the fastest ones, but they're always cute. And that's not so much the case in the mens. I mean, I'm sure men face it in some ways, but I don't think that sponsorship has as much to do with how they look. And if they're willing to put pictures of themselves in a sports bra as their profile picture on Facebook or whatever. It's just a huge, huge topic.

Shannon Sepulveda:      00:37:19           It is. I know it brings me back to, I played tennis when I was younger and so it brings me back to a New York Times article awhile ago on Serena Williams and Sharapova and it was just like, how much more money she got.  She's pretty. 

Nikki Kimball:                                        That sort of Sharapova thing happens everywhere.

Shannon Sepulveda:                              So let's talk about physiology. When are the women going to beat the men?

Nikki Kimball:                                        Women beat the men when the race is long and difficult and has really bad conditions.

Nikki Kimball:                00:38:24           Men do have a physiological advantage. Yeah. They absolutely do.  That's why we need a men's race and a women's race because they absolutely have a huge physiological advantage. However, when stuff gets bad, women thrive. It was so cool to see. I know that if I'm in the last 10 miles of a hundred mile race and I come upon a guy, I'm going to beat him. If I come upon a woman, it’s on and that's not just because we're competing against each other because I see this in my practice as well. Due to biological differences we do tolerate pain better. Is that biologically something that happens so that we can survive childbirth, you know, I don't know, I think it is a real thing.

Nikki Kimball:                00:39:17           Like I think that pain probably hurts more for a guy then for a woman on average. And that's totally on average, but women just push themselves, so they're just able to push through so much. All the times I've been in a national or world class event that I've been on the men's podium, which has been three times it's been bad conditions. One of the hottest years at Western states, I was third out of the men and you know, there were a lot of men there who could have beaten me, but they, you know, it's super hot and they're just dropping like flies and the women are just kind of like were fine. So there's gotta be, you know, something going on there and how much of it is so is social construction and how much of it is biology and how much of it is psychology and you know, all of these things playing a role.

Nikki Kimball:                00:40:13           I do know that we do relatively better to the men when things get tough.

Shannon Sepulveda:                              It's like grit. I wonder if, I'm just thinking about, since I'm a women's health PT, like sleep deprivation, I wonder if women deal with that better than men do just because of we have to, we have newborns. Same thing with pain, like you have to deal with it in childbirth.

Nikki Kimball:                                        And whether we have kids or not, right? We still have those genetics to say, how would humans continue to continue? Evolve, how would any of that happen if we went, couldn't go nights without sleep and a very, very painful pregnancies and deliveries. And then come back from the aftermath of delivering a baby, which is just like, it's just something that doesn't happen in any other part of our lives.

Nikki Kimball:                00:41:11           We just don’t go rip tissue, men don't experience that. I haven't experienced that and I'm not sad to miss that. We have to be able to do that and it would make sense evolutionarily that we have some, you know, women have some capability to withstand and thrive through pain that men may not have as much access to and we also have to forget about it and do it again.

Shannon Sepulveda:                              Right. That's the other thing. And I often wonder that I'm like, Gosh, we just forget about that so quickly. Like with childbirth. It's like in a couple days or a week, you know, you forget about the pain. And I often wonder that with like, you know racing. you just forget about it. You're like, oh, I forgot how much that hurt.

Nikki Kimball:                                        And you remember that at mile something in the race and you're like, while you're racing, you're like, why did I sign up for this again?

Nikki Kimball:                00:42:12           And that's regardless of sex because we all feel it. And we all come back and do it again. There's something greater about running and racing than there is about pain.

Shannon Sepulveda:                              Do you feel like physiologically in the last 20 years, like women have made incremental gains as far as like ultra running? Are you feel like it's always been like the popular.

Nikki Kimball:                                        No, I don't think physiologically we really have changed. But I think that, and this, it goes across from men and women, is that there's just more people doing the sport. So we are with greater numbers. We're going to have more fast people and those more fast people are going to teach other, the ones who come behind them.

Nikki Kimball:                00:43:16           And like records always fall, right? Like why did nobody run a four minute mile until Roger Bannister did? And then everyone starts running, well, not everyone, but many, many elite men were running for a minute sub four minute miles. It wasn't that he was physiologically different. He was just the one to be able to say, no, that's not a barrier. You know, and I think that every time one of us breaks a record, it gives the person behind us that confidence that if the course record used to be 20 hours in and now it's 19, well now we know we can break 20 hours. And then so everybody comes to I think there's such a huge mental component to this because we certainly don't evolve that quickly. And granted, there's so much more media attention and money.

Nikki Kimball:                00:44:06           I mean, like people are now guys are making a livable wage. So few of them, you know, from running, maybe a couple, maybe some women are, I don't, I don't know. I don't think so. But we're starting to see, you know, we're starting to get a lot of gain. And also, you know, my generation of ultra runners, the women were all, we all had to work full time who aren't getting paid or we weren't getting paid well. And so, you know, I think of course records going down and people getting faster, and that's just a natural evolution that happens in every sport. I mean, the science behind it gets better, the training gets better, the food gets better, I remember one year, this guy writing, oh, my time at western states would have won in 1970 whatever.

Nikki Kimball:                00:44:55           And I'm like, let's talk apples to apples in 1970 you would have been in a canvas shoe and you might've had a potato chip and a couple bottles of water. I find that very frustrating. I do think that each generation, it's still going to be the same qualities that bring those top people up. We do bill, like I wouldn't have run the times I did had people not done similar things before me. I wouldn't have even known that that was something to go for. And so each of us who publicizes the sport and who does good things in the sport makes it easier for the person coming up behind him or her.

Shannon Sepulveda:                              How long does it take for an ultra runner to peak? Like how many years?

Nikki Kimball:                00:45:45           That's a really good question. Honestly the science isn't there. We are evidence based practice for us physical therapists is so, so important. How do like do evidence based practice on somebody who's an ultra runner? I tried to extrapolate from studies done on a marathon or maybe, but they're not even that many studies on those folks. So you know, I really don't know that we know that, but I do know a couple things. One is that people tend to have a race career of somewhere between like three and 10 years where they're really, really good, but they don't seem to have much longer than that. Like, there's a steep drop off in speed at some point. And is that mental, is that physical?

Nikki Kimball:                00:46:38           I’m not sure how linked it is to actual chronological age. You know, you might fly in your twenties and then by 31 you're kind of done, or your best 10 years might be 40 to 50. Like it just, it seems that there's some equation out there between age, miles on your body and you know, hard races run and length of duration of your running career that would sort of point to, you know, when you might be best. But I've seen, you know, I peaked at 36, I've seen people peak in their forties, people peak young, you know, so it's all these n of one groups. I mean, it's really, I love to know more it, but it's just so multifactorial. How would we ever study it?

Shannon Sepulveda:                              And everybody has different backgrounds and high school in college.

Shannon Sepulveda:      00:47:39           Right. So this would be a great transition to talk to you about hardrock this year. For those of you who don't know, Nikki came in second. And we were all cheering her on like on, so just tell us about that, your age and how that impacted you.

Nikki Kimball:                                        Yeah, hard rock was amazing. It was easy to get into it in the nineties and now is so popular that thousands of people apply for 140 something spots. So anyway, I've tried to get into it for years and I finally got in and I knew that at my peak, I would run that course really, really well. It was really made for me. It's super, it was really high altitude. You know, you're going over many peaks over 13,000 feet.

Nikki Kimball:                00:48:39           You're not getting below 10,000 feet very often. I mean, it's just, it's just fantastic and it's exposed and it's rocky and it's gnarly. And it's just a steep and fun and 31,000, 33,000 feet of gain and a hundred miles. It's awesome. So part of me really wanted to run it when I was younger and really, really strong because I'm hours slower in a hundred mile race than I used to be. I mean hours. So for this race, you know, finally get in, I know I'm not at my best. I'd also been battling an injury from a snowshoe race that really, that finally took me out later in the year. I had actually been training for about four months because of this injury had sort of taken me out for a while and I had four months of really fantastic training going into that. So not a lot, but I still had 30 years of competition to go back on, or 40 years actually of competition to go back, fall back on.

Nikki Kimball:                00:49:41           So, you know, so I get there and I know I'm not at my best, but I also know that two of the other top women in the race are also in their forties. And you know, none of us were all way past our prime. And one person who was, who was young, who, you know, who won it, you know, she's 20 years younger than me, she better be able to beat me. So it was just this magical race where we just start, you know, you just running along and talking to people cause that's a big part of ultra marathon culture is amazing and shifting with the influx of money and influx of people self promoting on social media. That stuff's really, really frustrating. But, hardrock the spirit of hard rock is very much in that old school, ultra running.

Nikki Kimball:                00:50:34           We all want to get into the finish. I mean, yes, we're going to compete against each other, but we're also really supportive of each other. And we are having a few people in the sport who aren't supportive of their competitors and that's really, really sad. But at hardrock I ended up, you know, in this group of people, one who was a PT, a pre PT student of mine. He and I along with Darla, ask you the Darla ask you and somebody had a couple of other people ended up in this group and the six person group and Jeff was my student. He and I were having a competition to see who could tell the most bad jokes. And so that was really fun. And this is the first like 20 miles. We're just kind of like chill and having fun and you do things like talk and tell horrible jokes because it makes the time go cause you can't race for all 30 hours, you're going to race for the last couple.

Nikki Kimball:                00:51:28           Sort of having that community around me just made me happy. I was running well, you know, running up towards the front and I had a bit of an explosion. Like, I just, you know, you have really bad patches and I had this massive just meltdown after one aid station and I just kind of walking up through the woods and frustrated and I know, and all I'm thinking is even five years ago, I would be, I'd be four miles ahead of where I am right now. And it was really hard and I've been dealing with the slow down for at least eight years at this point. And I just laid down in the middle, you know, like mile 29 I just laid down in the woods where nobody could see me and just sort of thought about age and really had this sort of amazing epiphany of like, I was just, I mean, I laid there for like 15 minutes.

Nikki Kimball:                00:52:34           But just thinking about, you know, why, why am I expecting myself to still be on the podium for the men and all these races when these men are now 20 years younger than me? And, you know, this is like, like I am asking my body to be what it was when I was 30, and when I was in my mid thirties and I’m 47. Like it was amazing to finally, after fighting and fighting and just being like, why am I slowing down? This is so frustrating. I'm training just as hard and I'm getting slower and now that the sports popular and people are winning with times that were easy for me at one point in my life. And, you know, just that sort of Sour Grapes of, uh, and it finally sort of occurred to me that, you know, in this little part of the race, and this is what ultra running does, is it pushes you so far that you have to think beyond the way you would think in normal situations.

Nikki Kimball:                00:53:30           And it finally sort of dawned on me, and this should have come more easily than this, but that I should be celebrating what my body can do instead of what it can't. I mean, I'm 47 and still running, you know, a hundred mile race with 30,000 feet of gain and being on the podium. Like that's huge. And I'm doing it with people I've run with my whole life and with people who, with a former student of mine who is now just graduated PT school and he actually ended up second for the men. So we ended up sharing the podium spot and you know, he's 20 years younger than me. And it just made me think about what's important in ultra running. And really what drew me to it is that I love running in the woods and that I love the mental clarity that comes with running.

Nikki Kimball:                00:54:28           And I love the community of people who do this sport. And you know, like you sort of getting back to that despite a massive slow down in my racing was critical. And it's something that I've just been fighting. I've been fighting a cancer, my body changing rather than sort of managing it. Like we talk about managing chronic pain, managing depression, managing these things. We had to manage our aging and instead of just, you know, I was totally know my body doesn't obey the laws of physiology. I'm not aging, Duh, Duh, Duh and, but you know what I am. And I had to give myself a little permission to do that. So hard rock really, really gave me that back. I mean, yes, I was probably five hour slower than I would have run it when I was 35 but I should be 47 and I have 90,000 miles on my body.

Nikki Kimball:                00:55:28           Like I shouldn't be fast anymore.

Shannon Sepulveda:                              And you still came in second which suggests you got faster, like literally like this epiphany and then you're like, I can just do this.

Nikki Kimball:                                        Yeah, kind of cause I had, you know, been caught by a bunch of people and then I just sort of gave up the results. This is hard rock. Like this is the race. People sell their soul to get into like, I'm here in the most beautiful mountains of San Juan mountains are stunning. I am having this catered hundred mile trek through this beautiful country with amazing people. That's what it is, you know? Yeah. Winning races is cool and that's fun and it's great, you know, like it's a huge ego boost and all that but it’s pretty shallow.

Nikki Kimball:                00:56:22           It is fleeting. Like you might win now, it doesn't mean you're going to win the next time. I mean, you know, there has to be something much, much bigger than results to get you to do the sport. And I think giving up any care of where I finished and just being like, you will finish this, you know, it's a gift to be able to get into this race unless you're injured, you better finish. It was just a good sort of cap to my running career.

Shannon Sepulveda:                              Yeah. It almost seems like that's almost a gift of aging because maybe you couldn't think like that when you were 35 and you did have another race. You know, like, I could never, I always did have the next thing and now you're like, I can just do this for fun.

Nikki Kimball:                00:57:13           Right. And I can coach other people and coach them in a way where I attempt to use my physiology but my physical therapy knowledge and help them to run without injury or to get any injury that comes up. We treat it immediately, we immediately manage it. We don’t run somebody into the ground and there's so many people coaching. There's no oversight in coaching, you know, who maybe took a three day course and have a certification. That does not make them a knowledgeable coach. And we're seeing that all the time. And so I like sort of, I love that I get to coach and I usually I keep about eight clients at a time because I don't want more than that because then I can't take care of them.

Nikki Kimball:                00:58:11           I can't help them. And I want people to love running and I want it to be, I want it to be healthy. In a lot of the people I work with used running as part of their mental health treatment plan. And if you're treating depression with running and you have an injury, it's disastrous. You could die. Keeping people running healthy is my new thing, you know, like that's my, you know, it's like, okay. Yeah, it was great to, you know, be the best ultra runner in the trails runner in the world for a while. That was awesome. That was really fun. It was great. Now it's more about like, what running's really about and what am always has been about. But I probably lost sight of when, you know, traveling the world and you know winning stuff.

Shannon Sepulveda:                              So let's talk about your coaching because it would be pretty cool to be coached by a world champion, technically one of the best in the world. So tell us about your coaching and what you do.

Nikki Kimball:                00:59:23           And so if my clients, I coach people locally, I mean, you know, I sort of just starting, I've taken people under my wing my entire running career and sort of coached without coaching, you know, and now if I coach people locally, it's amazing because I actually get my hands on them, you know, I can do a screen of where are they tight, where are they strong, where are they weak, where they loose, where, you know, is there something funky going on with their running? Has somebody tried to change their running gait? Because that usually messes stuff up because you have all these people who, you know, went to a CI running course and think they know my biomechanics and usually massive changes to people's gait gets them injured.

Nikki Kimball:                01:00:11           I just like being the person who runners can come to for physical therapy and for coaching who could hopefully do a better job of predicting and avoiding injury. I've treated runners for 20 years as a physical therapist. I mean because our evidence isn't great, we have to combine mechanical knowledge with physical therapy evidence on sports that might be similar and on our experience, I mean I can't, I just look back to the 1990s. I'm like, how the heck did anyone I treat get better. You know, like it was luck. Cause you know, I think of all the mistakes I made in my first, and I'm still making mistakes, but the horrible mistake I would make, things I would miss and my first 10 years of treating runners, I mean just, I mean I think that's what I can offer.

Nikki Kimball:                01:01:10           And coaching is something that's just well beyond what, you know, your person who never studied physiology or mechanics or something and there are some people who are self taught coaches who are very, very good, but they have a lot to catch up on.

Shannon Sepulveda:                              And do you coach remotely to your work with like physical therapy remotely? Like you do the screen, tell me what you found. I'll do the coaching.

Nikki Kimball:                                        Absolutely. Absolutely. And I think that's critical. The hard thing is knowing who the physical therapist is in that area. I have a Bozeman client right now whose wife is on sabbatical from the MSU. So He's traveling around. So when he's in another place, like who do I send them to for PT? And I don't insist, I mean I need hands on the people who I coach if I can, like I want to know how they're doing, but I'd certainly don't insist that they use me as a physical therapist that's referral for profit and I don't, I'm not okay with that. And there are fantastic running PTs in town.

Nikki Kimball:                01:02:19           I've got great people to send my people to and sometimes they come to me often they do and that's great too. But if I'm missing something, I want to call in another therapist because why not, why not use that knowledge that's there? So really what I found is the best thing I can, the best thing I've come up with, with getting, working with a PT, if I don't know the area, is having the athlete go to the running store, they're running specialty store and say who's good here. Not to say that it's always going to give you the best result, but, you want to go to a therapist who has seen runners, who's worked with runners, because it's just a different skill. I mean, you're not going to come to me for neck pain because like, no, I give you really a problem.

Nikki Kimball:                01:03:06           So I think that can help. And then physical therapists who specialized with treating runners were super geeky about it and we love when our patient comes and says, Hey, can you talk to my coach? She's also a PT or ex phys. I mean oftentimes or physiologists. I mean, you know, like what I, you know my strength and in biomechanics I also have a weakness of physiology cause we don't study it as much. So it's great to be able to talk, you know, if one of my patients says, Hey, I want you to talk to my coach. And they sign their release. It's fun to talk to their coach and be like, Hey, and you just, you know, the coach is going to see if it's something different than the PT is and you know, and you really work together. I love that part of it.

Shannon Sepulveda:      01:03:51           Oh yeah. I mean even with me and when I have, you know, women who come to me that leak when they run and I'm like, I'm really good at making you not leak when you run, maybe making you not have prolapse symptoms when you run. I'm not your performance coach. Like you go see experts and experts and an expert and they're going to like Dork out on the stride and you know the form and everything. Right. But I can help your pelvic floor when you're running. Exactly. And that's why we specialize. I was like, you know, you can geek out with running.

Nikki Kimball:                01:04:33           Like I could go to so many courses and I don't have time to do that. It's not my forte, but these people are really good at it. And the thing is you're really good at women's health, pelvic floor stuff because it's what you do. And you applied the geekiness of pelvic floor health that I applied to running. So of course, yeah, of course. I want my person with incontinence to see you and my person who was a runner to see me and I think if we all shared it would be great.

Shannon Sepulveda:                              It would be so great because as you realize how much more you don't know, even when I have an injury, I go see a PT, like I'm not treating myself. I don't do stuff right. I never do it. So I think your PT tells me, he tells me to do it, I do it. And they do hands on things that are just so different. And so I go see a PTs all the time for my stuff because I'm really good at what I do and they're really good at their niche and what they do. And PT is such a huge field that you can't be good at everything. Well, so where can people find you if they want coaching?

Nikki Kimball:                01:05:20           I've always done it word of mouth, but it's is sort of my public address that people can reach me at. Facebook doesn't really work because I get frustrated, but don't answer stuff. I just love coaching people of all levels, you know, but again, you know, I'm going to coach somebody for mostly ultra running or I love coaching, people in their fifties, sixties, seventies for shorter distance stuff because I think masters in veteran athletes, you know, athletes over 50 have, you know, they have so much to gain from sport and the book knowledge I have, there is no way I could have coached people people past, you know, 45 and before I realized a massive slow down myself.

Nikki Kimball:                01:06:46           It doesn't matter that you get it intellectually. You don't get it until you feel it. And when I'm three minutes a mile slower than I was at my best, you know, you know, you know, age is something.

Shannon Sepulveda:                              It is, it totally is. I mean, it's the same thing when, you know, I have pregnant women that I've never had a baby before and then want to run a, you know, I thought I could run a 5K like eight weeks after I had a baby before. Because when you don't know, I know it happens to you and then you're like, oh yeah, like I do get sore with age. Childbirth does something to your body, right. You don't know until you experience it and you can't expect someone to know that you can't.

Nikki Kimball:                01:07:39           The other thing, I mean, it's not like all parents throughout history haven't told their kids. You just wait. Sony. I mean, but it doesn't matter. We can say those things. It doesn't, it doesn't, you don't get it until you go through it. I mean, and I think book knowledge is super, super important and evidence and all that, but experience can't be discounted.

Shannon Sepulveda:                              Well, and it's also really nice to have someone that has gone through it and knows because you want someone that has been through it and knows what to do and has experienced that. So they can have empathy for you as a person, as an athlete, and assist you.

Nikki Kimball:                01:08:16           And also, you know, if it took me nine years to come to terms with my aging as an athlete, well, why would I expect my 57 year old runner to be okay with running a 30 minute 5K when she used to run a 20 minute 5K? Like how? Yeah. You know, like, it's important, you know, to have gone through that too, you know, I don't know, you know, seeing as it took me forever to teach myself that lesson and I still don't think I'm completely there. I don't know how well I do helping people through that. But I wish I had had some buddy who had gone through that slow down with me when I did.

Shannon Sepulveda:      01:09:12           Thank you so much for coming on the podcast. We'd really, really appreciate that.



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


Mar 26, 2019

LIVE from the Align Conference in Denver, Colorado, I welcome Kory Zimney and Jessie Podolak on the show to discuss why language matters to patient care.  Dr. Zimney is an Assistant Professor within the Department of Physical Therapy at the University of South Dakota, Senior Faculty with International Spine and Pain Institute (ISPI), and researcher with Therapeutic Neuroscience Research Group and USD Center for Brain and Behavior Research. Jessie currently owns and operates her community's first direct-pay physical therapy practice, seeing a variety of patients with acute and chronic pain conditions. She has been teaching pain science and manual therapy techniques at continuing education courses since 2013.

In this episode, we discuss:

-How language affects your actions

-Looking at language through the patient perspective

-What is negative effective priming

-Ways that you can enhance your communication style

-And so much more!



Align Conference

Kory Zimney Twitter

How to make stress your friend Ted talk


For more information on Kory:

Kory Zimney, PT, DPT has been practicing physical therapy since 1994 following his graduation from the University of North Dakota with his Masters in Physical Therapy.  He completed his transitional DPT graduate from the Post Professional Doctorate of Physical Therapy Program at Des Moines University, Class of 2010. At this time, he is in the candidacy phase in the PhD PT program at Nova Southeastern University.


Currently Dr. Zimney is an Assistant Professor within the Department of Physical Therapy at the University of South Dakota, Senior Faculty with International Spine and Pain Institute (ISPI), and researcher with Therapeutic Neuroscience Research Group and USD Center for Brain and Behavior Research. His primary teaching, research, and treatment focus is with pain neuroscience, therapeutic alliance, and evidence-based practice for orthopedic injuries of spine and extremities.  He has published multiple peer reviewed research articles in these areas. Past work experiences have been with various community-based hospitals working in multiple patient care areas of inpatient, skilled rehab, home health, acute rehab, work conditioning/hardening and outpatient. 


He has completed the Advanced Credentialed Clinical Instructor program through the American Physical Therapy Association and is a Certified Spinal Manual Therapist (CSMT) and assisted in the development of the Therapeutic Pain Specialist (TPS) through the ISPI certification program; and has a Certification in Applied Functional Science (CAFS) through the Gray Institute.


For more information on Jessie:

Jessie received her Master's Degree in Physical Therapy from the College of St. Catherine, Minneapolis, in 1998. She completed her transitional DPT from Regis University, Denver, in 2011. She has been teaching pain science and manual therapy techniques at continuing education courses since 2013. Jessie currently owns and operates her community's first direct-pay physical therapy practice, seeing a variety of patients with acute and chronic pain conditions. She has special interests in manual therapy, Pilates, spine and running injuries. She is a certified clinical instructor through the APTA and has completed her Therapeutic Pain Specialist certification through ISPI.





Read the full transcript below:

Karen Litzy:                   00:00                Hey everybody, welcome back to the podcast. I'm your host, Karen Litzy coming to you live from the align conference in Denver, Colorado. And I am fortunate enough to be sitting here with Kory Zimney and Jessie Podolak and we're going to talk about the workshop that they did yesterday and will probably do again tomorrow on moving our language and why language matters around people with persistent pain. So my first question is why does it matter?

Jessie Podolak:                                      Well, words are powerful. We started off by just doing some cool quotes that words change worlds, right? And words can pierce like a sword.  The tongue of the wise brings healing. And that's just ancient wisdom, right? We've known that words just have so much power. They shape our perceptions, they shape our action.  We know even from the research, just how we look at something.  So for example, one of the studies we cited was if crime is presented as a beast, okay, crime is a beast versus crime as a virus.

Jessie Podolak:              01:12                When crime is presented that way with just those two words. And we survey people and we say, what should we do about crime? Those who hear crime is a beast, 71% say we should increase law enforcement. 51% of those who hear crime has a virus say we should increase law enforcement. So the word evokes more of an action response when we hear the beast versus virus. And other one was the economy, is the economy stalled or is it ailing? If the economy is stalled, we jump start it, right, stimulus package. If it's ailing, maybe we take measures that are really going to do long term change. We look at education levels or socioeconomic things and what can we do with this economy? So words shape so many things in general and in healthcare, the word surrounding pain, can evoke a lot of fear.

Jessie Podolak:              02:08                They can evoke a lot of a knee jerk reactions of what needs to get done. It can kind of force us to look at these more short term solutions. And I think that's been a theme emerging throughout this conference is that there's so many things that we do that are helpful in the short term but can actually be harmful in the long term. So the words that we have surrounding pain, probably lend themselves many times to short term solutions. And if we want to look at really a sea change in how we approach pain, we've got to think and consider our language.

Kory Zimney:                02:45                When we look at what we're just talking about, you know, a lot of people, I think they look at it and they go, well that's just a little change. You know, it was only 20% different. What's the big deal? And to me, you know, and it's all about nudges, that a lot of times it's just these little changes that can make huge difference for some people. And I get for a lot of people it probably wouldn't make a big difference, but if it did make a difference for a person, why wouldn't I want to try to maximize every little opportunity that I could get? And I know some people look at it like, well, I don't think language is that be all, a lot of people I can tell arthritis and they don't have a problem because I used that word and I get that. But what about that one person that it did make a difference for? How do you know it didn't make a difference for somebody? And if we have good evidence that shows that these little changes can make a difference, why wouldn't we try to maximize every little bit of that?

Karen Litzy:                   03:33                Yeah. And I think that harks back to Kory to what you said this morning about everyone in the room has probably treated one person in pain and that's great. You treated one person, but you can't extrapolate what works for one person to a population. And so I agree that I think in as much as saying, do no harm, changing words around that might connect with someone I don't think is going to be incredibly harmful. By reframing words that maybe we know might be a little harmful. Like arthritis or what are some other ones from yesterday?

Jessie Podolak:                                      One for me was wear and tear. How often do we say wear and tear. And what's the first thing that pops into your mind when you hear wear and tear? What's an object? Yeah, the tire. And what's that gonna do? It's gonna blow.

Jessie Podolak:              04:24                Right? So if I say you have wear and tear, what is kind of even a subconscious thing? They're just waiting for it to blow. And how does that influence your movement? How does that influence the adventure you have in life? How does that influence your whole being? Just knowing I have wear and tear for some people they might say, well I don't care. I'm going to wear it out. I'm going to grind that thing to the ground. But for others they might say, oh my gosh, these tires have to last me another 20 years. I better take really, really good care and back way off. So wear and tear is a hot button one for me.

Kory Zimney:                05:03                But yeah, so it's just those little phrases that are so easy for us to throw around. But we have to recognize that the lens that the patient looks through is probably different than the lens that me as the therapist with all my education and training on how I look through it. And I think that's just, again, taking that patient perspective is something that we all can hopefully try to do a little better sometimes.

Karen Litzy:                   05:28                Yeah. And one thing from yesterday's class that I had never heard of before was negative effective priming. So can you explain what that is and then how we use it maybe not even knowing we're using it as therapists.

Kory Zimney:                05:43                Yeah. It’s really kind of what you talk about is kind of what you start thinking about. And so if I'm telling you how you're going to lose, if you don't do your exercises, you won't be able to do these things. And just create more of a negative type of attitude to everything, in everything the patient sees then will be directed more towards the negative.  Where if you can flip it to more of a positive type outlook as far as when you do this, you'll be able to do these things and you can do that. And again, always flipping it to more of a positive direction. So again your just priming them, nudging them, turning them towards things that they can do as compared to, you lost this, you won't be able to do that. So, it's those little shifts and changes to focus on those positives. As a clinician, you know, you struggle like our patient’s so negative. And then we come up with these negative phrases sometimes and it's like, well, how are we helping prime them the right direction?

Karen Litzy:                   06:34                Right, and what are some examples of maybe common negative priming that we may do as therapists?

Kory Zimney:                06:41                If you don't do your exercises, you know, that shoulder's gonna only get worse. You know, if you're overweight, you know, this puts lots of extra pressure on your knees, they're more likely to wear out. It’s just those little negative type of things. It's so easy. We can look at, we were talking about what they lose, you know, the kind of the gain aspect or the loss aspect. And oftentimes we tend to talk about the losses and patients will get focused on that, on the negatives. That's just human nature that we focus on negatives.  As a clinician, if we're adding to that, it's only going to multiply more. Back in younger days as a clinician, I'd always get so proud of, you know, if I could get their problem list to 10, I thought, how cool am I am double digits.

Kory Zimney:                07:24                You know what I mean? Just get that problem list as long as possible, you know, but really looking at the optimism list, what things can they do? You know, what things can they do better? And you know, isn't that, how cool is that? That you can do that? In focusing on those things and what they can do better, what things they can do instead of on what things they've lost, what things they couldn't. So that's that kind of priming a kind of nudging more into a positive direction compared to our traditional, you got dysfunction, you can't do this, you're broken.

Jessie Podolak:              07:50                Yeah. And even the way we asked that question, Lindsay had just a really nice thing this morning that she talked about with goals instead of, you always think of, you know, what are your goals? And that's kind of an obscure thing, but I think she asked it in a way that was something like, tell me something that you'd like to do more of, be better at, or return to doing that you currently can't. It flipped it because it started, you know, there's this great quote from a Ted talk that I love by Kelly McGonigal called making stress your friend. It's awesome. She has this quote in there near the end where she said, you know, it's so easier to run towards something than away from something. And if you look at your patients, what are they right in their goals?

Jessie Podolak:              08:29                I want to get rid of this pain. I want this away from me. I want to avoid it. It's so overtaking their life that they're running from it. But if we can just direct people towards what is to come and even get them to maybe cast a little vision, which I know is scary. Right? And you don't want to have false hope. We talked a lot about that, about how to balance reality and honesty. And sometimes to say, I'm not sure how this is going to turn out, but I'm with you in it. Right? But I think, you know, this is the worst I've ever seen, or man, this is the biggest trigger point I've ever felt, no wonder you hurt.  Those things come from a place of pity or sympathy which it's well intended, but it's not as far on the empathy and compassion scale that we want.

Jessie Podolak:              09:26                We want that empathy and compassion of, I see where you're at and where you've been, but I'm with you as we go forward, I guess how I look at it.

Karen Litzy:                                           Absolutely. And I think that sentiment of yes, I'm with you, but being honest, so doesn't mean everything's pie in the sky. And I think that's where people, when they hear about this, explain pain, quote unquote or PNE, they think, oh, you're just talking away the pain and you're not being honest. You're not being realistic. But that's not what we're saying when you're talking about language and talking about communicating with someone who has persistent pain. So one of the examples we used yesterday was like hippo A and we said, you know, yes, you're, you may have pain and we're going to work on strengthening.  There is a chance you might need surgery, but if you do, you'll be stronger going in. So you have to be honest, you can't say to someone with severe hip OA, you'll be fine. Just do a couple exercises. It's just not realistic. And then when the person isn't fine, that's a steep fall.

Jessie Podolak:              10:18                Yes. And it goes back to this, not swinging too far on the pendulum away from the bio, it's still bio-psychosocial. And how do you explain something that there are biomechanical issues in a way that's not scary that still honors the bio, but that kind of de-catastrophizes or softens, it's really just about softening and responding. Like watching the patient's nonverbals. You can tell when you're starting to freak somebody out. And so then you make the adjustment and you just be very, very present.

Jessie Podolak:              11:12                So it's certainly our language, but like, as you know, Kory talked about is communication. And I really like what Jonie said about pain neuroscience communication versus just education, I the smart therapist I'm going to teach you, silly patient about how this works. No, this is about communication and dialogue and how do we do that?

Karen Litzy:                                           Yeah. And Kory, I think you said this yesterday, but correct me if I'm wrong, I think you said that the body is not fixed rather a robust ecosystem that has the ability to change and grow.

Kory Zimney:                11:54                Yeah. And that was actually a TPS grad that we have that talked about that. The beauty of the amazing plasticity and I mean I go back to when I used to, you know, work somewhere in our rehab unit and when a patient came in with a stroke, you knew there was brain damage and you could see the MRI report. But the beauty is you had no idea what they might be able to function and do afterwards, right? Because you'd look at those areas that were destroyed, where the infarct was and stuff like that. And some of them amazingly regained function and the ability to walk and their ability to transfer and get out of bed. So you just always had this ultimate optimism, you know, as the traditional neuro type of Rehab Therapist, when somebody would come in with their stroke or spinal cord and in their ability to be able to do things. But for some reason in the orthopedic world, we just have this like, oh, well, yeah, sorry.

Karen Litzy:                   12:38                Yeah, sucks to be you.

Kory Zimney:                12:44                We just create this, like the body can't be adaptable to these things. And now that they've done the imaging studies on normal people, we're all walking around this stuff. We've all had this beautiful adaptability, whether it was from a neurological orthopedic, any kind of change that's gone on on our body, but we don't ever appreciate, and look at that from that optimistic again in realistic sense, you know. But again, we know that if you have a little tear in your meniscus that might be an issue. Yes, it's a huge bucket handle and you can't straighten your knee out and it clicks every step. Yup. That's probably a major deal. But otherwise a lot of people can get by with that. No, I don't know with absolute certainty, but the beauty is we should be able to find out in four to six weeks because we can train the body, help it become more adaptable. We can explore different motions and movements and see how you do with it. And if it still doesn't, the awesome thing is we do have surgical options, to make that better. And so that's just that beauty of appreciating the adaptability of the human body. And I don't know that we, for some reason, we seem to have lost that appreciation to some degree.

Karen Litzy:                   13:46                Yeah, and I think that's something that I know I'll be using with my patients just to say, listen, you are this robust ecosystem, and I think if we share that with all of our patients, I think they may have a mind shift change there.

Jessie Podolak:                                      Yeah. If you think of ecosystems, so many things go into it. Yeah. Right. It's not just the musculoskeletal. I think just that if people could really view the body as juicy and more robust and just multifactorial, and I think that's where maybe we got off track is we just started seeing the body as a machine.

Karen Litzy:                                           Which I have to say is my pet peeve. I hate when people say, your body's just like a car. I'm like, no, it's not because the car doesn't breathe. We're not mechanics. We're not this. Like that is not how it works. Where I'd like to think as people we’re a little more complex and in a very good way, right? So now what would be the thing that you want people to take away from why language is important when it comes to working with people with persistent pain.

