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Healthy Wealthy & Smart: Where Healthcare Meets Business. The Healthy Wealthy & Smart podcast, hosted by world-renowned physical therapist Dr. Karen Litzy, offers a wealth of knowledge and expertise to help healthcare and fitness professionals take their careers to the next level. With its perfect blend of clinical skills and business acumen, this podcast is a one-stop-shop for anyone looking to gain a competitive edge in today's rapidly evolving healthcare landscape. Dr. Litzy's dynamic approach to hosting combines practical clinical insights with expert business advice, making the Healthy Wealthy & Smart podcast the go-to resource for ambitious professionals seeking to excel in their fields. Each episode features a thought-provoking conversation with a leading industry expert, offering listeners unique insights and actionable strategies to optimize their practices and boost their bottom line. Whether you're a seasoned healthcare professional looking to expand your skill set, or an up-and-coming fitness expert seeking to establish your brand, the Healthy Wealthy & Smart podcast has something for everyone. From expert advice on marketing and branding to in-depth discussions on the latest clinical research and techniques, this podcast is your essential guide to achieving success in today's competitive healthcare landscape. So if you're ready to take your career to the next level, tune in to the Healthy Wealthy & Smart podcast with Dr. Karen Litzy and discover the insights, strategies, and inspiration you need to thrive in today's fast-paced world of healthcare and fitness.
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Apr 26, 2021

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Jonas Sokolof, DO, a physician specializing in physical medicine and rehabilitation at NYU Langone’s Rusk Rehabilitation to talk about the importance of exercise therapy in cancer care. 

 

In this episode we discuss: 

  • What is Oncological Physiatry
  • Use of exercise in improving function and quality of life 
  • Lifestyle Medicine in Oncology
  • Dr. Sokolof's baseball diamond analogy for rehab 
  • The importance of collaboration in the treatment of patients live with and through cancer 
  • Common side effects from cancer treatments
  • And more! 

 

Resources from this episode: 

Round Table Talk: Cancer Rehab and Survivorship 

More info on Dr. Sokolof

NYU Langone Oncology Rehabilitation Summit: Optimizing Rehabilitation Outcomes Through Exercise

 

More About Dr. Sokolof: 

I am a physician specializing in physical medicine and rehabilitation at NYU Langone’s Rusk Rehabilitation. After completing my residency training at Harvard Medical School, I subspecialized in musculoskeletal/sports medicine and interventional spine care. During this time, I acquired additional skills in the nonoperative treatment of various musculoskeletal conditions, including arthritis, lower back and neck pain, coccygodynia, neuropathy, dystonia, and tendinitis.

As a physiatrist, my goal is to help my patients regain function through various nonoperative treatments, including rehabilitation, injections for spine and joint pain, and medication. Whenever possible, I try to avoid prescribing medications for long-term use and prefer a more holistic approach to patient care.

For instance, I have expertise in osteopathic manipulative medicine treatment (OMT), also known as manual medicine. OMT is “hands-on care”; I use my hands to diagnose, treat, and prevent illness or injury, through stretching, applying gentle pressure, and using resistance. I often find this modality useful as a supplement to other treatments. If needed, I can also provide people with image-guided injections for the spine and peripheral joints. Additionally, I perform electrodiagnostic testing to diagnose and guide treatment of various neuromuscular disorders.

A major focus of mine is the rehabilitation needs of cancer patients and survivors. My goal is to help individuals, from diagnosis to cure, improve overall function and quality of life. I have expertise in diagnosing and treating a variety of cancer treatment–related side effects, such as chemotherapy-induced peripheral neuropathy, radiation fibrosis, lymphedema, and post-mastectomy pain syndrome. As the need for physical rehabilitation grows in the field of oncology, I find it exciting and rewarding to help restore function in anyone who has experienced cancer. I’m also certified in sports medicine, so I’m experienced in treating sports-related injuries in cancer survivors and helping them return to sports and exercise routines.

I am passionate about lifestyle medicine, an evolving field that focuses on lifestyle interventions, such as diet, exercise, stress reduction, and smoking cessation, to treat and prevent various chronic conditions and improve function. In my research, I explore lifestyle interventions to improve the lives of people who have had cancer. I also speak at the local and national level about rehabilitation programs for people with cancer. I am a co-chair of the lifestyle medicine counsel for the American Congress of Rehabilitation Medicine and a co-chair of the medical fitness working group for the American College of Lifestyle Medicine. Additionally, I sit on the executive committee for the American College of Sports Medicine’s Task Force on Exercise Oncology.

 

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Read the full transcript here:

Speaker 1 (00:07):

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

Speaker 2 (00:36):

Welcome back to the podcast. I am your host, Karen Litzy and this month, which is the month of April, 2021. We have focused our attention on cancer, survivorship, and oncological rehabilitation. To that end. I am thrilled to announce that on May 11th at 8:00 PM Eastern standard time, this is a Tuesday evening. We will have our round table talk focused on that subject. Oncological rehabbing cancer survivorship. All of the guests from this month will be on that round table talk. So that includes Kristin Carol Jillian Schmidt, Dr. Lisa van Hoose, and our guest today, Dr. Jonas Sokoloff. This is your chance to ask these four amazing experts, any question you want. And I know being a physical therapist going to conferences, I always want to try and get the person's attention to ask them a question. Sometimes you never get the chance. This is your chance. So if you have questions on oncological rehab on cancer survivorship, whether you're a physiotherapist, a healthcare professional fitness, professional, learning more about how to treat this population is imperative because a hundred percent of us are probably going to see someone who has cancer, who has lived through cancer in their lifetime.

Speaker 2 (01:55):

So how do you sign up? Go to podcast dot healthy, wealthy, smart.com click on the link that says round table talks, and you can sign up right there. And again, it's going to be Tuesday, May 11th, 8:00 PM, Eastern standard time. Now onto today's episode, like I said, today's guest is Dr. Jonas Sokoloff. He is a physician specializing in physical medicine and rehabilitation at NYU Langone Rusk rehabilitation. After completing his residency training at Harvard medical school, he sub-specialized in musculoskeletal sports medicine and interventional spine care as a physiatrist. His goal is to help his patients regain function through various non-operative treatments. And he also has expertise in osteopathic manipulative medicine treatment. Also known as manual medicine it's hands-on care. So he does use his hands to diagnose, treat and prevent injury or illness through stretching, applying gentle pressure and using resistance. A major focus of his is the rehabilitation needs of cancer and survivors is goals to help individuals from diagnosis to cure, improve overall function and quality of life.

Speaker 2 (03:06):

He has expertise in diagnosing and treating a variety of cancer treatment related side effects, such as chemotherapy induced, peripheral neuropathy, radiation, fibrosis, lymphedema, and post-mastectomy pain syndrome. As the need for physical rehab grows in the field of oncology, he finds it exciting and rewarding to help restore function in anyone who has experienced cancer is also sort of certified in sports medicine. So he's experienced in treating sports related injuries in cancer survivors and helping them to return to sport exercise and routines. And he is also passionate about lifestyle medicine as am I and ever evolving field that focuses on lifestyle intervention, such as diet, exercise, stress reduction, and smoking cessation to treat and prevent various chronic conditions and improve function. And we talk about that in the podcast today. What else do we talk about? Well, we talk about exactly what a physiatrist is and how they work in the field of oncology.

Speaker 2 (04:06):

We talk about some common side effects that people may experience from cancer related treatments. We also talk about the, his baseball analogy on rehabilitation and getting people back to their sport or back to life, which I love because I'm a softball player. So I had anything with a baseball analogy I'm all in. And he also talks about the importance of lifestyle medicine and why that's important, especially with cancer patients. And he lets us know exactly why that's so important. So a huge thank you to Dr. Socolow for coming on the podcast. And everyone don't forget to sign up for our round table on May 11th, by going to podcast at healthy, wealthy, smart.com and clicking on the round table tab. Enjoy everyone.

