On this week’s episode of the Healthy, Wealthy and Smart Podcast, I welcome Leda McDaniel on the show to share her experience with persistent pain. Leda McDaniel is a Physical Therapist in Atlanta, GA. As a physical therapy student, Leda published a book that chronicled aspects of her three-year battle with chronic knee pain and ultimately led her down a path of discovery on her way to healing with a holistic approach.
In this episode, we discuss:
-Leda’s experiences with Complex Regional Pain Syndrome (CRPS) and how it impacted her life
-Pain neuroscience education and a holistic approach to treatment for CRPS
-How Leda’s approach to patient care has shifted to a biopsychosocial framework
-The importance of listening to the patient’s story and being a voice of hope
-And so much more!
Resources:
Email: LedaMcDaniel1@gmail.com
Moments from a Year of Healing: A Book of Memories and Essays
The Outcomes Summit: use code LITZY
For more information on Leda:
Leda McDaniel is a Physical Therapist in Atlanta, GA. She earned her Doctorate of Physical Therapy from Ohio University and holds a B.A. in psychology from Trinity University, in San Antonio, Texas where she also played Basketball and ran Track and Cross Country for the NCAA Division III School. As a physical therapy student, Leda published a book that chronicled aspects of her three-year battle with chronic knee pain and ultimately led her down a path of discovery on her way to healing with a holistic approach. It was this experience that motivated her to become a physical therapist in order to help others recover from chronic pain.
Her book is entitled: “Moments From a Year of Healing: A Book of Memories and Essays” and can be found on Amazon:
Leda’s Professional Blog:
https://sapiensmoves.wordpress.com/
Read the full transcript below:
Karen Litzy: 00:01 Hi Leda welcome to the podcast. I'm happy to have you on and a big congratulations to you for being a new physical therapy graduate. So welcome to the field. And you know, longtime listeners of this podcast will know that I often have people on the podcast who have struggled through persistent pain, who maybe are still having persistent pain issues and you are one of those people. So what I would love for you to do is just let the audience know who you are and tell your story and then we'll take it from there. So I will throw it over to you.
Leda McDaniel: Thank you. Yeah, so I just recently graduated from physical therapy school and I’m entering my clinical practice as a physical therapist. So I'm in Atlanta, Georgia and I'll be starting residency at Emory university for Orthopedic Physical Therapy in August.
Leda McDaniel: 01:03 So I'm really excited about that. A little bit about what got me into this field and interested in being a physical therapist. I had an ACL injury that I suffered in my mid twenties, tore my ACL playing soccer and then I had surgery, reconstructive surgery, to repair that ACL. And the recovery from the surgery didn't quite go as planned, so I had had a prior ACL surgery, so it kind of knew what to expect. What's this time it was not quite so good and it was a little bit different and challenging in that the physical therapist I was working with kept pushing me to strengthen my muscles and try to get my range of motion back and all those things that I was familiar with, but I knew it wasn't really responding as you might expect it would after surgery. So I had this chronic pain and inflammation that developed over the next six months to a year.
Leda McDaniel: 02:04 And both my physical therapist that I was working with at the time, and then, a handful of orthopedic doctors, including the surgeon who did the surgery, they were a little bit puzzled as to what was going on because I had a repeat MRI. They couldn't find any structural issues. At the time I was really focused on that idea of well I still have pain, what is wrong structurally? And I just had this feeling that something is wrong. It didn’t feel right. It was always painful and it was always swollen and I really couldn't it over the hump to the extent that I was even limping when I was walking about a year after surgery. So I continued to try to rehab and over the next additional year and two years out of ACL surgery I had a second surgery.
Leda McDaniel: 03:00 The idea that they clean out some of the scar tissue in there. It's the joint capsule is scarred up a little bit and try to get things work in a little bit better or feeling a little better after that surgery. Again, that kind of made my situation worse and I developed this mirror pain cause I knew I was hypersensitive at that point and had after that diagnosis of complex regional pain syndrome and just really severe nerve pain to the extent that not only was it painful to walk, but I really couldn't walk and I couldn't put pressure on that knee. I couldn't touch the knee without it being painful. And kind of just spiraled into it's really bad situation where I was pretty disabled. I wasn't able to work at the time. And in that time period had gone back to school for physical therapy because I'm flattered by this injury and wanting to help other people regain their health.
Leda McDaniel: 03:59 I had some really excellent physical therapists along the way who really try their best to work with me even though things weren't going in an ideal direction. So, anyway, so I had to take time off school. I couldn't work. All of this really pursuing or being fixated on this idea of what structure is injured. And it really, the course of my injury and health didn't really change until my perspective or kind of switched my focus to more of a treating pain based on what were currently understanding is more of a progressive approach to chronic pain, which is pain neuroscience education where we're understanding that there are many components to pain not just structural ones and a lot of these inputs can contribute to these situations where you have this over sensitivity or hypersensitivity.
Leda McDaniel: 05:05 And that's kind of the place I found myself in. So I really started to self treat based on some of those principles and try to reduce the sensitivity that built up within my nervous system. And over the course of about a year, I was able to turn things around and get back to the point where I was walking. I was back to school, working, functioning in society like I wanted to and my pain levels were significantly decreased. And gradually, gradually got to the point where I was pain free.
Karen Litzy: And can you talk about what specifically you did during this time in order to treat the pain? Obviously not treat the structural issues, but to treat the pain just so the listeners have an idea of what you did.
Leda McDaniel: Sure, absolutely. So it's not a quick fix approach by any means, and it's not a singular approach by any means.
Leda McDaniel: 06:08 So I really had the perspective of creating as many positive inputs to my life as possible. And I was really diligent about addressing all the different components as we know, pain really has this bio, psycho social, construct. And so I really wanted to have positive inputs physically, mentally, and emotionally and socially. So physically, I was eating a really nutrient dense diet, so lots of full foods, real foods, fruits, vegetables, bone broths, collagen stocks, things like that. So really preparing foods from scratch and eating a lot of nutrient dense foods. I was meditating to decrease my sympathetic activation or over sensitivity work on the mental component. I was doing a psychological therapy at the time. So cognitive behavioral therapy to try to just that psychological component. I was using visualization to try to incorporate the lowest level input that I could to that system and really start preparing for movement in a joint that couldn't really take movement in the beginning, but trying to retrain my brain to prime it for the movements I want it to be able to do.
Leda McDaniel: 07:42 So I did a lot of visualization on walking, moving my knee. When I got a little bit better, I would visualize myself doing higher level athletic activities such as running or jumping or those sorts of things.
Karen Litzy: 09:44 So over the year plus time that you started incorporating all of these different kinds of inputs into your system, did you start doing everything all at once or did you sort of slowly pepper things in?
Leda McDaniel: Yeah, so there was definitely kind of a gradual addition of different components. As I learned more, I was trying to incorporate different types of movement to try to make a difference. So, for example, I'd started a mindfulness based stress reduction meditation course online. That was free. Because I had found out about that and that helped quite a bit. But I gradually added other things in. And one of the things I wanted to mention as well is I was doing, it's hard to mention every single treatment I was doing cause I was really trying to address all these little pieces and I think addressing all those little things really made the difference to turn the tide.
Leda McDaniel: 11:07 So one of the other important things that I was doing not overly relying on but definitely helped me get out of the most acute and serious pain so that my nervous system could reorganize was pharmacological treatment. So I was taking so medications to get me out of pain. And I think that as an adjunct treatment to the other things I was doing, it was actually really important. So you have these periods of not being in such severe pain that I had the ability to you some of these other treatments.
Karen Litzy: Yeah, and I mean I don't think that there's anything wrong with pharmacological interventions, especially for people with CRPS. I mean this is really painful and I think that you're right, you kind of need the medications as a bit of a reprieve for your systems so that you can get to all this other stuff.
Karen Litzy: 12:08 Now the question is, is are you now on the same medications that you were on in the sort of height of this pain process?
Leda McDaniel: I am not. So I was pretty resistant to taking medication in the beginning. And I really used it for the smallest duration that I could to get me out of that really severe pain. Once I was on my way with this combination of lifestyle factors and I'd really seen the pain decrease to the extent that I could walk without being in pain, or I could touch my knee without having a severe pain reaction, I really started to taper off these medications with the guidance of the prescribing physician.
Karen Litzy: Right. So I think for listeners is just important to remember that if you have pain, we're not saying do all of this other stuff and don't go a pharmacological route because sometimes that's necessary, but you have to make sure that you go that pharmacological route with your physician and that when you're ready to kind of taper down that you do that also under the guidance of your physician.
Leda McDaniel: 13:31 Absolutely. That's a great point. I think also it's important to mention that, and this has been mentioned by others in the field that are doing this work, really trying to get patients to take an active role in their treatment. So just taking medication but not doing these other active components such as meditation, the prescribed loading if that's appropriate. And really addressing lifestyle factors and taking ownership of those in addition to these more passive treatments I think is really important.
Karen Litzy: Yeah, and I think when you're talking about people with persistent pain issues like CRPS, you kind of, I think it's okay to have that combination of active and passive treatments. But yes, the patient has to know that they're not coming to the healthcare practitioner to be fixed, but instead they're coming to be guided and that they need to, like you said, take an active role because all of this, you know, nutrient dense diet, meditation, psychological therapy, visualization, progressive loading, exposure training.
Karen Litzy: 14:49 So exposure to movement, exposure to activities that maybe you have fear avoidance behaviors around. All of this requires active work from the patient, active work from you. Right? And if you're not doing that as the patient, I think that you’re not giving yourself an advantage. Would you agree?
Leda McDaniel: Yeah, absolutely. Well said, Karen.
Karen Litzy: Yeah. And so let's talk about timeframe here. So obviously changing your diet. We know that diet does have a huge ramifications to overall health, the psychological training, the meditation, the gradual loading, exercise, movement, visualization. This all takes time. So people will probably be thinking how many hours a day were you working on this stuff?
Leda McDaniel: Well, for better or worse, I wasn't able to work or go to school at the time. And so really regaining my health over this year period, I actually deferred a year from physical therapy school.
Leda McDaniel: 16:00 I had started and completed my first semester, but then wasn't able to continue sequentially, but my program allowed me to defer a year. So for that year my fulltime job was getting back to health and I really took that seriously as a full time job. So, a majority of my time was spent trying to create these positive inputs. I was doing a lot of reading and trying to learn as much as I could about pain and physical therapy related things, because that's developed into one of my passions and I really felt like it was important to maintain this engagement in intellectual pursuits as well, so that I could have some connection and some purpose to my future, even though I wasn't actively in school at the time or actively working at the time. So really to answer your question I was working on this pretty diligently.
Karen Litzy: And what was, and maybe you didn't have one, I don't know, but did you have this sort of Aha moment at any point? So from the first surgery to where you are now, can you say there was one point where you reached this crescendo and then things started to fall in place?
Leda McDaniel: 17:24 Yeah. Thinking back, I think, I can't pinpoint a specific time point that I would say generally it was about the time when I was forced to take a break from school. So it was almost at the lowest point where I wasn't able to walk on my leg, wasn't able to touch my knee because a sensitivity pain had gotten so bad that it really taken me out of a normal functioning, productive life. And somewhere around that point I was researching and reading as much as I could on my own. And I really stumbled upon this pain neuroscience education approach and some of the work of Lorimer Moseley and Butler and Lowe. And this idea that the pain that I was experiencing didn't necessarily have a structural cause. And to me that was the time period when I really changed my approach from this fixation on trying to find a healthcare practitioner who would tell me what is structurally wrong and how can we fix it to an approach of my nervous system.
Leda McDaniel: 18:42 My brain is just creating this maladaptive signaling, maladaptive pain response and I really need to target my nervous system sensitivity versus trying to pinpoint what is wrong structurally for me, that seems like the turning point, where I was able to really start making gains and gradually progressed back to health.
Karen Litzy: Yeah. So it was kind of the light bulb went off and you said to yourself, I think there's another way. And was there any one piece of reading book article that you can say, you know something, this really helped me to understand what's going on?
Leda McDaniel: 19:30 Yeah. I think as somebody who's interested in health at the time, but you didn't have a great grasp on some of the biology and physiology surrounding pain systems and the nervous system one book that really helped me understand these things and I would recommend to clinicians and patients who are wanting kind of an easy buy in to these sorts of principles is Lorimer Mosley's book painful yarns. He tell stories to communicate these principles of how pain systems work in our bodies. And really does a lovely job making these principles accessible to people who might not have the scientific background to understand because pain is complex. These systems are complex. But listening to these stories, I think it makes it really understandable.
Karen Litzy: Yeah. A little bit more digestible for folks. I often tell my patients to get that book because it really is a patient forward book because of the stories and the metaphor that he uses throughout the book to make you say, Huh, okay.
Karen Litzy: 20:51 I think I'm starting to understand this a little bit. Because for the average person, maybe they don't need to get too into the weeds as to the chemical reactions happening in the brain and within the body in the spinal cord and why these persistent pain issues can arise and kind of take hold in the body. But we certainly can give patients stories and metaphors to help them have a better understanding of maybe what's happening and to decrease the fear around what's happening within their bodies. And I think painful yarns does a great job at that.
Karen Litzy: And all right, so you are diagnosed with CRPS you dive in, you start treating yourself. Were you still seeing a physical therapist over this year? Or were you really just at this point working on all of the components you mentioned above on your own?
Leda McDaniel: 21:51 I had actually stopped seeing a physical therapist because as I was learning more, I was seeking a clinician who had some of these approaches in their toolbox. For example, the graded motor imagery. And I really unfortunately couldn't find one in my geographic area. And so I was actually doing these treatments, kind of self treating at that time, hoping that eventually I could work with a PT for some of the loading components. But knowing that at that point I just couldn't tolerate the exercise based physical therapy.
Karen Litzy: Right. And now were you ambulatory at this time? Were you using an assistive device were you in a wheelchair. How were you getting around?
Leda McDaniel: So after that second surgery I was using crutches for about nine or 10 months. And really non weight bearing. I couldn't put weight on my leg so I didn't go to a wheelchair.
Leda McDaniel: 22:55 Partly probably out of stubbornness. But yeah, I was using an axillary crutches to get around everywhere.
Karen Litzy: Okay. Well that is not easy as we've all had patients who've been on crutches for like six to eight weeks and they seem to just be completely spent. I can't even imagine for 10 months. But I mean good on you for keeping up and I'm assuming you started seeing progress, which is why you kept with all of this stuff. Right? So how long into this year and a half or a year plus did you start to see changes within your pain?
Leda McDaniel: I would say probably within, it took probably three, four months of diligently committing to these practices before I really saw some noticeable change. Which was really hard. But at the same time I think is an important thing to communicate where these changes and the sensitivity that's been built up in your nervous system, it does take time.
Leda McDaniel: 24:10 It does take some patience and some persistence and I would really encourage patients and clinicians alike to have this longterm perspective of if we can introduce these positive things just to kind of have trust and just kind of have faith that they're going to make a difference, that they are making a difference on some level, but that noticeable changes might take awhile to manifest.
Karen Litzy: Yeah, I agree. I think it is very important when you have patients with persistent pain to be very honest with them and make sure that you're giving them some realistic timelines. Because let's face it, we're human beings and we get frustrated, right? We want things to happen sooner rather than later. Especially when you're in pain and especially if you're suffering. I mean you just can't imagine doing this for another month or week or even day for some people. But I think being honest and giving realistic feedback is very important because that also helps you to mitigate your expectations, which is important, especially when you have such a serious pain complications as CRPS. And now, how has this experience influenced the way you will now treat as a physical therapist?
Leda McDaniel: 25:48 I think ultimately while there are a lot of things that I think it adds to my ability to treat patients as a clinician, maybe the first thing is to have a little bit more empathy and compassion for what these patients are going through. Having had this experience, I think I understand what the chronic pain journey and struggle looks like, but also what it feels like to be in that. And I think it helps me relate with my patients a little bit better. So that I'm not just talking at them, but I'm really able to kind of imagine what impact it's having on their life and to try to communicate accordingly and really, really develop some good therapeutic alliance with these patients. I think the other thing that it allows me to do as a clinician is kind of as we were talking about, have a little bit more patience and approach these patients in a little him more of a calm manner.
Leda McDaniel: 27:01 I think in realizing that it's going to take time to see changes, but that doesn't mean that it's not worthwhile to work with these individuals on improving their function but also on improving their pain. And really promoting this expectation that recovery from pain is possible or could be possible, but that's more of a longterm goal for these individuals than some of the patients that we work with who are in an acute injury or an acute pain situation.
Karen Litzy: Yeah. So it's really providing hope to the patient, allowing them to even visualize themselves pain free. Cause oftentimes if you're years into a painful experience, sometimes you can't even picture your life without it. So I think it's really important to give that hope to patients. And another thing that you had mentioned in some of the pre-podcast writing is that allowing the patients to tell their stories.
Karen Litzy: 28:16 So just like today having you tell the story, it can be very powerful way for you to continue with your recovery and for others to learn from. So as clinicians, we have to allow these patients to tell their story and also noting that that story may not all come out at one visit.
Leda McDaniel: Yeah, good point. I think there's just like in any physical therapy session or clinician patient relationship, depending on the personality of the patient and the clinician, there's just a natural unfolding of developing trust and developing an ability to communicate between the two people where you really can't force that story out of the patient and you really can't force that trust or rapport but I think as you're intentional about listening to your patients and understanding where they're coming from and how their injury is affecting their life, personally I think over the course of a few treatments or however long it takes to naturally work itself out, you really can develop a close alliance and improve your ability to the effect that patients' health in a positive way and garner some positive outcomes from your treatments.
Karen Litzy: 29:48 Yeah. And I think the other thing that's important to mention is sometimes patients aren't ever pain free. And that's okay. Sometimes patients aren't pain free, but they're doing all the things in their life they want to do. You know, they're working towards the things they want to do. Or maybe they went from taking four pain pills a day to a half of one a day. So they may still have pain. And I think as physical therapists, it's sometimes a little difficult because we want to fix people, right? We want to make people 100% healthy, but it's okay if the patient continues to have some level of pain that they're coping and they're living the life that they want to live. So I think as new graduates, if I could give a little piece of advice to all of you guys, it's to not take on your patients outcomes as your own, but to really, like you said, have empathy, sympathy, step into their shoes and understand that hey, maybe they're not pain free, but they can do everything they want to do. And that's okay. They can live with that.
Leda McDaniel: 31:00 Yeah, that's a great point. There are different markers or ways that we can see positive change in physical therapy and decreasing pain is one, but improvements in function are another one and absolutely mentioning if we can reduce medication use that can have positive implications of a person's experience and their overall health as well. So I think all of those things are great. Great things to think about.
Karen Litzy: Yeah, absolutely. And now, you know, is there anything that we missed? Anything and we're going to, I'm going to get to your book in a second, but is there anything that we missed about your story? Any piece of advice that you know, maybe you would like to give to clinicians as someone who's gone through it?
Leda McDaniel: 31:52 I think the first thing that comes to mind is as clinicians, sometimes faced with individuals with longer lasting pain or sometimes pain that doesn't quite match a structural issue or a clear PT diagnosis or medical diagnosis. Sometimes the inclination is to get uncomfortable and maybe distrust the patient or the cognitive dissonance that you're feeling into more of a situation. What I would really ask you as clinicians to first off, no matter what, no matter how uncomfortable this makes you or how puzzled you might be as far as what's going on, I would just ask that you really trust what your patient's telling you. Trust their story, trust their experience. And if it takes a few visits to kind of reconcile what they're communicating with, maybe what is going on, whether it's a sensitization or a longer lasting pain that's manifesting in some other way, I would really ask that you treat them as if what they're telling you is the absolute truth.
Leda McDaniel: 33:19 And give that a chance to really play out before making assumptions about a malingering or a psychological primary component to what they're telling you. I think in a lot of cases that's too soon of an attribution from clinicians who are uncertain about what's going on.
Karen Litzy: Excellent advice. And you know, at the end of each podcast I usually ask someone, hey, what advice would you give to yourself as a new graduate right out of PT School? But since you literally are a new graduate right out of PT School, it doesn't seem like the right question to ask. But what I will ask is this, knowing where you are now in your recovery and in your life, what advice would you give to yourself during the height of your pain experience? So if you could go back in time knowing where you are now, what advice would you give to yourself then?
Leda McDaniel: Oh yeah, that is a great question. I think what I would tell myself is, and I did this a little bit, but I think I would try to encourage myself further, is to keep an open mind about what is possible for your improvements in health and for the body's ability to really heal and recover given the appropriate inputs.
Karen Litzy: 35:01 Excellent advice. Thank you so much. And now if people wanted to know more about your story and dig a little bit deeper into your year of healing, they could read your book Moments from a Year of Healing a book of memoirs and essays. And where can people find that?
Leda McDaniel: Yes, so my book is available online. It's available from Amazon, both in a print paperback version and also as an Ebook, supported by kindle. So they can search for the title of the book, Moments from a year of healing, a book of memories and essays or search for my name as the author. And I believe either way they should be able to access that.
Karen Litzy: Awesome. And what if people have questions for you? Are they want to talk to you a little bit more? Where can they find you?
Leda McDaniel: Sure. My email is LedaMcDaniel1@gmail.com and I'm happy to open conversations and really talk to patients or clinicians who are wanting additional resources or just wanting to hear more about my story. Yeah, I think that would be great.
Karen Litzy: Well, thank you so much for coming on and sharing your story. And again, congratulations on being a new physical therapist. Good luck in your orthopedic residency at Emery. And I am very certain that any patient that works with you will be very lucky to have you. So thank you so much for being on the program. Everyone listening. Thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
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LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Christian Barton on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada. Dr Christian Barton is a physiotherapist who graduated with first class Honours from Charles Sturt University in 2005, and completed his PhD focusing on Patellofemoral Pain, Biomechanics and Foot Orthoses in 2010. Dr Barton’s broad research disciplines are biomechanics, running-related injury, knee pathology, tendinopathy, and rehabilitation, with a particular focus on research translation. Dr Barton has published over 40 papers in Sports Medicine, Rehabilitation and Biomechanics journals, and he is an Associate Editor for the British Journal of Sports Medicine.
In this episode, we discuss:
-The inspiration behind TREK Education
-Different mediums that facilitate knowledge translation from researchers to clinicians and patients
-Common misconceptions around running and injury prevention
-The good and bad surrounding social media and knowledge translation
-And so much more!
Resources:
Third World Congress of Sports Physical Therapy
La Trobe University Sport and Exercise Medicine Research Blog
For more information on Christian:
Dr. Christian Barton, APAM, is both a researcher and clinician treating sports and musculoskeletal patients in Melbourne. He is a postdoctoral research fellow and the Communications Manager at the La Trobe Sport and Exercise Medicine Research Centre. Christian’s research is focussed on the knee, running injuries and knowledge translation including the use of digital technologies. He has written and contributed to a multitude of peer-reviewed publications and is a regular invited speaker both in Australia and internationally. He also runs courses on patellofermoral pain and running injury management in Australia, the United Kingdom and Scandinavia. He is on the board of the Victorian branch of the Musculoskeletal Physiotherapy Association, and a guest lecturer at La Trobe University and the University of Melbourne.
Christian is currently studying a Master of Communication, focussing on journalism innovation. He is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine, as well as Associate Editor at Physical Therapy in Sport.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody, welcome to our live broadcast. I'm just going to take a look quickly on my phone to make sure that we are in fact live, which I think we are. Yes. Great. All right, so we're live, which is awesome. All right, so thanks to people who are already on and thank you to my guest, Christian Barton, coming all the way in from Australia. So it is my times as you're watching this. It's 9:30 New York time. So Christian, what time is it in Australia right now?
Christian Barton: 00:37 11:30 in the morning. That's quite a nice time to do this.
Karen Litzy: 00:43 Yeah. So we're doing this over two different days, so Tuesday for me and Wednesday for you. So crazy. But anyway, thanks for taking the time out to come on to chat with us. So for all the people who are on right now and for as we go through, if you have questions, you can type them in the comments, we can see them and we'll be able to address them as we go along. But before we get started, Christian, what I would love for you to do is just to tell the viewers and the listeners a little bit more about you and how you got to where you are now.
Christian Barton: 01:18 Yeah, sure. So I'm a physiotherapist by background have been for nearly 15 years now. So it's getting on. I've always had an interest in research and clinical practice and continuing to try and juggle the two. And that probably started from the very beginning. I finished my undergrad course and well tried to find a position to do some research assistant work on clinical trials and things like that. And quickly my mentors taught me to do your PhD and actually started that about a year and a half out. And so I did that quite early in my career and probably since then I've been probably a mix of half, half clinic and research. So along the way, probably as I've gone through more recently doing more and more research because it gets harder to keep the research, you can do bigger picture things, which is something I've become really passionate about and I'll talk more about later.
Christian Barton: 02:05 And so currently I work three main roles. One is my own clinic in Melbourne, which is a sports and an injury clinic. And we work one day a week there and then also work at the Trobe university three days a week. And my main research focus areas around there it's translation and implementation. And then the past couple of years have been doing one day a week with a surgical group. So the Department of Surgery, it's in Newton's hospital in Melbourne and there big project or area of research is around preventing inappropriate surgery. So that aligns very well with what I do of trying to optimize what we do as therapists to prevent unnecessary or inappropriate surgery as we go along.
Karen Litzy: 02:44 Yes. Fantastic. Busy weeks. You have busy weeks.
Christian Barton: 02:48 Yeah, I work alongside the three kids at home and yet it's not, not the easiest to juggle at times, but it's certainly all things that I enjoy.
Karen Litzy: 02:55 Yeah, that's amazing. And every time all the interviews ever had with all of the speakers who are coming to Vancouver in October, all do so much. But we didn't do one time is just have an interview on how you manage your time. But that's for another interview. But I think people would really enjoy that. So now let's talk a little bit more about physiotherapy. So why this field?
Christian Barton: 03:23 Yeah, I think as a kid I was always active, playing a lot of sports and had a few injuries myself. And I think I always valued the physios guidance about getting back from some of those injuries. So that got me interested in the field and then you go to university, you actually realize physio has a lot more than just train sports injuries. And you need to have to think about pulmonary rehab and cardiac rehab and you're electrical physio. There's a whole range in spectrum that we through. But I think pretty quickly when I come out I would want it to go back to musculoskeletal and sports. And so we went back down that path. And I think what I enjoy about being a physio therapist is just keeping people active. That's your more sedentary person, where you're trying to motivate them through lifestyle changes to get active and manage their persistent knee pain or back pain or whether it's a really elite sports person. I really enjoy trying to get people to achieve their physical activity goals essentially is what I'm enjoying.
Karen Litzy: 04:18 Awesome. And now I can see more and more people joining you. Again, if you're joining, please write like where you’re watching from and if you have any questions, put them in the comments because we'll be talked with, you know, so now let's, you had mentioned this earlier, talking about kind of what you do, part of what you do and you're involved in several knowledge translation initiatives. One of them being the trek group, which I remember I guess it was last year after sports congress and we all changed our social media to the trek elephants logo, which was really great. So this is a nonprofit initiative created to enhance knowledge translation to healthcare professionals, but also to patients and general public. So can you tell us a little bit more about trek and how it all started?
Christian Barton: 05:13 Yeah, sure. Also I think my research journeys being quite interesting. When I first started off doing research, I was in a gait clinic doing biomechanics research and I've always found that side of our practice really interesting. And you do this real integral research and you spend a long time for assessing data and finally end up with maybe a couple of things that you can share in the community and they share them. And then I started doing more clinical based research and trials. Firstly looking at biomechanics and then did you that exercise interventions. Very early on I actually worked on a lot of systematic reviews and my passion for doing that was, well we have all this great body of research, we need to bring it together so we can disseminate a little bit better. And then I actually did a project in London where it was actually looking at clinical reasoning of physical therapists and how they integrate evidence into their practice.
Christian Barton: 05:59 And what I discovered really quickly is not only were people not using evidence based practice all that often when I actually talked to them about patellofemoral pain, which I'd spent the best part of seven or eight years researching, they've never read any of my papers, never read any of my research. And so it sort of made me reflect a little bit and go, well, why am I doing all this research? And it's not actually being translated into practice. And so I started to have a bit of a flipping all I did and instead of spending time in the lab alongside doing clinical trials, I started to focus a bit more time on actually getting information out there. And so have a good friend of mine, Michael Ratliffe who's based in Denmark and we often catch up and catch up at conferences.
Christian Barton: 06:40 And actually one of the first times we spent a lot of time together was when I went to a Danish conference a number of years ago. It was actually after that conference, I was sitting down both quite frustrated, having a couple of Belgium beers talking about this problem and the acronym trek come up with just on a random occurrence sitting his kitchen table. I still remember it. It was like, how do we do this? We'd probably need to brand it with already and get people behind a movement and something happening. So trek stands for translating research evidence and knowledge. So it fits really nicely with that. It actually has more meetings in that. And if you look at English language for trek, it means a long and arduous journey, which I think an old translation very much use when you try and actually make change. And then it also fits with
Christian Barton: 07:22 probably one of my favorite books I've ever read, which is called switch, which is how to make change when change is hard. I highly recommend people read this book. It changed my life. And it's a really simple analogy. You have a rider sitting on an elephant and you need to get to a destination. So there's three main parts to that. The rider needs to know where to go. The elephant needs to be motivated because it doesn't matter if the writer tells them how often to go. It's not going to go anywhere to be big beast. Right?
Christian Barton: 07:48 We also need an appropriate pathway to get there. So if you picture yourself as an elephant rider on an elephant and an elephant in the middle of the jungle, we want to get to the beach. There's no path to get to the beach and it doesn't matter, you're not going to get there. So the concept of trek is that we have clinicians, we have patients searching for health information who are all motivated to learn more and to do better. They don't really know where to find that information and they certainly don’t know appropriate path to get there. So the idea of trek is to try and improve that. So that sort of started as an idea about how we do this. And then we've, I guess talking and trying to work with lots of people. It's been set up as a not for profit.
Christian Barton: 08:25 So it's not meant to be owned by anyone. No one's meant to profit from it. It's trying to bring everyone together and break down the silos of competition between universities because universities don't like to talk to each other and help each other because they're in competition for the same grants and that they might be buried. The knowledge translation. So it's been really important to me from the beginning that yes, we'll try here where I work supports it. But it's not meant to be owned by the tribe. It's not meant to be by myself. It's meant to be everyone seeing. And it comes from a socialist I guess, concept called connective action where we actually, it's basically a meeting which we connect people with the same ideas. And then I did a communications degree and was focusing on journalism and multimedia and social media and writing a whole bunch of stuff around that.
Christian Barton: 09:10 And I thought, well, this is a nice platform to use. I think about not just mainstream media, but also social media or whatever people turn. And then our favorite thing, doctor Google, where most people turn to health information. And when you start looking at doctor Google, it's a pretty broken system with a lot of misinformation. And so the concept and my hope is that in time, this trek movement or trek concept could maybe be something that we can't take over with Dr Google, but we can certainly contribute to the information that people find on doctor Google. And so it's getting people around the world to contribute information but create it in an engaging format that will actually get people to rate it and use it. We know there's lots of barriers to reading research for clinicians, understanding your research their reading, but also it's time.
Christian Barton: 09:53 And if you can consume the same information sitting on a train, listening to a podcast or looking at a brief video or infographic that maybe gives you the key information from some research and you can trust that source, that it's not biased, it doesn't have an agenda, then that means you can be confident that you can bring that into clinical practice. And for a consumer or a patient that gets that information, they can maybe make health decisions based on that as well. So that was kind of the origins of the project and it's still growing and developing. A lot of people were helped along the way and hopefully we'll get more as well.
Karen Litzy: 10:24 And what has been, so this sort of launched last year, right? Like officially launched. So what metrics have you found from launching last year to where you are now?
Christian Barton: 10:39 Yeah, so what I did is actually was lucky enough to get a small grant from the Australian physio association to build a platform to improve physiotherapists knowledge of exercise prescription. And so we did a study last year where we basically built a website, which is exercise.trekeducation.org and before we gave access to everybody, we made them do a test, which is about 20 minutes. And so I have this great data for grants. It's linked with your physios. You've still need to sit down and write up and we see big variations of knowledge of exercise prescription. And we kind of expected, our hope was that we could then test the evaluate, right? This website helped to improve people's knowledge. Now out of 1,600, I think about a hundred filled in that follow up survey or questionnaire rate. But it was at least as the grant gave us the funding to build a platform.
Christian Barton: 11:26 And it's a multisite platform. So since this time we've built a website now for many patellofemoral pain, which is a big area of mine for clinicians. We've actually just finishing up a low back pain site and a knee osteoarthritis sites. So by the time the conference is around, we will have launched them and be available and working with some other researchers to make a shoulder side. So think of all the big musculoskeletal conditions with variables. And we've also been developing platforms, consumer patients as well. And so we have one which a PhD student in new idea, Olivia or Silva has been working with me for the last two years and we did a super little trial looking to see how beneficial that might be by itself. And then in conjunction with physiotherapy intervention. And certainly the website by itself is incredibly helpful for improving patient's knowledge and self management strategies, their confidence in doing things.
Christian Barton: 12:17 And it seems to lead to reasonable clinical outcomes as well by itself, but probably better outcomes if we combine it with physio. And we haven't done what to evaluation yet, but we're hoping that we can start to do that more and more as we go along. And most importantly, just have some quality resources that are free. You don't have to pay for it, just there, you can use them. And it's been nice to see the exercise site. And certainly the one with the value at the moment. There's plans to do this as well, but they've been embedded into teaching curriculum as well, which has been really good. So University here at La Trobe is using them, but other universities around the world have also used bits and pieces of content and that's the idea of it is to write and use it all way pointless multiple people around the world creating the same content when we could work, maybe be better together.
Karen Litzy: 13:06 No, that makes a lot of sense. And now you're sort of like you said in the beginning, sort of doing a little bit of both your research and clinician. So why are we, in your opinion, why is it so important to bridge that gap between research and clinical practice?
Christian Barton: 13:23 Yeah, I think from, if I put not my research hat that my clinician hat on and I think about our physiotherapy profession, I think we have some amazing physios around. We do really, really good job. We have others who are very good physios that are working really hard to continue to improve knowledge. We have a lot of practice that I would also consider as pretty low value care and sometimes iatrogenic care where actually maybe delivering health education and information is actually detrimental to the patient. And so I think collectively we need to work really hard to establish our brand better and better because we can do better. And a big part of that is actually making sure that what we do know to be beneficial for patients all around the world is actually disseminated into the hands of people who can use it. And that's a big part of that is physios and other health professionals. So that's the big passion for trying to change it. And I see in my clinic second and third opinions and sometimes it's just the patient hasn't been motivated, haven't done the things that I need to do that have actually been given really good guidance. But equally we see cases where they've seen multiple health professionals and just the treatments and information being given is just not aligned with what we know of contemporary knowledge around evidence about what should help that person
Karen Litzy: 14:36 As physio therapists, what do you think we're doing really well and were doing right and what do you think we need a little bit of hopefully they’re not doing wrong. But what they just need a little boost.
Christian Barton: 14:57 Yeah, it's a good good question. I think in the most part physio practice and physical therapy practice is moving towards more active management and there's lots of debates on Twitter and social media and people argue about the value or lack of value, whichever side to sit on about manual therapy and things like that. But I think overall we are moving to more active management approaches. We are moving more towards managing the pain science side of things and educating patients better about that. And I think that's probably what we're not doing very well is building that brand of what we deliver. And as a couple of hours to that one is I guess getting collective way across the board that we're all on the same page and delivering similar high value interventions. And what that means is some patients will go to see for therapists or physiotherapists, then they maybe get delivered a lot of electrotherapy or something else and they don't get better in a long time. And then they go back to their doctor or their surgeon and say, oh, I did PT, I did physio. It didn't help.
Karen Litzy: 15:54 Yeah, yeah. Failed PT.
Christian Barton: 15:57 It failed. And I think that's something that drives me a little crazy is you don’t fail that profession, you fail an intervention. It's a lot of inappropriate surgeries and other treatments. I think collectively we need to be more on the same page, but that's something the knowledge translation probably helps with a lot. The other part that I think we do very, very poorly and actually worked with Rob Brightly, he's going to be presenting the conference and that is collecting outcome measures. So we don't actually measure what we do very well. We occasionally measured them and this is the same around the world for compensable patients because we're forced to. But if you were to audit most people's clinical practice and say, can you show me that what you do is truly valuable, it's worth something.
Christian Barton: 16:48 Most physio practices won't be able to. And I reflect on myself and I can't do this very well. So we need to get better at measuring the value of what we do. So we can take that information to funders and say, hey, we are actually worth something in what we do is worth something. And so I think that's a cultural thing and it's a systems thing and I think it's something we collectively maybe need to work pretty hard to, to try and change. And certainly locally I'm trying to work with the Australian physio association here and it started to come up with some processes that you can, we might do that and knowledge translation. One of the projects I've enjoyed the most here in Australia is a program called GLA:D. I'm going to talk to Ewa recently and that will be certainly discussed at the conference in the biggest strengths of GLA:D isn't it aligns with clinical practice guidelines.
Christian Barton: 17:34 That's education and exercise. So I'll bring that standard up across the board. So first to trust that when they send someone to the program they will get exercise with education and it also raises the outcomes related to that as well. So it can turn around and we have some great data in Australia which were yet to publish, but it certainly shows from now data that not only does pain improve, which is something that may or may not be the most often, but also changes things like medication and also changes things like surgical intention. So people may believe I need surgery or going down the line to surgery. Am I saying certainly in Australia that less people are desiring that. But we look at that in GLA:D that's great here. But the rest of physio practice so you have nothing to contemplate. Suddenly we need to work. You don't run out.
Karen Litzy: 18:19 Yeah. And I know the APTA here in the United States does have an outcomes registry that they started I think maybe a couple of years ago, maybe two years ago is starting to collect that data so that we can take it at least here in the US to insurance companies to show that what we do is valuable and that what we do should be reimbursed.
Christian Barton: 18:42 Do people contribute to it, do the people actually give data?
Karen Litzy: 18:51 I don't know the answer to that question cause it is voluntary. So I don't know the answer to that question at the moment. But I would assume some people do, but do the 300,000 physical therapists that work in the United States? No, but hopefully it's something that will grow over maybe the next, I mean it's slow. Right? So it may take like a decade plus to kind of, if we're being realistic. Right? If someone were to audit my books so to speak, I dunno. I can certainly show that. I don't know. I don't know. That's something I need to get better at, so I'm calling myself out, I guess. And it's something that I certainly need to do better at myself.
Karen Litzy: 19:52 So let's talk about your experience as a researcher. So we'll move from kind of the clinical dissemination to do you have any tips for, let's say, new and upcoming researchers or even physio therapy students who maybe want to go into the research track to kind of help maximize their potential for reach and for knowledge dissemination? So, you are the researcher, you're doing great work and then what? It doesn't get to where it needs to go. So what tips would you give to people to help with that dissemination?
Christian Barton: 20:37 Yeah, sure. So we put together a paper, which was just recently published in BJSM, trying to remember the exact title, but it's time. I think it's something along the lines of it's time for a place, publish or perish. We've got vanished. Yeah. So we have this in research that if you don't publish your work, then obviously there's no record of you doing it. But also you can't give credibility to your work in peer review processes. Very important to doing that. When we go for job promotions and we got the scholarship, for example, to do a PhD or whatever it might be, they're a competitive process and people look at metrics and one of the key metrics is really simple is how many papers have you published? What journals are they publishing? So it's really hard to get away from that. But ultimately, as we've discussed, that doesn't put the knowledge into the end users hands.
Christian Barton: 21:23 And what happens is we end up with commercial companies selling pharmaceuticals and nutraceuticals and surgical interventions. That can be, I guess maximize money. And even pay teams event and for that matter. And so therefore the researchers, good knowledge doesn't get there. And maybe in health information that if news information gets cut through to clinicians and to patients, so you simply have to allocate some time to do it and you have to be quite aware and understanding that that might mean that you take a little bit of a heat on your academic gap or from a publication perspective because when they have so much time in the day. So that's a thing. It's just having that expectation that you can't do it all. That's really important. Spending some time on it. But in saying that it's not a ton of extra time to, after you publish a great RCT that was part of a PhD or whatever it might be, to spend some time with your media team at the university, put out a press release about that RCT and what the implications might be, which there may be ways from a radio interview or getting picked up in papers.
Christian Barton: 22:27 And so that's not a lot of extra work on top of maybe two or three years of the study even. Right. I think linking in with me, your teams at different universities is a really good starting point if you can. Then we have the social media world, and the social media world as a challenging one because there's a lot of strong and loud voices on there. Some of them are good, strong amount, Sometimes there's misinformation from those strong loud voices. And so you're going into competition for the microphone essentially on social media to do that. And you can get on and you can have debates and arguments and discussions and conversations about your research that you've done. But ultimately the people who disseminating, interpret that are the ones with the loudest voice and that's kind of, you can lose your information, which is a bit of a frustrating thing.
Christian Barton: 23:12 So yeah, so people get very frustrated about that when they've spent two or three years doing some research and then it gets misinterpreted by someone on social media who's got the microphone. So there's a few options around that. I think one of them is either creating a skill yourself or working with someone who has the skills to create knowledge translation resources. So we know from research that we've done and certainly evaluation of this is that the general consumer and that consumer can be the coalition or it can be the patient won't engage with your article, but they are likely to engage with your article but they are likely to engage with an infographic or an animation video. And so spending some time and effort on creating those types of resources to summarize your research findings is probably time and money well spent. So I'd strongly encourage people to price some emphasis on that.
Christian Barton: 24:04 And then you've got an asset on social media, and if you already have a big following on social media, you have to be the one that shares that asset because you've created the asset. So you've controlled the narrative of what goes into that asset and the key messages. You can then leverage the people. We do have a market friend and hopefully they can then share for you, et Cetera. We help with so you can spend your time arguing with the people, misinterpreting your work on Twitter or you can spend your time maybe creating some of resources. And I guess the concept of trek is to try and create resources with those types of things can be embedded into a web page. So if you've done research on my back pain and it's game changing research, then those knowledge translation resources can be put onto a platform on trek.
Karen Litzy: 24:50 Yeah. Great Advice. Anything else? So we've got getting to know the media team at your university to release a press release, which is huge because that can lead to other opportunities. And knowing how to either get your original research onto an infographic or an info video or a podcast, and then use that as your vehicle via social media, attaching that to some social media influencers, if you will in order to kind of get that out there. But I definitely think that's much better advice than banging your head against the wall and arguing with loud voices.
Christian Barton: 25:34 Yeah, exactly. Probably the other advice, if you go back a step in terms of designing search, it's probably really important and this hasn't been done well, but you engage the end user from the beginning. So going back a step and when you're designing your clinical trial, no good designing an intervention that no patient is going to engage or to use. So you might design an exercise program that you think is amazing and it's fantastic, but actually when the patients in the trial do it because they in a clinical trial, but then you go into the real world, It's too challenging for them to do. It's just too difficult. And therefore you're going to get criticized for your intervention that isn't clinically applicable. You want to cop that criticism in that design phase and people say, this is not clinically applicable. This won't work. Because then you've got time to redevelop on it and evaluating it and then realizing it won't cut through. So that's, yeah, I will probably important thing to think about. So when we talk about engaging the end user, particularly patients as the end user, but also clinicians as well, and getting their input because they're all going to be the ones delivering yet. And just to some extent, funders, they're a little harder to talk to.
Karen Litzy: 26:45 Yeah. Yeah. A little bit easier to get in with the patients or your fellow colleagues, hopefully. And now earlier you had mentioned that you have done research into topics such as patellofemoral pain. We also know that you do research in running injuries, obviously knowledge translation. So let's talk about kind of some common misconceptions around, we'll take running injury prevention and management, right. Cause these misconceptions come about because of poor dissemination of information I think is one aspect of it. So what would you say are some common misconceptions around running and injury prevention?
Christian Barton: 27:32 Yeah. So we can go into lots of areas here.
Karen Litzy: 27:35 No, it’s a lot of branches.
Christian Barton: 27:37 Yeah. So let's stick to running because it's a popular thing again. Everyone likes to manage runners and treat runners and not a lot of people like to run themselves. We actually put an infographic series out on our trek website. So James Alexander who is a master student environment moment putting together a series and we have the graphics and there's a few key ones for running injury prevention. One being stretching helps. And so that's something that has long been ingrained in people's beliefs that why you’re getting injured is that you haven’t stretched enough then stretching doesn't actually help us prevent injury. So it's not that it's a bad thing necessarily, although there is some evidence that stretching might impair muscle function, might actually reduce your ability to have muscle function but certainly it doesn't prevent injury.
Christian Barton: 28:31 So focusing on that as the problem is probably not the answer. Footwear often gets blamed for injuries, prevention and also as though the key focus. Now typically most of the times if you changed before where yes, it could definitely cause the injury drastic change, but a lot of times it's not the fault of a footwear. Someone buys a new pair of shoes, but they also decide they want to get fit and lose weight at the same time. And they go out and they overload and they train too much.
Karen Litzy: 29:01 Yeah. So those things kind of do overlap cause you get motivated, you go out and buy the new shoes and then you blame the shoes and not so much the amount of load that you just put through your body that you haven't put through your body in months or years.
Christian Barton: 29:14 Exactly. This is not the shoes that are important because they will moderate where the loads go can to some extent. But I think we get very obsessed and part of that comes back to who controls information that gets out there. And it's shoe companies, right? They sell shoes. There's all these motion control technology that shock absorption technologies. And so that's a big marketing campaign and that changes what people buy. And what I will say, it's a big problem. People have that answer. And then we have big pushes about minimalist shoes and they're the answer to everything. And in reality it's probably going to be very variable across different people in it. People with running shoes, all their life will be taken into women's shoe. That's a big change. So that will probably injure them. So yeah, might help. They need, they might get some acuities buying.
Christian Barton: 29:59 It might help their heel pain or forefoot stress fracture. So again, just that big emphasis on footwear and often because it's a commercial and marketable thing is offering the way what happens? I always love the example of Australia by a guy called cliff young. So some people are watching may know him, but those who don't, he actually run the first ever Sydney to Melbourne ultra marathon. So that's 800 kilometers or so. And one of our quite a few hours now, cause John did most of his training in numbers. He used to run two or three hours on his farm every day chasing sheep in Gum boots. So Wellington boots, clearly he didn't have any significant injuries. Right. And I have some great footage that I take when I teach my running course. That's some great footage of me doing that. And that's not to say everyone should go out and run in gumboots.
Christian Barton: 30:46 But certainly for him he was doing it his whole life. So he's adapted to doing that. And if you're adapted to doing something, don’t change it, right? Maybe maybe you might modify footwear to reduce the weight because that we know that helps with performance, but beyond that we don't really have a lot of good evidence that changes footwear will help with injury or performance or anything like that. So my philosophy mostly before where it ain't broke, don't fix it. But there are some nuances around some biomechanical considerations depending on what you want to try and change. But that's probably a couple of the key points of stretching and in footwear and the importance we place on them. I think it's probably more important to get our training loads right. And probably also thinking about, and these are my biases and there's not strong science on this, but doing a resistance training program might be more beneficial for preventing injury. We could do more loading with our muscles and tissues without that impact. And so that's possibly beneficial. And we do see some evidence that may be doing a resistance training program helps with performance as well. And most people get down because they're trying to run personal best times or beat their friends or whatever it might be. So rather than smashing yourself more and more on the training track, maybe get in the gym and do some resistance training would be my advice.
Karen Litzy: 31:57 Great. All right. Now, we're gonna shift gears just a little bit here. So the next question is what is or are the most common question or questions, I'll put an s on there that you get asked. And this could be by researchers, clinicians, patients, maybe you've got one for each. I don't know. What are the most common questions you get asked?