Kory Zimney:                14:56                For me it's just being mindful of that, you know, taking that moment and again not to as a therapist, don't overthink it either. Don't think, oh, what words can I say? And if I said arthritis all crap, their patients going to catastrophize and never be able to walk again. No. But just be mindful of it and be present with your patient. Because when you're truly present with your patient, you can see that look in their eye and you can get that sense that they may be getting a little bit worried or catastrophizing or a little anxious and stuff like that. So it's that ability to just be present and mindful that words do matter. But again, not so overly mindful that you freeze and you don't act either. We still have to just be human, just being a part of that. And again, that's just that communication piece that really is what we're talking about.

Jessie Podolak:              15:38                I would just echo what Kory said. It's just be with your patients. Care, invest in them. Some of the patients who it takes every ounce of energy they have just to make it to your appointment. Realize that they're giving you the trust and kind of the gift of their time and their precious energy. And so, even when you have that busy day, even when you know you're kind of sucked dry, just to give them that time that you have with them and to slow down a little bit, listen, be mindful and you know, I just think it's just about being a little softer, just softening out the rough edges and being that safe place. You know, Louis Gifford, one of our heroes said reassurance is an analgesic and sometimes we can't reassure that that hip is going to not need surgery, but we can reassure that I'll be with you. We’re in this, I'm in this with you. So that's what I would say.

Karen Litzy:                                           Awesome. Well, thank you so much, Korey, Jessie, I appreciate both of you and I really enjoyed your talk yesterday, so thanks so much for coming on.


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


Mar 21, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Duane Scotti on social media marketing.  Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.

In this episode, we discuss:

-How to decide which social media platform is right for your marketing strategy

-What social media content will best build loyal customers

-The benefits of scheduling out social media content in advance

-And so much more!



Duane Scotti Twitter

Duane Scotti Instagram

Spark Physical Therapy Facebook

Spark Physical Therapy Website 

The Clinical Outcomes Summit 

For more information on Duane:

Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.


Duane is currently the founder of Spark Physical Therapy, providing prehab, rehab, and performance optimization services either onsite or in the comfort of your home within the Cheshire/Wallingford CT region. He also is a clinical assistant professor in the Department of Physical Therapy at Quinnipiac University responsible for coordinating and teaching musculoskeletal examination, intervention, and advanced manual therapy within the orthopedic curriculum.


Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation, dance medicine, gymnastics medicine, and rehabilitation for runners.


Duane has been in clinical practice working with orthopedic, sports, and performing arts populations since 2003. He has strong clinical and research agendas in screening, injury prevention, and rehabilitation for runners, dancers, and gymnasts. Duane uses an integrative model of manual therapy including manipulation, mobilization, and soft tissue treatment including dry needling and the Graston technique for the management of musculoskeletal dysfunction. Duane is a physical therapy advocate and is actively engaged with the American Physical Therapy Association and serves as Vice President of the Connecticut Physical Therapy Association.


For more information on Jenna:

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


Read the full transcript below:

Jenna Kantor:                00:00                Hello, this is Janet Kantor with Duane Scotti, a physical therapist from Connecticut who is joining me today on healthy, wealthy and smart. And today we're talking about doing a specific niche on social media and really just nailing it. You are nailing it, Duane. So first of all, thank you so much for coming on.

Duane Scotti:                00:19                Thank you for having me. This is awesome. I'm very happy to be able to talk to you about this topic today.

Jenna Kantor:                00:26                Yes. So I would love to know first, how did you choose what social media platform you were going to put most energy on or also I've seen you on Instagram, but you may also be on other platforms and I would just love for you to expand on that.

Duane Scotti:                00:41                Great question. When I was looking into kind of getting into social media and using it as a platform, I thought about what is my audience, right? So most of the patients that I treat are adolescents, so I basically treat gymnast runners and dancers and a lot of them are on Instagram. So I started the Instagram account and started learning everything I could learn about Instagram, but their parents are on Facebook. So a lot of, you know, their parents are on Facebook and there's different groups on Facebook. So that's been beneficial from that standpoint. So those are really the two platforms that I utilize. I do have a Twitter but I haven't used it. Primarily because that's more for professional and other PT’s and that's not really my target audience.

Jenna Kantor:                01:27                Right, right. Absolutely. I like how you hit the nail on the head regarding Twitter specifically, I'm not as active myself. I have something set up where it automatically posts, but my heart isn't there because that's like you said, not where my target audience is. And I like how you bring that up. So how does your content differ from Facebook where the parents are, to Instagram, where the kids are?

Duane Scotti:                01:52                There's not too much differences in terms of I do post the same content basically to both platforms. The messaging is a little different if I'm sharing it to a group. So specifically at our local dance studio, we have a closed group so my messaging is going to be a little bit different, kind of targeting the parents and looking out for their dancer, as well as the stories on Instagram. So the stories are on Instagram are a little different, but the content posts that I do on a daily basis, they are going to be the same post that just instantly goes over to Facebook and I'll shoot it over there from Instagram.

Jenna Kantor:                02:27                And you just mentioned a little bit about you have kids who are going to these dance schools. There's a relationship you already have with these parents that's helping you build these groups. Would you mind elaborating a little bit more on how that came about?

Duane Scotti:                02:44                Yeah, so, well I guess first off, I do have two daughters. One is a dancer and one is a gymnast

Jenna Kantor:                02:49                Shout out to your kids.

Duane Scotti:                02:51                So they are at the local gym, the local dance studio that I've been affiliated with awhile. I also taught at the local studio, I was a dance instructor there. And you know, obviously those relationships, the families, they kind of have known me and trusted me for years and I've helped out their dancers before. So those are kind of how those relationships have been built. It's really more of me just being present and being there for, you know, picture day and you know, I'm there doing, you know, kind of complimentary screenings and things of that sort. So you kind of develop that rapport and relationship with the families where you kind of earn their trust, that you're going to be kind of looking out for their dancer.

Jenna Kantor:                03:34                You know, you hit upon something that I think is so valuable. I actually interviewed Karen Litzy the other day for her own podcast, this podcast in which we are interviewing for right now. And she was talking about these relationships and how she just lives her life and through the things that she's already passionate about. She's made these relationships and help those relationships grow. And it sounds like that's what you have hit upon, which you agree.

Duane Scotti:                04:01                Absolutely. Absolutely. Relationships are everything and from a practitioner standpoint, your relationship with your patient and their families are important. But then expanding beyond that and you know, things are a lot different than the healthcare world. And when I first graduated, you know, it was prior to direct access time and everything was about trying to foster that relationship with your referring physician. Now it's a completely different animal. You know, my relationships I'm fostering with are the communities in which I serve. So looking at the gymnastics community or it's the relationship with the coaches, right? And having, you know, I'm just thinking about the first facility that I started in, it was talks with coaches, not just one saying, Oh yeah, I'm a physical therapist, let me treat your gymnast. But it was many talks, many conversations you developed that rapport, that relationship, and then that turns into, hey, can you help this gymnast out?

Duane Scotti:                04:56                Oh we have another one. Can you help this one out? And then you kind of foster that relationship over time and then you wind up seeing, you know, your practice or your business kind of growing from that standpoint. And it's really kind of getting into our communities and for me at least that has been successful is having those relationships with, you know, the dance studio owners, the gym owners, now we're treating out of an aerial silk studio. So really you develop that relationship and then they recommend your services to people that are in their circle, right. And their business because they trust you. So I think those relationships are definitely, definitely important for kind of long term success.

Jenna Kantor:                05:38                Yeah. And it just makes it more enjoyable because you honestly enjoy each other and so I think that's great. So let's go back to the social media stuff. Your content itself, I mean, I've seen the video of you dancing with your daughter, which was great. What was it? The diggy?

Duane Scotti:                05:53                That was the Kiki challenge.

Jenna Kantor:                05:56                I think that video pretty much went viral. Am I correct?

Duane Scotti:                06:00                Yeah. That one was definitely my best performing video. So yeah, it was fun. That was something that, you know, a lot of people were doing that. And I think you saw on the news like a dentist had done it. I was like, you know what, we should do this as a physical therapist and just showcase what physical therapists do. So, you know, my daughter's a dancer and she was interested. I said, Gabby, let's do it and let's do a little dance. So we just kind of put it together real quick and that was fun. And that's the thing I do like about social media. It's really nice. You can have fun with it. We are professionals and we always have professional interactions with our patients, but we also have fun with them.

Duane Scotti:                06:37                Right. And we're human, we’re people.  So just kind of showing some of that human side I think has been definitely beneficial. And you know, if you look at your insights on, you know, Facebook or Instagram, the posts that do the best are the ones where I am not trying to be super serious and I'm not showing the best technique and the best tool in my toolbox that I know it's more of me just being genuine and it's more of you know, doing a silly dance or you know a picture with the family or you know, something that's kind of outside the box.

Jenna Kantor:                07:14                It lets people feel more connected to you. So let's go into more on Instagram because Instagram unlike Facebook, Facebook you can schedule posts for free, Instagram you can’t right? So are you using one of those paid for platforms to post or do you just post daily and what is your schedule that you abide by to be consistent?

Duane Scotti:                07:40                Well, you hit a really important point is that consistency is key with Instagram and Facebook. It is one of those things and it's just like anything we do in life habit, right? Exercise goals, running goals, wherever it is. Getting to the gym, you gotta be consistent and I don't know, people for different things what like two or three weeks to form a habit and then it becomes a habit. And for me that's been helpful where now it's just part of my daily routine and scheduling it in advance and doing batching and kind of putting videos together, putting, you know, writing, you know, batching all your posts together. It's definitely helpful. It makes it easier. But unfortunately Instagram does not have, like you said, where you can schedule out your posts, so you do need to post it. Then I have heard of other platforms that you can utilize to put your posts in, but it still will send you a reminder to your phone saying this post is ready to go. And then you'd have to open Instagram and actually post it. So that is the limitation in terms of time management. So it is “work” where you need to think about it. Hey, I have to post on this day. I've thought about and you know, and maybe in the future trying to delegate a bit of that out, just to ease a little of the burden of having to do that. And I actually trialed that shout out to Nikki when I was on vacation.

Jenna Kantor:                09:04                Hi Nikki. I don't know who you are, but thank you.

Duane Scotti:                09:07                She did an awesome job and I wrote all the posts in advance and she did the posting for me when I was out of the country and I couldn't post. So I think it's a doable model, but you still needed to write the post. And because I think, again, going back to being human and genuine, right? So a lot of these bigger businesses, you know, they have marketing people who are doing their posts, but you can tell it's more from a marketing angle and standpoint. It's not that person being genuine and who they are.

Jenna Kantor:                09:34                That was so eloquently said. I don't know if we'd go out for coffee, but good, good job.

Duane Scotti:                09:41                Right, right. So that is, you know, on Facebook they do have the scheduling, but if you're going to wind up forcing an Instagram, again, like I said, you can just shoot it over to Facebook then. So yeah, I unfortunately don't have a scheduling system that will just like send them all out. Which would be nice.

Jenna Kantor:                09:58                And then for the content preparation, do you pretty much do like on Sunday you prepare for the week or do you kind of do daily? Do you have a system for that yet or how do you do that?

Duane Scotti:                10:10                Sure. I don't do that specifically on Sundays, but on Sundays I do iron all my outfits for the week.

Jenna Kantor:                10:15                You buy clothes that you need to iron? That's lesson number one. You're supposed to buy shirts that are iron free, like you don't need an iron. So let's start there. Now move onto the creating of content.

Duane Scotti:                10:33                Yeah. So it's really whenever I have free time, so there's no specific day where I'm like, okay, Sunday is the day that I'm going to do all that. It's whenever I have a chunk of time, then I have a calendar. I have a plan for what's going to be coming out when and then it's a matter of all right, I'm going to do these videos, whether I'm going to write some captions in the videos from adding music, whatever the case may be. And then I have all those ready to go. So that's like my videos ready to post folder on my phone there. And then I will have the write ups. So then whenever I have free time it's like, okay, let's write up this post that post that post. And so then it's kind of done in advance. Ideal world is I would have like a full week's worth of content and I found that is so much better because it's not stressful thinking about because your day is busy, right?

Duane Scotti:                11:17                So I teach during the day, you know, doing the practice in the evenings and on the weekends. And you know, if I get to the point where it's, oh, I don't have a post today, it’s stressful and then you have the pressure of coming up with something right on the spot. And so having it in advance, it's a lot easier where it's ready to go, the writing is done, the post is actually done, the videos are done and then it's a matter of just literally opening up the platform and hitting the plus button and there's your video and copy paste, boom, boom, boom and then you're off and running.

Jenna Kantor:                11:48                Yeah. And you're hitting upon why I'm actually considering investing in an Instagram, a paid for platform to post for Instagram because this is where the value of being able to schedule it out really comes in because you could schedule it out for a year. I mean, imagine that you just hammer it out, you know, you're like, I love you children. You go play, you get to watch movies this whole weekend while I create content. And then you pull them in, you say, hey, you know what, I would like you to create choreography to five songs. So then you could do the family thing a couple times. But yeah, I think that is a key thing to maybe even tap on. I'm actually brainstorming for myself, not even giving you advice because for me, Instagram personally is a platform that I'm just about to start going for. I took the time with Facebook first, I'm very on top of that and now Instagram is my next target to like create those habits. So it's really good for me as a practitioner to hear what you're doing, what your experience is and how possible it is, so thank you.

Duane Scotti:                12:58                Yeah, I know. And on Instagram, you know, it is a little different from Facebook in that I feel like you need to write a little less. And attention spans are a little different on Instagram. So, you know, those things are different and obviously the hashtags are important on Instagram, whereas Facebook, they're not. So you know, knowing which, you know, tags to use can help bring your reach to a wider audience and kind of your target audience. So you do have to give some thought to the actual tags that you are going to use on Instagram, which I think helps, you know, get your stuff seen.

Jenna Kantor:                13:35                Yeah. How did you find the Hashtags for you? Because you could sit there and say Hashtag dance and see that a lot of people post dance, but if you're going to really target the people in your area, how did you get those hashtags?

Duane Scotti:                13:48                So I do some local hashtags. I'm still looking at towns, right. So Wallingford, Connecticut, Cheshire, Connecticut, North Haven, Connecticut and we'll look at those local tags. And I don't know if anyone really truly knows the answer to the algorithm. But it is, you know, do you go with the hashtags that have the most numbers or because there's so many things posted on them anyway your stuff's never going to be seen. Or do you go with some that aren't in the millions or the hundreds of thousands so you can get into your niche, right? So I try to make them relevant to whatever the post is and then relevant to my target audience and you know, looking at if it is something on the ankle and ankle pain or maybe you're someone searching for that or ankle sprain I use those tags.

Jenna Kantor:                14:38                Yeah. That's great. Well, thank you so much and my last question would be do you consider yourself an expert on social media?

Duane Scotti:                                        Definitely not.

Jenna Kantor:                                        That is where I think it's perfect to end for all you practitioners. We have worked so hard to get our licenses to work on these patients in physical therapy or honestly in any health career that you are pursuing. You don't need to be an expert. You just need to start. And the more you do, the more curious you get and the more you will learn. And Duane Scotti here is definitely a perfect example of that. So thank you so much for coming on this podcast and sharing your knowledge.

Duane Scotti:                                        Yes, thank you so much for having me.



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


Mar 18, 2019

LIVE from Graham Sessions in Austin, Texas, I welcome Justin Moore on the show to discuss the American Physical Therapy Association.  Dr. Justin Moore, PT, DPT, a physical therapist and veteran of both the profession and the association with more than 20 years' experience, leads the American Physical Therapy Association in the role of CEO. He has been with APTA for 18 years and has held numerous positions, including executive vice president of public affairs, leading the public policy agenda and payment and communications departments, leading its federal and state affairs advocacy departments and serving as the association's lead lobbyist on Capitol Hill.

In this episode, we discuss:

-How the APTA strives to provide an inclusive experience as a macro organization

-What Justin would change about the APTA

-APTA’s role in the World Confederation for Physical Therapy

-Justin’s biggest takeaway from the Graham Sessions

-And so much more!




Justin Moore Twitter

Justin Moore LinkedIn

World Confederation for Physical Therapy Congress 2019

The Healing of America by T.R. Reid Book


For more information on Justin:

Justin Moore, PT, DPT, a physical therapist and veteran of both the profession and the association with more than 20 years' experience, leads the American Physical Therapy Association in the role of CEO. He has been with APTA for 18 years and has held numerous positions, including executive vice president of public affairs, leading the public policy agenda and payment and communications departments, leading its federal and state affairs advocacy departments and serving as the association's lead lobbyist on Capitol Hill. Moore also previously oversaw APTA's practice and research departments. He has been honored for his contributions to physical therapy and public policy by receiving the R. Charles Harker Policymaker Award from APTA's Health Policy and Administration Section and the Distinguished Service Award from APTA's Academy of Pediatric Physical Therapy. In addition, Moore has written, presented, and lectured on health policy, payment, and government affairs issues to a variety of health care and business groups across the country.


Moore received his doctor of physical therapy degree from Simmons College in Boston, Massachusetts, in 2005, his master of physical therapy degree from University of Iowa in 1996, and his bachelor of science degree in dietetics from Iowa State University in 1993. He was honored by Iowa State University's College of Human Sciences with the Helen LaBaron Hilton Award in 2014 and the university's Department of Food Science and Human Nutrition's Alumni Impact Award in 2011, and he was the Family and Consumer Sciences' Young Alumnus of the Year in 2003. He also recently completed a 3-year term on Iowa State University's College of Human Sciences Board of Advisors. Moore was part of the inaugural Leadership Alexandria class in 2004 and served on the Northern Virginia Health Policy Forum Board of Directors.


Read the full transcript below:

Karen Litzy:                   00:01                Hey Justin, welcome back to the podcast. I'm so happy to have you back. So we have a couple of questions to get through today and we also want to talk about the first half of Graham Sessions. So we are recording live at Graham sessions in Austin, Texas. And I've got a couple of questions for you and then we'll talk about your big takeaways from the morning session here at Graham sessions. So first thing is, and this will probably be addressed at Graham sessions tomorrow, but what is the APTA doing the American Physical Therapy Association doing to address the current needs of physical therapists, physical therapist assistants and students to ensure their membership is quote unquote worth it?

Justin Moore:                00:44                Yeah, it's a great question.  It's a question I get often and unfortunately don't have always a great answer because it is such a personal and passionate issue of how do you find value inside this community of APTA. And as you know, value has two meanings, an economic meaning, do you get a return in your investment? And so we look at the physical therapist and the physical therapist assistant of investing in APTA and do they get a return, so there's an economic part of this question, but there's also a principal part. Do you value APTA? And we'd like to focus on that. And then how can we really engage the physical therapist and the physical therapist assistant and really showing value to APTA and getting value from APTA. And I sort of look at it in Adam Grant's philosophy of give and take, you know, the transactional or economic value is what do you get from APTA?

Justin Moore:                01:38                And then the give is what do you give to APTA? We're really blessed by our members giving to us and increasing the value for all. And I think the value at the end of the day, the take home value that PTs get from APTA is we're an unabashedly, aggressive about increasing the opportunities for physical therapists. So if you believe in that mission and that value, how do we continue to connect you to your colleagues? How do we continue to build a community that's going to make this career you've chosen make a difference in people's lives, but also return a fulfilling career to you. And so get that return on investment and that value. So, another thing I'll just tie is our board of directors has been really aggressively looking at how do we continue to be relevant to the next generation of clinicians. And we know healthcare is changing. We know business is changing and we have to be getting better at being relevant at the point of care. We have to get better at promoting the value of our profession and we have to get better at connecting our experts. And right now, I think that's what our strategic planning process is about, is how do we become more relevant to those individual clinicians and professionals.

Karen Litzy:                   02:50                And I think that's different from a couple of standpoints. One and we’ll probably talk a little bit about this tomorrow, is that APTA is obviously a macro organization. There's 101,000 members. So how do you incentivize members from one not dropping off, So a retention issue, right? And two, how do you attract them in to have that feel of more of a micro organization? Right? Cause it's all about the details and it's all about incentives.  So how can the APTA, which is a very large organization and it needs to be that way. It can't be small. So how do you give a macro organization a micro feel?

Justin Moore:                03:35                Yeah, absolutely. It's our greatest challenge. And I think, you know, one of the things that is very good about APTA is we interact with probably 95% of potential members in a five year period. So we have 80% market share of students, 30% market share of practicing professionals. It's a little less than 10% of physical therapist assistants. So we do engage with almost our entire community over a five year period. But we have to return value in the short term to keep them a member. And the greatest challenges that is, how do you let this very diverse clinical community, how do you build a spirit and harness the power of inclusion? So people can find their people so they can find their community inside this large network of professionals. And sometimes APTA has been too complex, too fragmented, and too divisive to achieve that objective.

Justin Moore:                04:29                And so we have to look at those themes on a pretty regular basis is how do we become more inclusive? And so how do we help people find their people, their network of individuals, because they're going to get great value in that if they're going to be a better private practitioner, if there going to be a better pro Bono clinic operator? If they can connect to their people that's going to return value, how do we reduce the fragmentation? We all are committed to promoting the value of PT Well, if we're talking about the value of a certain part of PT, we're constantly competing inside the PT world. It really dilutes our impact. And we know that from data is we're a pretty fragmented community. And so we've got to reduce that fragmentation and build unity. And have to be better working together.

Justin Moore:                05:17                We're not unified.  The bigger you get, the harder it is to feel the intimacy. We had a consultant work with APTA’s board one time and he put up a matrix.  He said, you can be three of the four things in the quadrant, but you can't be the two things that are across from each other. And the two things that cross each other in that matrix were intimacy and strategic. And so to be a strategic organization, can you still be intimate in an association of one where you address every need, every one, and we have to figure out, we're going to be a complex organization, but we have to figure out how to give an intimate experience, but be strategic in that intimate experience.

Karen Litzy:                                           And it's a challenge. It's a challenge for a large organization, but it's good to hear that that's on the minds of the people at APTA.

Justin Moore:                06:06                Yeah. I think we've realized that we have fallen short at times of really being able to connect people, really giving people a sense of inclusion. Even though we've tried to be inclusive. If it is not conveying that to the end user or member and they don't feel included then we're missing the mark.

Karen Litzy:                                           One thing it's not about is the money.

Justin Moore:                                        We can give you in economics, I always tell the story is, you know, it is a federated model, has a complex new structure, but APTA dues are 295 in the realm of that, it's a pretty low price point inside of professional associations.  If you compare us to other medical associations, other nursing professions, it's a pretty low price points. We probably return economic value for transactional value to the member, and show that value pretty well. But if they don't value their experience, it doesn't matter what the price point is. And so that's what we really have to work to achieve.

Karen Litzy:                   06:59                Yeah. Not Easy. I look forward to seeing what comes out in the next couple of years there. Okay. Moving on. If you can end with, maybe we already said this a little bit, but if you can change one thing about the APTA organization, what would it be and why?

Justin Moore:                07:13                I think it would be to harness the power of inclusion. We've really been focused on that and how do we create a community that at times has been competitive or fragmented and how do we bring them together for commonality and unification around promoting the value of PT, promoting the brand of PT and we're going through a process right now at APTA of rebranding and we're going to be launching that in the next 12 months. And what we found is we went through the research on doing that is we're conveyed way too many opportunities to put your own perspective of what the value of PT is. And we need to really get unified and more inclusive in that march toward promoting our value.

Karen Litzy:                   07:57                Simplify the message a little bit more.  It is hard because within physical therapy you have so many options of workplaces and how you work and who you work with and states and personalities. And I mean the list can go on and on. I would imagine having that sense of inclusivity among 101,000 members, but 300,000 PTs across the country is not easy when everyone is so diverse, diverse in race, religion, gender and diverse in practice settings. So it's like you have to not be, I'm trying to do everything but a master of none.

Justin Moore:                08:43                If you're trying to do everything, you're actually doing nothing. That's sort of been a challenge for APTA. They're trying to be all things to all people and was at times maybe a little bit mediocre at everything. So we really have to do that. And I think the common theme is we've done some analysis both on the data side and then actually a social listing. And two themes come out about the PT community is we're pretty divisive. So when you guys see this is people like to tear other people down or can say that they're better at a certain thing than others. So if we could get away from that divisiveness and correct that, that would be great.  If an outsider was looking at our dialogues, it would not be a positive experience. 

Karen Litzy:                   09:36                I’ve had a patient tell me like what you guys really don't get along.  I’ve seen some conversations on social media. And I was first of all shocked that a patient would actually bring that up so people are looking and they are reading.

Justin Moore:                09:44                We've had outside consultants that have look at this and they said they can't believe two things. How some of our acting members tear us down. And so these are people who have already made a decision to join us but yet like to tear down the organization. And then what we found is when we were out looking at the research on our next strategic plan and looking at net promoter scores our highest distractor group, was some of our longest serving members, and essentially we figured out we're not engaging their expertise well enough. And so that was sort of a wake up call for us instead of saying, oh, why are former leaders tearing us down? We said, wait a minute, they're feeling lost. They're feeling not included. They have given a lot of time to this association and now they feel like they've been dropped off a cliff. And so how do we give them a parachute, how do we give them a glider? What can we do to keep them in the spirit of inclusion?

Karen Litzy:                   10:36                I think that's great because you know, in some conversations I had yesterday, someone brought up to me that it was really great and it was that the APTA has 101,000 quote unquote experts. So the organization is not the expert. They're the facilitators of all these experts that they have at their fingertips. And just think how much the organization can do by being a stellar facilitator of all those experts.

Justin Moore:                11:05                APTA is a vehicle. We don't practice, we don't do research, right? We don't do, we do a little bit of education. We do a little bit for professional development, but we can be a vehicle where our educators can educate, our researchers can publish, our researchers can have access to funding and our practitioners can get that. So we have to really leverage our role as convener. Our role as networker. As a funder. The very basic principle of association is people come together for collective success. So they give us dues you use to put into a collective operation for PR, for advocacy, for all those things. And we've got to get better at that. Include that spirit of inclusion.

Karen Litzy:                   11:46                Perfect. Alright, next question. So the World Confederation of PT Conference is coming up in a few months in Geneva in May. So how is the APTA improving its outreach and involvement in the international world of physical therapy? Are you going to be in Geneva?

Justin Moore:                11:54                Yeah, it's a big priority for APTA to be an international partner and contributor to global PT. And so WCPT is one part of that. It's not our inclusive effort. But APTA has a long history of involvement with WCPT including being one of the founding countries and including having at least a couple of presidents I believe. So, most recently, Marilyn Moffat was president of the WCPT. So we have a longstanding commitment and contribution to WCPT and the conference in Geneva will be a great community of international leaders where we can go and be in a posture of learning. So a lot of times we're not going to, we go and have a delegation at WCPT, but we're really going to interact with our colleagues in Australia and the UK and the Netherlands and really learn from their successes and how we can apply those back here.

Justin Moore:                13:01                I think this morning at the Graham sessions when we heard T.R. Reid and it's a great book. I highly recommend it, but he went around and experienced healthcare in different countries.  That's sort of what we do at WCPT. We go and we talk to the Netherlands of how did they stand up their registry? How did the UK be frontline in primary care, how did Australia get this great expertise in sports and orthopedics and manual therapy? And so what can we do to really leverage that global community to improve care back in the US as well.  WCPT is just like APTA, it’s an organization. And so we have a responsibility as a member. It's interesting, WCPT doesn't have members that are individual physical therapists. Their membership is the organizations that comprise the countries.

Justin Moore:                13:49                And so we are one of about over a little over a hundred member organizations at WCPT and we, you know, we take that responsibility very seriously and always are looking for opportunities to contribute to their objectives and especially when they're aligned with our objectives.

Karen Litzy:                                           I’m looking forward to going to Geneva. I can't wait. I think it's going to be awesome and I'm actually going to be staying with some international PTs. So one from Canada and one from Ireland. I go to a lot of international conferences. It has really changed the way that I practice, it has changed my outlook on the profession as a whole. And what you find when you talk to therapists from different countries, we're not all that different. The way we practice, the challenges that we all have in these different countries are very similar. And I found that to be very eye opening.

Justin Moore:                                        As a physical therapist who's gone into association management, I've gotten huge value from some of my colleagues of other physio therapy associations.

Justin Moore:                14:46                So Cris Massis at the Australian physiotherapy association, he's just been a great role model. Someone to learn from. And it's nice because it's safe. You know, we're not competitors. He's got his lane. I got my lane and he's been a great resource. Mike Brennan, who was at the Canadian Association a few years ago has been a great reference and resource and I've just been able to observe a lot of these international CEOs and how they conduct their business. And it's been a great learning opportunity for me as well, a little different clinic than the practitioners.

Karen Litzy:                   15:20                The parallels are there and the APTA, we’re as clinicians trying to learn from each other and as heads of organizations you're trying to learn from each other.

Justin Moore:                                        It's one of the strongest things is the opportunity to interact with those other CEOs.

Karen Litzy:                                           So before we finish up, what were your biggest takeaways from the morning here at Graham sessions?

Justin Moore:                                        Well, I thought my biggest takeaway, or I don't know if it’s a takeaway or my biggest observation is a lot of thought provoking conversations are already starting. And this concept, and we're going to face this all the time, this concept of what is next in healthcare reform that was started by a T.R. Reid’s presentation, but also what does that mean for physical therapy and where do we need to change our lens? Where do we need to change our focus and how do we need to adapt to be part of the solution, not part of the problem was a key theme. There's a lot of brains in that room, and so I'm looking forward to how they process over the next several hours and come up with solutions. It's easy to point at the problems, but the solutions are always more complex.

Karen Litzy:                   16:29                So thank you so much for coming on.




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


Mar 14, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Jim Dunleavy on the New York House of Delegates.  Jim Dunleavy is Chief Delegate of the New York Physical Therapy Association Chapter.  James Dunleavy graduated Cum Laude with a Bachelor of Science in Health Education from Manhattan College in 1976. He received a P.T. Certification in 1977, followed by his MS. P.T. in 1983 from Columbia University. James was a Co-founder and acted as its first President of the Acute Care Section from 1992-1997. He served as an APTA Director from 1998-2004 and received the APTA‘s Lucy Blair Service Award in 2005. Currently, James is the President of the New York Physical Therapy Association, an office he took in 2006.

In this episode, we discuss:

-What is a motion?

-An overview of how the delegate assembly functions

-Jim’s advice for new graduates who are looking to get involved in professional organizations

-And so much more!



Jim Dunleavy Twitter

New York Physical Therapy Association


For more information on Jim:

APTA spokesman James M. Dunleavy is administrative director of Rehabilitation Services at Trinitas Regional Medical Center in Elizabeth, New Jersey. He also serves as adjunct faculty in the Transitional Doctor of Physical Therapy Program at Rutgers University. As an active member of APTA, he founded the association’s Academy of Acute Care Physical Therapy and served as its president for 5 years. He has held various volunteer positions within the association, including serving as a director on the APTA Board of Directors. Dunleavy also has held many volunteer leadership positions on APTA’s New York Chapter Board of Directors, including treasurer, district chair, district director, and president. In 2005 he received APTA’s Lucy Blair Service Award. He was the first recipient of APTA’s Acute Care Section Leadership Award, now named after him. He received a bachelor’s degree in education from Manhattan College, a master’s degree in physical therapy from Columbia University, and a doctor of physical  therapy degree from Massachusetts General Hospital Institute of Health Professions.


For more information on Jenna:

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


Read the full transcript below:

Jenna Kantor:                00:00                Hello, this is Jenna Kantor with Jim Dunleavy who is the NYPTA chief delegate. And I am very excited to be interviewing this morning. So first of all, thank you so much for agreeing to be interviewed on the wonderful, healthy, wealthy and smart. So delegate, chief delegate. Would you mind explaining what that is for anyone who does not know and what that is related to within the New York Physical Therapy Association?

Jim Dunleavy:               00:30                Well, the chief delegate actually leads the delegation from New York to the national house of delegates each year. I'm basically the organizer. I do the assignments of motions. I hold webinars and phone calls with the delegates during the course of the year to get them up to speed with the issues that are facing us that are brought before the house of delegates each June.

Jenna Kantor:                00:58                Yeah, it's excellent. And I'm on that email list and so I'm always just going reading, having different physical therapists help transcribe it for me. So thank you, you just are so good at keeping us up to date with that. So for you, I'm just wondering on a weekly basis, how much time do you need to put into your job?

Jim Dunleavy:               01:17                I would say it varies. It gets more as we get closer to the house of delegates each June. The APTA has gone through kind of a metamorphosis and has created almost a year round type of governance process. So, the motions are starting to be brought out in concept form, usually early in the fall. In the past it's just been we get it in March, we read it, we go to the house, that's it. But now we have to really look at it almost as a year round job to keep people on top of it. Make sure we see what issues are coming possibly before the house. And giving our input from New York as to how we feel about these motion concepts and then the full blown motion will affect us in New York.

Jenna Kantor:                02:15                So when you're saying motion, what do you mean by motion? Is that a new law? What is that?

Jim Dunleavy:               02:20                We run a house of delegates. It's similar to a mini Congress or a mini house of Representatives. And so the issues that come before that house have to be in the form of a motion, which is a clearly defined statement, whether it be a policy, whether it be charging the APTA to do something, whether it be a philosophical or sociological position. And the group will review it, they will discuss it, they will argue about it and then they will vote on that motion.

Jenna Kantor:                02:54                Oh, so it's like when it goes to the Senate or Congress. So if I was to think of the school house rock video where they're singing, I'm just a bill. Do you like that reference? Yes, but honestly, that's where my brain needs to go cause I'm massive beginner with this. So I right now I'm an alternate, which I'm very just honored to even be an alternate for the possibility of going. So I was wondering what is it like, let's say day one at the delegate assembly? Is it just people just kind of, you know, is it, how are things brought in order? Is there an introduction? Are there, is there a ceremony with candles and, and you know, it was some sort of like traditional dance. What happens on day one at the delegate assembly?

Jim Dunleavy:               03:49                The candles and the dancing, that's a good idea. Maybe we'll get them going a little bit more. First two things. One, you mentioned the term delegate assembly. The delegate assembly is actually New York's own little congress, little house of Representatives. What I'm chief delegate of is the delegation of New York that goes to the national house of delegates. So in New York, we're a little different than other states. We have 10 districts. We have representatives from each of those districts come to our delegate assembly, usually in April or May, where we review all the things that are going to come before the house of delegates plus vote on any bylaw changes or other issues that are going on in New York state alone. In terms of how it's structured, you have delegates are voted upon to go to the house of delegates by our delegate assembly.

Jim Dunleavy:               04:51                So that's one set. Then in addition, each district has the ability to designate one person. So there's 10 and then whatever is left in the order of the voting in the delegate assembly, those people are on our alternate list. So, believe me, it happens every year. We have people who drop out for various reasons. In fact, I have one right now that I have to replace, so I don't know where you were on the list, but you might be getting a call from me later. I have to keep track of that and I have to constantly update the APTA delegate list and the chapter deligate list. So they get all the information that they need either as now an active delegate and not an alternate.