Speaker 3 (04:59):

Hi, Dr. Sokoloff welcome to the podcast. I'm happy to have you here this month, where we're talking all about cancer survivorship. So thank you so much for coming on. Oh, thank you very much for having me. It's really great to be with you. Yeah, this is really exciting. I'm definitely familiar listening to your podcast or floor gray while you're doing and you guys, my pleasure. Awesome. Well, thank you so much for that. And like I said, in your bio, you're a physiatrist and you're here at NYU. And we'll talk about that a little bit later, cause you guys have an oncology summit coming up and we'll talk about how people can sign up for that, but they have to listen to the whole, they have to listen to this whole podcast to get all the goods. So before we get into the meat of the discussion today, can you tell the listeners what oncological physiatry is? So uncle logical desires, you, maybe I should start by what is desire?

Speaker 4 (05:58):

You know, there's, I'm sure most of your listeners are well aware of what the field of desire tree is all about, but there may be a few that aren't so desire tree also known as physical medicine rehabilitation is a sub-specialty of medicine that involves essentially working with patients to enhance quality of life and physical function for patients that may be suffering from whether it's a an illness or an injury traumatic brain injury, spinal cord injury, or musculoskeletal injury. And it's a, it's a very multi-disciplinary field that overlaps a lot with orthopedics neurology, internal medicine rheumatology sports medicine, and, you know, several others. So you kind of have to know a little bit of everything, but basically the main goal of [inaudible] is to enhance quality of life and physical function. Now in oncological, physiatry is, is sub specialty.

Speaker 4 (06:57):

So we are experts in neuromuscular and musculoskeletal and other functional impairments that directly affect you know, people living with the beyond cancer, whether it's from the actual cancer itself or from the treatment of cancer. So surgery, radiation, systemic therapies, chemotherapies, immunotherapies, targeted therapies, et cetera. So in a nutshell, that's, that's, that's essentially what the field is about and what drew you to this subspecialty. So I am a sports medicine trained physiatrist. I did three years of a physical medicine rehabilitation residency. Before that you have to do a, a year of a general internship. And then I went on to do a three-year residency in PMNR. And then after that I did another year long fellowship and what's called spine and sports care or spine and sports medicine. So I received training in sports medicine care. So sort of like non-surgical orthopedics, interventional spine psychiatry, injections under fluoroscopy and under ultrasound.

Speaker 4 (07:59):

And, you know, I thought I was going to, you know, treat, you know, weekend warriors and, you know, athletes and, you know, yoga moms and so forth. And you know, essentially non-surgical orthopedics. But for me, I learned kind of early on in my fellowship year that, you know, I, I tend to kinda get bored doing the same thing, you know, over, over and over. And I, I really liked the variety and really like the challenge. And there was an opportunity to major cancer center in New York where they were looking to hire another physiatrist. They already had two physiatrists and they were looking at another physiatrist who actually had more of a sports medicine, interventional background. And I ended up applying for the position and it was, I was so impressed with the institution, but more importantly, I was, I was really impressed with this opportunity to really make a big impact in the field of oncology and really help like enhance the quality of life for people living with and beyond cancer.

Speaker 4 (09:03):

I just felt for me, that was more meaningful because there's such a huge need. Unfortunately, people who have the disease of cancer and go through treatment through the whole continuum, they have a lot, a lot of problems with, you know, getting back to the way, the level of functioning and quality of life that they had prior to their diagnosis. There's just a tremendous need, but we've gotten so much better at treating a variety of different types of cancers keeping people alive longer. Unfortunately a lot of these treatments do have a lot of sequelae that, you know, the oncology field, it's just not, they're just not well equipped to deal with these issues. And that's where we really shine as rehabilitation professionals because we are the experts in physical function and quality of life, and we really can make a difference. And I liked that feeling of really being able to make a big difference in the lives of these people.

Speaker 3 (09:59):

And you had mentioned in there that a couple of things that stood out to me, one that there are more people living after and beyond cancer than before, because of I'm assuming better treatments, better detection. Correct. And you also mentioned that there are side effects from some of these treatments and interventions. And I think oftentimes people think physical therapists alike think, Oh, someone had cancer, they survived it, they must be fine. So what do you see as the most common side effects and where can rehabilitation physical rehabilitation make a difference with those side effects?

Speaker 4 (10:44):

I would say probably amongst the most common side effects that I see, for example. So I see a lot of breast cancer patients and survivors in my practice and a lot of head and neck cancer survivors, a lot of prostate survivors. I'd say, you know, sequentially after surgery, for example, after mastectomy, or even in breast conservation, surgery, lumpectomy, and so forth. Whereas like you're, you're right. Patients, essentially in many, in many cases they're diagnosed early. They are, you know, very high success rate. The achieved cure is very often, but unfortunately a lot of these people, these individuals are left with a lot of pain and dysfunction, everybody heals at their own pace or rate. So their ICL, I see a great deal of patients who, whereas it it's expected that they're going to sail through their, their treatments. And men, many instances, they have achieved the events they have achieved you know, complete remission, but yet in some way, they're, they're left kind of broken and they're not able to get back to their baseline level of functioning.

Speaker 4 (11:50):

They have, they may have prolonged pain that lasts longer than what would be expected. They may have more scar tissue. And there's there. These factors may be, are usually multifactorial lifestyle factors come into play. Underlying premorbid conditions come into play you know, whole host of factors. And in many instances they are not, they don't recover as fast and they need a lot of help. So I'd say the biggest, you know, impact. I think the, in my practice, I would say in our breast cancer patients, we see a lot of patients with post-mastectomy pain syndrome pain that lingers way past the recovery period with scar tissue that often results in shoulder dysfunction adhesive capsulitis rotator, cuff dysfunction and impingement, bicipital tendonitis, various other factors that really adversely affect people's abilities to get back to like their life. That's one example that comes to mind, radiation fibrosis.

Speaker 4 (12:55):

So, you know, chemotherapy, radiation being the cornerstone of treatment for head and neck cancers, a great deal of morbidity there, you know a lot of scar tissue that forms after radiation, that impairs neck range of motion, ability to open your mouth trismus swelling, lymphedema in the head and neck population. Nobody, nobody knows how to handle these types of issues, but as rehabilitation professionals are really well equipped in you know, are able to really make a big impact in the lives of these folks. So I'd say those, those two populations really stand out to me and they are, they do make up a majority of my practice.

Speaker 3 (13:37):

And one thing that rehabilitation professionals are really proficient as in is exercise. So how can exercise help with these patients to improve their function and quality of life?

Speaker 4 (13:49):

Right? So we do have very robust data in the form of randomized controlled trials that exercise both aerobic training and resistance chaining can actually help improve several different cancer-related health outcomes. And that includes overall physical functioning lymphedema, anxiety, depression, overall, quality of life and wellbeing. And this comes from, you know, a tremendous amount of rigorous, you know well-designed clinical trials. So we do have, we now have really great evidence supporting this. We actually know that it, that it can be used as medicine, and we all know, I'm sure your listeners are well aware that exercise is medicine and really in oncology, this is actually even more apparent.

Speaker 3 (14:39):

And when we think about these patients living with and living beyond and through cancer, one of the things at least that I've seen with a lot of my patients that I have seen is that fatigue is an issue. And so when we're thinking about exercise, so as physical therapists, you're sending your patients to us, fatigue is a big issue. Do we center our treatment approach around a graded approach to exercise or to a paced approach to exercise? Or is it one of those answers that it depends.