Christian Barton: 32:28 Yeah, so I'll start with researchers. So academics, you sort of touched on this a little bit before, but it's often around how to dedicate time and make knowledge translation, but not just that. So creating the resources we've talked about before, but how to navigate media or platforms like Twitter, like you get on Twitter and someone's attacking your research and let me see, interpret it. Or you get on Twitter and you put something out there and someone gets offended and that's a problem as well. And so it's actually, it's very difficult on social media because when you're typing things and writing things in, emotion gets taken out of things and people interpret emotions. So you might write something that has really no emotion attached to it, just a simple statement, right? But someone who thinks that you might be attacking them, we'll take that as an attack and then that creates a problem.
Christian Barton: 33:19 All the time. And I know that I offend people at times because they tell me that I've offended them and that's what I really appreciate it at least it gives me a chance to reassure and go look. It's not meant to be offensive when used social media is a positive way of translating knowledge and then other people probably get offended and just don't talk to me anymore. Yeah, I think I've been blocked a couple of times.
Christian Barton: 33:51 So my advice usually to people about Twitter is I think it's immediate that you can get a really good understanding about how part of the world is thinking. It's only a small part of the world. And then I think it's important to understand that that's the case. You're only getting a snapshot of some people and often it's people who have louder voices and want to go on talking, but it does give you some insight into that. And I think for me that frame some of my research questions and maybe modify as and move it and helps me narrow it down. It gives me a media where I can use assets that we've created to put them in hands of people who will disseminate them. So I think that's really, so sharing a good infographic or podcasts or video on that platform is one of the influential people there who hopefully then share your message. So I think it's important to have some presence there for that reason, but don't get emotional about it. If you feel like you're engaging in a circular conversation, you probably are engaging in circular conversation. You just stop, don’t keep going.
Karen Litzy: 34:48 Pull yourself out of it. Like I think often times what I see in those circular conversations is like somebody, it just seems like one of the parties within that conversation wants to win more than the other one. Or are they both really, really want to win. And so it's just like, I'm going to get the last word. No, you're going to know I am. No, I am. It goes back and forth and you just like,
Christian Barton: 35:14 My advice in those situations, for someone who feels like they're in a circle of conversation, they're beating your head against the brick wall. Just step back for a little bit and just think why is this happening? Why is what I believe or what I think not being interpreted the same way. Right. And it might be that actually you discover your own biases and it might be that. And that's a good reflective thing. It's ok to change you mind and beliefs. That's a good thing. That's a positive thing. Or it might be that actually you don't have as much supporting evidence for what you believe in. And maybe that's because you need to do some better quality research to test your biases and maybe you discovered that actually you were wrong, or maybe you test your biases properly and you discover I was on the right track, so that's good. Yeah. You usually have to prove myself wrong more than I proved myself. Right. That's a good thing. Yeah. Or actually worse what's happening, it comes back to that communications is you're not disseminating your messages very well. So you're actually not providing an adequate messenger. You can sit back and think about that and don’t keep argue with that person. You think about some strategies to disseminate and put together a podcast or a video, or write a blog about the topic that has really good details where you've got more than a couple of hundred characters.
Karen Litzy: 36:30 Yeah, that is really useful. So, and sometimes in these kind of conversations, if you will, sometimes you can also just take the person and send them a direct message where you can write a novel if you want to do as a direct message. And I find that when you do that and you kind of can explain yourself a little bit better, it helps to kind of foster better communication and a better conversation. And oftentimes when it's in private, people are different.
Christian Barton: 37:07 Yeah, that's great. And, taking the conversation off the social media platform is often a really good strategy too. Navigate and get over those miscommunications that can happen. Yeah.
Karen Litzy: 37:17 Yeah, I've done that before.
Christian Barton: 37:20 That's really spread enemies. Right. And then probably the other advice I'll give to people when I've actually put a tweet about this I think earlier this year or late last year. It's just, I'll refer to them as trolls and I'll call them trolls in until they show their face. People who are on there who don't have a public face. So it's social media. So for me you should have the transparent profile and the reasons for that is you want to know where people come from and where their beliefs come from so you can understand their point of view. And if you can understand that point of view, it makes it a little bit easier to have discussions with. But there's probably people on Twitter who just set up their identify profiles just to kind of attack and stir the pot and it's just not worth engaging with those people's I used to try and have their fun with them and make a few jokes and I've done that a few times. If you'd be probably saying that like, so that's also a time wasting. So it's kind of entertaining, but it's also time wasting as well. So I think when you identify, communicates, asking you persistent questions and almost feels like you're having circular conversations just block that person. There's no, you don't know what their alterior motive is. You don't know what their conflicts of interest are. You don't know where they're coming from.
Karen Litzy: 38:28 Well, you don't even know who they are.
Christian Barton: 38:31 Exactly. And so I don't think we should engage with those people. That's my first way. Most people won't like hearing that and they just keep creating new profiles. Right. Well that's okay. I never used to block anyone until six months ago, are quite a few people in racing time for that very reason. In short, if you get it, get into social media and you kind of, so you can learn from it and focus more on giving some quality content and having meaningful discussions rather than arguing. Yeah.
Karen Litzy: 39:01 Yeah. That's sort the idea of social media, especially when you're a professional, you want to be a professional because you're a professional and so, and the point of social media is to be social.
Christian Barton: 39:20 Yep. I like that.
Karen Litzy: 39:21 You know, it's not to go on there and be antisocial and argumentative. You're there to be socially it's fine to debate. It's fine to disagree. But some of the things that people hear this all the time that you see on social media, you would never see that kind of an argument with people face to face. It just wouldn't happen. You know? So you have to remember to keep this social in the social media and not be like a maniac.
Christian Barton: 39:52 I like that phrase. Keep the social in social media.
Karen Litzy: 39:54 Yeah. So if you could recommend one must read book or article, what would it be?
Christian Barton: 40:02 Yeah, so I mentioned earlier about with the trek origins and the concept around that. So switch is probably my book. I think it's influenced my life the most from many respects. I think I gave a really brief, probably poor synopsis of it. It is the elephant, the rider and getting to the destination. But it just changes the way you think. And when you're trying to make a change, it gives you nice, simple way for you where your barriers are. So is it people don't know what they need to do? Is it about the emotion and motivation? There's lots of great analogies that examples within that that I think will kind of really inspire you to think about the rest of your work. Not just research it, it's not just clinical practice but how to change relationships with different people and things like that. So I think it's a really good book to read. I'll give you a second one as well. John Rockwood. Yeah, no, he's translation and dissemination is a book called made to stick and that's basically made to stick. So it's around how to make your messages stick. So that's a really nice book as well. So if you're trying to communicate more clearly, that will hopefully give you plenty of ideas and concepts to look out for. That'd be my to go or recommendations.
Karen Litzy: 41:12 Perfect. All right, now let's get to the conference. It is October 4th and fifth in Vancouver of this year, October 4th and fifth of this year. And can you give us a little bit of a sneak peek about what you'll be speaking about at the Third World Congress?
Christian Barton: 41:32 Yeah, sure. So we've got a couple of presentations. One is actually in the session review, which I'm really looking forward to discussing with yourself and all around knowledge translation. And one of the things I want to talk about in that is how healthcare disinformation develops and spreads? Cause I think it's important we understand the mechanisms of that. And that also allows us an opportunity to understand how we can spread good information because we understand how, how can this disinformation grows and spreads. And hopefully that gives us some insight into how we can grow and spread the good quality information. And so we'll go through some of that and break down some of the things we've talked about around using I guess digital assets for knowledge translation in. One of the things I've actually really looking forward to talking a little bit more about is some of the outcomes from the research we've been doing, particularly around patients and finding them and what we can achieve through a good quality website.
Christian Barton: 42:23 So we have a review at the moment, which is under peer review looking at patellofemoral literature and it doesn't just do a systematic review of patient education. It also looks at online information sources. Basically when we look at all of those is the vast majority of conflicts of interest, often financial conflicts of interest. There's a lot of missing information on there. And so for the person navigating that, that's really challenging for them. And we've done a lot of qualitative work with people with the patellofemoral pain. And then part of the new ways work I talked about before, we actually did reasonably if we needed to clinical trial where for a period of that trial all they had was a website that we developed for them. And we put multimedia and engaging resources with quality information and accurate information, simple exercise program that they could do.
Christian Barton: 43:12 And so we're still pouring through the results and we'll have it done before the conference and I can see from the preliminary stuff was actually do really well by themselves with quality information. And certainly that then makes your life easier as a physio cause you don't have to fill in as many gaps. I can focus on adequate exercise prescription or clarifying some information and things like that. So it makes us more efficient. So yeah, really looking forward to talking about that in our session. And then the second session I'll be talking on is around exercise prescription and I think the title is beyond three sets of 10. And so I mentioned at the beginning my research started in the biomechanics lab and I used to think biomechanics, were the be all end all and I've probably changed my opinion on that over the years and very subtly, very slowly and I still think biomechanics matter, and exercise prescription around that can be important, but equally education alongside your exercise prescription to address things like Kinesiophobia and pain related fear or something that we find is a really important factor in managing people’s pain.
Christian Barton: 44:19 So yeah, a huge barrier to actually getting engagement, but even getting, they might do exercise but they won't get as much out of it if you haven't tackled those fears and beliefs. We'll talk some of the research we've done in that space recently around how that can guide exercise prescription and some processes around that. And then I've had some fun almost on the other end of the spectrum where we've actually just got people in the gym and focus more on physiological responses and we just smashed it in with strength and power. And one in physical therapy in sport, which is just a feasibility study. Probably 10 people, people who we just put through a resistance training program of strength and power and the reason we did this study is when you look at all the patellofemoral literature, no one has done a program of adequate intensity of progression and duration.
Christian Barton: 45:10 You would actually see any meaningful changes in strength and power despite the fact that a lot of them say that they do strength from your title when you actually look at their protocols are not true strength protocols. So we decided to just put great people through this program and just smashed them in to do. And they did better than I thought they would do. I was actually surprised. And so we'll talk about some of the findings and implications of that and how to put that into your clinical practice. And I think the whole idea for me is we have these programs that physios focus on around motor control and they often low dose exercise. Don't know what the education part alongside that done very well around pain, weighted fear and even exercises to tackle that. And simple great exposure. But equally we don't get the end stage stuff done very well. Actual really good progressive resistance training. Yeah. I think we get the middle part done well, but we kind of miss those two elements that's trying to bring all that together. So I'm looking forward to that where it’s not just three sets of 10 of hip abduction and knee extensions.
Karen Litzy: 46:11 Yeah, no, that sounds great. And, and I know that anyway, they'll probably be a lively discussion around that topic. I know here in the US, if people are using their insurance, they're often cut off before we would ever even remotely get that. Let's get you in the gym and really do it, you know, let's really kind of work and like you said, like smash it out, get them stronger, get them confidence and, and it's unfortunate, but that's the system that we have to play in and yeah.
Christian Barton: 46:44 Well, we can put a link up to the paper on the Facebook group. It’s actually open access at the moment? It's appendix of all the exercises. I think they're really simple exercises which was kind of cool about. So we just, we really just pushed it straight away and we only went for 12 weeks. And that was purely from a feasibility perspective of yeah, it just costs money to do these projects over a long period of time. Yeah. But my bargain is that if we kept going and with the clinical hat on, they continue to improve, at least in terms of function. A whole different kettle of fish, but they can do more exercises, more progressive. We make it, the more they can do and wherever their pain usually reduces. But wherever it gets to the point where they're happy or not, at the conference we'll talk about that.
Karen Litzy: 47:29 Yeah. Sounds great. I look forward to it. And are there any presentations at the conference that you're particularly looking forward to?
Christian Barton: 47:38 Yeah. So I think, and not just because I'm talking to you now, but looking forward to our presentation, not just from me talking but also hearing from yourself and rod and I, I think one of the things I've appreciated about knowledge translation and using social media experts, there's no person in the world that knows everything you guys had it through. Then over the years I've actually learned quite a bit from yourself with the podcasts and stuff you do and really enjoy some of yours. And I think I like the process and approach you've taken and I think you've been quite inspirational about how you can actually find a model where you can spend time doing it, which is really cool. I'm so looking forward to hearing more about that and maybe you have some good tips for me, but also Rob Whitely presenting in the same session.
Christian Barton: 48:22 I really like the way rob thinks, he thinks very differently to most people. He's got my favorite Twitter profile picture that I've seen so enough. Those are not from Australia where I quite understand it, but there's a picture of a kid with his head down looking asleep. We've got ex Prime Minister Tony Abbott talking at the same time. So it's quite a funny picture. But he's, yeah, he's a bit eccentric, but also very clever for instance. The whole conference is really good with lots of, I think clinically focused presentations because everyone presenting going through it has a really strong clinical focus here in what they do. I think that's a real strength of it. The Saturday morning there'll be a couple of really good workshops I was looking at it yesterday and trying to work out knowing that you would ask this question where I want to go.
Christian Barton: 49:13 And you've got that and it's allowing presentation with Ewa Roos, Christine, both of which have a huge respect for and I’ve learned a ton about exercise. And so I'm looking to that and saying what other things I could learn from my clinical practice. But at the same time, talk to you about upper limb, the same stuff. Now I see a few cases in shoulders. I don't see as many as Rollin, so it'd be great to learn some things from them, but also I liked to take knowledge from other areas and see how I can apply that to lower limb in my research and yeah. One interesting to do that, but I reckon I'm going to have an apology to those guys for saying that I won’t be able to make both. I'll have to make sure I send someone along.
Karen Litzy: 49:55 It’s going to be hard to choose, but you know, you'd take someone over, you have to divide and conquer. Exactly. You know, can you send someone with that? Yep. Need a team. Yeah, yeah, yeah. Over a beer or wine
Karen Litzy: 50:32 No, for me, like a small little glass of beer. That's right. Yeah. Thanks. Yeah, that's true. That's true. And you know, look at sports congress. This past year I did not have the flu. So drinking those like small little ones kept me awake.
Christian Barton: 50:49 Good, good, good.
Karen Litzy: 50:51 I found like this sweet spot. Well Christian, thanks so much for coming on and giving your time. Thanks everyone for coming on and listening. And Christian, where can people get in touch with you? Where can they find you? They have questions or they want to give you some unsolicited feedback or arguing.
Christian Barton: 51:26 Very happy, very happy with any feedback or questions. Probably easiest way to engage is probably on Twitter. So do you use Twitter a little bit for that? We also have a Facebook group for the trek exercise group. So if you look that up, I might put a link to that as well. So it's trek exercise group. And so that's not a bad medium to kind of start to engage with the trek initiative. And we'll actually use that to launch the back pain and also arthritis websites and I can put some links on there to the top from a website which we set up. And actually the other thing on that note, and I might put this on the Facebook page here as we have a course for anyone who's interested, it's a free online course learning how to critique randomized controlled trials.
Christian Barton: 52:14 So basically it takes you through some modules about how you go back to taking them. Before that we kind of get your knowledge and confidence on your capacity to do that. Do the course and then you could take a few articles and then at the end of it there's a followup test to see how you go. There are actually some prizes as well. So at this point in time we've had I think over a hundred people sign up to this. But only around about 20 finished. Yeah, there are two $500 prize as far as with Australian dollar prize. So at the moment those 20 people will have finished it or, and we've a one in 10 chance we'd pop your dollars. Say I would suggest that you jump on board and have it for learning, but chances to win a prize
Karen Litzy: 52:51 This is 500 Australian dollars or US dollars.
Christian Barton: 52:56 It’s about $350 US. So it's not as lucrative. It's not a small amount. So this is actually part of the, the trek project in collaboration at the University of Melbourne who established this. And so that's the sort of stuff that we're trying to do with trek is to put these types of resources out there and Yep. So hopefully we can get a few people on board back.
Karen Litzy: 53:21 Yeah. So you will try and put all the links. I'll find the links to books and everything that you had mentioned. Switch and make a stick and trek and we'll put them all in the comments here under this video. So that way people can click to them, and join the trek group and figure out how to get in touch with if you have any questions. So everyone, thanks for listening, Christian. Thank you so much. This was great, and I look forward to seeing you in Vancouver.
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On this week’s episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr.Tami Struessel and Colleen Rapp on the show to discuss holistic physical therapy. Tami is an Assistant Professor in the Doctor of Physical Therapy Program at the University of Colorado Anschutz Medical Campus and treats patients in an outpatient clinic. Colleen Rapp has worked as a journeyman and press operator at The Denver Post for more than 30 years. Decades of physically demanding work plagued Colleen with back and shoulder injuries as well as significant chronic pain, ultimately requiring surgery. In 2014, she turned to physical therapist and University of Colorado faculty member Tami Struessel, PT, DPT, OCS, MTC for care.
In this episode, we discuss:
-The key elements that allowed Tami and Colleen to develop a strong therapeutic alliance
-The importance of a holistic treatment approach to physical therapy care
-How Tami’s treatment approaches have shifted to be more patient centered
-How physical therapy has changed all aspects of Colleen’s life
-And so much more!
Resources:
University of Colorado Tami Struessel
Clinical Outcomes Summit: use the discount LITZY
Benefit Concert for CU PT Scholarship
More information on CU Giving Scholarship Program
For more information on Tami:
Tami began with Physio pro in 2018, and enjoys working with patients after all types of injuries and surgeries. She is an Assistant Professor in the Doctor of Physical Therapy Program at the University of Colorado Anschutz Medical Campus, and has been awarded Bachelor’s, Master’s and Doctoral degrees in Physical Therapy. Clinically, she has been recognized since 2003 as an Orthopedic Clinical Specialist (OCS) through the American Board of Physical Therapy Specialists and since 1999 as a Certified Manual Therapist (MTC) through the University of St. Augustine. She is a past recipient of the American Physical Therapy Association-Colorado Chapter Physical Therapist of the Year, and teaches, and researches in the areas of clinical reasoning, orthopedic physical therapy practice, and practice management. She is a member and past president of the Colorado State Physical Therapy Board through the Colorado Department of Regulatory Agencies (DORA).
Outside of work, she spends as much time with her family in the mountains as possible, enjoying cycling, hiking, skiing, snowshoeing and mountain music festivals. She has 2 adorable dogs, Daisy a boxer/great dane mix, and retired seeing eye dog Donovan, a yellow lab.
For more information on Colleen:
Life-Changing Experience with Physical Therapist Inspires Patient to Give Back
Colleen Rapp has worked as a journeyman and press operator at The Denver Post for more than 30 years. Colleen noted, “I'm very proud to be a woman working in a ‘man's world’ where the work is difficult, but rewarding.”
Decades of physically demanding work plagued her with back and shoulder injuries as well as significant chronic pain, ultimately requiring surgery. In 2014, she turned to physical therapist and University of Colorado faculty member Tami Struessel, PT, DPT, OCS, MTC for care.
After being introduced to and working with Tami at Physio Pro Physical Therapy in Denver, Colleen’s outlook on maintaining a healthy lifestyle began to shift. Colleen reflected, “Life-changing care, to me, is defined as care that influences great changes in self.” From the beginning, Tami approached Colleen’s treatment from the whole-person perspective. “In addition to my treatment, Tami showed me online anatomy classes so I could learn muscle groups and have a better understanding of my body,” she said. Additionally, Tami introduced her to things like a calming application, in efforts to reduce stress.
Tami said, “Colleen is one of those patients who truly embraces the idea of becoming stronger and healthier, and is a huge believer in physical therapy.”
“For years, I viewed my work as my exercise,” she said. Through the help of Tami, Colleen lost 30 pounds, has better eating habits and consistently exercises 5-6 days a week. “Tami has taught me the concept of working smarter, not harder,” said Colleen.
“I feel like a whole new person thanks to my care, and it has led to a newfound appreciation for exercise and for keeping my body strong,” Colleen added. “Tami really wants to see her patients succeed, it matters to her.”
Admittedly, Colleen wasn’t fully aware of physical therapy and its importance when she was first referred. From learning movement, stability and range of motion among other things, she realized there were many elements of physical therapy beyond what she initially thought. “I realized that physical therapy was the most important thing in between the points of injury and health,” she said. While every day presents challenges to stay on a good path of nutrition, exercise and the willingness to strengthen her physical fitness, Colleen is greatly appreciative of Tami’s influence and care in her life.
“Through her hard work, Colleen has transformed herself into a much healthier and more resilient person,” said Tami. “To me, that is what being a physical therapist is all about!”
Colleen’s experience and Tami’s impact was so life-changing that Colleen felt inclined to give back. With Tami being a Professor for the CU Physical Therapy Program, Colleen felt the best way to honor her was to support funding for student scholarships. Colleen initiated a fundraising campaign for the Physical Therapy Student Scholarship Endowment, supporting future leaders in physical therapy. “I not only personally donated, but I’ve run multiple online auctions where I have sold sports and music memorabilia,” she said. Colleen is not only motivated to improve herself and her quality of life, but ensuring the availability of funds to help the next generation of physical therapists impact their own patients.
CU Program Director Margaret Schenkman, PT, PhD, FAPTA has led the charge behind student scholarships since the inception of the CU PT Scholarship & Endowment Board in 2012. Colleen noted, “Margaret supported my efforts to give back and help the students. She reached out to me with so much kindness.”
“I know that my efforts will impact a student’s life just like Dr. Struessel has impacted mine,” added Colleen. “She’s far more than my physical therapist.”
Read the full transcript below:
Karen Litzy: 00:01 Hi Tami and Colleen, welcome to the podcast. I'm so excited to have both of you on. As I said before we went on the air, this is a first time I've had a physical therapist and a patient on at the same time. So I'm excited for the listeners to learn from both of you. So welcome. Welcome to the podcast. All right, so Colleen, let's start with you. So, why did you seek out a physical therapist?
Colleen Rapp: 00:32 Well I was working and I hurt my back and I went to a doctor and basically he had me go to physical therapy, which I had gone before maybe like a couple of weeks. So I wasn't really familiar with physical therapy, but I had hurt my back really bad. So I knew it was going to be a long road and I was kind of nervous at first. And so he recommended me to go to low high physical therapy. And that's where I met Tami.
Karen Litzy: 01:02 And so I know you said you didn't know a lot about physical therapy, but once you were referred to physical therapy, did you look anything up? Did you have any expectations?
Colleen Rapp: 01:13 I really didn't have many expectations because I'm working with a lot of people that have gotten hurt in my job, I'm a pressman of the Denver Post. It wasn't a very good report from the people because they just didn't get a lot out of it. So it was kinda like, oh, I'm going to physical therapy, what a drag. And that's kind of what I was looking at. So I didn't really know a lot about it, so I just kind of walked in there and had to go basically.
Karen Litzy: 01:45 Okay. And so Tami, let's talk about kind of that first visit. Did you know any of this before Colleen came in to see you or did she say, Oh, I'm just here because the doctor told me to.
Tami Struessel: 01:57 Well, this particular clinic, sees a fair number of people who are press operators at the Denver Post where where Colleen works. And, so I had seen, you know, a few people here and there. So I knew a little bit about the job. I knew it was a pretty physical job that they had a fairly high injury rate. I evaluated her and, you know, found out that she had had a long a history of being very healthy in her job until she hurt her back and that she was, you know, she was in a lot of pain and I'm having a really hard time getting back to work. And so that's where we started.
Karen Litzy: 02:45 And it's kind of look at this as like a mini case study right now. Right. So Colleen she comes in with low back pain, injured at work calling. Were you unable to work at the time?
Colleen Rapp: 03:01 Yes, I was taking off work. I could barely walk. So I was taking off work. I couldn't even go down to modified duty. I was at home.
Karen Litzy: 03:10 Okay. So Tami kind of walk us through your evaluation, meaning when she came in, what kind of questions did you ask for this subjective? And then what did you look at for the objective part of the eval?
Tami Struessel: 03:36 She'd had a long history of working in a very physical job and the vast majority of people that do the job or are men and that she had been very successful and really loved her job and worked hard at it and was very proud of it. And I think she's still very proud of it.
Tami Struessel: 03:58 And I think I asked probably fairly typical questions about the mechanism of injury, how she was injured and you know, what kinds of, you know, what kinds of things she was not able to do and what kinds of things she could still do. And then did a full lumbar and hip examination, which I always do. You know, kind of head to toe but focused on those areas.
Karen Litzy: 04:31 After that evaluation, Colleen, what did you feel after that first visit when you left? Did you feel like, oh I think I'm in good hands here? Or were you like, oh maybe this might work but I'm not sure.
Colleen Rapp: 04:46 No, I definitely at first knew I was in good hands with the way Tami treated me when I came in. I think she knew I was a little nervous and so she kind of, you know, kind of joked with me and she kind of liked explained things to me and then she examined me. But through the examination it was very comfortable. So I was like, oh okay, this isn't so bad. You know, you have to feel comfortable at first and get that report and then you're just not like shaking going, oh my gosh, where am I at? And so I think after like 20 minutes of that and just talking to her, cause the first session was an hour and after her examination she sat with me for about like 10 minutes and explained everything to me about, not exactly what was wrong with me because she doesn't really believe in that she believes in, you know, the fact that I need to know to listen and not concentrate on that. So she kind of just explained to me about, that we were going to work together. I was going to see her twice a week in that we were just going to get me better and get me stronger and made me feel really comfortable. And that was the first step of like just being a good experience.
Karen Litzy: 06:03 And you know, before we went on the air, I've talked about this idea of a therapeutic relationship. And I think Colleen, you just really described a really great first step in achieving a therapeutic relationship. So Tami, did you have a sense when Colleen left that A she is going to be coming back and B she was probably going to be pretty invested in this.
Tami Struessel: 06:36 I mean, I guess there's always a possibility that you don't connect with people and that they, you know, they choose not to come back. But I didn't get that sense from her. I think, from the very beginning she was very interested and I think because she does like her job a lot and, really wanted to get back to it. Just in general she was invested and I think one of the things she talked about is, as most people do, to know the thing that was wrong with her back. And I'm pretty averse to the, you know, biological approach model and explaining all of the anatomy and everything.
Tami Struessel: 07:27 Because I've been doing this now for 28 years, so, I used to do a lot of that. And I realize now that that's just not healthy. And she, she actually, you know, she embraced that. And she already said that that clearly is kind of a core principle for me that, you know, I'm not gonna, I'm not gonna, you know, get that model out and say, here's the thing that's wrong with your back. And, you know, unfortunately sometimes, you know, depending on who she's talked to, whether that's coworkers or that's the nurse at work or that's one of the workers comp physicians or something like that. I think she got a little bit of that. And I tried to divert away from that mindset and that she's really been very receptive. She doesn't ask me very much anymore exactly what you know about my disk or about my, you know, I mean, we talked a little bit about your SI joint but we try not to focus too much on it.
Karen Litzy: 08:32 Right. And so Colleen from a patient standpoint, what Tami was saying, is it just for your clarity, so a lot in the physical therapy world, we used to rely on the sort of biomedical model where you know there is an issue with the tissue A plus B equals C. So this hurts and this tissue is quote damaged. This is why you have pain. Now pain, we know is much more complex and we use what's called a bio psycho social model of care, which is, yes there is the bio part is still in there, but we also want to take into consideration that there are psychological aspects to pain and social aspects to pain. So Colleen, my question for you is, did you feel like not focusing solely on the biomedical part of it or just on the tissue part of it was helpful for you in your recovery?
Colleen Rapp: 09:34 Yes, because it made me realize that I needed to just work and get better instead of like, oh, this is what happened to me, this is what I have and if I knew, I think I probably would have been scared, you know, or like, Oh, poor me or this or that. And I didn't want to get into that, that view point. I wanted to kind of just say, okay, all right, I got somebody that just basically let's do this. Let's get working, let’s get me back to work. I'll work with you. You work with me, I'll teach you things and do the best for me. And I needed to listen and I needed to do those things. And that attitude gave me the will to do that and not focus on the other stuff. And that helped. It really did. If you get your mind focusing on what is wrong it doesn't really help. You got to kind of move on and try to do the things you need to do to get better.
Karen Litzy: 10:32 Yeah. I think that's great advice for anyone. Instead of dwelling on what's wrong, let's start dwelling on what's right and what you can do to improve your function and to improve your life. Two very, very different ways of looking at things. And from a patient standpoint. I think that's great to hear. Now, Tami, you were saying before we went on that, okay, the back thing was a couple of years ago, but then there were also some other things. So Colleen is a bit of a repeat offender, no offense Colleen. But again, I think that shows the strength of the relationship. And now I don't know what the laws are in Colorado, but do you have direct access there?
Tami Struessel: Yeah, we have a 100% direct access.
Karen Litzy: Lucky. So, Colleen, when you were injured, let's say subsequently after the back, you had gone to see Tami for other things. Did you know just to go straight to her or do you still have to go through a system?
Colleen Rapp: 11:32 When I went I hurt my shoulder, I basically asked my doctor if I could see her and I told my doctor that I was comfortable with her and the success that I had with her, with my serious back injury and that I really felt comfortable with her and he was okay with that.
Tami Struessel: 11:54 These were work related injuries. So there's always going be a claims process and a physician, now take a little bit of a step back after we finished treatment related to her back. We did do some training sessions to really get her beyond, you know, kind of basic back to work and those kinds of things and work a lot on fitness and exercise and those kinds of things, which was fairly new for her. I mean, not that she didn't exercise before, but I think she can probably talk about like what her fitness routine was like.
Colleen Rapp: 12:43 Okay. So I think that the most important thing that we're kidding here and I have to kind of come on and for 33 years I worked at the post and I'd never really had an injury and like little things until like five years ago when I hurt my back and that it just seemed like, the last few years with the, you know, staff decrease in everything, we might work a little bit harder or faster and stuff. And I think things have gotten a little bit to where I had had like three injuries and so that's really cool cause Tami actually working with her has reminded me to always make sure that I work smarter than harder and got me back to where no matter what my position is, my work or my life or anything, I always have to be smart and I always have to take care of myself first and you know, be careful what I do and think about what I do. Cause it's the job I do is very dangerous and it is really scary. And, this whole PT thing is really important because it did change everything that I do at my job and it has made it so much safer for me.
Karen Litzy: 14:04 So Colleen, I'm going to ask out of pure ignorance here, what exactly does your job entail?
Colleen Rapp: 14:21 I actually worked on a five story press. Like on TV where the paper's coming on a conveyor and yeah that's what I worked on. They're a little bit more fancier but they're a little bit bigger. Now there are about five stories high. They're really long. I'm really not sure how long they are, but I do like 600 steps a day. I lift 50 pounds, I push a 1500 pound rolls. I do a lot of climbing. I do a lot of everything. It's eight hours, 10 hours, sometimes 12 hours of just physical work.
Karen Litzy: 14:56 Okay. Wow. So that's a lot. So now Tami, as Colleen is coming to you for various injuries. You obviously have this in mind. So my question for you, and this might be some good advice for other physical therapists who might be listening, is how did you take into account her job and the requirements of her job when it came to exercise prescription and things like that. And then, and now I understand why you moved onto the fitness part of things because you know, you hear a lot like, well, insurance cut me off so all we could do or just these little exercises or I only saw the patient for six weeks when in reality, we know they need a lot more to stay healthy and to not reinjure themselves. So what advice would you have for therapists who need to take into account the person's very physical job?
Tami Struessel: 16:02 Yeah, so I think there's probably two components of that. So, one is definitely, the work itself and, you know, if I was having her do basic, you know, transverse abdominal contractions and, and those kinds of things, it was just never going to be, you know, to a point where she was able to, you know, get strong enough to actually physically do her job before. And I knew she was able to do it before so she would be able to. So there was definitely, I believe in Colleen could tell you this. I believe in hard exercise. I think sometimes we don't push people enough and some of it does have to do with, there's times where we have a very short, you know, we see somebody for three weeks and, you know, how much can you do from a fitness standpoint.
Tami Struessel: 16:55 But we were lucky. We got to see Colleen for longer. And so I had her work hard, as far as kind of general exercise and fitness and getting stronger. There was a time in my career where I would go out and visit the patient and see what their job was and those days are mostly gone, honestly. We get video, you know, off of people's phones. And so I had a pretty good idea of what the work was. But, several times Colleen, brought in, you know, we've talked about it and she's brought in video of, you know, the types of work that she needs to do. And then we would go through things like, you know, so what of your job duties do you think is the hardest or most trickiest? Because she would have to get into like, you know, awkward positions or I think I remember trying to work with her on like what her foot position was or something. She's like, you realize I'm standing on this little bitty platform that I can't really move off of. And I was like, oh, well maybe we need to re rethink that. So I don't know if Colleen you want to talk more about that asset
Colleen Rapp: 18:10 There’s sometimes where like I'm standing on a platform and there's like a drop on either side of me and I have to reach up and lift up probably about a 45 pounds piece of press. It's called a bar and turn it around and position it in a different way without falling. And it's really crazy because on this precept, the press, there's an air connection to it. So once you take it off where it goes, it pulls you back. And so you have to be pretty strong and you have to be pretty smart or you know, you're in trouble. You can drop it, break your toe or something. So I think we worked on that and that was the most important thing that I think while we're on the subject is the greatest thing about Tami was, is that she saw that I needed to stay strong. When you injure yourself, I think that you have to learn that it's not over.
Colleen Rapp: 19:11 As soon as you walk out at therapy, you have to stay strong. You have to keep on doing your job and you have to do the things that are going to make you able to do that and not keep getting hurt. So would this keep working together? I learned all kinds of stuff. I learned how to, you know, just talking with her, she would say, well, can't you move the press down a little bit so you're not, your arms aren't up so high or can you just position yourself or can you not twist? Then, it just all made sense to me and I always say that you can walk up some stairs and you come up really fast. This for example, but if you walk up the stairs right, sounds weird. But if you walk them up right, you can do a whole bunch of them and you're not hurting yourself. But if you don't do things right, the repetition does wear on you. So my period of time with Tami and learning all these things and doing the things that I needed to learn just totally, it was life changing for me.
Karen Litzy: 20:12 That's amazing. Tami what a great job. And if I can go back to kind of just reiterate what you had said before. So when you're working with someone who may be has a complicated job situation, not everyone sits at a desk for, you know, eight to 10 hours a day. Not everyone does that. I love the advice of asking the patients to take video of what they need to do. And then the question that you asked, well what are the things that you know are most problematic for you? What are the trickiest things you need to do at your job? Because if you can get the things that are the hardest things to do, I would imagine that working on those and getting some confidence and to be able to do those really difficult parts of the job, then you can get down to like some of the easier work after.
Tami Struessel: 21:04 Definitely. Yeah. I mean, and some things are not modifiable. I mean, when you're a large piece of equipment. But what I found with Colleen is she was so familiar with the job and what she had to do that, you know, both we could work together to find alternative ways or alternative positions. I'm like, is there any way you could step up or, you know, do something so that you're not reaching so high or, you know, whatever. And many times she was like, Oh, actually, I've never really thought about doing it that way. I'll try. And, often she was successful with that. And the other aspect was that she had such seniority that she is able to, she has such seniority that she's able to bid on shifts that are a little bit healthier for her in general now. We can talk about things like sleep and diet and stress reduction and weight loss and all these things are a result of her really embracing the idea of, you know, she wanted to continue to work. She knew that she wasn't probably going to be able to, if she didn't really change her lifestyle. And to her credit, she absolutely did. And I repeatedly tell her she's the one that put in the hard work cause I can do all of these same things with somebody else and if they don't take it seriously and they don't really embrace it, then it doesn't matter.
Colleen Rapp: 22:42 I think that that's the greatest thing about this is Tami taught me it’s not the exercise it's eating well, nutrition, losing weight, sleeping good, using your environment. I was hiking today and I was thinking about, you know, about what the most important thing about, you know, physical therapy and everything was, and I always think that some people that are really working out and stuff, they have to use weights and they have to do things and they think they're so strong and they still do things wrong. And I was hiking and I was like, I use my environment to make myself better every day because of Tami care. By the way, I walked, at work, the way I move and the way I eat, the way I sleep, the way I think because actually, injuries and especially a couple injuries, you know, I just got out of one injury and got hurt again and that was totally mentally hard on me and all this connects to the patient and that's what a patient goes through.
Colleen Rapp: 23:58 So when you can correlate all this in your life as a whole body and like Tami teaches, it's amazing. It is. I truly believe that physical therapy is the most important thing between the point of injury and health. And if you keep on going, I'm going to be walking when I'm 62 and I want to be doing a whole bunch of things and it has just changed my life.
Karen Litzy: 24:23 I think this is such a great example, Tami, of being a physical therapist, treating at the top of your license and really, really incorporating lifestyle change into your practice. You know, it sounds to me like you're more than I see someone for a bout a therapy they're discharged, Versus giving them a lot of skills and tools to not just take care of that bum knee or the painful shoulder, low back pain, but rather let's look at this person as a whole. Let's take a holistic view of this person. So you know, you said you've been
Karen Litzy: 25:23 practicing for 28 years. I've been practicing for like 20, so I can certainly attest that my views have completely changed from when I first started. So I'm not going to assume that yours have or haven't, but if they have changed, where was it in your career where you feel like you had a major shift? Like I can say I know exactly when I had sort of this major shift in treatment paradigm. Did you have that major shift or was it just as more research came out, you just started incorporating all of this? Or were you doing it from the beginning.
Tami Struessel: 26:03 I would say that I don't know that I had a shift. I'm fortunate enough to teach at the University of Colorado and so I'm around really smart people all the time and I don't want to minimize how that is so important including people that practice in all different areas. And so I've learned a lot from, you know, from our neuro folks, from our cardiopulm folks, from other, you know, musculoskeletal people. I guess, you know, there was a shift at some point, and I don't even remember, I think I might've gone to a course where the emphasis is like, you know, your orthopedic people have neurological systems. I would say that's probably, if I had to have a point of shifting that was like, oh, of course, you know, if I'm not addressing that, then, you know, then I'm missing the boat.
Tami Struessel: 27:06 That was a while ago. But, I would say from a language standpoint, you know, therapeutic neuroscience education and motivational interviewing and some of the things that, you know, I think probably took the first of those about maybe four or five years ago. So, I was never a big, well, I can't say never, but I think I figured out that, you know, just pulling out the spine model and scaring people to death was probably not a good idea a long time ago. But I do think that that, you know, I think we all have learned that probably some of the language that we use is not helpful. I don’t know if I had a Aha moment or it's just, I think I've always been very open and from my first outpatient job, I remember I did inpatient for a couple of years and then, I worked at a clinic where the people had continuing education lists that were just enormous and that had a big impact on me. I specifically remember thinking, you know, wow, these people really are invested in learning and learning from each other as well. I think that was instilled in me very, very early in my career and it's continued with me. I have a pretty long continuing education list because I've, you know, been able to glean something from every single thing that I've gone to.
Karen Litzy: 28:40 Yeah. That's amazing. And Colleen, as the patient, do you get a sense of that, this sort of lifelong learner in Tami?
Colleen Rapp: Oh, yeah. I think Tami inspires me. I mean, I kind of look at her like, who else could you be in your profession? I meen, you teach, you practice, you govern, you everything, you know, I mean it's so inspirational. I have to tell you one thing that she did for me that was kind of relative for this. Not only did she teach me about my health and help me see my things, I kind of like, I'm in a world where the press room so I'm not like very, I'm educated, I'm smart, but I'm smart and the things that I know, and she introduced me to classes online where I could learn about anatomy. And so I took them and it was amazing. She taught me how to be a better person in a whole bunch of ways and being able to go into a doctor's office and know what my quads were and kind of explain things a little bit more and understand what we were doing and what was firing and actually all the way around. It's really incredible. So yeah, I think very highly of her. I think that she totally is a true inspiration. And a gift for her profession.
Karen Litzy: 30:12 Sounds that way to me. That's for sure. And it also sounds that, you know, from the patient's standpoint, and I think this is so important, it's something that we hear so much about is that through education she was able to empower you to take control of your own health. You were partners in your care versus her just telling you what to do. And you did it without knowing why or what behind it. And, like you said, really inspired you to reach for more. And if every physical therapist can do that with every patient, then I think that would be such a boon to the profession.
Colleen Rapp: 30:52 Oh, definitely. It would, it would kind of, yeah. I mean, you guys, you guys are really important and you guys change lives, but you know, it's hard because not everybody's accessible to that. So, but in this story, I was and it's changed me. I've lost like I think, tell me what, like 35-40 pounds and I exercise like, yeah, like three or four times a week. And I'm just overall a better person. And, it's just a wonderful thing. I'm very, and as, you know, it's in me now and it's not just physical therapy. It's life. It brought life back in me. I can say it that way.
Tami Struessel: 31:44 You already said, well, you know, I was hiking today and, you know, I mean we're fortunate enough to live in one of the most beautiful places on earth. Colleen has taken full advantage of that. You know, I think there was a time where she would come home from work and was tired and he wouldn't do a whole lot. And now she's really, she's really a drank the Koolaid of being an active person. I think she exercises, but she's also just a more active person in general and thinks about activity and exercise differently. And, she embraces that and embraces making some lifestyle changes that has made all the difference.
Karen Litzy: 32:36 And you know, before we kind of wrap up here, I just have one more question for each of you. They're going to be slightly different, but Colleen, I'll start with you and you've kind of, I think might've already answered this question sort of throughout, but as a patient, how has physical therapy changed your life? And part two of that, what advice would you give to someone who's on the fence about physical therapy?
Colleen Rapp: 33:10 I think physical therapy changed my life because I've learned that the most important thing is mobility and stability and so movement. I was always thought that to be a strong person, I had to go out and, you know, get a trainer and do 50 pushups and 30 squats and walk home, couldn't breathe, you know, and what I learned through physical therapy is that the exercises that you get are, are really important to learn how to balance. The simplest things can impact you in a certain way. And the other thing is that I had to embrace it because if I embraced it and learned how to do the things Tami taught me, not on any of the exercises, but if my leg hurt and how to take my leg, or I said, or something I could achieve to be better and to stay better and not be a person that was going to a year from now say, oh my shoulder still hurts or my back still hurts.
Colleen Rapp: 34:20 And that's what I worked every day for is finally instead of, you know, I finally found something that like physical therapy that just had an impact to me. And it's very important and it's very important if you do those things, you'll be successful. And that's the way I believe. I think that to tell somebody is to give it a chance. Because I work with so many people that don't, they automatically say, I want to have surgery, I don't want to go to physical therapy. And, I think you get into that stuff where they just assume that it's a waste of time. But I think if you would just give it a chance and just see and, and give it, you know, give it a try and listen, I think you'll learn that it's gonna Change Your Life. Like it did mine.
Karen Litzy: 35:11 Incredible. And Tami, this is a question that I ask a lot of my physical therapy colleagues that come on the program and that's given what you know now where you are in your life and your career, what advice would you give to yourself as a new Grad right out of PT School?
Tami Struessel: 35:38 Wow. That seems like a long time ago. You know what I think, it might be similar and actually I give this advice to my new grads that I teach. And that is that first of all that your first job or two is so formative and so select wisely, you know, look for places where you have a sense that the culture is good, that there is a lifelong learning mindset. I want to be sure that my patients that have come to see me, if I'm on vacation for a week, then they can go to somebody else and I know that they're going to get really good care. And then just that lifelong learning for yourself. You know, if you get stagnant and, you know, kind of bored, maybe you need to kind of figure out what you might be able to do to kind of spark that again.
Tami Struessel: 36:45 There was a time where I decided that I wanted to pursue teaching and I really sought out that opportunity and that's been extremely enriching for me as well. So I'm really fortunate there, but I also don't want to, you know, teach and not treat patients. As long as my body can hold up. I want to, I want to keep doing that because it gives me all kinds of great stories for a class. And it’s also fun. I think I was born to be a physical therapist, so, I know I made the right choice a long time ago and it still is really a terrific profession.
Karen Litzy: 37:32 Amazing. And Colleen, can you tell us a little bit more about your student scholarship fund and what you have coming up?
Colleen Rapp: Well, Tami changed my life so much that I wanted to do something in return. And so I found out this scholarship fund at her school didn't get a lot of funding, so I worked like a year and sold, sports memorabilia and I basically sold concert tickets and all kinds of stuff and I put all the proceeds for a year to the fund. And so the year was up and I kind of wanted to do something. I was like, well, this was really good. I want to do something like really crazy fun, you know, go out with, you know, happy, you know. So I decided to arrange a concert on September 5th, and it's going to have a pretty good artist in Denver. Her name is Hazel Miller and all the proceeds will go to the scholarship fund. They will be donated. So I'm kind of excited about it.
Karen Litzy: 38:37 That's incredible. And what a great way to kind of pay it forward. And then just to be clear, this is a scholarship fund at the University of Colorado.
Tami Struessel: 38:48 The doctor physical therapy, specific student scholarship fund.
Karen Litzy: 38:54 Awesome. Well, I mean, Colleen, what a great way to give back to the profession and to the future of the profession. So, and I'm sure those at the University of Colorado are very thankful for all of your help and enthusiasm in getting the word out about physical therapy. I know. I am. So Colleen, thank you for coming on and sharing your story. And Tami, thank you for coming on and sharing your story. In the way that you've worked with Colleen, and I think that you're giving a lot of therapists, especially newer grads or students, a nice glimpse into really how we can move beyond just take an injury and rehab it to take an injury and change a lifestyle.
Tami Struessel: 39:42 Yeah. Thank you so much, Karen. That's what I'm practicing at the top of your license, as you said before, you know that’s where you can really feel good every day about inspiring people and getting people to make lifestyle changes, like Colleen made, so that they can be a better, stronger, more resilient person. That's what it's all about.
Karen Litzy: 40:08 Amazing. Well, thank you both ladies, for coming onto the podcast today and to everyone listening, thank you so much. Have a great couple of days and stay healthy, wealthy, and smart.
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LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Lars Engebretsen on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada. Lars Engebretsen is a professor and consultant at the Orthopedic Clinic, University of Oslo Medical School and professor and co-chair of the Oslo Sports Trauma Research Center.
In this episode, we discuss:
-Dr. Engebretsen’s career shift from being reactive to proactive in injury treatment
-The importance of a team approach for injury prevention in sport
-Programs that focus on translating injury prevention research to coaches and trainers
-How to develop your research portfolio
-What Dr. Engebretsen is looking forward to at the Third World Congress of Sports Physical Therapy
-And so much more!
Resources:
Third World Congress of Sports Physical Therapy
Oslo Sports Trauma Research Center
For more information on Lars:
Dr. Lars Engebretsen is a professor and consultant at the Orthopedic Clinic, University of Oslo Medical School and professor and co-chair of the Oslo Sports Trauma Research Center.
He is also a consultant and former Chief Doctor for the Norwegian Federation of Sports, and headed the medical service at the Norwegian Olympic Center until the autumn of 2011. In 2007 he was appointed Head of Science and Research for the International Olympic Comittee (IOC).
Lars Engebretsen is a specialist in Orthopaedic and general surgery and authorized as Sports Medicine Physician (Idrettslege NIMF) by the Norwegian Society of Sports Medicine. He serves as chief team physician for the Norwegian Olympic teams.
The main area of research is resurfacing techniques of cartilage injuries, combined and complex knee ligament injuries and prevention techniques of sports injuries. He is currently the President of ESSKA (European Society of Sports Traumatology, Knee Surgery and Arthroscopy).
He is the Associate editor and Editor in chief for the new IOC-BJSM journal: Injury Prevention and Health Protection. In addition, he serves on several major sports journal editorial boards and has published more than 200 papers and book chapters.