Jenna Kantor:                05:44                If somebody was an alternate, like my situation and then I'm down at the end of the list. But I'm also, honestly, I really am grateful to be on the list especially as a new Grad. So I'll take it, so if I was able and fortunate enough to, you know, be able to fill in for someone, does that make me for the next year as a regular delegate or am I still considered an alternate?

Jim Dunleavy:               06:10                The delegation is a one year service time. So we will vote this coming April I think is the delegate assembly. We will vote for the delegates going to the 2020 house of delegates. This group of delegates that are going to Chicago in June of 2019, they were voted upon last delegate assembly. So it's a one year cycle. We've actually talked about changing that to maybe get a little bit more experience in four people. So we're talking about maybe changing the bylaws to two years of service. I'm not sure yet, but it is a one year service time.

Jenna Kantor:                06:58                Okay. Very good to know. Alright, so let's go back to day one. So we're at the house of delegates day one. So apparently there was no dancing ritual.  So what is the order usually on day one at the House of delegates?

Jim Dunleavy:               07:24                For the New York chapter, what we usually do is our delegation comes in usually the day before the house opens. And I usually try and hold a, what we call a caucus meeting to just orient everybody, go over any changes that I'm aware of and in any of the motions, prepare the delegates for the next morning, which are the interviews for people running for national office because the house of delegates is the voting body that votes for president, vice president and so on. We have interviews of those candidates all morning and we have I think four rooms or five rooms that we have delegates in who asks these candidates questions, we will then come back as a delegation together. We will talk about the candidates, make our selection and then start to work on the motions. Then after that, usually in the late afternoon, early evening, the house of delegates starts and it's a pretty impressive place if you've never been there because you have over 400 plus of your colleagues from around the country sitting in front of a large dais with the speaker and other officers there. And we run a parliamentary rule meeting with the idea of making the best decisions for the profession in the United States.

Jenna Kantor:                08:53                This is honestly very exciting to me as much as I'm calm as I'm saying this, like it's just, it's getting my heart beating and I'm like, I want to be there one day.  This is just a random, silly question, but Lord knows anyone who knows me, I love random silly questions. So if I was to be interviewing for any of these amazing higher positions, that can make a great difference. If I did the splits or broke into a song and dance, would that help my position or possibly pull things back or maybe would you cast me in a Broadway show instead?

Jim Dunleavy:               09:24                I'd probably go with the Broadway show. Probably doing the song and dancing in an interview here, I don't think the culture would really take to that very well. I think though that the culture in the interviews is changing with the age of the delegates. We talk a lot about millennials. We talked a lot about all of them, gen x’ers and everything else. And how we have to change our communication style in order to reach out to our newest members and future leaders. I've seen a change in culture and that it's a little bit lighter, but I don't think we're doing the song and dance just yet in the interview process.

Jenna Kantor:                10:18                So no Hamilton rap? No, no, no. Okay. Okay, good. Just good to clarify it. In the hallway, right to take care of those nerves. So when going in the rooms, this honestly reminds me cause I have the musical theater background of auditions. It really does. So for you guys on your end, as you are interviewing these people, I mean aside from the buckets of coffee that you're probably having to just stay really focused. You really need to see that people are right for these positions. Do you try to make it a friendly environment or like what kind of environment are you trying to create to help that person who is being interviewed?

Jim Dunleavy:               10:59                Well, I think we're trying to make it a level playing field because what we have done is we have agreed to do a set questions in every room so that the delegates that are in each room gets to hear each candidate's answer to the same question. Then each room does have an opportunity to ask some of their own questions. So when I ran for APTA board and I had to do these interviews myself, that was not the case. I had no idea what was going to be thrown at me in terms of questions. You could be asked anything. I think now it's at least fairer, it's a level playing field for the candidates. They know they're not going to get any serious kind of Gotcha questions cause we went through a period of time where people thought that was fun. So I think it's a much easier experience for the candidate then perhaps maybe it was when I ran. I think people still get insights into these people.

Jenna Kantor:                12:16                Absolutely. And for working with your team when you are discussing, cause you're saying people are in different rooms, you know, you have the different rooms and are you guys all, is it say Melanie goes in, she gets interviewed in one room. Does she get sent to the next room and the next room? So all three groups interview?

Jim Dunleavy:               12:37                Yes. The candidate will get a schedule for the morning, what rooms they have to be in.  So usually very close to each other

Jenna Kantor:                12:48                And muscle relaxers. Anything for the nerves, right?

Jim Dunleavy:               12:51                Absolutely. Yeah, there is. And there is a candidate's lounge where they set up food and coffee and everything else. So you have a place to go and cry when you mess up in the interview. It really is a very well oiled machine how they do it. So what I'm going to have to do as chief delegate, I'm going to have to basically divide up our delegates equally for each room. And then I'm in one room with what we call the Northeast Caucus, which is all the states, pretty much in the northeast. But they'll be New York delegates probably somewhere in the neighborhood of six or seven, maybe eight in each room. So they can hear the differences in the different questions and then I will bring them all back together after the interview session and go through that and make sure that everybody hears what was said in every room by each one of the candidates.

Jenna Kantor:                13:48                Oh, that's so smart. Yeah. I really like how you guys have a system because that's not easy to even develop that system that works for everyone. So I think that's really, really cool how you guys have that organized. So you're done with all these interviews, you have to decide that night for that or was that during the whole weekend that that's part of the house of delegates?

Jim Dunleavy:               14:09                It used to be much more laborious until we went to electronic voting. So after the day of our interviews that evening, the house will open and one of the first orders of business is that we will all vote on the candidates. And then at the close of that session, which is usually around eight o'clock that night, the results are posted both outside the house of delegates room. And on these huge screens that we have in the house of delegates proper.

Jenna Kantor:                14:40                Wow. Wow. Well organized. So you've done the interviews and now we're at lunch.

Jim Dunleavy:               14:49                Up to the interviews, I bring my delegates back to a caucus room that I've got assigned and we start to talk about the candidates and start talking about the interviews.

Jenna Kantor:                15:02                Okay. And then after that discussion, what's after that?

Jim Dunleavy:               15:07                Then later in the afternoon, we're going to have what we call motion discussion round tables where chief delegates and some delegates if they want to come, can come. But we come and discuss strategy issues and or changes in motions, get more information on particular motions that are going to come before the house. And usually we have two or three of those in the course of the days that we're together. So that once we get to the floor as many of us as possible, have the same information about a particular motion.

Jenna Kantor:                15:44                Oh that's so great. So you can get on the same page. That's brilliant. I really liked that. That's so smart. And that's the new thing you were saying.

Jim Dunleavy:               15:50                Well we used to do it a different way. We used to have these called motion discussion groups where motions were assigned to a room and then you would run around and trying to listen to the information that way. We're going to try these round tables where I'm assuming it's going to be set up, like each table is going to be a motion and you could go to whatever one you want, and just do that for a period of time. I think that's a good change.

Jenna Kantor:                16:18                I love that. I like how you guys are always trying to fix a problem, solve and improve. That's really incredible. And then we get to the meeting after everybody's on the same page. Everyone understands what's going on. Everyone then comes together. There's that vote at the beginning, right, like you said. And then is it all run by Robert's rules?

Jim Dunleavy:               16:39                Yes. Everything we do is via Robert's rules. We have a speaker of the House who's basically our facilitator, making sure everything moves forward as quickly and efficiently as possible, but also within the realm of Robert's rules of orders. So everybody is dealt with in a fair way. We don't want people, we have very small states. For example, we have states that may only have two delegates there. New York is a larger state. We have 25 delegates. So if you're looking to influence votes in order to get something passed, you're generally going to try and go to the California's, the New York's, the Illinois’, the Florida’s, the Texas’, to try and garner as many votes as you possibly can for whatever issue you're trying to support. So the smaller states need to have protections. And so I think the caucus process of them being assigned to the caucuses from throughout the United States, they get much better information before they meet because then they're just not talking amongst themselves and they also have the ability to create relationships with some of the larger states. So we all know what everybody is doing.

Jenna Kantor:                17:57                What do you mean by caucus? Would you mind defining?

Jim Dunleavy:               18:00                There are caucuses set up throughout the United States. The one New York is in is called the northeast caucus. It's actually the oldest. We have states from Maine down to DC, I think it is on the east coast.

Jenna Kantor:                18:17                Oh. So it's like a region essentially?

Jim Dunleavy:               18:19                It’s a regional Caucus. Now that caucus does not have any authority in terms of voting. We don't block vote. We don't try and get everybody together and vote one way at a particular issue. That's not the purpose of the caucus. The purpose of the caucus is to share information, to perhaps bring a motion concept like I did with the New York motion this year to the caucus to get viewpoints and ideas. And perhaps as a caucus, ask for information, ask for changes in the way we do things, and send that to the house officers. So it's an information gathering, sharing and actually very stimulating meeting. We have one in the fall and we have one in the spring, and we have one here. We had one here the other night, so we're looking I think in March or April to have one. It's up in Vermont, I think. And then the one in the fall, I don't remember where that one is, but basically it is part of a year round governance process where we'll be talking about motion concepts at all of these.

Jenna Kantor:                19:38                And for those who don't know, we are actually at the combined sections meeting, which I did not say. So when he's referring to here, he's talking about here in DC 2019. Yes, yes. This is excellent. So during Robert's rules, how was it handled for someone who's new and they're not familiar with what even Robert's rules is? Is there somebody who teaches them when to raise their hand or say a motion or a vote of where somebody to just make sure, for lack of a better word, that they're in line?

Jim Dunleavy:               20:16                It can be intimidating the first time for a new delegates especially when they first walk into the house and they see the physical enormity over get it. You don't get a sense of that until you're there. It's also very, I find it very exhilarating to have all our colleagues together in one place. What APTA does, it's a PowerPoint slide presentation to orient new delegates to the process. We have an orientation handbook in New York where I do a conference call and we're probably going to move to a webinar format next time, with all the new delegates each year. So I basically go over what their role is, what to expect, some of the mechanics of what they need to do. And even with that, I know some of them are still not totally clear, we did that in November. And so I'm still getting questions. So, the good part is I'm getting the questions. In the past, I remember when I was a new delegate, we had no such orientation. It was, here you go and you're done and you just deal with it.

Jenna Kantor:                21:42                Oh, just praying that you just rose your hand the correct way.

Jim Dunleavy:               21:47                Exactly. Right. They do have a lot of resources now. In New York, we usually buddy up, the new delegate with an experienced delegate. So if they feel for whatever reason, they don't feel like you can find me or talk to me, they have this other person that they can reach out to.

Jenna Kantor:                22:09                Yeah, that's wonderful. I definitely could see myself wanting to lean over and be like, what are they talking about? And you know, would you mind defining this? So I think that is a great thing that's already in play to get that mentoring. I could definitely imagine myself, and this has been advice from others that the first year, not that  I wouldn't vote on things, but to spend more time just being quiet and listening because there's so much to take in. Would you agree?

Jim Dunleavy:               22:37                Absolutely. It takes time to get used to the process. And so you have to, early on as a new delegate, you have to spend your time dealing with the mechanics of what's before you. But there are also situations where new delegates may feel very passionate about a particular issue that's coming before the house. And so how we've done it in our chapter, is we've tried to keep it as open as possible. I do not restrict our delegates from getting up and having their say at the mic. And what I have noticed is I think the newer delegates are much more better equipped, I guess the best way to handle that situation. I know in the past and I was one of them, the first time up to the mic in front of 400 of your closest friends can be a little intimidating. I've seen with our newer delegates, a much higher sense of confidence in and a knowledge base and again, the passion that they bring. I think we're going to have a number of delegates here in New York for many, many years to come that will be great representatives of the chapter.

Jenna Kantor:                24:06                I love hearing that. It's very exciting. I'm so grateful to have somebody like you in New York who's really leading us with such clarity. And I just want to thank you. Thank you. Thank you. Thank you for coming on to this podcast because this is going to be a resource that I'm going to be sharing out with people who are interested, a lot of students for sure. Cause I'm definitely, even though I'm still a new Grad so I still have that, you know, flowery perspective. So for you to take the time and sit with me on the last day of CSM when we're very exhausted. I am truly grateful. So thank you Jim Dunleavy for coming on. Do you have any final words of advice you would like to give to anyone regarding the house of delegates?

Jim Dunleavy:               24:50                Well, I would just say for everyone to get involved. In New York you have multiple places to get involved. You can get involved at your local district level. That's where I started. Somebody invited me to a meeting and here I am years later doing these types of things and also having served in national office and creating a section. It's been a wonderful, wonderful part of my career. You always get paid back 10 fold, what you give. And so I would say get involved. Call the chapter, call your local district representative, find out when the meeting is locally, and start that process there because the thing that drove me was going to a meeting that a friend brought me to actually when I was in PT school. And I left that meeting thinking I do not want these people making all these decisions without me talking about this. And that was kind of my driver. You know, people have different drivers, but I think get involved because that's the only way the profession is going to move forward.

Jenna Kantor:                25:58                Thank you. Thank you so much. Those are excellent words of wisdom. Thank you for coming on.



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


Mar 11, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Karen Litzy on her journey to become a leader of the physical therapy profession. Karen Litzy, PT, DPT is a licensed physical therapist, speaker, owner of Karen Litzy Physical Therapy, host of the podcast Healthy Wealthy & Smart and creator of the Women in Physical Therapy Summit.

In this episode, we discuss:

-How Karen started her career in New York City

-The importance of relationship building to grow your practice

-Why you should say yes to things that align with your values

-A sneak peek at the Strictly Business Mastermind

-And so much more!



Karen Litzy Twitter

Karen Litzy Instagram 

Karen Litzy Facebook

FOTO Outcomes Summit, use the discount code LITZY


For more information on Karen:

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


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


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


Karen has been featured in magazines and websites like Redbook, Women’s Running, Martha Stewart Living, Family Circle, and CafeMom. She has been a guest on several podcasts including Entrepreneur On Fire, Hack the Entrepreneur, and The Healing Pain Podcast. She lives in New York City.


For more information on Jenna:

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


Read the full transcript below:

Jenna Kantor:                00:00                Hello, this is Jenna Kantor interviewing for Healthy, Wealthy and Smart. And I am here with the founder, the original Mama Jamma, Healthy, Wealthy and Smart Karen. And I am going to be a major fan girl. No apologies for this at all because I've been wanting to interview Karen for a long time because she is just one of the most inspirational people in physical therapy. And I would say honestly amongst women and physical therapy, the leadership that you take is absolutely incredible and I appreciate you agreeing to coming on. So thank you.

Karen Litzy:                                           Well thank you. And I think this is the first time I've been interviewed on my own podcast. I think so unless you count the time Bronnie Thompson was asking me questions and made me cry. But for the most part, this is definitely the first time.

Jenna Kantor:                00:51                Not a meltdown in this one. Well what I'm really excited about as so anybody who is a fan of Karen lets you see all that she does. This is to really learn about her backstory and also how possible it is to get to where she is at now. So one thing we were talking about the other day, Karen, as you were saying, how you moved to New York and you knew no one, I would love for you to expand upon that and how you took those steps to knowing everyone.

Karen Litzy:                                           Well, so when I first moved to New York, I knew my roommate because we had gone to high school together and maybe two other people that we went to high school with. And what I decided to do when I first moved to New York is I couldn't find a physical therapy job that I felt like it was a good fit.

Karen Litzy:                   01:43                And so I ended up working at what was then called Reebok Sports Club. It's now an Equinox, but it was this sort of a country club in the city. So it was a very high end, very expensive gym. So I started working there as a personal trainer. And because of that environment, there were so many personal trainers, Pilates instructors, nutritionists, not to mention all of the people who go in and out of the gym and all the clients I was lucky enough to work with. And because of that I was able to meet hundreds and hundreds of people. And to this day, those trainers, the people who work, like a computer program there for children, there are nutritionists, pilates instructors. To this day they still refer patients to me. And that was wow, 18 years ago. So, you know, we talk about building relationships and how important that is.

Karen Litzy:                   02:41                And I think having that as my first job in the city and being exposed to so many different people, I felt like it really helped me build relationships and friendships at this point that have continued to blossom and grow. And I mean, I just had a patient that was looking for a strength and conditioning coach. And so I said, well, I work with one, a person who is amazing. And he was one of the first people I met at my new job 18 years ago. So it was a bit of like an unconventional path for a physical therapist and it's just cause I couldn't find my fit. I couldn't find that niche that I really wanted and maybe the clinic that I really wanted to work at and now that being said, I knew ahead of before I moved to New York that this gym existed and that it was a high end gym and that I would be exposed to a different kind of clientele.

Karen Litzy:                   03:36                I don't know why I looked that up to begin with, but it was because of that, that gave me the idea to go out on my own and to start seeing patients in their homes and home gyms and homes and offices because all of the personal trainers at this gym, we're seeing people outside of the gym. If they're doing that, then why can't I do that? Why can't a physical therapist do that? Why do they only have to come to a clinic in a more traditional sense of the word? So it was because of that first job that I met so many people and those relationships continue to grow other relationships and that I got the idea to do my business.

Jenna Kantor:                04:28                That's incredible. So for you, now that your network has expanded over time, clearly it's like full bloom. Hello, I look at you almost like the Oprah of physical therapy here. So how do you keep in touch or maintain these relationships with all these people? Like what is your skill for that?

Karen Litzy:                                           So as far as maintaining them within New York City, it's pretty easy because we'll get together or you send a quick text. Cause most of these people are my friends and I credit working at that gym and also playing softball in central park that I was able to meet so many people.

Jenna Kantor:                                        You play softball. Hold on, pause, elaborate.

Karen Litzy:                                           So one day I was running in central park and I was like, Ooh, softball. So I went down and I was like, Hey, do you guys allow girls to play? And they were like, no. And I was like, oh, um, okay. And they said, well, what do you do?

Karen Litzy:                   05:16                And I said, well, I'm a pitcher. And then they asked if I was good. And I peeked my head around and looked at their pitcher. I'm like, I'm better than the one you have. And so the next week I went for my tryout and then I became their pitcher. And then the following, summer I was recruited to play in a fast pitch like windmill fastpitch league. So I played there for several years and all the guys that I played with on that softball team, are lawyers, and they have referred patients to me. And you know, you just keep in touch. And so I met my two best friends that way in the city and they refer people to me from a business standpoint, but they're also my friends, you know, and they're part of my lifeblood of being in the city. And so my best advice if you're moving to someplace where you don't know anyone is to get involved in things you like to do.

Karen Litzy:                   06:07                So I love playing softball. So that's what I did, you know, and I loved working out. So I decided to work in a gym as my first job. So instead of kind of pigeon holing yourself into what just physical therapy or just this, just that, like really kind of open yourself up because you never know who you're gonna meet. So in this city it's easy to keep in touch, well, I shouldn't say it's easy. It's not easy, but if it's a priority for you and your life, you make it and you make it a priority and you put in the effort. And so for me, and as you know, Jenna, you keep in touch with a lot of people. You spend your time on networking and on making those relationships. And the best way to do it is to make it a priority.

Karen Litzy:                   06:47                And so I may have, you know, my week is sort of chunked out so I have patient care, but then there's times where I'm like, okay, all I'm going to do is write emails and send messages to people and it's in my calendar, it's write emails and send messages to people just so that you're still in there hemisphere.

Jenna Kantor:                                        You know, it's keeping those relationships. Otherwise it becomes that long lost relationship. Even if when you hang out with them again you could just act like no time has passed. It's still something that needs to be rekindled. So it avoids that.

Karen Litzy:                                           And it's putting in the effort. Like a good friend of mine, his name is Dr. Jordan Metzl who's a physician in New York and he does free workout classes every month. And so I try and make it a point, okay, I'm going to go to one of his classes even though I can't walk for two or three days because my legs are so sore afterwards. But I make it a point because he's my friend and I want to support him and I think what he's doing is important.

Jenna Kantor:                07:37                I love that. I'm sure I've probably seen pictures of you after the workout going, just finished the workout with Metzl right now. I love that. And you actually are tapping upon something that I know we are 100% agree upon is really supporting what other people are doing. Showing up for what they do is a real big part of the networking and how your life and your career has truly grown.

Karen Litzy:                                           Yeah. It's just being supportive of people that you believe in. So going to something like the CSM where there's 16-17,000 people here, like there are people that I want to make it a point that I at least say hello and that I have a conversation with, even if it's just five minutes, you know, because it's important to me and I hope it's important to them, but I know that it's important to me because I want to show up for them and I want to support them.

Karen Litzy:                   08:31                And so that's just what you do if you want to keep your relationships going. And as far as keeping relations with international colleagues, it could just be a quick, a quick note on Twitter or a quick email or hey, I thought about you the other day because I really want to introduce you to this person because I think you guys should at least know each other cause you're doing the same research or you know, I met a colleague in the Netherlands and he has since referred patients to me in New York and he's a physio in London, but you just keep in touch with people and you do good work. And I think that's the best way to keep your relationships going. And it doesn't have to be every day, right? It could be consistent.

Karen Litzy:                   09:24                It takes five minutes. A lot of times I do this when I'm on the bus cause I'm going from patient to patient. So what else am I supposed to do on the bus? You know, so that's sometime when I'd be like, okay, I'm going to make sure that I reach out to so and so in Australia or to this person in Pennsylvania or to this and that's a good time. So I'm lucky in that sense that I have like random downtime. Chunks during my week and you just, if you think about someone, just let them know.

Jenna Kantor:                                        Yeah, it takes seconds. It takes seconds. Okay. So you have your hands on many things which I love about you. So you have this podcast, which is amazing and soaring and now you also have a team working for you with this podcast.

Jenna Kantor:                10:07                You have your own practice, you have the speaking course. What am I missing? You have a course coming up that's going to be helping practitioners, which is amazing. You’re the nominating committee for the private practice section? Am I missing anything? I want to make sure we tap and tap everything. Okay. So you're doing all these things now, did they all come about all at once for you to achieve it? Or did some of them overlap as you were developing them? Oh, and you're working to become a paid speaker. I mean these are a lot of fantastic things, all a hundred percent possible to achieve in a life, but for you achieving each and every one, have some of them overlapped in the process of growing? I would love to hear that journey.

Karen Litzy:                   10:56                Yes. And I also think that one allows for the next and allows for the next. So one event allows for the next event and for the next and for the next or one experience allows for the next. So for instance, starting the podcast many years ago, I took a couple of years off to go back to get my DPT, but starting the podcast had led to credibility and has led to visibility and in maybe some vulnerability on my part. So when people can see that you're being credible and you're being authentic and you're putting yourself out there, they're drawn to that. And so from that, I was invited to be on a proposal to CSM and then that got me public speaking a little bit. And then maybe from that someone sees you, it's like, hey, you know something, I really like this. We should try this.

Karen Litzy:                   11:50                And so I kept saying yes, yes, yes, yes. And to say as a piece of advice, say yes to everything until you can say no, terrible advice. I don't know. It was terrible advice. Awful. So what I started to do, cause I was saying yes, everything and it is overwhelming and you get burnt out and you start to cry and then you don't feel like you have a personal life. And I want a personal life as well. So now what I've started to do is say yes to things that align with your values. Say Yes to things that in your gut it's a hell yes. Because when you start saying yes to things that are like, I guess I should do it, it's a no, like if you're saying I guess I should do it, you don't want to be shoulding things.

Karen Litzy:                   12:30                It's like, yes, I want to do this. Not, yeah, I guess I should do it. And so I think having that in my mind has been able to narrow my focus a little bit more. So it sounds like I'm doing a lot, but it's all inter related.

Jenna Kantor:                                        It's connected.  And I even left out that you have the annual women in PT Summit.

Karen Litzy:                                           But again, that's all connected, right? So I think it started with the podcast and then doing a little bit of speaking and then I really started to enjoy speaking more and more. And because of that I have made that a priority. And for me each year I pick a word that I like to kind of follow my year and to base decisions on and things like that. And so this year it's courage. And so one of the things that I really wanted to have the courage to do was to do more public speaking and to put out a course to help physical therapists create their own private practice and occupational therapists create their private practice.

Karen Litzy:                   13:27                And these for me, takes a lot of courage and planning and things like that. But if you, like I said, I sort of planned my week in little chunks. So if you can do that, you can get everything done. You just have to put your mind to it. And I also as just a FYI on how I manage my time is that I kind of use pomodoros. So a Pomodoro is a concept that's a 25 minute work block. So I'll set a timer for 25 minutes. I turn everything else off. Sometimes I'll put theta wave music on in the background or binaural beat music because that music is supposed to help increase theta wave, excitability in your brain, which is supposed to have, this is all very, you know, but it's supposed to help you be able to block out distractions and help you focus and things like that.

Karen Litzy:                   14:17                It's the kind of music you hear when you're at the spa. And so I will do that and block everything else out. And it's amazing how much you can get done in 25 minutes. Like so if you are full of distractions, yeah, it's going to take you forever. But if you can really focus for 25 minutes, then you can write that blog post in 25 minutes instead of screwing around for three hours. You know what I mean? And if emails come in, like I'm not the president of the United States, like it's not that important. It's just not. I think we're in a world now where everything has to happenmnow. Now, now, now, now. Whereas I mean, I can say, I mean I started my podcast in 2012 and then took a couple of years off.

Karen Litzy:                   15:03                It's 2019 so it's not like it's an overnight success. You know, I started speaking, the first CSM I spoke, it was in Indianapolis, which was, I don't even know how many years ago. So again, this is just been years of work and years of working on your reputation and years of working on myself in order to get to these points. Nothing is an overnight success because you're always laying foundations and groundworks that can take months or years. So I think it's really important for people to understand that.

Jenna Kantor:                                        And habits, habits are a big thing too, because I'm sure it took you a bit to even make this, this 25 minute habit.

Karen Litzy:                                           Oh my God. Yeah, because I love to be distracted. Squirrel. I'd be like, what? I love to be distracted. But it's true. So to be able to do that and calm my mind down to focus on one thing took practice, but just like we tell our patients with like practice your exercises, if you practice these methods, you become better at the methods. It's the same thing.

Jenna Kantor:                16:02                Yeah. I definitely can relate with that. So now for you, what is your next, oh my gosh. I can't wait for you to listen back to this podcast in like a couple of years and be like, what is your next, cause you have, you have things coming up and maybe those will be your next you would want to discuss, but I would love for you to share that.

Karen Litzy:                                           My probably biggest next is the soonest are the quickest next, let's put it that way. The quickest next would be this course that I'm developing for physical therapists and occupational therapists called Strictly Business Mastermind. And it's to help them create their own cash PT or hybrid or if you already have a practice and you're trying to transition out into a cash based practice.

Karen Litzy:                   16:52                So it's really for those two groups of people. And I'm really excited about that and hopefully we'll have that solidified in the next couple of weeks and put that out there.

Jenna Kantor:                                        That's going to be incredible. And honestly to speak to the fact that we don't have a woman and physical therapist yet leading something like this and we need to, it's for anyone. You need to see somebody who you can even visually identify with. So on top of the content that you're going to be providing, which is going to be off the charts, I'm grateful that you are filling a void that needs to be filled in.

Karen Litzy:                                           And I think it's important to know that I'm not teaching this on my own because I don't have the answers to everything. I can't do everything. It's just physically impossible and mentally impossible.

Karen Litzy:                   17:36                Like I can't do it. So I'm lucky to have a lawyer involved. I'm lucky to have an investment advisor involved. And someone who's an expert at SEO and Michelle Collie who's an amazing colleague with like 5,000, no, not really, but like a whole bunch of clinics in the Rhode Island area because these are people who quite frankly are doing things better than I am. And so to be able to share their knowledge with people, I think it's going to be a little bit unique in that space. Because I know I can't do it on my own. And so I asked for help.

Jenna Kantor:                                        And it's okay to ask for help. And honestly, I definitely wouldn't use the Hashtag better together right now for this because it really is, as much as you are taking the lead on it, it is so good to get to work with other people and everybody benefits from it.

Karen Litzy:                   18:26                Of course. Of course. I just feel like that's important for people to understand that you can't do any of this alone. And that if, if you do, you'll burn out, but if you have the wherewithal to find out, well, what are your weaknesses? Like, what are you good at? What are you not so good at? What do you love? What will someone pay you for? And if you can fill that out and kind of connect the dots, then you'll know what you're good at and then what you're not good at. Just find someone else who is. Because you're doing a disservice to yourself and you're just doing a disservice to people who are spending their money and their time to learn from you. So it's all about respecting the audience. And so what I really want to do is respect the audience and give them the best user experience that they can get and meet those expectations. And I'm my harshest critic.

Jenna Kantor:                                        So I think everyone is, I think everyone is their harshest critic. Well, thank you so much for coming onto your own podcast to just share this. I love how you're just so authentic and insightful and just so true to your own story. And I think a lot of people just appreciate that about you and I definitely do. So thank you.

Karen Litzy:                   19:52                Thanks for having me on.



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


Mar 4, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Sue Griffin on how to be the speaker for the APTA’s House of Delegates.  Dr. Sue Griffin is the Speaker of the House of Delegates for the American Physical Therapy Association.

In this episode, we discuss:

-What are Robert’s rules of order

-The responsibilities of the Speaker of the House of Delegates

-What roles you should seek in order to prepare for Speaker responsibilities

-Why Sue loves the APTA

-And so much more!



National Association for Parliamentarians

 Use the discount Code: LITZY


For more information on Sue:

Dr. Griffin has been a physical therapist for more than 30 years. She has practiced in a wide variety of clinical settings throughout that time, and continues to practice in acute- and long-term care. Dr. Griffin has taught ethical coursework for entry-level and post-professional PTs and PTAs at the state and national level.


Examples of Dr. Griffin's accomplishments include:


Elected Speaker of the House of Delegates for the American Physical Therapy Association in 2014.

Full-time professor for the Physical Therapist Assistant Program at Blackhawk Technical College in Janesville, WI for more than 20 years.

Served on the Ethics Committee for the Wisconsin Physical Therapy Association from 2007-2013.

Chaired the Wisconsin Physical Therapy Association Task Force in 2004, when the Wisconsin PT practice act was updated.


Lead instructor in a PTA program, delivering content in a wide variety of clinical areas. Long-term and

indepth involvement in clinical education. Licensed doctor of physical therapy with a broad background in many areas, including longterm care, acute and rehab spinal cord, acute head injury, inpatient and

outpatient orthopedics and neurology, and amputation. Board certified in geriatrics. Very active member of WPTA and APTA.


For more information on Jenna:

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


Read the full transcript below:

Jenna Kantor:                00:00                Hello, this is Jenna Kantor with Healthy, Wealthy and Smart. And I'm here with Sue Griffin, which is absolutely incredible. I am just a fan of anyone who is involved with the APTA and really making a change. So would you mind sharing, your the speaker of the House of delegates, would you mind explaining what is that position? I would love to learn.

Sue Griffin:                   00:20                Sure. So speaker of the house runs the house of delegates. So the house of delegates is pretty analogous to like a representative body like you'd have in your state legislature, like the assembly. So, every state chapter gets to elect physical therapists as representatives. And it's the number is based on the number of members they have in their chapter. So we have about 400 every year that together and they kind of look like, you know, if you've seen those old convention things like the long tables and the state signs, I mean, that's kind of what it looks like. It's in these huge ballroom. There is a day is, and so up on the day is, that's where I preside from. And so the speaker stands on the day is and runs the meeting and it's incredibly formal because you can't have 400 people like talking over one another.

Sue Griffin:                   01:09                It sound like, you know, English parliament or something, which we don't want. So that's the state chapter part. And then we also have all of the sections have a representative, the student assembly sends two representatives, the board of directors are there and the PT Caucus. So they all have representatives. They don't have a vote, but they are able to speak and debate and offer motions and things like that. So that's how our association creates positions and policies.

Jenna Kantor:                01:44                So with all these people together, you are leading the meeting? Robert's rules and all.

Sue Griffin:                   01:51                Yes, very, very formal. And so we stick to Robert's rules really strictly because otherwise again, like it would be chaos.

Jenna Kantor:                02:00                Oh yeah, absolutely. And would you mind explaining what are Robert's rules for those who do not know?

Sue Griffin:                   02:06                Everyone knows what. No, I'm kidding. I'm kidding. No.

Sue Griffin:                   02:09                So Robert's rules of order is a specific kind of school of parliamentary process. So there are a couple of different schools, but this is probably the most famous. And so there's literally a book that kind of like a thick little mini Bible and it helps you run a meeting. So it has rules about procedure, like who can speak when and if someone brings a motion, in other words, if they want to take action, they present in a very carefully worded format and then there are processes for how people can change or amend that motion so that you can, it's a way for a group to make decisions.

Jenna Kantor:                02:47                And it makes it easier for everyone else to follow.

Sue Griffin:                   02:50                Right. And the basis is really to protect the voice of the minority and yet still let the majority accomplish their will.

Jenna Kantor:                03:00                I love that kind of the whole purpose of it.  And what is the time commitment for your position?

Sue Griffin:                   03:05                It varies a little bit, but there's kind of a low level steady level of commitment that's probably five to 10 hours a week because I also serve on the board of directors, so I have to participate on all the board activities as well as manage the house activities. And then like times like this, like pretty much from January through June. So the house of delegates right now is always in June, so pretty much from January to June, or at least CSM to June is when people are really working hard on their motions and we're trying to help them craft them. And so I would say the time commitment is, you know, probably 15 to 20 hours a week.

Jenna Kantor:                03:45                That's great. That's great. Well, you're making a big difference, so that makes sense. And then of course as it gets closer, I'm sure it increases.

Sue Griffin:                   03:52                It does. I don't know that I'm making a big difference. I think I'm helping everybody make a big difference. Now, I'm going to think I'm trying to just, you know, I'm the facilitator. I'm not the, I'm not the maker.

Jenna Kantor:                                        Yeah, yeah, absolutely. So as the facilitator, why do you like this job?

Sue Griffin:                                           Oh, it's just great. I mean, first of all, it's just so many passionate and really smart people, you know, coming together and they all have such great intent. I suppose every process like this is political to some extent, but you know, we don't have, everybody is really trying to move and accomplish what they really believe is best for the profession. And I feel like we really have a group that shares common values at a really deep level. And it's just so exciting to see those people come together and be able to accomplish things because physical therapy is the best profession. Right? And so for us to be able to do things that can help us elevate our level of practice, get people to access us better. I mean that's the kinds of things that you know our association is trying to drive to do. And this is, this is a big part of that. This is the driving body in many ways.

Jenna Kantor:                04:59                Oh absolutely. That's honestly why I love the APTA personally. So for you, what past experiences greatly contributed for you being able to handle and take on this position? I would love to hear your journey.

Sue Griffin:                   05:12                I think a really formative part was when I served as the secretary of our state chapter in Wisconsin and I did that role for four years and you know, secretaries have to take minutes. And so, you know, you're in a meeting with maybe 12 or 15 people and that meeting is not run very strictly on Robert's rules of order. So, you know, there's a lot of discussion, which is really perfectly appropriate. But at some point, you know, I would find myself kind of listening and then I'd say is so is this what you're trying to say? No, I'd take notes and I help people craft motions and they're like, yeah, yeah, that's, that's what I want to say. That's good. So it really helped me learn how to listen to a lot of conversations and try to distill the essence of what people were trying to accomplish.