Speaker 4 (15:11):

So it's all it's should be a personalized approach, right? It's really not a one size fits all. And that's why, again, it helps to be, you know, it helps for a patient to work with a highly skilled trained rehabilitation professional so that they can really hone in, do a full comprehensive assessment and really understand, you know, what exactly that particularly low patients struggling with with the impairments may lie what their history has been and order to come up with a real, you know, comprehensive, structured, personalized program. Oftentimes we use in rehabilitation, we're using a therapeutic exercise program. So for example, patient has, let's say rotator cuff dysfunction, right? They have imbalance of their scapular scapular stabilizing muscles, right? And they may have altered glenohumeral mechanics that are promoting this condition of impingement, let's say of the supraspinatus tendon and that leads to pain, loss of range of motion.

Speaker 4 (16:14):

And then that then progresses to let's say, adhesive capsulitis or frozen shoulder, for example. So we would, we would construct a therapeutic exercise program specifically honing in on that specific dysfunction, right. The shoulder. But we can also use, you may say generic exercise. We could use aerobic training and strength and conditioning on top of the therapeutic program, all from a personalized standpoint for what meets the needs of that specific patient in conjunction with a therapeutic exercise program. And that's where I think really where the field is headed is really being able to the goal should not just be, to get the patient out of pain, would get them back to, you know, being able to do some of their life specific activities, but also getting them to an exercise program that should be one of the main goals of ecological rehabilitation program.

Speaker 3 (17:10):

And I think that's great advice for all the physical therapists and physiotherapists out there listening is that when these patients are coming to you, like we'll take the example of shoulder pain post-mastectomy or post some sort of treatment that we don't want to just focus on. Let's just do exercises and rehab around the shoulder, but let's take it broader and try and make this into like a lifestyle change for the patient.

Speaker 4 (17:40):

Exactly, exactly. There's a there is a diagram that I often use on a lot of my talks when I lecture on this subject. And it's

Speaker 5 (17:50):

The baseball diamond approach to rehabilitation is a approach that is utilized in sports medicine. It was it was passed on to me by some folks some physiatrists at the Mayo clinic. It's very simple way to think about it, but essentially your goal is to get, get to home plate, get back to return, to play, you know, so to speak or return to life, do advance through all the bases to get the first space you have to restore range of motion from first base to second base. And you have to start to work on strength from second base, third base. Now you're starting to work on the neuromuscular kinetic chain on the pitcher's mound. You really want to put an exercise program that they should be able to be able to do for the rest of their lives. Because what it's going to do is actually going to, it's going to improve survival.

Speaker 5 (18:32):

It's going to improve cancer related you know health outcomes. Okay. So it's gonna help them to improve. It's going to help to improve anxiety, fatigue, physical functioning. And this is another thing that I really love about the field of oncological rehabilitation, because not only are we helping to restore quality of life and overall physical function, but we actually have the opportunity to make an impact on the disease itself. We actually can, as rehabilitation professionals can actually change the course of the disease by getting our patients back to a safe and effective exercise program. So it really needs to be incorporated into rehabilitation. It really should be all part of what we're doing as rehab professionals.

Speaker 3 (19:14):

I really liked that baseball diamond analogy. And, and oftentimes when we think of that return to play, I know the first thing that comes to my mind is as an athlete. So you're getting them back to their sport, whether whatever that sport may be, but you're absolutely right, that that same framework can be used for all of our patients. They have to get back to, it may not be back to the soccer pitch or the baseball field, but they are getting back to returning to play, which is their life

Speaker 5 (19:49):

That's correct. And even back to their familial roles, there's societal roles, there are vocational roles really getting them back to the things that they want to be doing, the things that they need to be doing to live out the rest of their life.

Speaker 3 (20:06):

Yeah. I love that baseball diamond going to be using it all the time. I love it. Especially as a former softball player and a former pitcher, I can definitely relate to that. Now we've been saying this word a couple of times throughout the interview, and that is lifestyle. So there is this lifestyle medicine, branch of medicine. So how does that fit into the oncology patient in the world of oncology?

Speaker 5 (20:34):

So two thirds of the world's cancers, according to the world health organization can actually directly be linked to lifestyle, right? So smoking alcohol dietary intake lack of physical activity, increased stress levels and so forth. So we have as rehabilitation professionals, the opportunity to intervene to provide lifestyle interventions and again, help restore physical function, but also have a major impact on the, the course of the disease itself. So I believe that lifestyle medicine actually should be, is a very important aspect of what we offer in rehabilitative care, especially in on-call oncological rehab. So I try to incorporate it into my practice counseling patients and educating patients on proper nutrition, certainly exercise. We do a lot of cancer counseling and exercise. We offer stress reduction techniques. Certainly when, when patients are smoking we, you know, get them as soon as we can plugged in with smoking cessation programs and so forth and so on. So because there is such a direct relationships to lifestyle and cancer it, it has to be a key component of the rehab plan as well.

Speaker 3 (21:51):

Yeah. And that, that is all in our lane.

Speaker 5 (21:54):

Exactly, exactly. Yeah, I mean, you know, the F really up until, you know, recently the thought process, you know, cancer essentially had a very strong genetic component. But right. The it's the way the, the environment or lifestyle is affecting those genes, which we know that, that poor lifestyle can actually turn on a lot of those oncagenes and promote you know, promote cancer growth. So yeah.

Speaker 3 (22:26):

Yeah. And so what is it coming from you from your position as a physiatrist? What are some things that you really want physical therapists to know when it comes to treating patients that have, or have lived through cancer,

Speaker 5 (22:43):

Physical therapists that it's, it's safe to put these folks through an exercise program it's safe to put them on a resistance training program as long as it's, you know supervise and as long as, you know, if you're working with a physical medicine rehabilitation physician or a physiatrist, it's really great to partner up so that you can learn, you know, what would be a safe way to approach, for example, a patient with metastatic disease in the spine or metastatic disease somewhere else. You know, in the, in the skeleton, for example, cause I think a lot of therapists may be apprehensive. They don't want to, you know, cause a fracture, for example, they may not want to injure a patient and they're not sure what would be safe. Just know that it is safe when it's done, you know, under the supervision of someone who's as skilled, as trained as yourself, but also helpful if you have members of your oncology community that you can communicate with and determine you know, what would be the great, the best plan for that patient and what would be the safest plan?

Speaker 5 (23:57):

I mean, therapists were, we, we were in constant communication about the patients programs in our, in our at our site as to what, how you can progress them through an exercise program safely based on, you know, review of imaging and based how, and then how they present clinically. So yeah, I mean, I, I would, I would just say, I think, you know, a lot of these patients can tolerate probably a little bit more than what's been previously done in the past.

Speaker 3 (24:29):

Awesome. Well, thanks so much for that. And hopefully all the physical therapists and physios and even other healthcare professionals listening or taking notes on all of this, cause this was great. Let's talk about the NYU Rusk rehab. They have an oncology summit coming up. Is it in October,

Speaker 5 (24:49):

October 1st, it's going to be

Speaker 3 (24:51):

Featuring our very own Nicole Stout as a keynote. We love her here. Love her, love her so much. So go ahead and talk a little bit more about that.