Read the full transcript below:
Karen Litzy: 00:01 Hey everybody, welcome. Happy Saturday to everyone. For those of you who are on the Facebook page right now, welcome. I'm just going to check and make sure it's on. Yes. So we are live, which is awesome. As you know, we've been doing live interviews with speakers from the Third World Congress of sports physical therapy. And for those of you who, if you're on this page, I hope you know when it's going to be, but it's October 4th and fifth in Vancouver, Canada. And today I have the distinct pleasure and honor to be talking with Professor Lars Engebresten. So, professor, welcome. Thank you so much. And as we said before, I've been practicing that name for at least a week, so. All right. Chris Napier, welcome. We said welcome, to you, thanks Chris for being on. It's a little bit early. They're over in Vancouver. So professor, before we get started, can you please tell the audience and tell us a little bit more about you, your career trajectory, and what you're up to?
Lars Engebresten: 01:17 Yeah, I'm a professor at the University of Oslo Department of Orthopedic Surgery. And then I work, at the Olympic Center of Norway getting gold medals for Norway. And then I do work at the Olso sport Trauma Research Center, which I run together with Rollbar. And then I am a professor at the medical school and I work every other week for a couple of days in the Olympic national committee. So I have a very good combination or clinical practice. I still operate and I see patients quite a bit every week and research. I have many PhDs working on projects that I would say coordinated by myself.
Karen Litzy: 02:02 That's an amazing amount of work to do. It's like five jobs all rolled into one and I'm sure, although this is not what we're going to be talking about today, but maybe another time we'll have you talk about your time management skills. I mean, how you get all of that done because that's an amazing amount of work to fit in. But let's dive right into, since you just mentioned that you're still doing clinical work and research, so how being that clinician scientist, how important is that to merge your clinical work with your research work?
Lars Engebresten: 02:38 Well, you know, I think I found out very early in my career in orthopedics how important researchers, I was actually, you could tell this story I was doing in clinic as a resident, up in Trondheim where I did my residency and next door to me was one of the professors. And I had many patients with anterior knee pain. And I would ask him, what do you actually do with those patients? Cause they now see him a little bit strange now on them and then suddenly I operate and all that. So I said, yeah, what kind of operation do you actually do? And then it sounded, you see, I do a Mickey operation, like, elevating the tibial tubercle to reduce the load on the Patella site. And I said, oh, that's strange. How are they doing? And he said, oh, they all do very well.
Lars Engebresten: 03:35 And then I actually looked up 50 of those patients. I am in the hospital and then sure enough about one third did pretty well. One third was about the same and one third was much worse. Then I realized, you know, you can't really trust the old professors. You have to in the areas where there are some doubts here and there and what to do, you have to do research in those areas there. There's no way you can be a clinician in your university clinic without, doing that kind of research. So since that time, which was a long, long time ago, I've actually been doing all kinds. So both clinical and basic science research
Karen Litzy: 04:18 How does one inform the other? So how does clinical inform research and research informed clinical for you?
Lars Engebresten: 04:28 Well, for me it's been like a, you know, I see patients, I follow a various teams. I'd done all kinds of soccer teams, handball teams, ice hockey teams and so forth. I see the issues, what kind of problems do patients have. And I see what we have to, give them in the form of various therapies or various surgeries. And I realized that we aren't really perfect. That there is a lot of research that remains to be done actually. So that's a general in general speaking the way, I've found out that this is something I have to do. And, when I was young I was doing all kinds of sports myself. And I also realized that, you know, when you got the injured really, we really didn't have that much of a argument for getting people back. And that was a long, long time ago. And now we're better, we aren't getting better, but, we still have a way to go. So the last, I would say, 30 years I've been working on the three different research areas. So I've been working on a cartilage issues, a ligament issues, and then later on the prevention of injuries issues.
Karen Litzy: 05:48 And you know, since you mentioned the injury prevention issues, let's dive right into that now. So, you've been involved in conducting a number of studies regarding, sports injury prevention. So what would you say are some of the common misconceptions around injury prevention?
Lars Engebresten: 06:10 Right. It's very difficult to get people really interested in that area because, you know, it doesn't really pay much on an individual basis. It does pay back to society because you get less injuries by doing it, but to the individual doctor or Physio, it is a difficult because of the payment schedule in these cases. In my case it was actually more specific at what made me change my attitude to this. So I was doing, all kinds of basic science and also can you go studies in the ligaments and tendons and then, you'll see them and they are very good. They were supposed to win the gold medal. Actually in Sydney. The star player had an ACL eight months at a time. And, which was a major issue of course.
Lars Engebresten: 07:17 And we operated on her and the most successful and she came back, Nora did not win the gold medal. Olympian bronze medal and she didn't really perform the way she was supposed to. And I realized then actually, that, you know, what we were doing was not really that great. I realized that she was on track for getting osteoarthritis pretty early after the surgery. And I realized, Oh, all my efforts in the, you know, ligament, design and, new ways of doing the surgery and stuff wasn't that great because I thought, you know, I should spend more time on how can I prevent these types of injuries at the same time as I treat them later on. But I kind of refocused towards prevention all these injuries after that incident.
Karen Litzy: 08:25 So getting back to this injury prevention, so based on our current knowledge of injury prevention in sports, what would be your recommendation or go to strategy intervention for injury prevention? So for example, is it exercise? Is it load management? Is it education?
Lars Engebresten: 09:05 The most important thing is to look upon this as a team effort. There's no way you as one person, I would be able to make a huge difference in this area because prevention is all the aspects that you mentioned. And therefore, you know, in our case, you know, also sports trauma research center, we are a quite a few people working in this field and there's no way that not one of us could make a big difference. Yeah. It's all about the team effort. Because you have to do research, just figure out whether your program is working. Secondly, you have to make people do it. And third, you have to look at results of it. And that really demands a manpower, budgets, long term studies in this area.
Lars Engebresten: 10:13 We’ve done a lot on randomized control studies showing the effect of these programs, but we still don't have perfect compliance, you know. What we have found out lately is that, we are changing our approach and it can be towards instead of travel around I get a mixture of some of this to athletes and stuff. We actually tried to teach the coaches in Norway anyway. The coach educational programs are now filming this prevention programs we have. So it's all about, I think parents and coaches, then the doctor or the physio doing it. So we have to be able to relate all the knowledge we have and to be able to implement it. And that is the biggest challenge at the moment.
Karen Litzy: 11:17 Yeah, that makes a lot of sense. Changing people's behaviors is not easy.
Lars Engebresten: 11:25 It's not, but you know, at least where I live and I'm sure also in the US, we have been able to stop people from smoking. Very, very few smokers left here. So we should be able to, you know, instigate the system where, if you are young and you're doing a sport, part of your sport is the prevention part.
Karen Litzy: 11:50 Yeah. And, and I think that that's great example that yes. Smoking, when I first moved to New York City, so many people smoke. Now it's a rarity mainly because of good outreach campaigns, via media and things like that. And sometimes they think that's where, injury prevention and sports injury prevention is just not getting its fair air time, I guess. Right. So when you look at mainstream media and news and things like that, they focus on the injury. So the professional player who gets injured or the collegiate player that gets injured, this is the injury. This is the surgery versus look at all the people who haven't gotten injured and why is that?
Lars Engebresten: 12:33 Hmm. Yeah. You know, there are some good examples. For example, hamstring injuries, we have a pretty good way of reducing and reducing those by maybe as much as 75%. And even in the premier league in England, the best, very best teams, you don't really do those exercises. And it's really, really crazy cause the number one injury, keeping people out of premier league soccer is actually hamstrings, it's a very strange thing that I've not able to, and I think that's all about, you know, the coaches being involved and understanding how important is this.
Karen Litzy: 13:15 Yeah. And are you doing things in Norway? I know you said that now you're getting more coaches to come to lectures and things like that. So if there are people listening from other parts of the world, what sort of system are you using to get those coaches in?
Lars Engebresten: 13:32 Well, there, you know, almost every country has some sort of cultures of education and it's like level one, two and three and so forth. And, now we have introduced international programs, you know, all those levels. That’s part of some sort of daily education is about prevention. And I think that's I must add a key in this area. We have shown that we are able to reduce the number of serious knee injuries for example by more than 50% in some sports that are really prone to those type of injuries. Team handball is a very good example. Basketball could be another one. So I think that education day is very, very important. But as I said, we are trying out new ways of getting compliance improved cause that's still an issue.
Karen Litzy: 14:30 You can have a great injury prevention program but if nobody does it.
Lars Engebresten: 14:36 Hmm. I know, you know what we are trying to do is to teach the parents. If you have a daughter, 12, 13, and 14 year old and if she plays soccer or team handball, the chance of having a serious knee injuries are very high and you can really take out insurance by doing a these kinds of exercises at the same time that you are training. So maybe spend 10, 15 minutes, three times a week on this that would be able to reduce the percentage risk for having an injury like that.
Karen Litzy: 15:13 Yeah, I mean from the standpoint of the clinician and the researcher just makes so much sense. We just have to get the coaches and the players and the parents and team organizations in schools and things like that on board. And I would assume that takes time and some effort and the incentives.
Lars Engebresten: 15:35 I think that in the US you have all the sports in schools, right? Whereas in the rest of the world, for the most part the sports are outside schools and community teams and stuff like that where it is a little bit more difficult to get this through. So there should be good chances in the US and Canada as well.
Karen Litzy: 16:01 Alright, well hopefully people listening to this will kind of take this to heart and go to their local high schools and middle schools and try and educate those coaches and parents. All right. Now you already touched upon this I think a particular patient case that you personally treated that caused you to reevaluate your whole treatment paradigms. And I feel like you touched upon that a little bit already. Do you want to expand on that at all?
Lars Engebresten: 16:31 Yeah, in a sense that, for me personally, it really changed me from, you know, doing surgery four times a week, four days a week, to spending more work in the research lab, trying to design exercises to help in preventing these kind of injuries. We have done a lot of work on looking at why are they happening and how are they happening. And our team here in Oslo has relatively good knowledge in this area and that has helped us in designing programs. It's taken a long time and takes your way from the OR and into a different environment and that has really put the major change in my medical activities.
Karen Litzy: 17:24 And are you happy with that change?
Lars Engebresten: 17:30 I am, I'm going to a meeting, for example now in a couple of weeks and I'm preparing for it in Pittsburgh on the ACL, various kinds of injuries. And that just tells you here all these, experts from around the world. They still attending as still the same question comes up. And again, there hasn't been a huge development, I would say, when it comes to serious knee injuries in the results of the treatment we have. So there, you know, the area that I'm interested in, this prevention area probably have still a lot to contribute to the field because you would, the surgeons haven't really caught on, at least not on the measure where of them. I would say in this, even though if you guys have done it, the physios have done it. The big story is still lagging behind a little bit.
Karen Litzy: 18:36 Yeah. And it's to me, what it sounds like I'm hearing from you, is it sort of forces you to be instead of a reactive doctor, a more proactive physician.
Lars Engebresten: 18:47 Absolutely. That's a good point. That's a difficult change.
Karen Litzy: 18:54 Yeah. Especially because you had a lot of training, but it's still, I mean, it's still all medicine and in the end it's helping the patient, which is the most important thing. That's why we do what we do. Right. As we said in the beginning, you're also a researcher. You have an impressive publication record, hundreds of peer reviewed articles. So if you kind of take a look back at all of those articles that you published, which one of your research projects or papers is most meaningful to you? So maybe it doesn't have the highest altmetrics score, but which one to you is like most meaningful?
Lars Engebresten: 19:40 For me that's very difficult to say actually because you know, not because I have some many, but more so because I have various fields and I've been very heavily involved in, there were some really important ones in a mechanism and I was working in the lab and then taken lab or to the OR. But I think that, overall the most important one is probably the one we did on, prevention of ACL injuries and team handball and follow, this for 10 years. I mean, you could see, you know, when we went in there actively and we were able to reduce number injuries and then we kind of stepped out and let the players do themselves, ramp back up, all the injuries. And then we really, reinforced our efforts and all of a sudden we were able to really reduced the number of injuries again and just shows us that if you really, put your mind to it, you can really achieve something. So that's probably the most important paper to come up with. Then again, you know, this is all about a team, a group, a team thing. It's not something I've done myself. Yeah. I've been part of the whole team, so really that's probably the most important.
Karen Litzy: 21:00 Nice. And then what advice would you have for young researchers who are trying to develop their publication portfolio?
Lars Engebresten: 21:10 Yeah, I keep telling my coworkers in the hospital, that's not the university that although it is great to have patients and to treat them and see that they're doing fine. Still if you've been doing that for 10 years, you kind of get bored after a while if you don't really progress and develop yourself. So you have to be able to do some sort of research during your clinical work as well. I'm really trying to tell them some examples here and there, why I did this and that. And then it is absolutely possible to combine a missing clinical practice with some sort of research at least if you're able to work as a team. So you still as you know, have other orthopedic surgeons or in my case physios and trainers that you work with, which will enable you to do much more then you can do only by yourself. I think their whole, the most important advice is to, you know, if you look at your 10 last patients and you see and you really look, take a close look at them, then you realize that, you know, there are many things you don't really know. So there many things that needs to be researched. I had one young person come up to me a while ago saying that he was discouraged because there's nothing more left to research. That’s all wrong.
Karen Litzy: 22:51 Yeah, everything's been done?
Lars Engebresten: 22:54 Everything has been done and you know, that is absolutely wrong there's so much left to do. So there's work for everyone.
Karen Litzy: 23:07 Yeah, I would think there would be. And now let's talk about what you're going to be speaking about at the Third World Congress on Sports physical therapy. So can you give us a little sneak peek as to what you're going to be speaking about?
Lars Engebresten: 23:20 Yeah, I see from the program that I'm going to talk about ACL or ligament injuries and a surgical treatment versus non surgical treatment. And that's something that we have been working on for awhile in Norway and also with other groups, where we have lots of research have been showing that in Norway we actually do about 50% of our ACL patients are having ACL surgery. The reason is that, you know, people that are not doing pivoting activities or pivoting sports they are completely able to continue what they're doing without having a reconstruction, things like that. The key there is of course, range of motion proprioception and strengths. And, if you are able to do that, then you can do well without having an ACL reconstruction. And even if you have an ACL reconstruction, if you don't do those kind of rehab are, you'll never be successful. That's probably what I would be talking about and some of the results we have from our area in the room.
Karen Litzy: 24:39 Sounds great. I look forward to it. And I think it is amazing that it's only 50% of people in Norway. I feel like in the US it's much higher. You probably know the figures better than I do. But just from an anecdotal standpoint, it seems like the moment someone has an ACL tear, they're having surgery regardless.
Lars Engebresten: 24:57 Yeah. I'll let you know. The point is nobody knows that in the US because you don't really, you know, how the numbers on people and not having a ACL injuries. It's very interesting because I been working with China actually on developing an ACL program for them. And you know, they have thousands of ACL injuries, but I have no clue on how many actually, because I think they have mostly injuries and China is not really being operated on, at least not until now. But you are right in your part of the world. If you have an ACL injury, you will be operated on automatically almost. And the same goes for central southern Europe. It's the same thing. And in Scandinavia, Sweden, Finland, Denmark, Norway. We're trending to operate only on the ones with the pivoting work and the rest we don't do so in Norway we have about 4,000 ACLs a year. You know, 2000 see surgery.
Karen Litzy: 26:14 Right. We'll see what happens as time goes on and people start to realize that maybe there are some other options. But I'm definitely looking forward to that talk in Vancouver. And are there any talks that you're looking forward to or people that you're looking forward to seeing?
Lars Engebresten: 26:32 Yeah, you know, I look forward to see some of the PT work on the new ways of getting people proprioceptively sound new ways, testing people for it, in sport, things like that. That is really something that interests me.
Karen Litzy: 26:50 Well, I have to say, I want to thank you so much for taking time out today. Is there anything we didn't cover that you have like a burning desire to talk about before we end?
Lars Engebresten: 27:00 No. I look forward to come to Vancouver. It's a wonderful city. I was there during the Olympic Games in Vancouver, and Whistler and also down in Vancouver and it was a beautiful area.
Karen Litzy: 27:16 Yeah, me too. The only time I've been to Vancouver was when I went to whistler to ski. I was only in Vancouver for as long as it took me to get off the plane, get into a car and drive up to whistler. So I'm definitely looking forward to spending a little more time there. But thank you, professor so much for taking the time out and speaking to everyone and Chris and everyone else that's watching. And Mario gave a thumbs up. Mario Bozenie, thanks so much for tuning in and hopefully we will see you all in Vancouver October 4th and fifth so thanks so much.
Lars Engebresten: 27:50 Thank you.
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On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Tamara Rial on hypopressive exercise. Tamara Rial is the creator and co-founder of Low Pressure Fitness which is an exercise training program based on hypopressive, myofascial & neurodynamic techniques.
In this episode, we discuss:
-What are hypopressive exercises?
-Patient populations that would benefit from hypopressive exercises
-The latest research on the mechanisms and effects of hypopressive exercise
-Common criticisms of hypopressive exercise
-And so much more!
Resources:
Email: rialtamara@gmail.com
The Outcomes Summit:Use the discount code LITZY
For more information on Tamara:
Tamara Rial earned dual bachelor degrees in exercise science and physical education, a masters degree in exercise science and a doctorate with international distinction from the University of Vigo (Spain). Her dissertation focused on the effects of hypopressive exercise on women’s health. She is also a certified specialist in special populations (CSPS).
She is the creator and co-founder of Low Pressure Fitness which is an exercise training program based on hypopressive, myofascial & neurodynamic techniques. In 2016, this program was awarded the best exercise program by AGAXEDE, a leading sports management association in Galicia, Spain. Dr. Rial is the creative director and professional educator for Low Pressure Fitness. At present, over 2000 health and fitness professionals from around the world are certified Low Pressure Fitness trainers.
Dr. Rial is a professor of pelvic floor rehabilitation in the masters Degree at Fundació Universitaria del Bages in Barcelona, Spain. She is the author of several scientific articles and books about hypopressive exercise. She has also published numerous articles and videos about pelvic floor fitness, hypopressive exercise and women’s health. She is an internationally recognized speaker and has presented at conferences throughout Argentina, Canada, Mexico, Portugal and Spain. As an established researcher and practitioner, she continues to collaborate with colleagues at universities and health care settings to explore the effects of hypopressive exercise on health and wellbeing.
She lives with her husband and two dogs in the United States and Spain. Dr. Rial is available for consulting, speaking and freelance writing in Spanish, Galician, English and Portugues.
For more information on Shannon:
Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.
Read the full transcript below:
Shannon Sepulveda: 00:00 Hello and welcome to the healthy wealthy and smart podcast. I'm your guest host Shannon Sepulveda and I am here with Tamara Rial. Hi Tamara. Can you tell us a bit about who you are and what you do?
Tamara Rial: Well, we're going to introduce a little bit how we met because Shannon came to our hypopressive course that we hosted in Portland with Bobby Grew, right. So I like to call myself a hypopressive expert. I been studying and practicing and teaching this technique for over 10 years and I did my PhD based on hypopressive and its effect on urinary incontinence. And then I began teaching this technique to professionals as also to practitioners. And well, I happened to live in Spain also almost all my life and they do my work there. And also I have been a professor in the University of Vigo in Spain.
Tamara Rial: 01:13 But two years ago I came to United States because I married my husband who happens to be American and we moved into New Jersey and that's where I currently live.
Shannon Sepulveda: Well, can you tell us a bit about what hypopressives are and what low pressure fitness is because I would assume the majority of the audience has no idea what that is. I think some of us pelvic health PTs know and some other people in the world, but it's all the rage in Spain. So tell us about what it is.
Tamara Rial: Yeah, I understand because there's this word hypopressive and some people kind of listen to this word for the first time. So if we look at the etymology of hyper pressure, really what it means, a hypo pressive, it's Hypo. Less pressure pressure of course. So it's an exercise that reduces pressure.
Tamara Rial: 02:16 It's specifically a intraabdominal pressure intrabdominal pressure and intrathoracic pressure. So normally we call the hyper pressive exercise as a form of exercising with different postural cues and different poses throughout and a specific mechanism of breathing. And the general name of these exercises was named after that reduction in pressure that we have observed after doing these poses, combined with this specific hypopressive breathing technique. So yes, I know that sometimes it’s quite hard to understand, but they name and especially in some countries are for those people who are not familiar with it pelvic PT area. But, it will be the name given to a form of exercise.
Shannon Sepulveda: So can you talk a bit about what you mean by poses and then what you mean about the breathing technique?
Tamara Rial: Well hypopressive exercises are also known as the hypopressive technique as I said, as a form of exercise that is mainly postural and breathing driven.
Tamara Rial: 03:42 So I also like to say that it's a mind body kind of technique because it is based on low intensity poses that can resemble a little bit of the kind of poses we were doing pilates exercise or when in Yoga many yoga instructors will find that many of those poses and breathing techniques are very similar of the ones they also practice. So the postural technique of hypopressive is basically one that aims to do a postural correction, a postural correction in a more body awareness. Like how is our spine, how do we activate our pelvic girdle, how do we activate our pelvic, abdominal muscles or shoulder girdle? So we would focus a lot of body awareness as I said, and on posture reeducation, making the person aware of how they stabilize their spine, how they stabilize their body.
Tamara Rial: 04:54 And from there we would progress the exercise from a more static poses. And then from there going to a dynamic postural position, and then the breathing exercise is mainly the technique made up of lateral costal breathing that is also practicing in pilates and also by a form of exercise that is also called the Ooda bandha technique. So this is a Pranayama, yoga Pranayama that we use in hypopressive and we call it the hypopressive breathing. So it's a very noticeable and visible technique. But you, because when you practice it, you see how they add them in draws in and the thorax expands and sometimes people confuse it with a hollowing, abdominal vacuum hollowing. Because when you're doing abdominal hollowing, you see how they belly button draws in and there is actual a little scoop in your abdomen, right?
Tamara Rial: 06:10 But really when you're doing abdominal back q or a do the Anna Vanda or hypopressive breathing technique, what is happening is that you're actually opening your rib cage throughout a breath holding maneuvers. So that means you expel all the air or you expel the current volume of air you have in your lungs. And then after that you open your rib cage. And that will lead to a observable and very noticeable draw in of your abdomen. It is going to be even more noticeable that the actual abdominal Holloway maneuver. Why? Because their rib cage opens and lifts and that's gonna draw in the abdomen and in and create this vacuum that we call in yoga with the Yana Veranda, which is a Prana Yama. They are yoga teachers in some practitioners may be also aware of. And the combination of this type of breathing in a sequence with different poses that they instruct are not normally a progressive. The person through these form of exercise, the low pressure fitness technique.
Shannon Sepulveda: 07:31 That's awesome. So let's talk about who can benefit from this form of exercise because I think that it's become really popular in the pelvic organ prolapse community and the urinary incontinence community. But then we also had a bodybuilder in our class because she needs to learn these poses for her bodybuilding. And we also learned about other types of athletes in particular in Spain that use this technique to help with their sport. So could you talk about like who can benefit from this?
Tamara Rial: 08:03 Right. That's a great question. Well, hypopressives at the beginning where as you a correctly said, we're especially aimed for the post natal woman. And so specially after giving birth woman began to have some urinary incontinence and many women develop some type of prolapse and also they want to rehab there mommy tummy. So the application of this type of exercises that reduce their waistline and also reduce pressure, especially at the first weeks after giving birth where especially in France and in Belgium, the exercise that they were doing and performing and in France and in Spain, these exercise became to get a more popular and I think almost all a postnatal woman do this kind of routine and pelvic floor physical therapist and also midwives and duolas recommending and teach this kind of exercises in the postnatal phase.
Tamara Rial: 09:18 So that's why I think it got very popular. But it's true that many other people and at the beginning I wasn't very aware of it because I also began focusing a lot in urinary incontinence because I thought that we're dealing with pressure, right? So this thought of I want to reduce pressure so it will benefit those women or those people who have some type of issue related with increase or dynamic pressure. So the one that always can come to mind or what stress urinary incontinence and pelvic organ prolapse. But there are other pressure issues that can go that people can deal around. And in the woman's health community we are very aware of constipation because it could also lead to constipation in the way we breathe and we push when we go to the bathroom can also lead to some symptoms.
Tamara Rial: 10:23 So we've seen that people who a incorporate hypopressive breathing and also hypopressive technique from a regular basics and have constipation issues can benefit. And also there has been some research done on pelvic who suffer nonspecific, lower back pain and who have shown good results doing a basic series of exercises because many people ask what are the exercises? Are they're doing a lot of a complex exercise or are they doing dynamic? No, the basic routine. For example, in the course we learned the basic normal static exercises and in the easiest vacuum, that means a vacuum that is performed with a low breathe breath holdings only between 6-10 seconds. And also very easy poses that almost anybody can do in a standing position in a sitting and a kneeling. So really you don't have to be at gym to perform it and even our elderly in our and people with any type of a movement issues or even people who are in wheelchairs can also perform it because really the exercise is very easy.
Tamara Rial: 11:52 It's basically controlling your breathing and control your pose. So it's specifically, we began to see that not only the woman's health, a community could benefit from hypopressive, but also people suffering, as I said, with a constipation, low back pain. And then there has been an increasing application of this type of training from an aesthetic point of view. Why? Because doing this type of exercise, the transverse abdominis muscle gets quite activated and when you see the abdominal vacuum maneuver, you can see that really the transverse and all the abdominal muscles have this corset effect. There's a visible waistline reduction so that waistline reduction is visible during the exercise. But after two or three months of continuous practice, that means doing two or three sessions of 30 minutes over a period of three months. You can observe a statistical reduction.
Tamara Rial: 13:07 Yeah, significant statistical reduction in waistline, we're talking about between two centimeters of average or 2.5 between 3.5 right? So that will be the average waistline reduction. So for people who really want to reduce their waistline because they want to look better or they're doing a competition for bodybuilding for example, they are really want to find exercise that can achieve a waistline reduction without only thinking. Of course we all have to think about our food intake and our caloric expenditure. But when all those variables are taken into account and you also want to want to work on your natural corset that means your abdominal muscles. We all know that we have to train our core, but we can train our core in different ways. And one way that we have seen that also can be an alternative to normal or traditional core training methods is also the stomach vacuum or the abdominal vacuum or the hypopressive technique.
Tamara Rial: 14:27 In fact, it's funny to observe that in the body building community they have a pose that they execute. That is called the stomach vacuum pose. And this stomach vacuum pose was a popularized by Arnold Schwarzenegger in 1970. There are many, there are some pictures of him that if you go to the Internet and you put an Internet Stomach vacuum pose, you can really see how he had a pose I think he's the king of the stomach vacuum pose. And he really popularized it because when he would go on stage, he will want to show his serratus. So a way to show the great development or the mass development of his serratus would be going into a big rib cage expansion, lifting his arms behind his head and just pulling in his stomach throughout this abdominal vacuum technique that is really hypopressives.
Tamara Rial: 15:29 So he even wrote in his bodybuilding, he wrote that he usually trained this technique to achieve a waistline reduction. And if you see his body, it was amazing. He really had a very thin waistline and a big thorax. And now bodybuilder nowadays they're there. Well at least what they are seen as they're getting, they're having trouble in and getting a great lat spread and a great big thorax and in comparison have a very, very thin waistline. So that's why now we're recovering a little bit. This knowledge that he brought us in the 70’s it seemed that now more bodybuilders are being aware of doing this type of a stomach vacuum exercises. And even in Spain, the Federation of bodybuilding has a included the stomach vacuum pose again as compulsory for the male competition, which is kind of cool.
Tamara Rial: 16:34 And that's why I think it was two years ago. And we begin to see a great demand of body builders to come to our classes to learn, only from aesthetic purpose is to learn the technique because it's not easy. It's not easy to be onstage, hold your breath, be smiling, and at the same time hold your breath for 10 seconds when you're already very tired and open, open your ribs and show that stomach vacuum so you really have to train it. And in our bodybuilders, that came to the course. She is amazing. Of course she was absolutely gorgeous, but she wanted to work a little bit more on her stomach vacuum pose.
Shannon Sepulveda: 17:20 Yeah, yeah, yeah. She told me that, that maybe the difference, like it like she's like, I need to learn this. And I was like, wow, that's, I didn't even think about that. And then when you showed us the pictures of Arnold Schwarzenegger I was like, oh yeah. I mean I remember seeing them as a kid, but I was like, oh, it totally is a stomach vacuum. And so I think it's really fun when you have all of people from different
Shannon Sepulveda: 17:50 backgrounds in the courses because it's just fun to talk to them and pick their brains and see like why they're here. So I thought that was, that was really cool.
Tamara Rial: And how different people from different areas, from fitness professionals for women's health, from even massage therapists, it can have a common link. There was also the course, we had a several yoga instructors because I guess it also makes sense to incorporate a technique that has so much in common with already yoga.
Shannon Sepulveda: Yeah. Can you tell us a bit about your research and your education and your PhD work?
Tamara Rial: Okay. Yes. So as I said I was Spanish and I think some of our listeners have noticed that I have a little accent. Well say. I've grew up in Spain. I did my education, all of it over there.
Tamara Rial: 18:54 I also did a semester in the University of Porto, part of my PhD and they laboratory of CNN, Tropo Matree with the professor. But my main focus was always a pilates, and some type of mind exercise. Mind body exercises a woman's health. So I began to get interested in this because I've seen at least in his Spain, it wasn't a woman's health wasn't a topic that was taught so much in the physical education and fitness community. We were talking about the benefits of exercise for health, but we were looking so much of the benefits of exercise also for Woman's health and how some type of techniques and pelvic floor muscle training could also benefit a lot. Mainly females and males who have some type of dysfunction.
Tamara Rial: 20:00 And we really had to bring this knowledge into the physical education to the exercise science community and into the gyms. And I also think into the woman's community because sometimes there's that, well I really think there's this feel like great taboo talking about women's health issues. So maybe it will be easier if we begin to talk about it in a easy way from the gyms and bring this topic into the fitness instructors. So they would bring more awareness and also the coaches into the sports community and that way make aware to our woman and our males that there is option to, and there's options to take care of your pelvic floor and your health with exercising correct movements and how just by breathing you can affect immensely your pelvic floor health because we are not aware of how we breath, how we are standing now.
Tamara Rial: 21:06 Now our listeners they’re maybe they're sitting in the car they're walking, but are we taking our time? Are we looking in was and are we feeling our brand that we fit in our body? So all those things I thought we, I had to bring it into the fitness community. And that's why I really wanted to focus on how some type of mind body techniques could impact urinary incontinence. And at that time hypothesis was not a very famous thing in Spain. I think it was not famous. Nothing. Maybe some pelvic floor PTs who had been taught in France. Know a little bit about it, but really it wasn't a big thing. So I learned about it from Marcel Frey, who was one of the main people and teachers who begin to get interested in this topic. So I thought, why don't I do a research study on this on urinary incontinence?
Tamara Rial: 22:12 And I remember at the beginning it was hard because imagine telling your doctoral advisor that you want to do a study on woman that's kind of, okay, I'm focusing on women and then say I want to focus urinary incontinence. So I'm getting more specific. And then I say, I'm going to assess the effects of hypopressive exercise. When I said this word, he was like, what is this? And we went into the literature and there was nothing in the literature, nothing at that time. And right now there's still nothing. Okay. But at that time there was negative and it was kind of hard because what is the basis? There is almost no basis. And I know, I know I took a risk, but I began to apply it on myself and I begin to apply on some practitioners and I saw results very quickly and they were telling me even after three sessions that they already were feeling a decrease in their ordinary symptoms and they were, I was even shocked because I like time.
Tamara Rial: 23:25 I didn't believe it. I was still one, I was one of the skeptic that's a little bit the reason why I said I want to study this to prove it's not working, but when people begin to already tell me, you know, I feel great and I begin to see how women were enthusiastic about it. I said, okay. I really had to give it a chance and that's how I got paid. I'm really passionate now about it and people say, you're very passionate. Why? I think that people who I work with made me passionate because whenever I see that somebody can benefit from what I'm teaching, that makes me happy. And that makes me really think that maybe I'm, if I'm making somebody better, I'm helping in some sort of way, I think that's how I've been driven to keep on in this path.
Tamara Rial: 24:19 And also because I want it to make it more on evidence based or a technique that would have more support. Because at the beginning I would hear people say, hypopressives does this, or hypopressives does this, but there was no, there was no basis behind that. Even sometimes the physiological description of the exercise was wrong and people were very assertive. Like people would say, it does this to the body or you can achieve this, whatever. But what is the research like? What is the, what is the, even the physiological mechanism, which explains that. And, and there was very contradictory explanations in the literature because I guess nobody has really wanted dive into it and study to show that maybe it's correct or not as correct because I even at the beginning thought that maybe intraabdominal pressure doesn't increase or maybe decrease.
Tamara Rial: 25:29 We still don't know. We still don't know what has happened at the thoracic level so we cannot just assume things if you really don't study it. I think that was the big mistake with hypopressives. People got excited and they began to say, there's no thing called hypopressives. It's fantastic and blah blah blah, but you cannot put something out in the market and say it is great without really having to first apply it with real people as it in a clinical way and then begin to do some short term studies or some physiological studies. That means, for example, if you argue that there is a decrease in pelvic pressure, you have to assess it. You cannot say it without even assessing, maybe not 200 people, but at least a group of people. And then from there, which we would have to see if there is some type of chronic effects.
Tamara Rial: 26:39 We still don't have a research that really shows many claims that people say. So those are lacking in the literature. So we always have to be cautious and see, you know, we don't know. We don't know. People are getting some good benefits and they're claiming that they're feeling better. For example, they're feeling more posture rehabilitation or they feel there breathing capacity has increased. But that's anecdotal evidence and we have to prove that with more randomized trials. Right. So, that's a little bit how I started and I got interested in it and I'm still working with it and teaching. I came to United States and I did my first courses through Herman and Wallace, pelvic rehabilitation institute, and also through pelvic guru that we're the first people who trusted me in United States.
Tamara Rial: 27:52 And they led their hand and they began also to hear from some pelvic floor practitioners who in United States who were already working with this. And I guess there was a little bit of spread of the word and that's why I think in the United States some people began to get interested in it and now let's just see how it works and hopefully more universities can open new lines of research on this topic because I think women's health and pelvic health, although if we focus a lot on urinary incontinence in pelvic organ, there are many other issue that have not been so much address like a hypertonicity, a topic for dysfunctions, pelvic pain. So there is still a lot of research that we can do. And I think also the area of alternative movement exercises, for example, Yoga and even pilates, there should be more, more interested in it because our woman and our people, our population, we need to move, we need to do exercise.
Tamara Rial: 29:13 And we really, when there is a public condition, many women are afraid of moving and doing exercise. And I don't think it's good to tell a woman or to tell a postnatal mom, you know, you have to be careful, don't lift weights or don't do this exercise or don't do curl ups. So are I feel that sometimes we're frightening too much are woman and there and instead of going to the gym or maybe sometimes you can have a leakage and you say, Oh, I'm a little embarrassed because I'm leaking during my crossfit activity, but I love going to crossfit. So maybe I can also compliment my activity with other more pelvic floor friendly programs or with some programs that kind of counterbalance that high intensity activity. I kind of, I sometimes say that a low pressure of hypopressives are the best friends of high impact activities because we have the metabolic benefits of a high intensity interval training, which has a great background of research that shows that is one of the best type of training for many metabolic conditions for our cardiovascular health. So we want people and we need people to be doing their physical exercise. And on that note, we're going to take a quick break to hear from our sponsor and we'll be right back.
Shannon Sepulveda: 31:36 Okay, so we learned about some awesome new research in the course. So can you share that with us?
Tamara Rial: Yes. Well, we still didn't know until some weeks ago what was happening in the diaphragm. Because it's true that when you do the abdominal breathing maneuver, the hypopressives maneuver, you're actually opening your rib cage in, you're holding your breath. So it was hypothesized that because you're using your inspiratory muscles to hold and expand your rib cage, that diaphragm what is happening it raises up, right? So imagine when you breathe in your diaphragm goes down, contracts and lowers the position and also the pelvic floor because the movement of the breathing and the synergy or the diaphrgm the pelvic floor diaphragm is synergistically, right? So then when you exhale, the diaphragm raises up and also the pelvic floor contracts and raises.
Tamara Rial: 32:38 So when you're doing this hypopressive maneuver, what has happened is they're opening your rib cage in your allowing to your Diaphragm to raise up a little bit more. So that means that it achieves a little bit of higher position than when you're only exhaling because it's kind of a stretch of the diaphragm. But the question was, well, but what happens? Because we have some studies that have shown through ultrasounds and MRIs that when you're doing this hypopressive breathing, there is a pelvic lift, right? There's a raise of the pelvic floor and also the bladder and the uterus. So this is something you can actually see. And in the course we also see it in ultrasound measurements, but it's difficult to have an ultrasound measurement of the diaphragm and also it's difficult to see the pressure in your esophagus or in your abdomen.
Tamara Rial: 33:40 Because that would have to be through a more difficult assessment that normally in the pelvic settings we don't have have. So normally if we want to assess in a pelvic floor or physical therapist setting the pressure, we can use intrarectal devices or intra vaginal devices. And that way when we're doing different types of maneuvers, we can assess what's happening, right? So when you're doing the maneuver, what happens with hypopressive is there's going to be a decrease of intrarectal pressure intracolon and also vagina, right? If you performing the exercise with the correct form, and I always like to say and this and make it a specific, that it's not something that you can achieve the first day of practice. You have to know how to correctly perform the technique as well as we teach how to correctly perform up pelvic floor muscle contraction to enable the pelvic floor muscle to really lift and contract and not to, for example, Bulge.
Tamara Rial: 34:51 That can happen if the technique is not correctly performed or if they breathing phase doesn't accompany the contraction. So in the same way, when we're doing a hypopressive maneuver, what would happen is that we would exhale first and then after that exhalation we would hold their breath and we would only perform a voluntary muscle contraction of our rib cage muscles. So the question is the diaphragm what happens is a very relaxed is a very contracted, is it not? So Trista sin, which is my colleague and one of my friends who have, I been working also very closely and she teaches courses over there in Canada, she actually flew to Vancouver because there's a research group there who's going to access actually with the group of people who are going to do hypopressives and I can't recall right now his name, but he's a phd candidate who is a looking forward to do his phd on the effects of a hypopressive technique on the EMG activation of the diaphragm and also into the pressure management, intrathoracic pressure.
Tamara Rial: 36:29 So we won't call it the pilot testing and because Trista is a very good practitioner, she already knows how to do the technique and I know that not everybody wants to introduce a catheter, it's not one of those research that a everybody would want to do. So she did it. And, we have the preliminary results that I can, I can read you some of them. And she also did different poses. So she did the analysis in the standing pose, which was more easier to assess also in kneeling. Because you don't have to move your face or you're not on a board where sometimes you can change the position of the catheter.
Tamara Rial: 37:32 Yeah. And, also supine was an easy pose. So that's the assessment and there actually was electromyographic activity shown in the diaphragm from which would make sense because the diaphragm cannot relax. So there's a quite of lengthen in an activity going on even if you're doing the breath holding maneuver. So I guess that when they results on the group, they're going to test on the trial. We will get to know more of really what happens, not when you're doing actually that technique, but what would happen, what chronic effects would have your intercostal, your breathing muscles. And also your Diaphragm from when you're doing this kind of vacuum technique and also what happens into the pressures. So we would be able to show that there is a reduction, the reduction of thoracic pressure and intrabdominal pressure, which is kind of cool.
Tamara Rial: 38:40 It's pretty cool because at least now you can say that it makes sense to call it hypopressives. So, well, that's the thing. And also when you're doing hypopressives, the thing is that you're lifting your rib cage and you're using your breathing muscles. So for example, they, SCM muscle increases his electromyographic activity because it's all it has, it enables their rib cage to lift, right? So whenever you're doing a hypopressive, you will really actually see the lift of the rib cage and also the widening of your intercostal rib cages. All the rib cage actually open. So also this serratus is a muscle that is also going to increase as is electromyographic activity. Right. And there has been another group from Brazil that actually did not a chronic study, but they did an acute study that they assessed the electromyographic activity of the abdominal muscles, so transverse, Oblique and internal oblique.
Tamara Rial: 40:01 They did it through superficial electromyographic activity and it was with some female practitioners. They were healthy. There were no pelvic floor dysfunction. Just testing when you're doing the vacuum, what actually happens in the core muscles because some people think that when you're doing a hypopressive, maybe there's a high electromyographic activity, but really you're not doing an active contraction. For example, if you do a a crunch exercise or you actually contract forcefully your abdomen, you will have a very high electromyographic activity, but because what you're doing is just having a stabilizing pose that makes your spine grow and you're actually doing a low intensity postural activity and you're opening your rib cage in your muscles. There's not going to be such a high activity. There is an increase of activity but not so much on the rectus abdominis and the external oblique as much as there is in the transfers and in the obliques. So that's why it's especially indicated for people who need a rehabilitation of their deep inner unit and not so much of the outer unit. So especially in the first rehab phases for example, for those with lumbar pain and want to achieve
Tamara Rial: 41:34 a greater mind body connection of your deep core muscles or we want to a connect that transverse and the pelvic floor. This could be a technique that we could use for example. So especially more indicated for our deep system. And then from there we can build on a more dynamic exercise that will recruit the larger muscles and the larger dynamic muscles.
Shannon Sepulveda: Cool. That's awesome. Thank you so much for that explanation of the new cutting edge research. I think that's awesome. In my experience, it seems like there's a little bit of controversy surrounding hypopressives and low pressure fitness where some women's health people are like, yes. And some women's health People are like, no. And in my opinion, not that it means anything, but my opinion about something like this is if it works for somebody and there's no harm in it, then why then what's the problem?
Shannon Sepulveda: 42:41 Because it's not like we're causing any harm with any of this. And so if it's a tool in your toolbox and it works for certain women, what's the harm? Yeah. Because really there is none. And so why not try it? But I just wanted to get your thoughts on, you know, what's going on in the, I mean, I feel like hypopressives are so hot right now. It's Kinda like diastasis is just so hot right now and it's the new buzz word I think in women's health, physical therapy. So, but there's been, you know, people are like, if people don't, I don't really know. But what's your take on all of that?
Tamara Rial: There has actually been all a lot of controversy and even a lot of controversy in the scientific literature because I think it was last year there has been a discussion paper published by Carrie Bowen, a researcher from Spain, on hypopressives saying that there wasn't enough evidence to support that hyporessives could be an alternative exercise for women with pelvic organ prolapse.
Tamara Rial: 43:54 So they based their discussion paper and their results on the articles that our group has published it on this topic. So I wrote a letter to the editor and it was published on the British journalist sports medicine blog. It's available and they had also a reply. So it's kind of funny when you get to have these replies. So there has been a lot of controversy even in this field because as I said before, it's true that there has not been a lot of research and there are studies that have been publishing from the Brazilian groups. They have done some studies on woman with prolapse. We can find a on pub med with the word hypopressive but my argument and my counter argument in the letter and the response to the letter to the editor that is available as you said in British Journal of sports medicine, you can read it is that the thing is when we are applying a technique and especially a technique as hypopressives, that is first difficult to teach, difficult to a specially properly perform if there's not a good instruction and supervision.
Tamara Rial: 45:25 That means that first we have to assess if the person is correctly performing the exercise as well as anything as well as pelvic floor muscle training. We will teach first how to do a optimal pelvic floor muscle contraction before beginning the trial. We have to perform or assure that the person who is really doing that vacuum is actually doing a vacuum and if the form is correct that means does that person do a vacuum that is really lowering the pressure. Is that person really in the correct positioning or does that person need a little bit more of supervision of somebody who really knows how to correct and see if the pose is correct? Is the breathing so in the description and they papers and you can read the paper. They don't describe the exercise as a form of different postural exercises.
Tamara Rial: 46:25 They only described that they performed on a technique where there is an abdominal contraction a transverse abdominal contraction. But that is that you don't really know. They have been doing the whole series of exercise as this has been described in the literature because hyporpressives are currently describe the technique as a postural base and a breathing base. So that was my critique that you're basing your argument on the low number of research that is still available and on research that doesn't describe quite maybe let's use the word accurately as all their manuals and other professionals and other also because we can see other research common from other groups that are already doing and describing the technique. And this happens a lot in exercise science and physical therapy. Whenever we're using exercise that involve a lot of supervision and technical instructions, we have to be very clear and describing that technique.
Tamara Rial: 47:37 That means how many repetitions did you do, how many rest breaks, how many seconds did you rest between exercise and exercise? Because we know that changing one little variable can change the whole exercise. And, even when it comes to breathing exercise, we have to very accurate accurately describe the time that means, for example, you're breathing in how many seconds you're breathing out, what way you're really now doing a four, six inhalation, or you're breathing out doing a a more relaxed maneuver. Are you for example, doing a more intercostal breathing? Or are you doing a more diaphragmatic breathing using, you know, there's so many different aspects that if we really don't describe how is that technique, it's gonna be more difficult to replicate that and more. And it's going to create even more controversy between the readers or the listeners because we really don't know what the technique is about.
Tamara Rial: 48:49 And many times we see a video on youtube. This is the worst thing to learn from youtube. I know that we all go to youtube many of our listeners are now, many people that are doing it, but you can see the person do the exercise. But how did you know if you're really doing what that person is doing it maybe you are contracting or you're trying to pull your shoulder up or it's Kinda hard and I would never I love watching those youtube videos and there are some yoga professionals that do amazing exercises, but it will be very hard for me to know if I'm doing the exercise correct if I don't have somebody that is telling me I think, I think you're doing the pose or even when I'm instructing pelvic floor muscle training, we really have to have somebody that is supervising that technique and giving us advice to progress in the technique.
Tamara Rial: 49:56 So I think this has been the first controversy, the lack of research and the claims of some Gurus and like they is the best exercise for the pelvic floor. Well that's a huge claim. You can never do the say that and, or some people will have, I have also claim a hypopressives if you do hypopressive's is much better than Kegal Well, no, no, no, you can never have those because that's going to go against you and, and that's why maybe I think there has been such a bad reputation and also because maybe there has been a lot of marketing towards that waistline reduction. So if people say you're selling it as a tool that is only aesthetic, but it kind of sounds like a selling thing, right? Where we want to sell a product only because it Kinda is new, but why, what is it, how is it an other profession?
Tamara Rial: 51:07 Is it professionally driven, technique driven, and that has been the big, I think, huge controversy in the literature and also between practitioners. Right. And I think also another controversy that I see from my point of view is, is that one of people trying to learn, learn it from professionals who learn it from youtube. If I'm not sure about it and I would rather not do it or if you really want to practice it. I always advise people even to exercise under the guidance of professionals and I know that sometimes hiring up a personal training or higher, you know, going to a physical therapist once in awhile people can say it's a waste of time. I think I'm good on my own. But no, even, even us as professionals, we should be instructed on the care of over there people because the eye of a professional is better than your own eyes and we need that supervision.
Tamara Rial: 52:20 We need to a planification and we also need an assessment. So maybe when you're under the guidance of a pelvic floor physical therapist or a instructor, they would assess you and say, you know, maybe we should do other exercise or we should begin with this. But then progressed to other phases and talking about progression, the idea that hypopressives would be like the magic pill. No, I don't. I think that that's a very wrong message to tell our people because there's nothing that is magic pill there. It's a tool in your toolbox. So it can be something that you can do to help you in some part of your life, but then you're going to progress and then you're going to do more things. Because for example, hypopressive is a good maybe reputative tool kind of. Yeah, kind of reputation tool.