Sue Griffin:                   05:55                And that has served me very well because part of the speaker's role is to serve on a committee called the reference committee, which is a group that helps people guide and craft their emotions in a way that's specific. And so it's really helpful for that, but it's helpful when you're trying to facilitate a group of 400. You have to be able to listen and kind of hear and try to sense where people are going. Cause they kind of know where they want to go. They don't always know how to get there. So I think that really helped. But then, you know, early on I became a member of the National Association of Parliamentarians, which has a lot of great educational resources. So that's how I learned a lot about, more about the intricacies of Robert's rules. And I was really lucky that I got to serve for seven years.

Sue Griffin:                   06:39                So I'm from Wisconsin, and Illinois runs a state assembly like New York does. So I served as their parliamentarian for several years. And so, you know, again, I wasn't running the meeting, but I had to understand it. I had to prepare it, it had to help me learn how to anticipate when amendments might be coming, how would you handle them. And so it really taught me a lot about how to prepare for the meeting in a way because you never want to be surprised if you can avoid it. So I would say those are really the main things that helped me prepare for the speaker role in particular.

Jenna Kantor:                07:15                I love that because there's not one way. What are other jobs, as obviously from what you got to be part of was helpful, What are other jobs that you would recommend people try to be appropriate for your position?

Sue Griffin:                   07:34                I think anytime you can be in a position where you are responsible for facilitating, so certainly, you know, being a chapter president, but even, you know, running a committee meeting. So, I think those are good roles. There's a position on the board of directors called the Vice Speaker of the house. So that person becomes obviously intimately involved.

Jenna Kantor:                08:00                So going back to that question, so what jobs, aside from the ones that you just mentioned, would you recommend people could take on in order to be appropriate for your position if they were looking and going, oh, one day I'll be Sue Griffin.

Sue Griffin:                   08:19                Well probably one thing I should've mentioned that I didn’t and it's you really need to be a delegate to the house of delegates, right? I mean, I did that for 15 years at least. So they need to be a delegate and that really helps them, I think link into other, I mean, at least to help me link into other opportunities, either at the chapter or section level so that they can kind of figure out their path. But again, being a secretary I think is a really good role. Anything where they have to run a meeting so they could be like even a SIG chair or a, you know, a committee chair. It doesn't have to be president, but certainly being chapter president could help because you obviously have to run meetings. Being on the reference committee is phenomenal. I mean it gives you a great role. And then we also have another position on the board called the Vice Speaker of the house of delegates. And sometimes people who've been in the vice speaker wanted to go to speaker and sometimes they haven't. So I mean it's not obligatory of course. And it's not required to be vice speaker, but those are some other ideas or options I would say.

Jenna Kantor:                09:20                Awesome. I love that. And what motivated you to work specifically towards this position? Cause there's a lot of positions that make a great difference in the APTA. So what made you go this is the fit for me.

Sue Griffin:                   09:33                Yeah, that's actually the only one I've ever really wanted. And you know, my very first probably hour as delegate, you know, back in 1995, I just was captivated by the formality of the proceedings. I was captivated by how he managed everything and how he really helped people accomplish their work. And that was very appealing to me to be able to help people move forward and accomplish what they wanted to do.

Jenna Kantor:                10:01                What is something you have accomplished in this position that makes you so proud? There may be many.  I can see your brain going tick, tick, tick. Oh Gosh, there's a lot. But I would love to hear one or maybe a few that pop in your head.

Sue Griffin:                   10:14                Well, it's funny cause you know, I'm a Midwesterner so I can't be proud of myself for anything. You know, I can be proud of other people.

Jenna Kantor:                10:21                That counts, that counts. We're all in this together, so I would love to hear that.

Sue Griffin:                   10:25                I mean I'm really proud of how the delegates work really hard. Well first of all I guess I’ve been really honored because they really have put a lot of trust in me and so they have allowed me to help them enact procedures and activities that make the house more efficient. And so I'm really proud of how people who've been really entrenched in something that's really formal and very traditional laden had been really willing to change and to take on change and to try different things and procedures to see if we can improve. I feel like the association on the whole is like on the cusp of really bold things and so I'm really proud of being able to help the house as a major decision making body try to also change in ways that are kind of in lock step with that boldness. I'm really proud of all the work the house created for the first time in my knowledge, a special committee to do a complete revision of every single policy position, standard document guideline in our whole association, like 350 documents and they've done this over the course of two years. So I'm really proud of their work and again, how they've really elevated the level of work and function of the house. So that's pretty cool.

Jenna Kantor:                11:40                That is. That is, and you've been around for all of it to happen. I love that. What goals are you working towards now or goal that you are working on in your position to just up the ante. Make it even better.

Sue Griffin:                   11:52                I think it's just kind of that same thing right? Like trying to continue to move on with that progression, stay in with the boldness, we're all moving into our next century, right. As a profession and as an association. So I think again, you know, people don't come together and meet in the same way that they did 50 years ago and the house is 75 years old this year. That's very exciting. It's got a solid feel. So you know, we don't do these things, obviously nobody works the way they worked even 10 years ago. And people I think think differently and want to interact differently than maybe they did 10 or 20 years ago.

Sue Griffin:                   12:38                So in order for the house to be meaningful and be a way for people to make decisions, it has to allow processes that are comfortable to people in that they facilitate the way they're used to working together.

Jenna Kantor:                                        Oh yeah, absolutely. Final question. Why do you love the APTA?

Sue Griffin:                                           Oh Man. Cause I said, you know, this is the best profession ever. And to be able to come together with a group of like minded, passionate, brilliant people, to be able to, you know, move our profession forward and to get people to access physical therapy who really need it. There's nothing better.

Jenna Kantor:                                        Yeah. I couldn't agree more. Thank you so much for coming on and just sharing your passion and also helping people understand not only what you do, but if they want to be the next Sue Griffin, how they could do it. So thank you. Thank you. Thank you.

Sue Griffin:                                           Well, thank you for having me on and everybody should go be a delegate.



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


Feb 25, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Jenna Kantor guest hosts and interviews Phil Tygiel on bylaws within the APTA Private Practice Section.  Phil Tygiel, PT, MTC, is the PPS Bylaws Committee Chair.  The Bylaws Committee reviews, maintains, and updates the Section bylaws to meet the needs of the membership and the requirements specified in the guidelines set forth by APTA.

In this episode, we discuss:

-What information is contained within the bylaws

-The process for changing a bylaw

-The multiple avenues you can enact change within your professional associations

-And so much more!



PPS Member Bylaws


FOTO/NetHealth Outcomes Conference (use the code LITZY)


For more information on Phil:

Phil Tygiel, PT, MTC, is the PPS Bylaws Committee Chair.  The Bylaws Committee reviews, maintains, and updates the Section bylaws to meet the needs of the membership and the requirements specified in the guidelines set forth by APTA.

For more information on Jenna:

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


Read the full transcript below:

Jenna Kantor:                00:00                Hello, this is Jenna Kantor. I am here with Phil Tygiel who is the head of the bylaws committee for the APTA private practice section. So first of all, thank you so much for coming on to healthy, wealthy and smart to be interviewed. So I just wanted to do this podcast for people to get a better understanding of bylaws and their value and why it can be a long process for some, for change. You were actually, before we even started, you started to talk about how there is this rule where it's like this five year rule and I would love for you to go into that. Why there's a five year rule for change.

Phil Tygiel:                                            We're actually, that's for APTA, not for the private practice section.

Jenna Kantor:                                        Oh, okay. Okay. Oh, thank you. So there we go. It's something you already clarified. Thank you. So for the private practice section, is there some sort of rule like that?

Phil Tygiel:                    00:51                No, you can bring up bylaw changes anytime you want to. I always discourage it. I always say my job as chair of the bylaws committee is to put the bylaws in an envelope, seal the envelope and keep it sealed for the duration of the president's term. Bylaws are great. They outline rights, privileges and responsibilities, and they are not to be taken lightly or changed lightly. And very often people will come to me and say, we need this change in the bylaw. And when I look at what they want to do, they don't have to change the bylaws to do that. Bylaws, as you mentioned, are somewhat rigid and they're supposed to be, they're not easy to change. It requires prior notice to all of the members that you intend to change the bylaws. And the reason for that is you're changing their rights and privileges.

Phil Tygiel:                    01:41                They have a right to know that you're changing the rights and privileges. You have to have prior notice of at least 30 days prior to the meeting. And then there's debate and it takes a two thirds majority to change any bylaw. As I said many times, the board will come to me and say, I want to change this bylaw. And I usually try to discourage it and figure if there's ways to do what they want to do without changing them is all too often people run to the bylaws and we have to change this when actually the bylaws are pretty good. They don't need change. For instance, there was one year the board, I think it was the membership committee wanted to have lowered starter dues for new members and they wanted to change the bylaws. Biggest dues are outlined. The dues structure is outlined in the bylaws. But I looked at the bylaws though the board had the right to lower the fee but not raise it. So they didn't need a bylaw change to get that starter dues change in that case and discouraged it. And we didn't go in there and change the bylaws.

Jenna Kantor:                02:47                So you were saying that you guy’s meet and they have to submit it 30 days prior. So I'm wondering for the 30 days prior, like how often do you guys meet in general, so how many times would there be that opportunity for it to be heard and voted upon if it would get that far?

Phil Tygiel:                    03:07                Technically we have two meetings a year, one at the private practice section annual conference and I think they have one at CSM this year. I'm not even sure about that. So those are the only two times that you can change the bylaws. You do need a quorum at a meeting, which was a certain number of people have to be there. And usually the CSM of business meeting you don't have one. So pretty much the only time we tried to change the bylaws if needed is at the annual conference. As I said, the 30 days notice goes out and all of the discussion occurs at the business meeting when we vote yes.

Jenna Kantor:                03:46                How long have you been in this position, first of all. And then from your experience and all the years that you've been in this position, how many bylaws have you actually changed?

Phil Tygiel:                    04:00                Yeah, I think I've been doing it about 20 years now. Nobody else wants it. So I keep on getting recycled and in those years I think we've probably changed, made minor changes to the bylaws about five times. Don't ask me what those changes were. I put the envelope away.

Jenna Kantor:                04:23                So for you it doesn't sound like it makes much of a difference when these bylaws are changed that much because it really is set up pretty well already.

Phil Tygiel:                    04:33                I think they're pretty good. I mean they let members know what they're entitled to do, what the dues are going to be. If they have concerns how to raise those concerns. It tells them how often we have meetings. What prior notice we have for those meetings. It lays out the fiscal responsibilities of the board and all the board positions. So most of that doesn't have to be changed. It can stay where it is. Sometimes I've been in situations where one of the positions on the board has certain responsibilities that are assigned, like they're in charge of three committees and sometimes people want to put that in the bylaws that the vice president will be in charge of these committees. And that's usually a mistake because you'll change committee liaisonships based on the new personnel you have, you know, you're going to let new people every three years and you might have one person who's vice president who was very good on programming. So they will be liaison to the program committee. The next vice president might be much better off from communication. So they'd be the liaison to publications committee though, that type of thing. So you don't want certain things you don't want etched in stone and the bylaws, remember, if you make a mistake with the bylaws, it also takes a two thirds majority to correct that mistake. So sometimes bylaws mistakes stay in place for years and years. So again, you want to tread very lightly on changing them.

Jenna Kantor:                06:11                Well, I mean you were already saying that you're only meeting two times a year, so that already is a limitation on getting that two thirds majority vote. So I can definitely see how that could be impeding on change. No, I definitely have to be honest. From my perspective, this seems like a definite area where there might be room for change and my mindset, because I'm a new Grad, so I'm thinking, oh my gosh, this sounds so stagnant. Like there is not a set way to really make big, big changes. I would love for you to speak on where my brain is going and educate me.

Phil Tygiel:                    06:47                Oh, actually there's a way, there's lots of ways to make big, big changes that don't require bylaws changes. For instance, let's say there was direction that you wanted the private practice section to take, you wanted them to lobby congress to do something and you wanted to make that a priority. That's not a bylaws issue. You would show up at a business meeting and say, I move that the private practice section endorse this position. Okay. Now, first of all, it does not require prior notice. It only requires a majority vote, not a two thirds vote. And those are the more important things that most of us are concerned about. Which way we're going, what do we want to accomplish? Those things are not in the bylaws. What is in the bylaws is how you can do those things. The fact that you have to have these meetings, that you have the right to speak, that you have the right to vote, that you have the right to make motions. So that's a very, very fluid process. Also remember sometimes if you have a really good idea that nobody else thought about, you can go to the board and say to the board, hey, why doesn't the section do this? Same with your state association and all that. So you can just say, let's make this happen. And that can be done with the snap of a finger. So not being able to change the bylaws does not restrict what you want to accomplish. Does that make sense to you?

Jenna Kantor:                08:10                And then what you do as somebody is saying it's not in the bylaws, it doesn't allow it in the bylaws and then you can't find that it's in the bylaws. What is the professional way to handle that kind of communication with that individual that you're trying to work with?

Phil Tygiel:                    08:28                The first thing I usually do is ask what is it you are trying to accomplish? And I want to see if there's a way they can accomplish that without having to change the bylaws. If we find that they do need to change the bylaw to accomplish what they want to accomplish. Let's say they want to add two new people to the board of directors, that would require a bylaws change. We would then draft a motion and to change the bylaws by changing this section on the board of directors by adding two positions.  The executive board would look at it and see if they approved it, which they don't have to do. Membership has priority over leadership. We should always keep in mind that the pyramid is inverted. Membership is on top president is way at the bottom.

Phil Tygiel:                    09:22                So the membership has the right to do what they want to. So anyway, then we would draft the bylaw in the case of APTA sections, chapters, any bylaws change that the section has, has to be in keeping with the bylaws of APTA. So we'd run it by APTA to make sure it's not in violation of anything that APTA wants to do or says you have to do. For instance, let's say we wanted a bylaw change that would prevent life members from being members of the section. I don't know why anybody would want to do that, but the APTA would look at that and say, you can't do that. That's a violation of the APTA bylaws. So we do have that higher authority anyway. If the bylaws are keeping with what the APTA will allow we would publish it to the membership and probably in Impact or maybe online saying we will be voting on this bylaw at the next meeting.

Phil Tygiel:                    10:31                Next meeting comes and the bylaw is moved. And someone has to say it and then there's debate and then they call for a vote. Since you need a two thirds majority with a standing vote, it's carried if it's not clear with standing vote, but it could be close, you do a roll call vote where everybody stands up and counts off. And if you don't get your two thirds, you don't get the bylaws. And it's important to remember what I said originally. The bylaw protects your rights and privileges as do Robert's rules of order. So even if there’s a fairly hefty majority that feels that their rights and privileges of being violated, they have a right to say we're not going to let you pass this.

Jenna Kantor:                11:21                I like how you connected it back to the APTA because they are the Higher umbrella organization if you will, of the private practice section. And this actually can segway into what I was mixing up at the beginning of this interview. So if you wanted to make a change but it didn't go in accordance with the APTA bylaws, now this is where they have the time limit on how often?

Phil Tygiel:                    11:47                Yes. It got to be a nuisance of people would come in with requiring bylaws changes every year and many of them were really not necessary, but they are very time consuming to debate. So many years ago, and don't ask me how long ago it was moved and seconded and passed that it's in the bylaws that you can only have bylaws amendments every five years I think it is with the APTA and that goes through the house of delegates which is a completely different process membership doesn't vote, your delegates do. That can be bypassed. It requires a two thirds vote just to hear the bylaws if you want to do it in an off bylaw year. So it got rid of some of that cumbersome activity that really wasn't necessary.

Jenna Kantor:                12:38                No, it's good. It's really good to hear your perspective and just gain a better understanding of how well put together everything already is and why it may not be the fastest for the change, but there's a big reason for that. So thank you so much Phil, for coming on to just share your knowledge. So people who are looking for change, they may not necessarily, well now they know they may not necessarily need to go to you to find out about how to change the bylaws. They are actually still a lot of opportunities to get it done elsewhere. So thank you so much.

Phil Tygiel:                    13:10                My pleasure. I think the main messages that the association, whether it's private practice section, or any other section, belongs to the membership and they have rights and privileges. They can make change and sometimes the change comes from a single person with a new idea and sometimes that new ideas violently objected to by people in leadership, people who have been there forever. But there is a mechanism to be heard. There is a mechanism to make change and advance and we do very well with it. Sometimes, a good idea, it takes three or four years to pass. But that's not because of the system. It's just cause it took you that long to get people to understand what you were trying to do. That's not necessarily bad.

Jenna Kantor:                13:50                That's good. And I love that. I like how it really does revolve around membership because we are all in this together. And for us to just come forward with an idea, thinking, oh, I'm right, I'm right, I'm right. That's not how it works in a community at all. So thank you. Thank you so much.

Phil Tygiel:                    14:04                Thank you.



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


Feb 18, 2019

LIVE from the Combined Sections Meeting in Washington DC, I welcome Dr. Mike Pascoe on the show to discuss the use of social media to disseminate physical therapy educational resources.  Mike Pascoe, PhD, is a neurophysiologist and assistant professor in the physical therapy program at University of Colorado.  His scholarly efforts center around the investigation of constructivist approaches in technology-enabled learning environments (e.g., wiki usage, interactive modules, cadaver skin examination, etc..) to improve learning outcomes and student satisfaction in anatomy courses.

In this episode, we discuss:

-Research highlights in the field of cadaver anatomy

-How Mike utilizes social media and live blogging during his anatomy courses

-How the Anatomical Board serves anatomy educational goals in Colorado

-Cognitive principles of learning for success in PT school

-And so much more!



#APTACSM Twitter

Mike Pascoe Twitter

Mike Pascoe Website 

Mike Pascoe Snapchat

TedxBoulder - Mike Pascoe - The Ultimate Gift - Donating your Body to Science

Learning Scientists Website



For more information on Mike:

Mike received his PhD in neurophysiology from the University of Colorado (Boulder) in Dec 2010. He then joined the faculty of the Physical Therapy Program in the School of Medicine at the University of Colorado, Anschutz Medical Campus. He teaches clinical anatomy and in his spare time loves hanging out with his wife Stephanie and their dog Maia.







Read the full transcript below:

Karen Litzy:                   00:01                Hey everybody, this is your host, Karen Litzy and we are coming to you live from the combined sections meeting in Washington DC. And I have the pleasure of once again seeing assistant professor Mike Pascoe. I saw him late last year in Denver. So Mike, Welcome to the podcast. Thank you for coming on.

Mike Pascoe:                00:18                It's my pleasure. Thanks for having me.

Karen Litzy:                   00:20                All right, so we read your bio, but what I would love to hear from you is a little bit more about yourself so the listeners kind of know where you're coming from and what we have in store for our talk today.

Mike Pascoe:                00:32                Yeah, let me give you some things about myself that I really just drive who I am and what I do. So I am a Colorado native, so there's just a lot of fun things to do in Colorado and I've managed to stay in a really awesome place. And so there's a lot of fun to have there and a lot of that fun I have with my family. So I'm married to Stephanie Pascoe, she's a PT, so she's the clinical half of the marriage. And so we liked doing a lot of things together and we like keeping our two daughters busy as well. So very family driven and we've got a lot of fun with a five year old and a three year old girls. So I like to bill myself as a minority in a sorority. That's what things look like around my house. Lots of pink and yeah, so I basically am here at CSM with Stephanie and we both get to go do our own things and check out the various different talks, different posters, different presentations. And I've been able to come to CSM since I started at CU in 2011 so yeah, it's been a great conference. Great to catch up with old friends and make some new ones.

Karen Litzy:                   01:36                And so today we're only on day one of the conference, but have you gone to any lectures or any poster presentations that really stand out in your mind?

Mike Pascoe:                01:45                Yeah, I really wanted to see what Chad Cook and others had to say about predatory publishing. So that was very informative. I'm aware of the concept and fortunately have not fallen prey myself, but it was good to just see the numbers and how big of a problem in this, you could, you could call it an epidemic. So

Karen Litzy:                   02:03                Yeah, package that really well. Predatory journals, predatory conferences, things like that. I mean it's a thing and people fall for it.

Mike Pascoe:                02:11                Yeah, they said that the analogy is everyone's got a rich relative in Africa that just died and wants to offer you $1 billion. So it's a new spin on that old email tactic.

Karen Litzy:                   02:23                Exactly, exactly. And it's unfortunate. It's unfortunate, but hopefully they're chorus kind of gave you a little bit of insight on what to watch out.

Mike Pascoe:                02:33                Yeah. If you go onto Twitter, which if you're not on Twitter, then I don't know what's going on. It's the best way to find out what's going on, at the conference. Great #APTACSM. And that's where a lot of us are sharing the real pearls from the session. So there's a lot to catch up on there. But then following that was a real exciting meeting of special interest group with the Academy of physical therapy education. Then that's the anatomy educators special interest group. So that grew last year was the first year there were maybe 50 of us and now there's 133 so we're really growing a nice base and we're really starting to cut our teeth on what we wanted to find and how we want to really enhance PT education specifically in the anatomy domain.

Karen Litzy:                   03:16                Great. So now let's talk about that. So let's talk about your teaching background and what you’re doing over there at the University of Colorado medical campus.

Mike Pascoe:                03:27                Yeah, so about 80% of my time on campus in my role is as a teacher. So I'm really striving for excellence there. And basically I started in 2011 they hired me with very little teaching experience at the professional level, but I really had a passion for teaching undergraduate students when I was a graduate ta. So that's where I first fell in love with teaching anatomy. And then I got on board with CUPT and I teach PT anatomy. That's my main role. About 50% of my job is designing and delivering the content for the PT students. But I've also been able to extend into the physician assistant and a medical student anatomy courses. So that keeps me pretty busy. It's a lot of gross anatomy. It's a lecture in the morning and then going into the lab in the afternoon and looking at the cadaver donors.

Karen Litzy:                   04:17                I remember those days.

Mike Pascoe:                04:20                I'm telling Ya, it's the most memorable and favorite course of all PT students

Karen Litzy:                   04:26                It actually was my favorite course and I firmly believe every human being should take gross anatomy because you should know what's going on in your body.

Mike Pascoe:                04:35                You should know how the equipment operates. And there's some real good research out there and you know, a lot of people can identify where the heart is, but you ask them where the liver is and that's where we need a little bit of improvement.

Karen Litzy:                   04:46                Absolutely. So now outside of teaching, what other things are you working on? Any kind of research?

Mike Pascoe:                04:53                Absolutely. And you know what I've learned from all the excellent mentoring I've had in my role is that you should really cover your basis. It should really be optimized in what you're doing with your research as an educator. So what you do is you do education scholarships. So I walked away from bench research and neurophysiology and now my laboratory is the classroom. So I do educational research. It's every bit as rigorous as looking through a microscope and you know, modifying genes in a lab. But basically the students are my subjects and I will take an idea that I think is going to be a way to improve my anatomy, teaching, design a protocol, get my IRB approval, collect the data, get some graduate students under my mentorship to help run through the project. Sometimes we find a positive result and sometimes we don't, but we send those results out anyway and I've been able to get some projects out the door.

Mike Pascoe:                05:46                Just a couple of highlights. There's a type of photography called light field photography, so that's been really interesting to see how you could change the focal point of a cadaver photo after the photo's been taken. Lot of anatomy clustered together, so it's often hard to get everything in focus so that gets around that. But also publishing on students using a Wiki to organize their study materials and why blogging. Actually I got to do a lot of live blogging, have a PT conference and we surveyed the people using a viewing the coverage and they really had positive rankings and satisfaction with the coverage. So I'm really promoting that and hoping that more PT conference organizers jump on top of that. It's a compliment to Twitter.

Karen Litzy:                   06:31                So how were you live blogging and how is that different? I was going to ask is that, what kind of platform is that?

Mike Pascoe:                06:37                Yeah, we use a platform called cover it live. They're still out there. No conflict of interest, no disclosure, no relation, but basically what you do with live blogging as you can really issue more of a transcript of what's going on there. No character limits. Like Twitter, Twitter is usually more about the bite size pieces, but a live blogging is much more of a script and you can really capture a lot. You can integrate photos. And what's been really fun is to capture the question and answer session part of the session. People really rated that as a really good feature of live blogging.

Karen Litzy:                   07:11                So you pretty much have to know how to type well to do that.

Mike Pascoe:                07:14                Right.

Karen Litzy:                   07:16                Because for someone like me who has to look at the keys at the same time, cause I never learned how to type. Yeah, that would be my problem.

Mike Pascoe:                07:23                Hunting and pecking is hard, but the bigger skill is contextualization and knowing your audience. And it was real good for me to learn about how to interpret what a physical therapist was saying about a whiplash and the anatomy of neck muscles and how that can be put together so that way a PT audience would benefit the most. So yeah, that's a big skill as well.

Karen Litzy:                   07:47                That's awesome. I've never heard of that. I mean I don't think I can do it because like I said, I can't really type, but I love the fact that it's long form. And so if I wanted to, if, if I wanted to watch you do this, how do you, how do you do that Mike as not for you as a person blogging but as the consumer.

Mike Pascoe:                08:09                So we have to get a marketing campaign out there. And what we ended up doing was just promoting the link to the webpage through social media. So fortunately people are very aware of that conference has come with their own hashtags and people are having conversations around the conference leading up to the conference. So we took advantage of that. Now we would just publish in advance, these are the sessions Mike is going to be covering. So come back this day at this time for the live coverage. The real beauty of this platform too, as you can play them back, well you don't play them back, you, you scroll through a timeline and you get to look at the content that way. So it was really rewarding to know that you're helping people real time, but for the busy clinician that can't step of treating patients at 2:00 PM that could come in and look at it later. That's really good.

Karen Litzy:                   08:59                Sounds great. So aside from being a little more innovative in your teaching and in academia, in education, which obviously, is a must these days. What else are you doing as your role at CU or your role as an educator?

Mike Pascoe:                09:19                So another real cool role that I took over about a year ago was, it's an administrative role, but it's for the state, Anatomical Board of Colorado. I serve as the secretary treasurer. And so I oversee the day to day operations at the anatomical board. And basically this is still educational because what we do with the anatomical board, our big mission is to serve the educational goals of anatomy education in the state of Colorado. So think of every health care profession program, PT, OT, MD, dental graduate programs. Whenever a program would like to use a donor for an educational resource, they approach us, they make a request, we take a look at how many donors we have available. And we're very fortunate in Colorado that we have a very large donor pool, a large donor base, and I help assign the donors. And so indirectly I'm able to impact thousands of students a year with anatomy education simply by facilitating the use of cadaver dissection.

Karen Litzy:                   10:21                That's awesome. Very cool. I often wondered how that worked now, well at least now I know how it works in Colorado. So you had mentioned earlier the use of social media. So if people are listening to this and they're not familiar with you, I obviously suggest following you on social media, but how has your use of social media impacted the way that you teach and the way that you sort of view education in physical therapy?

Mike Pascoe:                10:51                Yeah, so I incorporate social media into my teaching directly and indirectly. So directly I have recognized that there's a real power behind this, this cognitive psychological principle called retrieval practice. So any way you can get your students to practice retrieving information without the learning materials in front of them, they're going to benefit. Studies have shown that for decades. So how am I going to, aside from doing like the polling audience response system, how can I really get their attention? And I found what's really successful is to use social media and people are doing Twitter, people are doing Instagram, but students really pay the most attention to content on snapchat. And if you're not familiar with snapchat, the thing that makes it different, what sets it apart is that the content disappears after 24 hours. So when you're doing retrieval practice, you don't need it necessarily for the student to preserve the questions and answers.

Mike Pascoe:                11:49                They just need practice interacting with the content that goes away. And they know this. So there's something about the way the brain is wired and the brain pays more attention to ephemeral content so they know it's going to go away. And so I, I push out questions during the semester and they get the question, they get the answer later. So it's great for the students, but it's great for me, the educator I found with Twitter and Instagram, it really took so much time, to perfectly create the right content. But everybody on snapchat understands that it's raw, it's unedited and it's uncurated. So as long as I put the correct information out there, it's quality enough. So it's very quick. It's very rapid. And every time the students find out that I run in anatomy related snapchat account, they can't believe it. At first they’re in disbelief like what's going on.

Mike Pascoe:                12:38                But once I convinced them that this is educationally based on sound pedagogy, they're onboard. And then I'll have a break from it and they'll bug me. We need more snaps. Pascoe put some more content out there. So if you want to check out what I'm talking about, the handle, the username on snapchat is anatomy snap. I'm all one continuous word and I'm telling you, it's been really exciting. I collected data this summer. I'm looking at the data now and hoping to see, number one, if students found it satisfactory, but number two, how did their exam scores look? They could have been the same. They could have been worse, it could have been better. The exciting thing is I've learned how to put a protocol together that will allow me to level up beyond satisfaction. And did your learning change has your knowledge base change? So stay tuned for that publication.

Karen Litzy:                   13:28                Awesome. And now can you give an example of some of your snaps? So yeah, give me a couple of examples so that people kind of get an idea of what you mean. Like what do you mean you're putting stuff out for anatomy? Like just taking a picture of like a muscle or dissected bodies. So give me an example, but before you do well give me an example for us then I have another question.

Mike Pascoe:                13:53                Yeah, no, it's good to leverage it. Leverage the principles, you can get retrieval practice and you can also get leverage examples and just to like real life examples. So you're at a table, you're just going through the upper extremity anatomy and you're between lectures or whatever you're doing as an educator. Put your hand on the table and elevate your thumb and get the extensor pollicis longus tendon to pop up. Take a picture, add text. What tendon end do you see here? Drawn Arrow. Then you can take it further. Just keep building, keep elaborating. What's the line of inquiry that the student would go through? How would you go through this at the cadaver? What anatomical region does this tendon define? Anatomical snuffbox? The next snap question is now what structures as a physical therapist are you most interested in finding in the stock box? So then you could go through that. You can step through a very sequential Socratic series of snaps, and then you can say, okay, everybody send me a snap of your snuffbox if you so choose. They'll usually do this without solicitation. But that's an example.

Karen Litzy:                   14:59                So I think that's great and it actually leads perfectly into my next question is, are you creating a curriculum for your snaps or is it just off the cuff?

Mike Pascoe:                15:10                You know, I'm very mindful and aware that doing things intentionally is the best way to go. So what I did for the summer is I did focus my snaps on a specific aspect of anatomy in the course and that was blood flow diagrams. So I do look at my learning objectives and those informed my teaching methods. So these snaps, although they seem frivolous and accessory, what they really do is there a direct extension of being able to describe the path that blood takes from the left ventricle to a distant site in the body. So it is very informed. It's very intentional, it's in the curriculum, but you have to be mindful that not all students are going to go there. It has to remain optional. I do not think it's appropriate to push your students into social media. There's a lot of valid reasons students don't want to go there, but for the ones that are there, I've found it's 90 to 95% of the students. And you know what? It's a great way to role model and show them how to be professor professional and how to use social media in an appropriate way. That's beyond tearing down somebody's beliefs and ideals.

Karen Litzy:                   16:16                Well said. So there is a method to your madness is what you're saying. There is not, it's not random like, oh, I stub my toe today, I know I'm going to do something on the foot.

Mike Pascoe:                16:28                Yeah, exactly. It's intentional and yeah, it's been out for so long that it's just time that everybody had a good understanding of how to use it appropriately and then how we can really think about incorporating it into education.

Karen Litzy:                   16:40                I think that's a great way to incorporate into education and hopefully people listening to this will now follow anatomySnap. No S. I follow you on snapchat and I can say that it's really interesting. It's really interesting even as a, a more quote unquote seasoned PT because I feel like you can never have too much anatomy. That's so great. Now, anything else that you're doing that's kind of outside of the box with your students or even without your students as far as furthering your education?

Mike Pascoe:                17:16                I think that another thing to bring up here is how there's a real need for physical therapists that are anatomy instructors to understand what is needed to know and what is nice to know. So that's my second area of work. The first area is the technology integration, but I've really developed some nice ways to look at what do anatomist that teach physical therapy students need to teach their students. So I'm just looking at the data now, but I recently put out a survey to about 200 people in the, that our stakeholders for the physical therapy programs, talking faculty, clinical instructors, recent graduates, the two most recent classes. Do you and your opinion think that in your practice you need to name all 10 bronco pulmonary segments of the lung? That was an example of an objective for which most people rated. No.

Mike Pascoe:                18:11                Like that is not essential. So I take that feedback and I improve my curriculum. On the other hand, should a PT student be able to know name every spinal segment that is serving a muscle, the myotomal innovation and most people, the majority came back saying, yes, that's neat to know. So it's been really nice not being a PT to survey a wide base of people. The next step is going to be to survey the community at large to kind of level up the methodology, get a consensus document together and then present that to the educators in the PT Community.

Karen Litzy:                   18:49                Great. Well it sounds to me like you're up to some really fun stuff and I look forward to touching base again when you have a lot of this data together and you're ready to present. So is there anything that we didn't touch on?

Mike Pascoe:                19:03                Well, Gosh, let's see here. Anything else? I guess if you're really interested in body donation, it's often, it's often confused with my driver's license has a heart.

Mike Pascoe:                19:17                But that's organ donation and that's totally separate. You do need to opt into whole body donation. And I go through this concept in a six minute ted talk and basically if you, if you just search youtube for Pascoe Ted x, you'll find a nice little talk I was able to put together for Tedx Boulder in Colorado and just kind of let people know what body donation is all about. And the title of the talk is the ultimate gift because we have extreme gratitude to the individuals that make this choice to, to give us the ultimate gift, the body that has served them all of their life. And now we'll go on to serve health care professionals as they work toward being able to take care of, to treat those patients.

Karen Litzy:                   20:04                I love it. So everyone, don't worry, we will have links to everything on the show notes under this episode. So before we wrap things up, I have one more question. Given where you are now in your life and in your career, what advice would you give to yourself as a new Grad or to your students? Like when you were a student, what advice would you give to yourself?

Mike Pascoe:                20:40                So there's two I want to give you. One is more like the life side of things and learning to say no, I had definitely gotten myself in trouble. Okay. So I'm super passionate about teaching and every time I was approached with a teaching opportunity I rationalized how I could make it work and I trick myself and I got way overloaded with teaching. So I would go back to, you know, 27 year old Mike. Like you're going to have a lot of opportunities, but there's a, there's a tactful way to say no. And even though that time may not be the right time, things do cycle back around, you'll get another pass at it if it was meant to be. And then the other more practical. For those of you that are PT students, those of you that are looking at getting into PT school, you have to look at your study techniques.