Speaker 5 (25:00):

So we are having our first you know, annual uncle logical rehabilitation summit Ruskin suit, NYU school of medicine on it's gonna be October 1st, it's going to be a hundred percent virtual. Eventually as we come out of the pandemic, we will hopefully transition to an in-person program. But this year we're going to starting off as virtual. And the theme of this year's symposium is going to be exercise oncology. So we are going to have oncologists lecturing, certainly physical therapists, speech therapists, occupational therapists Dr. Katie Schmidts, the CSM round table leader in luminary in the field of exercise oncology as well as Nicole Stout, excited to have them are two keynote speakers are really looking forward to providing a robust program for anyone interested in how to implement exercise into a rehabilitative care plan for oncology patients.

Speaker 3 (25:58):

Yeah. And it's like total coincidence. I got the email for that. Like a couple of days ago, I was like, Oh, this is perfect because here we are doing this interview. So this worked out very, very well. And now where can people find you, if they want to ask you questions, they want to connect with you? Where can they find you?

Speaker 5 (26:17):

My email probably is the best. I'll definitely find putting it out there. It's my first and last name, so that's Jonas, J O N a S dot SoCal off that's S like Sam. Okay. O L like Larry off, likeFrank@nyulango.org, one word, NYU llangollen.org.

Speaker 3 (26:37):

Perfect. And we will have all of this links to sign up for the summit and your email in the show notes for this episode at podcast at healthy, wealthy, smart.com. And last question that I ask everyone, is that knowing where you are now in your life and in your career, what advice would you give to yourself as let's say, fresh out of medical school?

Speaker 5 (27:05):

What would the advice would I give myself fresh out of medical school? I would say, you know, I would say, probably go with your gut. Right. You know, there's a lot of pressure. I think when you're, when you're going through medical training and medical school you know, pulling in different directions on planning your career you have a lot of different factors, financial and I think, you know, I always had wanted to, into going to have a medical career that was going to make a big impact. I think I got a little bit sidetracked along the way, and I, I kinda may have been chasing a different dream, but then when I finally realized what I think what I was meant to be doing, it really kind of brought me back in line on my path. So I'd say, you know, just really follow your gut, you know, pursue your dreams. You know, really go with what you feel is right deep down in your heart, and now you really can't go wrong. So

Speaker 3 (28:06):

I love it. Great advice. And, and frequently heard advice here on this podcast. So it must be a good one. So, Dr. Sokoloff thank you so much for coming on today and look forward to seeing you at our round table discussion in a couple of weeks. So thank you for that as well. So thank you. Thank you. Thank you.

Speaker 5 (28:26):

Thank you. I'll look forward to the round table.

Speaker 3 (28:28):

Yeah. As in everyone for listening everyone out there listening. Thanks so much. Have a great couple of days and stay healthy.

Speaker 1 (28:34):

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

 

Apr 19, 2021

In this episode, Associate Professor and Program Director in the Physical Therapy Department at the University of Louisiana Monroe, Dr. Lisa VanHoose, talks about the provider role in cancer survivorship.

Today, Lisa talks about implicit provider bias, survivorship as a concept, social determinants and healthcare access, and provider trust. How can physical therapists help lessen the overload? How do you determine whether or not you’re a trustworthy provider?

Hear about the effects of cancer on co-survivors, get some advice for screening when working with cancer survivors, and learn about the disease burden on marginalised communities, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • The definition of cancer survivor: “You become a survivor from the time of diagnosing.”
  • “When we talk about survivorship, it really is a conversation about how well are you able to live your life.”
  • “Cancer and its treatment is one of the top causes of bankruptcy in the US.”
  • “Cancer and Alzheimer’s Disease are two chronic diseases where we’re seeing the caregivers die earlier than the survivor because of the caregiver burden.”
  • “Medical access accounts for about 20% of someone’s health outcomes.”
  • “Cancer survivors who have unmet social determinants of health are more likely to miss appointments.”
  • “If you want to know if you’re a trustworthy provider, you should probably ask.”
  • “You can condition yourself to have less bias, but you have to actively do it.”
  • “100% of physical therapists are going to see someone who had cancer or has cancer.”
  • “Everyone needs to be doing a self-assessment of where they’re at in regards to their own biases.”
  • “African American women were dying at rates 3 to 4 times higher than those of their Caucasian peers.”
  • “That difference in healthcare is avoidable if we would just stop and be intentional about the care and the way in which we deliver care to each other.”
  • “We’re one decision away from someone having a different type of cancer survivorship journey.”
  • “Although we know cancer survivors are recording these side-effects to cancer and its treatment, only about 20-30% get referred to a provider to address them.”
  • “In our quest to provide care for others, we forget to refresh and replenish ourselves.”

 

More about Lisa VanHoose

Dr. Lisa VanHoose is an Associate Professor and Program Director in the Physical Therapy Department at the University of Louisiana Monroe. Dr. VanHoose received her PhD in Rehabilitation Science and MPH from the University of Kansas Medical Center. She completed fellowships at the University of Arkansas Medical Sciences Donald W. Reynolds Institute on Aging and the National Institute of Heart, Lung, and Blood Institute PRIDE Summer Institute with an emphasis in Cardiovascular Genetic Epidemiology. Her Bachelor of Science in Health Science and Master of Science in Physical Therapy were completed at the University of Central Arkansas. Dr. VanHoose has practiced oncologic physical therapy since 1996. She is a Board-Certified Clinical Specialist in Oncologic Physical Therapy. As a NIH, PCORI, and industry funded researcher, Dr. VanHoose investigates socioecological models of cancer related side effects with an emphasis on minority and rural cancer survivorship. She has been an advocate for movement of all persons, including the elimination of social policies and practices that are barriers to movement friendly environments. Dr. VanHoose served as the 2012-2016 President of the Academy of Oncologic Physical Therapy of the American Physical Therapy Association. She currently provides oncology rehabilitation services through the Ujima Institute, PLLC, as the owner and service provider.

 

Suggested Keywords

Physiotherapy, Research, PT, Health, Therapy, Healthcare, Cancer, Oncology, Survivorship, Rehabilitation, Mental Health, Providers, Biases, Movement, Wellness,

 

To learn more, follow Lisa at:

Website:          https://www.ujimainstitute.com

                        ULM - Lisa VanHoose

Facebook:       Ujima Institute

Instagram:       @ujima_institute

Twitter:            @LisaVanHoosePT

                        @UjimaInstitute

LinkedIn:         Lisa VanHoose

 

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Read the Transcript: 

Speaker 1 (00:07):

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

Speaker 2 (00:35):

Hey everybody. Welcome back to the podcast. This month is all about cancer survivorship. So if you missed the episode two weeks ago with Christine Carol and Jillian's Schmidt, make sure you go back and listen to that episode. Lots of great information, especially for providers on how to treat people with cancer currently, or cancer survivors. Now today's episode is brought to you by net health and tomorrow, which is Tuesday, April 20th, net health has a three-part mini webinars series bet with best-selling author, Stacy Fitzsimmons and Kelly Castillo of net health. They'll be talking about the three T's of creating revenue ownership beyond just billing beyond just the billing department, training tools and transparency. Stacy and Kelly have over 25 years of combined experience helping private practices give the best possible care while increasing their revenue head over to net health.com/litzy. To sign up as a bonus. If you put Litzy in the comment section and show up, they've arranged for net health to buy lunch for your office.

Speaker 2 (01:44):

Once again, that's net health.com forward slash L I T Z Y. So head over and sign up now and moving on to today's episode again, following in our theme of the month, which is cancer survivorship. I'm thrilled to have on the program, Dr. Lisa van hus. She is an assistant professor and program director in the physical therapy department at the university of Louisiana Monroe, Dr. Van who's received her PhD in rehab science and MPH from the university of Kansas medical center. She completed fellowships at the university of Arkansas medical sciences, Donald W. Reynolds Institute on aging and the national Institute of heart lung and blood Institute pride summer Institute with an emphasis in cardiovascular, genetic epidemiology, her bachelor of science in health science and master of science and physical therapy were completed at the university of central Arkansas, Dr. Van, who says practiced oncologic physical therapy since 1996.