Tamara Rial: 53:20 But I won't think that I'm going to get better improvements in my cardiovascular health doing hypopressives, for example, I'm not going to lose weight doing hypopressives it's not an aerobic driven kind of tool. So if you're beginning to sell a technique as something that is the best for everything, or maybe that thing of a reduces waists. So people say it's because it's because you're losing weight. No, no, no, it's maybe because you're getting a better posture so then you don't have such a bulge in your abdomen. We all know it. Right? If you have bad posture, your abdomen is going to bulge more so by again having a better posture or by having a better breathing habit, you're going to help you to have a better abdominal appearance. Right. And then if you tone your inner unit, that will also help, but we will never, never achieve a waistline reduction or a better appearance without a loss of weight because you almost don't use a lot of energy.
Tamara Rial: 54:33 In fact the heart rate will even decrease a little so, so not not increase. Interesting. So we still have to do cardiovascular work. We can then counterbalance our running.
Shannon Sepulveda: I know. I was like I love to run and I was like okay, 20 minutes a day, 10 or 20 minutes a day. Like I can do this. And it actually felt really good because I'm so tight for running and I just like them. Then it was actually pretty awesome doing it in the class.
Tamara Rial: Yeah. And many, many people who perform running or other type of high intensity activities or aerobic cardiovascular training, they use what he'd do this training, they could operate it after. So as a way of cool down. Yeah. So it's a set of doing other type of exercise or we can incorporate it into our cooling down or even our stretching because many poses are like our stretching houses lying on the floor, stretching and our arms stretching our legs.
Tamara Rial: 55:41 So we just incorporate it and it's 10 minutes. You don't need much, you really don't need much. 10 minutes for those that need other 15 maybe 50 minutes and, and I think everybody can find 15 minutes in their day to have sum up some sort of mind, body practice. We really need it nowadays with so much going on. Social media.
Shannon Sepulveda: Yeah. Well, it actually, it was interesting, I was thinking about why it felt so good and why say I would stick to something like that instead of yoga. I've tried yoga before and I wasn't too into it. I think it's because never in my life have I stretched that area. Like it's so hard to stretch your thoracic area, right? Like I couldn't, there's no way. Or like even my rectus, right, your front abdominal muscles. Like it's, unless, I mean you could do up dog to stretch, but it's really hard to lengthen and stretch all of that. So it was like the first time in my life where like those muscles stretch and it feel really good.
Tamara Rial: 56:39 Because we're stretching from the inside. You've seen our breath instead of pressing it down, we're pulling it inwards. So that's why maybe this sensation is different. I think also the concentration on the breathing in that now it gives you a kind of mindful sensation. So for many people, they only do it as a mindful practice. They're pressing because they're so focused in on their breathing. It takes you out of your daily worries.
Shannon Sepulveda: I think that's what I found too because it gave me something to like focus on, like I had an objective so I wasn't thinking about anything else because it's hard to do. And so it's also like a new challenge.
Tamara Rial: Yes. Yeah. So it was really great. And to challenge your breath Holding and to only think as well as we count, we always tell people sometimes when they're breathing to count breath up to one, two, three.
Tamara Rial: 57:41 So whenever you're counting, you're mindful in your present. And also we're gonna add they've beneficial effects of having us slow paced breathing. That's to add down train our nervous system. So we're also going to help us if we want to just do a mindful or a relaxation kind of technique.
Shannon Sepulveda: Well thank you so much for coming on the podcast. And so where can we find you? Email social media courses and you teach people like where can people find you if that.
Tamara Rial: Thank you. My name is Tamara Rial So my website is tamararial.com but I'm very active in Instagram, so you can find me as Dr.tamararial and I also have another, another Instagram account that is a specific only, only for hypopressive that is called hypopressiveguru because I also teach other women's health programs, not only hypopressives.
Tamara Rial: 58:53 So I focus also on the female athlete. Pelvic friendly exercises, so, so you can see all my programs and courses on my website, although in my social media, especially on Instagram and know the courses I'm hosting in United States are throughout Herman and Wallance and also pelvic guru. So if we'd go to the websites we would see their announce all the hypopressive or low pressure courses. And I think contact email is rialtamara@gmail.com.
Shannon Sepulveda: Great. Well thank you so much. We really appreciate it.
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LIVE from the APTA NEXT Conference in Chicago, I welcome Duane Scotti on the show to discuss gymnastics medicine. Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.
In this episode, we discuss:
-The most common injuries in the youth gymnastic population
-Differential diagnosis for low back pain
-Key features of a rehabilitation program following an ankle sprain
-How to enhance communication between athlete, coach and clinician
-And so much more!
Resources:
Spark Physical Therapy Facebook
Spark Physical Therapy Website
For more information on Duane:
Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.
Duane is currently the founder of Spark Physical Therapy, providing prehab, rehab, and performance optimization services either onsite or in the comfort of your home within the Cheshire/Wallingford CT region. He also is a clinical assistant professor in the Department of Physical Therapy at Quinnipiac University responsible for coordinating and teaching musculoskeletal examination, intervention, and advanced manual therapy within the orthopedic curriculum.
Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation, dance medicine, gymnastics medicine, and rehabilitation for runners.
Duane has been in clinical practice working with orthopedic, sports, and performing arts populations since 2003. He has strong clinical and research agendas in screening, injury prevention, and rehabilitation for runners, dancers, and gymnasts. Duane uses an integrative model of manual therapy including manipulation, mobilization, and soft tissue treatment including dry needling and the Graston technique for the management of musculoskeletal dysfunction. Duane is a physical therapy advocate and is actively engaged with the American Physical Therapy Association and serves as Vice President of the Connecticut Physical Therapy Association.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody. Welcome back to the podcast. I'm coming to you live from Chicago, Illinois at the APTA Next conference. And I have the great pleasure to welcome back to the podcast. Dr. Duane Scotti physical therapists. And today we're going to be talking about gymnastics medicine. So Duane, welcome back.
Duane Scotti: 00:19 Thanks for having me Karen. It's good to be back
Karen Litzy: 00:21 And I have to tell you, gymnastics is something near and dear to my heart. I was a gymnast for many, many years as a child. And luckily I didn't have any major injuries, but what we're going to be talking about today are kind of the most common injuries you might see in a gymnast. And this is something that Duane is so passionate about. These are the people he sees. So if you're a physical therapist out there, and maybe you have the off chance that you might see one of these young athletes, I think this'll be really helpful for you to give us your insight. So Duane, tell us what are the three most common injuries one might see in a gymnast?
Duane Scotti: 01:02 Well, I think first off is I definitely do have a passion for this area. Like you state because I have a daughter who's a gymnast. So that is one of the things that I kind of in my career from a clinical standpoint, kind of focused a little bit more in this area is spinning off of like dance medicine and got into the realm of helping gymnasts out because I did see there was a need in the local club in our region. So in terms of the most common injuries I would say, you know, definitely low back pain, in gymnasts and specifically extension based low back pain. So because of all of the kind of back bends you think about, they do like bridges, back walkovers, back handsprings all of those, especially in the young developing gymnast. So usually the smaller ones like the level fours and fives, they're doing a lot of those skills. A lot of times you'll tend to see that occur as well as a lot of the compressive loads that happen especially during your floor passes in gymnastics, there's a lot of compressive loads as well as shear loads that get transmitted to the spine.
Karen Litzy: 02:11 And can you kind of briefly tell us what exactly you mean by when you say a compressive load and can you give an example of when a compressive load might happen and a shear load? Same thing.
Duane Scotti: 02:23 So it's really the compressive load is if you think of landing, right, so you're landing, your body weight is coming down. So we know that actually landing, you know, there are some studies that look at between 12 to 17% of your body weight is actually, or times your body weight is actually being loaded through the spine. So that's that compressive load as opposed to like a shear load, which would be something like if you think of doing that back bend or that bridge where you're getting one bone kind of shearing on the other. And in the young developing gymnast who is still growing, that can be problematic. And then that's where we start see things such as stress fractures. So that's kind of really the most you know, important thing. And the thing that I tried to intervene and educate because a lot of times most gymnasts have the perception that maybe back pain is normal with gymnastics due to the training and it's going to happen. But being a young gymnast with their bones developing, if they develop that stress fracture that could be detrimental to their long-term health if it goes undiagnosed.
Karen Litzy: 03:28 Oh that was my next question. So let's talk about differential diagnosis of that stress fracture. Cause I think that's really important to think about. And I would imagine that a lot of therapists aren't thinking stress fracture when they're thinking of a young girl or a young boy. Most of the time we think stress fractures in our older adults with osteoporosis, osteopenia. So how do you differentially diagnosed that stress fracture from other causes of back pain?
Duane Scotti: 03:59 Yeah, so the stress fractures are, they call spondylolysis and it is really diagnosed based upon the history. So kind of taking a report, is that something that typically it can occur acutely from like a specific landing where they felt an acute kind of sudden onset of back pain, but usually it is something that's developing over time and it's not getting better with rest and it continues to get worse over time. And then there are some things on the physical exam that we can evaluate whether they have pain usually commonly with extension. So they're, you know, doing a standing extension test or a stork test standing on one leg, bending back. You can look at the irritability based upon if they have pain with that or if they don't have pain with like a press up on their stomach, then I feel pretty confident that this person doesn't have a stress fracture, that it is more muscular.
Duane Scotti: 04:50 But you always have to kind of make sure and rule that out and then looking at confirming that. So you, you know, you send them to a specialist, a spine specialist. It's not going to show up on x-ray unless it's chronic by that point that they'll see the callus formation on x-ray. But it's really an MRI or a bone scan. And a lot of times, you know, if it is kind of consistent with the history, then even the specialist may not even recommend an MRI just because it's sometimes not necessary. So sometimes it just requires that kind of protection phase and avoiding the extension based activities. And then that allows that to heal.
Karen Litzy: 05:26 And how long is that protection phase?
Duane Scotti: 05:29 So it's around, you know, everyone's different but around six weeks. So that's the most common timeframe you'll see. And there are some that recommend bracing. So they call that like the, the Boston braces, the Bob braces where they will brace them. So that athlete is actually preventing any back bending at all. So they're not going into any extension and forces them. So it's a hard kind of turtle shell brace. And they'll wear that for six weeks to really make sure that it heals up. Cause some of these young kids don't even realize and they don't understand the severity of it. I actually just had a girl recently who, you know, tried not bracing at first and then wasn't getting better and now she's braced and it will allow things to heal.
Karen Litzy: 06:10 Mm, Nice. And my next question was actually going to be how do you communicate this to a young boy, a young girl, young gymnast, that it is of utmost importance to not move into these motions. And then I'm sure you're reinforcing that with parents, guardians, coaches, etc. So talk to us a little bit about the communication that needs to happen around this. A child with a stress fracture.
Duane Scotti: 06:38 So I'm lucky in the fact that I'm on site, so I have these relationships with the coaches already. So I'm seeing a lot of the gymnast actually within the gym and I have those relationships with the coaches as well as with the patients. I see the parents are always there during the evaluation. After every visit, I'm always communicating, you know, even if they're not there for the visit, we do the visits in the gym and then I communicate all my findings on each day with them. That being said, it gets challenging, especially during competition season. So this is where the difficulty comes in. And I think it is a very important role we play as healthcare providers where sometimes we have to be the bad guys because we're looking out for their health. So I had a girl this year before regionals, it was, you know, big competition for her and we have to make that decision and there are tough decisions and if things are sounding and going down that route that you think stress fracture, then it's like you have to take care of your long-term health.
Duane Scotti: 07:36 And it's, you know, one of the hardest conversations, honestly, I've had, I go, you know, home at night thinking about these decisions. I have these long conversations with their parents and, but in the, you know, in the long run, when I reflect back, I'm like, okay, this was the right decision because you know, I don't want this, you know, female to have persistent low back pain for the rest of her life and she wants to have kids one day and grandkids and be able to move later in life. So you know, you want to make sure that you're thinking for their long term health.
Karen Litzy: 08:04 Yeah, I think that's very well said. And you know, I used to work at the lion king in New York and I remember it was like their last performance at the new Amsterdam theater before they moved to the Minskoff. And one of the young simbas was limping around, limping around. So they brought him in and he was not fit to dance that day. And so I had to make the professional decision to call in stage management, call parents, call tutors, call everyone around this huge production of he can't go out and dance because I'm looking out for the longterm house. So it is a lot of tears, which I'm sure you can attest to, but you're right, it's being a good health care professional. It's not about just that moment. It's looking out for these young kids.
Duane Scotti: 08:53 And you know, I definitely pride myself on, you know, getting the recovery for injuries as quick as possible so they can get back out there doing what they love, being able to compete. So when something like that happens, you know, you almost feel like, oh, was I a failure or in, you know, but you have to think about the bigger picture and their long-term health versus that short term gain.
Karen Litzy: 09:14 Yeah. That's when you take yourself out of it, right. As the therapist, as we should all be doing, we check our ego at the door. It is not us. Sometimes things happen. Timing sometimes sucks and we have to make decisions based on what's in front of us. And I think if you're making what you feel is the best decision at the time for the health of that patient, then it's the right decision. And all right, so outside of stress fractures in the low back, what are there other common types of low back pain? Is it muscular and mechanical, low back pain. And what do you then do for those gymnasts?
Duane Scotti: 09:54 So very good. Mainly there's not a huge amount of mechanical low back pain that I tend to see when we think of disk related low back pain, sometimes some facet joint. But these kids are a lot younger so it is usually muscular in nature. I kind of see that common pattern, but it is usually due to an underlying instability in the lumbar spine. But honestly more importantly that I'm seeing is the contributing factors. So specifically looking at hip flexibility, so limited hip flexibility specifically the hip flexors, is going to cause more lumbar extension as well as kind of a weakness or inactivation of the glutes. So these girls are doing these leaps and they're doing these movements where they are extending their hip but they're really not turning on their glutes and their using, you know, if they do have flexibility issues. So I found, you know, addressing those issues. Number one from a treatment standpoint is going to be helpful in the long run, but also for Prehab standpoint. So in prevention. And that's what I kind of do in the gym with all these girls is take them through a full screening help to identify those risk factors and then get them on plans to address the soft tissue care because they are doing a lot of strength and conditioning their front of their hips get really tight and that causes that excessive shearing in the lumbar spine.
Karen Litzy: 11:13 Great. So I think for me a big take home here is when you're looking at these young kids, you're not, they're not just tiny adults and so we're not necessarily looking for disc issues, but rather we really need to look above and below to kind of see, well is the back pain, this muscular back pain a result of compensation from other parts? Right?
Duane Scotti: 11:36 Absolutely. Yes, definitely. And then even the core stability aspects of most of these gymnasts, like super strong, but sometimes there's still these little muscle imbalances that you can find with like a good examination that they're not using the muscles you think they're utilizing. And a lot of, you know, even physicians and you know, these athletes will go to a, you know, a pediatrician or primary care provider or an Ortho and then you're like, oh well there look at them. They're Jacked, you know, like you've seen gymnasts there, Jacked, like really, really good conditions. Yeah. So they, they're like, oh, there's no way they could be weak. But no, like when you actually watch them move and you watch their movement patterns, then you pick up on some of these weaknesses and then you know, having them get into, when they're doing their extra, it's like, okay, well where are you feeling this and this. I go, if they're not feeling they're glutes at all. They're like all of their feelings and their hamstrings. So I find a lot of that they're kind of using your hamstrings to extend their hip joint and not using their glute. So you kind of work on correcting some of those kinds of muscle imbalances.
Karen Litzy: 12:34 Perfect. All right, so let's move off of low back pain. What's another common injury that you see in your gymnasts?
Duane Scotti: 12:44 So definitely you know, the most in terms of the research is ankle and foot are kind of the most common region or you know, area to be injured. And most of that is due to traumatic ankle sprains. So they get their classic inversion ankle sprain while they're beam landing from a pass on the floor, dismount off bars, everything vault like you name it, you know, an ankle sprain can happen. And it usually happens in practice. Not so much in competition. We know that the majority of gymnastics related injuries happen during practice. So I do see a lot of ankle sprains. I do a lot of triaging, especially because I'm onsite. So I need to make that clinical decision on, you know, do we send them out for a radiograph? So utilize the Ottawa ankle rules, and seeing, you know, if they can't put weight on it, then they're definitely getting a radiograph. If they're having pain and they have that bony tenderness, then sending them out for a radiograph. And again, this is where I see us as physical therapists being able to make an impact in our communities in being that point person and make that decision so the athlete goes to the proper place versus just putting ice on it and then going home. And then, you know, so I've been able to kind of streamline that process for a lot of the athletes that I see.
Karen Litzy: 13:56 Fabulous. And I don't think we need to go into the ins and outs of ankle sprain rehab. But have you found amongst this population, what is one thing you can tell another therapist if you do nothing else to rehab these gymnasts after ankle sprain, you must, must, must include this in your program.
Duane Scotti: 14:20 Can I say two things? So first is one thing that I see overlooked a lot is mobility issues. So a lot of people have the assumption that you sprained your ankle, you have a loose ankle and we need just stabilization, stabilization. And that is important. Don't get me wrong. And kind of proper stabilization going from your balance activities proprioception to plyometrics. Definitely necessary need to do the plyometric training with your gymnast before you release them to do gymnastics training. But also checking for mobility issues, specifically lack of Dorsiflexion during like a weight bearing dorsiflexion test. And I've seen that where there's, you know, asymmetries on both sides and that's going to be important because when these gymnast land from their floor passes a lot of them, sometimes land short and if they land short, that requires more Dorsi flexion motion. So that can in turn cause you know more limitations of Dorsiflexion, anterior ankle pain. So you really want to make sure you normalize the joint mechanics and the talocrural joint and do your manipulation mobilization techniques to kind of restore that. So that's one thing. And then, especially if someone's been immobilized. So if there are mobilized in the walking boot or in an air cast, a lot of times you'll find stiffness in those joints as well as the distal tibiofibular joint.
Karen Litzy: 15:35 Perfect. Thank you. That is great. I would have thought your firsthand, so we would have been propioception exercises, which are important, but I'm glad that you brought up the mobility stuff. Great. All right, let's talk about one more common injury that you see in this population.
Duane Scotti: 15:51 So this is more your kind of growth plate injuries. So the kind of growing gymnast as they're growing, they go through that growth spurt. So commonly in the younger gymnasts, so like the nine 10 year olds, you're going to see like the Seavers, so they're going to have heel pain. The calcaneal apophysis and then as they get a little older, usually around 12 ish, you're going to start to see knee pain. So whether or not it's Sinding-Larsen-Johansson Syndrome, which is the inferior pole of the Patella or the more common one that everyone knows about osgood schlatters which is at the tibial tubercle. So you will tend to see these kind of growing pains if you will. The big thing is to educate the parents, the gymnast, and there are things that they could be doing at this time.
Duane Scotti: 16:38 They don't just need to train through pain and usually it relates to soft tissue flexibility. So for Seavers, it's really the calf, the Achilles, make sure they're on a good mobility flexibility program for those structures. And then for the knee, a lot of rectus tightness I tend to see, so working on some of the flexibility mobility during this time period and watching load management, so maybe not doing their rigorous training and if they're going through that kind of gross spurt and they have some pain and now let's say like summer conditioning starting, then they might need, be able to kind of do a modified practice, especially when it comes to the jumping and the plyometric training. So they're not doing because we know that's what really caused it. And that's why the incidence is so high in gymnast is because they're going through this rapid growing and they do a lot of jumping, a lot of contraction of the Achilles and contraction of the quads. So that's why you tend to see pains in both the ankle and the knee area.
Karen Litzy: 17:35 Perfect. Yeah, I had a patient a couple of months ago Seavers disease, she was nine and she was a gymnast. And what was really interesting is I would have her, because I needed to see how she jumped and how she landed. And I don't know if this contributed to it or not. In my line of thinking, I felt like maybe it did, but when she landed she tended to land in a very valgus position of her knees. And I don't know, can that, so looking at the biomechanics of the landing, can that help in the treatment of Seavers disease? Cause then we kind of worked on that so that she wasn't landing in quite such a valgus position. So that in my line of thinking was that if we can help to normalize her landing a little bit more, that she’d be able to more effectively use her calf muscle in order to land instead of being at this very sort of sharp valgus angle.
Duane Scotti: 18:33 Yes. I think that's definitely important. And then even I guess going one step further than that is looking sagittal plane and with ankle Dorsi flexion. So if they're limited there because their Achilles is tight and their gastric is tight, I see that even more so. But maybe like you said, if even if they're weak hip muscles, so your abductors external rotators are weak and they're going into that dynamic Valgus, you know, could that be a contributing factor to different mechanics going down at the ankle? Possibly.
Karen Litzy: Interesting. Yeah. There's so much to think about with these gymnast's that you would not think about in your ordinary population.
Duane Scotti: Right, right. No, absolutely. And it is as you said that they have such high levels of training, you know, the girls I see, you know, once they get up to level six and above, they're in the gym for 24, you know, 25 hours a week.
Duane Scotti: 19:21 So it's a lot of training. The only get like two weeks off a year. So it's like at the end of the season befor summer starts and then before a fall starts. So it's a lot of training, a lot of wear and tear on their bodies. And that's why it's so important to be able to pick up on, you know, contributing factors. Cause every gymnast is different too. So someone's going to have maybe a tightness in the front of their hips. Someone's gonna have some tight calves, so I'm just going to have maybe week shoulder muscles and they're starting to get shoulder pain with bars or tight lats. So that's a common thing where they're limited with overhead mobility with reaching. So you kind of need to identify what each one does. And that's what I like to do is to get them on like a customized kind of program and it's like, okay, here are your like top five exercises you should be doing before practice every single day.
Duane Scotti: 20:03 So as opposed to just like chatting with your friends, like, let's prime the body, let's get, you know, warmed up. If it's rolling the front of your hips, doing some glute activation exercises, make sure they're turned on before practice starts. That's what they need to be doing.
Karen Litzy: And you know, I was just going to ask you, what advice would you give to, let's say, any physical therapists out there listening to healthcare practitioner who maybe doesn't have the amount of experience you have with the gymnastic population, but like I said, maybe they've got a gymnast coming in and I feel like you just kinda answered that. Do you want to add anything to it? What advice you would give to that PT?
Duane Scotti: 20:48 Don't be afraid to reach out and talk with the coaches. I think a lot of the gymnastics world and culture, I tend to see a little bit of kind of medical professionals on one side, coaches on the other. The coaches think that the medical professionals don't understand their sport and vice versa. The medical professionals think that the sport is just bad for them and they shouldn't be doing it almost that it's too much and it's not good for their bodies. So I think we need to kind of meet in the middle and actually communicate and have these conversations and you know, try to meet in the middle. And that's what I tend to do with the coaches and cause they, I could see where their mindset is. And I, you know, with my years of experience coming from the kind of clinical mindset and injury side, and I've shifted a little bit in some of my thought processes as well. Being able to actually be on site and see some of the training that they do and to see some of the practices.
Duane Scotti: 21:32 So just don't be afraid to communicate and I guess reach across the aisle and be able to say, okay, this is what I'm finding, and even just letting them know that, hey, this is pretty irritable right now, but it's a minor problem, but if she can do a modified practice today and tomorrow and then she has off on Sunday, that will give her three days of this kind of protected rest phase and the next week she'll be able to do full practices to have you kind of frame it like that. Then the coaches are like, okay, I could, I could deal with that. Versus the coaches being like, no, they can't modify practice right now. We have a competition in two weeks. But if you've kind of framed it that way and say like, Hey, if we just allow these couple of days and then next week they're going to be able to have full practice without limiting themselves at all, then they're more likely to kind of go with your recommendations versus, you know, everyone being on kind of different sides.
Karen Litzy: 22:20 Perfect. I think that's great advice. Communication is vital and everything we do with our patients from all the different stakeholders that are involved to the patient themselves, to parents and caregivers and to each other. So I think that's great advice. Thank you so much. And I have one last question for you and it's the one that I ask everyone and that's knowing where you are now in your life and in your practice. What advice would you give to yourself as a new Grad right out of physical therapy school?
Duane Scotti: 22:51 So this is a tough question because I hear this all the time because I listened to all your podcasts and you would think I would have the answer right off the top of my head. But I would probably say, there's a couple things is one, just not be afraid to fail. Failure is good because we learn from that and then don't abandon certain techniques or philosophies early on if you're not getting it right. Continue to learn and grow, evolve. And that's how we all get better in what we do.
Karen Litzy: 23:22 I think that's wonderful advice. That's perfect. Resonates with me. Very much so. Thank you, Duane, for coming back on the podcast again and educating us all around gymnastics medicine, so thank you.
Duane Scotti: 23:32 Awesome. Thank you for having me. This has been great.
Karen Litzy: 23:35 My pleasure. And everyone out there listening. Thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Megan Sliski and James Nowak on the New York Physical Therapy Association Student Special Interest Group. Megan is the NYPTA SSIG President, National Student Conclave Project Committee Chair and NYPTA Central District Conclave Committee Chair. James is the NYPTA SSIG Vice President.
In this episode, we discuss:
-The roles and responsibilities of the President and Vice President of the NYPTA SSIG
-A few of the highlights and accomplishments of the SSIG this term
-What Megan and James look forward to in their future leadership roles
-And so much more!
Resources:
For more information on Megan:
Favorite PT Resource: PT Now
School: Utica College: DPT 2020; Utica College: Health Studies, Healthcare Ethics
“I’m excited to see the team grow & work together to create opportunities for DPT/PTA students around New York.”
For more information on James:
Favorite PT Resource: New Grad PT
School: Utica College: DPT 2021; Utica College: Health Studies
“I’m so excited to be a part of a growing team that has the opportunity to truly enhance the student physical therapy experience in New York State.”
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 (www.jennakantor.com) 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: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor here with healthy, wealthy and smart. And I'm here to interview Megan Sliski and James Nowak. First of all, thank you so much for coming on and agreeing to speak about drum roll please. The student's special interest group. You're here in New York and you two are a power duo and Megan here is the president and James is the vice president and you're halfway through now. Is that where you're at? About halfway through. So I would love for those who don't know, when people say, what does this SSIG do? That’s the student special interest group. Could you start from the elections? Don't worry about taking me through the whole year. I'll ask you questions as we go through. So you got elected. What happens next? I'm going to hand it to Megan and then when you need help you can pass it over to James.
Megan Sliski: 00:57 So when we first got elected, Jenna, a lot of it was just trying to figure out what the dynamic of the new team was going to be and how we were going to encompass the goals of the SSIG into the individuals that we were introducing into the SSIG. And so the beginning of the term involved a lot of transitioning and a lot of, of trying to make sense of, you know, what we were going to do and how we were going to progress forward. And the SSIG being just only in its infancy, only two years old at this point. You know, we had a lot to consider. We had to, to figure out, you know, what had worked the previous year, what hadn't worked, how are we going to move forward? How are we going to make this organization successful? How are we going to pair with the NYPTA and, and really make this an organization that was going to succeed.
Megan Sliski: 01:44 And so at the beginning we really focused on trying to get to know each officer individually as well as trying to get to know the positions individually. And so the nominating committee chair from last year did a wonderful job slating candidates. And we were very fortunate that the candidates that we had were so wonderful and that all of the individuals who are elected were just so great for their positions. And you know, we're really lucky for that. And so what we did was move forward. We got to know the individuals on an individual basis and we figured out how we were going to make the organization work for us. That being said, you know, there were times where there were hurdles, but when aren't there hurdles will a new organization, especially when the organizations only in it’s second year. And we were fortunate enough that, you know, James and I actually go to the same school.
Megan Sliski: 02:32 And so we were able to meet almost weekly to talk about some of the challenges we were having in some of the successes and how we were going to make sure that the successes continued. But at the same time, how are we going to approach the challenges that we were having? Again, with it being a new organization. And I happen to think that we're very lucky that James and I went to the same school because in the second year of this organization, we were able to work through some things that were a bit challenging that we hadn't maybe thought about before, that maybe weren't issues the year before. And I think that we've been very lucky so far with the caliber of people that we've had and the team that we've had. And I think that the rest of the year it's going to be so wonderful. I love that.
Jenna Kantor: So, James, for you, when you got elected, what happened? Was there a meeting? Was there, I mean, you already knew Megan, I'm assuming. I would love to know.
James Nowak: 03:26 It's actually a really funny story. So I'm wrapping up in my first year of DPT school and I remember, It's the fall with heavy musculoskeletal stuff. And then this girl by the name of Megan comes in and does a little introduction on this state organization, state student special interest group called the NYPTA SSIG. And immediately within, probably within a couple of minutes of her presenting it, I said, oh my God, this like, like this is for me, this is what I want to be a part of. And at the time, I probably saw Megan around a little bit, but I had never talked to her. And I gathered up the courage and I introduced myself and I said, you know, this right here is something I want to be a part of.
James Nowak: 04:13 I want to make a difference, not only at my school, but on the state level I want to interact with students and professionals both throughout the state, you know. And so I said, I went up to her and I said, how do I get involved? And then she kind of talked me through the election process and how that was gonna be coming up. She did a little presentation right before elections ran. And so from there I decided to apply. And thankfully I got slated. Luckily, luckily enough, I got elected as the vice president. And I was very, very thankful for that. And I think my process after that really my first initial thought was, okay, so now I'm a part of the state organizations, such a phenomenal opportunity. I wanna be able to work with students throughout the state.
James Nowak: 04:58 I'm here in central New York. You know, if you think of a map of New York state, you put a dot right in the middle. That's where I am. And I'm going to get to work with people who are all the way down south in the city and all the way up towards Canada. And getting to being able to really get the wealth of knowledge and experience from them. It was very exciting to me. I hadn't had the opportunity to interact with the students yet. So I think my first thing was really getting to know my team, you know, getting to know the people who were elected. So initially it was phone calls, just to get to know them. Eventually as the year turned to the start of our term.
James Nowak: 05:41 We had a nice transitional meeting, so we had a transitional meaning from our board from the previous year and the people who are elected for this year that we're currently in. And that it wasn't just a phone call on the phone, it was face to face through the computer. Really, it's almost like Skype, but they use, it's a platform called goto meetings that we use. And I got to see the past president of the SSIG and I got to see all the people that I was working with throughout the year and it was such a unique opportunity to be able to interact on that level. Even though I'm sitting in my apartment in Utica, New York, I got to talk with students who were from, you know, places like Columbia all the way down in the city. And that was such a unique opportunity.
Jenna Kantor: 06:25 I love that. So for you, James, what have you been doing? Cause you look over all the regional reps. So for those who don't know, I was part of the SSIG, so I'll educate you guys on this. So there are regions within New York in which there is a student that represents several schools and we'll handle the communications with several schools because New York is huge and we have a lot of schools here. So when you're working with the regional reps, how often do you meet and how do you run those meetings?
James Nowak: 07:00 So I think that's a great question Jenna. As of right now, we try and meet on a monthly basis. And with that being said, coming up towards our midterm here where, you know, something we really put at the forefront is getting immediate feedback on things and we're going to get feedback from students and see is that something that's working? Is this something that's not working? You know? So that's something we're going to see. But as of right now, that's kinda how we do things and enables us to really, on a monthly basis be able to say, okay, so these are the things we're working on. How can we contribute? How can the representatives throughout the state really add various ideas to your advocacy dinner? Let's say for example, that you're planning, you know, how can we bolster this? How can we support you to make this a reality?
Jenna Kantor: 08:11 I love that. I love that. So they're not thrown to the wolves. Megan, for you, we went a little bit backwards because I jumped to the interactions with the regional reps. You're working with the board. So I always forget because there's the main board and then there's the extension people. What are the terms? The advisors and the advisory panel. I should know this because I was on the advisory panel but, but so in these meetings with the advocacy chair, somebody who's in charge of volunteering and somebody who's in charge of events. What do you guys discuss or what even did you guys discuss and how was it passed along to James to be passed along to the regional reps? I mean just throwing out 5 million ideas.
Megan Sliski: 08:56 So I think that that was something that was a challenge last year. We were trying to work through how do we communicate from the executive board and advisory panel to the Board of Representatives. And that's something that James and I did not take very lightly this year. We worked very hard to figure out how we were going to communicate with the board representatives. The Board of Representatives and the liaisons are our main contact with the schools. And without them, our structure falls apart. We need them, we need the communication with them. They need to know what's going on. And so the way that we worked through this was yes, we had our executive board meetings where the executive board talked with the advisory panel and we figured out the plans for everything and we figured out, you know, what we were going to do for the rest of the term or even for just the upcoming months.
Megan Sliski: 09:53 Not even extending until the end of the term and just focusing on the now. So we would talk through that. But what we added this year, Jenna, that I think you'd be very happy to hear is that the board of Representatives were invited to every single executive board meeting. And so not only do they know what's going on at the executive board meetings, they have active voices in what's going on at the executive board meetings. So the board of reps have become this voice for us, the voice of we know what's going on in this region, we understand our schools, we can give you the information that you need to help the SSIG be successful right now in these regions, in these schools. And I think that that was what was crucial and that's what we added in, that's really been beneficial to our organization is that we've been able to encompass all of our officers and we've been able to involve all of those officers in the decisions and we've been able to hear all the different perspectives and I think that's been great.
Jenna Kantor: 10:55 How did you narrow down exactly what you were going to be doing this year, Aka advocacy dinners or even conclaves?
Megan Sliski: We haven't actually, we haven't narrowed that down and I think that maybe that's one of our strengths is that we're trying to figure things out as we go. I talked earlier in the podcast about how this organization is in its infancy and how we don't actually know exactly where it's going. And I think maybe that's the best part of this organization right now is that we don't know. You know, so we've thrown off ideas, we've talked, we figured out what everyone's strengths are. We figured out where we can go with the ideas that we have. And from that we've decided that, you know, we have a very strong advocacy chair who's really great at working with the student assembly and working with you as the past advocacy chair.
Megan Sliski: 11:47 She's had wonderful mentorships. Which I can say for a lot of our officers, actually all of our officers, they've had wonderful mentorship to be able to guide them to what we've done now. I think that talking about the strength and talking about, you know, what succeeded last year, you know, what we can do better from last year. We had such a strong board last year and they left us with such monumentous advice and you guys were so wonderful in guiding us to where we needed to be for the next year. And we've taken that and we've run with it, you know, and everyday we may not have the answer to what we're doing tomorrow, but I think that right now the plans that we have in place are wonderful and I think they're great for enhancing the student experience.
Megan Sliski: 12:36 And I think that as the term continues, we're just going to keep coming up with more ideas and we're just going to be able to keep invigorating students to be able to get involved with the special interest group. And personally, that's what I love about it. I think that every day we just grow more and more as an organization and I love that.
Jenna Kantor: So what have you guys accomplished this year so far? You share some and you share some split the mic.
Megan Sliski: So I’ll start. I don't want to sell so much of James’ thunder, but I think so far one of the wonderful things that we've come up with is that we've voted in the establishment of an advocacy task force. And we've also voted in the establishment of a service task force.
Megan Sliski: 13:21 The advocacy task force is going to promote legislation nationally and statewide to help students become more informed on the issues that really pertain to us as physical therapists and physical therapist assistants. And the service committee, the service Task Force, I'm sorry I should use the right language, is going to really focus on helping our service chair with implementing a really great day of service project. Something that we really hold to high standards in New York state. And I am so excited to see what they accomplish. So I'll give the mic to James and I’ll let him talk about more of our successes.
James Nowak: 13:55 Well, without further ado, so I think really two things stand out to me early on. One first is it's really a continuation of last year and it's really implementing the advocacy dinners. We've really tried to put a focus on students networking not only with themselves but with professionals as well too, to really advocate for our profession out always. PTs with PTAs as well with one common goal of, educating folks, educating just our regular public along with educating our legislators. You know, that's put a focus on is initially, you know, extending that to things such as lobby day. And really just letting students know that, hey, this is something, you know, your classroom education has relied on. It's very important, but you also should be concerned about some of the legislative issues that are going on cause it's really going to impact your future.
James Nowak: 14:48 So we've already had a couple of advocacy dinners. We've had some standout speakers such as former NYPTA president, Dr. Patrick VanBeveren. He gave a phenomenal presentation at Utica College. And really I want to say with that is a huge shout out, not only to our advocacy chair Liping Li for, for really making these things happen, but also, our regional representatives, down to the liaisons at each individual school. Really Planning and being our boots on the ground. We're making these things happen. They did a phenomenal job. And I would say our second accomplishment of this year, which I really feel strongly about is connecting with the NYPTA and specifically the NYPTA districts. Something we've really made a push for is to start to really try in and promote similar events, you know, and get students involved in mingling with the professionals in their various regions. We had our regional representatives actually reach out to the district chairs and the NYPTA and really trying to foster that relationship. So then you know, in the future we have that great connection with professionals who are in the field, and that will really provide students with phenomenal networking opportunities that they might not be able to get at their individual programs, but they can receive that from us.
Jenna Kantor: 16:16 I freaking love that. Okay. So I am going to move you both forward into the future. The future of when your term ends. What are you going to miss most?
Megan Sliski: 16:36 I think what I'm going to miss the most is being able to inspire the students in New York from my leadership position as the president. I'm going to miss talking with them on a weekly basis and you know, hearing their thoughts and hearing their opinions on how we're going to better things for the physical therapy profession in New York state. But I say I'm going to miss that. Although I have a feeling that those relationships aren't going anywhere and I have a feeling that knowing myself, I'm still going to be reaching out and talking to all of those individuals I think I’m going to miss inspiring the team. I think I'm going to miss the SSIG. This being my second year involved I think the SSIG has really given me an opportunity to grow and I think it's helped me realize who I am as a person and who I want to be as a professional. And although I'm eternally grateful to the SSIG for what it's given me in my role as a graduate student, I'm gonna miss that. I think I'm gonna Really Miss Interacting with the people that I've met, but I also know that that's not the end of what I plan to do. And although it'll be a little bit of a bittersweet ending, I'm excited for what comes after the SSIG for me.
James Nowak: 17:58 Just got to wipe away my tears after that one. I don’t know how I’m going to follow that. What I think really going off what Megan was saying, our organization, one of the things were really true is we try and do is deliver the experiences to students throughout the state. And that I think I would miss a lot is hearing feedback from schools saying, did you know, did you like this? You know, and stuff like that. And really being able to implement things that, you know, and give students the experiences that they might not be necessarily getting in the classroom directly. But I think just Kinda like what Megan was saying, working with the team, you know, when you're in an organization like this and you're able to network with students throughout the state, you really do build close bonds, you know, and there's something about that atmosphere of, you know, coming together, collaborating, sort of to deliver those experiences and really make a difference. You know, what we're doing here is we are inspiring and we are educating the future professionals of our field and to really be at the forefront of that is something that I think I'd miss greatly.
Megan Sliski: 19:09 I want to comment James on what you just said. So I happen to think that our dynamic duo of leading a team isn't quite over yet. And so our sounding all somber here and sad about leaving, I have a feeling that James and I are going to continue our little teamwork and leading teams and things are just going to get a little bit better. So look out for the dynamic duo.
Jenna Kantor: I love it. Well, thank you so much dynamic duo for coming on. Take care everyone. Thanks for tuning in.
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LIVE from Graham Sessions 2019 in Austin, Texas, Jenna Kantor guests hosts and interviews Lisa VanHoose, Monique Caruth and Kitiboni Adderley on their reflections from the conference.
In this episode, we discuss:
-The question that brought to light an uncomfortable conversation
-How individuals with different backgrounds can have different perspectives
-How the physical therapy profession can grow in their inclusion and diversity efforts
-And so much more!
Resources:
Handling Your Health Wellness and Rehab Website
The Outcomes Summit: use the discount code LITZY
For more information on Lisa:
Lisa VanHoose, PhD, MPH, PT, CLT, CES, CKTP has practiced oncologic physical therapy since 1996. She serves as an Assistant Professor in the Physical Therapy Department at University of Central Arkansas. As a NIH and industry funded researcher, Dr. VanHoose investigates the effectiveness of various physical therapy interventions and socioecological models of secondary lymphedema. Dr. VanHoose served as the 2012-2016 President of the Oncology Section of the American Physical Therapy Association.
For more information on Monique:
Dr. Monique J. Caruth, DPT, is a three-time graduate of Howard University in Washington D.C. and has been a licensed and practicing physiotherapist in the state of Maryland for 10 years. She has worked in multiple settings such as acute hospital care, skilled nursing facilities, outpatient rehabilitation and home-health. She maintains membership with the American Physical Therapy Association, she is a member of the Public Relations Committee of the Home Health Section of the APTA and is the current Southern District Chair of the Maryland APTA Board Of Directors.
For more information on Kitiboni:
Kitiboni (Kiti) Adderley is the Owner & Senior Physical Therapist of Handling Your Health Wellness & Rehab. Kiti graduated from the University of the West Indies School of Physical Therapy, Jamaica, in 2000 and obtained her Doctorate of Physical Therapy from Utica College, Utica, New York, in 2017. Over the last 10 years, Kiti has been involved in an intensive study and mentorship of Oncology Rehabilitation and more specifically, Breast Cancer Rehab where her focus has been on limiting the side effects of cancer treatment including lymphedema, and improving the quality of life of cancer survivors. She has been a Certified Lymphedema Therapist since 2004. She is also a Certified Mastectomy Breast Prosthesis and Bra Fitter and Custom Compression Garment Fitter.
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 (www.jennakantor.com) 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: www.jennafkantor.wixsite.com/jkpt
Read the full transcript below:
Jenna Kantor: 00:00 Hello, this is Jenna Kantor with Healthy, Wealthy and Smart. And here I am at the Graham sessions in 2019 here. Where are we? We're in Austin, Texas. Yes, I'm with at least. And we're at the Driscoll. Yes. At the Driscoll. Yes. I'm here with Kiti Adderley, Monique Caruth and Lisa VanHoose. Thank you so much for being here, you guys. So I have decided I want to really talk about what went on today, what went on today in Graham sessions where we were not necessarily hurt as individuals. And I would like to really hit on this point. So actually Lisa, I'm going to start by handing the mic to you because you did go up and you spoke on a point. So I would love for you to talk about that. And then Monique, definitely please share afterwards and then I would love for you to share your insight on that as well. All right, here we go. Awesome.
Lisa VanHoose: 00:52 So first of all, thank you so much for giving us this opportunity just to kind of reflect on today's activities. And so, I did ask a question this morning about the differences in the response to the opioid crisis versus the crack cocaine crisis. And I was asking one of our speakers who is quite knowledgeable in healthcare systems to get his perspective on that. And he basically said, that's not really my area. Right. And then gave a very generic answer and as I said earlier to people, I'm totally okay with you saying you don't know. But I think you also have to make sure that that person that you're speaking to knows that I still value your question and maybe even give some ideas of maybe who to talk to and this person would have had those resources. But, I guess it was quite evident to a lot of people in the room that they felt like I had been blown off.
Lisa VanHoose: 01:48 So yes. So that was an interesting happenings today.
Jenna Kantor: And actually bouncing off that, would you mind sharing how this has actually been a common occurrence for you? You kind of said like you've dealt with something like this before. Would you mind educating the listeners about your history and how this has happened in your past?
Lisa VanHoose: I think, anytime, you know, not just within the PT profession but also just in society as general when we need to have conversations about the effects of racism. Both at a personal and systemic level, it's an uncomfortable conversation. And so I find that people try to bail out or they try to ignore the question or they blow the question off and ultimately it's just, we're not willing to have those crucial conversations and I think they almost try to minimize it. Right.
Lisa VanHoose: 02:41 And I don't know if that comes from a place of, they're uncomfortable with the conversation or maybe they just feel like the conversations not worth their time. But, I can just tell you as just a African American woman in the US, this is a common occurrence. As an African American PT, I will admit it happens a lot within the profession. But I do think that there are those like you and like Karen and others that are willing to kind of move into that space because that's the only way we're going to make it better.
Jenna Kantor: Thank you. Thank you for giving me that insight. Especially so because people don't see us right now, so, so they can really get a fuller picture of it. And now, Monique, would you mind sharing when you went up and spoke, how that experience was for you, what you were talking about and how you felt the issue that you are bringing up was acknowledged?
Monique Caruth: 03:37 Well, as Lisa said, we're kind of used to talking and it going through one ear and out the next day and our issues not really being addressed. I think it comes from a point where a lot of Caucasians think that if you try to bring it up, they would be blamed for what was done 400 years ago, 300 years ago. So it comes from a place of guilt. They don't want to be seen as they have an advantage. And I think as blacks we had a role to play in it by saying, oh, you’re white and you’re privileged. So you had an advantage, which structurally there is an advantage. There is structural advantages as I was discussing with Lisa and Kiti last night that as an immigrant, even though I'm black, they're more benefits that I've received being here than someone who was born maybe in Washington DC or inner city Chicago or maybe even, Flint, Michigan.
Monique Caruth: 04:51 I can drink clean water, I can open my tap and drink. What I don't have to worry about, you know, drinking led or anything like that. I can leave home with my windows open, my doors open and feel safe that my neighbors will be looking out for me and stuff that I can walk my neighborhood. So there are privileged even though I'm black, that some people that can afford and would I be ashamed of being in that position? No, acknowledge it. And even with an all black community, there are a lot of us, we may not have been born in a world of wealth. I wasn't, my parents sacrificed a lot to get me where I am today, but not because I have somewhat made it means that I have to ignore the other people that have struggled.
Monique Caruth: 05:43 And this is a problem that I'm noticing in a lot of black communities, like when someone makes it or they become successful, Aka Ben Carson, Dr Ben Carson, we feel that if I can make it, why can't you? And because some of those people were not afforded the same privileges that you were afforded, and it's kinda not fair to make that statement that if I made it. So can you, and you can't tell people that you worked your butt off and pull yourself up by your bootstraps when you were afforded welfare stuff. Your, you know, your mom benefited from stuff. I was afforded scholarship so that I don't have to have $200,000 in debt. So I could afford to purchase a home after I graduated and all that stuff because I was not in debt.
Monique Caruth: 06:47 And a lot of people do not have that luxury. So I can tell people if I can do it, you can do it too. I have to try to find ways to address their concerns and see how I can better help them to move forward and live better. And the problem within our profession is that many in leadership, even though they see themselves as making it, they don't want to have acknowledge that not everyone comes from the same place. It's not a level playing field. And they try to dismiss those by saying, Oh, if I can make it, everybody else can as well.
Jenna Kantor: Thank you. Well said. Well said. Kiti. would you mind sharing in light of what everybody said, some of your thoughts on this matter?
Kitiboni Adderley: 07:30 While it was interesting to watch the conversation, listen to the conversation today. I have a unique perspective in that I don't practice in the United States. I don't live in United States, but I frequently here taking part in education, but also watching the growth and development of the physical therapy profession. So I'm from The Bahamas and it's predominantly African descent population. Right? And so some of the issues that people of color in the United States deal with, we don't really deal with those in terms of that limitations and privileges. And you know, it's more of a socioeconomic for us. And once you can afford it, then you go and do. And, and I think we're pretty fortunate if we talk about while across the board that most people can afford some form of education and get it.
Kitiboni Adderley: 08:30 So I'm in a unique position because I look African American, it was, I don't open my mouth. You don't know. And so I'm privy to some conversations on both sides of the role, you know, and if people are probably, so what do you think about this and how do you feel about that and how does it bother you? And you know, so while I'm not the typical African American and they see them start to take a step back and it sort of gives you the understanding that they don't truly understand that every person of color does not have the same story. And so you can approach us expecting us to have the same story. Right? Cause your three x three women of color here, one's born and bred African American ones born and bred Trinidad and transplanted United States and one's born and bred, still working in The Bahamas and the Caribbean.