Mike Pascoe:                21:27                So I've totally revolutionized the way I do office hours. When students come in and they've had a bad performance on an anatomy exam and they say, I don't understand, I studied so much, I blow a whistle and I throw a yellow flag on the ground and I say, hold up. The penalty on the field is quantity does not equal good learning. So you have to look at these psychological, cognitive principles of learning and what got you through in Undergrad will not get you through in PT school. The volume is too much. So in the show notes, I'll give you a link to a really excellent website that summarizes these key principles of learning and you've got to look at your study habits. Then you've got to be prepared to change them. Otherwise you're in for a really painful and arduous path through your physical therapy curriculum, in other programs that you might be pursuing.

Karen Litzy:                   22:20                Amazing advice. Thank you so much. What's the name of the website?

Mike Pascoe:                22:24                So the name of the website is a learning scientist. And I believe if you just Google learning scientists, you're gonna find a website that has principles of effective learning.

Karen Litzy:                   22:36                Thank you so much for sharing that. And I'm sure the students and myself will greatly benefit from that. So thank you. And now where can people find you on Twitter? We know where they can find you on snapchat. How about Twitter?

Mike Pascoe:                22:49                Yeah, go ahead and look for me @mpascoe. You know what, if you're looking at the Hashtag for the conference, I'm tweeting up a storm here, so that will be a good place to catch some of my contributions and go from there.

Karen Litzy:                   23:05                Awesome. Well Mike, thank you so much for taking the time out at CSM where we, everybody's busy. I get it. We're all busy. So I really appreciate you for taking the time out coming on the podcast and sharing all this great info. So thank you so much.

Mike Pascoe:                23:19                Yeah, my privilege and thanks to you, Karen, for getting everyone together and being a vessel for getting this information out.

Karen Litzy:                   23:25                Thank you very much. And to all the listeners, have a great couple of days and stay healthy, wealthy, and smart.



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


Feb 14, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Shayla Swanson on her company, Sauce.  Sauce was founded by a former Canadian national team cross country skier as a way to support her ski racing. Sauce founder, Shayla Swanson, was frustrated with traditional winter headwear that she found to be too hot, too itchy & too ugly. An avid sewer, Shayla set out to create functional, stylish and comfortable products that met the needs of elite athletes and outdoor enthusiasts alike.

In this episode, we discuss:

-The story behind the beginnings of Sauce

-How Sauce tailors and personalizes their products from Bozeman

-What is in the future for Sauce

-Shayla’s advice for female entrepreneurs

-And so much more!



Shannon Sepulveda Website

Shannon Sepulveda Facebook

20% off with code “hws19” on: Sauce Website

Sauce Facebook

Sauce Instagram


For more information on Sauce:

Sauce was founded by Shayla Swanson, a former Canadian national team cross country skier as a way to support her ski racing. Sauce founder, Shayla Swanson, was frustrated with traditional winter headwear that she found to be too hot, too itchy & too ugly. An avid sewer, Shayla set out to create functional, stylish and comfortable products that met the needs of elite athletes and outdoor enthusiasts alike.


Sauce started as a hobby for Shayla while she was ski racing and working through her degree in Exercise Science from Montana State University. She began selling Swift Toques to teams and clubs who wanted a custom item for their group. The product line evolved from there, and soon saw the additions of the Swift Headband, Ventilator Headband, and the fleece-lined Chill Toque. After several exciting seasons of ski racing full-time and a near Olympic team miss in 2010, Shayla decided to jump into Sauce full time, putting 100% of her enthusiasm and effort into the entrepreneurial venture.


Commitment to pursuing one’s goals, a strong belief in one’s own potential, and using constructive evaluation for growth, are all important ingredients for a successful athletic career. While skiing and sewing hats are not the same, it turns out that those behaviors are also the key to making it as an entrepreneur. The lessons learned in Shayla’s ski career have helped her navigate the business world and grow Sauce into a company with distribution across North America and beyond.


For more information on Shannon:

Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.


Read the full transcript below:

Shannon Sepulveda:      00:00                Hello and welcome to the healthy wealthy and smart podcast. I am your guest host, Shannon Sepulveda and I am here with Shayla Swanson. Can you tell us a bit about who you are and what you do?

Shayla Swanson:                                   My name is Shayla Swanson. As you said, I am the owner of a company called Sauce and we specialize in headwear and select apparel pieces for endurance athletes. My background is in Nordic ski racing. So I spent my teens and twenties training really hard to try to make the Olympics in cross country skiing. I didn't quite, but I got close and I got to do some really amazing things. The other thing is that I was always a sewing nerd and I love to sew and make clothing. So I began making headwear for my ski team and other ski teams. In the early two thousands, we found that most of the headwear we were given was really hot, too itchy, really ugly.

Shayla Swanson:           01:02                And so we set out to kind of fix that situation and things moved from being kind of a hobby or an accidental business and to being a real business. So that was pretty exciting.

Shannon Sepulveda:                              Take us from your competitive Nordic ski days to just like why you started the company, where it was, what you did, like the start of the company.

Shayla Swanson:                                   The start of the company was really just me talking to a couple of teammates saying, hey, I have this idea, let's make some hats and try to sell them to stores and then we can make a little money to help support some of our ski racing. And I had at that point made maybe a couple of orders for local ski clubs and then realized I didn't like sewing that well. So I got some people to help me.  My tolerance was about two CD's worth of sewing.

Shayla Swanson:           01:59                Like I would listen to two albums and then I was, I was done but that didn't get me very many in the grand scheme. So these teammates of mine said, yeah, we'll help. And we basically devoted a weekend to cutting and sewing and making hats to try to sell to some of the local stores and our connections in the ski world helped us. So they said, yeah, we'll put these in our store and put a little tag on them that says the proceeds benefit you guys. And so that was kind of your one. And then from there things changed and you know, some of my teammates weren't interested anymore and they didn't like sewing all that well either. And so we basically, from there it was kind of me and one of the teammates, my friend Rhonda, that continued on with the business.

Shayla Swanson:           02:49                So Rhonda and I started turning things into a little bit more of an actual operation where we would create a catalog and send out to stores and actually try to sell at wholesale. We also had a custom program that we offered to teams and clubs and events. And amazingly enough, it kind of, it worked. So that was in 2000 probably, that was from like about 2003 until 2008 and all that time we were operating under the name SOS headwear and the name SOS came from a blog that I had and my blog was where I updated results and stuff that I was doing skiing and it stood for Shayla on Skis. So we were at SOS headwear, and then in I think it was 2009 that we decided to kind of rebrand and there was a nice little phonetic connection between SOS, which you know, is phonetically pronounce sauce and then the brand name sauce, which is the topping that you use to spice something up.

Shayla Swanson:           03:54                And so we thought that are colorful, boldly patterned headwear that kind of worked. It still confuses people and I get email solicitations from India, but that's kind of where the name came from. 2009, we started operating under the brand name Sauce.  Rhonda and I were both still ski racing, trying to make the 2010 Olympics in Vancouver. Unfortunately neither of us were successful in that, although we both got really close and she knew at that point she wanted to go and work in a different field. So at that point she kind of left the business and I carried on and I started attending trade shows and actually trying to sell some product. So I would say the start of the official like 100% effort toward the business started in 2010. And it's been quite a rollercoaster ride of fun since then.

Shannon Sepulveda:      04:50                That's awesome. So I should say to our listeners, for those of you who are not familiar with Sauce headwear, if you can picture a kind of like a workout hat and really, really fun prints, that's how I would probably describe Sauce Headwear I know this podcast is based in New York and we were in Bozeman, Montana. But whenever I wear my Sauce hats in Manhattan, I always get comments like, people love them. They're like, where did you get that? And I was like, I'm going to try to get Shayla to get these in the stores in Manhattan. But I was running in central park with all my Sauce stuff and I always got compliments because they're just kind of fun. They're not muted in any way.  I did not grow up Nordic skiing because I grew up in New York, but, I did not know that.

Shannon Sepulveda:      05:43                I feel like the Nordic see culture is kind of fun in that sense. Like they tend to wear really bright, fun colors. And so that's kind of what Sauce headwear looks like. And you now, not just, you don't just make hats. Now you make other things. So why don't you tell us about branching out from hats?

Shayla Swanson:                                   We are not trying to be a huge apparel line. What I think our sweet spot is and has been, is bringing a product to the market that we think we can do a better job at, I guess do something a little different that isn't out there and really focused on kind of our elements of like making stuff that's just right, warm, really comfortable and easy to wear and you know, brightly patterned and really pretty. So we make a couple of leg where styles, one of them that I think is our most unique and really applicable to our female athlete audience is our flurry tight.

Shayla Swanson:           06:45                We've put some fleece lining on the quad and also sections of the butt where you get cold in the winter. Those are the two areas where, you know, you come in from a winter run or a winter ski and you think, Oh, I'm freezing on my butt and on my quad. So what we did was we left the rest of the tight unlined cause those areas stay pretty warm and I'm just focused on those spots. So, that's an example I guess of one of our apparel pieces. And we also do like a winter skirt and we have a summer product line that includes some tights and a tank top. And then also another product that I think I liked this one because of the name, we call it the cheeky retreat. So what it is just a nice skirt to cover up your tush if you really don't want it on display. Anyway, that's some of our other stuff.

Shannon Sepulveda:      07:29                I bet you that skirt would be really good for like changing out of your bathing suit, like on the side of a river wherever you are.

Shayla Swanson:                                   Yeah, it's an excellent, it's a great little coverup.

Shannon Sepulveda:                              Yeah, it keeps things hidden while you want to change underneath. It works out really well for that. And I have tried the flurry tights. I loved them because yes, when you're a female and you run your butt gets cold and your thighs get cold and everything else does not. So it's really nice to have, you know, your calves can breath.  What Shayla does is also takes her hat patterns and creates leggings out of them.

Shannon Sepulveda:      08:22                So they're just the really fun colors. And why don't you tell us a bit about like your custom program, because I know at least for most of the races in Bozeman and probably Missoula and probably Canada to lots of light, lots of places, in our race bags we get Sauce hats or headbands that have a logo of whatever the races generally which are awesome. So why don't you tell us a bit about that custom program?

Shayla Swanson:                                   One of the really great business avenues that we sort of happened upon by accident was custom headwear for teams, clubs and events. We do two different options for custom. One is we take our stock product, so all of the hats and head bands that we have in stock and we add a logo to them. So we call that are basic custom program.

Shayla Swanson:           09:16                And it's really great cause that allows we can do orders as few as 12 and it's really relatively inexpensive and it’s kind of a nice option for people. And then we also do what we call our full custom program. And that involves working with a customer to put a design together that is totally unique to their event or their store. We’ve outfitted orders that are like just an event order, but we've also gone as big as working with the whole, Canadian Jack Rabbit program, which is a youth scaly program in Canada that has over 10,000 kids in it. And they submitted drawing ideas to us and we held a contest to see who liked, you know, which design idea they liked best. And then we turned that little kids designed into a hat pattern and outfitted the whole country's youth programs. So that was pretty exciting for us. We currently don't do that order anymore because they have a sponsor that outbid us, but we loved it. It was awesome. Sometimes we have worked with, currently all of our product is sewn in our facility in Bozeman. In the past we have worked with manufacturers based in Los Angeles to help us out with orders that we couldn't quite handle on her own.

Shayla Swanson:           10:36                So the nice thing about it though is that with the options that we have, we can accommodate, you know, we can really be, you know, cottage industry and do something really small and unique for a small customer. And then we can also access those other avenues to produce larger orders for big groups. So it's kind of fun.

Shannon Sepulveda:      10:54                So along those lines, why don't you tell us about like your manufacturing, cause I think you do everything in Bozeman, right? Which is really awesome. So tell us a bit about that.

Shayla Swanson:                                   Sure. Initially when we started doing this, I did not really contemplate the idea of doing all of the sewing in house. I was kind of content working with the manufacturer. But then we started just running into situations where you get a batch of hats back that weren't quite right. Or you know, you wouldn't be able to tweak a sizing concern until you already, you know, had placed your order with this group. And anyway, we just were running into all these situations where I thought, man, it'd be awesome if we could just make this stuff here. And so I bought some industrial sewing machines.

Shayla Swanson:           11:41                Industrial sewing machines are interesting because they only do one thing. So unlike a home sewing machine that can do a bunch of different stitches in a programmed, you know, design, basically industrial machines only do one thing. So in order to make our products, we have four different machines that are able to do all the stitch patterns that we use in our stuff. And yeah, I was lucky enough to find some amazing sewers so, Bozeman is a funny little space in the world of manufacturing because we have several different companies that are much larger than we are, but they make all of their product here. So there's this weird little, like sims makes their waders here and mystery ranch backpacks. So we have access to are sewers in town who are, who are really skilled at what they do.

Shayla Swanson:           12:28                And I was lucky enough to actually hire on three former sims employees, sorry. Sims. And they've been awesome. So they love it. They are given super flexible work hours. They do what works for them and they just sit around the machines and laugh and talk and have a great time and they make all of our stuff and they're really fast and good at it. So it's really fun. We have rolls and rolls of fabric and the corner of our space, we have a big cutting table. We use a big upright solid to cut all the patterns out. We're able to, you know, make small adjustments to sizing on the spot, you know, which is really great.  And then they just sewed them up, finish them up, keep them in our inventory space where our office is basically a large garage. So it's not pretty, but it works really well for our purposes. And it's just really fun to think that of all of the love that goes into each thing that we ship out the door.

Shannon Sepulveda:      13:32                So I want to know how you create your patterns. And how you get that fabric made because you have fun new patterns every year. And I didn't know if that was like your brainchild or if it's a couple people's brainchild or if it's the company's brainchild or how you pick what pattern you'd like.

Shayla Swanson:                                   Yeah. So it's not all me, that's for sure. There are trending reports that come out for the outdoor industry and I don't think they're as important in the outdoor industry as they are in, you know, the fashion industry. But, but what will happen is, a couple of companies come out with these trending reports that, that show you kind of what colors they think are going to be on trend for the upcoming season. And then what we do is we are an accessory piece.

Shayla Swanson:           14:24                And so really we don't need to follow, we don't need to create our own trends, but we need to kind of follow what the other brands are doing. So if we see a company if the trending reports are coming out that, you know, really muted colors are, are going to be more prevalent than we want to try to offer some of those colors in our prints and patterns so that we can match your jacket from say Patagonia or something like that. So what we do is we just tried to I work a couple of different graphic designers who specialize in textile design and they'd come up with some concepts based on textile trends as well as color trends. And then we put that all together to try to make our line a really nice, complete offering to people cause you also want to make sure, you know, we want to make sure that if somebody loves pink, they can find a little pink in one of our hats.

Shayla Swanson:           15:11                So we try to make sure kind of every main color is offered as well. So it's something between the science and art, I guess it's not all just creative energy going into that. We have to also look at some of the other factors and figure out where we fit in the mix. It's pretty fun and exciting. I wish I, I can't, I'm not as adept to the graphic design part of things. So I don't do a lot of the actual design, but I get to pick what I like best and, and where to go next. So it's really cool.

Shannon Sepulveda:                              Especially because I love you Patagonia, but this year their colors were terrible. They were all these like muted colors. They had maybe like one bright color. And so I was like, I guess I'm just going to have to get a muted color and like wear a fun sauce hat.

Shayla Swanson:           15:58                Well, I hope you were at least able to coordinate one color out of our hat with your jacket.

Shannon Sepulveda:                              I was, yes, I was. I appreciate that you have fun colors. Oh, I'm hoping next year Patagonia, we'll have more bright colors. Bright colors will be back in season.

Shayla Swanson:                                   Right. What I've actually had to do is, because I'm always going to be wearing one of our hats and I don't want to buy a new jacket every year is I've had to resort to black and gray in my outdoor apparel, because then I know I can always look okay with whatever hat I'm wearing and not have to buy a new jacket every year.

Shannon Sepulveda:                              Yeah. I also think another great thing about Sauce hats, so, so Shayla and I both have kids is that and we both have a boy and girl is that, you can throw a toddler girl in all boy clothes and put a really fun toddler pink sauce hat, and then they look really, and then they look really cute. Yeah. So it's pretty awesome. Oh, why don't you tell us about your Kiddo?

Shayla Swanson:                                   Oh my. I have two little ones and they are really fun and really hard at the same time. But it's been kind of fun because we made a baby hat for a while. And I was sort of like, yeah, it's really super cute, but I couldn't really get behind it as far as like whether or not it was a great product for kids. But yeah, we have this little chill hat that we make and I should also mention, we call our hats tukes that stems from my Canadian background.

Shayla Swanson:           17:32                Winter hats in Canada are called tukes and it's spelled in a way that makes everyone want to say Toke or Torque even. So, it's a little confusing for people. But anyway, we make a little chill tuke for kids and it's been like the best hat for my young ones. I can't believe it. It's like I just have this constant stream there. I start them in the small move them up through the other, the other sizes. And what's great is that they're tight enough that they stay on their heads and I think they forget that they're on, which I think helps they so they don't pull them off. And the other thing is that they're warm but they're not like so hot that the poor little kid is like drenched with sweat underneath their hats.

Shayla Swanson:           18:12                So they don't try to rip it off because they're uncomfortable either. So our chill tuke for kids has been amazing. My daughter who is almost a year, wears our large and my son who is three, where's our toddler size and yeah, it's been great. I can get behind them now.

Shannon Sepulveda:                              Yeah, they're pretty awesome. Cause they have just like a fleece band. Right. And the top doesn't have fleece. So like when kids are playing hard, they don't totally sweat.

Shayla Swanson:                                   And that's kind of our whole little goal with our headwear line is just to make sure that we're keeping, you just right warm. We want to make sure that you don't notice your head when you're out there exercising. Because I know for myself, I've worn Wool hats and been drenched with sweat and miserable and then you want to pull them off and then your hair freezes and then you're more miserable.

Shayla Swanson:           18:57                So that's kind of our whole mantra is just let's keep you warm but not too warm.

Shannon Sepulveda:                              Yeah. So, along those lines, since not everybody Nordic skis or lives in a place for Nordic skiing so runners really wear these hats a lot. I see out even when I was visiting Seattle, I saw a lot of runners in Seattle wearing the hat. So why don't you talk to us about just like other sports that they're useful for?

Shayla Swanson:                                   Our line has now expanded to be a 12 month, you know, four season line we have some of are products that are ideal for summer activities. And then we also have our winter product line. So our winter product line, I would say we're kind of geared really, you know, well basically any activity really, I mean anything where you want to be comfortable and colorful and you might work up a sweat.

Shayla Swanson:           19:54                So that might be running or hiking or skiing. And also we're a great little, like if you're an alpine skier and you wear a helmet so you don't really need a hat while you're skiing. We do make a helmet liner that fits under helmets. And then we also make a lot of our products are great little like lodge hats. So if you want to cover a pure helmet head and feel like you have put a little bit of effort into your appearance our products are great for that. And the other thing that we have when we expanded into this spring summer product line, we've introduced a couple of visor styles that have really flexible brims. They can be worn under helmets if you're a cyclist. They are great for running and hiking. And then we also have a product that's like a kind of two ways visor that can be worn.

Shayla Swanson:           20:37                It's really if you're hiking and you're not sure what the weather's going to do, so you can cover, you can kind of cover up or wear less people say they love those on a boat too, because it keeps you from burning. That's our viser. I think what the feedback that I'm thinking about what's coming from this woman who said she loved, she always wore her hair in a ponytail and she always had like a part in her ponytail, in her hair, you know? So the way she would brush her hair back, she would always end up with like a sunburn in that area. But she said that with that product, she loved it because she still had plenty of room to like get her hair out the back, but she could kind of pull that piece back and so she didn't burn her head.

Shayla Swanson:           21:21                So anyway, just little random stuff. Some of the stuff that, some of the benefits we claim are things that we thought of. A lot of them aren't benefits that we didn't think of, but there were people have decided works well for them. So that's pretty nice to hear that stuff too.

Shannon Sepulveda:                              Why don't you talk about your tassels because I feel like you're the only, I don't know. I haven't seen any other hats that have flower tassels.

Shayla Swanson:                                   The Flower Tassel. Yes. So, so our idea was kind of to bring a little bit of fun and spring summer brightness to the coldest dreariest winter day. So along those lines, we started using these little tassels on the top of some of our hats. Some people love the tassels, some people hate the tassels, but there are enough that love them that we definitely keep doing it.

Shayla Swanson:           22:11                And so we offer three different styles of Tassel on the hat. And one is like a traditional kind of looks like a graduation tassel. And they're kind of popular in the Nordic world and maybe not anywhere else, but a runner sometimes or sometimes they bounce a little in your head. So, yeah. But they're cute. They're cute. And the colors are really pretty. The other type of tassels that we make is a flower tassel. And those come with mixed reviews. But again, it's one of those things that people who love them love them. We have a few stores that order exclusively flower tasseled hats because they know they will sell them because people think they're cute. In our offices I will say that we don't love the flower Tassel because while we've been able to outsource manufacturing of most of the tassels just cause they're kind of a pain, we have, we still make the flower tassels.

Shayla Swanson:           22:58                We’ve tried to find someone who can help us make them but no luck so far. So, so we have some weird weird little non transferable skills that we joke about in our space where like we're really good at tying knots really quickly because you need to tie four knots on a flower tassel. And then we have a pom pom we can put it on the top of our hats too. A little pom is really cute. We get lots of different colors and anyway, that's another piece when we try to pick our prints and patterns, we have to try to figure out if we have tassels that work with the prints and patterns.

Shannon Sepulveda:                              And so if someone wants to do a custom order, they can pick their hat print, tassel, logo.

Shayla Swanson:           23:44                And that's kind of what's nice about say working with us versus other larger businesses that do custom work is that we can really say like, you'll get, you know, get an email saying like, these are all of your tassel choices, these are your fabric choices for your hats. It's kind of very customized. Very cool.

Shannon Sepulveda:                              So why don't you talk a bit about your price point? Because for the life of me cannot understand how you make everything in Bozeman and the hats are still $30. Wow. Because that's pretty awesome, I think for a company to be able to do that.

Shayla Swanson:           24:20                Yeah. The honest truth of it is this is the healthy, wealthy, smart podcast. Let's just say I probably won't be getting overly wealthy, but I love what I do. And so it doesn't matter too much. But it is true. There's something, the reality of it is that if you want to be really profitable in the apparel industry, I think you definitely have to send your stuff to places where they don't have to pay people much to make it the reality was sewing a hat or a piece of clothing is that it's touched. Every single seam is basically driven by a person. There are a few exceptions, but in general, a person is responsible for every seam on your clothing.

Shayla Swanson:           25:11                Unlike an injection mold plastic piece or something like that where it's, you know, where it's really mechanized and automated. And so, yeah, as far as our price points go, we have to maintain some level of competition or competitive, you know, placement in the industry. So, yes, it is true that our profit margins are not as great as they could be, I suppose. But then we couldn't offer, we really, I think that we wouldn't have a business if we outsourced to somewhere like Asia or places because they have high minimums. They can't offer the flexibility that we can. So I feel as though, it's an interesting situation because I don't think we could do what we do using a different type of manufacturing model. Yeah. So what's really been great for us is that we have, this year in particular, we have really streamlined a lot of our production processes.

Shayla Swanson:           26:07                I think we're getting faster and faster at everything we make, we're cutting down on complication and skews and things. Anyway, everything we can do to basically improve our efficiencies and make sure that we can be competitive with our price point and also be a healthy business. Yeah. So, yeah. So it's interesting.

Shannon Sepulveda:                              Can you talk a bit about the contest? It seems like you have every year where someone designs a hat.

Shayla Swanson:                                   Yeah, that's a fun one. So one thing that we have started to do, well I guess it's been probably five years of the contest now. We have a contest that runs every year in August or September, we call it our special sauce design contest. And what it is, is we basically send out a little pdf template and people can download it and basically send in a design idea.

Shayla Swanson:           27:04                And what's really great is that we used to get comments, people would email us and be like, hey, why don't you have any hats that are blue? Or why don't you do this, this, this, or the other thing. And so it's been really great to be able to put the ball in our customer's court and have them tell us what they want to see. Every year we receive entries and we put them up on Facebook and we also allow people to vote on our website. You know, Facebook may or may not be a great avenue for that but yeah, people vote for their favorite designs and then we make them. So this year we had two really beautiful, we had a really beautiful floral that came through. We had basically two that were really neck and neck for first and second, so we decided to produce them both.

Shayla Swanson:           27:49                And this graphic designer in town here in Bozeman that submitted this ridge line mountain design. And then what's really cool is that at the end of the year we kind of tally up how much we sold and then a percentage of the sales go back to the winners chosen charity. So yeah. So this year one of the hats we'll be donating to a foundation called the neo kids foundation. It's up in Sudbury, Ontario, which is where the winners of the contest live and that's where they wanted their proceeds to go. And then one of the designs here is going to go back to basically a fund for the Bozeman education. That foundation that supports kids that are homeless basically, who come and need some assistance that way.

Shayla Swanson:           28:41                So we're really excited about that part of the contest too, cause it just gives us a chance to give back.

Shannon Sepulveda:                              So we can find you in Bozeman. We can find you online. So why don't you tell us a bit about like where you're located in the country, what types of stores and like if people want to check out your products, where would they go?

Shayla Swanson:                                   We are carried by about 200 retail locations across North America. So if you go to our website does have a store locator, which I will admit is about 90% complete. It's really hard to stay on top of all this stuff. We are distributed in the types of stores that carry us or generally like running shops. More like outdoor stores.

Shayla Swanson:           29:32                Also anything that's kind of got a Nordic edge to it. Those shops typically carry us. So yeah, so we're available online. They're available about 200 retail locations and if somebody out there can think of a store that we should be in in that we're not, we always take suggestions for wholesale accounts that we should be reaching out to. So that's where you can find us.

Shannon Sepulveda:                              Yeah, I was thinking about that when I was in Manhattan in November. I was like checking out stores. I was like where it just be as so many people complimented me on my hat. Cause I feel like New York is a lot of people tend to wear more muted things. Or in big cities in general, I think it's more muted. It's more muted.

Shayla Swanson:           30:22                And that is one thing I will say is that we do, well, a lot of our patterns are kind of bright and colorful. We always make sure we have a black and white option. We always make sure we have a gray, you know, it's like we try to make sure we can also appeal to the more subtle Palette. Our winter product line has men stuff. And we always carry a black plain old basic black as well too. Our neck gator product is called our frosty. Kind of like the buff is sort of the Kleenex or the bandaid.  The brand that became the thing. So, my parents used to call it a chill choker.

Shannon Sepulveda:      31:10                That was a new brand, like back in the 80’s. But we as children, I was growing up, we used to always call the chill choker. And I feel like it was wool and we wanted to just like rip your neck off and awful. And then they were like turtle fur, do you remember that?

Shayla Swanson:                                   Well and that brand is still that brands still around there. You see them in places that carry us as well. Occasionally. But turtle fur is still around. We have a product coming out next fall. We currently make a like a neck breeder, but it's a lightweight net gate or color frosty for the neck. Next season, next fall we have a product that'll be coming out called throat coat. It's our aligned neck warmer.

Shannon Sepulveda:      31:57                Oh, that's such a good idea. My son had, I think I got it at your clearance sale at the Cammo.  But it's really good idea to get, um, like a fleece lined one for the really cold days for, especially for downhill skiing.

Shayla Swanson:                                   And the product we're, we're using the liner, we use them polar tech products to line our stuff. So for installation their fabrics and we're using a kind of a mid weight style, so it's like warm, but it's not going to be like saturated with breadth and moisture, like a fleece might be. And then it like freezes and it's stinky. My team might still be stinky, hard to say, but yeah, there anyway, all this stuff you try it, you try to think about, but it's something that's just a reality.

Shannon Sepulveda:      32:49                There’s a place in Bozeman where you can Nordic ski and it's like all sourdough, right? So it's all up for nine miles, go all the way up for 10 all the way up for 10 miles. And so you get super sweaty all the way up and then you come down and you pretty much don't really have to ski on the way down and you're buff just becomes like an icicle because just like knock knock, by the time you get to the trail head because you've sweated all the way up and then you just freeze, freeze all the way down, all the way down. That's a tough, tough trail to dress for. You have to have like a backpack of layers to it. Right. To get down, to get down comfortably. I typically choose to just be really, really cold at the bottom. Yeah. And then turn on and then get in your car and turn on your seat heater. By the time you get to the house, then the cars finally warmed up and then you feel pretty good. What's new in the future? What can we look forward to?

Shayla Swanson:           33:50                We have a few new products next season. We have really cool new patterns that are kind of basically images of our natural world that are going to be placed in the hats and the headbands anyway, so we're venturing out a little bit from what we typically do, but I'm really excited about. It's been well received by the stores that have seen the line already. So we have some new prints and patterns. It's usual. And then we have a couple of new headwear products that are sort of like hybrids of stuff we've already been doing just to I guess diversify the line a little bit and make sure everyone can find products that are aligned and warm enough for them.

Shayla Swanson:           34:37                Anyway, that's kind of confusing. But I guess just in general, I'm our main product designer and I've been having children for the last few years and I haven't been feeling overly creative. My mom brain has, has really, I would say, shut that down for me. So I'm feeling like I've turned a corner here. I have a nearly one year old and I can, I'm feeling like I can start to think again. And so I'm looking forward to seeing what that, what that brings because it's always when I'm outside skiing or outside running or hiking that ideas come to me where I'm like, Ooh, this is, this would be a great product. So I'm looking forward to that. And so as far as what's coming next, I have a few things on the immediate horizon and then after that we'll see.

Shannon Sepulveda:                              Cool. Yeah, I feel like you need like for at least for headwear winter headwear I feel like you need like the fleece line warm hat for like walking around town. And then you need like the thin hat for exercising and then you need the thin headband. Cause sometimes it's just your ears it get cold. And then you need the fleece lined headband. And then you probably need more stuff, but those are like my four go tos for like winter. But you definitely need the like non, it's nice to have the nonactive totally fleece lined hat for like warmth.

Shayla Swanson:           35:30                The two products that we make that I think are good for casual or activity on a cold day. If you will athleisure headwear, we make a slouchy beanie. It's kind of like a slightly more, styled hat I guess. And it's, and it's really warm and cozy. So I, that's my like where around Go to and then we make our chill.

Shayla Swanson:           36:19                Tuke is another one that you can wear casually in and look pretty cute, but it also works really well if you're skiing on earth, doing something on a cold day. And that's the one that has our little swirl closure at the top where you can kind of create some space and vent a little bit if you get too hot or you can throw a topknot out there if you, if you're so inclined. I never have hair long enough to do that. And that wasn't an intended benefit. The ponytail through the hole. People have figured out how to do that. Ooh, it's really cute picture of that on our website. And right now actually of someone doing that who had long, beautiful hair and just put the hat down over top of it and it's like, anyway.

Shayla Swanson:           36:55                We have products that have more of like a standard ponytail hole right at the back of your head. But this one is kind of more at the top, which makes it a little weird, but it's still pretty cute if you have the right length of hair. I have recently kind of refallen in love with is our Bandura and it's basically like a kind of a pocket band. But what's nice about it versus some of the other brands that make more of like an active pocket band is this one. It doesn't, it looks more like an intentional addition to your outfit. So it's something you can work casual or active and basically it just looks like a little tank top sticking out from underneath whatever your layer over top is.

Shayla Swanson:           37:39                So it's kind of hard to explain I guess on audio but it's like a fabric piece that goes around your waist. Elastic. Yeah, it's like a, it's kind of like a tapered fabric piece that goes around with the band around your waist. And it separated into six pockets and all the pockets are kind of semi secure, so they have a little flap over top and then they have an elastic drawstring waistband, so it's got some nice integrity. If you do pack it with stuff, it's not going to fall off. And like uses that. I, you know, I've been using it recently to cross country ski and I've thrown my water bottle in the back. And then I put my keys and my snack and my kick wax and my cork and I'm all, I've got everything I need.

Shayla Swanson:           38:23                And what I also like is it's not tied around my waist. So that's really comfortable for me too. And then but other things I've heard people say like I've been at events where someone will come by and say, Oh, I wore this and while I was backpacking in Europe, I need another one. It was amazing. Like, so she said that she wore it everyday in Europe as kind of a money belt, but what was great is it just looked like a little black layer sticking out from under her shirt. So she's just, it was funny, she came, I didn't expect such a rave review from somebody, but she came back and was thrilled. And then it can also turn like any, it's great for cycling because if you want, if you want extra pockets but you don't want to wear a jersey that has pockets. You can throw that around your waist and then you can turn any shirt into a jersey.

Shannon Sepulveda:      39:11                How about the sports bars or you're going to start making sports bras?

Shayla Swanson:                                   I don't know. People ask me to, the two questions I get a lot. Are you going to make sports bras and then also are you going to make like cycling shorts with shammies? Oh, the thing I feel about both of those products is there's a lot of r and d that goes into making the perfect shammies and making the perfect sports bra and, and I'm just not sure we're, we're up for that. I don't want to throw something out to market and then being like, oh that actually is really not as good as the other ones you can find out there. So you know, maybe maybe it would be like, uh, yeah, probably not is realistically the answer.

Shayla Swanson:           39:49                But I think what would be interesting is maybe we can find a way to supply people with like cute little shammy containing underwear that, you know, I can buy from someone else and then they can make sure that they can wear it under our shorts and then it would be kind of work for that as well.

Shayla Swanson:                                   So to answer, I guess I should probably clarify like that's the kind of sports bra that maybe we could make, but if, but when it comes to making something that's really supportive and actually does a great job for women who have larger breasts, I don't think that would be hard.

Shayla Swanson:           40:33                Yeah, there are some really great brands. Like there's actually a Montana based company called Anelle and it was founded by a woman in a small town in Eureka, Montana who I think she, well their company's based in Eureka. I think that's where she's from, but they make this amazing Bra for women with large breasts and like sports bra. They do a really great job and they're there. I see them at some of the trade shows I attend and am friends with some of the people that work for that brand, but so yeah, I think we'll leave it, leave it to the experts.

Shannon Sepulveda:      41:06                Awesome. Anything else you want to add or talk about as far as Sauce and your company, Bozeman? Did you start it in Canada and then came to Boseman?

Shayla Swanson:                                   Yeah. I moved here in 2003 to go to school. So I think we had made hats for one year before I moved here and then I moved here and I kind of became the US distribution center. Rhonda was still in Canada. But no, I guess, I mean it's become this really great and exciting thing. I didn't ever really anticipate for my hobby to grow into a business that would actually pay me a wage and it does. So it's pretty awesome. And I really like what I do, although I do wish every now and then, there wasn't a day when I learned, like, I kind of would like to like not learn an important lesson every day, be nice to have one or two days where I didn't think to myself, oh, that's something I need to remember.

Shayla Swanson:           42:01                You know, I'm sure that's the case for most of us that you, I mean, you never want to stop learning, but sometimes you just wish it was a little bit easy for most entrepreneurs. I have been pretty good. I think one thing that has really helped me is that I truly have this, I learned how to lose early on, I guess with my ski racing. Like it's, you know, it sounds like a weird thing to say, but it's true. You know, you win some, you lose some. And I think it's important to learn how to lose and understand that it's not the end of the world and understand that really every time you try something, as long as you learn something from it, it's a success, you know?