Speaker 2 (02:40):

She is a board certified clinical specialist in oncologic physical therapy as an NIH, P C O R I and industry funded researcher, Dr. Van who's investigate socioecological models of cancer related side effects with an emphasis on minority and rural cancer survivorship. She has been an advocate for movement of all persons, including the elimination of social policies and practices that are barriers to movement friendly environments. She served as a 2012 to 2016, president of the Academy of oncologic physical therapy of the APGA. She currently provides oncology rehab services through the Ujima Institute PLLC as the owner and service provider. So on today's episode, what do we talk about? Well, it's all about the provider. So in today's episode, Lisa talks about implicit provider bias, survivorship as a concept social determinants of, and the healthcare and healthcare access and provider trust. So how can physical therapists help lessen the overload? How do you determine whether or not you're a trustworthy provider we'll hear about effects of cancer on coast survivors, get some advice for screening when working with cancer survivors and learn about the disease burden on marginalized communities. So there's lots to dive in. This is a long episode but it is well worth it. I highly encourage you to listen to the very end because everything is so good and you will get so much information from Dr. Van who, so I want to thank her and thank net health and thank you for listening.

Speaker 3 (04:20):

Hey, Lisa, welcome to the podcast. I am very happy and honored to have you on, so thank you. Thank you. Hi, everyone. Super excited to be with you today. And now all this month, we are talking about cancer survivorship. This is your research. This is your wheelhouse. This is what you teach. So let's get to it. What we're going to talk about today is provider bias in that lens of cancer survivorship. So can you tell us how that works and what that is? Yes. So I think most of us are now familiar with the term implicit bias because of all the things going on in the social environment, right? So implicit bias is basically those preferences, attitudes, stereotypes that we might have towards a person or towards a specific group of people. And so when you talk about provider bias, it's that implicit bias, but it's something that is hailed by a provider that might then potentially impact have a interact with that patient or client, and even the decision-making process for that client and the research to just that it, a lot of times occurs either subconsciously or unconsciously. And so we're not even realizing how we might be negatively impacting somebody's care. And how can that provider bias affect outcomes affect treatment and affect the survivorship of these cancer

Speaker 4 (05:58):

Or patients with cancer. I don't want to say cancer patients. I want to say patients, people with cancer almost, almost, almost set it wrong.

Speaker 3 (06:09):

No worries. So when you think about provider bias so the research should just that most of us have a bias towards people that are a bigger body size or what we call obese, right? And so if you were a PT, a nurse, a physician, and you were talking with someone that is of a larger size, and they're trying to articulate to you that maybe their knees hurt, or maybe they've got, you know, some type of discomfort provider bias might make you minimize their complaint. It might make you not do a full assessment because you're like, ah, it's just related to their weight. Or you might just go, well, you know, it's part of their lived experience because they chose to be fat. And so there are things that instead of us doing the standard care, we actually will deviate from it because of our bias.

Speaker 3 (07:04):

And so where we see that happen, where that has an influence on cancer survivorship is we know that every cancer survivor will have at least one physical impairment and most of the time it's fatigue, but let's say that cancer survivors, someone who identifies as as a sexual orientation, that's not heterosexual. And you as a provider, you may believe that, you know, there's a moral or religious issue with that. So then when that person's talking to you about their fatigue, as it relates to maybe their sexual activity, or maybe just how it relates to their everyday life, you may decide consciously or unconsciously to not listen. Or you may decide that, you know what, that that's, God's answer to, you know, their, their lifestyle choice. So, sorry, y'all just, somebody is having a healthcare emergency right now.

Speaker 4 (08:06):

That's okay. Normally it's on my end because I'm right on Broadway. So there's always a siren going off. The listeners are used to it, please continue.

Speaker 3 (08:14):

So I think when we think about, you know, someone's care, we're all talking about, you know, high quality care and standardized care and trying to minimize variations. But a lot of the variations we see are related to our biases.

Speaker 4 (08:29):

And so let's talk for a minute about, so we know outcomes may be different because of this provider bias. And, you know, we are talking about cancer survivorship, but there's a difference between you're alive. You lived, you survived and the concept of survivor ship. So can you talk a little bit about that and how again, where that bias may play a role?

Speaker 3 (09:01):

Yes. So the new definition for cancer survivor is that you become a survivor from the time of diagnosis. And so often we think of that as binary, right? Are you alive or not alive? When we talk about cancer survivorship, it really is this conversation about how well are you able to live your life? Right? So regardless of the cancer diagnosis are, do you have the resources that you need to live the life that you choose at the best level that you so choose? And so when we talk about survivorship, now we want to know about all of your physical wellness. We want to know about your emotional wellness. We even talk about financial wellness because one of the side effects to cancer is financial toxicity cancer and his treatment is one of the number one causes of bankruptcy in the United States. So survivorship is really about how well are you able to live your life?

Speaker 4 (10:05):

And I would also have to assume that within that survivorship is the environment in which you're surviving. So can you talk a little bit about that as well?

Speaker 3 (10:14):

Beautifully stated. So the hot topic everywhere right now is social determinants of health. And I think that is also just as true for cancer survivors. And I also want to say their caregivers because when we talk about cancer survivorship, we want to also talk about the coast survivors, right? So a lot of times we'll focus in on the cancer survivor. But the work that we did in Arkansas, a couple of years back, we went throughout the state talking with cancer survivors and caregivers. And the thing that cancer survivors told us over and over again, was I'm more concerned about my loved one. I'm more concerned about my coast survivor because everyone's focused on me as a person with cancer, but no one is thinking about the lived experience of my of my caregiver. And I was at a conference once and they were talking about how that cancer and Alzheimer's diseases, Alzheimer's disease are two chronic diseases where we're actually seeing the caregivers die earlier than the actual survivor, right. Because of the caregiver burden. And so that's a trend that people are watching in the data. So, yeah.

Speaker 4 (11:29):

Yeah. So it's, it's more of, it's more than just the patient, it's the caregiver and it can also be their community. Do they have access to their treatments? Do they have access to the things they need to help them survive and survive? Well, if you're living perhaps in an area that you don't have access to a lot, these things might

Speaker 3 (11:54):

That also be something that can cause a bias in the provider, almost definitely. So I think you have to think about all of the social determinants of health. So in the, the literature suggests that the medical access, like the healthcare access, a counselor, about 20% of someone's health outcomes. Now we do know that your ability to get to a provider of choice is important. And we also know that people typically don't want to travel more than a 20 minute drive to get to care, but there are some areas where people are driving hours. I remember when I was in Kansas practicing, I had clients that would drive three to four hours one way to see me. And so when you think about cancer survivorship, and we know one of the number one complaints is fatigue. If you're driving three to four hours to get to therapy, then the expectation is you're going to work with a therapist for an hour, hour and a half.

Speaker 3 (12:58):

It's just not a realistic journey. So we have to figure out a way to improve access. Most definitely. We also have to think about the fact that, that it's not just can someone access care, but can they access high quality care? So there is a time and a place for generalists. I totally love my generalist, right. Shout out to you. But then there also Toms for specialists. And so there are certain geographical areas where it would be really difficult to find a specialist in cancer, be it an oncologist, be it a PTB in an OT, be it a dentist. So we have to think about those issues when we talk about healthcare access. But then you talk about the 80% and the 80% are going to be the things like what is the environment that that person with cancer has to live in.