Kitiboni Adderley: 09:17 Good. So we all have different perspectives that we all come from different backgrounds and different experiences. But it was interesting and when Lisa asked a question and you know like, you know, people say you will, you know you need to bring it up if we don't talk about these things enough. And it's almost like, okay, you bring up the conversation. So the balls in play, it's tossed from one play at an accident and be like, Oh shit, we can handle, listen to bar this draft again. And so the conversation shuts down and you're like, but you didn't answer the question and you're like, you know, well, yeah, okay, well we'll throw the ball up in the air. And at another time, and I think this is where the frustration comes in for people of color that live in United States because you want us to have these conversations were given quote unquote, the opportunity to ask questions or have these discussions and the discussions come up and at the end of it it's like, okay, we just gave you the opportunity to discuss where do we go from here?
Kitiboni Adderley: 10:14 What's done, what's the recourse, what's our next step? What's our plan of action? And when we talk about inclusion and diversity, if you're not going to take it to the next step, if you're not going to have a call to action, then what's the point? And this is why probably people of color don't come back out again because what's it's a bit, it's a bit annoying. It's like frustration because you stand there, you're waiting for a response. And I was like, oh, well, you know, this isn’t my field and I appreciate the honesty, but then let’s address this at some point we have to address this. So do we need another meeting just to address this? Do we have to have, you know, just, let's pick the topic and work on it. So like I said, it was a very unique perspective.
Kitiboni Adderley: 10:57 I sort of like watching the response of the other people in the room and see how they respond to it, but the conversation needs to keep going for those of us who can tolerate it or have the patience to deal with it at this given time. And, it was a great experience. It was a good experience.
Jenna Kantor: I love it. So I would have just one more question for each of you and it's what would you recommend we do as a profession, both individually and as a collective in order to grow in this manner?
Monique Caruth: 11:37 Well, piggy backing off of what Kiti mentioned, I was sort of blown away too when he said that that's not his field because he's a reporter, he does documentary stuff all you was asking was one opinion you want asking for, you know, an analysis or anything. It was just an opinion and he refused to give that. And his excuse was, I don't know much about it and what was, it wasn't surprising but no one else in the crowd said well we then address her concern and immediately he was, she didn't put it in a way that made it seem or the crack epidemic was black and the opioid crisis as white. He was the one who drew it up cause I was actually praising her for how skillfully she worded it. I'm learning a lot of tack from obviously Lisa I'm not that tactful and my family tells me I need to be tactful, but it's that no one else said, okay, let's discuss it.
Monique Caruth: 12:51 Really. Why, why is APTA making such a big push choose PT. Now. Versus in the 80s when the crack and the crack epidemic was destroying an entire city because DC was known for being chocolate city on the crack epidemic, wiped it out and it got judge all. Alright, it rebuilt it. But now again, it's trying to find like I went to Howard University, you know, I could walk around shore Howard and I'm like, am I in Georgetown? Because you don't recognize, you know, the people live in that. It has driven out a lot of blacks that were living in drug pocket. You know, it's now predominantly, young white lobbyist living in the area. So if we don't have the support of our colleagues, how can we address inclusion? How can we address equity if they're not willing to put themselves out there to say, Hey Lisa, I got your back.
Monique Caruth: 14:05 We need to talk about this. We need to discuss it. Let's have a discussion. Your question was not answered. It wasn't even to say that it was acknowledged with a dignified response because we're spending millions of dollars under choose PT campaign. Why is it because the surgeon general is saying, oh there needs to be another alternative because Congress is trying to pass bills to lower the opioid crisis. Why? If you asking people to choose PT what makes it different? Okay. Even with the Medicaid population, the majority of people who receive Medicaid are black and brown. Are we fighting to get make that people have medicaid coverage or other stuff. Or are we fighting running down Cigna and blue cross blue shield and Humana and all those other types of insurances? Because we think the money is in these insurances. When they could dictate whatever they want, then you could provide a service and say you're providing quality service.
Monique Caruth: 15:14 But if they say, oh, we're just gonna reimburse you $60 we are getting $60 and people on our income. So people complain on Twitter and on social media about, you know, insurance stuff. But if I see a medicaid patient in Maryland, I am guaranteed $89 and that person has the treatment. They’re being seen, they're getting better. It's guaranteed money. But a lot of people don't want to treat the Medicaid population because they think they're getting blacks or Hispanics. And I hear complaints like I don't really want to treat that population because we are going to have no shows and cancellations and all that stuff, which is bs. It's excuses. And we have to do better as a profession to acknowledge or biases and work on ways to help work with the population that we serve. Because let's face it, America is not going to remain white? It's gonna get mixed. We're going to have some more chocolate chips in the cookies. Okay. All right. It's going to be more than two chocolate chips in the whole cookie next time.
Jenna Kantor: 16:33 Before I pass it to you, Kiti, I really like where you're going with this, Monique, and I think it's important to acknowledge why, which I didn't at the beginning. Why, why, why we're tapping on this one incident and really diving in and it's because what I learned today from my friends is that this is a common occurrence in the physical therapy industry. It's not just it and it's not just within our industry. It's what you guys deal with regularly. And if we are talking about our patients providing better patient care, we need to really, really be fully honest with where we are at. Even as they are speaking, I'm constantly asking myself, what are my things that I'm holding within me where I'm making assumptions about individuals? There's always room for growth. So please as you continue to listen to Kiti speak next, just keep letting this be an opportunity to reflect and grow.
Kitiboni Adderley: 17:50 Okay, so I recognize that incident was uncomfortable. It was an uncomfortable conversation to have and it's okay to have uncomfortable conversations. As physical therapists, we have uncomfortable conversations with our patients all the time. We have uncomfortable conversations with our colleagues and we have to call them out on some mal action or when they call us out on something that need to do. And because the conversation is uncomfortable, it doesn't mean that we don't have it. We probably need to talk about it more. And so if there's anything that I want to say, I think we need to have more of these conversations and have them until they no longer become uncomfortable until we could actually sit down with, well no, I shouldn't say anybody but, but the people of influence, cause this is what it's really about. We were sitting with very influential people today and all of us there, I'm sure where people of influence and you know, this is what we need, this is what we need to use. And don't be afraid to have the conversation. As uncomfortable as it may make you feel. Why are we having this conversation? We want inclusion, we want diversity, we want a better profession. And those are the goals of the conversation. We shouldn't shy away from it.
Jenna Kantor: Thank you. I'm gonna hand this over to Lisa for one last one last thing.
Lisa VanHoose: 18:43 So I just want to talk about the fact that part of the conversation was this dodging right? Of a need to kind of have this very authentic and deep conversation. The other part of today's events that I'm still processing is this conversation about the need for changed to be incremental, right? Comfortable. And for those of us that are marginalized to understand that the majority feels like there has been significant change and that was communicated to me in some side conversations and I was challenged by one person that was like, well, I think you have this bias and you're not recognizing the change that has occurred and how that this is awesome that we're even in a place to have this, that we're having this conversation today.
Lisa VanHoose: 19:46 You know, that you need to acknowledge that success that we've made. And so I do agree that, you know, what all work is good work and I will applaud you for what has been done today. But I also would say to people who feel that way, step back and say, okay, if the PT profession has not really changed as demographics in the last 30 years, and if you were an African American and Hispanic and Asian American, an Asian Pacific islander or someone of multiracial descent would you be okay with that? Saying that, you know what, I started applying to PT school when I was in my twenties and I'm finally maybe gonna get in my fifties and sixties. How would that feel? Right? That wasted life because you're waiting on this incremental change. And I think if we could just be empathetic and put ourselves in the other person's shoes and say, would I be okay with waiting 30 years for a change?
Lisa VanHoose: 20:53 Would I be all right with that? But I often feel like when it is not your tribe that has to wait, you okay with telling somebody else to wait? Right? And so, I want to read this quote from Martin Luther King and it was from the letters from Barringham where he criticized white moderates and he said that a white moderate is someone who constantly says to you, I agree with your goal, with the goal that you seek, but I cannot agree with your methods of direct action. Who believes that he can set the time table for another man's freedom. Such a person according to King is someone who lives by a mythical concept of time and is constantly advising the Negro to wait for a more convenient season. And that's how I felt like today's conversation from some, not all was going. King also talked about the fact that that shallow understanding from people of goodwill is more frustrating than the absolute misunderstanding from people of ill will. Luke warm acceptance is much more bewildering than outright rejection. And I say that all the time because I would prefer that you be very honest with me and say, I don't really care about diversity and inclusion, but don't act like you're my ally. But then when it's time to have a hard conversation, you say, I can't do that. I'm like, choose a side, pick a side. There is no Switzerland. There is no inbetween.
Jenna Kantor: 22:25 Thank you so much you guys. I'm so grateful to be having this conversation to finish it with a great Martin Luther King quote, which is absolutely incredible. I'm just full of gratitude, so thank you. I'm really looking forward to this coming out and people getting to share this joy of learning and growth that you have just shared with me right now.
Lisa VanHoose: And thank you for being an ally. We really appreciate that. So we're not, I just want people to know, we're not saying that the African American or the immigrant experience is different from the Caucasian experience. I think we all have this commonality of being othered at one time or another, but yes, with being a white female LGBTQ, I think the complexities of who we are as a human, there's always going to be a time where you're an n of one or maybe of two and you get that feeling that, Ooh, am I supposed to be here? But I think what we're talking about is being empathetic and if we're going to talk about being physical therapists, being practitioners and compassionate, and we're going to provide this patient centered care, how can you tell me you're going to provide patient centered care when you can't even have a conversation with me as a colleague, right. When you can't even see me. So I just want the audience to know, that we're not coming from a place of being victims were coming from a place of really wanting to have collaborative conversations.
Monique Caruth: 23:59 I like to view my colleagues as family members. There are times, as much as I love my family, my mom and my dad and my sisters and my brothers in law, there are times we will sit and have some of the most uncomfortable conversations, but at the end of it it’s out of love. It's all for us to grow as a family. And Yeah, you may not talk to the person for like a day or two, but you're like, shit, you know, that's my sister, that's my brother in law. You know, I have to love him. But you know, you try to hear their perspective, you try to make sure they hear your perspective and you come out on common ground so that the family can grow. And we don't treat this profession as a family, the ones who are marginalized are treated as step children.
Monique Caruth: 24:57 And that's a bad thing because stepchildren usually revolt. And when they revolt, the ones who are comfortable with incremental change and are afraid of chasing the shiny new object. Because when I heard that comment today, I felt like the shiny new object was diversity, equity and inclusion that people were trying to avoid without saying it outright. And, someone who feels like they have been marginalized. It was like a low blow. So I, for one, appreciate people like you, Ann Wendel, Jerry Durham, Karen Litzy, and stuff. Who Have Sean Hagy and others, Dee Conetti, Sherry Teague reached out to us and say, how can we help? And you need people like that to be on your side. Martin Luther King needed white people. Okay. Rosa parks needed white people. Harriet Tubman needed white people to get where they're, even Mohammed Ali needed white people to be as successful as he is. We all need each other. If we are saying championing better together, how can you be better together if you're not willing to hear the reasons why you feel marginalized or victimized, it's not going to work. Stop turning around slogans or bumper stickers and start working on fixing the broken system that we have. That's all I'm asking for and we got to start working as a family, as uncomfortable as it may be. All right, we'll get over it and you're going to like and appreciate each other for it later on.
Jenna Kantor: 26:44 Thank you guys for tuning in everyone, take care.
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!
LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Greg Lehman on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada. Greg is a physiotherapist, chiropractor and strength and conditioning specialist treating musculoskeletal disorders within a biopsychosocial model. He currently teaches two 2-day continuing education courses to health and fitness professionals throughout the world. Reconciling Biomechanics with Pain Science and Running Resiliency have been taught more than 60 times in more than 40 locations worldwide.
In this episode, we discuss:
-Common misconceptions surrounding the source of pain
-Do biomechanics matter?
-Promoting movement optimism in your treatment framework
-What Greg is looking forward to at the Third World Congress of Sports Physical Therapy
-And so much more!
Resources:
Third World Congress of Sports Physical Therapy
David Butler Sensitive Nervous System
For more information on Greg:
Prior to my clinical career I was fortunate enough to receive a Natural Sciences and Engineering Research Council MSc graduate scholarship that permitted me to be one of only two yearly students to train with Professor Stuart McGill in his Occupational Biomechanics Laboratory subsequently publishing more than 20 peer reviewed papers in the manual therapy and exercise biomechanics field. I was an assistant professor at the Canadian Memorial Chiropractic College teaching a graduate level course in Spine Biomechanics and Instrumentation as well conducting more than 20 research experiments while supervising more than 50 students. I have lectured on a number of topics on reconciling treatment biomechanics with pain science, running injuries, golf biomechanics, occupational low back injuries and therapeutic neuroscience.
While I have a strong biomechanics background I was introduced to the field of neuroscience and the importance of psychosocial risk factors in pain and injury management almost two decades ago. I believe successful injury management and prevention can use simple techniques that still address the multifactorial and complex nature of musculoskeletal disorders. I am active on social media and consider the discussion and dissemination of knowledge an important component of responsible practice. Further in depth bio and history of my education, works and publications.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody, welcome to the live interview tonight with Doctor Greg Lehman. And we have a lot to cover tonight. So for everyone that is on watching, oh good. And we're on. Awesome. Just wanted to make sure, for everyone that's on watching and kind of throughout the interview, if you have any comments or you have any questions or you want to put Greg on the spot, feel free to do so. We can see your comments as they come up. Greg, if you can't see them, just know I'll kind of let you know. But one thing we do want to know is if you're watching, say hi and let us know where you're watching from. And that way when you start asking questions, at least I'll have a better, kind of know who you are a little bit. Now before we get to the meat of the interview, I just want to remind everyone that if you are watching this, this is not on my page and it's not on Greg's page, but instead we are on the Facebook page for the Third World Congress in Sports Physical Therapy and that is going to be taking place on October 4th and fifth in Vancouver, Canada.
Karen Litzy: 01:20 So hopefully we're going to be doing more of these throughout the year talking to a lot of the presenters and Greg is one of the presenters at the congress. So that's why he's here.
Greg Lehman: 01:31 Not just me every time
Karen Litzy: 01:35 Although I have to say, I bet people would really enjoy that.
Greg Lehman: 01:39 Yeah, I'll fill in for whatever speaker it is and I'll just learn their stuff and then pretend like I know
Karen Litzy: 01:46 Okay. So I'd like to see you fill in for Sarah Haag.
Greg Lehman: 01:50 Done. I’ll shake my pelvis.
Karen Litzy: 01:53 Pelvic health and stuff like that. That would be amazing. I would actually wouldn't mind seeing that. Now before we get started, Greg, can you talk a little bit more about yourself, just kind of give the listeners, the viewers here a little bit more of a background on you so that they know where you're coming from, if they are in fact not familiar with you.
Greg Lehman: 02:13 Okay. Well, leading into that, I'm a generalist. I'm not a specialist. I have a background in kinesiology and then a master's in spine biomechanics and I was really into spine biomechanics for a long time. But you know, I became not, sorry, I was going to say dissolutioned. That's a little too strong. I've always been skeptical, skeptical of everything that I've known, and that's probably why I got accepted to my master's in biomechanics because they liked the questions I asked. And then my research there was in mainly exercise, like EMG and manual therapy, what manual therapy does. And I was pretty lucky because I was with Stuart McGill and two chiros named Kim Ross and Dave Breznik, who I always have to mention. And I should give a big shout out to Stu because he took on Kim Ross Dave Breznik who were chiros at the time and they did like amazing research that challenged so much of what we know about, you know, spine manipulation.
Greg Lehman: 03:19 And they also challenged me to think about what I thought about low back pain at the time. So my master's was really helpful for me because it challenged so much of what I thought. And so that's when I was first introduced to the bio psycho social, not actually first, cause I used to read John Sarno when I was like 19 years old. I was a bit of a nerd when I was a kid. But definitely the occupational biomechanics at Waterloo, even though they love biomechanics, even back then they knew that psychosocial factors were important for your pain and injury. And then I went to chiro school, actually I went to, that's like in quotes. I like was registered, but I didn't go to class, but I had a research program and they were awesome. They funded me to do more biomechanical research. Then I was in practice for a long time and then I went back to physio school and then I was in practice for a long time and didn't do a lot of research. And then I just started teaching with John Sarno who's running the conference with the running clinic and they were great. And at the same time I also started teaching my course which is about biomechanics and pain science. How do we like bring them together? And you've hosted me.
Karen Litzy: 04:38 I've taken that course. Yes.
Greg Lehman: 04:41 For you is like an echo chamber. Just it was confirmation bias. Yeah, yeah, yeah. We know this shit, Greg. But thanks for confirming what I already know. And my course does that a lot, which I don't mind. So that's me. There you go. That was fun.
Karen Litzy: 04:56 Excellent. Very good. And, you know, just as a side note that I spoke to John Sarno a couple of years, like when I was in the middle of like all my neck pain, I reached out to him via email and he said, you need to call me.
Greg Lehman: 05:11 Oh, interesting.
Karen Litzy: 05:12 So I called him and I spoke to him. I never saw him but I spoke to him and he was like, you're a young chickadee. I was like, what? And like crying and all this neck pain. I'm like, who is this guy? And he said, well, just get my book. Read it. If it doesn't work, come in and see me.
Greg Lehman: 05:30 Yeah, that's funny. I had a patient, he was very famous, very rich, and he bought like a hundred of his books and gave them out to his friends. He thought it was amazing. Sarno was interesting because and this happens, this is the issue with biomechanics sometimes is he had physios working with him for a long time and then he realized that doing physical medicine conflicted with the message he was giving about where pain came from, meaning like predominantly emotional, I'm probably bastardizing my sense in a long time since I thought about them. And so, which is funny that he had the problem that I had for a long time and so many of us do where we think it's bio-psychosocial, but often our biomechanical ideas will conflict with their psychosocial. So we have to be careful in how we navigate all the multidimensional nature of pain.
Karen Litzy: 06:26 I think that's the important part is that it's multidimensional and that you can't have that pendulum swing too far in either direction. And you know, now that we're on the topic of pain, let's go in a little bit deeper, so what would you say are the biggest misconceptions or common misconceptions around pain and it's, I'll put this in quotes, sources, quote unquote sources.
Greg Lehman: 06:53 Yeah. The biggest one. And I really like to focus on this because it helps me in practice, it's this idea that, and I like this cause it's how our practice is that we don't always need to fix people, right? And I kind of mean, I don't just mean that in the biomechanical way. And I would have meant that in the biomechanical way five years ago where I would have said, well, you don't have to fix that posture. You don't have to fix that strength or that weakness or we don't fix strength. We're gonna have to fix that weakness or tightness. And I believe that although I do think strength and weakness and range of motion can be relevant sometimes, but I also don't think we need to always fix catastrophizing and depression and anxiety and worry, and so that criticism goes both ways.
Greg Lehman: 07:53 It started out for biomechanical with me, but I would also say psycho social and we see that in the literature where people recover and they still have these, you know, mediators of disability and pain. It could be high catastrophizing but they still do really well because maybe they built up their self efficacy and they got a little bit of control and they were able to do something and something to control their pain or do something that they loved or they had some sort of hope. And so that's the biggest one, that idea of like fixing and if you want to be more technical or mechanical, it's the same idea. Like I don't think you have to get rid of nociception. So like your tissue irritation stuff, you can have shit going on in the tissues, but it's how you kind of respond to that stuff. That’s exciting.
Karen Litzy: 08:45 Well why would want to get rid of nociception.
Greg Lehman: 08:49 Yeah. Well I mean I don't, well I know what you mean. Like, we don't, you don't want to, cause when you sit down you want to get an ass ulcer. Right. You definitely want to move around. So, but that now we get into crazy stuff with that.
Karen Litzy: 09:03 Well do you mean the sensitivity around it?
Greg Lehman: 09:05 Yeah, it'd be like you definitely don't want like a raging disc herniation that's pressing on a nerve root and you have chemical inflammation, things like that. It’s worthwhile getting rid of. But you know, other things, you know, you can have tendinosis and a muscle strain and it can definitely hurt. But it's the idea that sometimes maybe what our rehab does is helps us cope with those, with those things, right? That's at a peripheral level and more central level. You can have anxiety and worry and those might magnify your pain response, but you can also cope with them as well. And so I love that message because I think it's just positive. Like people think I'm so messed up, I got scoliosis, I'll never got pain. And I'm like, dude, like it might contribute. I don't think the research actually supports that. Perhaps. Perhaps it does, but you can have that and still be doing awesome.
Karen Litzy: 10:00 Right. So just cause you have chronic, let's say persistent pain or you've had pain for x amount of time, it doesn't mean that that should be the thing that defines what you do or defines whether you're happy or sad or anxious but that it's a part of your life that perhaps you can cope with or like in my case I had many years of chronic pain. Now I have pain every once in awhile. But there are times where it's more severe than I would like it to be. And there are times when I want to fix it or I need to fix it. And then there are other times where I feel like I can cope with it and it's not horrible.
Karen Litzy: 10:45 I think it's context dependent. So like I had pain last year, like pretty severe for like a week or so, and I knew that in another couple of days I had to get on a flight to go to Sri Lanka. And so I needed it. So what I did for myself was I decided to get medication to help bring those pain levels down and that's what I needed at the time. But I felt so guilty about it. I would like say is this the bio psycho social way? Is this the way I should be handling this?
Greg Lehman: 11:20 I would think so. I’m going to mansplain you for a second. Cause I'm guessing that you knew that this was just a flare it was going to go away and that you've managed it before, but you're just giving yourself a break for a few days. Yeah. I don't think there's anything wrong with taking Tylenol for a few days. I've talked off topic, but it's how you do manual therapy, I don't do a lot of manual therapy, but I don't begrudge people that do. And it's, especially at an athlete level, I brought this up with some of the people who are going to be at the congress and I'm like, I find it ironic that all of us who teach a running course, none of us really teach manual therapy at our running courses and no one would ever say that manual therapy is a strongly evidence based, you know, modality for running injury.
Greg Lehman: 12:16 It's not, we would all talk about load management and exercise and blah, blah, blah, blah, blah, all of these things. Yet when you're a physio or a chiro training like elite athletes and you're working with them the day before their competition, what are you doing? You're probably doing some manual therapy. And so I just found that ironic that we do that, that when we're traveling with the team, I don't travel with teams, but I do have athletes come to see me the day before an event or I've been working with them for months and here I am doing what people would call low value care. But I'm like, no, sometimes it's a bandaid, but sometimes bandaids help and that's the only solution. Well, the solution that works then.
Karen Litzy: 13:08 Well again, it's context dependent, right? So if, and I saw this conversation on Twitter about, you know, what are we doing race day and race day yeah you probably are doing some sort of manual therapy.
Greg Lehman: 13:30 You’re treating that little niggle and this things tight and sore and you treat and people feel better. And if fatigue is psychobiological, which it is, then our intervention is probably psychobiological and it could certainly be more psycho based. Yeah.
Karen Litzy: 13:48 Right, right. It’s still real. And you know, in the context of athletes and being, this is the Third World Congress in Sports Physical Therapy. So there'll be a lot of, we can assume, I don't know, physios there that probably work with an athletic population. And so I think it's important to bring that up. All right. I digress.
Greg Lehman: 14:14 I did, you were the professional.
Karen Litzy: 14:20 So one common misconception is that we don't have to fix everything and not just the biological part, but the psychosocial part as well. Is there any other, maybe one other common misconception around pain and its sources that you hear a lot or you see a lot?
Greg Lehman: 14:40 I mean if I had to say anything, it's like it's the relationship between bio motor abilities, which would be like strength and flexibility and pain. I think that it’s over sold. You know, I don't think posture is relevant. I don't think strength or motor control is irrelevant. I just think it gets over done in that, that to me is that kinesio pathological model, which I have a big issue with, which would be like your knee goes into Valgus, you're going to pay for it later and you're going to get knee pain or hip pain. And, I'm like, well if your knee hurts and it goes into Valgus it's certainly a reasonable option to avoid that for a little bit. And then you might recover cause it's an avoidance strategy and build yourself back up and you'll do great. But I think what often happens is we then say, well, you went into valgus and it hurt, therefore valgus is inherently wrong and we need to make rules for everyone on how they should function. I hardly saw you when we were in Denver together, but I gave that whole, I forgot about that. We just saw each other, sorry, I was with Betty the whole time. I couldn't hang out with you guys. And so that I gave that example of limping, like when you sprain your ankle.
Karen Litzy: 16:06 That example was great.
Greg Lehman: 16:08 Yeah. You sprained your ankle and it feels better to limp. That's totally reasonable. But no one would then conclude that we all should be limping. That that's the right way to move. When I see like people I really respect, like Shirley Sahrmann or Jill Cook who will, you know, say avoid hip abduction, right? It's so horrible on the tendon, on the outside of the hip or is so bad on the knee. And I'm like, yeah, it's reasonable for symptom modification but I don't want to make a general rule and that happens too much and then we're too quick to be like, well just cause someone got better with exercises that try to change those movement patterns. That doesn't mean that's why that treatment was successful. Often those rehab programs that try to change movement patterns are like amazingly comprehensive and excellent rehab programs. And then you have like awesome therapists like you know, Stuart McGill or Shirley Sahrmann who just like build in this graded self efficacy and pump them up and they tell them you can do whatever you like. Let's just change your movement patterns and start doing this stuff you love again, may have nothing to do with the movements. It's just like the person was like, wow, I'm awesome, you're awesome. Let's do it.
Karen Litzy: 17:26 I think you can’t sort of parcel out one part of that complete treatment program and say this is the thing that worked. This is why this worked. I mean, you can't do that. I think that's impossible.
Greg Lehman: 17:37 No. And it's certainly the same with the people who I really love, like Peter O'Sullivan and that whole group when they help people, like I don't really agree. I'm such a jerk. I don't always agree with their mechanisms because when I see Pete treat, he's just so confident. It's like, you can do this, you can do this and bend over and do this and do this. And like, and I would never practice that way. I just couldn't pull it off. But I can imagine how much he helps people. That's actually why I really respect him. What he does really well. When he tests RCTs, he doesn't test himself. He trains people and other people do it. So, I actually shouldn't, I'm not knocking his research. I can't get to his style because he's so confident. It's absolutely really honorable what he does where he's like, I'm not going to be the dude that's in the RCT and train people and then we'll do the studies on them, which is just, that's nice science.
Karen Litzy: 18:34 Yeah, for sure. And all of those people you mentioned also have great reputations. People are referred to them when nothing else works. And so as the patient, you're like, well I know this person's the expert.
Karen Litzy: 18:49 Right. So I think in the patient mind they're thinking, if anyone can fix me, yeah, it's going to be this person. And I think that that also plays into it.
Greg Lehman: 19:00 I just opened my own little clinic out of my house. We have like a little gym. It used to be a workshop and now it's a clinic gym and I have nothing on the walls. And I'm like, how can I placebo the hell out of this? So that's my answer. I like art. I want to put up like, no, I should put up like placebo shit. Like what was like going to make me look amazing?
Karen Litzy: 19:25 Yeah. Well you can put up like awards you've gotten put up your degrees. People will be like, look at how many degrees he has. Look at all of his qualifications. He must be amazing.
Greg Lehman: 19:37 Yeah. Maybe, I don't know.
Karen Litzy: 19:41 You see that a lot in the US like when you walk into an office, the degrees and the licenses and certifications, right?
Greg Lehman: 19:46 All that weekend certifications, all that nonsense. After I teach, I always tell everyone, like, whenever you want me to write on your certificate, I will write levels six fascial blaster done, master Fascia blaster. I don't care. It's all bullshit.
Karen Litzy: 20:03 Biomechanics. Does it matter?
Greg Lehman: 20:07 Since the sport conference let's start. They definitely matter for performance. We got to listen to our coaches and the physios. But biomechanics and technique matter for performance. So if you want to tell someone to sit up straight, yeah, it's totally reasonable to do that if you're thinking how they're going to function 30 years from now. So that's great advice. And then, it's like a question of when they matter after that. And so I kind of Parse it into a few different areas of when they matter. The big one for me is like what's more important, is it's not how you move, it's that you're prepared to do what you're doing. So make the mechanics and the loads on the person matter.
Greg Lehman: 20:59 But it's the movement preparation. So my pithy expression is preparation trumps quality, right? Something like that. And then the other way or the other area where they matter is this symptom modifications. So if it hurts to do something, like if you're a runner and your knees hurt and you heel strike and you have a long stride, it's totally reasonable to shorten your stride, maybe changed your foot strike, although that's debatable, but it could serve it is certainly is an option. And if it feels better, keep running like that. So the mechanics there help but it doesn't prove, you know, the thesis that there's a right way of running. It's just that you're running differently cause another run or you're going to be like stop forefoot striking and actually lengthen your stride. I've done that plenty of times. So you're just symptom modifying.
Greg Lehman: 21:45 So mechanics help a ton for symptom modification. And then you know there's probably under high high loads, there's probably better ways for your tissue to tolerate strain. You know, like if you're landing and cutting you can go into valgus but you probably don't want to go into Valgus if your knee's not flexed. Right. So high loads where the tissue gets overloaded matters. And then after that with that principal there, it gets more difficult because you start thinking of the spine and you're like, okay, is there a better way for the spine to tolerate loads? And that's where we have been debating biomechanical principles here because certainly the bio does drive nociception sometimes. And so those are the big areas for me where biomechanics matters. Sorry I went over that fast.
Karen Litzy: 22:39 I think that makes perfect sense. And I mean, I don't know if you saw this since you are probably more into tumbling and gymnastics than I am. I haven't seen this yet. But did you see yesterday a gymnast broke both of her legs or something.
Greg Lehman: 23:01 I saw that by accident. I won't see it again.
Karen Litzy: 23:02 But I don't know what happened there.
Greg Lehman: 23:07 I think it may have been in a double Arabian or a double front tack and she landed and then hyper extended. And what freaked me out a little, only saw it once and I'm not gonna see it again, is I don't think she landed with straight knees. They were like bent and then they went into extension like, which freaks me out because my daughter's learning front and I'm doing them with her front tuck step outs, and you kind of land on that one leg and it's straight ish. And I was worried of extending.
Karen Litzy: 23:46 Yeah. I mean I haven't seen the footage of that, so I was just wondering if that would be a time when biomechanics mattered or just an accident.
Greg Lehman: 23:55 It certainly did. But here's the problem with all the biomechanics mattering stuff, is it the mechanics mattered and caused the injury. It's just whether you can prevent it. Yeah. It's like so many ACLs. Someone might cut 10,000 times with their knee in valgus. Well, that's proof of principle, that they're safe and then they do it one way that's slightly different and then they tear their ACL. But it doesn't mean that the way they were doing it before was unsafe because they could have had less valgus pattern before and then they could have done that too. Like, yeah, I don't know. It's difficult.
Karen Litzy: 24:34 Yeah, and I think when you're talking about injury prevention, I mean that's a whole other conversation. But I think that so many factors go into that as well. It's sleep, it's nutrition. It's what did you do the day before or was the beginning of the game, the end of the game? Are you fatigued? Are you not? I mean, so much can go into that. So yeah, you can cut 10,000 times and one time you have an injury. It doesn't mean that the way you did it was incorrect. It doesn't mean that the preparation leading up to it, it could have been that day. It could have been what you did the night before. I mean, so many factors and elements that go into something, some sort of accident or injury like that, which is why injury prevention programs are difficult.
Greg Lehman: 25:25 Yeah. And, and we see them running, you know, like we've been saying the same thing for years. So you don't have training errors, which just means don't do too much too soon. And then you try to nail it down in the research and you say, well, what's too much and what's too soon? And then there's no real good research on that, right? Because there's so many different variables that influence that. So my joke tonight, we're arguing not we were talking on Twitter about this. I'm like, well, we can probably all agree when it's like just looks ridiculously like too much too soon. And that's the pornography test, right? Which is your old Supreme Court justice is either pornography or obscenity and they're like, I can't define pornography, but I know when I see it. And so when a movement pattern or a training load is pornographic than maybe you avoid it or depending on your personality.
Karen Litzy: 26:17 Right. Well, you mean it just gets a point where it's so obscene.
Greg Lehman: 26:20 It's so obscene. You say, ah, that's probably some of them. But it has to be that and who knows? That's the worst part is there's probably people who can handle that obscenity. And I stopped this analogy because I dunno, they're built for it. They prepared to handle.
Karen Litzy: 26:41 All right. Let's talk about being a movement optimist. Yes. So for those of people watching and listening that aren't familiar with this, can you talk about it a little bit more and how this came about?
Greg Lehman: 27:02 Well, I mean, I have already, I've already said all the good stuff I've run out of material.
Karen Litzy: 27:08 I can't, I can't even believe for a second. That's true. You're not like your greatest hits album.
Greg Lehman: 27:18 I was in Denmark and they gave me this little bobble head that you've pressed the top of and the whole thing like bounces. And it's funny, I was in Scandinavia three or four years ago and they gave me the same thing. It's like this thing that I would get there, but it's called a hop to mist. I loved it. My kids have it anyways, so what it means is like we need to stop vilifying like certain movements. You know, like when you look at someone's skateboarding, their knees are going to cave in and it's amazing and it's a successful movement pattern. If you rock climb and you were just at a birthday party.
Karen Litzy: 28:01 I was at a rock climbing birthday party yesterday for my 10 year old niece.
Greg Lehman: 28:05 Well, I doubt they were doing it, but there's something called a drop knee, which is what I do on a climb is, is you can do it. I'm not doing it. You put your foot up behind you almost and drop your knee down into valgus and then stand up on that and you go into that.
Karen Litzy: 28:24 There are actually some more like real climbers there and they were doing that. There are a couple of people doing that move. Cause I remember my friend that I was with was like, oh my God, look at that person's knee. How is she doing that?
Greg Lehman: 28:37 Yeah. And so Alex Honnold is a famous rock climber. They just won the Oscar for Free Solo Yosemite without a rope. But I have sometimes he's in another documentary about Yosemite. I've filmed it when he's in it because he sits like me. He's like super hunched forward with the super forward head posture. And here he is climbing, you know, these massive granite walls and that's a movement optimists, it says you can do all these weird funny things with your body and still be fantastic. You can be a paralympian where you're missing a limb than have induced, you know, assymmetry that you can have scoliosis and make it to the Olympics. You can have scoliosis and lift five times your body weight. And so that's the optimism. It's this revolt a bit against the kinesio pathological model, which to me is certainly has value.
Greg Lehman: 29:39 It's certainly has treatment efficacy because I like the treatments that are associated with it, but the fundamental ideas behind it that there's like bad ways to move or better ways to move for injury and pain, that's what I would challenge. I'd be like, let's be more optimistic about how we move, you know, we don't have to always fix these things right now is go and anytime someone like me talks and says to people, all you can move this way, you always want to look for exceptions, right? When you're in practice, like, when should I, you know, disregard what I think, like when you know, when is how someone moves. Like when is that important? You know that and that'll help him be a better clinician. I think. I always challenge challenging whatever you think is true. It makes it difficult.
Karen Litzy: 30:40 Yeah. But I think having that as a clinician, having that sense of doubt is not a bad thing.
Greg Lehman: 30:48 Yeah. I mean, I'm going to want to agree with you. Sorry. It was like, why am I listening to this guy? It's like, but then there's those clinicians that get people better by sheer force of personality. They have that utmost belief in what they do, even when they may be full of shit. And so that's how it was hard.
Karen Litzy: 31:16 I have a great example of that, I'm not going to go into it right now.
Greg Lehman: 31:25 Now you also have to wake up in the morning and be happy with yourself, so.
Karen Litzy: 31:29 This'll be an easy one for you. What is the most common question you get asked by other physio therapists? If you could say whether it's maybe they private message you or at your courses or lectures. What is the most common question that other physios or healthcare providers ask you?
Greg Lehman: 31:59 Oh, that's funny. I didn't read this one before, but a few things. But usually it's like what's the paper that you mentioned? And then I have to like come up with a name and I usually know it, but the bigger one is this is what I do with people. This is not what you talked about, but tell me why it's helping them. That's, what I get a lot, they want validation and then they want to like, you know, tell me their theories of things, but really tell me they want me to tell them why it's great. It's like what the mechanism is.
Karen Litzy: 32:47 That's why it's okay. Looking for just your confirmation.
Greg Lehman: 32:54 Confirmation and then like, and then trying to like find out why it works. Like they want me to do the research behind it, I'm going to go. Okay. So what do you say? I mean it depends. Like I probably do like the motivational interviewing thing where I roll a bit with towards distance and I just probably, it's pretty bad, but I probably just read say are actually depends if I've met them before, I'll just talk about the general things that help pain and I'll say maybe it's working this way, but I don't, that's all I do if I think they're totally off base. I don't think I ever really say that. I don't know if I've ever done that.
Karen Litzy: 33:49 Now, and you kind of alluded to this in your answer there, but if you could recommend one must read book or article, what would it be? And if you want to say one book and one article, but just one.
Greg Lehman: 34:06 Yeah. You know what I'd go old sounds funny saying old school, but I would read David Butler's the sensitive nervous system. So good. Yeah, it is. Cause it's not only good in like a pain, but if when you read that he's just throwing out little ideas all the time. Like it would be nice for me to reread and just pull out his anecdotes and like little things that he says to do because there's things that I do and I thought, oh, this is kind of neat. And I thought I'd discovered them myself. I thought I'd, you know, you know, found it myself and then I'm realizing here at, he said it 20 years ago or something like that. Yeah, yeah, yeah. That, and then like his former partner would been Louie Gifford and I've only read parts of his books, but I've read some of his other writings and I like his stuff too. But David Butler's the central nervous system, which is just, and it's what, 15 years old, but it's still plenty accurate.
Karen Litzy: 35:07 Yeah. Yeah. And for people who are listening or watching, I can plug that into the comment section, when this is done. All right, so let's move on to the conference. October 4th and fifth in Vancouver, the Third World Congress is sports physical therapy. So can you give us a little bit of a glimpse into what you're going to be talking about?
Greg Lehman: 35:32 Not really. I am talking with Alex Hutchinson who's kind of a friend of mine here in Toronto, like the same kind of know those same people.
Karen Litzy: 35:46 You run in the same crowd.
Greg Lehman: 35:53 Like, you know, like we rock climb together. We've been to some similar weddings. I've known Alex for awhile and I love his stuff and I always pump up his stuff in my courses. That's what's funny. And then when they put him with me, I was like, this is awesome. Because I always talk about the psychobiological model of fatigue, which is that fatigue is kind of a nice analog for pain. That it's not just purely physiology, that there's a psychology component to fatigue. And I'm like, Whoa, we should talk about this because look how this area of function relates to pain. But so we're talking together on like this massive nebulous talk topic of pain science and athletes.
Karen Litzy: 36:44 Yeah. Yeah. That's a heavy one. I listening to his book Endure right now.
Greg Lehman: 36:48 Yeah. See I like the breath holding stuff in there.
Karen Litzy: 36:55 That's the chapter I'm on now, which I can't even fathom.
Greg Lehman: 37:13 So go, go online and find David Blaine's breath holding stuff. He needs to have the breath holding record. He did. But he could also do like eight minutes without that. I used to hold my breath in church all the time to pass the time. But breath holdings interesting because if you just hold your breath right now, you might make it 30 seconds, but you can train yourself to make it for four minutes. And so within like a few days if not an hour. So it means your physiological reaction to try to breathe is way over cooked. And that often happens with persistent pain. We do this protective response. So I've been talking about breath holding for years and then Alex's book came out and I'm like perfect. Now I can refer people to that way better down. But so like finding analogs between weird things about pain and then interesting things about performance or breath holding is really nice.
Greg Lehman: 38:04 So we've been talking, we were probably going to go rock climbing and then we're going to try to maybe come up with something that parallels each other. I will probably, I'm guessing talk about like how we, I like doing something really practical, like instead of saying this, which might have a negative connotation to some patients, like set them up to have some, you know, less than good expectations say this instead. So, you know, like the diet stuff, don't eat this, eat this. Well it would be the same idea with explaining common running injuries. Which we'll probably talk about, cause Alex’s a runner and I'm a slow runner. So mine will probably be something like that. Just met her way to phrase things. And because everyone always says to me like, okay, well what the hell do I do then if I don't tell them that they have SI joint pain cause it's out of place than what the hell do I say? No, no, not yet. Yeah, I think. And then that's really fun and it's a nice end. We'll have time to talk about it too because there'll be a lot of wisdom in the room and hopefully we'll maybe pull that out.
Karen Litzy: 39:22 Yeah, that sounds great. And I really appreciate those kinds of conversations because then I know that I can kind of take that and use that with my patient population on Monday. Or Tuesday, whatever day. But you know, the next day in clinic.
Greg Lehman: 39:38 That's the idea. I don't want to hammer people with research. I know I won't do that. That's for sure. That's easy. I could do that. And it'll be entertaining by your life. Go. Well I got some more research, but it'll probably be more practical. Right. And we're real, more practical story.
Karen Litzy: 39:52 Nice. And I look forward to, you know, the two of you speaking together, I think we'll be entertaining and educational and I look forward to that kind of play that you guys will most likely have off of each other. I’m reading his book and you brought the bread holding, which is exactly where I am. And it reminded like in the breath holding chapter, you know, he said like the people who had like, who broke these records or who could really hold their breath the longest are the people who knew that someone was there to pull them up if they needed it. Yeah. And so when I think about that as it compares to pain, like especially persistent pain, I wonder if you knew like you had an out, would that pain still be as persistent? So that's what got me thinking listening to this chapter was like, hmm, if you knew your pain had a safety net, how would that change your view of your pain?
Greg Lehman: 41:03 Oh, that's interesting. No, and I think what you're talking about has actually more ramifications for the negative aspects, right? Because most people think, oh, this will pass, but there's some that think that this won't pass. And Yeah. And that's why there is no optimism. And that's of building that where, there's no reason for them to think that it will change. And that's kind of what we have to do is build that model that there's a possibility for change.
Karen Litzy: 41:35 Yeah. And before we're going to wrap things up in a second, but Kate Pratt said, well, I find one of the greatest sources of misinformation to patients about pain and biomechanics is their MD/ortho. As PTs we hopefully consistently educate our patients. Do you think it's possible to educate MD’s or orthos regarding pain and how would you begin to approach such a scenario? So I think she means as the individual clinician with, you know, the referring physician or the physician who's seeing that patient.
Greg Lehman: 42:11 Yeah. I mean in general, I think that's a problem across the board of all professions. How we change our colleagues, view the docs, like our colleagues. And I'm not really sure cause you would assume that has to happen at a school level, right at the training there and at a conference level. So it's really conferences in schools who are open to, you know, providing the different messages there. But I would say, and we've talked a lot about this is when you do have patients who have these beliefs from their doctors or other healthcare providers, which is super common, there are routes that you can, you know, still address those beliefs without throwing the doctor under the bus and that’s what you have to figure out. So often it's more like acknowledging yeah, that's, you know, you have hip pain because he has OA or something you can say that's part of it.
Greg Lehman: 43:15 This is the my optimism approach. Yeah. The hip OA is part of your hip pain, but you can still do great even though you have those changes on the scan. And that often really helps, especially with when physios and like we're navigating referral sources. And it's so funny that you bring, I just got, I just like 10 minutes ago before we started, I got a referral from a sport MD who was in the course. I taught with JFS school. On running five years ago and said, are you seeing patients? And like it was so funny that she was in the course because you don't normally see MDs. Yeah. You know, taking courses with the PTs. Great to do that. And so that's how we have to change. You use it somehow get into that educational system.
Karen Litzy: 44:01 Yeah, I agree. And from a one on one. I think it's difficult. I mean
Karen Litzy: 44:11 What I've done once that worked with the referring physician was, you know, I said, hey, you know, we're doing this, this, this and this, but I found this article, do you want to take a look and let me know what you think? Cause I'm thinking of incorporating it. And it was like an, I don't know, I think it was an article, Moseley or Peter O'sullivan. And so I sent them that and then he was like, oh yeah, that's really interesting. Yeah, definitely start doing that. So that's a way you can kind of maybe start.
Greg Lehman: 44:44 Yeah. O he or she just rolled with your resistance maybe. No, I totally agree. Yeah. I think we're good.
Karen Litzy: 45:00 It's so hard, but it's a way to be diplomatic. It's a way to say, you know, I don't know.
Greg Lehman: 45:08 I really liked that you just sold a good treatment plan and then you gave them other research behind it. That's nice. Yeah. That's probably better than saying you're an idiot.
Karen Litzy: 45:20 Yeah. Well, yeah. But I mean I also find that like I had one doctor that came back to him and he's also a good friend of mine. He was like, that's really interesting. Like we need to talk more about it. Oh, that's cool. Which is awesome, you know? But he's also a friend began, you know, we played softball together. So it's like the different opinions.
Karen Litzy: 46:01 Chris Johnson said to say thanks for carving out the time you need to stop picking your eye. Always exercise diplomacy and avoid creating a disconnect. It doesn't accomplish anything. And that's in regards to Kate's question that we just tried to answer. Like I'm bringing a course to New York City and we're going to have like a free two hour preview of it and just invite doctors.
Greg Lehman: 46:44 Wow.
Karen Litzy: 46:45 That's, you know, one way to do it if you want to get them involved in the educational process with Physios, which I think is great.
Greg Lehman: 46:52 One of my best course ever in Toronto here was, we had three physiatrists that came and they were fantastic. That's awesome. Go into this stuff. It was a bit, some of it seemed a bit new, but they're open and like, and then the email to everyone after and they share their experiences. I love when you have multi disciplinary people at the course. There are some, I mean I'm not throwing MDs under the bus. They certainly, it's so hard. I have a friend who was an MD and he's like the best motivational interviewer. He was so good. Like he knew this thing is that as patients had to do, but you know, in Canada you only have eight minutes with them. Yeah. And there or whatever. Anyways, so I'm off topic.
Karen Litzy: 47:42 So let's wrap things up here. Are there any presentations you're looking forward to seeing at the conference?
Greg Lehman: 47:48 Rob Whiteley. Yeah. I really like is like career and that the stuff he's done and what he's doing there, you know. I'm a socialist I like exercise for everybody and I like the name to change things. But I have trouble like arguing with exercise. It's amazing. It's jam packed like there, there's so many. So that's one of the reasons I wanted to go cause you know, I would have, it'd be nice to go to that conference as well.
Karen Litzy: 49:22 Well, I am looking forward to your talk with Alex. I will obviously finish his book within the next week, so that's very exciting. And I've already taken your class and read your free resource. So I feel like I'm like ready for it.
Greg Lehman: 49:39 I'll bring something new.
Karen Litzy: 49:42 I'll come armed with lots of questions. All right. So before we hop off, where can people find you?
Greg Lehman: 49:49 Just my website I guess, which is Greglehman.ca. Which I hardly do anything on and then Twitter, same thing. Twitter is my favorite. I like the discussions on Twitter, even cultivate them, trying to keep them polite and nice and you know. So Facebook, Nah, it's for the trolls.
Karen Litzy: 50:15 I think. Yeah, I guess it depends anyway. Again, a whole other conversation. Yes.
Greg Lehman: 50:21 No, I'm doing a big thing on Facebook right now. I shouldn't say that.
Greg Lehman: 50:29 Yeah. Cause we have like a podcast with me and Oh, I have a podcast, I guess. Never. It's, well it's Adam, it's Meakins podcast, but I'm the cohost so I guess is mine. I don't know. When do you get part of that? I've done three with them. I'm just baggage. I'm a carry on.
Karen Litzy: 50:52 Yeah. I think, I think you need, you need a little bit more. I don't think that three really qualifies as like a permanent cohost.
Greg Lehman: 51:01 Oh yeah, yeah. I don't think I want that.
Karen Litzy: 51:03 No, no, no. You're still like a guest cohost, give it a couple more and then I think you're in.