Shayla Swanson:           42:43                Yeah. So that's kind of how I try to move forward. I've only made one or two, like really expensive mistakes, so these ones are harder to deal with. But you know, we're all doing our best, so you gotta just have to do what you can and, and move forward.

Shannon Sepulveda:                              Do you have any advice for any other female entrepreneurs?

Shayla Swanson:                                   Oh, I think one thing I'm not doing a great job at, so this is I guess me telling someone to do different. I love every part of my business and the problem I'm having right now is that I'm trying to do too much of it. And I've heard that that's a kind of a common thing, probably also a barrier to really making it big in some of these things as I have a little trouble letting go of certain aspects of my business.

Shayla Swanson:           43:30                But truly it's not necessarily because I am like super type A and can't let someone else do it. It's more just cause I really liked doing it. So anyway, I have to, I have to figure that out for myself. So I guess my advice to someone would be if you can, you know, delegate and do a good job of getting someone else to take care of some of this stuff off your plate is probably a good idea.

Shannon Sepulveda:                              What I find is, I mean, after I started my own practice, it was great and I love it, love it, love it. But you can't turn off. No, there's no, especially with kids too, it's like I would love to be able to turn off, be present, and I'm trying really hard to do that. But it's hard. There's always something to be done.

Shayla Swanson:                                   And that's one thing, you know, having kids, like before I had kids, it was, I worked long days, I liked what I did and then I went home and that we didn't even have internet at our house at that time.

Shayla Swanson:           44:21                We did that on purpose. My husband and I just decided like, we want to work when we're working and we want to not work when we're at home. And so we had this great little like work home separation was really helpful. And now I can't have that because there and we don't really, we, my husband and I swapped to take care of our kids. So basically I'm either working or I'm taking care of the kids and there's never enough time to do either one. And then you have to sleep because if you don't sleep, you get cranky. So yeah, I don't have a great solution for that. I think you just have to do what you can to try to turn off when you're with your kids and keep a list. I think a list is really critical because then you can turn off your brain as long as the stake has been planted somewhere where you know you won't forget what to take care of.

Shayla Swanson:           45:05                I read that in a great book. It was called, I think it was called getting things done and that was his main, main, main advice was you only have, like if it's, you have one place where you keep track of that kind of stuff and only one, like you don't have a phone and then a calendar and a little mole skin notebook. And then you have one place where you keep track of things and you always write down what you're doing and what you need to do. And then that way when it's time to not think about it, you don't have to think about it cause you know where it is. And you know that you won't forget because it's in that one place.

Shannon Sepulveda:      45:40                That's such a good idea. It's really helpful because like last Friday it was late. I was trying to get all my paperwork done and I knew I had all day. Monday is my admin day, but I still felt like I needed to get it done on Friday. But if I had just re wrote it down, these are the things we're going to do on Monday, then I come back on Monday and I finished that. Right. All there.

Shayla Swanson:                                   Thank you. Getting things done. Book. I don't remember who, that was helpful. It was a good book.

Shannon Sepulveda:                              Why don't you tell us where we can find you? Social Media, etc. And how we can get in contact with you.

Shayla Swanson:           46:32                Sure. So I'm online, we are at I'm on social media. You can find us at Sauce active on Facebook. That's Facebook and Instagram primarily when we actually post. And if you want to get in touch with us by email is probably the best email address.

Shannon Sepulveda:                              So if someone who is listening has a great store that says, Hey, they should carry sauce, we should email you.

Shayla Swanson:                                   That would be great. That would be great. If you have anything to anything to say, we'd love to hear from you.

Shannon Sepulveda:                              Do you have a newsletter?

Shayla Swanson:                                   Oh Great. Yes, we do have an email newsletter that we send out. It's not super regularly regular, so don't, don't be afraid that of a bombarded inbox. But there is a newsletter sign up at the bottom in the center of our website, so we do send that out.

Shannon Sepulveda:                              Cool. And why don't you tell us about the gift to our listeners.

Shayla Swanson:           47:23                That is great idea. So if you want to buy something on our website, we would love to offer you 20% off if you enter code hws19. So that's hws19 20% off online

Shannon Sepulveda:                              That's a good deal. It's a really good deal. Especially, like I was saying, I don't know how you make hats for $30 in the US because they're awesome and we support the local community

Shayla Swanson:                                   And you're supporting our sewers, Linda, Laura, and Karen, which I think is pretty fun. So you're not just, you know, buying a hat. You're actually supporting Linda, Laura, and Karen and Shayla.

Shannon Sepulveda:                              Well, Shayla thank you so much for coming on the program and we really thank you, it was really great talking to you.

Shayla Swanson:                                   Thanks. Thanks for having me. It was really fun.


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


Feb 11, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Sarah Haag on the show to discuss pelvic health for the non-pelvic health PT.  Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health.  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.


In this episode, we discuss:

-Intake questionnaires to screen the pelvic floor for patients with low back pain

-Pelvic health red flags

-How to address pelvic floor health with a conservative population

-Assessing the pelvic floor muscles without doing an internal exam

-And so much more!



Oswestry Low Back Pain Disability Questionnaire:

Sarah Haag Twitter

Entropy Physio Website

Home Health Section Urinary Incontinence Toolkit


For more information on Sarah:

Sarah 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:

Karen Litzy:                   00:01                Sarah, I was going to say doctor Sarah, hey, it just feels weird because we've known each other forever. But Sarah, thank you so much for coming on the podcast to talk about pelvic health for the non-pelvic health PT. So there are a lot of physical therapists who I think are interested in pelvic health, but maybe they don't want to like dive in literally and figuratively. So what we're going to do today is talk about how we as physical therapists can treat people with pelvic conditions, with pelvic issues without necessarily doing internal work. What are the functions of the pelvis, really important for bowel and bladder health, right?

Sarah Haag:                  00:49                I mean, it is very important for survival, sex, very important for quality of life and propagation of the species. So these are all things that matter. But also when people come in with low back pain, when people come in with hip pain, I always find it very interesting that people say, but I don't do the pelvis. You know, the pelvic floor is only a musculoskeletal structure. We're not trained in most programs to palpate or to touch. It's just skeletal muscle. That's all we're assessing for really as pelvic floor PT’s. So I just think it's interesting. It's like a blurry void when you're looking at a body diagram.  Oh, there's your knee. So it's really important I think to understand what's there and you don't have to go there, but you have to know what's there and know that some people need help there and help them find the help.

Karen Litzy:                   01:34                So if someone, let's take this person that has low back pain because that's a diagnosis that we can all agree that we see on a regular basis. So what are a couple of questions you can ask during your initial evaluation?

Sarah Haag:                                          So the subjective part of the initial evaluation that perhaps a lot of people are missing or that can take in that pelvic area. There's a couple of ways that you can kind of like cheat your way in where you don't even have to think about what to ask to begin with. If you have a red flag questionnaire, there is a bowel and bladder question on there. So, it’s really interesting because people will sometimes circle yes on those and then never discuss it. Like, wait a second, we asked the question, they said yes, it's a thing.

Sarah Haag:                  02:22                So there's your in, it was like, I noticed you, you marked yes on the bowel and bladder changes. Can you tell me a little bit more about that? Most of the time it is not truly a red flag. Most of the time it is not a sign they need to be referred to a physician.  Most of the time it's like no one's ever asked me that. Yeah. Stuff is different. There's your in. And then also if you use the classic Oswestry. So it was modified I think in 2001 or 2002 to take off a sex questionnaire. The second question of the questionnaire and it was revalidated and all of those things, but if you use the original, it's pretty awesome because now they're like, Huh, nobody's asked me about sex. And then you'd be like, ah, I see that this is an issue.

Sarah Haag:                  03:06                One of my favorite Twitter stories is I get a direct message from someone asking me about a patient who was having pain with intercourse and I was like, thanks for reaching out. Absolutely. Can you tell me more about when they're having trouble and where it hurts? Would you like to know where it hurt their knees in one particular position? And I said, fantastic. You can help with that. So, so it's not always, it might be a sex problem, but it's not necessarily that problem. So we have to not be shy about asking those. Low back pain is the most expensive health care problem we have in terms of multibillion dollar, probably millions and millions worldwide. And so of course addressing back pain, we're still working on the best way to do that.

Sarah Haag:                  03:52                But there’s a high prevalence of urinary incontinence and people who have low back pain. So if you're seeing people who have low back pain and after, if anyone else went to the pregnancy talk this morning, after vaginal deliveries, the prevalence of incontinence goes ways up, goes way up. So if you're seeing someone with back pain, if someone has had babies, all you can eat what you can do. So we were like, well I see this in your history cause that's pertinent history for back pain. Correct. And then it's like, Hey, I noticed this, any issues with this? And here's the reason I'm asking because you can't just go, do you pee your pants? Because people like, do I smell like what happened? Like, so if you're just like, you know, there is a really high prevalence and the nerves in your back go to your pelvis and all of these things.

Sarah Haag:                  04:32                So I'd be really curious to know are you having any issues in this area? Cause there's help if you are. And then kind of go from there.

Karen Litzy:                                           And I want to backtrack for just a second. When you were talking about red flags and said some are truly red flags and some aren't. So just so that we're all on the same page, what would be those truly red flags?

Sarah Haag:                                          Truly in the pelvic world or in the entire rest of your body world is any unintentional weight loss or weight gain, 10 or 15 pounds over a short period of time. Also like fever, like temperature issues, loss of appetite when you have those other constitutional symptoms that go along with it. So just having some quirkiness with your bowel and bladder, it's really no reason to panic. But if you have also a fever and also a recent traumatic event, no, no, we want to just make sure everything's okay.

Sarah Haag:                  05:26                And the cool thing is that if you go to the doctor, it's like you don't have a UTI. Everything else is looking fine. Awesome. Then I can help with that. But the red flags, there's been a couple of great papers that have come out where it's like, it's not like if you have pain at night, freak out. No, no. If you have pain at night but also a sudden bowel and bladder change and also, okay, now we need to check in for it. But don't panic if it’s the only one.

Karen Litzy:                                           And now let's say you're using these questionnaires and someone puts on bowel, bladder or someone circles sex as something that they're having difficulty with. And I love this question because this was something that was brought up last year at CSM. So there was a physical therapist there who said, well, I live in the south and these are not easy questions to ask because people are more conservative or they don't want to talk openly about their bowel and bladder issues or about sex with their partners.

Karen Litzy:                   06:28                And so what do you say to those people? Those therapists that, are dealing with a population that's maybe much more conservative and they're not sure how to approach those subject matters.

Sarah Haag:                                          I always say just always with kindness and with a good intention and with a good explanation. So you can't not do it because it's awkward for you. You should be asking for a medical reason, right? So quality of life is in our wheelhouse, right? Like we're doing all sorts of quality of life questionnaires. Pee in your pants is a huge detriment for your quality of life in many cases, not being able to have sex can impact your relationship with your partner, your feelings of ability to even have a partner, having babies. All of these things that end up being huge stresses, which is gonna make a lot of other things not as good either.

Sarah Haag:                  07:28                Just start simple if you're asking questions. So if someone comes in with like straight forward knee pain, I'm like, how sex, no, that's not how, that's not where we go with that. But if someone's coming in with low back or pelvic issues, the way I usually approach it is to bring it up anatomically. So this is the anatomy. This is what we're doing. These are where the muscles go. Most people don't think about them. And when they're, if they're having issues like incontinence or have had babies, those pelvic floor muscles are muscles. Like everything else. We're going to work in PT. So I'm going to ask you some questions and I try to do it in a spot where you have some privacy. I know some PT places you're like in the middle of a gym.

Sarah Haag:                  08:06                If you can find a quiet corner, do everything you can to put them at ease. But just to be like this is why I'm asking. And if you can see that resistance be like all right, like it's not necessarily the number one priority for this treatment anyway, but if those things happen to be issues there is help, it can get better and you just let me know if you have any questions. Cause not everybody wants to talk about it and it's not my job to convince you to deal with it. It's my job to help you if you want help.

Karen Litzy:                                           And if you're a physical therapist that isn't specializing in pelvic health, it's a little bit different. Cause if you're specializing in pelvic health and people are going to you because you specialize in pelvic health it’s way easier, you know, these questions are going to come up.  But for those of us who don't specialize in pelvic health, then those questions can be a little bit more sensitive. So I just want you to make that distinction there for people.

Sarah Haag:                  08:48                Yeah. And also if you're going to ask if you're going to take that step and be like, all right, I'm going to ask about the incontinence. I mean cause sometimes you're in situations where it is an obvious issue. Other times it's like, well, based on their history they're actually at risk for it. Then you can talk prevention, which has always been kind of fun. But just if they give you some information, especially if you got up the guts to ask them, then please, please do something with it. Don't just be like, oh yeah, so great incontinence noted in the chart. I'll put it on the diagnosis list, like how the plan and there are some things you can do without doing a pelvic floor exam that can make amazing changes.

Karen Litzy:                   09:49                How can you evaluate pelvic floor muscles without having to go internally? I think that's a question everybody wants to know.

Sarah Haag:                                          Great question. I'll be honest, some people don't want you to touch him there like full stop. And so I will actually give people, I would say it's kind of like a choose your own adventure. So we can actually, we can all check our own pelvic floor muscles right here. And I would basically talk you through it. You would tell me what you felt. I keep an eye on everything else to see what else you were doing. But it would be very honest that my assessment is going to be, I believe you, it seems you're doing it correctly. Right? But I have to believe you, but you can actually palpate externally. As a clinician you can actually do it and you can do it in sidelying.

Sarah Haag:                  10:33                You can do it in hooklying and some people will do it in prone. I'm not a super big fan cause I can't see their faces. And also it can be kind of a vulnerable position. Basically if you just palpate, if you find the ischial tuberosity, you know about where the anal sphincters are. Okay. There's normal human variation. So I always say move slow and make sure you're asking for feedback. But you know, mid line is where the sphincters are going to be. We're not going midline. So you just kind of find that ischial tuberosity and palpate your way around to the medial part of it. And that's where the pelvic floor attaches. So then you can kind of talk them through, like I'd like you to squeeze and there's a bunch of different cues.

Sarah Haag:                  11:22                One of the most common cues, especially for the back end, is to like squeeze. Like you don't want to pass gas and that's awesome. But if you're a main problem with urinary incontinence, that's the back side, back side, not the front side. So how do we get it up there? So another cue that has been found to be very helpful, it's only been studied in men, but it is, shorten your penis. But what's interesting is ladies, I know we don't have them, right? Imagine that feeling, right? So like just imagine like pulling in, right? It totally changed where hopefully if this is a class, it would have asked where did you feel it? But like it, it changes it from the back and biases it towards the front of it. So find a cue that gets them to go, oh my God, I felt something.

Sarah Haag:                  12:07                You're like, awesome. So if you're doing a Kegel and like this happens, you're probably not doing it right. If that's happening, you're probably not doing right. But if like I'm Kegeling now and then I let go, you shouldn't have seen me get taller or tensor or breathe funny. It should be very sneaky. So as you're palpating on the medial side of the ischial tuberosities your feeling for those muscles to contract. So it's kind of like a gentle bulge and you can totally feel this on yourself here if you're comfy or somewhere else. But when you feel it, it's almost like when you're feeling like if you have your biceps slightly bent and you kind of like contract and you feel at tensioning and like a little bit of a bulge, that's what you're feeling for.

Sarah Haag:                  12:51                Okay but it can always be tricky cause I use the word bulge. Some people will have people push down. So we should also be able to like relax your pelvic floor and push down, like having a bowel movement. That shouldn't happen when you're trying to contract. So like when I say bulge, you should feel like a gathering of the muscle. That's what you're feeling. If you feel your fingers get pushed down in a way they're doing the opposite of a contraction. So there they're relaxing.  It would kind of depend on what they were doing and the cues you were giving. So it could just be like, I'm pushing down like doing a Valsalva. But it is basically a lengthening into the pelvic floor. I don't know if it's always a relaxation, so to speak.

Karen Litzy:                   13:33                It's kind of lengthening. And what is the difference between that Valsalva or lengthening and that small bulge? Like why is that significant?

Sarah Haag:                                          When you feel it, you'll know it's significant because if they're pushing down in a way that's not a contraction. So if you're going for strengthening or more closure to hold things in, yeah, you want that kind of like tensioning and bulge. But if you're actually the problems, constipation, I can't get things out, you want them to be able to relax and link them.

Karen Litzy:                                           Got It. Okay. All right. So now we know how we can kind of feel our pelvic floor muscles without having to do an internal exam. So once you figure out, and kind of what you said sort of leads right into the next question is if you have someone that's coming in with incontinence and you are looking for that sort of tightening or gathering up of the muscle, which I think that's a nice cue for people to understand because bulge can sometimes be a little confusing for people, but I liked the cue you're feeling the gathering of that musculature.

Karen Litzy:                   14:45                Is that something that you are then going to add into a home exercise program or like once you find that the pelvic floor muscles working or it's not working, what next? What do you do?

Sarah Haag:                                          Well, so I'll be honest. It's always I like him and people are brave enough and the patients were brave enough to be like, sure you can have a feel like let's figure this muscle thing out. I usually try it in a normal active kid in a normal setting. So not a public one. No pelvic settings are normal too. But in like just a normal like say outpatient therapy, be it or orthopedics or neuro, I would actually have them ask more questions about incontinence before even checking the pelvic floor muscles. Because the different types of incontinence are going to kind of tell you a little bit more about what you should do.

Sarah Haag:                  15:35                So some people have incontinence when they tried to go from sit to stand or when they cough or when they go running. So I want to know a little bit more about when is it happening because if it's only ever when you're putting your key in the front door or when you're running into the bathroom, that's more urgent continence. Would pelvic floor muscle exercises help? Maybe, but also probably looking at their overall bladder health, which is where a voiding log would come in very handy. And actually a shout out to the home health section and they have an incontinence urinary incontinence toolkit. It's free for members for sure, but I think it might be free for everyone.

Sarah Haag:                  16:15                So it's a pdf that actually talks you through the different types of incontinence because the most common form of incontinence urge incontinence, which is you're an urge incontinence is proceeded by a strong urge to go. So this is one of those things where, so there's a bathroom at the end of the hall. So if you're like, I'm totally fine, but then your eyes wander, you're like, oh, I could go and I didn't have to go. And then I would get up to go and I got to the bathroom and all of a sudden it's like, oh, where did that come from? Like all of a sudden it felt like your kidneys did a big dump, but they don't, that's not how kidneys work.

Sarah Haag:                  16:59                It's just how it feels to you. So what that really is, is your detrusor muscle kind of going, I'm so excited. I imagine a puppy, like have you ever like gone to let a puppy out the door? Like, so they're like, hey, I want to go out and you get up and you make a move for that door. And they're like so excited. Your bladder is like that sometimes. So that's more of a behavioral thing because what would you do with the puppy who's now like, wait, every time I do this, she lets me out. Pretty soon you're letting that puppy out every 10 minutes because yeah, because that's what the puppy trains you to do. So that's kind of more of a behavioral thing. And so that's proceeded by a strong urge. So it's not just when you're going to the bathroom, but if you get a strong, unexpected urge and leak, and that's usually a lot of people also experience some urgency and frequency.

Karen Litzy:                                           So if you feel like you're not getting to the bathroom in time, what would be a really logical plan to that?

Sarah Haag:                  17:52                You'd go more often, you're like, Ooh, maybe I need to not wait so long. But the thing is that then you're training yourself to go more often, your bladder is perfectly capable of holding more that kind of sensitivity and those signals you're interpreting or like, ah, no, I should go now. And then pretty soon you're that person who can't make it through a movie. You're that person who can't make it past a bathroom without needing to go. And you're the person that no one wants to go on a road trip with because you're stopping every like hour on the hour and every rest stop. But now is that because your brain is interpreting this as such? I know that there's a physical manifestation obviously, but is that like have you trained your brain and to feel that way to interpret that as such? I would say yes because most of the time, even if it wasn't intentional, like it's kind of like a slippery slope. It's like I almost didn't make it that one time. I'm going to plan ahead. And then what starts to happen, especially if you're like, all right,

Sarah Haag:                  18:54                your bladder is filling up. You kind of feel like you need to go and you go to the bathroom and it came out and it's like, all right, so that was nice and normal. But then imagine that time where you're like, hold on, I almost didn't make it, but you were stretched this much. You're going to start going when the bladder stretches this much. And then pretty soon if you let it so you're like, Ooh, now I'm going down here. Now I need to go sooner. And this is one way you can tell this is happening. And it can happen sometimes without ending up with a diagnosis of urgency, frequency or incontinence. But where you get to the bathroom and you feel like you've got a goal, but then nothing happened. Goals, like it's the smallest tinkle and you're like, I thought it wasn't gonna make it, but that's ah, that's all that's in there. And so that was like big urge little output. That's kind of a mismatch. And that'll happen sometimes.

Sarah Haag:                  19:48                But like if you're paying less than that, that's not much more than your poster board then a nice healthy post void residual. So you don't have to empty at that point if you're bladder’s saying, empty me now. And that's all that's in there. Yeah. So it's kind of like you're the sensitivity of your bladder has turned way up. Just like how we would compare that to the pain. So the sensitivity is turned way up so that it takes less of a stimulus in the bladder itself to trigger that feeling of you have to go, even though the bladder is barely full.

Sarah Haag:                                          And there's actually some interesting conversations with urgency and frequency in that feeling of extreme urge, can that be considered a pain? And so it's kind of interesting conversation because there is normal, there is a normal sensitivity of normal urge, but when that urge becomes pathological, yeah.

Sarah Haag:                  20:47                Too bothersome. Does that crossover into it? Distressing emotional experience? I would think so. Like can you imagine if you're like on a train or something like that and you have to really, really, you have, you're having that urge. I mean, that's very distressing dressing. That's very distressing. That's like you're suffering. So if you have someone like that what do we have them do? So they keep a diary, which you can get on the home health section and we'll have a link to that in the show notes. You basically ask them to keep track of things for a couple of days. I tend to keep it simple with what are you drinking and when and when, when are you going to the bathroom? If people are willing to measure, that's the best, but not many people are willing to measure.

Sarah Haag:                  21:37                So what I try to have them do is to kind of come up with their own plan. And I tell them this is not an exact science because you're not measuring, but that's okay because if you have a strong urge, which is kind of a lot, but you have like a little tinkle, that's kind of a mismatch. If that only happens after your third Mimosa, okay, that might actually be like a normal bladder thing. Do you know what I mean? So we kind of look at things that they're bringing in that may or may not be irritating to them. We look at are they getting enough fluid and bladder loves, loves water. But the first thing most people cut out if they're having urgency, frequency or incontinence is water is they cut out their water. It'll almost always backfires.

Sarah Haag:                  22:19                So don't do that anyone watching. It also makes you constipated, which you can increase your urgency and frequency. So, so yeah, so surprise. Everything needs to work well to work well. Okay. But yeah, so you kind of look at that and I just look for patterns and then I have people try to change one thing at a time. If all you're drinking his coffee all day, but actually you have good data, good parts of your day and bad parts of the day. Is it the coffee? Because if you're drinking coffee all day, you're probably not going to be very nice to me if I say, how about you stopped drinking coffee? Um, emotional response up. So you just kind of look at it. It's like, Oh, when does this happen? What do we need to change? And it can really help you narrow down. Is it really urge incontinence? Is it actually just frequency and they're not leaking like they thought they were or you know, is this primarily a stress incontinence issue?

Karen Litzy:                                           Well, so it sounds to me like there's not a lot of hands on work there.

Sarah Haag:                                          No, no, it's more behavioral.

Susan:                          23:27                Do you ever use pelvic tilting to get the posterior versus anterior pelvic floor?

Sarah Haag:                                          So that's a neat work with from Paul Hodges Group. So however you're sitting, most of us are Slouchy, just do a pelvic floor contraction, however your brain tells you to do that, do it and just feel where you feel it. But then if you get yourself in a situation where you like get more of that Lumbar Lordosis, and so like you stick your tail out, you get more lumber lordosis and then you do the exact same thing. So you're not changing your cue. For most people it's cuts to the front. And it's kind of neat because one of the things, one of my pet peeves is when we were talking about earlier is my pelvic floor therapist get tunnel vision and are just doing pelvic floor exercises, but not reintegrating it into how they're, they're using their body.

Sarah Haag:                  24:18                So if you have a runner who's a chronic but Tucker and she's leaking out of the front, obviously, how would it feel if you like got those glutes back a little bit? Because you can't run and Kegel at the same time. You can't, you can try. It's not going to go well. And certainly not for like a 5K and let alone not a marathon. So changing how that is biased because most of us don't think about the pelvic floor until you have a problem, right? But they've been working, right? They've been doing their thing. You're using them when you walk up those stairs you're using them when you're getting up off the floor. So they do something, the key goal is like your bicep curl. You want a stronger bicep, you're going to do some curls, you want a stronger pelvic floor, you're going to have to do some pelvic floor exercises.

Sarah Haag:                  25:07                But that's not your management plan. You kind of want to, someone said it yesterday, kind of like the core muscles are there like automatic, like when you get ready to do something you don't think, okay transversus were good. Like it just all happens and you want to kind of get the pelvic floor back into that system and make sure it's strong enough and coordinated enough to do its part. So you don't think about it.

Dave:                            25:37                So along those lines then, would you say that if somebody is more lordotic, they're more likely to engage the anterior floor and then flat back more of the posterior floor?

Sarah Haag:                  25:47                That tends to be what they're finding on like EMG studies and what I will see clinically with people if they do a ginormous buttock. It’s really interesting if you're like, how's your breathing when you do that and, and how good is your squat, let's say when you do that. And it's like, Eh, it is what it is. I'm like, okay, so what if we do kind of take it into where some people, especially if they've been told by other practitioners to like watch your Lordosis, it's kind of huge. Which isn't really a thing. But you know, they kind of, they're kind of like going in there, they're like, I'm so scared but it kind of feels good and then you have them do that movement or try that exercise. Usually they're like, that was way easier than I thought it was going to be.

Sarah Haag:                  26:30                But again, if it's not working, then we try something else cause everyone's anatomy is different. Sometimes if they have a lumbar issue, getting into the ideal position for their pelvic floor, may or may not be easy for them, at least at first. But I think you need to play around with how it feels and how it's functioning as opposed to, I mean, I've been guilty of it in my career of like, ah, you need more or less of what you're doing with your spine and were just different. So it's where it works best is where it should be.

Jamie:                          27:03                So for a lot of the outpatient conditions and orthopedic setting, there's still an emphasis on giving some kind of qualitative documentation to the muscle contraction, whether it's a manual muscle test or something like that for payment purposes. So what are some strategies or tips for clinicians to be able to take that palpation externally and then relate that into their strengthening documentation?

Sarah Haag:                  27:29                So if you're just checking externally, like just palpating outside, it's like a plus minus like, Yup, I felt it. Uh, they couldn't find it. So kind of plus minus, cause you can't give it more than that. We also have to remember, so when I write about pelvic floor strength in my documentation, I have a number I can put and you can grade it. You have to do that internally, which is why if you're like, ah, we need to know more, refer him to a friend or go to the training. But I usually give a lot more information. So like, all right, so they, you know, they had like a three out of four, three out of five squeeze. The relaxation was not very coordinated and kind of slow, but then their subsequent contractions were five out of five.

Sarah Haag:                  28:09                All right. Do you know what I mean? We have to, because of payment and insurance and all of those things, we have to write something down. So what I do is I write down what I find and I'm happy to talk about it. So if you want to deny it, I can talk vagina all day with you. And I have, and their questions usually get shorter and shorter. Um, because really they're asking for information that isn't necessarily the most helpful. So if you're checking an externally plus minus, but also I've had people who five out of five but still incontinent,

Sarah Haag:                  28:41                So then they're like, well they're not weak but you put down, you're going to do strengthening. I'm like, well yeah, because it's more of a strengthening, not just a strengthening with a functional goal attached to that, if that makes sense. So sometimes it's more words, but don't be shy about one. Well, first of all, please be honest, be as accurate as you can be, but also don't be shy about doing the best care and be willing to stand up for it. If it gets denied. It's not cause you gave crappy care likely. I mean, do you know what I mean? I'm like, I dunno how long you practice, hopefully. Good. But if you get denied, it's not necessarily key because you gave bad care or even did a bad note. It's because they decided they weren't going to pay based on something. Hopefully logical that you can talk about. You can always appeal. So don't let payments scare you away from giving the best care.

Sarah Haag:                  29:36                Sorry. Another soapbox of mine.  So that was urge incontinence. Stress Incontinence.

Karen Litzy:                                           So let's talk about that because I think that gets the more airtime, so to speak. So that's when you see the crossfitters are the weightlifters or there's a great gymnast pitcher yesterday going backwards where you there backwards over the pommel horse, not the pommel horse. It's the worse just a horse. A spurt. Like it was, yeah. And you're just like, that could be photo shopped, but also it probably isn't. Yeah. Or like we've all seen like the crossfit videos where women are peeing and then everyone high fives them because they worked so hard that they peed, which, you know, not normal. We know that that's been addressed by a lot of a pelvic health physical therapists.

Karen Litzy:                   30:32                So I would like to know first I think we just gave the definition of stress incontinence, but I'll have you give the definition quickly. But then I'd like to go back to something that the question that Dave had asked about the positioning and how that works within weightlifting or within, you know, waited or loaded movements. But go ahead and give the definition of stress incontinence first.

Sarah Haag:                                          So stress incontinence is basically when there's an increase in intrabdominal pressure that is greater than the closure of pressure of the urethra. And you have some sphincters as well as the pelvic floor helping keep all of that closed. But if you increase the pressure enough on the insides, and that's why you hear, and again, it's primarily women, but also a lot of men after prostate surgery, they cough and you get a spurt or you know, you jump and you feel it come out.

Sarah Haag:                  31:21                Those are usually because the closer pressure has gone down or the intra abdominal pressure has gone up.

Karen Litzy:                                           Okay, great. So now what does that look like? For the average physical therapist who's not a pelvic health therapist. And let's say they are seeing someone for hip pain and you ask them, are you ever incontinent? Or if they are, you know, heavy lifters are, they are adding load and they say, oh yeah, but that's normal. Or they have low back pain and they say, yeah, but that's normal. Everybody does it at my crossfit box or whatever at my gym. So how do you then, if you're not you, you are someone who's not a pelvic health therapist, how do you address that?

Sarah Haag:                                          Well, first of all, what all of us should know while incontinence is super common, it is not normal.

Sarah Haag:                  32:16                Not ever being dry is normal. So we need to get away from this idea that like, well, everyone's doing it. It's like does that make you want to do it? Like I feel like, no, I feel like no is the answer. So first of all, just, and sometimes they don't know that. Like, I know that in some like young girl gymnastic teams, like the color of their leotards are chosen to like, not show the pee because they're incontinent that young. Yeah. And I see a lot of women as adults sometimes before they've had babies sometimes after, right? So like what's the, what came first? But they've had lifelong issues with what's essentially public flourish. She's with incontinence, sometimes pain with intercourse, all of those things. Competitive gymnasts, competitive cheerleaders. Dancers tend to be probably the biggest, runners or another group.

Sarah Haag:                  33:12                There's been some studies, there's one study and I cannot recall it. I mean, it's probably like 15 years old now. We're 100% of this division one female track team reported urinary symptoms. 100%. Like every girl. So common. Heck yeah. Normal. So many girls. Yeah. So the biggest thing if you're not a pelvic floor therapist is to check out their function. So if they can identify when they're having issues, it's when I get to this particular weight or it's when I get to mile 17. Okay. And I usually throw in, like if I ran 17 miles, I'm not really sure what my body would do. Like I dunno, but it still shouldn't leak. But if you can find out where that breakdown in the coordination in the endurance and the strength and whatever it is happens and look at what's happening there.

Sarah Haag:                  34:04                Because if you can run 17 miles or you can lift 200 pounds without leaking, but then you do, you're not, you're not weak. Right? Like if you can do all of that, something's happening there to make this happen. Cause if you can lift 200 pounds in that league, something's working, it's just not still working when you try to live 210. Okay. So let, let's look at what's changing or number of repetitions. Right? That’s what you're looking at.

Sarah Haag:                  34:52                So if you collapse your chest and which I would probably do after running 17 miles and I'm like this. And now what happens when I collapse what happens to my bottom half when I collapsed my shoulders? Well my butt just tucked. Cause I'm just trying to get through now. The funny thing is the breathing is also harder. So while I'm doing this as kind of a mechanism to keep going, it's harder to breathe because nothing's working diaphragm to have a full excursion, right? Yeah. So, so I like to look at if you're running fine for 17 miles, I want to see you at mile 16. I want to see what's changing over that mile. I want to see what you looked through my team. And can you, when you start to get to that point, can you make an effort to change something?

Sarah Haag:                  35:32                Do you notice a change in your breathing when you're lifting 210 instead of 200 and kind of look at it from that way cause you're not going to kegel why you do that. What do you mean? Oh well say to like precontract and prime and all these things and, and that's fine, but it's like if we go back to the running, you're not kegeling and all that time your pelvic floor after like 30 seconds is like, dude, you don't want me to get that tired. Like it's going to be like, we're going to stop that now. So yeah. So the way I would approach that, if you're not me, yes and not going to do a vaginal exam, is you look at their performance. So if they said, I have knee pain when I do this, when I go from 200 to 210, they're my squat.

Sarah Haag:                  36:13                How they do, they're looking at the mechanics. You would look at what's happening, what is different? Cause you know, the joint can do it, you know, the muscles can do it. What's changing. And you would address that. So it’s really no different if they can tell when they're leaking, you're just looking what can, what are the things that can change it? Usually the tail lift and looking at their breathing or two really easy ways to go about it.

Karen Litzy:                                           Okay. All right. That's great. And, and, and that goes with that. Does that also work with, let's say instead of you're not a runner weightlifter, but you’re like a new mom or something like that and you're okay, but then by the end of the day after you've been maybe lifting the baby or you know, doing whatever you're doing it, it doesn't necessarily have to be sport related is what I'm saying.

Sarah Haag:                  37:06                I think about like function, but definitely, I mean, you asked about, but no, just everyday if getting out of a chair makes you leak, that's, but then it's basically a squat. So you are, you're looking at the activity that they're having difficulty with and making small changes got in most cases.

Karen Litzy:                                           So I think the biggest takeaway here for me is that not everything is solved by doing a kegel.

Sarah Haag:                                          I think a lot of non pelvic health PT’s may have that, that misconception that if someone has incontinence, well Kegel time. Right? And that's all you gotta do. That's what most people do. If they go to the doctor and they mentioned it's like, ah, you know, that's pretty normal. It's not, it's common. And then they'll be like, do some kegels and, and a lot of women and men don't know how to do them.