Speaker 3 (13:50):

So like I'm here in Louisiana and Louisiana has a stretch of highway that's known as the cancer corridor, right? Because we have hundreds of production, meals and industries that have a lot of waste products. And so because of that, we see this uptake in cancer prevalence, we see a different survivorship experience for those cancer survivors because they're constantly exposed to these environmental exposures. So I think, you know, that's one thing when you think about cancer, survivorship is what is the environment in which they're living right now? We're talking to everybody about, you know, physical activity, the, the APA has just launched a physical activity campaign, but then you have to think about, okay, what, what is their green space availability? Is it safe for them to be out and walking, right? Then you have to think about how are they going to fuel that movement. So are they close to grocery stores, right? Or, you know, community gardens. So I think when we think about cancer, survivorship, healthcare is one piece, but then we also have to think about all those other determinants of health as well.

Speaker 4 (15:02):

And it's does it not seem overwhelming? I mean, gosh, to me it sounds, seems so overwhelming. So how can as providers, let's say, as physical therapists, healthcare providers, what can we do to help lessen that? What that

Speaker 3 (15:19):

Overload? Yeah. So I think if we, number one, just all can agree that we have some level of implicit bias because we're all animals. So therefore we are slightly tribal in animalistic, which means that you're naturally going to have a preference towards people who look like you or people who act like you or think like you, so you have to engineer the system to combat that. And the best way to do that is with screening tools, right? So could you introduce a screening tool that asks that client about their cultural beliefs and their lived experience? Right. so then that way you can incorporate that into their care because I was pulling up some articles that looked at the lived experience of black or African-American and Hispanic or Latino X cancer survivors. And one of the things that they talk about is the fact that their provider, who is often, you know, someone who identifies as white, doesn't really ask them about their life.

Speaker 3 (16:27):

They might give them instructions, but doesn't ask them about the context right. In which they're supposed to implement this. And they're like, that's part of the reason why I don't follow those instructions and then they get dinged for noncompliance, right. Or, or non-adherence, and they're like, that person never asked me anything about me. So could you potentially introduce that as a screen in regards to kind of getting some information about their cultural values and beliefs, and then introduce a social determinant of health screen. So then you can find out kind of what their needs are because one of the articles I pulled up was talking about how that cancer survivors who have unmet social determinants of health are more likely to miss appointments. And so how often do we all get frustrated at that patient? That's a no show. Well, have you asked them about what's going on in their life and then help to align them or connect them with some community resources, because that might be the root of a no-show right. So I would say start off with some screening.

Speaker 4 (17:37):

Yeah, that's great. And you know, we had a conversation last night on clubhouse with a group of physical therapists and it was about the female athlete, but one of things that

Speaker 2 (17:50):

Was very clear is, are we asking the right questions? And I think that completely aligns with what you just said. So what is your food security? Like, what is your home security like, right. Do you have children? And this is another one, do you have pets? But if you have, what is your responsibility in your home life? If you have a dog, if you live alone or do you have to walk this dog? We just talked about fatigue being one of the major aspects. So what if they have to walk their dog three times a day and they have physical therapy that day? Well, which one do you think is not going to happen?

Speaker 3 (18:28):

Exactly great points. You know,

Speaker 2 (18:31):

These are all great questions to ask. So it's, we're asking questions, but are we asking the right questions? And I think that was a solid point that you just made.

Speaker 3 (18:41):

I love that. Are you asking the right questions and then are you living?

Speaker 2 (18:47):

Hmm, well, even more important because like you just said, implicit bias can make us our brains be like, blah, blah, blah, blah, blah, blah, blah. Oh, were you saying something or, or, you know,

Speaker 3 (19:01):

Often someone will say something, someone will tell us what they value and then, because we don't value that we'll minimize it and that might've actually been the secret sauce to them being able to achieve their healthcare goals.

Speaker 2 (19:15):

Yeah. Yeah. Another and again, gosh, another great question that was brought up yesterday is, well, what kind of successes are you having right now? And then, like you said, that might be it, that might be the secret sauce. So if we're not tuned in, are we going to miss it?

Speaker 3 (19:33):

Great points. And then I think often as providers, we tend to ask all the questions about the negatives. And especially when you add in your provider bias your implicit bias, because we've been conditioned to think so many negative things about different subgroups. So we automatically start asking them all these questions about all of these negative things that we think should be occurring in their life. So I love this concept of saying, well, what's going well, right? What are the successes? Because then it also changes the dynamic of the relationship, because then that helps you to understand what are the things that you could leverage. Right. And expand. So I, I really think, you know, the other hat I wear y'all is I'm an educator. And so when we talk about culturally responsive pedagogy, one of the core elements is are you coming into that exchange with the student from a positive lens?

Speaker 3 (20:36):

And I think we also have to think about that as a provider. Because anytime you interact with a human, it's an exchange of energy, and if the energy I'm putting to you as negative, that's going to impact you. So I think always kind of, you know, asking, you know, what's going on. Well also thinking the best of the person that's sitting in front of you. That's one thing that I've learned from the patients that I've been able to serve is they're like, there are some days that I just have to borrow the positivity from my providers. Right. And I think we have to recognize that that some days we are, we are that, that shining star, that good vibe for another human, but that requires us to actually believe in that other human and in their experience. So you got to see that human in front of you perfectly said, of course. And that leads me to the next topic. Is, is, are you a trustworthy provider? And how do you determine that? Because is, is trust normally determined by the person in front of you? They feel you're a trustworthy provider. If you feel you, are, are you biased towards yourself? Like, yeah, I'm awesome. Right. So can you expand on that? And on that note, we'll take a quick break to hear from our sponsor and be right back

Speaker 2 (22:03):

Tomorrow, April 20th, as part of net health, three part webinars series bestselling author, Stacy Fitzsimmons, and Kelly Casio of net health. We'll be talking about the three T's of creating revenue ownership beyond just the billing department, training tools and transparency, head over to net health.com/lindsey to sign up as a bonus. If you put Lindsey in the comment section in the registration page, sign up and show up net help, we'll buy lunch for your office. Once again, that's net health.com forward slash L I T Z Y. Sign up today.

Speaker 3 (22:39):

Oh, that's a good one. So there are two dynamics that occur in the therapeutic Alliance. There is the trust that the patient or the client, or maybe their caregiving unit, the stove's on us as providers, right? So that's the gift. And I think often as providers, we feel like we're entitled to trust and you're not, it's no different than any other relationship. It is something that someone is gifting to you, if they're dressed. And then for us as providers, we have to prove to be trustworthy and trustworthy is reliable and honest, right. And authentic. And so how do you know if you're trustworthy is that patient or client is actually the judge of that. It's not you. And so the definition of trustworthy may slightly vary for different patients, right. Because they are actually the judge and the jury in that. So if you want to know if you're a trustworthy provider you should ask, or maybe it should be part of your customer satisfaction survey, but I think, you know, when you think about provider bias or even implicit bias most of us can sense when the person that we're interacting with is not being authentic.

Speaker 3 (24:03):

Right? And so your bias thing can impact your ability to be, to be perceived as trustworthy as a provider or even just as a human. And so that's why it's really important for us to do the self work, to really kind of sit with ourselves, know what our triggers are. So, you know, who is it that we have these really negative perceptions of, or thoughts about, and then really questioning that. So Eckhart totally talks a lot about watching your mind. And so my challenge to providers is even in that interaction with the client or the patient in front of you, you know, always kind of paying attention to what are the voices in your head saying, you know, as you're doing that interview, listening to that client what, what is really S what else is going on? You know, like when that patient says, you know, no, I've not been able to, you know, take my blood pressure medicine, are you like, yeah, it's probably because, you know, you're doing X, Y, and Z with your money, or, you know, you're always telling a lie, but could you say to yourself, is that true?