Greg Lehman: 51:08 Okay. Well we're doing like a thing on neurodynamics like their dynamic techniques. And so I wanted to poll people and see what people thought. You know, I was curious what people thought, what the hell we were doing when we do them for that.
Karen Litzy: 51:27 I use them, I use them. And oftentimes in people who are a little fearful of movement.
Greg Lehman: 51:33 Yeah. So what does that tell you what you're doing? Or you really like manipulating the nerve to, you know, feed them more oxygen or something. Getting someone moving again?
Karen Litzy: 51:45 I think you're getting someone moving again, I think you're taking them to a place where they can stay within a relative comfort zone and you can kind of see, I think what I use it is because you can see some changes pretty quickly. And so I think patients then get a little more confident that they can move because they can see those changes pretty quickly. So that's why I like to use them is to give people some hope.
Greg Lehman: 52:15 It’s a modification.
Karen Litzy: 52:18 So that's why I use them, but I use them quite a bit just because I think, I think that they work very well. The only time I don't use them was really with like one person who said I was doing all these nerve glides and now it made my arm so much worse.
Greg Lehman: 52:37 It's like everything.
Karen Litzy: 52:38 You know, but I don't know how many, what they were doing, why they were doing them, what explanation they were given. I have no idea that I just sort of held off for a little bit and had the move a different way. But yeah. So that's why I use them.
Karen Litzy: 52:59 So if no one else has any questions. So Agnes said that she'll play softball with me in Vancouver.
Greg Lehman: 53:08 Tell her I’m going trampolining and rock climbing.
Karen Litzy: 53:15 I would go trampolining but I really just like bungee trampoline.
Greg Lehman: 53:19 Let's do stuff.
Karen Litzy: 53:20 Well you're attached to a bungee and then you obviously go down and then you can go up and flip like two, three times in the air and come back down again. You can't twist, but I did do a double layout. Yeah, it was pretty cool. But yeah, I would definitely play softball. I will bring my glove and I can do some trampolining. I wouldn't have done it 10 years ago or five years ago because of my neck, but now I can do it. Yeah, totally can.
Karen Litzy: 54:14 Just so people know when Greg and I were at the align conference a couple of weeks ago in Denver, Colorado and he had his daughter Betty with him cause it was her birthday weekend and she was his personal photographer just so that it made him look better than everyone else because he had personal Paparazzi. And she was just super adorable and doing back walkovers and she probably would've done a lot more, but we were at a conference on the first day.
Karen Litzy: 55:21 She was very sweet and that's who we're talking about. All right. And I’m going to edit all of this out before I put it out on a podcast. Thank you everyone so much for listening and sorry for rambling at the end. If no one else has any questions, I just want to thank you all for listening and make sure you go and click on the link on this Facebook page. Should take you to the website for the Third World Conference in sports physical therapy. Again, it's October 4th and fifth, and Vancouver. Greg is speaking with Alex Hutchinson and I think that's going to be a highlight of the conference. You don't want to miss it. So Greg, thanks so much for hopping on the call and sorry for the technical difficulties. Thank you so much and we'll try and put all the information that we spoke about in the comments section here. So thanks everybody. And Greg, thanks again.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Kelly Duggan on the show to discuss her hybrid physical therapy business model. Kelly is the creator and owner of Physical Therapy U, a successful insurance based PT clinic in Bridgewater Massachusetts. PTU is focused on changing the healthcare experience for their community with a focus on youth athletes.
In this episode, we discuss:
-How Kelly’s hybrid practice has married quality patient care with financial freedom
-Marketing strategies that have exponentially grown Kelly’s practice
-Top key performance indicators Kelly tracks to ensure her clinic meets its mission
-Why your life vision should align with your daily life
-And so much more!
Resources:
Email: PTUclinic@gmail.com
For more information on Kelly:
Kelly J. Duggan is a physical therapist with over a decade of experience in both inpatient and outpatient settings. Kelly is the creator and owner of Physical Therapy U, a successful insurance based PT clinic in Bridgewater Massachusetts. PTU is focused on changing the healthcare experience for their community with a focus on youth athletes. Physical Therapy U is a hybrid clinic offering PT, massage and sports/fitness trainings. Kelly uses this hybrid approach to combat the typical decline in revenue that most insurance based outpatient clinics (that aren’t tied to a hospital) experience over time.
Kelly is also a proud wife and mom of her three young children. Kelly has worked hard to show that although the timing doesn’t feel “perfect”, you can open a clinic at any time of life. Physical Therapy U was created during the 3 months after her third child’s birth, while she also had her 1.5 year old and 3 year old home with her. Kelly encourages others to go after their dreams and although being in the spotlight causes significant anxiety, she continues to push herself forward so that others can see what is possible.
In just three short years Kelly has successfully tripled her small business from a 1200SF space to a 4500SF space without the need of tripling her patient visits. Kelly enjoys sharing her highs and lows with others so that they can learn the best techniques even faster than she did.
Physical Therapy U continues to grow and evolve and Kelly welcomes any and all advice for the future success of her business.
Read the full transcript below:
Karen Litzy: 00:01 Hey Kelly, welcome to the podcast. I'm happy to have you on. Welcome.
Kelly Duggan: 00:06 Thank you so much for having me. Excited to be here.
Karen Litzy: 00:09 And today we're going to talk about your business, the growth of your business. I would say the very fast growth of your business over the past three years. So PTU opened its doors three years ago. It was you and your sister working 10 hours a week. And now let's fast forward to three years. You have 17 employees, four PTs, one PTA. I mean that's a huge growth in three years. So I'm really excited for you to come on and let the listeners know how you did it. So let's first talk about how you started. So take it away.
Kelly Duggan: 00:49 Yeah. So how we started, I was actually nine months pregnant and trying to decide which direction I was going to go with things. I had always been an employee that worked like around 30 hours a week and I would have one day off with my other kids. And when we got pregnant with our third, we realized that financially that was not going to be an option anymore. I needed to work full time. So I started looking at different options to do that, who I would work for, what I would want to do. I've always really enjoyed, the program development and the marketing aspect of physical therapy. For me, you know, I've always needed a creative outlet and that was kind of my outlet in physical therapy. But where I was and kind of what I was looking into, that wasn't going to be an option.
Kelly Duggan: 01:43 So it kept getting thrown around. Like what about your own place? What about your own place? And so finally, as the pregnancy progressed, I sort of started looking into it. So what do you, what do you do when you first start looking into stuff? You start googling it. So that's where this all came from, is kind of a few Google searches of like, how's this going to work? And, what I did at the time, was reached out to a few other people that were in my situation, parents of multiple kids that own their own practice to see because for me, that was the big hangup of, you know, this is going to take a lot of time away from my family. Am I going to be okay with that? And how, you know, how is that gonna work with my family and work with myself or my kids in the future.
Kelly Duggan: 02:31 So I reached out to a few other moms of multiple kids who had opened their own practices. And, you know, I got some feedback that I liked. I got some feedback that I didn't like and, you know, I kind of just hung on to the words of advice from the people that said, go for it. And Yeah, I think my son was like one month old when we finally committed and I said, you know what, I'm just going to do this. And I think, and I always laugh about this, but I think that I was so massively pregnant and then postpartum that my husband was just like, yeah, whatever you want to do, whatever that sounds great. Whatever we have to do, we'll find the money and just kind of like on board. So yeah, we started out really small.
Kelly Duggan: 03:20 I found a clinic that allowed me to do a one year lease because for me, I was just preparing for, well, if it doesn't go well, what are my options? I'll always have my license. So, you know, where could I work if this doesn't go well and it doesn't build and it doesn't grow, like I want it to grow. So I found a clinic that did a one year lease. I looked at all the bare minimums of what do I need to make at the bare minimum. And I just laid it all out. You know, I always say I'm not a huge numbers person, but I think owning your own practice turns you into one. So now I'm like all about the numbers and that's, you know, my mom took this photo of me sitting at my laptop.
Kelly Duggan: 04:05 Like, I dunno what I was doing either making the website or trying to crunch the numbers and I've got a coffee in one hand, one hands on the mouse and somehow I'm like balancing my newborn like on me. And it was just like very kind of how my life was at that moment. And for me it was if I want to do what I'm really passionate about in PT, which is marketing program development in sports, then I have to create it myself because it's not there. The option is not there for me. So it's just figuring out what I had to do to do it myself.
Karen Litzy: 04:58 And I mean to do this massively pregnant and then with a newborn, I mean that is ballsy. Like that is no joke. I mean, I don't have children, so I don't know what those first months are like, but I mean, and this was your third. It's not like it was your first, you had two other children. I mean what a leap.
Kelly Duggan: It was. And again, it was just kind of like, all right, it's go big or go home. Like if we're going to do this and I'm very much a determined person. If something is not there that I want, I'm going to create it or make it or somehow make it happen. And this was an opportunity for more time with my family in the long run. So in order for me to have more autonomy in the long run, it had to be done and it had to be created and it was, you know, it was for me and it was for my family and it was kind of like that, you know, you see like the parent lift a car off their kid, you hear those stories of was that sort of situation, it was like, okay, here’s this person with no business background, who hates numbers.
Kelly Duggan: 06:01 Who is going to like create this massive thing because I have to, that was the option, so it had to be done, you know?
Karen Litzy: Yeah. And so that's when you started three years ago. So let's fast forward now to today where like I said earlier, 17 employees four PTs, one PTA. So can you break down for the listeners how you did that because that is massive growth and Kudos to you.
Kelly Duggan: Thank you, so it's funny because I didn't plan it that way. It's not like I was like, you know what, my three year plan is this and my five year plan, 10 year plan says this again, I was very naive going into it. So I thought this is my plan and this is where I'll be, you know, three years from now if it's successful, I'll just stay in that same location.
Kelly Duggan: 07:00 So we opened our doors in May and in September I looked at my sister, I'm like, well, this isn't going to work. You know, we were in a 1200 square foot space, you know, it took about a month and a half, but we went from no patients to I had a full schedule and I was prepared on the opposite end of that. Like I was prepared for all right, maybe I'll have three days or whatever it is. But we scaled really quickly. So starting in September, I started looking for additional staff and it took me until January to actually hire someone. So I would say anybody that's kind of in this position is just make sure you're preparing ahead of time for if it does go well. Cause I did not. And so I hired someone in January and then I hired my second person in February and that's when I said, okay, I'm not even gonna make it to a year in this location.
Kelly Duggan: 07:56 Like we need to expand. So it was probably March so not even one year in where I started looking into what is this location need to look like in order for it to be a success because the demand was there and I didn't want to not provide the same service for more people. Like, you know, you see clinics that ended up getting stacked in their booking. People on top of the next person is just crazy and busy. And I didn't want to do that. I wanted to still be able to provide the same level of service just for more people. So that meant expanding. So I started looking at additional locations and how that was going to work and started hiring and scaling is the big word that we used, but we scaled up from March when I started looking to the following March when we moved into our new location.
Kelly Duggan: 08:57 It was just kind of a slow scale and I was lucky enough to find a team of people that understood the importance of where we were going. And they were willing to adjust their hours as needed, but also work anywhere between like 28 and 40 hours as needed as we scaled. So for me, you know, I don't like to use the term, I was lucky because I busted my ass for everything that I've done. But in the sense of hiring people, in a kind of a team and a family that understood the importance of that, I was lucky. I mean these, these people kind of worked as hard as I did to get us to where we need to be. So that was good because you don't always find that in employees, you know?
Karen Litzy: 09:44 Yeah. For sure. And now let's back up for a second. How did you go from zero patients to a full schedule? Cause that's what everybody wants to know. How do I get more patients on my schedule? How do we let people know we’re here and we’re ready to help?
Kelly Duggan: 10:03 So. MMM. Yeah, you know, I hustled basically. So in whatever that term means to you, you know, like the older generation are horrified by the use of that term. But, I worked really, really hard. And I just networked and got my face everywhere. And you know, it, I think we've talked about this before, but I feel really uncomfortable when I'm talking in group settings or in front of people
Karen Litzy: 10:34 I know, but I don't get it.
Kelly Duggan: 10:38 Thank you. The Facebook lives, but again, it was there was a need to do, I knew that if I wanted to grow my practice, people had to know who I was. And I had to be seen as kind of an authority in the PT World, in my community. So in order to do that, you have to put yourself in front of people. So I was putting myself in networking groups, putting myself in business associations, talking, volunteering to talk, I'm doing all these live videos and posting it to different groups and doing all these things that are way outside of my comfort zone because I knew that people had to recognize me and my brand as, you know, as healers. So, on top of that we did like a lot of online marketing or I always say we, but I did a ton of online marketing.
Kelly Duggan: 11:29 As well as, I did some print ads, not a lot because they're so expensive. But what I did do, which I tell everyone to do, cause it's such a good idea, is I think it's everyday direct mailers is what it's called for the post office where you can either create a postcard or a letter and you can map out on the US Postal Service website, who you want to get your letter. And so within like a three mile radius of my clinic, I sent out a postcard, which one side had who we were and what we did and the services we offered. And then on the other side I did a baseball schedule. Right. Or you do a football schedule or basketball or whatever. Because for me, like when I get mail, if it's junk, I throw it out unless it has a sports schedule on it.
Kelly Duggan: 12:24 And then it's on my fridge. And then I don't even know who these people are and they're on my fridge, the entire sports schedule because it's the sports schedule. So I put it up there. So to put the sports schedule or whatever that is, you know, in your community, it goes right on people's fridges. And then every day they were opening the fridge and they see your logo and they see whatever it is you put on there. And that helped. And I did have a lot of patients that came to me because they got the flyers and they're like, oh yeah, you're on my fridge.
Karen Litzy: Yeah, because don't they say it takes like x amount of touch points before some of them will decide to pull the trigger and make a purchase.
Kelly Duggan: So I did a ton of marketing, you know, and even, you know, the patients that we did have asking them, but I don't want to use this as like a copout as to why we scaled so quickly.
Kelly Duggan: 13:16 But you know, I also take insurance, so that obviously is a lot easier than convincing people, you know, over your cash rate. But in the beginning I wasn't contracted with every insurance, so I was actually seeing, you know, a handful of patients that were paying my out of pocket rates because I wasn't contracted with their insurance yet. So that was kind of cool.
Karen Litzy: Yeah. So you had a little bit of a hybrid in the beginning and then, and now, do you take all insurances in your area or just a couple?
Kelly Duggan: I take most insurances there. Again, from the business side of things, there are a couple of insurances that financially, we wouldn't just lose money, but I'd lose like a lot of money. So we can't take every insurance, but we do take most and then we do offer our cash rate or a prompt pay rate if people don't want to use their insurance or some people don't even want to use their insurance benefit.
Kelly Duggan: 14:21 So, even though they have an insurance that we would contract with, they choose to still pay us a cash rate and then you know, we have additional services since moving into our larger location that cause again, PT insurance, it doesn't, unless your really savvy is the word I'll use, it doesn't make good money. We basically we paid the bills and that's how we get by. But if we want to make additional incomes of that, you know, my employees can get raises and we can buy new fun equipment. We had to take on all these additional ancillary services in the new location.
Karen Litzy: 15:02 Okay. So what are these ancillary services? Because this is something that I think we really want to touch upon because listen, not everyone has a cash based service. I would say the majority of people by and large do not. Yeah. And that most physical therapy offices around this country take insurance. And like you said, sometimes the insurance does not reimburse a lot. I know New York state, it's very, very low. So what ancillary services have you added? So again, kind of make that hybrid practice.
Kelly Duggan: 15:40 Yeah. So in our previous location, which was really small, what we did, and it was a much smaller scale, but we would hold classes every now and then, so we'd have, you know, a yoga class or a strength and conditioning class or something so every now and then we could get a little bump of money, in our new location, which is 4,500 square feet. We're able to add in a lot more.
Kelly Duggan: 16:10 So we're looking to make it a little more consistent, but we've had yoga. I hired, so I didn't like rent out, but I hired two massage therapists, and they work on kind of like a per diem rate. So they're not there all the time, but you know, when they have clients. So we've built up and that's really been a huge compliment to our physical therapy services, not only for our patients, but for our therapists in kind of taking the load off of not having to do as much manual because if people are getting massages with it, it just helps that much more and then people are carrying over better. And, so that's been a benefit all around financially and for our patients. And for our therapists. We hired massage therapists.
Kelly Duggan: 17:11 I had massage therapists and I have a program that we call the elevation programs so that, we all know that insurance doesn't cover everything, right for physical therapy. They don't really cover the sport based stuff or transitioning someone back to crossfit or whatever it is. It's not always covered within their plan. And then, you know, there also insurances that cut you off after 60 visits or at 90 days. So what we did was kind of bridged the gap between physical therapy and a patient's return to sport or return to their full activity. So we created something called like an elevation plan where people can purchase it on a monthly basis, you know, similar to how you would purchase a gym membership. And the elevation plans include, you know, PT visits, massages and an exercise prescription by a personal trainer, which one of our rehab aids is a personal trainer.
Kelly Duggan: 18:21 So we utilize her and kind of kick people off with this really great program. And it's really meant to be a transitional program. So people will do it for a month or two, and then they have the confidence in order to get back to sport or gym or whatever it is they wanted to do. And maybe they're like getting back to, but maybe they're starting it for the first time. So we have yoga, we have the elevation plan, we have massage, and we do like sport performance clinics. So, you know, sometimes we do two hour ones. We just had a dance one for our dancers. Sometimes we do, you know, like a six week program for our youth athletes. We really focused on, at the new location, kind of like, my big thing was, okay, you know, I love to work with athletes.
Kelly Duggan: 19:15 I think it's an underserved population. The youth athlete, I think we get lost in the shuffle. So that was for us kind of a big part of what we're trying to do with PTU. So we have all these programs for our youth, for flexibility, coordination, the things that the coaches can't necessarily allocate time for in their practices. We again, are just trying to bridge the gap and support where there is a need. So we created all these programs. So all of that is additional money that helps to run our insurance based practice.
Karen Litzy: 19:54 Right. Fabulous. And I love the sports performance for our kids because you're right, that is not something that is widely used. You know, kids they go to their practice, they do their sport, and then that's it. And I mean, I see a lot of kids in my practice having very adult injuries, ACL injuries, you know, knee pain, a torn labrum. So things like that. So I think what a great idea. And then that's also great for your marketing. Right?
Karen Litzy: 20:37 It’s also great for your marketing because then you have the kids coming in, the parents know you’re there. So if something happens to anyone in the family, they're going to come to you because they already know you, like you and trust you.
Kelly Duggan: 20:53 Yeah, absolutely. I think, you know, with having like kind of the youth athlete as your main population, you know, they can't drive themselves. So someone has to bring them, whether it's a parent or an aunt or you know, and then they're exposed to your facility and exposed to what you do. And, I think once they see that you're providing something different, that's of quality and the services, the customer service there, it just spreads like wildfire.
Karen Litzy: 21:28 Yeah. Fabulous. And now so we spoke about what you did to get patients in the beginning, how you've expanded and how you've expanded so quickly, which is all awesome. Now can you tell us, were there any mistakes, any pitfalls along the way that you can share?
Kelly Duggan: 21:50 I mean, there's always, pitfalls. I'm trying to think of something.
Karen Litzy: 22:00 Yeah. Like if there's something that you're like, oh man, if only I knew I would not have done it this way.
Kelly Duggan: 22:10 Yeah. Well, you know, a lot of pitfalls that were kind of, if I had known I probably would have done differently. The billing aspect of things in the beginning we outsourced, which was fine because again, it wasn't like I was learning so much at the time anyways. It's not like I could learn another skill of the billing side of things. So I outsourced. But we lost a lot of money in outsourcing. And I think not only did we lose a lot of money, but I think there was a lot of opportunity for me to have learned more about why we bill and what we bill and that aspect of things that I just wasn't paying attention to for the first year and a half. I was just kind of filling out and assuming that everything was fine and coming back on in it and it was fine.
Kelly Duggan: 23:10 It was just once we decided to take on billing and hire someone, the learning curve there of what we're billing, how much we're billing, why we're billing it, what we get paid. I learned a lot in those first like six months of bringing on billing that in hindsight probably should have just figured out like how I could have done that earlier on. Because once we took it on and we started learning more about what you know, actually pays and what doesn't pay, we were able to make some adjustments in what we do to make more money through insurance. So that was definitely kind of a big eyeopener for me switching from outsourcing billing to taking it on.
Karen Litzy: 24:01 Great. Yeah. Know your billing know where your money's coming from, where it's going and why some things are being paid and others are not. And I mean the list can go on and on. Right,
Karen Litzy: 24:14 That's great advice for people who are wanting to start their own practice, especially in an insurance based practice.
Kelly Duggan: 24:24 Yeah. And a lot of those outsourcing companies, they will train you, you know, that's an option. I just kept saying, Eh, I'm like, like this one more thing I don't need to know. And it was like once I learned it, I'm like, wait, what was I doing? Why did I not want to know any of this is so important. Making more money.
Karen Litzy: 24:42 Right. And now what are the things that you look at now? So in business, you know, we talk about key performance indicators. So what are let's say for you and your business, what are the three most important KPIs that you look at?
Kelly Duggan: 25:08 Yeah, we look at cost per visit. So obviously you're looking at what you make per visit cause that's important for me. I'm looking at cost per visit and obviously I want that to be lower than what we make per visit because my overhead is so high, our cost per visit is a bit higher. Which is why in going to the new location and tripling in size. It's funny cause a lot of like insurance based PT clinic owners were like, no, like that doesn't like, you can't do that, it's not gonna work. Insurance doesn't pay enough money for that model to work. That's why people don't do it. And I just kept going back to like, yeah, but it's a service to our patients. It's exactly what they need and somehow we're gonna figure out how to make it work because it's what people want and it's going to just provide so much for them.
Kelly Duggan: 26:12 So a huge one for me is cost per visit cause it's high. But we want it to be below what we make per visit. So I'm looking at cost per visit and then I'm looking at how can I make that lower? I pay attention a lot to like how many elevation plans were selling in a month, how many massages we're selling in a month. Because again, that is going to bring down that cost per visit for me so I focus a lot on there. I used to focus on, you know, the average amount of visits we were getting out of people. But over time it's been similar over time, so it's not like I'm like, you know, worried about it. But there are certain key performance indicators that I don't know how I want to say this without sounding like, I don't want my therapist to be aware that all right we need every patient to have 12 visits because that's what we need financially.
Kelly Duggan: 27:26 You know, you don't want someone's treatment to be affected by the bottom line. So I track it, but that's not something I share with my employees or even try and like, oh, we got to get that to, you know, 13 visits or 14 visits because I mean, it's a wonderful thing if you can get somebody better within four visits or six visits, cause then they're gonna, you know, talk about, Oh my God, I felt better in six visits. So you don't want to focus on those numbers. So I think, you know, you do see that number of listed a lot when people are talking about key performance indicators and how many visits you're getting out of your plan of care. But I think going into it and focusing on that number is not a good thing for us as PTs.
Karen Litzy: 28:15 Right. Yeah. And, also it then puts these perhaps unrealistic what's the word? When they have to meet a quota, is that a thing? Like PTs have to meet a quota or something like that? Yeah, some clinics. It incentivizes the wrong thing, right? I think what you're doing is you're incentivizing patient care. Versus incentivizing patient visits. Those are two very different things. More visits doesn't equate better care. It just equates more visits.
Kelly Duggan: 28:59 Yup. Exactly. Exactly. And we've talked a lot about in talking to my coworkers and stuff of, all right, well, what do we have to do? How many visits do we need to do? And how many massage appointments do we need? How many elevation plans do we need so that we continue to deliver the level of care that we're delivering. I don't want to change my business model to seeing a patient every half hour, or, you know, forcing that sort of way to hit our bottom line. I'd rather have it, well, you know, can we get more people in? Can we do performance clinic? Can we, you know, add in yoga again, like how can we add additional services? Because you hate to really like turn into a mill to hit your numbers, you know? So for us, we need to encourage more people to, you know, sign up for massage or maybe we need another deal because we're getting close to that number of we're not gonna, you know, make our minimum requirements and we don't want to change our model. We don't want to change the level of care we're able to provide to people. So I think that therapists knowing that they are getting so much better with like, mmm, you know, wanting to do these additional programs and wanting our patients to do these additional programs. So it's been good in that sense. You know, and I've heard from other business owners and other PTs that they’ll get a bonus if they hit their productivity.
Karen Litzy: 30:42 That's terrible.
Kelly Duggan: 30:46 That’s not what we want to do at all. You know, it's like, it's just, again, it's the quality of care and it's then the PTs just thinking about their numbers and not, am I getting people better?
Karen Litzy: 30:58 Exactly. And then, you have PTs saying, oh, I can work through lunch or I'll stay later, or I'll come in earlier because they're just so focused. I mean, let's be honest, a lot of PTs are type A, right, so focused on hitting this arbitrary number to get a bonus. Right? So let's say they get $1,000 bonus. Well, right, that thousand dollar bonus down to all the times coming in early and lunches that you worked through, guess what, that thousand dollar, $2,000 bonus that it doesn't equate to what you're making per hour. Right. And then it just, I think it's a great way to burn out your therapists. And I'm not sure, is the care better? Is it not better? I don't know that I can't say, but I think it's, like we said, just incentivizing the wrong thing. So glad you brought that up. Is there any other big KPI that you look at regularly and that forces you to maybe change the way your business is being run?
Kelly Duggan: 32:17 Not really. I mean, I look at a lot of stuff just to monitor for myself. You know, I look at average codes for treatment, you know, and are we in line with the national average. You know, how can we make that in line with the national average while still providing the quality care that we're providing. I mean there's nothing that I, again, it's a lot of stuff that I look at kind of the behind the scenes stuff, but nothing that I would want my therapist too be concerned with I guess.
Karen Litzy: 32:59 Yeah. And what about cancellations? No shows? Yeah. It's always one that everybody always touted as being one, but I dunno.
Kelly Duggan: 33:10 We track that and if it starts to get higher than like, you know, a certain number, we were like, okay, what's happening? But we have things in place that, kind of limit the amount of cancels and no shows. You know, we do our reminder calls. We, you know, people that are dropping off, patients that drop off. We use like an automated email system we use. We're integrated with strive, so we use strive, but I know some people use infusion soft.
Karen Litzy: 33:45 Infusion soft is very expensive.
Kelly Duggan: 33:48 Yeah. I love strive. It's really user friendly. And the customer service has been awesome and you don't have to like build your own sort of stuff. It's, you know, you create your own content and all of that, but you don't have to like be a computer genius to use it.
Karen Litzy: 34:12 And is that strive labs through web PT?
Kelly Duggan: 34:16 We were using them before they were integrated with web PT and they do work with, you know, if you don't use webPT, I believe, you know, but I do use webPT.
Karen Litzy: 34:28 Cool. Very cool. And so we talked about where you came from, where you're at, what you're looking at, how you're growing. So now where do you see yourself going in the next three years?
Kelly Duggan: 34:43 Yeah, so, you know, I’m always thinking about that. But you know, one of my biggest struggles I would say right now is because we're so busy as just like, how do I get through the day? How do I get through the day? And I would say a couple of weeks ago, I'm like, what am I doing? Like all of my energy is focused on how am I getting through today and this week? And I'm not thinking of kind of the long term. And every time we have either a student or someone interviewed, they're like, what's the longterm plan for PTU? I'm like, well, you know, I don't really know.You know, people ask, because for me it was, I opened PTU because I wanted that creative outlet. You know, I wanted to support our athletes, but I wanted autonomy and I wanted time with my family. And I'm starting to get that so I don't want to, you know, it's not in the cards for the next three years to expand to another location.
Kelly Duggan: 35:42 It's just to get this PTU central location successful in the insurance world. And, you know, I'd like to be able to give everybody raises. And all of that. So I want the next three years is figuring out how do we make this insurance hybrid model, successful so that we can, you know, give people raises and continue to treat at the level that we're treating. And you know, so that I can get the time that I wanted with my family. And then if we're able to do all of that in three to five years, maybe, you know, I've talked about adding on a second location, but I don't even want to think about it because I'm, again, like you mentioned, a lot of PTs are type A, I'm so type a that if I decide that I want to have a second location, I can't say, well, I'm going to do it in five years.
Kelly Duggan: 36:39 Like it'll be here in six months. Like that's just how like I work. So I just, I want to keep putting that off. And for right now it's just PTU. It's our central location. I want it to be, you know, successful. And when I say successful, you know, I don't want to sugar coat it. I want it to be lucrative. I want it to be a business that makes money.
Karen Litzy: Of course you got, why wouldn't you and what other business world outside of like PT, the healing world do people say I really hope it's successful. Like of course yeah I still want to make money though. Yeah! That's why you started your own business for some freedom, for stability to be with your family, to help the people in your community and to make money. You didn't start a business to not make money.
Karen Litzy: 37:32 He didn't start a non for profit, which is a totally different world. So like if you opened up a clothing store, you wouldn't be like, man I just, I just hope I can make money one day.
Kelly Duggan: Yeah. It's funny cause it's the PT struggle, you know, it's like I want to support my patients. But you know, you have to put on that business owner hat and be like, well we need to make money to support our patients.
Karen Litzy: So that's right. It's your responsibility to make money so that you can be present in your neighborhood and that you can be present in your community and help people. Because if you didn't make any money, you'd have to close your doors and all those people who depend on you, what do they do then?
Kelly Duggan: Yeah, exactly. So in three years, you know, I want, you know, hopefully two more PTs is like the goal, you know, and I'd like to have that within the next year. And I want one of those PTs to take over the performance side of things because I feel like that's one area that we can continue to grow and we could have, you know, we could constantly be hosting some sort of sport related supportive group or clinic or camp or whatever. But I don't have time to plan all that. So I want to hire, I want one of my PTs to kind of take over the performance side of things.
Karen Litzy: 38:49 Very smart. Well, it sounds like you have a good plan in place and I love the fact that you said, you know, I just want to make this into a well oiled machine. This is what I want. And that's amazing because not everything, like you said, not everything has to be scaled to infinity. I mean, knowing where you are in life and knowing what you want and knowing how you want to live your life and if you can achieve that
Karen Litzy: 39:20 Achieve those goals within the parameters that you have. It just has to be, like you said, little tweaks here and there. I think that's amazing. So congratulations on such a huge, huge change in three years.
Kelly Duggan: 39:34 Thank you. Thank you. And I want to actually bring that up. I want to say something to that because, I think again, PTs as kind of type A, and especially PTs coming out of school, we are so on this really, really like fast train of trying to be successful and achieve our goals. And, for PTs a lot of people are so focused on their career and their career ladder in their career growth. And I just want to say a reminder to people to kind of pull yourself away from that for a second and just think like, what do I want out of my life? What are my life goals, right? Is it that I want to travel more? Is it that I want to have a lot of money?
Kelly Duggan: 40:25 Is it that I want more time with my family? Whatever it is for you. Think about that for, you know, a few minutes and then think about, okay, so how does PT fit into that? And not the opposite way of like, let me like reach the top of this career ladder and then like, well, is PT my life? Or like where am I now? So just pull yourself away from that and think of, you know, like for me it was and it might take a life event for you to figure out that. Like for me it was having my third kid and like, wait a minute, what the hell am I doing here? And it was okay, I want more time with my family. How do I do that? How does PT fit into that? And I just want to encourage more people to do that. Cause I think as type a people, we get so obsessed with climbing this kind of career ladder that, you know, we can get lost in it.
Karen Litzy: 41:19 And great advice. And I am in this, speaker's group, which is really a bit of an entrepreneurial group as well. And the woman who runs it Trisha Brook, at one of our first sessions, she had us write out kind of what do you want your legacy to be? And that's if you think about that you're doing exactly what you just said. You know, you're putting forth what do you want your legacy in this world to be? Right? And it sounds like for you it was too, you know, be with your family to have an influence over your children and to have that be such a great legacy. Have your children, your family, be your legacy, have the community that you're in, be your legacy. But what I didn’t hear from you, and correct me if I'm wrong, but what I didn't hear from you is for PTU to be your legacy.
Karen Litzy: 42:21 Right. It was, I want to make a change in my community and my family and that's the legacy. PTU is part of the way I do that. But it's not everything. Excellent advice. And now I feel like I'm going to ask you this last question, but you might have just answered it. But the question is, given where you are now life, career, what advice would you give yourself as a new grad out of PT School?
Kelly Duggan: 42:57 That's it. Don't fall for the trap.
Kelly Duggan: 43:12 Don’t fall for the kind of trap of just trying to, you know what, nevermind, I wouldn't say that. Because I feel like all of that got me to where I am right now. You know, the struggle of how do I get high around the career ladder and how do I do all of this. And, so I guess what would I say to myself straight out of PT School is take jobs that you have fun at. If it's not fun at the end of the day, if you didn't laugh, if you didn't enjoy yourself, get out of that situation sooner than later. I think I held on to certain things knowing that they were good for my career and I should have let go of them sooner.
Karen Litzy: 44:08 Excellent advice. Couldn't agree more. And now where can people find you and the clinic if they want more info or they want to talk shop with you.
Kelly Duggan: 44:17 So I'm on my website is PTUclinic.com. The email is PTUclinic@gmail.com. I'm on Facebook, I'm on Linkedin. I'm not on there too often, but I'm on Facebook pretty regularly and my clinic is on Instagram. So any of those realms reach out if it's something that you're thinking of doing. I love talking with people that are thinking about opening their own clinic. I love to just encourage it, I think, you know, if it's something that you want to do then to go out and do it and yeah, reach out to me. I'd love to be of any help if that's what you're looking for.
Karen Litzy: 44:57 Awesome. Well thank you so much, Kelly, for coming on and sharing your entrepreneurial journey. I think you gave a lot of people a lot of help today, so thank you so much.
Kelly Duggan: 45:07 Thank you so much for having me. Really appreciate the opportunity to talk about it and I hope we encourage some people today.
Karen Litzy: 45:15 Yeah, I hope so too. Thanks so much. And everyone out there listening. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Megan Rigby on the show to discuss how she found success with her online nutrition and fitness consulting. Dr. Megan Rigby is a doctorate prepared pediatric GI Nurse Practitioner, IFBB Figure Pro, blogger, macro lover and online coach. She is on a mission to help others become fit, healthy and happy.
In this episode, we discuss:
-How Megan started her side hustle and when she decided it was time to leave her corporate job
-The pro’s and con’s of being an online entrepreneur
-The importance of vulnerability and integrity on social media
-And so much more!
Resources:
For more information on Megan:
Megan Rigby is a Doctorate-prepared GI Nurse Practitioner, Certified Nutrition Consultant, IFBB Figure Pro, and Owner of MacroMINI. She is passionate about educating others through her coaching, as well as publicly speaking on topics surrounding food, fitness & healthy mindset. Megan has helped hundreds of people experience great physical and overall lifestyle changes. She is on a mission to empower others to become healthier, happier versions of themselves while still enjoying food as one of life’s simple pleasures. In 2018, Megan left a corporate position as a Digestive Nurse Practitioner to open her own coaching business & has made over 400k+ within her first year. Megan has been featured in Oxygen & Strong magazines as a content creator, along with appearances on News Channel 12. She has been recognized as a top industry leader within her community.
Read the full transcript below:
Karen Litzy: 00:01 Hi Doctor Megan Rigby, welcome to the podcast. I am happy to have you on.
Megan Rigby: 00:06 Thank you so much for having me. I'm excited to do this with you today.
Karen Litzy: 00:10 Yeah. And so what we're gonna do is we're going to talk about your sort of entrepreneurial journey, your business story, because, as I said in the intro for you, you are a doctorate prepared GI nurse practitioner and a nutritional consultant and a whole bunch of other stuff. But, something that I think the listeners of this podcast can relate to is there's a lot of healthcare workers, things like that who are listening to this podcast who maybe have started their careers in a hospital and clinic, but maybe you want something a little bit more. So I would love for you to kind of share your story of how you made that transition from, I love that you say you were like a corporate girl in a hospital or clinic, but when you're in healthcare, that's kind of the equivalent. So go ahead and tell us your story. How'd you do it?
Megan Rigby: 01:03 I never planned on being an entrepreneur having my own business. That's just not something I ever saw in my future. My Grad program, I had focused on family and childhood obesity. It was my dissertation. I love health and nutrition. I think it's the preventative to a lot of health care. So I always tried to teach all my clients that, but I started to get frustrated a few years in just because working for corporate, you're kind of inside a box. And I think there's a time and place for complimentary medicine and modern medicine and sometimes that can be hard when you're working for a hospital. And so I started having more and more people talking to me on the side about health and nutrition and fitness and people would just start asking, Hey, can you give me an advice? Give me tips and I'll pay you. And so slowly I started doing nutrition plans and education on the side.
Megan Rigby: 02:05 And over time I was able to build it into an online business. I realized that my limitations that I have within the clinic are able to actually be kind of removed online. I get to spend more time with my clients, educate them, and truly provide a service that's unique to them. So with time it took probably, I mean two years I was doing a lot of my own online stuff, while working full time in clinic. And then I gradually dropped down to more of a part time position once I started picking up online. And then within the two years I was actually able to make more than what I was making clinic with the online business and I transitioned over and I left September 2018 and now I run my own company doing health, fitness and nutrition.
Karen Litzy: 02:57 And I would imagine that there are pros and cons to this. So I'm just going to name one pro and one con. Right. So the pro, obviously you can probably help more people with online programs. Con would be, do you miss having that person sitting in front of you?
Megan Rigby: 03:16 I do. I missed that. But the beautiful thing about online is you can still do zoom calls face to face. So there is still that where you can talk to them. So almost like a telehealth. I would say one of my biggest cons is when I used to leave the clinic, it was kind of like my work was done. Like my charts were done, I was done seeing patients. Now, I feel like I'm on a lot more so my day doesn't end nine to five. I work a lot more around the clock. I feel like, and that's something I'm still trying to work on as a new entrepreneur.
Karen Litzy: 03:50 Yes. And that is absolutely true. I think a lot of people when they think I'll just start my own practice, they think you can leave it at the door when you leave, but you cannot. You're always doing something. I mean, there are times like last night it was midnight and I'm working.
Megan Rigby: 04:09 Yes. It never goes away because it's now your business, you're responsible for everyone you're taking care of and you're responsible for bringing more clients in. And so definitely you work, I think a lot more being an entrepreneur, but at the same time you have more freedom, which is nice.
Karen Litzy: 04:26 Yes. You have a little more flexibility, you have a little more freedom. So there's pros and cons to all of this. But let's start, how, if you can get even a little more granular into your kind of transition from hospital to on your own. So my first question is how did you have this conversation with your employer? That's a question I get asked all the time.
Megan Rigby: 04:51 Yeah. So I think you have to just be honest about it. And that was something that they knew that I loved the nutrition aspect of things. I love being able to teach and spend more time. So when I went down to part time, you know, I let them know that I was, you know, on my side I was, you know, just educating and teaching people about nutrition and health. And that was not going to interfere with my job. And I think that's the biggest thing. If you can, you know, let them know, reassure them that you're not letting it interfere with your work and how you come in every day and interact with your patients there that you know, helps them as well, as well as not ever taking any of the businesses patients.
Karen Litzy: 05:37 Of course I think we say that of course, but maybe people do. I don't know.
Megan Rigby: 05:46 Yeah. And that was something where it's kind of drawing, you know, a line in the sand and making sure that both of the jobs stayed away from each other and they never came together. And I think that's something that a lot of people have to remember. Like I would love to have been able to work at work, but you can't do that. I mean, I came home at night and I saw my clients from online at night and there was no crossing that during the day at all when I was clocked in and I was being a nurse practitioner in the clinic.
Karen Litzy: 06:13 Yeah. And I think that's great advice. And it's just dry and clear boundaries for yourself and also being respectful of your employers.
Megan Rigby: 06:21 Yeah. Because in the end, if you decide to go back to clinic, you need recommendations and burning bridges is not something you want to do because who knows? I mean the venture that we have or I have, it may, may die down one day and I do need to go back to the clinic. So I never want to slam that door shut because it provided me so many opportunities.
Karen Litzy: 06:42 Absolutely. And I remember when I left the physical therapy clinic I was working at, it was really hard to do because I really loved working there. But they now refer patients to me and I refer patients to them. Right. So it's like you don't want to burn those bridges because guess what, they can help you and you can help them. And I think you want to really make this a win, win for everyone. So you have this conversation with your employer, they're understanding, you go down to part time for you, what was, if you can describe kind of the hours worked in clinics or are you down to like 20 hours a week or less and obviously we know you're working then on the online part, but what was the breakdown for us?
Megan Rigby: 07:33 They let me go to three and a half days a week, which was nice. And so that was considered more of a part time position there. So I worked Monday, Tuesday, Wednesday, and then half day Thursday and I was off Fridays. So I would make sure that all my check ins and my main communication with my clients would be on the weekends. That works best for me. So Thursdays I would do all of my prep when I got off work. And then Friday, Saturday, Sunday, those were my days that I was really able to devote to the actual online business and evenings whenever I, you know, was able to after work I would come in home and I would do what I needed to do. But otherwise it was an 8:30 to 4:30 Monday through Thursday, half day.
Karen Litzy: 08:21 And since going completely on your own, do you give yourself a schedule? Because it must be difficult, right?
Megan Rigby: 08:28 I'm still close the computer when there's still work to be done and I always want to make sure that everyone is getting the, you know, service and communication that they deserve. And I think that just comes from being a healthcare professional that you know, you want as much time devoted to each and every client. And so it can be hard to kind of turn that off and feel like you still have unanswered questions or things going on.
Karen Litzy: 08:59 Yeah, there's no question. And again, that's where kind of setting boundaries for yourself comes in handy or making sure that you know, you have scheduled times that you're working even with the online clients and that they know that. Not that they're taking advantage because I don't think they are, but if you allow yourself to be available 24 seven then guess what, people will take you up on that offer.
Megan Rigby: 09:27 Yeah. So it is, it's creating boundaries too. And that's what I have learned. It's been hard, but yeah, working, you know, maybe nine to like four and allowing lunch in there, is something that I'm striving to be more consistent with. But it is nice because if you have appointments, you know, you can schedule those in and that's where the flexibility has been really good. But also drawing the line of when you kind of cut it off at night.
Karen Litzy: 09:52 Yeah, absolutely. And now how do you advertise? How do you market yourself?
Megan Rigby: 09:56 So social media is kind of where it's all at, as exhausting as it can be. I have, you know, my page and that's where a lot of people find me word of mouth has been the biggest thing and I value that the most. I think if people can refer other people to me because they've had great experiences and outcomes, that's where I've actually gotten a lot of my clients. I don't really do a lot of paid advertisement or anything right now. Like I said, it's just word of mouth and then making sure people who do follow me or start following me understand, you know, where I'm coming from and really being open and vulnerable on social media so everyone kind of knows who I am and there's no hiding.
Karen Litzy: 10:44 And what advice do you have for the listeners on how to be vulnerable? Because that's hard.
Megan Rigby: 10:50 It is really hard. I think it's just to be true to you and stand by what you believe in and how you practice. And provide honest, you know, education, advice and share yourself I think with people has been the hardest thing because a lot of people will look up to healthcare professionals, you know, and think that there may be on a pedestal or something. And I think making yourself relatable is the most important thing because we're all humans and so we all have struggles as well. And I think putting those out there so people can relate to you is going to bring more clients in and more, you know, followers as well.
Karen Litzy: 11:30 Okay. So how do you make yourself more relatable? Because isn't social media is supposed to be like, it's your highlight reel. We don’t want to show people that we have any problems. Right.
Megan Rigby: 11:40 With me, it's a pretty easy with the nutrition and the fitness and health because I think, you know, as a female we struggle with appearance. We struggle with, you know, day to day eating healthy, making the right choices, preparing food for our family. So I can relate to a lot of that. You know, I've had my own insecurities and I'm not perfect every day with how I eat. There are days that I want to go to dairy queen and have a blizzard. So I'm able to really relate to people in that spectrum and then talking about, you know, different health issues that so many of us women struggle with and it can affect how we lose weight and really making sure that we stay on top of those. So whenever I talk about something, I try to draw in my past experiences with it and I think that usually helps a lot.
Karen Litzy: 12:28 Yeah. I think that's really good advice. And what would you tell people who maybe have these great stories and we know this is what you should do to kind of get people to get to know you, like you and then eventually right purchase from you. Right. What if you're scared to put yourself out there? Like how do you overcome that fear?
Megan Rigby: 12:53 I think you have to jump in with both feet. Like if you are truly passionate about starting a business, that's vulnerable in itself and then putting yourself out there on social media. Like you just have to realize that people are gonna love you or hate you. And as awful as that sounds, it's the truth. I mean, people are going to be drawn to you. So just jumping in and sharing it, whether it's just the writing at first. I know a lot of people are camera shy, so sometimes they say like blogging at first is really good. Or just sharing it on your Instagram through words, before going into any of the videos or anything like that. Even you know what sharing with your family sometimes too because you can be vulnerable with them and getting feedback sometimes can be a little bit comforting if you're not ready to just jump.
Karen Litzy: 13:40 Yeah, I think that's great advice kind of sharing with friends and family are sharing within a trusted circle.
Megan Rigby: 13:47 Before it's scary. You're going to get judged. That's human nature I feel like so people will judge, but people also will be able to relate to what they hear from you. And those are the people you want following you and interacting with you.
Karen Litzy: 14:05 Yeah. And do you have any sort of memorable comments or notes or things that people have sent to you that have stood out because you've been a little bit more open?
Megan Rigby: 14:17 Yeah. So when I do stories I try to talk about topics that have affected me recently. I usually always try to keep things kind of close to my heart. And so when people message me and say, oh my gosh, I needed this today. It's been such a struggle, like it, it's so nice to know someone else's out there going through it with me or I appreciate the advice. So those things always help to kind of reaffirm like there are people listening and what I am saying is holding others. So, you know, it makes me want to keep doing that more and more.
Karen Litzy: 14:52 Yeah. I love getting those notes. I think it's so cool. And I always think to myself, Gosh, you never know who's watching, sitting, listening. You just don't know.
Megan Rigby: 15:01 Cause you're always impacting someone. There's always someone out there watching and listening. Like she said, you never know. So if it's something you're passionate about, something you love and you want to be heard, then it's worth sharing.
Karen Litzy: 15:15 Absolutely. I agree. 100%. We’ve been talking that you're in that nutrition, fitness realm, very crowded field. Every time you turn, everywhere you look, someone is talking about nutrition, whether that be good or bad evidence based or not. It's out there. So what advice do you have to stand out amongst all this competition? Because I'm sure it can be applied to almost any industry.
Megan Rigby: 15:49 It can. I always say be true to you. So whatever you believe, stay with that. It's so easy to get into the comparison game of you know, what they're doing or you know, this is the new trend, but you have to do your own research. You have to believe in what you believe in and talk about that. I think that's the most important. So many people in the fitness industry just jump from one trend to another. And so it's whatever the hottest topic is. And I think when it comes to, you know, this industry, you have to really stay true to the basics and what is science saying and what you believe in. Because if people hear it consistently and they can expect the same thing from you, which is the honest truth in what you believe in, they will trust you. It's the people who kind of jump all around that, you know, you kind of start to say, Hey, wait, last week you were talking about this. And that was the best thing there was. So that's what I found is people, they expect the consistency from me and they know that I believe in what I'm talking about.
Karen Litzy: 16:52 Yeah. So not jumping on the bandwagon every time something comes out, but rather look at it critically.
Megan Rigby: 17:00 And not comparing yourself. I think that derails a lot of us is when we start to look at what other people are doing in the same field and we feel like we need to mimic that or we need to jump on that. And that can be very distracting too.
Karen Litzy: 17:20 But it's so hard.