Sarah Haag:                  37:53                So then they're just, I'm squeezing stuff and it didn't work. And it's like, Oh, before we get too far, can we check and see how you're doing them? And I think that's kind of a beautiful segway. So let's say you have your new mom or you have your athlete or whatever and you are, you've tried some stuff, right? Cause none of this is life or death, right? I mean it's fine to try some things. So already not doing anything about it. So trying to change up a couple of things is perfectly within your purview, especially again, you're seeing them for hip or low back. It all, it's all together. You're good. But if it's not changing, if it's not getting better, if when you ask them, you know, can you contract your pelvic floor, what do you feel? They're like, I got no idea.

Sarah Haag:                  38:33                And they're like, but please also don't touch me there. Or are you touching there and you're like, yeah, I don't feel anything either. And I've used all my cards but I don't know what to do. That's when you refer. Because just like any other things, somebody coming to see you as a physical therapist, you're going to do some things. And if those things are not working or they're getting worse, you're going to try something different. Or call the doctor or refer to a friend. Right? So if you change some things and you're like, I'm amazing, they're all better. Awesome. Do they need to go to pelvic floor therapy? I'd say no if their incontinence resolves or their pain resolves. But sometimes with especially we see it a lot more in I would say the more active athletic population is a pelvic floor that's more like this.

Sarah Haag:                  39:19                So it's like tight and there's a hundred people call it hypertonic or high tone or short pelvic floor and all these things and basically in my brain, the way I categorize it is like you should be able to contract your pelvic floor and you should be able to let it go. And we can all get better at that. But if you're like, I'm here, how good is my contraction going to be? Because I'm not showing you my pelvic floor. Like it's not going to, it's going to taste like it's going to not move very much. But if you get them to relax more or they're like, oh, I didn't know that was there, that's better. Then you all of a sudden you have a good contraction.

Karen Litzy:                                           How do they relax? Do you just say relax?

Sarah Haag:                  40:01                Before somebody tells him to relax, the worst thing to do is be like, can you just relax? So I try to have them feel the difference between contracting and not contracting. Because what will happen and people use what the traps all the time is like. So like, ah, so much tension. All right. Again, telling you to relax your shoulders. Things I didn't think of that. But if you squeeze and let go like as a little bit of like, Oh, I feel that, oh, oh there's some more space there. So I start with that. Okay. The pelvic floor. But again, if they're like, I just don't know, that's something that is so easy to feel with a vaginal or rectal exam. So that's where it's like, ah, you're having some trouble. I would recommend, would you see my friend for one visit have this exam, they're checking out your muscles and just see if he can feel that relaxation and then come up with like cueing or a plan that works for them.

Sarah Haag:                  40:54                Cause it's not just about like slacking everything out. It's really feeling that that relaxation, that lengthening of the muscles there and being intentional about it. You don't want to lie there would hope like maybe it'll let go at some point.

Audience member:                               So you talked about kegeling and what about dosage or prescription and quality versus quantity and how you prescribe that to your patient.

Sarah Haag:                                          There is no hard and fast rule as to like how many, how much. So that's where, again, I would have them do some and see how the coordination goes. Cause if they're otherwise neurologically intact and they're kind of getting it, how many do they need to do?

Sarah Haag:                  41:57                I would say it's not unreasonable to go kind of basic strength and conditioning principles of, you know, like I know eight to 12 reps three times a day. That's an okay starting point. And actually, I don't know if you know this, so I'm writing a book on incontinence and the PT people have it, but it's the editor just asked me, she's like, well, since we don't have like a hard and fast number, do we, should we put that in there? And I said, I think we do. So that's a good starting point. Not everyone would be able to do that right off the bat, but also some people be able to do that and they're not getting better. So it's kind of like let's start here and see what happens. And then you can kind of titrate it up and down. If I do an exam on somebody and they can't contract for 10 seconds, they can only contract for five, I'm not going to have them contract for 10 seconds at home. I would probably honestly in that case, have them go, I need you to make sure you can feel the good contraction. So you actually also asked about quantity and quality. I want quality, because all of us can do 100 crappy ones. I'm not sure how much it would help. So really looking to be like, okay, so I feel that contraction and I'm breathing

Sarah Haag:                  43:10                and I usually actually have stopped counting seconds. I've had people go by breath, so if you, let's do it. We're going to squeeze our pelvic floors and you're just going to keep squeezing as you breathe in and breathe out normally. Nothing, nothing fancy. And then keep squeezing while you breathe in and breathe out and let go. And what I hope you felt was a squeeze to start with maintaining the squeeze. Some people will feel kind of like a little, a little wave as they breathe, which is not unusual. But then when you stop the breathing and you let go, you should feel that let go. So if you didn't feel that, let go. I usually say that's one of two things without feeling right. I can't tell without feeling is that you got tired and you lost it or you forgot to let go.

Sarah Haag:                  43:51                So that's okay. Have a wiggle reset and try again. Because if you're not feeling the contraction, what are you doing? Like you might as well take a walk because then you'll actually be using your pelvic floor. I like going with the breath because a lot of people like to hold their breath when they're like, they'll do like they'll just suck at it and it, you'll feel a lift, but it's just a vacuum. It's not really your muscles doing their thing. So by doing the breathing, if you breathe in and out twice nice and slow, it's 10 seconds. You don't have to count. So if I have you do four of those, you just have to like count on fingers, two breaths come and arrest for two breaths. So much easier to keep track of. And then people actually do them. Cause if I could tell them to do ten second holds, one, two, three, four, five, six, nine, done. And that's not really helpful either. So like the too slow breaths. Now you're breathing and don't have to count and you're going to stay honest.

Audience member:       44:57                So trying to bring this into the neuro world for someone who's post stroke and has stress incontinence or they've had neural damage of some sort and have stress incontinence, Are there any PNF techniques where you can incorporate the pelvic floor to help with that?

Sarah Haag:                                          I haven't had PNF stuff since college. And I'm old. So what I would say is, is if I'm recalling that they go through movement patterns and as you're doing those things, there are things will be happening on the pelvic floor. It seems to make sense. What specifically, I don't know, but if you're kind of working more with that tone in general, I've only had a couple of patients come see me like post CVA and feeling their pelvic floors is amazing because while it makes perfect sense that one side might be like hypertonic are nonfunctioning until you feel it.

Sarah Haag:                  45:49                It's like, wow, that's so cool. Like once I totally normal springy, they can contract and relax the other side just like they're, they're hemiparetic arm. It's cool. With stuff like CVA or neurological involvement, you really want to make sure you're on board with the physicians and you know that bladder function is still intact because depending on where the stroke is and what exactly happened or where the spinal cord injury is, you don't want to mess around with screwing up the bladder or the kidneys. So if they're not going to the bathroom or they're only leaking during transfers, that could be stress incontinence or it could be overflow incontinence because their bladder is so distended with the effort. So that's something you would really want to make sure you talk with their nurse or their attending physician and make sure, so how are things working?

Sarah Haag:                  46:38                Because the other thing we need to remember is a lot of things we're still working on people who have had neurological insults, right? So once you're like, okay, bladder is relaxing as it fills, contracting, as it empties, it's emptied fine. We're not worried about this being overflow incontinence. I would actually start to incorporate stuff like blow before you go. Where you're managing it the same way you would for someone not having a stroke, but half of that, the beam continent and actually going to the bathroom it seems, I can make it sound very simple, but I have a slide and of course that I teach where it has all the like the tracks up to the brain and all the tracks who, the spinal cord to the bladder. But we got the sphincters, we got the detrusor, all of this stuff just happens.

Sarah Haag:                  47:25                And when I click the slide from this beautiful simple picture, it's just font about this big, explaining all of the complex things that are happening so far as we know. So again, as long as they're, bladder is functioning on that basic level where it knows when to empty and it can empty, I would treat him like a anyone else and not assume that it's just because of a high tone pelvic floor on that one side. That's the issue. But if you get that person and you do your PNF, please tell me what happens. And if it changes their incontinence, I would really like to know.

Karen Litzy:                                           And when you're looking at the bladder function, that is something the physician is doing through an ultrasound, is that how that works? How did they do that?

Sarah Haag:                                          They can do it through an ultrasound so that that they are, they can look mostly at like post void residual.

Sarah Haag:                  48:12                But then also there's a test called neuro dynamics. And this is a test that involves, a catheter and there you're a threat. And then a probe and another orifice down there to help measure for intra abdominal pressure. And it's kind of a neat test. If someone wanted to do it on me for free, I would probably do it. But they're also looking at an EMG the whole time. So they start to fill up your bladder was sailing so you know how much is in there and you're awake for this test because they go tell us when you, when you feel the first urge to go and they mark where that is. And so you can see how much fluid is in there. And I'm like, tell us when you get like the, I should go to the bathroom now urge. And they mark that and then they're like, okay, tell us when you can't take it anymore.

Sarah Haag:                  49:00                And they mark that. So then they know how much your bladder can truly hold. But also looking at what's your detrusor doing, which is the smooth muscle around your bladder, what's happening to your pelvic floor, where is the weakness? And usually when they're full, sometimes they'll have people cough to see if anything leaks or if any sphincters happen or sphincters what they're up to. But it's, it's involved. But there's a lot of good information. And interesting side note is that if you do so, that's really I think really helpful for like a neurologic population just to make sure. I did have one patient I was lucky enough to work with a PT who became a physiatrist who specialized in neurogenic bowel and bladder and she let me come down to watch  urodynamics of one of my patients who was really against cathing.

Sarah Haag:                  49:46                He didn't want to cath. So she came down, she brought him down to the urodynamics and as it and cause he's like, I am voiding 400 to 600 milliliters every time I have a bowel movement. And like that's pretty good. I mean like most are four to 600 CCS and turns out it was only under very high pressure. He was already getting reflects into his kidneys and after he voided four to 600 CC's, he still had four to 600 left, which is too much. So even though he was having some output, that was the test that really made it clear to him like, oh, it's coming out, but it's not healthy. Like I need to cath.

Jamie:                          50:41                What are some of the considerations that you might go through in your thought process when you're dealing with a male versus a female pelvic pain or incontinence issue?

Sarah Haag:                  50:53                That's a lot. I could talk for days on that. Well I'm not sure. When you're talking about considerations. We need to take into consideration our patient preference and what they're comfortable with. We can tell when our patients are uncomfortable or we should be able to but then kind of try to work out, they might not want to talk to me about this, but who can I get that they would, cause a lot of people would assume that men aren't really comfortable talking to females. But a lot of the men who come to see me, just want help, and we've had several male students come through and you know, they run into like women not wanting a male therapist to do it.

Sarah Haag:                  51:36                It's just finding that, right? Just like any other body part, finding the right person to help. But then if we go to, you know, bringing up those subjects, I don't know that in my brain it's so, so different. Male to female, you're going to take into consideration their history for sure. I feel happy saying that because now with we have kind of like a gender spectrum, right? We have people who, who have transitioned in varying degrees and we have people who haven't transitioned but totally identify with the gender. They weren't assigned at birth and all of these things. So basically I take it functional. So can you just walk me through the issues you're having, your questions, concerns when it's a problem, if anything makes it better, does anything in particular make it worse? And then we problem solve from there?

Sarah Haag:                  52:26                So I guess I didn't really have a good, a good answer, man. Male to female. Their situations are usually different, but it's kind of different across one gender or the other. Anyway. Is that kind of answer it? Yeah. Great question.

Karen Litzy:                                           Well, thank you so much. Thank you. I think we covered a lot and I thank you guys for being here and I hope that you guys got a lot out of this and can kind of take this back to your patients now. So last question that I ask everyone and it's so knowing where you are now in your life and your career, what advice would you give to yourself as a new Grad?

Sarah Haag:                                          Ask more questions. To be honest on, I came out of school pretty much like, like the teachers know best and what I learned is right.

Sarah Haag:                  53:16                And then when you get into the real world, I ended up thinking I was not very good at my job for awhile because like you would do what you were taught to do but it wouldn't work. And then, you know, some things happen and I got older and more comfortable and when you start asking questions you realize there isn't one answer. So if you start asking those questions, you're part of, you're part of the solution. By kind of pushing those boundaries and not like, I wish I would've just asked more questions sooner. I'd be so much smarter than I am now.

Karen Litzy:                                           Where can people find you on social media if they want to get in touch with you?

Sarah Haag:                                          Sarah Haig, PT on Twitter, you can find me on my website, and um, I mean Facebook, Sarah Hague.

Sarah Haag:                  54:07                I don't know what my picture looks like right now, but I'm friends with Karen, so if it says I'm friends with Karen, that's probably me.

Karen Litzy:                                           Awesome. And just so that everyone knows a lot of this stuff that Sarah spoke about, we will have links to it. We'll have links to the home health section. We'll have links to the testing, the urogenic testing. Is that neurodynamic testing? You could just send me a link or something about it. So we'll have it all in the show notes. Thanks everyone for watching the live. We appreciate it and everybody, thanks for listening. Have a great couple of days. Stay healthy, wealthy, and smart.




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


Feb 7, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jazz Biancci on the show to discuss the power of tuning in to your body.  Jazz Biancci, CAPP, founder and creator of The Consciousness Project 2020, is an Author, Speaker and Channel, helping people access their invisible influences to discover what they don’t know they don’t know, to have a greater impact in the world.

In this episode, we discuss:

-The importance of tuning in to your body’s awareness and emotions

-How to live with more integrity during your daily interactions

-Why you should shift your inner dialogue towards kindness

-And so much more!



Speakers Who Dare

Jazz Biancci Twitter

Jazz Biancci Website  

Jazz Biancci Facebook


For more information on Jazz:

Jazz Biancci, CAPP, founder and creator of The Consciousness Project 2020, is an Author, Speaker and Channel, helping people access their invisible influences to discover what they don’t know they don’t know, to have a greater impact in the world. Jazz has been a speaker at the Fit, Feminine & Fierce Conference in NYC, the Speaker Salon NYC, and a panelist at Soul Clarity & Abundance Live. She is currently the online host and co-producer of, co-host and producer of Spiraling Inspiration on, producer of Healing & Becoming The Divine Masculine, and producer and moderator of The Summer Series LIVE: Anchoring During Troubled Times, and Conscious Masculinity Part ll: Diving Deeper.

Read the full transcript below:

Karen Litzy:                   00:00                Hey Jazz, welcome to the podcast. I am happy to have you on. And for those of you who have not listened to the podcast before and have not heard me talk about the speaker salon that I was involved in over the summer last year and the mastermind that I continue to be involved in through Trisha Brouk, then you need to go back and listen to some of the episodes I did with Trisha Brouk because that is where Jazz and I met. So we met last summer. We were a part of a small group of this speaker salon. And for me it was a real big shift in mindset in life. And I always credit all of the people in the group, not just Trisha for being the leader of the group, but everyone else in the group, and Jazz was one of them. And so that's how she and I met.

Jazz Biancci:                  00:53                Oh, thank you. That was probably a crossroads in my life. It was definitely a game changer.


Karen Litzy:                                           Yeah, I agree. I, um, it changed my life and all aspects of my life, not just speaking, not just business, but personal confidence, everything. It was just this big, big, yeah, crossroads for me as well. I just absolutely loved it. And Jazz was just this amazing public speaker getting up on stage. Like I was saying, I remember the first time I went, everybody got up on stage. And I was wondering, I'm like, is everyone here a professional speaker?

Karen Litzy:                   01:37                What is this? And I was very, very intimidating, but at the end I think we all definitely got so much out of it. And the support and the love, the community was great. But today jazz is here to talk about the power of being in our body. So Jazz, my first question to you is, what the heck does that mean?

Jazz Biancci:                                          It means fully inhabiting your body to allow to provide some feedback that it's meant to provide. So I believe the body is a biological computer and it plugs us directly in to this energetic grid that lays across all things. And so when we're in our body, our sensory system is at work. And we receive messages. So the language of the body is very different from the language of the mind because there are no words. And so to understand and interpret those messages, it requires us to inhabit our body versus, you know, a lot of people live life from the neck up and it's all logic, linear thinking.

Jazz Biancci:                  02:47                And there's a level of detachment. So when their body has a response to something, a person, a situation, they're slower on the uptake if they even feel it at all. Because we can feel residents, we can feel when something is a no.

Karen Litzy:                                           So is this like an excuse my kind of layman's terminology here. Is this what people would refer to as their gut feeling? Or is this something more?

Jazz Biancci:                                          It's a combination. So there's a, there's a heart intelligence and there's the gut feeling and they all worked together.

Karen Litzy:                                           And how do we tap into this? So I feel like I am certainly hand raised one of those people that's probably more head up or neck up then the rest of your body. I fully admit that I am. So how can we tap into those other parts to the heart, to the gut feelings and how can we do that?

Jazz Biancci:                  03:54                I used to be a linear, logical head person too. And I found my way back into my body as an athlete and a dancer. And I started noticing when I was at the gym and in dance class, how the reach of my arm connected me to my heart. And so a great way to start is just to get physical if you can, and if not to take a moment and just put your hands over your heart in the morning. Take 10 seconds to remind yourself that your heart is not only beating to keep you alive, but it's also feeding you information. And then as you move throughout your day and you're having interactions, notice how you feel when you're ordering your coffee and they call your name. How does it feel? And without judgment, but start to pay attention to your responses to people, to the things you're saying and how it resonates in your body.

Jazz Biancci:                  04:58                Because often people will ask us questions like, uh, do you mind helping me with this? And sometimes the answer is no, but we say maybe because we're being polite and feel how that resonates because that lie resonates much differently than the truth.

Karen Litzy:                                           Interesting. And, and I, I think we've all been in these situations, like you said, someone asks you to do something and you say maybe are you say yes. And I was in a situation a number of years ago where I said yes to something, but it was literally giving me stomach pains and you know, it was making me so anxious because I knew deep down this is not right, but I am a bit of a people pleaser. And so I said yes.  So for those people like me, which I, I think there's a lot of us out there and a lot of the people that listen to this podcast are, you know, we work in healthcare.

Karen Litzy:                   05:57                We want to stay healthy. You want to stay fit. And oftentimes were big givers, right? Because we're, we want to heal people. You know, we want to help people, but then it kind of backfires on ourselves. So what do we do in those situations where someone asks you to do something, you feel it in your gut. It's not, it's literally making you sick, but you say yes anyway.

Jazz Biancci:                                          Well it's, it's baby steps, right? It's a process. So the noticing is a start. Like I used to tell myself, yeah, workout in the morning. I am not a morning person. I have never been a morning person. And so starting to notice how that felt in my body, whether I was able to change it or stop saying, oh I'm going to work out in the morning. It was a different story. So we start by noticing how it feels and then we start asking ourselves, well, why did I say yes?

Jazz Biancci:                  07:05                So why did I say maybe when I met and start delving into that because it takes a while before we are in grace enough to say, I would really love to help you with that, but my plate is full right now. Can I help you find someone else?

Karen Litzy:                                           That's great. That's a very, very nice way to say no. And the offer of saying, can I help you find someone else or I have someone else in mind I think is a great way to, from the people pleaser standpoint, again, I'm going to be selfish and go from the people pleaser stand point that you still feel like you're helping even though you're not the one who can do it.

Jazz Biancci:                                          Exactly. And you're in your heart. Because sometimes when we don't understand how to do something and we're, we're getting our legs about us, we can be short or curt or rude just to try to get that boundary laid down, you know? And we don't have to do that. We can take our time with this process and notice what we're doing when we're doing it, understand why we're doing what we're doing, when we're doing at being graced with that and sit in our hearts and give us an answer that's a win win for everyone.

Karen Litzy:                   08:32                Yeah. So when we're talking about, you know, being in your body, we're, I'm just going to recap the steps because I'm a step person. I'm a checklist person, kind of. So noticing first what's happening in your body. And like you said, it doesn't mean you have to sit and meditate for 20 minutes or 30 minutes. It's just take a moment to remind yourself where you are and how you feel in that moment. And then delve into the, why did I say yes or maybe when it should have been a no, and delving into the why is something that we've been talking about a lot lately on the podcast and that why goes pretty deep. So it's not just why did you do this? Oh, because I didn't want to. And that's the end of the conversation. And then finally being graced with your decision. And then the most important is to come up with a win-win response for everyone. Got It. Well that seems easy.

Jazz Biancci:                  09:38                It does seem easy. The hardest things usually do.

Karen Litzy:                                           That sounds like I've got it down pat now I just have to practice it. And I would assume just like, you know, you were an athlete and a dancer. How many times did you practice certain movements in order to perfect them? Or to feel comfortable with them. Right. So I would assume that this process is just a lot of practice, right?

Jazz Biancci:                                          Ongoing. And it's not about judging ourselves or being mean or shaming ourselves. It's not about that. It's just like, it's a scientific experiment. That's all it is. How can I improve? How can I shift?

Karen Litzy:                                           And so if you're, let's say you're working with a client and you're working with them on this sort of shift, what pieces of advice seems to resonate most with your clients? And again, knowing everyone is different and has a different path, but are there exercises or things that you do with clients that you're like, you know, this is pretty powerful. This is something that seems to work.

Jazz Biancci:                  10:55                I have them keep a journal. First I just do like the tick system. So noticing how many times a day that you lie. Like when you're like counting and you're like putting like marks and then you get to the five and you cross it over. So it's just that easy to start noticing how many times a day you lie. So you have a notebook and you just make a tick or use your notes on your phone and you just put a one Monday, one, two like you just keep adding ticks and you count it up at the end of the day. Because it's fascinating because we lie a lot, this self-deception is astounding and it does no service to anyone when we're out of integrity because that's what that is. We're being inauthentic in a moment because we are taught to be polite before we consider ourselves and we can do both without being disingenuous.

Karen Litzy:                                           So yeah, it'd be like little white lies or maybe, yeah.

Jazz Biancci:                                          Yeah, because it's all about the observation and understanding what kind of situations prompt us to lie. Noticing when we have fear, because fear is huge. If you're afraid of retaliation or punishment, you're prone to lie to get approval.

Jazz Biancci:                  12:40                So it's like noticing those moments that that turn up the volume and then noticing how that makes you feel. Because there is a different way. We just haven't been taught what that way is.

Karen Litzy:                                           So you start, you have people get a journal or like you said on their phone and write down how I'm going to do this because I wonder how many times do I even say a little white lie. I'm going to do this. I would encourage the listeners to do this as well and we'll see what we come up with. It's really fascinating. Yeah, it sounds really, really interesting. So, all right, let's say I do this system for a week and I like five times in a week. What do I do about it? What does that mean? What does that lead to?

Jazz Biancci:                                          Well, it leads to noticing what kind of lies you're telling it to whom, right?

Jazz Biancci:                  13:30                Because they may, they may be the lie that like, hi, how are you today? I'm fine and you're not, you know, and then reconstructing that answer so that it feels right in your body and appropriate for the social situation. So someone may say, hey, how are you? And you could say, well, I'm hanging in there, you know, that's acknowledging what you're feeling without giving too much information.

Karen Litzy:                                           Yeah, because I would think that you can acknowledge it, but giving too much information, people will be like, why is she inappropriate? So you have to kind of know where that line is between, you know, allow like divulging information but then being like, what is wrong with like why is this person saying this in this context at this time?

Jazz Biancci:                                          So you're honoring and acknowledging and being aware of your environment at the same time because the residents of truth and creating the habit of truth for yourself.

Jazz Biancci:                  14:43                As you begin to notice how that frequency vibrates, the way a drop of water into a glass of water does, you see the ripples, you can feel it. And over time it's, it's a purification. It's a gentle way to start the purification process because the body is an incredible instrument. What I found in doing these practices, I know when someone's lying to me because it feels different than truth. And so it's a confidence of knowing that I can rely on myself and my instrument and my body to provide information that I can rely upon because being able to rely on the body because there are no words attached to it, the body doesn't lie. And so those moments I've had moments. I'm sure you have too, that an alarm has gone off within you that you don't necessarily understand. And do you follow? Do you not follow it?

Jazz Biancci:                  15:52                Is your imagination, are you having an anxiety attack? For me it happened in queue boarding an airplane and I've been flying all my life and I was going to Haiti for work. It was my fifth trip to Haiti. I was excited, our whole team was going and we were waiting in queue and all of a sudden something happened in my core and I was terrified and I went to my friend and my coworker and told you, I'm like, I am not getting on this plane. I'm not going. And of course she was like, what are you talking about? We have a job to do. And I'm like, no, something doesn't feel right. And so we went to the director and she's like, you can sit by him and you've heard me speak about this. And I let myself be peer pressured and I wasn't competent in that feeling yet that alarm is one of the first times I felt that.

Jazz Biancci:                  16:48                And so I got on the plane, I was sitting next to the director and I buckled in and I'm like, what am I doing? But I still didn't have the courage to say, I’ve got to get off of this airplane. I sat there. So we take off, there's this huge commotion and the commotion is moving forward. The stewardesses cannot get the situation under control and the plane has to turn around the air marshals come on the plane and escort the situation off the plane. So the grid that we have within us in our hearts, that electromagnetic energy pulse connects to what's going on in our environment. And I was connected to that woman because she was in my environment and it was an alarm going off for me to get off the plane. It was also a great moment to take notice. Okay. So when my body does this, I now have evidence to listen and thank God it was just the air marshals and an escort off the plane.

Karen Litzy:                                           Sure, sure. That's Crazy. And you know, we've all had these, oh, why am I doing this? Why am I doing this? And then oftentimes that feeling ends up being validated somehow. Now through this work, through this, you know, learning how to be in your body, what has that done for you? So what has that done for your life or for your career that you can share?

Jazz Biancci:                  18:34                It allows me to stand in my power and I'm still in awe of it because it's like there's this super power with that we never learned about. No one tells us about that we can fall into by accident. And it's always there. I've always had this ability to be keyed in. And then, you know, you hit puberty and you're a teenager and you're rebellious and you fall away from yourself because you're trying to fit in and then you fall back into yourself somewhere along the line if you're lucky. And so for me, it's really being able to stand in my body, in my strength and know what is right for me. Because when situations happen, the tendency is to go outside of ourselves and have, a caucus about, well, this happened. What should I do? What should I do?

Karen Litzy:                   19:36                You always reach out to our friends or family and say, okay, what do I do now? What do I do? I want to do this, but I don't know if I should do this. So what do you think? What do you think? What do you think? And you know, it's like too many cooks in the kitchen.

Jazz Biancci:                                          It's too many cooks in the kitchen and it pollutes the truth for us. And so being able to be in our power is about being in authenticity and integrity and in truth so that you don't go to outside counsel because the reality is no matter how many angles I give you of a story, they're not going to give you the full picture. You aren't there and you don't know what I feel inside my body. You don't know the energy of the situation and I'm not going to have that much time to go into depth with you.

Jazz Biancci:                  20:22                So it's being able to hold your own counsel and, and stand in that council because everyone's going to have an opinion about that. So whether it's the choice you make in your career or it's a love relationship, there are going to be outside influences that want to put seeds in your ear. But the reality is only you know the truth. Only you have to deal with the consequences of your actions and only you can know what's right for you. And so being in my body and being in my heart and learning to trust this incredible mechanism has allowed me to do that. And it's changed my life cause I'm not wavering or trying to please anyone because even though we don't think we're trying to please anyone. Well we ask for advice. You know there's like, I remember this was really big for me back in 2005 when like sex in the city and and this whole dating thing and no, there was like the whole Mr. Big and it's a cultural thing, right?

Jazz Biancci:                  21:37                So we can think that we're supposed to behave a certain way and believe that that behavior is right and us, it's who we are. I'm a New Yorker. This is what I do when the reality is if you take a moment and you drop into your body, well maybe that isn't how you feel and that doesn't feed what you ultimately want and you're doing a disservice. Are you strong enough to make another decision and then strong enough to stand in it?

Karen Litzy:                                           Yeah. Doing a disservice to yourself.  And that's hard. It is. That's hard to, to make a decision and stand in it and be confident in that decision and confident with your own self and your ideals that this is what is correct. This is what is good for me when, yeah, you have the peanut gallery and either ear telling you otherwise or maybe agreeing or not agreeing or what have you.

Karen Litzy:                   22:36                But that's hard and I feel like I just want to acknowledge how difficult that is.

Jazz Biancci:                                          It is hard, but you know, it gets easier because you share less things with less people, you know? Because I don't really need to ask someone what I should do in my relationship. I know what I need to do in my relationship. I may need to vent, I may need a hug, I may need to pass an idea over with one of my friends. But it allows me to preface to preface the conversation and say, Hey, I would've had something by you and I want to know what you think about this specific point right here. Or I need to vent. So I really don't need any feedback right now. Are you okay with that? It lets us frame how we need people to show up for us because I don't necessarily want everyone's opinion.

Karen Litzy:                   23:41                Yeah, but you want and an ear to listen sometimes

Jazz Biancci:                                          If I know that I have the deli across the street and I want coffee and all I have to do is go across the street and get the coffee and come back, that's much easier. Okay. Then asking the doorman, the person in the elevator, the fire guide, the fire department guy standing outside, I'm the person holding the door for me when I go into the Deli and the Deli person, what kind of coffee I should get. You know this the same way when we have problems, we bounce like a pinball in a pinball machine back and forth. We know what we want to do. We're just trying to get comfortable with it. But if we are in our bodies and in our hearts and we, we feel the resonance because when something doesn't vibrate properly, like when alive vibrates in your body and you have been doing this practice for a while, it feels violent.

Karen Litzy:                   24:51                That's interesting. I'm kind of thinking on your, I love that example of why do I need to ask every person I come in contact with from my apartment to the Deli across the street, what kind of coffee I need to get. And when you say that, anybody would be like, well that's ridiculous. And yet that's what we do with big decisions in our lives, our relationships in our lives is we ask everyone.

Jazz Biancci:                                          We give our authority away when really we know the answers. It's just working that confidence and that trust in ourselves and the best way to work that confidence and that trust is to sit with what's going on and see what resonates, what choices feel right.

Karen Litzy:                   25:43                So it's really taking time out of your day. Not a lot, but working through those steps that we mentioned earlier. And the more you practice it, like we said, the better and perhaps more efficient you will get at tuning into your body and knowing what that feeling is like, because I would assume if you're new to this, that you're not even maybe sure what you should be feeling. Like how do you know what you should be feeling?

Jazz Biancci:                                          You don't because everybody is different. But if you had a friend who lied to you all the time, you couldn't count on them for anything. That's how it feels from the outside. And you would probably not be friends with that person. Once we start to notice how often we lie to ourselves, we realize that we’re that friend, except we can't get away from ourselves.

Karen Litzy:                   26:51                And so you need to be making some changes.

Jazz Biancci:                                          Because you need to trust yourself above all others. The relationship that you have with yourself is the map you take out into the world. And so part of this practice is seeing how it feels. And at first you may feel nothing. At first it's kind of amusing. Uh, it may make you like a little sad like, wow, why did I just do that? I didn't even have to lie in that scenario and I just did it completely unconscious, you know? So it, it helps you in that consciousness as well. So you can start making informed decisions and start listening because sometimes our mouth is on automatic and it's saying things that are completely detached from our truth. It's the talking of Shit.

Karen Litzy:                                           And only until you can kind of be in your body, can you really get a sense that's what you're doing?

Jazz Biancci:                  27:54                Yeah. That sometimes we talk ourselves out of the things we want. We pretend that we want something that we don't want.

Karen Litzy:                                           Yes, absolutely. Absolutely. That happened to me last year. I kept thinking I should do this. Someone told me to do this, I should like it, I should like it. And in the end I was like, this is not for me. And I just changed the entire thing for me like a year to figure that out here to kind of realize, wait a second. Oh, okay. No, I have a little more confidence and I know how I want this to go now I get it.

Jazz Biancci:                                          Yeah. Because you know it's okay to take your time. There's no rush. We think there's a rush, there's no rush ticket where we're going. We have to figure out how we want to do things.

Karen Litzy:                                           Absolutely. And I think that is a great, great piece of advice. And you know, I have one more question to ask is what I ask everyone. But before I do that, is there anything that we missed or anything that you really want the listeners to take away from everything we spoke about?

Jazz Biancci:                  29:10                I would say engaging with curiosity and practicing tenderness with yourself is epic because we're not tinder, especially if you're in New York. It's very, very rare that you get a tenderness, but it starts to allow you to discover more things about yourself because you start integrating and making space for the child within you. And it's really quite magical. I mean, your life can really change with a little bit of tenderness and it starts with you telling yourself the truth and how you do it.

Karen Litzy:                                           Yeah. That's such great advice and something that over this past year I have definitely started to do more of. We were speaking before we went on the air about how we are always like so harsh to ourselves and it got me thinking like I feel like we are the biggest assholes to ourselves. You know what I mean?

Karen Litzy:                   30:30                Like sometimes like you would never be friends with yourself the way you speak to yourself.  We put up with it, but now I can see through the tips that you've given today, how we can change that. That's a big shift for people and I hope that they use some of these techniques and steps to kind of stop being such an asshole to yourself and instead be the friend that you always needed. We should be able to be all of that to ourselves, like you said. So you can kind of stand in your power and know what you need and know what you want in your life. And I realized that doesn't happen in like a week, but it takes as long as it takes. Right?

Jazz Biancci:                                          Well, I mean it's a commitment, right? It's just like any commitment the gym, your career, they're all commitments and they're all a process.

Karen Litzy:                                           100%. And now before we go, I have one more question for you and that is knowing where you are in your life and in your career, what advice would you give to your younger self?

Jazz Biancci:                  31:51                I used to be, so I still am very sensitive, but I would break my own heart. So I would say I would tell my younger self to be less cruel and more kind.

Karen Litzy:                                           And that's great advice. And I think anyone listening to this can take that advice as well. Now Jazz, what do you have coming up in 2019 and where can people find you?

Jazz Biancci:                                          Oh, I'm so excited for 2019. So if you want to hear me speak live, there is speakers who dare, which is March 26 at the triad theater in New York City. It's going to be amazing. Um, they can find me and I'm working with an editor now, so I expect that my book will be out mid-summer, hopefully sooner. Yeah, I'm so excited. I'm so excited. It's been like a lifetime of making this happen. You can always check my website.

Jazz Biancci:                  33:11                I do a conscious masculinity panel the first Wednesday of every month and the panel is amazing. I am so blessed to have such brilliant men participating. So that's on a facebook live and you can find me on facebook at Jazz Biancci, conscious consciousness architect.

Karen Litzy:                                           Jazz. Thank you so much for coming on and sharing all of this good stuff with us.  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 iTunes!


Feb 4, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Mohammad Rimawi on the show to discuss foot and ankle health.  Mohammad Z. Rimawi, DPM, AACFAS, brings a wealth of knowledge and expertise to Grand Central Foot Care in Midtown East, Murray Hill, and the surrounding New York City area. As a board-qualified foot, rearfoot, and reconstructive ankle surgeon with specializations in traumatic foot and ankle injuries and complex deformities, he is able to offer his patients top-tier care no matter what problem they bring him.

In this episode, we discuss:

-The anatomy of the foot and ankle

-The most common foot and ankle injuries

-The differences between a high ankle sprain and low ankle sprain

-The importance of the diabetic foot check

-When surgery may be an appropriate intervention

-And so much more!


“If your body says something is wrong, chances are it is.”