Speaker 3 (25:12):

Cause Bernay Brown talks a lot about asking yourself is that the story is, you know, what's the story I'm telling myself. So could you really question that and then push back on, push back on that a little bit, cause you can condition yourself to have less bias, but you have to actively do it

Speaker 4 (25:32):

And it takes work and it can be uncomfortable. Yeah.

Speaker 3 (25:35):

It takes a lot of work, takes a lot of work. Because it's easier just to believe your own little echo chamber that you've created.

Speaker 4 (25:44):

My next question is what is your advice to providers when it comes to dealing with cancer survivors? Because as I spoke about in another podcast with Kristin is a hundred percent of physical therapists are going to see someone who had cancer or has cancer, the numbers are there. So what is your advice to providers when working with this population and kind of checking themselves? Quote unquote,

Speaker 3 (26:15):

Great question. So I'm, I'm going to say, first of all, we're going to go with your statement of ask the questions. Because I have actually seen therapists, physicians care for a client and never know that they had cancer because we didn't do a complete history. Right. and so you, you want to ask people that because the data says that one in two men will have cancer in their lifetime, one in three women. So just like you said, the odds are, is that you're going to care for someone that has had cancer or currently has cancer. So ask the question, number two is ask some details about it. So now the standard is, is most cancer survivors will have, what's known as a cancer survivorship plan that outlines the details of their tumor and also the treatment of it. And that's really beneficial to you as a provider because it'll help you be able to explain maybe some of the symptoms that they're reporting and also potentially anticipate some of the symptoms that they might have in the future.

Speaker 3 (27:23):

And there are things you could do to prevent that so that they have a better survivorship journey. Then number three, just listen and listen with a beginner's eye and beginner ears. Right? So be really curious about what that person is saying. Everything doesn't have to be judged because I always remind people, there are 8 billion people on the planet, so there are 8 billion ways of doing this thing. There's no rights or wrongs. And then the fourth thing is a screen, right? Because I have to recognize as a provider that I'm going to ask the questions, I'm going to do the things that are often comfortable for me because you get in this routine. And then, because this is a human sitting in front of me and everyone is diverse. I have to have some screening so that I don't miss anything. Right. Because often my pattern is based on what I like and the things that I do with the community that I'm, you know, most accustomed to.

Speaker 3 (28:28):

And so when I'm treating someone that might be different from me and everybody's different from me, then it's always good to have a screen that way you make sure you're not missing anything. And then I would say the last thing is ask that person what is important to them because often as providers will create a whole plan of care and never really asked people to rank or prioritize, what's really important to them. We often make judgements for people and that's not our jobs as providers, we're, we're part of their team. So those would be the things that I would say to remind people love. And then, you know, I think everyone needs to kind of be doing a self assessment of where they're at in regards to their own biases. And then just getting curious about it, be okay with talking with someone who doesn't think like you or who doesn't look like you.

Speaker 4 (29:23):

Yeah. Every point. Excellent. And hopefully people were taking notes on that. And now Lisa, where can people find you if they want to learn more about you and what you're up to and what you're doing.

Speaker 3 (29:35):

Awesome. so you can typically find me at the university of Louisiana Monroe. So I am the associate I'm associate professor and program director of the physical therapy program there. Or you can find me through Jima Institute. So the Ujima Institute is a grassroots organization that we started to primarily look at ways in which we could collectively come together to address the health and wellness of black communities. Because one of the things we didn't even talk about was health disparities as it relates to minority or marginalized communities. So when you think about black and Brown cancer survivors, when you think about cancer survivors from LGBTQ communities their disease burden is significantly different than the majority group. And even things like just their mortality rates are significantly different. That was some of the work that we did early on in Kansas city where we found that, you know, African-American women were dying at rates three to four times higher than those of their more of Caucasian peers. So yeah. Of white peers.

Speaker 4 (30:47):

And is that because of lack of access, was it because of lack of belief that they were ill or what, what did you, what did your findings

Speaker 3 (30:59):

So some of it was an access issue. So when you think about where the mammography centers located also the quality of the equipment at different sister centers varies as well. I think people often don't think about that. Then also the providers. So there's often a difference in which providers are available to which subgroups then also, and this is one thing that even, I think PTs and healthcare providers should think about in general is our typical office hours, right? So we tend to do eight to five. Well, if I'm a second or third shift worker that might not work for me, or if I work in an industry where I do a 12 hour shift that may not work for me. And those are often jobs that black and Brown community members are holding down. And so the very nature of how we deliver care often introduces some inequities. And I love that Def to my favorite definition of inequities talks about how they are avoidable, right? So that difference in healthcare is actually avoidable. If we would just stop and be intentional about the care and the way in which we deliver care to each other.

Speaker 4 (32:18):

Mm gosh, it's so multifactorial. But changeable

Speaker 3 (32:25):

Very changeable. I often say we're just one decision away. We're one decision away from someone having a different type of cancer survivorship journey because for your audience, fatigue is the thing that we often talk about, but the other things are like pain. Most cancer survivors are also experiencing a high level of anxiety. And in the United States, we're actually going the opposite direction in regards to our mental health resources, right. And cancer survivors need that support. Other things that bother them are things like neuropathy and even like itching. Like I cannot tell you how many cancer survivors are like, can you just make the itching stop? And people are like, well, who is it that big of a deal, but if I have a job and if my job is customer service and my receptionist is scratching, I'm like that impacts employment. So I'm like all of these things are, are part of the cancer journey where there are things we could do to prevent that or to attenuate it, even things like weight management, there are so many parts of this cancer sequella that we could adjust address early on. The other thing that has always been really interesting to me in the data is although we know cancer survivors are reporting these side effects to cancer and it's treatment only about 20 to 30% of them actually get referred to a provider to address them. So there are a lot of people live in a life that has less quality that really, that doesn't have to be right. And to me, that's not kind that is not con no.

Speaker 4 (34:14):

So you survived then what?

Speaker 3 (34:19):

Yes. Yeah. So, yeah. Yeah. So, and especially when we know that there are clinicians and providers out there that could be helping.

Speaker 4 (34:30):

Absolutely. And you know, I think don't you think that this is such an opportunity for the world of physical therapy? You know, we can be a conduit to other providers. Yeah. So, so if they, the cancer survivor is only spending 10 minutes with the doctor, but Hey, maybe they are coming to us maybe. Well, now it's like an automatic PT referral at the time of diagnosis. At least that's what the guidelines say. Am I correct in that

Speaker 3 (34:59):

Is the preferred guidelines. So that's kind of the pre rehab standards, right? That you get that diagnosis, you get a PT a Val, so we can get some baseline data.

Speaker 4 (35:10):

Right, right. Exactly. So might we also be the person to have the time to listen? And like I said, be that conduit and that super connector to people they need. So something to think about for the PT profession, you know, it's a huge opportunity for us to expand our reach, to be helpful and to make a difference in people's lives. And that's what we're supposed to be doing anyway. I totally agree. Because early

Speaker 3 (35:38):

On in my career I went through patient navigation certification and I remember people going, why would a PTB here? But it's a great place for us to be as a, as a rehab professional and especially as movement specialists, right? Because movement is the key to life. And so if I can help a cancer survivor, figure out the resources, they need to be able to keep their movement and function. That's a game changer in regards to health and wellness, even cancer outcomes. Some of the data even suggest in regards to mortality recurrence rate. So PT might, you know, often we talk about nurse navigation, but actually having a PTs, a navigator is not a bad idea.