Megan Rigby: 17:24 It is so hard. I do my best actually not to follow a lot of people in my industry. I'll follow the people who I think provide me motivation, but if there's anyone who evokes jealousy, or you know, kind of gets under my skin, I figure that's negative, you know, vibes and I don't need that. So I really tried to just stay with the people who motivate me the most. I think social media should be a positive outlet. And it's so easy to make it negative. And I really tried to avoid that.
Karen Litzy: 17:58 Yes. As a matter of fact, I'm part of a Oxford debate in a couple of weeks at a physical therapy conference. And so the debate topic is social media and it is, we believe that social media can be hazardous to the profession of physical therapy. And you know, people will argue in favor of that and against that and that can easily go either way. But in the end it's a tool. It is a tool and it's not the tool, but it's the user.
Megan Rigby: 18:36 It is. It's how we allow ourselves to use social media. No, I agree. I'm curious to hear how that goes. So I hope you will talk about that.
Karen Litzy: 18:48 I will talk about that. I'm curious to see how it goes to, I hope it goes well. I'm a little nervous about it, but I think it's supposed to be this like fun debate, like lively, fun and funny. But you still want to win the debate of course. So we'll see what happens. So is there anything else about kind of your entrepreneurial journey that you really want people to learn from?
Megan Rigby: 19:13 I think starting small, and a lot of people when they tried to start a business feel like they have to dump a ton of money into it. And I've learned that you don't, with starting small and using the skills that you have, you're actually able to start a business that may, you know, not be as profitable as you want in the beginning with time you can reinvest that money you make back into it without taking up such a huge loan in the beginning, especially when it comes to the online type of business. I think there's so much that we can do on our own before we have to really start spending money. And I think that's something that, you know, a lot of new entrepreneurs who are wanting to go the online business, just have to remember that it doesn't take a ton of money to get up and going and get clients. It just takes, you know, the passion and the time and the knowledge.
Karen Litzy: 20:09 Yeah, absolutely. And I have one more question for you. The question that I ask everyone and that is knowing where you are now in your life and in your business, what advice would you give yourself, not to someone else, but what advice would you give to yourself at like the day you graduated and we'll say with your doctorate, why not? Because you’ve got like advanced degrees here. So let's go with the doctorate. What advice would you give to that gal?
Megan Rigby: 20:40 Okay. My advice would be to not change anything, to enjoy the ride and kind of allow it to take you where it's going to take you. Because there are times that I wondered, you know, why was I where I was and what I was doing and it all led me here. So I think the biggest thing is enjoy the ride. So often we keep wishing the years away and if only I was here, if only I was there. But every step and every moment you have is leading you to where you really need to be.
Karen Litzy: 21:09 Very nice. It's like that sounded like from Game of Thrones and that's not a spoiler or anything for anyone listening. If you haven't seen the finale, it's not a spoiler, but that was very Bran like of you, it was great. Now where can people find you if they want to get in touch with you, if they want to work with you, they want to follow you. Where can they go?
Megan Rigby: 21:36 Yeah. So on Instagram, I'm macro_mini. And then why a website is www.themacromini.com.
Karen Litzy: 21:47 Awesome. And just so in case you know, you don't have a pen and paper and you're not taking notes right now, like I am, you can go to podcast.healthywealthysmart.com. We'll have all the links, one click will take you right to all of Megan's info so that you can get to know her, like her, trust her, and work with her. So Megan, thank you so much for coming on and sharing your journey. I think it will give a lot of people in health care a bit of a boost, maybe a little kick in the butt too, and the confidence to go out and kind of do what you're doing.
Megan Rigby: 22:23 Thank you. I appreciate that. And thank you so much for having me on.
Karen Litzy: 22:26 Yeah, my pleasure. This is a great conversation and everyone who's out there listening, thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on 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!
LIVE from the WCPT Conference in Geneva, Switzerland, I welcome Christina Le on the show to discuss youth kinesiophobia following knee injury in sport. Christina Le is a PhD candidate in Rehabilitation Sciences in the Faculty of Rehabilitation Medicine at the University of Alberta in Edmonton, Canada.
In this episode, we discuss:
-What is kinesiophobia?
-Preliminary results from the University of Alberta research team focused on prevention of early onset osteoarthritis
-Why clinicians should address kinesiophobia early and often in rehabilitation to minimize poor long-term health outcomes
-And so much more!
Resources:
World Congress of Sports Physical Therapy 2019
For more information on Christina:
Christina Le is a PhD candidate in Rehabilitation Sciences in the Faculty of Rehabilitation Medicine at the University of Alberta in Edmonton, Canada. As a clinician, she frequently treated athletes with anterior cruciate ligament (ACL) injuries. This experience has motivated her to pursue research to better understand health-related quality of life (HRQOL) following a sport-related knee injury in active youth. Her research include identifying what factors impact youth HRQOL during rehabilitation and developing strategies to improve long-term HRQOL.
Christina continues to work part-time as a physiotherapist at the Glen Sather Sports Medicine Clinic. She treats patients on weekends, participates in multidisciplinary clinics with sport medicine physicians and orthopedic surgeons, and teaches an ACL rehabilitation group class called the Functional Agility and Strength Training (FAST) Program. Find her on Twitter as @yegphysio or online at www.yegphysiotherapy.com.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody. Welcome back to the podcast. I am coming to you live from Geneva, Switzerland at the WCPT meeting and right now I have the distinct pleasure of sitting across a table from Christina Lee. She is a PhD candidate at the University of Alberta and she's also a physio therapist. So Christina, welcome to the podcast. And today Christina did a wonderful platform presentation on Kinesiophobia after knee injury and we're going to definitely get to her study on that. But before we do, Christina, can you tell the listeners what is kinesiophobia?
Christina Le: So kinesiophobia is taken from the chronic low back pain literature and has been applied in our knee injury population as well. And it's an excessive and irrational fear of movement due to feeling vulnerable to pain or reinjury.
Karen Litzy: And so now let's get to your study. So what I'll have you do first is maybe tell us why you thought this was an important thing to look at.
Christina Le: 01:02 Yeah. So I think after knee injuries in sport, knee injuries in particular, and we're looking more at our youth, we know that there are a ton of different consequences that happen after knee injuries and they spend the physical, psychological and social domains of health. And this is just one that hasn't been studied to great length in our youth athletes in particular. And it's something that I think can contribute to poor long term health outcomes because it's the most common reason for kids quitting sport after they get injured. It's related to physical activity. So it's something that maybe we can manage a little bit better as clinicians and moving forward to help out with better long term outcomes.
Karen Litzy: Right. And that sort of lack of return to activity, lack of return to sport can, like you said, have long term outcomes. So we know that inactivity can lead to obesity and childhood diabetes and a lot of downstream consequences.
Christina Le: 01:58 Yeah, exactly. Posttraumatic osteoarthritis is probably one that’s stuck in my head right now. Just coming from the International World Congress as well. And we know that that can affect almost up to half of our youth injuries that have a knee injury as well.
Karen Litzy: All right. So let's break down the study for us. So I will just have you kind of take it away and talk about the study now that we know the why behind it. Go ahead.
Christina Le: Yeah, so we are currently running an ongoing prospective cohort study at the University of Alberta. It's a part of the prevention of early onset of osteoarthritis research group, I guess that was initiated out of the University of Calgary. And we're looking at youth athletes aged 11 to 19 who have sustained a sport related knee injury. So tibial femoral Patella femoral injury within the last three months. They had to have seen a physio therapist, a doctor or some sort of medical professional and had to have missed at least one session or one game from their sport to be considered injured.
Christina Le: 03:02 And then we're comparing them to age, sex and sport match controls. I'd say kind of 75% maybe through our study right now. And so this study that I presented on today is just a preliminary analysis of what our baseline data was. And what we were looking at was self reported kinesiophobia. So using the Tampa scale for Kinesiophobia and its influence on bilateral knee strength, using isokinetic dynamometer and triple single leg hop and Y balance test.
Karen Litzy: Okay. So those were all of the things that you are looking at, that's the data you are collecting? All right. Before we go on, I think most people know what a single leg three hop test is and the Tampa kinesio phobia scale you can look up, but can you talk about what the Y balance test is really quick just so people have a frame of reference as to what you're doing?
Christina Le: 03:53 Yeah, sure. So the Y balance test is we ask our participants to stand on one leg, hands on hips, so they can't use their upper extremity to help out with their balance. They're reaching as far anteriorly as they can while standing on one leg. And then they also do a posterior lateral and a posterior medial reach as well. We do three trials and we take the average of the three direction reaches. So one point they're planted on the injured or the index side and then the other time they're on the other side.
Karen Litzy: Perfect. All right. So continue. Now we know what you're measuring. We know who you're measuring. So now let's talk about how?
Christina Le: 04:41 So we are looking at our mean within paired differences. So we take our injured scores, we subtract them from our uninjured scores in terms of study groups, and then we're just looking at the differences between the two groups on all those variables listed. And then we're also running a logistic regression model that's accounting for our match design. So it means that we are looking at the odds of scoring higher than 37 on the TSK. And we're looking at if there's a difference between our injured in uninjured groups in scoring higher or lower than that 37 and the 37 is based off of chronic low back pain literature where a study dichotomize their participants based on high fear responders are low fear responders based on that TSK score.
Karen Litzy: Right. And just so people know, the lower your score on the TSK, the less kinesiophobia you have and the higher score, the more kinesiophobia you are experiencing.
Christina Le: 05:39 Yeah, exactly. So I always say TSK is like a golf score. So higher scores worse lower scores better. And then we're also running separate multivariable linear regressions as well. So effectively looking at the Association of TSK on strength or triple single leg hop or Y balance.
Karen Litzy: Okay. And what did you find with that analysis?
Christina Le: So what we found was with our mean within pair differences, so when we're looking at our injured versus uninjured groups, just based on these variables alone, that the injury group scored on average about eight points higher on the TSK than the uninjured, which means that they are reporting greater kinesiophobia or higher kinesiophobia as you said. And they're also scoring lower on strength, which isn't maybe the most surprising finding considering they've just been injured. So we're testing them on a median of six weeks after injury.
Christina Le: 06:39 With our odds ratio where we found that the odds of scoring higher than 37 on the TSK was about 10 times greater for the injured group than the uninjured groups, which again, just means that they're more likely to be kind of in that high fear responders group. And then with our multivariable regression, we found that there is an association between our TSK scores and our knee extension strength bilaterally and actually flexion strength bilaterally as well. The differences or the relationship strength itself isn't the strongest. So if we have a one unit increase in our knee extension strength on our injured side for example, it just corresponded to a 0.1 decrease in the Tampa scale for Kinesiophobia, which is a minor change.
Christina Le: 07:40 It's probably not something that we can detect in all honesty or that's clinically relevant, but just tells us that there is some sort of association between Kinesiophobia and strength.
Karen Litzy: Got It. And so we know the results of your findings. What are your recommendations? What conclusions did you come to as a result of this study?
Christina Le: Yeah, so I think the two big take home messages is that kinesiophobia is present as early as the three months leading up to or after an injury. I think as clinicians we generally tend to look at this closer to the return to sport end of the spectrum of Rehab. But it's something that might be early, as our present, as early as three months. So we should be dealing with it as early as three months. And that it's potentially something that might affect both sides of the body as well.
Christina Le: 08:28 So if you've had a right knee injury, doesn't mean that you don't necessarily have kinesiophobia on that left knee as well. So it's just trying to get clinicians to think maybe a little bit more bigger picture here and that I think ultimately if we can address kinesiophobia early after an injury, then potentially we can set people up for more physically active lifestyles, that sort of thing. And then hopefully help out with that reduction of those poor long term negative health consequences.
Karen Litzy: And so as a practicing clinician, so let's say I am seeing a, just making this up off the top of my head this is not a patient I have I swear, I am seeing a 16 year old boy who plays Lacrosse and let's say he will use a term sprained his knee, maybe let's just say it's an ACL strain or sprain.
Karen Litzy: 09:22 So not a tear doesn't need surgery. So they're coming to me, should I be using the Tampa scale on the first visit that I see this person? Or do you wait for a little bit further down the line?
Christina Le: I don't think it hurts to be using that right away. I think that what these individuals with knee injuries or any MSK injury, realistically they might be fearful of different things at different times in their rehab. And I think picking that up early on might be able to detect that, oh, maybe he's scared of going downstairs or something like that. Whereas later stage Rehab, maybe it means that he's a little bit more fearful of changing directions with contact around. I don't think it hurts to necessarily use that Tsk early by any means.
Karen Litzy: 10:13 Okay, great. So that's a nice take home for the clinicians listening that hey, this is easy. It's simple, it's free. You can get it online and just have your patient fill it out and it’s easy to score. We just heard if you're over 37, maybe that's something to worry about. The lower the number, the less kinesiophobia. So it's something that we can easily incorporate as clinicians with youth knee injuries. Can this be extrapolated to other injuries outside the knee and let's say the back?
Christina Le: So the tricky part with the TSK is that it actually hasn't been validated for knee injuries yet. So it's hard to say is this something that we can use in other areas? I'd really think that there is a need to validate this tool or if it's not, then to generate a tool specifically for knee injuries.
Christina Le: 10:59 Cause I think it's something that we discuss a lot as researchers, as clinicians with our patients. So for now I guess it's the best tool that we have but it doesn't mean that it's necessarily the right tool yet.
Karen Litzy: Yeah. Well something to add to your list. Get Jackie Whittaker and get your team together. And that's another study you can do because you have the time. Right?
Christina Le: Totally. Really hoping to bring on Doctor Johanna Krista at some points on this topic as well. So I think she's a good one to look at if you're curious about the kinesiophobia stuff in our knee injured population as well.
Karen Litzy: Awesome. And then because you said you're about 75% through the study of preliminary data. Where do you see this going?
Christina Le: So in the grand scheme of things for my own PhD, I'm going to be using this data to look at more health related quality of life in our young adults and our young athletes with sport related knee injury.
Christina Le: 11:55 I'm a big proponents of kind of that bigger picture. So again, I think as clinicians, we're really honed in on the whole return to sport thing as are our indicator of successful recovery. And looking at the literature, we know that only 66% of people return to their pre injury sport at the pre-injury level. And we don't really have great numbers for anything past probably two or three years either in terms of sport participation. So are we may be selling our patients short if we're only focused on that one thing as recovery versus again, kind of thinking bigger picture. Can we set them up in terms of physical health, psychological health, in terms of Kinesiophobia specifically, social health as well, so that they are able to maintain these healthy, active lifestyles, avoid osteoarthritis, avoid obesity, all that kind of stuff.
Karen Litzy: 12:47 Awesome. Well it sounds like you have big plans and I think it's only going to help clinicians and help the young athletes and young adults and teenagers and tweens that we treat on a regular basis. So thank you for your work. And now I have one more question. I probably should have told you this ahead of time, but I didn't cause I forgot. But the question is knowing where you are now in your career and in your life, what advice would you give to yourself as a new Grad out of physio school?
Christina Le: I would've said seek mentorship early and often. I think it took me a long and windy road to kind of get where I am and in all honesty, that's probably made me who I am now as well.
Christina Le: 13:32 But I think it would've been great to have maybe a little bit early on into my career as a new Grad, a little bit more mentorships with somebody or some people to kind of cling on to more or less to have a little bit of guidance in terms of what I should be doing, where I should be focusing my efforts on and spending my energy on.
Karen Litzy: Awesome, great advice. Now, where can people find you?
Christina Le: I am a on Twitter, I'm @YegPhysio, Yeg is the airport code for Edmonton, Canada. So that's why I'm that. And that's pretty much the only thing I'm active on in tems of social media for professional stuff. So, yeah.
Karen Litzy: Perfect. Well, thank you so much for taking some time out of your schedule here at WCPT to come on the podcast.
Christina Le: 14:17 Thank you so much. I'm going to throw a quick plug in for the world sports physiotherapy Congress in October in 2019 I'm hoping that all of you guys are going to be there cause we are going to be there. So you should have a lot of fun of you'll come.
Karen Litzy: Yes. And it's in Vancouver in and around that first weekend of October. Yes, the lineup looks fantastic and even if you don't work with a sports specific population, you can take all of this information and you can pair it down or you can pair it up to the population that you're seeing because it's all about concepts. It's not necessarily sports specific.
Christina Le: Yeah, exactly. I think it's something that's going to be useful for every MSK general practitioner out there. Whether again, yeah, you're in sport or not so highly, highly recommended. Yeah, you guys should all come out and hang out.
Karen Litzy: Yes, absolutely. We will both be there and I'm definitely looking forward to it. So, Christina, thank you again 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!
LIVE from the WCPT Conference in Geneva, Switzerland, I welcome Daniel Board on the show to discuss torture-survivors’ experiences of healthcare services for pain. Daniel Board is a Specialist Pain Physiotherapist working in a pain management clinic at Chelsea and Westminster Hospital in London, UK. Clinically, he helps people with a variety of persistent pain conditions and has a special interest in refugee healthcare.
In this episode, we discuss:
-Torture-survivors' experiences of healthcare services for pain
-The importance of the patient-clinician relationship and communication skills
-How to avoid burnout when servicing this patient population
-And so much more!
Resources:
Chelsea and Westminster Hospital
For more information on Daniel:
Daniel Board is a Specialist Pain Physiotherapist working in a pain management clinic at Chelsea and Westminster Hospital in London, UK. Clinically, he helps people with a variety of persistent pain conditions and has a special interest in refugee healthcare. Daniel is also an early career researcher and recently conducted a qualitative study investigating torture-survivors’ experiences of healthcare services for pain.
Read the full transcript below:
Karen Litzy: 00:01 Hey everybody, I am coming to you live from WCPT in Geneva, Switzerland. And I have the pleasure today of interviewing Daniel Board. Daniel's a physio therapist in the United Kingdom and he specializes in persistent pain. So Daniel, welcome to the podcast. And today you had a really interesting platform. So I want you to kind of give the listeners a little insight into what your platform was, because like I said, you are specializing in persistent pain, but you really have a very unique perspective.
Daniel Board: 00:35 Yeah. So my background is in working with people with persistent pain problems. And part of that is that I'm lucky enough to work in a specialist clinic for torture survivors at Chelsea and Westminster Hospital in the UK. The platform presentation I did today was presenting the findings of a research study that we did last year, looking at the experience of persistent pain in survivors of torture survivors are kind of an underrecognized group. They have a variety of psychological, physical, and social, kind of consequences and burden as a result of torture. For example, persistent pain rates succeed. 80% inspires of torture. Rates of PTSD and depression exceed 30%. Issues aren't just standalone. Many certainly the torture survivors that we encounter are living in a country of excile and there are also lots of problems associated with that, such as seeking asylum, lack of social support, and also obviously the language barriers, and kind of what they're not necessarily knowing what their rights are with regard to accessing services within the UK. So that's the population.
Karen Litzy: 01:49 And what did your study specifically look at that you presented today?
Daniel Board: 01:54 So what we looked at from the evidence base is very limited. There was a Cochrane review last year that looked at interventions for managing pain in torture survivors and they find that there was no evidence to refute or support any intervention currently for managing persistent pain. Clinically, we see, as I said, quite a complex population and typically outcomes from treatment aren't great. We also find it quite difficult to engage them within our services. We have high sort of failed attendance rates and that really affects their ability to access and benefit from healthcare. So the study that we looked at or the study that we did was a study looking at what's torture survivors experiences of pain services in the UK is like so often, torture survivors that generally the first place they'd go to is that GP with a pain problem.
Daniel Board: 02:48 But they would also, the participants in our study, had seen GPs, they'd seen physiotherapist, pharmacist, they'd been referred to trauma orthopedics, cardiology, rheumatology, and that in itself posed a number of issues. So one of the first things we find was actually there was a big confusion over or a lot of confusion from the survivors of torture perspective over what their diagnosis was. So because they'd seen lots of different health care professionals, they're often confused. So for example, one of the quotes in our study was, ‘One says you have fibromyalgia, one said you had PTSD and another one said a slipped disc.’ So all of these things, they don't necessarily mean a lot to the patient and it can often leave them confused. So it was the first thing that we found.
Karen Litzy: 03:34 And with the finding like that and like the confusion of the patient, is that a reason that may be why they're not seeking out physical therapy or maybe why they drop off?
Daniel Board: 03:46 I think to be honest, I think there's a number of reasons why they might not engage very well. I think there's a couple of issues with diagnosis and let's maybe start with that. One of the things we noticed in the study was a really overly biomedical approach to diagnosing and treating pain, which isn't isolated to torture survivors. It's widespread, but certainly with this group that was relevant. So participants receiving diagnoses like degenerative disc disease or disc derangement. These were things that were noted in our study. And even if they didn't fit necessarily with the participants picture of pain, so they might have had widespread pain or pain that didn't fit that specific diagnoses. That does a couple of things. First of all, providing a diagnosis, which doesn't necessarily fit the clinical picture.
Daniel Board: 04:38 It takes away, I think, ownership of being able to do anything about it. So by saying you've got disk to arrangement that's going to instill fear, that's going to take away any kind of ability that they might perceive they have to change that situation. So that was one of the things with diagnosis. The other important thing we find was that there was a distinct lack of recognition of torture experience when diagnosing pain. So if torture was recognized often it was done. So the word that came up quite a lot in the study was that participants had a biopsychosocial overlay, which in itself is a pretty ambiguous term. And there was a real lack of recognition of the affective and cognitive components of a pain experience and how torture experience might influence that within a pain experience. So I think that would affect how do they engage with services because I think it takes away some of the ownership by providing that kind of diagnosis.
Daniel Board: 05:31 I think the other thing is that it's not as simple as there's not one thing that is the problem with us engaging this population. Rates of PTSD and depression are very high our participants said that they struggled to engage with services often because they either lacked motivation to get to the hospital or they were in too much pain to complete that physiotherapy exercises, for example. So those were a couple of things. And I think there's also one of the things that we find one of the problems that we think then as a finding from the study was that there seems to be not necessarily a dualistic on the part of the clinicians. I think that's probably a little bit outdated given what we know about current pain understandings.
Daniel Board: 06:18 But I think there still is that perhaps a dualistic tendency in the organization of services, particularly in the UK. And I'm sure it applies to other countries as well, that if you have a physical problem, you go and see the physical services. If you have a mental health problem, you go and see the mental health part services. And I think that leaves populations like torture survivors who present with a really complex mix of all of these factors in quite a precarious position. So for example, they might come to a pain service, I'll see a physio, and they might say, Oh, you look like you're really struggling with PTSD. Let's get you some help with that and then come back and see me. So then they'll get referred to a psychological service, but they might struggle to engage with the psychological service because of the pain that they're in. So it just seems to be, I think the service provision we have at the moment isn't well suited to this population.
Karen Litzy: 07:07 And so is this population, they're not being treated collectively. So if they're going to see, let's say you for pain, they'll see you and then if they're referred to psychologists or psychiatrists, they stopped seeing you and go see a psychiatrist or psychologist. It's not happening at the same time.
Daniel Board: 07:28 So at the moment, no, not in the general health services. I think the key thing with any care and specifically with this population is it is very individualized, each of their particular problems or the things that are affecting the very individualized. So, for example, we might have someone who gets referred to the pain clinic I work at and they might really be struggling with their mental health. They might be really struggling with PTSD, having regular flashbacks. And what we try and do is assess the weight of the various physical, psychological and social components and help them kind of almost line it up. As in what do you think is the most important thing to get sorted first? Do you think you'll be able to engage with the pain service?
Daniel Board: 08:13 You've actually got all this other really difficult stuff going on. So for those people we might say go and engage with a community mental health team, get some help with the PTSD and then come back. But that being said, I think that doesn't mean that people who are undergoing sort of significant psychological distress can't engage with pain services. So what we've started to do, we've just set up, a specific exercise class for this group of people, which is psychologically supported. So myself and one of my psychology colleagues, we've kind of paired the approach right down to keep it simple and actually you say kind of we understand you're really struggling with your pain problem. We can try and help you or try and help it impact you less. So actually setting some goals with you. We use the patient specific functional scales are really nice outcome measure if keep going, what do you want to do? I'm really struggling to bend over. I can't play with my kids. I can't climb stairs. Okay, great. Let's see if we can start doing that. And I think well slightly off on a tangent. Pain education is a really important part of that. But I think sometimes it gets lost in translation particularly.
Karen Litzy: 09:23 Yeah. I was just going to ask if it is a language barrier talking about pain education, we know that we can simplify it. Not Dumb it down but we can simplify it. But if there is this language barrier that Gosh, that must make it so much harder.
Daniel Board: 09:35 It is really, really difficult and there is some really nice work being done. The evidence base is limited, but there is some really nice work being done. April Gamble, who is a researcher who I've met here with the conference has done some really nice work looking at pain education in groups within their cultural setting and has come up with a variety of different tools that can be a cultural accessible tools that can be used. So she's definitely a person, a good person to speak to you. I think what we try and do in the clinic is find one very simple metaphor that we can use with patients. So I'll talk a lot about the volume on your nervous system being really high or I don't know, when you're assessing you find something that works for them and then when we're doing stuff in Vivo, kind of let's do some exercises, what's showing up for you?
Daniel Board: 10:23 Kind of what thoughts are coming in your head, how that might be a barrier and that's where the psychologist is really helpful. But then looking at reassurance, lots of reassurance and actually, okay, you're not damaging yourself. It's just a volume knob on high and I will mimic turning up a volume knob about a million times a day, I think with my patients. And yeah, it seems to work well for a group. But again, we can't be prescriptive and actually it doesn't work with everyone and we still need to look at other ways of engaging that group that it's not necessarily working for.
Karen Litzy: 10:55 Yeah, great thoughts. Thank you. And anything else? Did we miss anything else from the study?
Daniel Board: 11:04 So they key things, I'll summarize them cause I can remember them cause we just talked about them. I guess the key things were that there was a distinct lack of recognition of torture experience when diagnosing and treating pain. There was something which we haven't overly covered, which was that the patient clinician relationship.
Karen Litzy: 11:23 We're going to touch on that in a second. That was my next question, but go ahead.
Daniel Board: 11:27 We'll hold that one. And then the last thing was the current organization of health care services and how that's not necessarily conducive to such a complex population.
Karen Litzy: 11:36 My next question, if you didn't bring it up, was going to be how do you as the therapist, how are you able to connect number one and number two, is there a burnout rate for the therapist, working with people in this population? Because if you're an empath, let's say someone who's very, very empathetic, I would think this would be a really tough group to work with until you kind of get your bearings with them. So can you kind of touch upon that?
Daniel Board: 12:08 Absolutely. Starting with your question about the patient kind of clinician relationship and how you foster a kind of a good therapeutic relationship. I think you can probably over complicate it a little bit. I think from a therapist perspective, I think one of the key things that we have as physiotherapists is we're very good at talking to people and we're very good at helping people kind of be open. And I think actually what physios in the clinic, when we spend time with people, we're often the first sort of people that they might have told about that specific problem. I think we're really lucky. I'm really lucky that I'm able to work with psychologists, so if there's anything that is really significant that they're on hand and they can help me.
Daniel Board: 12:53 But I think as Physios, certainly when I was not working in pain, I think we look at mental health as a bit of a Pandora's box. And I think there is a fear amongst some therapists of going, well, I don't know. I don't want to ask the question about your mental health or how your depression is, or whether you've been taught, for example, because I don't know what I'm going to do with that information afterwards. So if I get an impression of you being a low mood and then you tell me that you've got some suicidal thoughts, I've got to act on that. And that's scary. So I think personally myself, I used to be perhaps that way inclined. But actually I think as I said, we're very good at talking.
Daniel Board: 13:31 A lot of what we do is talking as a profession. And I think actually just having a really good listening ear to someone, being able to say the things that come naturally to you with patients. So I'm not acting in shock at someone's telling you what's happened to them or avoiding questions about things that might be difficult and then dealing with whatever it is that comes up and that probably will have an element of you knowing what your support processes are within your service. So we have a really good pathway for suicidal ideation, for example. I think that patient clinician relationship is really, really important. And I think we as therapists, we've got really good chance to just be open and talk to patients. In the same sentence though, not with all survivors specifically. One of the things in the study was that actually some people really wanted to tell you about their experience and some people didn't. Some people were really avoidant of it. And I think it's just being careful that you're not overstepping. Just being kind of a really sensitive approach is important.
Karen Litzy: 14:31 So the other question was, as the therapist, how do you protect yourself from burnout, from feeling just so empathetic towards these people that you're taking it home with you at the end of the day?
Daniel Board: 14:46 I guess there's a couple of things. I'm very lucky as I said that I work with a really good team of Physio, psychologist, doctors, nurses, and I would feel very comfortable being able to say or talk about anything that I was worried at with them. I think, sadly you do get a bit used to those conversations at times. I think they do affect you less. But inevitably you're going to hear stuff, which is, which is horrendous. And I think the key thing in the same way that you would do with any other kind of mental health is not keeping it bottled up and actually if you need support, being able to talk about it, with your colleagues to get some support if you felt that that was needed.
Karen Litzy: 15:23 Yeah. No, that's fair. That's fair. Well, I mean, I have to say I think it's a wonderful service that you're providing for this group. It's not easy. I have never worked with that population so I can't put myself in your shoes. But I admire it greatly because these are truly marginalized group of people who really need the care. So congratulations to you and your clinic on doing this.
Daniel Board: 15:50 Thank you. I think this population encounters physios every day, I think we're just lucky that we've got a service, which is nicely set up to help the people.
Karen Litzy: 16:00 Yeah. All right. So I have one last question before we finish. Well two actually, but we'll start with one and it's a question that I ask everyone. So knowing where you are now in your career and in your life, what advice would you give to yourself as a new Grad straight out of physio school?
Daniel Board: 16:19 Very, very good question. As a new Grad, I'm going to say is probably the key thing is say yes to everything. Opportunities. A good physio colleague of mine, Dave Reese when I was applying to do the masters of research we did last year, I was unsure. I kind of had that imposter syndrome and I think we often feel that, and he said a really good, a good thing, just lean in. So any of those kinds of experiences, which might seem scary, like presenting at a conference or being interviewed for a podcast or whatever it might be in your professional life, whether that be clinical research, I think, yeah, just take any opportunity to develop and learn from people that perhaps know more than you.
Karen Litzy: 16:59 Great Advice. And then lastly, where can people find you if they have questions they want to follow you on social media, where can they find you?
Daniel Board: 17:05 I'm relatively active on Twitter and my Twitter name is @BoardDan that's probably the easiest way to get me as well.
Karen Litzy: 17:14 Perfect. And just so all the listeners know, we'll have links to your clinic and links to everything at podcasts.healthywealthysmart.com. So you can go over there one click and it'll take you to anything if you want more information. So, Dan, thank you so much for taking time out of your day at WCPT. And everyone, thanks for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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LIVE from the WCPT Conference in Geneva, Switzerland, I welcome Efosa Guobadia on the show to discuss entrepreneurship in physical therapy. Efosa L. Guobadia, PT, DPT, is the founder of the integrated wellness company FFITT Health; President and CEO of Move Together, a 501(c)3 for purpose organization dedicated to improving access to quality rehab medicine around the corner and around the world; Co-Founder of the initiative Global PT Day of Service, which has spanned 60 countries since its inception; Founder of the informational website PT Haven; and also developed and led the international volunteer program ATI MissionWorks for ATI Physical Therapy.
In this episode, we discuss:
-Efosa’s entrepreneurship in underserved communities
-How to approach roadblocks and tackle them head on
-Three qualities of inspiring leaders in the entrepreneurial space
-Exciting ways you can get involved with service through PT Day of Service
-And so much more!
Resources:
@efosaguobadia
@ptdayofservice
@ffitthealth
For more information on Efosa:
Efosa L. Guobadia, PT, DPT, is the founder of the integrated wellness company FFITT Health; President and CEO of Move Together, a 501(c)3 for purpose organization dedicated to improving access to quality rehab medicine around the corner and around the world; Co-Founder of the initiative Global PT Day of Service, which has spanned 60 countries since its inception; Founder of the informational website PT Haven; and also developed and led the international volunteer program ATI MissionWorks for ATI Physical Therapy. In 2017, he contributed a chapter on sustainability as well as the closing afterword for the book ‘Why Global Health Matters”, edited by Dr. Chris E. Stout, and with a foreword by Nobel Laureate Jody Williams. He received his BS in Kinesiology from the University of Massachusetts in 2007 and his Doctorate of Physical Therapy from the University of Scranton in 2010. He is recipient of the 2017 Distinguished Young Alumni Award given by the University of Massachusetts/Amherst School of Public Health and Health Sciences and is a 2018 American Physical Therapy Association Social Impact Award Recipient. He is currently based out of Guatemala City, Guatemala.
Read the full transcript below:
Karen Litzy: 00:00 Hey everybody, I'm coming to you live from the WCPT conference in Geneva, Switzerland. And I have the distinct pleasure of sitting next to Dr Efosa Guobadia who is a physical therapist from the United States now based in Guatemala. And he has also the cofounder of PT Day of service and move together, which we will talk about during this interview. But first, what I'd really love to talk about Efosa is you were on a panel today about entrepreneurship and physio therapy. So can you give us the highlights?
Efosa Guobadia: 00:34 Yes. Well, Karen Litzy is such a high pleasure to share time with you. The only time I get a chance to hang out with you, you put a smile on my face. I love the energy and all that. So yes, the panel is about entrepreneurship. So one of the things that I certainly talk about, I said entrepreneurship is a mindset, you know, it's about bringing the vision and the vision of your heart and the idea in your mind into actuation, you know? And with that being said what I also said, I think everybody has, it has the potentiality and the capacity to be entrepreneurial or you sometimes talk about product market fit or passion market fit and where does your passion, your idea slash your product meet the market. You know, and I think that's also very important. A friend of mine recently we're having a concept about what's an entrepreneur? He says an entrepreneur is the intersection of your idea, fundamental value and the wants, desires, desires and the understanding of the client and consumer. And that sweet spot is so important. If it's just about your ideas, you may be a starving artist, you know, but if it's a too much about the client, you know, you may be selling out a little bit. So find that great amalgam and that sweet spot and I think that's very important.
Karen Litzy: 01:37 Yeah. Thank you for bringing that up. I think that's great. I usually tell people when they're like, not sure if this idea can actually turn into a business. And I'll always tell people like, make a list. Like, what are you good at? What are you really passionate about? And what would someone be willing to pay you for? And if you can find that sweet spot, and again, it's like you just said, it's your passion where it intersects with what the consumer needs or what the consumer doesn't know they need yet. And that's where entrepreneurism really comes into, I think, a great place for the person. So let's talk about what you're doing as an entrepreneur.
Efosa Guobadia: 02:16 I love that so much. And I agree. To piggyback on what you just said, Karen, it's about fundamental value. And I think this is true in any industry. So whatever this thing, this fundamental value, your product service, after a person comes into contact with it, are they better off? And then well, we can talk about marketing or this or that, but that should be the first thing that you curate. So that's very foundational. I'm living a pretty interesting existence right now Karen Litzy so this past November in 2018, I actually decided to move to Guatemala and now I'm doing two different things. So I feel a part of my bandwidth is for the global health sector. You know co founding, you know I lead the organization move together and our mission there is to increase access to quality rehab medicine around the corner and around the world.
Efosa Guobadia: 02:56 I've been going to Guatemala now for the last seven years I've been doing this global health work for the last seven years. I moved together under that umbrella. We've been doing some pretty interesting work there for the last three years of amazing partners on the ground and amazing participants and volunteers that have joined us from the US and other places around the world. We help to build the development of rehab clinics in underserved communities. And the keyword there, this is the keystone where there's the operization, the local PTs and students on the ground. They run these clinics that we co set up throughout the year and on the ideas that it thrives uder them and we are glad to say it has been so. And then we have other programs under them, the nonprofit move together, PT day of service, which you mentioned, we have a program called that pro bono incubator and that's US based in which we dispense funds to pro bono projects in clinics in the US over the last two years we just spent $20,000 to a 11 different projects and a mentorship and resource to many more than that as well.
Efosa Guobadia: 03:53 So that's been pretty fun. So that's one part of my existence. The other part of my existence is entrepreneurial. This past I officially opened this March, but I did some ramp up work to it this past march. I opened up a clinic in Guatemala City and it looks at three verticals. It looks at mobility, which is Rehab. And I do some movement analysis with the movement three d camera. We do look at nutrition. I'm hiring some nutritionists to look at because nutrition is important for a few reasons, right? For pain. It's relationship with inflammation and with energy and a certainly with weight management, weight management is predicated on nutrition. I think above all cardio and then lean muscle mass. So it's looking at it through that portal has been important. And the third vertical has been mindset that, you know, a routine and breathing and sleeping and all that good stuff. So creating a team that helps me do those things in an ecosystem systematic way has been fun. You know, the early part of it has been mobility and people have been responding so very well to it in Guatemala. They're telling me now I can't leave, but you know, some of my clients and it's been fun.
Karen Litzy: 04:56 Awesome. And now, you know, your version of entrepreneurship is let's say different than maybe some traditional entrepreneurship where you're setting up shop in a very developed country and it's certainly different than what I do as an entrepreneur. I think from a practical standpoint, different, but I think from a fundamental standpoint and where our mindsets are and what we're trying to do for our clientele, it's pretty similar. Would you agree?
Efosa Guobadia: 05:23 A hundred percent fundamental value around the world. Its fundamental value in each industry needs to know their fundamental value. Let's say for us, our fundamental values as healers is help people move better so they can live better. That exists and is needed anywhere in the world. So again, know fundamental value, build the architecture and fit it to the market into the behavior and the knowledge and the awareness of your customers or customers to be and that's how you make it make sense wherever you go.
Karen Litzy: 05:47 And for maybe listeners out there who would like to replicate what you're doing in an underserved area or in an underserved country, what were some of the biggest roadblocks you experienced in the beginning that you would like to advise people on? Maybe how to avoid or at least how to minimize?
Efosa Guobadia: 06:07 Oh, interesting. I think it's so important to identify roadblocks and barriers. I sometimes say this with my clients now you need to know the dragon and sort of delineate the dragon so you could slay it. You know, so it's the transcend another general thought. Anytime Challenging things happen. I cheer this in the panel as well. It's information, you know, it's that when a situation happens, good or maybe not good to the way you want it to happen, it's situation. What's good about situations, it leads to solutions. So once you figure out how to handle something, now you have this tool of this extra solution. Now you can play defense and prevent that from happening again. Or if it does happen, you can handle a quicker, and actually turn it into a good, et Cetera, et cetera. So that mindset, that paradigm shift, the mindset.
Efosa Guobadia: 06:50 If you're an entrepreneur of how do you engage with things that don't necessarily happen the way that you want to have it on the, for me and some of my experiences, every country has its own things. And one thing is you go through the legal process is setting up your business. What I just had to learn is a little bit different from the US so tagging in this is a truth for all entrepreneurs and all projects, you know, identify and tag and the right people who could best help you with what you need to do. And then that saves time and that maximize your efficiency as well as your effectiveness.
Karen Litzy: 07:18 Yeah. So when you kind of hit those roadblocks, I love the way of reframing it as not a, Oh my gosh, I'm so stupid. Or how did I not see this coming? Oh great, now I'm sunk and I'm going to go sulk into a corner. But instead you're saying to reframe it as, well, here's this roadblock, but guess what? Now we have a system in place to avoid this from happening again. So being very intentional about how you're thinking of roadblocks or I don't want to say failures or things like that in your business, but being intentional so it doesn't happen again, and then you can go out and help others do the same.
Efosa Guobadia: 07:54 You said that perfectly. Nothing to add to that.
Karen Litzy: 07:55 Okay. All right. So let's talk a little bit more about entrepreneurship, specifically leadership. So if you're an entrepreneur, you're a leader, right? You're either leading yourself, you're leading others. So what do you feel like are qualities of, let's say leadership within the entrepreneurial space?
Efosa Guobadia: 08:15 Yeah, I can say a few of both. They overlap and they're interrelated like you're saying. But on the leadership front, I think, there's three things that are important. You know, maybe I'll break it down to three C’s. So one C is courage, the second c is compassion, and the third C is credibility. So I'm gonna explain what I mean by those. But first of all, with those three things, you start with yourself. You need to serve yourself. You need to lead yourself first, before you can think about leading people. So on the coverage piece that then set on your heart or the things that you believe in, do you pursue them or do you stand up for them? And the micro moments and the macro moments. And it's like a muscle you have to cultivate and you’ve got to work it out. You know?
Efosa Guobadia: 08:51 So expressing when things are more macro and big and where things are really intense. You've had this muscle, I'm going to be strong, I'm going to be courageous. I'm going to be dictated and guided by what I see is right and righteous. So courage is important. The other part is credibility. Again, starting with yourself. Do you do the things that you set that you intend to do we get the to do list. Have you written out 20 things consistently for the last month. I've only got three things done. You're telling your conscious and your subconscious, you can't trust what you write down. So start there. Create credibility and trust with yourself and then it’s metaphysical it transmits to your team, you know, you can't really have credibility with others without having credibility with yourself. And then caring and compassion. You know, one of the most important words in my life, caring, you know, caring about yourself, being compassionate about yourself.
Efosa Guobadia: 09:33 To be able to do that with your team. You need to be able to do it yourself. There's one politician and I heard say it as a couple of years ago, the best thing a leader could do for his team, his or her team is to care about them. You know how you do that by actually caring about them, you know, so actually care about yourself to take care by yourself, actually care about your team, to care about your team, on the entrepreneurial realm. A lot overlaps with say consider our focus decision making capabilities. And I will also say reasoning, you know, able to multidimensional think a lot of entrepreneurism is problem solving and thinking ahead and thinking what's coming down the pike. So that's the critical reason. A lot of the decision making, whether you've got to make quick decisions or deep decisions.
Efosa Guobadia: 10:14 What's your prototype, what’s your paradigm, how do you handle that? How do you stay calm under pressure? Maybe that goes to a curse a little bit. And then in focus, you read all the greats, you know, whether it was old school philosophy or current CEO's, one of the most important things that they talk about is the ability to focus on your task at hand and to chop wood on your task at hand as their old quote. I forget who said it now, the way you do anything is the way you do everything. So for me to close on this, I enjoy doing dishes. I don't do it that much, but when I do dishes, I'm locked in. I've tried to clean it as best as I can and I know that it's going to transmit to my clinical treating and my leadership or building your footing. So those would be some thoughts there.
Karen Litzy: 10:56 Yeah. And I loved the compassion I had a woman on a couple of weeks ago who talked about having compassion for yourself and forgiveness for yourself and how can you even make a decision if you can't even give yourself compassion? So, those qualities of leadership, courage, caring and compassion, and credibility. Yeah. So if you can't give that to yourself, then how can you give it to your business and be a successful entrepreneur? And courage by the way, this year was my word of the year on my vision board. So when you said that, I perked up and said, oh, courage. Yes. So that's something that I'm working with and I've been in business for a while. So I think another thing for everyone out there who's an entrepreneur or wants to be an entrepreneur is it's not like, oh, I have courage one day and then that's it. It is for ever, you are forever working on it. At least that's my view.
Efosa Guobadia: 11:56 I agree. Excuse me. I agree. It's a muscle and it's not this goal to achieve and that you're good at. It's an attention and intention really has to do a behavior and courage and you’ve got to be smiling in this world. It's so much about courage is a call to adventure. What is it in your heart, what do you feel pulled to and are you willing to answer that call and say, heed that call. Even if it's a small step, even if it's a big step, even as a small step that leads a big step. If you do, if you heed the call, if you go for it, if you stand up for the things that you believe in, you will live a life in full. You know? And it’ss be a certainly an interesting one.
Karen Litzy: 12:32 Wonderful. I have nothing to add to that. Now before we went live you were talking about how it's such an exciting time in physical therapy and we're here at WCPT with 4,500 people from around the world. And I have to say it is exciting. So what is your version of now is an exciting time for physical therapy?
Efosa Guobadia: 12:51 It's a combination of things. You know, there's so many exciting and interesting people doing exciting and interesting things you with your cash based practice you with this podcast. So many other people. The prehab guys, you know, I don't even know those guys, but I admire them from Afar, how they're growing, how they're fitting something in the market, how they're influencing and inspiring clinicians and clients have like so many others. So many exciting people doing exciting things. So that's one variable too with technology. You know, technology is allowing us to do a multiplication of things that we couldn't do six months ago, 12 months ago, and then certainly two, three, four, five years ago. So understanding where the tech is now or where the tech might go, it's a variable that leads to a multiplication. And then the consumer that, you know, they're more intentional with where they spend their time or where they spend their dollars, how they engage with health and health care and all that good stuff.
Efosa Guobadia: 13:39 So they're becoming more of a partner. That's how I treat my clients and my consumer, my patients as a collaborator in the journey. So you play with those different variables of technology ideas of different people, a consumer that's wanting to be healthier and then wanting to be fit. And intentional in that healthiness in that fitness, we're at this place really where anything is possible and everything can change. And I think in the next 10 years Karen the next 10 years, we're going to see an evolution slash revolution of efforts and actuations within our profession. And certainly the other step is how we collaborate with other verticals and other industries and other professions as well because not just about what we could do alone by what we could do is by what we could do together.
Karen Litzy: 14:21 And on that, that is just the perfect segway because the next thing I want to talk about is move together and PT day of service. So let's give a plug to both of these, well move together, the parent organization of PT day of service. So let's talk about that a little bit so that the listeners know what the heck you're doing.
Efosa Guobadia: 14:42 Yeah, sounds good. So move together is a 501©3 that I cofounded in 2016. And the way we define mission is that we measure everything that we do and say by. So the mission for the organization is to increase access to quality rehab medicine around the corner around the world and access being the keystone word and the keystone structure cause with access that we've seen in some of the places that we've been to, the place doesn't exist for people to go to or the place does exist. They don't have the means to go there of it does exist. They have the means that placement, I have the things that that community member that community needs. So it was a multidimensional challenge, so it needs a multidimensional approach. So that's been pretty exciting.
Efosa Guobadia: 15:18 I smell inside and out every time I think about our vision first. But the way we defined vision, vision is Simon Sinek talks about this a lot. Do you need to be able to see it? You know, that's why we call it a vision. And then when I think about it, I think about it as a guiding light or the northern star that's shining the way forward. I also think about it as the horizon. There's always going to be necessary distance between your horizon. That's the definition of horizon and so it becomes this pursuit and then you're pursuing the doing of good and doing and what your vision is, which I'll share in a moment, but also how you enjoy the journey. You're able to turn around and look at the shore, see how far along you've gone and also set up beacons and objectives along the way to measure your progress.
Efosa Guobadia: 15:58 Our vision for the organization is a clinic in every community and a sense of community in every clinic, a clinic in every community speaks to the horizontality of where we want to go, the geographical breadth of where I want to go. Community in every clinic speaks of punctuating depth and the verticality of what we do and the places that we do go. So a clinic in every community and community in every clinic. And that really drives what we do. We have three pillars in our organization, one that looks at increasing the quality and quantity of clinics. We do that. We have a program, PBI in the US and other clinic development program around the world or work with municipalities and mayors. And, and our community leaders to build development operationalized clinics. We have a second pillar called empower local clinicians. You know, not just a going and leaving going and leaving something behind and power and local capacity.
Efosa Guobadia: 16:42 Mike Landry talks about that term about local capacity. So most of our projects abroad we usually teach, you know, and learn and do labs things of that nature and we partner with other kinds of organizations to start doing it more in an architectural way for sustainable change. And then the third pillar, which ties into PT day of service is catalyzing servant leadership. What we've seen about our profession, certainly beyond our profession, PTs and PTAs and students, they like to serve we are a profession of heart and compassion. You know, so many people have been doing so many good things already, but for many people they don't know where to start, you know, so how can we create this junction of Bi directionality where people can be fulfilled while fulfilling other's? We see path for academic leadership and association leadership and corporate leadership and those are great.