“Proprioception is very key for me in the rehab process.”


“Preventive medicine is the best medicine.”


“Establishing ties with other professions is important.”


“The feet can be a window into your overall health.”


For more information on Dr. Rimawi:

Mohammad Z. Rimawi, DPM, AACFAS, brings a wealth of knowledge and expertise to Grand Central Foot Care in Midtown East, Murray Hill, and the surrounding New York City area. As a board-qualified foot, rearfoot, and reconstructive ankle surgeon with specializations in traumatic foot and ankle injuries and complex deformities, he is able to offer his patients top-tier care no matter what problem they bring him.

Dr. Rimawi earned his doctorate from the New York College of Podiatric Medicine, where he made his mark. Not only did he graduate above the 90th percentile of his class and serve as class president for four years, but he was also recognized with the Student Service Award. That award goes to the student voted by the graduating class as making the biggest impact on the field of podiatry. Beyond his peers’ recognition, Dr. Rimawi was inducted into the Pi Delta Honor Society for his achievements in his research and his studies.

With those accolades to his name, Dr. Rimawi continued on to a three-year reconstructive foot and ankle surgery residency at DeKalb Medical Center and Jefferson Health. His colleagues and the hospital staff at the latter named him the Podiatric Resident of the Year.                             

It’s no surprise, then, that Dr. Rimawi is still impressing in his field. He’s a published author and accomplished lecturer, as well as an associate of the American College of Foot and Ankle Surgeons.                                                                                       In the spare time Dr. Rimawi manages to carve out, he loves to read, hike, and root for his favorite sports teams.


Resources discussed on this show:

Grand Central Foot Care Website

Mohammad Rimawi Instagram

Address: Grand Central Footcare

122 E 42nd Street, Rm #2901

Midtown East and Murray Hill

New York, NY 10168

Phone: 212-697-3293


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


Have a great week and stay Healthy Wealthy and Smart! 


Xo Karen



Jan 28, 2019

Ashley Micciche is the CEO of True North Retirement Advisors, an independent financial advisory firm managing $230 million in client assets, and located just outside of Portland, Oregon. Ashley specializes in helping small business owners exit their business & retire with financial security by crafting and implementing a custom-designed exit plan.

Whether you’re looking to retire in the next few years or you’re on draft one of your business plan, you should plan for the end in mind. Ashley is going to walk us through the 3 universal, must-do steps to help you get what your business is worth so you can retire with confidence and financial security!


Press play and get ready to take some notes!


More about Ashley:

Ashley Micciche is the CEO of True North Retirement Advisors, an independent financial advisory firm managing $230 million in client assets, and located just outside of Portland, Oregon. It’s a family business, that she owns with her father. 

Ashley specializes in helping small business owners exit their business & retire with financial security by crafting and implementing a custom-designed exit plan.

She started her career as a financial advisor in 2007 after graduating magna cum laude with a Bachelor of Science degree in Business Finance from Portland State University.

Early in her career, Ashley developed expertise in 401k consulting for small businesses, and she quickly realized that business owners nearing retirement were not taking the steps necessary to exit their business. She watched several of her business owner clients walk away from their business at retirement without the financial security they needed.

Today, she is on a mission to transition 300 small business owners successfully into retirement in the next 10 years.

Ashley started her first business at the age of 8 years old, taking care of her neighbor’s pets & plants, and picking up their mail when they went on vacation – for $3 a day. She ran that business (a complete monopoly with 100% profit margin!) for 3 years.



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

Ashley Micciche:           00:04                Thank you so much for having me, Karen.

Karen Litzy:                   00:06                Sure. Now before we get to the meat of our interview, I would love for you to fill in the blanks a little bit from your bio that we read to introduce you so that the listeners get a little bit better sense of where you're coming from.

Ashley Micciche:           00:21                I know one of the things that was mentioned in there was I started my first business when I was eight years old. I didn't know it at the time, but you know, I was very entrepreneurial growing up and I started this business where I would pick up your paper and your mail and water your plants and feed your dogs and cats if you went on vacation. I found out really early on that if I worked really hard and I posted flyers and put flyers on mailboxes, put stuff in the newsletter and our neighborhood advertisement that I would get business from that. If I didn't work hard, if I didn't post flyers or do any of that, I got nothing. So I learned these really awesome lessons about hustle and working hard and making $3 a day doing all this work early on. And so that was a really neat experience because it taught me a lot that I have carried with me over the years and now starting my own real business.

Karen Litzy:                   01:32                And those are lessons that you know you can take with you for your whole life. And now you are at True North Retirement Advisors as the CEO and retirement plan specialist. So today you're going to share with us three universal must do steps to help you get what your business is worth so you can retire eventually which is something we all want to do. Well, maybe not everyone, but most people want to retire and we want to be able to retire with confidence that we can live a lifestyle that we want to live. So let's go through these three universal must do steps.

Ashley Micciche:           02:13                So what we do is exit planning for business owners. And I think what's really unique about that is that we don't have any skin in the game. Like it doesn't matter to us who you sell your business to or you could sell it to a family member, another employee, you could sell it to an outside third party. We don't have any skin in the game in that regard. So what we do is we really just work with our clients to identify those goals and what's important to them and what the value of their business is so that they can achieve what they're looking to do when they exit their business.

Karen Litzy:                   02:50                Oh, I was going to say, because I'm assuming everyone's got a different goal to exit their business. Right? And so it has to be personalized and individualized.

Ashley Micciche:           03:00                Yes. And so we have a step by step process for this. But what I found is that the process really diverges after the first three steps based on who you end up selling your business to, what that timeline looks like. But there are three universal steps to exiting your business. And so the first universal step is valuing your business, understanding what your business is actually worth. And it's kind of like if you know, you want to retire, Exit Your Business, sell your business in five or six years or whatever that is, that's sort of like the destination on your GPS. And if you don't put a starting point in, if you don't put in where you are today, what the value of your business is today, it's almost, your GPS can not tell you how to get where you want to go. So you really have to take inventory of what your business is worth today.

Ashley Micciche:           04:00                And I find that a lot of people don't do this vital first step because they have a lot of misconceptions about what's involved in value in a business. So they think that it's going to cost them thousands of dollars. It's going to take weeks or months. Someone's going to come in to disrupt their business because they need to ask questions and you know, dig into the books and records and all of a sudden, so they're like, no, I don't want to do that. Like I'll just use a rule of thumb or hey, I know this other practice across town that's close in size to mine and they sold their business for this much. So I'm just gonna, you know, I'll go with that. But you know, if you don't start with an accurate valuation, it's nearly impossible to take the other steps necessary to exit your business.

Karen Litzy:                   04:52                Okay. So I will admit, I have no idea how to do that. Yeah. So what would you say to someone like me and I am a business owner? How do I even start valuing the business?

Ashley Micciche:           06:07                Yeah, so that's a really good question. And you're not alone, Karen. There was actually a study done about three years ago by the business exit institute. They do a lot of research in this area and they found that 98% of business owners have absolutely no clue what their business is worth and how to go about doing that. So, the neat thing about valuing your business is that more technology tools exist today. So there's a software tool that we use to value a business and anyone can access this. It's free, but really with a pie with eight pieces of information, like your revenue, what you pay yourself, what your compensation is, your debt and certain other things like if you rent or own the space where your business is occupied, but there are a critical pieces of information to value your business.

                                                            And if you get those, if you can get those eight pieces of critical information and enter it into the valuation tool, then it will spit out an evaluation for you. It'll tell you, you know, Karen's practice is worth $689,000 or whatever it is based on those parameters that you put in. And it doesn't take long. It takes like five minutes to do it. Once you've gathered the data, the toughest part is gathering the data. When you use this software tool, there's 50 pieces of information you can put in. But what we did is we went back to the software developer and we said, okay, tell me the bare minimum pieces of information that I could put into the software tool for it to spit out the valuation for my business. And so we use that, what their advice was to us.

Ashley Micciche:           07:03                Plus some of the other things that we know from what we know moves the needle on valuation. And we came up with this checklist like, Hey, if you can get these eight pieces of information, what your revenue is, your pretax income, if you owe other people money, if you have bank loans, if you rent or own the space that you're in, those are the things that have the largest impact on what your business is worth. And then once you enter that into the software tool, it'll spit out your evaluation. It's fantastic. And I'm so excited about it because what I found, this is not our core business, like this is it. So we actually make this tool available to anyone who wants to use it for free. Because what we want them to do is get unstuck, get out of the head mind space of using a rule of thumb or a really inaccurate estimate.

Ashley Micciche:           08:01                Because once you know what your business is worth, it unleashes the rest of this process. And when you see that number tangible, you know, Karen's business is worth this amount, then you can start to make some important decisions about, okay, so is this going to be enough that, you know, if I want to exit and a year or two years, you know, what do I need to do if this isn't what I hoped it would be? So it really influences a lot of the other decisions we make in the process. Valuing your business and knowing how to value your business is step one. So what is step two? Step two would be establishing what your timeline is and your goals. So you know, a lot of people have this idea in their head, I want to retire and exit my business in 10 years or five years.

Ashley Micciche:           09:00                Or maybe it's like January 25th you know, 2021 like they've got it dialed in down to the day. And so that would be the first thing. And not just when you want to leave, but figuring out, okay, how were you involved in your business today? And then how do you see that involvement evolving over time? Because the reality is for most people who are not business owners or entrepreneurs, they have a very specific set retirement date and they go from working full time to retirement date and then fully retired. But for a lot of business owners there, they sort of have this phased out exit. And so it's important to kind of think about how to do that, which is great for a business owner because if you have somebody else who's taking over ownership at or who's doing a lot of the day to day management or seeing patients or whatever that may be, you can pull back over time a little bit and have this phased out retirement so that you can test the waters and make sure that whoever that person or those people are are fully equipped to be able to run things in your absence.

Karen Litzy:                   10:16                Yeah, that makes perfect sense to me. And also I would think it's really hard for some business owners. Have you found that with the clients that you work with that that's not easy?

Ashley Micciche:           10:28                Yeah. I mean, cause your business, it's like your baby, you know, blood, sweat, tears. You've made so many sacrifices, a lot of it too.  It is very much a part of your identity and who you are. And that's okay. You know, I totally get that. I think that the important thing about this establishing your timeline and goals is what feels right to you and what do you want. It's not up to me to tell you what you should do. It's up to you to figure that out.

Karen Litzy:                   11:00                Not Easy, not easy. But this is good. As you're saying all of this, I'm kind of thinking in my head like, okay, I should probably be thinking about this stuff cause it's not even something that's on my radar right now. But I guess it's never too soon.

Ashley Micciche:           11:14                No. And actually the best exit plan starts when you start your business, but most people are so heads down focusing in growth mode that rarely if ever happens because it really does require this mindset shift. But you have to start it before you're burnt out. So I've seen a lot of business owners who, because they didn't plan, they didn't start this process, you know, five, 10 years out, which is really an ideal timeframe to be doing this. They wait until they're sick and tired of working and they're ready to retire. And so they don't have the time to be able to craft that ideal accent or maybe they sell their business to somebody who in a fire sale where they just want out and they don't care what they get for their business, but if they would have planned more, they could have got, you know, what they wanted in a lot of cases.

Ashley Micciche:           12:18                I didn't work with this person on their exit, but I know somebody who just retired this past summer and he was a third generation owner of his family business that his grandfather started. It was a good business, a good cashflow, it was a solid business. But he didn't do any planning and didn't identify a successor and he just got way too burnt out and literally just walked away and shut the doors and left with nothing. And that, to me it was really sad just because it was, you know, third generation. And he was fortunate because he didn't need to sell his business in order to retire. You know, it wasn't a must do, but for most people, you know, your business is your largest asset. And so it's so important we plan for all these other things, like when we're going to take social security and investing in all these things, but a lot of times the business and the value of the business gets neglected.

Karen Litzy:                   13:29                Yeah. There's no question. I am in a lot of different entrepreneurial groups and this is a topic that never comes up.

Ashley Micciche:           13:39                Oh really? That's surprising.

Karen Litzy:                   13:40                Yeah. It's a topic that never comes up and it really should because now that as you're speaking more and more on this, it's got me thinking about my sort of long-term plan and where do I see myself and what should my goals be. So this will be something for 2019 for me to really sit down and give it the time and space that it needs. So I think it's great. Okay. So, number one, valuing your business. Number two, establishing a timeline and goals that I'm assuming are realistic. We don't want to say, well it's January, so I want to retire in three months and now this is it.

Ashley Micciche:           14:25                And actually before we move on, can I give you a couple of other questions that I think your listeners may not say. So obviously it's important to consider the WHO. So who is best suited to take over the ownership of your business after exit. Now a lot of times, especially in family businesses, there are family considerations and we'll just kind of a trick question cause there was always family issues, like maybe somebody is involved in your business, like one child out of your three children is involved. And you know, most parents want to do what's fair for their kids and so it can create a lot of strife in the family, when there's family involved. So we want to be really careful about that. And I think a lot of business owners make some not so good decisions because of that family element.

Ashley Micciche:           15:20                Like I'm sure we've all seen it where you have a second generation who doesn't have the same mindset, doesn't have that same fire and isn't very well equipped to, maybe they were a good employee, but they're not very well equipped to run the business. So that's really important as well. And then the other thing that I think really drives who you want to look at to be your successor is whether or not how important it is for the business to stay in the community. So a lot of business owners are really heavily involved in their community and no matter what an outside buyer tells you, that dynamic is going to change. So it's really important, especially if you're looking to sell to maybe like a competitor or someone like that outside of your immediate community. It's definitely going to change, you know, that experience from your client or your patient's point of view.

Karen Litzy:                   16:21                Oh yeah, definitely. Especially in health care because if you're in any sort of healthcare business, you are deeply entrenched into that community and they depend on you. Yeah, that's a great consideration to think about during this timeline and goal step. Anything else that we really need to think about in this second step?

Ashley Micciche:           16:48                You know, a couple of other things have to do with the financial element. There was this other study that was done that looked at most business owners want to retire in the next 10 years. And that same study that I mentioned before from the business owner acts or business exit institute said that they found that 75% of business owners would exit today if their financial security was assured. So most entrepreneurs, business owners who aren't looking to exit, aren't doing so because they feel like financial aid, they're not ready yet. So that really plays into the next step that's universal in that process, which is to determine if you have a gap financially. So you know what your business is worth, you know, what your other financial resources are. And when you look at all of those things, is that going to be enough to, do you have enough to retire?

Ashley Micciche:           17:51                Is that going to be enough to provide the income needs that you have and your family has in retirement or not? That's really the third step. And so what we do in this step is we look at what are your assets? We know what the business is worth, but we also have to consider the after tax business value. Cause that's a big surprise, right? Then you have what you get to keep after Uncle Sam does. So you know, we have to plan for that. And then you might have other assets like your investment portfolio or rental properties and all of these things are, or social security, you know, all these things are providing income for you in retirement. And so you have to replace whatever income you were getting when you were working in the business.

Ashley Micciche:           18:45                That’s usually the challenge is because most people, they do have a gap. The business or their personal financial resources are enough to provide the income that they want and desire in retirement. So, we have to start making some decisions about what levers we can pull. So sometimes you can pull levers to increase the value of the business. Depending on what the business looks like, sometimes there's not as much flexibility there. So it might be, you know, rethinking what your plan was for retirement. Like are you willing, you said you all work five more years, are you willing to work six, seven or eight more years if that's going to help fill the gap. So understanding if a gap exists or not, and discovering your gap, that's the third step because it really leads to how much are you either going to need to grow your business value or on the personal side, your personal assets and income in order to make sure that that gap is filled.

Ashley Micciche:           19:55                I would think that that third step is where you really have to start making some hard decisions depending on how you want to live your life when you retire. And actually one of the things that comes up a lot is if sometimes people get revenue from very limited sources, you might have, you know, five or 10 clients that provide 50, 60% of revenue or maybe you have a practice that especially on the medical side, maybe are more dependent on insurance reimbursement. And so one of the things that can increase value is if you can convert or incentivize more of those people to pay with cash. Know that can be something that's more attractive now to an outsider versus relying on insurance reimbursements found that true for dental practices. I would imagine it's true pretty much across the board for most medical or physical therapy type companies.

Karen Litzy:                   21:00                I would agree with that. And I think there is a big trend moving towards a cash based therapy practice. That's what I have. So I don't take insurance. I'm out of network. I'll help you get reimbursed. But my clients pay me cash for my physical therapy services. And I think there's definitely a big trend to that, especially now with rising costs of healthcare and large deductibles. Everybody's cash based at this point because some people have deductibles of $10,000, which needs to be paid before you can get reimbursed anyway. So everybody's paying out of pocket.

Ashley Micciche:           21:45                Yeah. Well good. Karen, you've already increased the value of your business by doing that.

Karen Litzy:                   21:50                All right. Yeah, go through this tool and look at my goals and all that other stuff and get at least a rough idea of the value of what my business is. I even think about retiring and I always said, you know, Oh, I've got like 30 more years before I retire, but I feel like I said that like 10 years ago and I'm 10 years older. You know what I mean? So this is a good reality check for me and hopefully for the listeners as well to really start thinking about your business and how you want to, like you said, how you want to exit and how you then want to move on into retirement years at whatever time frame that is for you. Do you have examples of clients, you don't have to obviously say their names, but clients that you worked with that did a really good job at all of this and how that ended up improving their retirement?

Ashley Micciche:           22:50                So one of the clients that comes to mind is somebody who's actually still in the process of exiting, but I think the key for this client was that they really started early on. So this is actually another medical practice and they have two other partners and both of whom are younger, but one of them is in their early forties, and then the other one's in their 50s and then the one who's retiring is in his sixties. So the trick is, the younger people have to be able to afford to buy out this older owner, but they have a great relationship. They've talked and communicated with each other along the way to minimize any misunderstandings or potential lawsuits or breakup of their partnership, so they've done a really good job of planning that and having those discussions.

Ashley Micciche:           23:46                He’s a planner by nature, so he's done a really good job in making sure that, this is what the practice is worth, this is what I need when I exit. And he's most likely going to get that just because he's done all this planning and all the partners are on the same page and they're structuring his buyout in a way that they can afford and they're not going to rely on bringing in somebody new or doing that before he exits. So just the planning element and the communication is really helping them out. We’ve had other clients in that same boat who did successfully exit. And it all started with just understanding what was required to exit the business. What do I need to do? What are the levers I can pull to increase either the value of my business or the value of my personal assets. So I'm not relying so much on the business now. Some people, their business is so huge as far as their net worth, the percentage of their net worth that they have no other choice than to really focus and hone in on that to maintain the same lifestyle that they had or provide a legacy or you know, satisfy some of those other exit goals.

Karen Litzy:                   25:15                Yeah. And it sounds like aside from these three universal steps to exit, that communication with other stake holders within your business and your family and business partners is paramount to having a smooth exit. So there's no surprises.

Ashley Micciche:           25:33                Yes. And actually that is something that we tried to do. So if we're working with a client x in the business before we ever draft the exit plan, it's kind of like the strategic plan, but it's for your exit. So before that's ever drafted, we bring everyone together the team. So family is involved, especially the spouse and if your children is in the business, we want to involve them early on in the discussion so we make sure everyone's on the same page. And then also all the others like CPA, attorney. There's a lot of people who have a role in making this process as successful as possible. And so part of our job is to facilitate all that and to help move the process along by getting the attorney or the CPA involved at the right stage of the game.

Karen Litzy:                   26:31                Yeah, absolutely. If you're not an entrepreneur or you're not a business owner, you don't realize how many people are on your team, how many people are working behind the scenes to make your business successful. And so it's obviously important to involve all of them in your exit plan cause everybody's going to be affected in one way or another. Now is there anything that we missed going through these three universal steps?

Ashley Micciche:           27:00                No, I don't think so. It's about sally in your business. First and foremost, figuring out where you're at and then get most important goals and what that timeline looks like and then figuring out if there's a gap or not and then what to do about it if there is.

Karen Litzy:                   27:15                Well, this was great and I have to tell you, I am really going to start looking at this more seriously now after having this conversation. Hopefully the listeners will as well who are entrepreneurs or even for people thinking about being an entrepreneur. So maybe you haven't started your business yet. Like you said, the ideal time to do this is when you start. So they'll have like a leg up on all of us entrepreneurs who have not done this yet. I'm a little jealous of those new bees. Now before we end, I always ask everyone the same question. 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 out of college?

Ashley Micciche:           28:00                Gosh, that is such a good question. It's funny cause when I graduated college I pretty much, I didn't have a lot of fun in my twenties. Honestly I didn't, I didn't travel. I started in what I'm doing today straight out of college and that was 11 years ago now. So, I think if you would've asked me that question a few years ago, cause I always regretted not having a bit more fun in my twenties and now that I'm in my thirties, I actually am glad that I did. I did what I did and I didn't travel more and I just really focused on my career because I think I'll have a few more options down the road. But honestly, to answer your question, the thing career wise that I wish I would've done when I first started as a fund generalist financial advisor, one of the things that I was told by a lot of mentors who had been advisors for 20, 30 years was that the best way to grow your business when you're new is to cold call.

Ashley Micciche:           29:08                And so I did that and I cold called for two years, I made over 25,000 calls and I wouldn't say it was a total waste, but when these people who are giving me this advice very well meaning advice, they were genuinely trying to help me. They built their business cold calling in the eighties and nineties before the do not call lists before, people hated you if you were calling them cold. And so it's a different world today. So I think I learned career wise is that I wish I would have been a little bit more creative and trying other things in order to grow my business early on because I feel like now if I would have done that, I would've obviously done some other things and not relied so much on a strategy that for me it just didn't work very well.

Karen Litzy:                   30:07                Yeah, I think that's why the advice to give to yourself and we've all been there definitely doing things that looking back on it, you're like, what was I thinking?

Ashley Micciche:           30:17                Yeah.

Karen Litzy:                   30:19                Where can people find you? Where can they find true north? Let us know where we can connect with you online.

Ashley Micciche:           30:28                Sure. So the website is for the free unlimited lifetime access to the valuation tool where you can enter that information, go to If you go there, you'll get access to the checklists. So it's a pdf checklist that explains to you here are the eight pieces of information to gather, where to find it quickly and easily. And then from there you'll get access to the valuation tool. And the beauty of this is you could go in and do the valuation for free and then you can update it in six months or a year or you know, if your business changes and see how some of those adjustments have changed or valuation. So it's cool. It's not a one and done and it's totally free because we really want people to just, we found that if they can figure out what their business is worth and that's the key to unlocking the rest of the steps that are so necessary to exiting.

Karen Litzy:                   31:41                I'm going straight to that url and I'm going to get this valuation tool because I think it's awesome. So thank you so much for sharing that. That's such a generous share. And how about social media? Where can we find you?

Ashley Micciche:           32:10                Yeah, so our YouTube channel where we go a little bit more in depth on some of these exit planning, retirement planning topics. We have our biggest presence on LinkedIn.

Karen Litzy:                   32:29                Yes. And just before we went on the air, I said, is this how you pronounce your name? And I got it right, but only because I watched your YouTube videos. I knew how you pronounced it, but don't worry, everyone will have a direct link to the youtube and to linkedin and to of course the free gift that Ashley has so generously shared with all of us. So Ashley, thank you so much. This was eye opening.

Ashley Micciche:                                   Thank you so much, Karen. This was a lot of fun. And I'm so happy to share this with your listeners. Awesome.

Karen Litzy:                                           And to all of you listeners, get that free gift and we will be back with you in a couple of days. Have a great few days and stay healthy, wealthy, and smart.



Thank you for listening to this episode with Ashley Micciche!


  • Share your thoughts with the Healthy, Wealthy and Smart family in the comment section below!
  • Connect with me on twitter, instagram  and facebook to stay updated on all of the latest!
  • Show your support for the show by leaving an honest rating and review on iTunes!


Have a fantastic day and stay Healthy, Wealthy and Smart! 


Xo Karen


Jan 21, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Dr. Evangelos Pappas joins the show to discuss the editorial in the Sports Medicine Journal, Time for a Different Approach to Anterior Cruciate Ligament Injuries: Educate and Create Realistic Expectations.  Dr. Evangelos Pappas’ research interests are in the areas of sports medicine, biomechanics and musculoskeletal physiotherapy. Specifically, his interests are in the areas of etiology of lower extremity sports injuries, effectiveness of injury prevention programs, motor control re-training for the prevention and treatment of knee pathologies, epidemiology of ACL injuries, rehabilitation of lower extremity injuries, and dance medicine

In this episode, we discuss:

-How patients interpret the practitioner’s language and use of medical terminology surrounding ACL injury

-Strategies to communicate the medical management of ACL injury to set realistic patient expectations

-The limitations of the research in determining who will benefit from surgical versus conservative treatment for ACL injury

-Physical therapy utilization and patient outcomes

-And so much more!


“We have identified a big discrepancy between the expectations of the patient and the research and the outcomes that we know are produced after conservative or surgical treatment.”


“It is very frequently a life defining moment.”


“We do fail to communicate accurate information to our patients.”


“It is really risky to advocate to all patients conservative treatment including those who want to return to high level pivoting sports.”


“We don’t have good data to know who’s going to do well with conservative management at this point.”


For more information on Dr. Pappas:

Professor Evangelos Pappas trained as a physiotherapist in Thessaloniki, Greece before pursuing a Masters in Orthopaedic Physical Therapy at Quinnipiac University and a PhD in Orthopaedic Biomechanics at New York University in the USA. Prior to coming to the University of Sydney, He taught for 11 years at Long Island University-Brooklyn Campus in kinesiology, clinical decision making and musculoskeletal pathology and physiotherapy. His excellence in teaching was recognized by his nomination for the Newton award for excellence in teaching. A/Professor Pappas joined the University of Sydney as a Senior Lecturer in 2013 where he continues to lecture in the areas of musculoskeletal physiotherapy, and particularly as it relates to the upper and lower extremities.

Professor Pappas is also active in musculoskeletal research. His research has been funded by the National Institutes of Health and intramural grants. He has presented his work in more than 50 national and international conferences and he has been interviewed on the radio as an expert on knee injuries. His publications appear in top journals in the fields of physiotherapy, sports medicine and biomechanics. One of his publications received the T. David Sisk award for best review paper from Sports Health; a leading multidisciplinary journal in sports medicine. In addition, Professor Pappas has served on the research subcommittee of the awards committee of the American Physical Therapy Association.

Resources discussed on this show:

Zadro, J.R. & Pappas, E. (2018). Time for a Different Approach to Anterior Cruciate Ligament Injuries: Educate and Create Realistic Expectations. Sports Med. doi: 10.1007/s40279-018-0995-0.

Episode 227: Dr. Evangelos Pappas: ACL Rehab & Research 101

Episode 048: Physical Therapist Dr. Evangelos Pappas

Evangelos Pappas Twitter

Evangelos Pappas Facebook



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


Have a great week and stay Healthy Wealthy and Smart! 


Xo Karen



Jan 18, 2019

F. Scott Feil chats with Mike Connors, Mark Milligan, & Dana Tew regarding the upcoming opportunity for the state of Texas to have Direct Access passed along with how PTs in Texas can get involved and contribute to making this a reality.

Texas Physical Therapy Association Website: 

TPTA Capital Area District Facebook Page: 

APTA Direct Access Page on Website: 

APTA Action App on APTA Website: 

 Texas House Bill 29: 


1. Texas Department of State Health Services. (2018) Texas Projections of Supply and Demand for Primary Care Physicians and Psychiatrists, 2017 – 2030. Austin, TX: Texas Health and Human Services 

2. Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort
ME Horn, JM Fritz BMC health services research 18 (1), 887 
3. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Frogner et al Health Serv. Res. 2018 
4. Denninger TR, et al. The influence of patient choice of first provider on costs and outcomes: analysis from a physical therapy patient registry. J Orthop Sports Phys Ther. 2018;48(2):63–71. 
5. Rhon, D. I., Snodgrass, S. J., Cleland, J. A., Sissel, C. D., & Cook, C. E. (2018). Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule. Perioperative medicine (London, England)7, 25. doi:10.1186/s13741-018-0105-8 
Michael Connors, PT, DPT, OCS, PhD received his Master of Physical Therapy degree from University of Medicine and Dentistry of NJ-Rutgers University in May 2003 with honors.  Dr. Connors obtained his post professional Doctor of Physical Therapy degree from Temple University in December 2008.  He became a board certified specialist in Orthopaedic Physical Therapy by the American Board of Physical Therapy Specialties in June 2011. He completed a PhD degree in Physical Therapy from Texas Woman's University in August 2017. Dr Connors is the current President of the Texas Physical Therapy Association. He also is an assistant professor within the UNT Health Science DPT Program.

Mark Milligan PT, DPT, Cert TPS, OCS, FAAOMPT

Mark Milligan is an orthopedic manual therapist that specializes in the evaluation and treatment of musculoskeletal and spinal conditions, both acute and chronic. He is Certified in Therapeutic Pain Science, Applied Prevention and Health Promotion and dry needling, Board Certified in Orthopedics and a Fellow of the American Academy of Orthopedic Manual Therapy.  He earned his Doctorate of Physical Therapy at the University of the Colorado School of Medicine in Denver, Colorado.  He went on to complete an Orthopedic Physical Therapy Residency and Orthopedic Manual Physical Therapy Fellowship with Evidence in Motion (EIM). He is a full-time clinician and Founder of Revolution Human Health, a non-profit physical therapy network and he also founded a continuing education company specializing in micro-education. He is currently a physical therapist with Encompass Home Health in Austin, Texas. Dr. Milligan serves as adjunct faculty for the Doctor of Physical Therapy Programs at South College and The University of St. Augustine.  Dr. Milligan is also primary faculty for Musculoskeletal Courses for EIM. Mark has presented and spoken at numerous state and national conferences and has been published in peer reviewed journals. He is an active member of the TPTA, APTA, and AAOMPT and is current the Capital Area District Chair for the Texas Physical Therapy Association and has great interest in public health and governmental affairs.  

Revolution Human Health is a non-profit physical therapy network in Austin, TX that transforms the healing experience by offering access to treatment, education, and movement based therapy for all. 

Continuing education division specializes in customized, micro-education for physical therapists across the country. Customizable options of courses include manual therapy, spinal and extremity manipulation, dry needling, clinical reasoning, and preventative care and population health. Please contact us about customizing a course for you and your team!


CEO/ Program Director of OPTIM Physical Therapy and OPTIM Fellowship Program. Dana specializes in orthopaedic physical therapy. His experience includes clinical management of patients with both acute and chronic orthopedic injuries in the outpatient environment. His practice is focused on integration of manual therapy and exercise into a holistic, evidence-based and biopsychosocial approach to physical therapy treatment. He is the residency manager of Harris Health System’s Orthopedic Physical Therapy Residency Program. He was honored by the Texas Physical Therapy Association Southeastern District, as clinical instructor of the year in 2013. He is also a guest lecturer at Texas Woman’s University and has presented at multiple conferences. Dana earned his APTA Board Certification in Orthopedic Physical Therapy and is also a Fellow, in the American Academy of Orthopedic and Manual Physical Therapists. He has served locally for the Southeastern District, as a delegate for the TPTA, and nationally on the American Board of Physical Therapy Residency and Fellowship Education credentialing council for the APTA.
Jan 14, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jamey Schrier back on the show to discuss business fundamentals.   Jamey is sharing his practice freedom methodology to practice owners all across the country who are looking for financial prosperity and a better quality of life. His book, The Practice Freedom Method: The Practice Owner’s Guide To Work Less, Earn More, And Live Your Passion, has been an Amazon #1 best seller.

In this episode, we discuss:

-How to establish a clear vision and find the why behind your goals

-Why comparisons to others will keep you small

-The importance of sharing the narrative behind your practice with your team

-Planning and budgeting for the bottom line that aligns with your goals

-And so much more!


“Measuring your progress, measuring your success compared to where you are now and where you’re going—when you do that—you stay in line with who you are.”


“When you put a pen to paper, it’s powerful.”


“Alignment is everything in our business.”


“Not knowing the answer isn’t the problem, it’s asking the right question.  The answer is out there.”


For more information on Jamey:

In 2004, Jamey Schrier was facing the soul-crushing struggles of private practice ownership. He couldn’t figure out how to grow his business without sacrificing family, income or time.

Armed with an insatiable curiosity, Jamey invested the next 9 years and over $300,000, to learn how to free himself from his practice. At the end of his journey, Jamey finally discovered the formula to creating a self-managed, profitable and stable practice that allowed more time with his family and more time to work “on” his business.

Jamey is sharing his practice freedom methodology to practice owners all across the country who are looking for financial prosperity and a better quality of life. His book, The Practice Freedom Method: The Practice Owner’s Guide To Work Less, Earn More, And Live Your Passion, has been an Amazon #1 best seller.


Resources discussed on this show:

Jamey's FREE training on howto generate referrals

The Practice Freedom Method Website

Jamey Schrier Twitter

The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change

Start with Why

The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing

Free online community for NetHealth



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


Have a great week and stay Healthy Wealthy and Smart! 


Xo Karen



Jan 10, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jeanette Bronée on the show to discuss mindfulness.  Jeanette helps leaders and companies rethink performance by asking the “Right Why®.” She teaches them how to create a culture of care by unlocking what truly drives performance, engagement and motivation from the inside out. For 15 years, she has coached clients and delivered speeches about how physical health and emotional-mental wellbeing affect performance and prevent stress and burnout. She shows how focusing on how our mindset affects our self-care habits at work and at home and believes, that when we leave our humanity at the door when we go to work, we leave behind our most valuable resource for success. She incorporates her background in integrative nutrition, mindfulness and hypnotherapy to help people work better by working healthy.

In this episode, we discuss:

-How to ask the right why to find a way forward

-Practical exercises to ground yourself in stressful situations

-The use of metaphors to describe experiences

-How mindfulness can facilitate change

-And so much more!


“If we can refocus our question, then our unconscious mind will help us find the answer.”


“We find solutions by acknowledging what’s not working and then moving into curiosity.”


“If we don’t pause for a moment, we can’t even listen.”


“We’re not running out of time, we’re running out of focus.”


“We don’t solve problems in a new way under stress, we just repeat what we’ve always done.”


“Our self-talk really creates our experience.”


For more information on Jeanette:

When Jeanette Bronée’s parents both died of cancer just one year apart, she was told it wasn’t a matter of if, but when she would get cancer, too. So she took charge of her health and wellbeing, sharing what she learned about the power of mindfulness by founding Path for Life in 2004. Since then, she has taught more than half a million people how to ask the “Right Why” to unlock the answers that prevent burnout, fuel peak performance and create a culture of care.

Now, she helps leaders and companies rethink performance and culture to create sustainable success by supporting our most important resource -- our human resource. She has delivered TEDx talks, as well as keynote speeches and workshops at corporate events and workshops around the world.

Her book, EAT TO FEEL FULL, a guide for eating to thrive, gained nationwide recognition in the news media as a new approach to health and eating that helps us break with our dieting mentality and focus on eating to fuel our performance. 

She holds a business, mark