Efosa Guobadia: 17:25 It was very important for us as an organisation. Josh and I, we talk about this a good amount is creating a path for servant leadership. You know, so we have two programs right now in that pillar program. We're very excited about anybody listening that is interested in our mission and vision. This would be a good portal to join, call the catalyst club and it’s all family for the organization. It's a critical mass to volunteer team that's going to help us fulfill the vision and pursue the vision. And then of course we have PT Day of service. Just an amazing program, really driven by amazing, amazing team which Karen, we love you so much for being on our team since really the beginning and then amazing people around the world participate in a PT day of service when we challenged students, clinicians to do an act of service on the same day and around the world.
Efosa Guobadia: 18:07 Year one we had 28 countries participate. Year two we had 42 countries participate. Year three we had 55 in year four we have 56 give or take, we're in year five which the big year for us and we're very excited and we’re looking to grow not just for the sake of numbers but to grow in the sake of service and showing that service can grow at the end of the day. What that program is about PT Day of service. It's about local service for a global effect and a global impact in your backyard in multiple places.
Karen Litzy: 18:35 Yeah. So this year it's October 13th and if you want more information you can go to PTDayofservice.com or move together.org
Karen Litzy: 19:01 And we'll have all of the links to everything, under this podcast at podcast.Healthywealthysmart.com. So one link can take you everywhere. So Efosa before we finish, I have one last question. I cannot wait to hear your answer. I'm like super psyched about this as a question I ask everyone and it's knowing where you are now in your life and your career, what advice would you give to yourself as a new Grad fresh out of the University of Scranton, right?
Efosa Guobadia: 19:27 So were you saying I'm having a conversation with a 24 year old, Efosa that guy was interesting. I wish I could have a conversation with that guy. So what I will say, I'm actually gonna say, he's gonna be interesting. So are you asking me to look back and what advice I would give that person will be to actually look ahead. So there's an exercise that I do sometimes called futuristic retrospection. I came with this term several years ago. And what the exercise you actually do is visualize yourself as an older person and this is similar to other activities but futuristic retrospection, it goes to visualize yourself as an older person. So 24 year old me is talking to 90 year old me, maybe I'm hanging out in pajamas, you know, and a cat is just doing whatever I'm doing.
Efosa Guobadia: 20:10 And in that conversation I would tell my 24 year old self do this. In that conversation, ask your older version of yourself, what do you wish you did? What do you wish you did at 24, 25, as soon as you graduated, what do you wish you did? Where do you wish you were at? Who do you wish you where? et Cetera, et cetera. And then, certainly you have to extrapolate what you think that answer might be. And then whatever that answer is, you've got to let it guide you. You know, there's an article I read at slate a couple of years ago that said, when we think about an older version of ourselves, the same part of our brain lights up as if we're thinking about a stranger, at least in the Western world, right? When we think about an older version of ourself, the same part of our brain lights up as we're thinking about a stranger.
Efosa Guobadia: 20:47 So this exercise allows you to get feedback and thoughts from your subconscious. The person who really knows you the best, and it's pretty powerful. Jeff Bezos, he utilizes something similar called the regret minimization framework. You know, think about an older version of yourself and what then do you think you regret not doing, you know, and then to make sure you do that. And then the other thing at least the character Togo has this quote, we're presented with insurmountable opportunities. So there's a never ended amount of opportunities in the world, you know. So with that being said, it becomes about being essential with your time. You know, people going to ask you to do things, you know, which is good, which is fun. And the better you are at things hopefully the more that you’re going to get asked. The honor is the ask, you don't have to say yes sir. So be essential about what you're doing so there’s this balance of knowing your measures, knowing your markers. Know you're vision and let that guy that didn't create or the things you accept and you multiply that by being adventurous as well. You know, trying things, finding that sweet spot will allow you to maximize yourself. Your time. 24 year old, they feel similar.
Karen Litzy: 21:54 Wonderful Advice. Thank you so much. Where can people find you if they want to ask you questions or find out more about you? Where are you on social media and all that kind of fun stuff?
Efosa Guobadia: 22:03 All my handles on social media or my first name followed by my last name, @EfosaGuobadia. I do a lot of mentorship talks with folks that are certainly a lot of folks, new professional folks, students and all that good stuff. I take much joy in that and is very conversational. A lot of the answers are within you and I guide you to some thoughts. So somebody is interested in that, shoot me an email and we'll find a time in the schedules, they can shoot me an email address. That's my first name, efosa@movetogether.org and you know, so whether it's email or whether we do a 30 or 45 minute talk, that's one of the ways I enjoy serving. So, be intentional reaching out cause I mean that.
Karen Litzy: 22:46 Well, and for all those of you listening, take advantage of that because to have Efosa mentor you or just talk to you about anything, you will walk away knowing more and feeling I don't know better about yourself somehow. I don't know how that's even possible, but that's the sense that you get after speaking with him, you're going to walk away with value. So take advantage of that. So folks, so thanks so much for coming on and taking time out of WCPT.
Efosa Guobadia: 23:15 Karen, thanks so much. I think this may be the third time between Josh and I are hanging out with you, we have so much love for you, I thank you so awesome. Thank you for this, another way for you to serve this information.
Karen Litzy: 23:26 Thank you. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Ryan J. Lingor, MD and Michelle Cummings, PA on the show to discuss HSS Ortho Injury Care. Dr. Lingor serves as an Assistant Attending Physician at Hospital of Special Surgery, faculty at Weill Cornell Medical College, Medical Director for HSS Ortho Injury Care, and Team Physician for the New York Rangers. Michelle is a physician’s assistant who enjoys helping patients get back to their active lifestyles while also providing them with a thorough understanding of their orthopedic diagnosis.
In this episode, we discuss:
-The unique offerings of HSS Ortho Injury Care
-Expanding patient’s access to quick and affordable medical care with the HSS Ortho Injury Care business model
-How to market your services and gain trust with your community
-And so much more!
Resources:
For more information on Dr. Lingor:
Dr. Lingor serves as an Assistant Attending Physician at Hospital of Special Surgery, faculty at Weill Cornell Medical College, Medical Director for HSS Ortho Injury Care, and Team Physician for the New York Rangers.
Upon graduating from St. John's University in Minnesota, Dr. Lingor obtained certifications as a Registered Dietitian, Certified Athletic Trainer, and Strength and Conditioning Specialist. He went on to complete athletic training internships with the New England Patriots and Miami Dolphins and was named Head Athletic Trainer of NFL-Europe's Hamburg Sea Devils.
Dr. Lingor graduated from medical school at Loyola University Stritch School of Medicine and completed his residency in family medicine at Illinois Masonic in Chicago and his sports medicine fellowship at the University of Notre Dame. He is board certified in family medicine and obesity medicine with a subspecialty in sports medicine. His previous experience includes working as an Assistant Team Physician for the New York Jets as well several local high schools and colleges.
Having professional passions in weight management and comprehensive sports medicine, Dr. Lingor utilizes his background in nutrition, athletic training, and strength and exercise training to provide a comprehensive, personalized approach to help his patients achieve their health and performance goals.
At HSS, Dr. Lingor utilizes musculoskeletal ultrasound for diagnostic and therapeutic purposes, performs and conducts research on biological treatments for chronic tendon problems, provides comprehensive concussion management, and employs dry needling for muscle and tendon problems. He is active as a researcher and regularly presents at national conferences in primary care sports medicine.
Outside of medicine, he enjoys traveling, cooking, and being active outdoors, having competed in several marathons and three Ironman Triathlons, including the Hawaii Ironman World Championships.
For more information on Michelle:
Michelle Cummings graduated magna cum laude from the University of South Carolina with an undergraduate degree in Exercise Kinesiology. During her studies, she spent three years as an undergraduate research assistant working on a study which focused on implementing health and nutrition programs into churches. Michelle then earned her Masters Degree in Physician Assistant Studies at the Massachusetts College of Pharmacy and Health Sciences. Prior to going to HSS, she worked as a PA for a private orthopedic and sports medicine practice focusing on upper extremity injuries. Michelle enjoys helping patients get back to their active lifestyles while also providing them with a thorough understanding of their orthopedic diagnosis. In her spare time, Michelle enjoys running, cycling, hiking, traveling, and crossword puzzles.
Read the full transcript below:
Karen Litzy: 00:01 Hi, Doctor Lingor and Michelle welcome to the podcast. I'm really happy to have you guys on today to talk about the HSS Ortho Injury Care. So thanks for coming on. Alright, so let’s sort of start from the beginning. All right, so what is the goal of this new clinic? What is the why behind it?
Dr. Lingor: 00:27 It just has always been a good place for orthopedic and sports medicine conditions. One of the problems that we've had at the hospital is getting appropriate access early on when patients need to be seen. So our providers tend to be pretty busy. So what we wanted to do is create a resource for patients to be able to go for their acute sports medicine and orthopedic needs.
Karen Litzy: 00:55 So that takes me to the next question is why sports medicine over other specialties? Obviously there was a hole to fill, right? So why this over others?
Dr. Lingor: 01:08 For myself, I really enjoyed helping keep people active and I think somebody’s activity correlates with their quality of life. And so if we can help, you know, people when they get injured or something to hold them back from, from being active on a daily basis, that's kind of where I wanted to help out.
Michelle Cummings: 01:33 For me, It's two fold. One because I'm so passionate about sports in general and secondly, the specialty itself, you can actually make people better a lot quicker than in other specialties. So that's what drew me to sports.
Karen Litzy: I agree. I think with those sports injuries, I know coming from the physical therapist’s perspective, you kind of see this progression, right? So regardless of the age of the patient you kind of see from injury and you can really follow them through to recovery, which is really exciting from my standpoint and now, what are the commonly treated injuries seen in the clinic?
Dr. Lingor: 02:14 So we see all sorts of musculoskeletal injuries, the common stuff if somebody has a shoulder injury or just shoulder pain, we see a lot of knee injuries after athletic event, hip pain, all sorts. So any of the extremity injuries we do specialize in. And for patients that have back pain, fortunately we are a suited at HSS to have a back pain clinic. So we direct those patients to the right, the right place.
Karen Litzy: 02:47 And so why should a patient come to this Ortho care clinic versus going to the ER? What is the difference?
Michelle Cummings: So the difference? Well, the ER you'll always have long wait times and they're not always apt to treat just orthopedic and sports injuries. So here we have an x ray onsite. Quick access to films as well as splinting and casting availability here. And what's Nice is you can actually schedule appointments online or call directly and we schedule same day and next day appointments. So if a patient sprains their ankle, you know, a night at basketball, they can go on and schedule an appointment early the next morning. So to try to shorten the wait time to the ER.
Karen Litzy: So you alluded a little bit to the splinting and casting, but you know, as non-operative clinicians, what types of conservative treatment are you providing for these patients as they come in?
Dr. Lingor: 03:49 So a lot of this stuff, you know, fortunately for us and most patients just don't want it to be checked out to see if they have something that they need to be more concerned about and kind of be directed in the right area. And fortunately we're kind of at a good position to give them access to all the resources that we have at the hospital for special surgery for those patients that need it. For stuff that we can take care of in the office here, we do have, as Michelle said, the x rays, we can do injections into different areas as necessary and we have the use of ultrasound to make sure that we are accurate with the injections and the care that we're providing.
Karen Litzy: 04:36 So this is how new? It's pretty new, right? When did you guys first open?
Michelle Cummings: Yeah, we first opened in November of 2018 so it's been a couple of months now.
Karen Litzy: And as with everything new, every new venture, right, it has its ups and downs. So what are some of the challenges that have come up since this clinic opened?
Dr. Lingor: 05:02 Well, the biggest challenge is just getting our name out there and letting people know that we exist. We've been very fortunate to have a lot of interest both in our hospital and in the community to get people in the door when they need to be seen and get them moving in the right direction. So there's been a lot of positive energy that we've been able to benefit from in our first few months and we're still working out some kinks and not everything is smooth as you mentioned when you first get going. But, we've been very blessed to have a great staff around here that, that are all interested in, in doing what's best for the patient and providing exceptional patient care.
Karen Litzy: 05:46 And so you have some challenges, I'm sure there's also been some pros, right. So what have you found since opening the clinic have been a real positive or maybe even things you didn't even expect?
Dr. Lingor: 06:03 I think one of the nicest things is that our patients generally are in a pretty good mood when they come here because they're oftentimes patients, they're looking to go to the ER and they anticipate, you know, waiting for a couple hours and may have been told to follow up with her orthopedist at that time. And so patients are, excited when they come to a very reputable hospital and then being able to get an appointment the same day or the next day. And so they're pretty excited about that, about that opportunity. And so that's just kind of fun to work in that kind of environment where everyone is in a good mood off the bat.
Karen Litzy: 06:44 Yeah, that sounds amazing. And I would also have to think that, you know, when you go, if you have an orthopedic injury or like you said, it's soft tissue ortho injury and you go to the ER, you're not guaranteed to get an orthopedic specialist to treat you in the ER. Would you say that's correct. So is that how this kind of differs?
Dr. Lingor: 07:04 That's exactly right. If you go to the emergency room, they have the resources for, you know, taking care of the life threatening or really serious things. And that's perfectly appropriate for the ER because we don't treat those sorts of things. And with patients that go to the ER and have a lot more of the, you know, 90% of the orthopedic injuries where it's appropriate for us. And so this is a way for us to cut down on patient’s wait times and their costs as you know, an emergency room bill. Get them moving in the right direction right from the beginning.
Karen Litzy: 07:50 Do you guys take insurance?
Michelle Cummings: It's actually listed on our website. So if a patient had questions about the insurances we take, it's all listed on the website, but we take all major insurances.
Dr. Lingor: 08:04 And that's pretty easy to find if you just Google HSS ortho injury care, you'll see it pops right up and you can see the insurances that we take and you can book yourself online and really booking an appointment is about a three minute process.
Karen Litzy: 08:19 Nice. And is this something that you patterned after? Like is there another clinic like this somewhere else in the country or is this one of a king clinics?
Dr. Lingor: 08:33 To our knowledge, this is one of the first ones in the region. I think a lot of other orthopedic places that have walk in clinics and stuff like that. I think this is the first stand alone clinic that operates, kind of how we do and you know, something we saw as a need and it's been a wildly successful in our first few months.
Karen Litzy: 09:01 Which is amazing. Dr. Lingor, I have a question for you. So aside from being an orthopedic physician, you also have a nutrition background, which I find really interesting. So are you able to infuse any of that within this clinic or do you see that as maybe something that you might want to infuse into in the future?
Dr. Lingor: 09:23 Well, with the sports medicine and medicine in general, being a field of nutrition in its other fields, it is something that I really enjoy learning about and trying to keep up with. In the clinic right now, it just helps me to better counsel patients and answer questions that they have, about nutrition and things that they can do to optimally heal and prevents some of the chronic conditions. And so I utilize it that way. And fortunately at HSS we do have a nutrition and dietetics team that we call upon as well as physicians who specialize in nutrition. We need more help. So it's not, I don't solely practice in the field of nutrition now, but kind of more as a complement to what we offer at the clinic.
Karen Litzy: 10:16 Yeah, I think that's great. Where do you see this going? Where do you see this, you know, that old question, where do you see this going in five years?
Dr. Lingor: 10:29 Yeah, so we're kind of looking at the hospital for special surgery as branching out to a couple of different other sites around the city, as well as a couple of places throughout the country in Las Vegas and in Florida. And so we're looking at kind of making this, you know, this being the flagship and then kind of model after the places just because it has seemed to do so well for our patients and for our physicians as well to get patients in. So by that I mean that when patients call other doctor's offices and they can't be seeing those to us, and then if necessary, then we get that patient back at an appointment that's a little bit more expedited then what the other physician would have been able to originally see them.
Karen Litzy: 11:26 Yeah. So you're sort of like, that patient could come in to you guys and if you feel like a referral is necessary, then you can kind of help streamline the process for the patient, which is amazing for patients because that's what they want. Because they come to you, they don't know what's going on.
Dr. Lingor: 11:41 Yeah, that's exactly right. And often times when they call one of our surgeons office, it may be a day at the surgeon just happens to be in the operating room and you know, regardless of how bad they want to see that patient, if they just don't have the ability to get them in. So, that's why I always say that we are here when the patient needs us and kind of get them moving in that right direction.
Karen Litzy: 12:01 And you know, and looking on the website, you have Michelle, a physician assistant and then a couple of other orthopedic physicians. How do you guys all kind of work together to make this clinic run?
Michelle Cummings: Now that’s a good question. So Dr. Lingor is here more than anyone else as the medical director. So He's here usually five to six days of the week. We are closed on Sundays and I come in later in the morning and cover the night shifts and then we have the other providers that will cover sometimes on the Thursdays and also on Saturdays they cover in the need to fill in the gaps.
Karen Litzy: Got It. And this will be kind of like you said, your flagship operation and then hopefully kind of move this model throughout the country. I guess my question is from where you are now then from where you started, I mean, you obviously see this as something that's sustainable, right? Because I think a lot of people, when new things kind of move into their communities, there are always a little hesitant. What do you do for the community? And New York City's a big community, right? Like you said, getting the word out is part of it. But do you have any plans on kind of being part of like really being part of maybe even smaller communities, New York is gigantic, but really kind of getting into the community to get people to trust?
Dr. Lingor: 13:39 Yeah, I think that's really great point. And that's one of the things that just in our area, we're located on 65th street and second avenue. And so we see a lot of patients just in our area with, you know, a few block radius of patients walking by who have seen the signs a little bit and then come in and check it out to see what it is and say, Oh yeah, I have this knee issue. I wonder if you guys can take a look at it. We do welcome Walk-in's we prefer patients to make an appointment just to decrease their own waiting time. But we do see a lot of that and just providing that access to patients when they need it. I think has really helps build our name in our own little community that we serve right now.
Karen Litzy: 14:22 Yeah. I have my own practice and that's always the hardest thing, like you said, is getting the word out, letting people know you're there. What other marketing things, have you guys done that you've found successful so that if people are listening, they're like, wow, I really wish we had something like that in our community. Maybe they want to start it. What would your best advice be?
Dr. Lingor: 14:49 Well, one of the things that fortunately New York City has a plethora of is sporting events around being open during those times. So, like for instance, when the New York City Marathon is going on, you know, on that Sunday will be open that day to provide, access and for again, people in the area just to kind of get our name out a little bit more that people are walking by and having, you know, welcoming people in if they need to be seen by one of our providers that day and not, you know, that for the runners. Cause they're a little busy that day. Right? Yeah, exactly. Hopefully not too many of them. But we are just one block off the race course over the edge of some of those special events and volunteering with those groups. It's something we look forward to.
Karen Litzy: 15:48 Yeah. So kind of making partnerships within the community so they know you're there and they can refer to you and all that fun stuff.
Dr. Lingor: 15:56 Yeah. So we have several of our positions that do volunteer in past years with those events. And so we see when patients come in for the marathon Monday that they host after the New York City Marathon. Those patients, you know, they're seen by a medical professional that then if they need to get further testing done now we can provide that access to people.
Karen Litzy: 16:24 Fantastic. I mean, it sounds like you've got a great, a great niche over there and that you've definitely found a way to kind of plug that hole, right. You've found a way, you saw this sort of lack of accessibility and have made something a lot more accessible. So is there anything that we missed or anything that, you know, you want to the listeners to kind of remember about the clinic?
Dr. Lingor: 16:53 Yes. Things come up and unfortunately musculoskeletal injuries come up unexpectedly at the worst possible times. And there's a lot that can be done if when patients have that time of need, whether they're going on vacation or have a major life events. That's our primary goal is to provide access for the patients when they need it and help them sort through some of the frustrations. And difficulties that come along with musculoskeletal and sports injuries and you know, get them back to their level of health and quality of life that they're used to enjoying.
Karen Litzy: 17:38 Awesome. And Michelle, how about you? Anything that we didn't touch upon or any closing thoughts that you want to share?
Michelle Cummings: No, I think just thank you for having us on the show and helping us get the word out. It's very helpful from different aspects to get out the word out in New York. So thank you for having us.
Karen Litzy: Yeah, you're welcome. And you know, I think it's also important, like now as a physical therapist, this is great for me to know because you know, we see patients directly now, so someone comes to me and I'm not sure, then for me it's great to say, Hey, there's a clinic that specializes in this. And then what it does for me is it kind of builds up my credibility with the patient because I'm sending them to a place where they're going to get the help that they need.
Dr. Lingor: 18:25 I’m very excited that physical therapists have the direct access, so through the physical therapy and find that, you know, the physical therapists that we commonly work with. It's been a great relationship with that. We look forward to expanding on that. And again, thank you very much.
Karen Litzy: 18:46 My pleasure. My pleasure. Thank you so much for coming on. So again, if you want to find out more information, you can go to hss.edu/ortho-injury-care. Is that right?
Dr. Lingor: 19:06 The easiest thing is just go to Google and type in Ortho injury care.
Karen Litzy: 19:14 Or you can go to podcast.healthywealthysmart.com and we'll have the link right there for you so you can just click on the link and go right to it. And hopefully we see more and more of these types of clinics popping up around the country because it certainly does fill a gap. So thank you guys for all that you do to help people with sports injuries, musculoskeletal injury. So thank you. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dolores Hirschmann. Dolores is a STRATEGIST & COACH. She helps clients clarify their “idea worth sharing”, design their communication strategies, and implement business growth systems.
In this episode, we discuss:
- THE IDEA OF YOU: A Framework for Clarity of Self
- Clarity of life purpose
- Clarity of who you are as a leader
- Clarity around how to set goals and set yourself up to achieve those goals
- Her work as a TEDx organizer and how you can get on that stage
- And so much more!
Resources:
Dolores’ LinkedIn
Dolores’ Facebook
Dolores’ Twitter
Dolores’ Instagram
Dolores’ YouTube:
Website: http://mastersinclarity.com/media/
Free Gift
"Stand Out the TED Way: Be Seen & Grow Your Business" eBook Download https://doloreshirschmann.simplero.com/bc
For more information about Dolores:
Dolores is a STRATEGIST & COACH. She helps clients clarify their “idea worth sharing”, design their communication strategies, and implement business growth systems. Her clients become speakers and authors and take their message to larger audiences like TEDx and beyond. She works through group coaching, workshops, one on one coaching, as well as public speaking. Dolores is a writer, TEDx Organizer, and participant in TED conferences. She is a CTI certified and ICF accredited coach and has a business degree from the Universidad de San Andres, Argentina. Originally from Buenos Aires, Dolores speaks fluent Spanish, English, and French and lives in Dartmouth, MA with her husband and four children.
Read the full transcript below:
Karen: 00:00 Yeah. Hi Delores, welcome to the podcast. I'm happy to have you on.
Dolores: 00:05 I am so excited to be chatting with you today.
Karen: 00:08 And now in your bio, like I read, you're a tedx organizer. You help support speakers on the TEDX stage. So can you elaborate a little bit more about that? Cause I know a lot of my listeners would love to one day be on a ted or a tedx stage.
Dolores: 00:23 Yes, absolutely. I mean at the core of my work is my passion for ideas and because of that I, I I pursued as a volunteer. I pursued the TEDX platform. If you wand as a tedx organizer and in doing so I really connected with something that I love to do, which is help people clarify. And I know we're going to talk a little bit about this today, but you know, clarity comes in two ways. First is an internal clarity and then annex I communications clarity. When you bring yourself out into the world, which is what speakers do day in and day out, right? They bring out their messages. And so what I do with speakers today in my work, I held them in both guide, find the message Clive, find the overall communication strategy so that they can actually engage their audiences and kind of moved on.
Dolores: 01:16 You love their other movement or their, their impact. Right. And so that's on the, on the strategy side. But on the tactical side along the speakers just are not getting out there often enough simply because they just don't have time to pitch and to put themselves out there. And being in front of organizers and event planners. So with, in my company, in the agency side of my company, we actually have two services. One is where we actually research and pitch of peoples we have for them to speak in virtual and live events. And another one specifically signed four stages that are a little bit more harder to get in. It could be a telex, it could be, you know, some of the newer stages are coming up that are more inspirational or more kind of the idea based stages versus more the pitching stages. Um, and so what we'll do is we'll help the speaker life other core idea, clarify the positioning so that they can send out in the selection process and then help them with the research and the application process until they get selected. And that's something that I, you know, we do it for very specific clients whose message is ready for that kind of platform.
Karen: 02:32 Okay. So let's talk about getting this clarity around ourselves as a speaker because you had mentioned that a couple times, you know, getting clarity on who you are on your idea and, and even on where you want your idea to be, right? Because not every stage is right for every person. So let's talk about that clarity. Let's first talk about how to get clear on yourself.
Dolores: 02:58 Yes. So one of the things I am involved into, and I haven't, I realized that all my life, whether I was aware of it or not, I have been kind of this puzzle maker. Right? You know, what once as we started evolving and developing ourselves and becoming more self aware, I mean, especially when I did my coaching training, um, a lot of my internal introspection was about what is it that I bring to this world? Like we all have unique brilliances who all have that thing that we do well. Um, and for me that is that p being a puzzle maker. But to make a puzzle, you first have to have puzzle pieces. What I mean by that is we are always kind of lumping all of ourselves together in a tight box. And so when we're in that place is very difficult for us to really get to know ourselves because we are kind of mishmash with what has happened today.
Dolores: 04:02 The pain we had 50 years ago, um, and what we think we want to do, right? It's all kind of all mixed. And in order to make a puzzle, again, you need to pull out the puzzle pieces. So one of the things that I consistently do is create frameworks to break things apart so that we can build them back together. And so this framework, I, there's a friend where I designed called the idea of view and all it is really ease, deconstructing the different parts of who we are and the different kind of what I call layers of clarity that we can access so that when we actually pull them apart and look at it layer by layer, we can have a much more comprehensive picture of who we are. And in doing so, we can better assess where we're going. Does that make any sense?
Karen: 04:52 It does. It does. And would you mind giving us a, an example of maybe an exercise within this idea of you like a deconstruction exercise?
Dolores: 05:04 Yeah. And so let me just run you through the layers first. Okay. Uh, and then we'll hop into one or two exercises here that will help you better understand what I mean. So in the idea of you, and you know, I, I can send you some images later. It's, it's all about mmm. Getting Cody from the inside out so that at the core we begin with terrifying the you and, and, and he's, I say the idea of you because I believe that each one of us was born in purpose and for a purpose that we're kind of a seat of a, of a something, right? And so at the core of this exploration is what is your life purpose? Now this is a really big question and the question that has been around for many years, but I'll buy that today. It's kind of very heavy in, in making the decisions of our career paths and where we want to go, right?
Dolores: 06:00 And so I posted not as exactly the word we're going to do, but simply the who we are at our core, independent what we do. And so one way to do this is to think of yourself as a metaphor. Now you do this exercise. Please don't go and knock on your neighbor's door and let them know what metaphor you are because they're going to look at you like you're crazy. But when I did this exercise myself, I came up with my own personal life purpose statement, which is going to sound grandiose and he should sound round you dos because it's a lifelong purpose, right? And for me is I am the light that brings clarity. Clarity is at the core of who I am, independent of any activity or job that I'm holding. You see the difference. It's something that I can help a being.
Dolores: 06:56 I am attracted to like that lump of puzzle pieces because I like sorting them out and making a new picture. That's what I am in all aspects of my life. I've been like the cloudy maker for family situations, for job situations, for ideas, for for four speakers talks. I always bring that element right? So we begin with that and then we go and transition into identify what are our values and when I talk about values, I talk about what are the top things in your life that when you don't have them or you're not honoring them in your life, you just feel off. For example, I am, I have a big value on adventure. And when I was doing this work for myself at the time I was a young, youngish mother of four children. And you can say that having four children is an adventure in itself, but when you're in it, diaper in diaper a how day in, day out, it doesn't feel like an adventure.
Dolores: 08:01 It really starts looking like a very big routine after routine. Like it just doesn't feel exciting. And I, and I met some people might or might not agree with me, but that was my experience. And so when I recognize that adventure was a very big part of who I am and that not honoring my sense of adventure was kind of bringing me down, just that knowledge made me ask myself, okay, what can I do to fulfill that need of adventure? And you know, here's the thing Karen, is that tell us a shifts and changes can be very subtle. They don't need to be like moved to Africa. You know, it just do. Okay. Then I will just make time every week and maybe an hour a week to learn something new or to meet someone new or to explore a new place, even if it's just a new supermarket where I'll do food shopping.
Dolores: 08:54 Right? But, um, but it's just understanding what is it that is then that makes you tick and making sure that those values are being honored in your life. Then we go to understand your unique brilliance. What is it that you would excel, add in a natural way that you are, that you love doing. You never get tired of doing it and that, um, and then you always bring value. And what happens is again, when we are not connected with who we are, we sometimes unconsciously move away from that. That comes easy. Sometimes it's, I believe that work must be hard. So I might as well put that grit to it and we, and we discard maybe opportunities that might come our way that our land with our unique buildings because it feels too easy. So therefore I'm probably not regulated. Right? Right. And then, and then we explore another ring of clarity, another layer of clarity.
Dolores: 09:59 Quiches and this might be a great exercise for, for me to pause for a minute, but it's a ring of clarity of how do we define your life's work. Now, if you remember when I talked about life purpose, I talked about purpose of your sole purpose of who you are. Who doesn't mean that he defines the work that you do? A lot of people are trying to like calm, packed your job with your life purpose. And you know, there's a, there's a, there's another step in between and that is a step of your life's work. And why is it important? Because you have to translate your life purpose into as something that the world needs. Because, because even nobody needs your life purpose as it states in its true form. Um, then you might be both frustrated entrepreneur if you launch yourself into, like for example, when I first started, I just wanted to bring clarity to everybody and he was like, I wasn't getting anywhere, right?
Dolores: 11:05 Was, it was a very broad, esoteric value proposition that everybody liked it. I mean, I remember people saying, I really like you. I like when you say I put your ride. I just not sure how I can benefit from you. Um, and that's really great feedback to get right because it's like you're casting the net a bit too wide, way too wide. And I, and I see this a lot in the newly, you know, new business owners, entrepreneurs, we're following their passion. And again, it's not about that they're wrong, it's about they just need one more step. And this step is the lives we're defining your life's work. And here's a little exercise that we can share with your audience. And it's redundant. You have a venn diagram and you have four circles. What is your life purpose? Right? Just in that way of stating it broadly and grandiose, you know that people will look at you funny to share it in the subway.
Dolores: 12:03 And then the other circle there would be what people will pay for Nike nearly researching what will people, what do people pay for people pay for photographers, for weddings be both paid for accountants. People fave for a strategy for business growth. Like those are real things that other people are salad. Then another circle in this, in this damn, I'm would be, what are you trained to do? Like what are, what is your academic background and your past job experience, bathroom. Why? Because you don't want to just hop on a wagon and say, I'm going to do this because I love doing it, but no real credibility or kind of credentials.
Karen: 12:51 Exactly. It'd be like me saying, you know, I'm really good with numbers, so I'm going to be an accountant to be a physical therapist. Yeah. No one's gonna pay me for that. They'll think I'm crazy. Exactly. Exactly. Because you know, it's, there's something to be said about
Dolores: 13:07 some credentials. Um, um, and so, so really make a list of whether you were wrong and choosing your career path, our certifications you received. I would challenge that and look at what they can still bring you to life right now. Like, even if you're a doctor and you don't want to be a doctor anymore, that doctoral degree will go a long way to validating what you know and then putting into some, some other kind of surveys. Right. Absolutely. And then the last one is, so we have life purpose, what people will pay for what you have experience, job or, or academic. Um, and the last one is what does the world need? Or what does the world need more off? So when you do those four kind of circles and maybe do a little less in the middle, what you then looking at is what are the common denominators?
Dolores: 14:07 Where do all these four circles come together? So for me, you know, clarity is what my brain, right? And people pay for business strategy. People go for communication strategy. People pay for, uh, you know, maybe speaking people who pay for growing their business. My academic background, which at the time I was in school, I was kind of resenting it because I wasn't excited about it. Every day. I remember my mom would say, okay, you don't like what you're doing. Do you have any other ID? And I would say no. Then she would say, then finish what you started. Best Advice I ever got. Um, like stay on. I get that degree. Even if you have to like, you know, put a little bit of effort to it. Just get that done. So going to business school, I have to say 20 years later going to business school was the best decision I made at 18, even if I did 11, because he gave me the tools to narrow down my business and to be our business strategist. And so, so that's where my academic and what does the world need more off the world needs more ideas that can have a positive impact in the world. And the truth is, in my work and masters in clarity, we stand behind those ideas, typically in the hands of service entrepreneurs who have new methodologies, new perspective, new angles or new ways to helping their market or the world.
Dolores: 15:40 And that's that. Um, so as far as you know, that exercise is, is really helping you narrow down of how to you become off service in this world with your life purpose in a way that can be financially, not just financially sustainable, but can I might say financially abundant.
Karen: 16:03 Right. And there's nothing wrong with that.
Dolores: 16:05 How old is all right with that? Because the more abundant you are, the more you can do the work you're called to do, the more the world's will benefit.
Karen: 16:15 Absolutely. And I really love the, that sort of venn diagram of those categories. So I'm going to just repeat them and I want you to let me know if I got them right. So, um, what is your life's purpose then? That's a big grandiose statement that's supposed to be grandiose. Uh, what will someone pay you for? What does the world need more of and essentially what are your credentials? That right. I think that four parts. Exactly. Okay, great. Great. Great. Yeah. And, and I think if, if you can really sit with those questions, cause I don't think it's something that's not answered in five minutes, right. Syntheses questions. And how do you, and, and, and I dunno if there's a straightforward answer to this, but how do you know what your life purpose is? Because you know, sometimes when people hear that they're like, whatever.
Dolores: 17:14 Yeah. So here's a couple of ways to do it. MMM. You can sync off and moment in your life where you felt completely, um, completely valued and completely, um, like you were, you were at critical element of a situation where we're maybe without you playing whatever role you were playing, maybe outcome would have been very different or not positive in one way or another. That's one way to ask yourselves and start asking, you know, some days is, is asking you as a, what roles have I played most of my life? What do people know me for? What do people say about me? Um, and I, and I did that exercise and I asked my, the people in my life, my food, my mother and my friends. And, um, and you know, a lot of people would say things like, well, I would always call for you to you is I was needing to make a decision. I was the go to person for decision makers. Um, it's funny, I'm actually posting a blog on, on that, on this particular topic this week, um, because I'm helping my daughter made college decision right now. Um, so it's just really going inside and also go into your inner circle asking how do I bring value? What, what is it that the role that I play that I'm somehow always falling into that role in any kind of social or professional environment.
Karen: 18:59 Yeah, that's great. And I think that'll give the listeners a little bit something more to think about when they're trying to kind of discover what their life purpose is because I know I find that to be a bit difficult as well and I'm sure I'm not alone in that.
Dolores: 19:15 Yeah. Yeah. It's, it's, it's, it's one of the things that can always include us. Um, but my experience is that it did for many years until I came up with that, with that metaphor that I'm the lie the breeze clarity and sometimes I want to challenge people because we try to make this life purpose statement very complex or very sophisticated and symptoms is so simple that we rejected for its simplicity.
Karen: 19:52 That's true cause because we think it needs to be so over the top. Amazing. When in fact some simple as smart, right?
Dolores: 20:01 Yeah. Yeah. And any, maybe it's simple bod grandiose and so are our cultural belief system that who are we to believe that we can be that good comes into play and also mucks things up.
Karen: 20:17 Yeah. That self doubt and lack of self compassion for, uh, for ourselves can kind of derail us every time. Right?
Dolores: 20:27 Absolutely. And I think, you know, I mean this is just my perspective and I, if I might share it, I think that I really believed that each one of us in the world, not just me, all of us are here in person for a purpose. We were a gift and that that grandiose side is actually bigger than us. Um, we're just here. I, I believe to do a job that we're called to do within a universe that is much bigger than us. So to reject our brilliance is a, it's a, it's to reject that gift of who we are.
Karen: 21:08 Yeah. I love that. Thank you for saying that. And now let's say we kind of have this clarity of life purpose. We have more clarity around who we are as a leader. What do we do then? What's the next step? How do we then
Dolores: 21:26 goals? Yeah, so there's a couple more layers that, um, that will take your right there. So then the next layer would be clarifying how you interact with the world. And for that you have a lot of online assessments. There's one that is free that I love is basic, but it works. It's called 16 personalities. Got Home. It's based on Myers Briggs. You have finder and Colby and um, uh, an agreement like this, a lot of assessments out there, but those are really great and those are fun. And you learn more about how the world perceives you because that's important as well. And then, and then, and then we put all this to work. How would we do to work? Two more steps or internal one is we, and maybe I, I'm happy to do this for you and maybe the lessons will love this is um, identify and bring forth your internal leader and that is the highest voice.
Dolores: 22:26 We have voices in our head just for all of you are there. Yes, I do have voices in my head and there's nothing wrong with me. And we typically have most of the judgmental whiny voice that says that we're not enough. That's usually the loudest, but when we tap into our internal leader or captain that voice, then we can start kind of all of those not so happy or positive voices. So tapping no leader is an great um, resource because it will be that voice of reason that says to me, the Lord is slow down. Think about what you're going to say. Like you got this, uh, yes, it's hard, but you know, keep them going. That kind of positive reinforcement. And then the other part of this kind of clarity is understanding again in the same line, what is that conversation in your head and how many times a day you're going into victim mode, things are happening to you versus I got this, this is hard, but this is happening for me.
Dolores: 23:34 Right? And, and so that, that kind of wraps up the clary layers and the mindset layers. And then I think this is what you were alluding. It's like, okay, now what we do, right, right. Was parts one is the exercise of goal setting. How do we set goals that are honoring our values, our purpose, our internal leader? And from a positive mindset or victory mindset perspective. So how do we set goals from that? And our goal setting is not mixed science is they have to be smart, specific, measurable, attainable, um, timely. Um, and uh, and they have to be a stretch from where you are. But nod, I want to lose a hundred pounds in a month, right? Setting yourself up for failure. And so the goals are the big kind of gps as well. We're going lag. You can have a goal for each part of your life or only the parts of your life that need attention right now and is a great exercise with that.
Dolores: 24:44 It's called a wheel of life. A lot of, uh, you can probably find that online is it breaks your life into different kind of sections like a pie. And he helps you really assess from one to 10, one being this is not working really well, 10 being I'm rocking aid and from one to 10 and tried to understand which part of the life is not doing so well and so that he can focus on that. And then at the end of the day, Karen, all this is wonderful, but that transformation and our true selves as leaders only comes to shine in the details of every day. And that's why I talk about habits all success. So at the end of the day, how we wake up in the morning, how we brush our teeth, how we get dressed, how we make our bed. And yes, making your bed is part of [inaudible] leadership and what we eat, how we greet the post man, how we say hi to our coworkers. Those are the tiny details of our day that honestly make our big life. Okay.
Karen: 25:56 And you, you, you're about that. The making the bed thing all the time. And I started doing that a couple of years ago and I remember someone asked, why, why do you make your bed? I'm like, cause then I feel like I start out my day with a little wind.
Dolores: 26:10 Yes. I actually, one day I may have, I've always made my bed. I was raised that way and it was actually bothered me not to, I think at some point I was, you know, this, this balance. And at some point I was so, so kind of one, I was wound, wound very tied when the kids were little. And I remember having a coach who said, I challenge you not to make any bad this week. So I actually had to not make that because it was becoming a burden to me. But years later, my sister, teen 16
Karen: 26:44 year old, oldest son, um, started making his bed and I hadn't said a word and I noticed it and he said, yes ma'am, I read this book and he gave me the book. And it's a book that I recommend always. He had read this book called the power of habit from child. I don't know if you've read it and I, it's, for me, it's an amazing book and everywhere. And that book taught my 16 year old back then to make us better. Oh, how wonderful. Charles Duhigg would be so proud.
Dolores: 27:15 I was going to say, maybe I should send a note that he accomplish almost impossible.
Karen: 27:20 I ain't got it. He had a teenage boy to make it better. Exactly. Yeah. That's amazing. Yeah. And then how, so, you know, you work with your clients and they've gone through all of these steps and then how do you, how do they then say or decide kind of where did it go from there? Right. So let's say someone's already a leader and they want to do a Ted talk. Somebody wants to do a Tedx talk. Right. Which are probably a lot of people listening to this podcast. So they go through all this. They have a good clarity of self, an idea of self, what's the Prac, what do you do, how do you do that?
Dolores: 28:06 So is a good question. So actually if someone comes straight, like let's say I didn't have work with me and they come to me just to do a talk, I will go through the process even though it might feel not linear. That is good to do with my talk because especially in the life purpose because with a talk like a Tedx talk on the of the talk is an idea that can have a positive impact in the world and that is right in the line of what we were just talking about. Your life purpose and your life's work. And so what I do is I bring that conversation APP and say, okay, this is your life purpose. Great. Your idea is kind of the cousin of your life purpose because it is an actionable version of your life progress. For example, for me, if I were to do a talk, it would be about how cloudy frameworks can help entrepreneurs realize their impact.
Dolores: 29:10 So my life purpose is clarity, but for the idea is the concept of clarity for frameworks as a tool for the purpose of serve as entrepreneurs realizing their impact. I'm just kind of very specific. So what we do is we tap into who the speaker is, what is it that they've always known about themselves, what is it that they've always longed to do or accomplish in this world? And then we explore about on the work they do, because here's the thing, can everybody comes to me and says, I want to give a talk. And I say, okay, what's, what's your core idea? What do you want to share? And they go on and say, well, let me tell you about my work. And it's on and off for like 30 minutes. Right? And and when you're pitching to any stage, but specifically at Tedx stage, the organize who will ask you one question and he's like, can you tell me your idea in one short sentence? And most people can. So that's why the life purpose, um, and a framework that I teach for, for stating your core idea come together to create this one line idea statements that then the top will be based on.
Karen: 30:22 Got It. Thank you for that. Cause I think that's a big point of clarity, if you will, for people who might be thinking about pitching themselves to do a big talk somewhere that you should be really be able to state the purpose of your talk, like you said in one sentence, succinctly and but with the punch, right?
Dolores: 30:46 Yeah. Yeah. But here's the thing is not, you know, they get caught up in this sexiness of it. Yeah. And they lose the practicality of it. So it depends the market. If you are looking to stand out in your market so that people will hire you, I would say lose a sexy gained the clarity. If you're looking to send out in an application to be speaking, then the stress, the, the to stress, the takeaway with the audience will get and the uniqueness of your process.
Karen: 31:27 Great. So it really depends who you're talking to him. Sure, sure. Because in the end, especially if you're talking about a Tedx talk, it's all about what, like you said, it's all about the audience, not about you, not you.
Dolores: 31:40 No, no, and I actually have had, you know, I love the work of the Tedx or the speaking if you want. What I love about it is that
Dolores: 31:53 people come to get that Karen, right? Like that kind of thing that they want the tedx stage or whatever stage and what they gads when they do this work of clarity is they get a Vishen so much bigger than they had before. I had a client what a multi multimillion dollars coaching program, a company, very successful is 16 years in business. And she did the work to get on that stage. And because of that work, she completely rebranded her company after 16 years, change the name because she realized that what the core idea of her work and the essence of our work was so much bigger than the brandy she of created for her company. And she was, she was kind of, she was feeling that the company was a little stale because she had reached the boundary, the box she had made for herself.
Karen: 32:52 Yeah. Oh my gosh. That has me thinking so much. It really does. And I think, you know, often times people get caught up in themselves instead of in the idea. And I think that can derail you.
Dolores: 33:09 It is, it is kind of a process then without knowing you'll fall in love again with your work. Awesome.
Karen: 33:18 Well, that just sounds amazing and I think you gave such great tips and, and really kind of got into the work that you do with, with uh, entrepreneurs and, and possible speakers and a executives. So thank you for sharing all of that with us. Is there anything that we missed or things that you want the listeners to really take away?
Dolores: 33:43 Um, I think that whatever you are doing, whatever situation you are in your life right now, just checking and understand where you stand. Don't make decisions from what other people say unless you also include your higher voice in the conversation.
Karen: 34:08 Excellent. I love that advice. And then I have one last question and it is again, another piece of advice and it's the question I asked everyone and that is knowing where you are now and your life in your career, what advice would you give to that? You know, fresh face Gal right out of college?
Dolores: 34:26 Well I, I, I would say to her, stay in this state of wonder. Trust your gut and yourself and it's okay. Life is not linear.
Karen: 34:41 Awesome. And where can people find you if they want more info or if they have any questions,
Dolores: 34:49 they can come to masters in clarity.com and right on the main home page you'll have a big orange button that says free resources and you can find different resources that you can download for free and start getting the clarity unique.
Karen: 35:07 Awesome. And then just so the listeners know, we'll have all of these links will be up on our website at podcast out healthy, wealthy, smart.com and that Dolores also has a free gift. Stand up the Ted way, be seen and grow your business ebook downloads. So we will also have that on the podcast page under this episode as well. So thank you for that and thank you for coming on today. This was great.
Dolores: 35:34 Thank you so much for having me. I had a lot of fun
Karen: 35:37 and everyone who's out there listening, thanks so much. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on 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!
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!
Resources:
Candida, IBS, and Heavy Metals Education Facebook Group
FREE GIFT: 7 STEPS TO KILL CANDIDA CHECKLIST
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 podcast.healthywealthysmart.com so you can one click and it'll take you there. And where can people find you?
Laurie Seely: 31:55 I am at laurieseely.com 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.
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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!
Resources:
3rd World Congress of Sports Physical Therapy
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 (www.glaid.dk). 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.
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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!
Resources:
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 www.robinjoymeyers.com. 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!
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!
Resources:
Professor Catherine Dean 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.
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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!
Resources:
Why Healthcare Professionals Should Speak Out Against False Beliefs
Email: jason.falvey@yale.edu
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!
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!
Resources:
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 Hss.edu 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!
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!
Resources:
Email: nikkikimball@yahoo.com
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 irunfar.com, 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 Nikkikimball@yahoo.com 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.
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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!
Resources:
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.
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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!
Resources:
Spark Physical Therapy Facebook
Spark Physical Therapy Website
For more information on Duane:
Dr. Duane Scotti is a physical therapist, educator, researcher and founder of Spark Physical Therapy. He is considered a leader in the fields of rehab, sports medicine, performing arts medicine, and human performance optimization. With years of experience as a physical therapist, runner, and dance instructor in combination with his strength and conditioning background, Duane has been working with many patients to improve all aspects of human performance.
Duane is currently the founder of Spark Physical Therapy, providing prehab, rehab, and performance optimization services either onsite or in the comfort of your home within the Cheshire/Wallingford CT region. He also is a clinical assistant professor in the Department of Physical Therapy at Quinnipiac University responsible for coordinating and teaching musculoskeletal examination, intervention, and advanced manual therapy within the orthopedic curriculum.
Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation, dance medicine, gymnastics medicine, and rehabilitation for runners.
Duane has been in clinical practice working with orthopedic, sports, and performing arts populations since 2003. He has strong clinical and research agendas in screening, injury prevention, and rehabilitation for runners, dancers, and gymnasts. Duane uses an integrative model of manual therapy including manipulation, mobilization, and soft tissue treatment including dry needling and the Graston technique for the management of musculoskeletal dysfunction. Duane is a physical therapy advocate and is actively engaged with the American Physical Therapy Association and serves as Vice President of the Connecticut Physical Therapy Association.
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 (www.jennakantor.com) 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: www.jennafkantor.wixsite.com/jkpt
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.
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