Speaker 4 (36:28):

Absolutely. Well, I have to say, I thoroughly enjoyed this conversation, Lisa, and as always, and last question is knowing where you are now in your life and in your career, what advice would you give to your younger self, maybe that fresh face gal right out of PT school.

Speaker 3 (36:47):

Yeah. If I could talk to her, I would tell her to put herself first. Cause I think there is a reason why that the triple aim moved to the quadruped blame, right? To include burnout of providers because often in our quest to provide care for others, we forget that we need to refresh and replenish cash sales have. That is really, really important. We take better care of the equipment in our clinics and our hospitals that we do of our providers.

Speaker 4 (37:20):

And if it's, if we can't take care of ourselves, we are the most important piece of equipment.

Speaker 3 (37:26):

Yes we are. So we are the most important piece of equipment as it. If you wanted to talk about resources and I think also in regards to, when we think about our patient you know, client interactions, cause I often ask therapists nowadays, are you causing harm to the client that you're serving because of who you are. And maybe that's because you've not done yourself care, maybe it's due to your provider bias. Maybe it's due to, you need to re upskill in regards to your clinical skills. But I think it's always good for us to ask ourselves, are we doing somebody harm and why?

Speaker 4 (38:04):

Excellent. And on that we will end. So I will thank you so much for coming on, Lisa. Thank you.

Speaker 3 (38:10):

Thank you so much for having me. It's always a blessing to be in your space.

Speaker 4 (38:15):

Thank you so much mutual mutual and everyone. Thank you so much for listening. Have a great week and stay healthy. Well, the in smart, a huge thing.

Speaker 2 (38:23):

Thank you to Dr. Lisa van who's. And of course, to our sponsor for today's episode net health, again, sign up for their webinar, which is out tomorrow, April 20th, as part of their three-part mini webinars series, bestselling author, Stacy Fitzsimmons and Kelly Casio of net health. We'll be talking about the three T's of creating revenue ownership beyond just the billing department, training tools and transparency, head over to net health.com/lessee to sign up. And remember if you put Litzy in the registration page, sign up and show up net health. We'll buy lunch for your office once again. That's net health.com forward slash L I T.

Speaker 1 (38:59):

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

 

Apr 9, 2021

In this episode, Associate Professor in the Doctoral Program of Physical Therapy at Rutgers, Dr. Ellen Anderson, talks to Dr. Stephanie Weyrauch about burnout in physical therapy.

Today, Ellen talks about her dissertation on burnout, the distinction between normal stress and burnout, and how these markers of burnout fit into the anecdotal accounts of burnout seen in blogs and magazines. Why is data so limited on burnout in physical therapy? Which settings within physical therapy experience the highest rate of burnout?

Hear about the many factors impacting the number of therapists affected by burnout, how Covid-19 has affected recent graduates and students, and the causes of burnout, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “When people work with people who are in crisis, there are a lot of demands placed on them - very different than in other kinds of work, for example.”
  • There are 3 categories in burnout:
  1. Emotional exhaustion.
  2. Depersonalisation.
  3. Personal Accomplishment.
  • “When we think about just being stressed out, it’s hard to know what that means because everyone’s stressors are different.”
  • “If a physical therapist has high perceived stress, that’s correlated with emotional exhaustion, which is a part of burnout, but not the full definition of burnout.”
  • Researchers have suggested that there’s 2 ways to look at burnout:
  1. The Personal Approach. Make the person resilient, and they will be able to handle any kind of environment.
  2. The Work Environment. Make a nurturing environment that’s conducive to good work, and supporting people who are in crisis, then you’re supporting the workers and you’ll have less burnout.
  • “Younger physicians have higher rates of burnout than do older practitioners.”
  • “When people in healthcare feel as though they don’t have control of the situation, or they cannot contribute to good patient care, effectiveness, and efficiencies, that the burnout rates are higher.”
  • “There needs to be an understanding on how stressful and difficult it is to work with people who are at risk and people who are in crisis.”
  • “We need to be thinking about ways in which physical therapists can have some participation in systems that supports everyone in that work environment.”
  • “One of the things that’s very detrimental when people share thoughts and ideas, is that the first response they get is ‘we cant’ or ‘no’ without any kind of real honest investigation into the suggestion or recommendation.”
  • “Breathing practices and meditation are two strategies which help people be able to manage their stress effectively. The idea is that you practice those things so that when you need it, you can use it.”

 

More about Stephanie Weyrauch

Stephanie WeyrauchDr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government.

Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery.

Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.

 

More about Ellen Anderson

[caption id="attachment_9555" align="alignleft" width="150"]Ellen Anderson Rutgers School of Health Professions in Newark. 11/7/16 Photo by John O’Boyle[/caption]

Ellen Zambo Anderson, PT, PhD is an Associate Professor in the Doctoral Program of Physical Therapy at Rutgers, The State University of New Jersey where her primary teaching responsibilities are in Therapeutic Exercise, Development Across the Lifespan and Clinical Inquiry. Dr. Anderson, a Board Certified Geriatric Clinical Specialist, earned a BS in Physical Therapy from West Virginia University, an MA in Motor Learning and Control from Columbia University and a PhD in Health Sciences from Rutgers University. She is the Assistant Director of the Rutgers Community Participatory Physical Therapy Clinic, a student-run, pro-bono clinic in Newark, NJ, and serves as the Special Olympics Global Advisor for Young Athletes.

Dr. Anderson is the co-author of the textbook, Complementary Therapies for Physical Therapy: A Clinical Decision-Making Approach and has spoken internationally on physical activity, mental health, and complementary health practices. She is also co-owner of YogiAnatomy, a company that provides continuing education for rehabilitation professions on topics related to complementary approaches for managing well-being, health and function.

 

Suggested Keywords

Physiotherapy, Research, PT, Health, Therapy, Healthcare, Education, Training, Stress, Burnout, Wellbeing, Mental Health, Stressors, Support, Covid-19, Exhaustion, Depersonalisation, Accomplishment, Environment,

 

To learn more, follow Ellen and Stephanie at:

Website:          https://stephaniesandvickweyrauch.academia.edu

                        https://ptsmc.com/stephanie-weyrauch

                        https://www.yogianatomy.com

Facebook:       Stephanie Sandvick Weyrauch

Instagram:       @thesteph21

Twitter:            @thesteph21

LinkedIn:         Stephanie Weyrauch

                        YogiAnatomy

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

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

 

Read the Full Transcript: 

Speaker 1 (00:07):

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

Speaker 2 (00:37):

Welcome back to the podcast. I am your host, Karen Litzy and today's episode. We have our good friend of the podcast back, Dr. Stephanie Y rock, and she is interviewing Dr. Ellen Anderson all about burnout in the physical therapy profession. I'm not going to go into Dr. Anderson's bio because Stephanie reads that in the beginning of the podcast. We don't need to double up on that, but what you're about to hear, I'll give you some highlights is they talk about the three categories of burnout and does the research definition of burnout jive with the anecdotal accounts of burnout that we see on blogs and podcasts and things like that. They also talk about the difference between stress and burnout or perceived stress and burnout. The main causes of burnout in physical therapy, how COVID is affecting burnout. And Dr. Anderson talks about some things that perhaps you can do as an individual to help with your perceived stress.

Speaker 2 (01:41):

And she hypothesizes on some things that perhaps some businesses, some physical therapy businesses can do to help their employees with stress and burnout. So thanks to doctors why rock and Anderson and everyone enjoy today's episode. Hello everyone, and welcome to the healthy, wealthy and smart podcast. I'm your guest host today, Dr. Stephanie, why rock and, or once again, going to partner with the American physical therapy association, private practice section to discuss a topic that has been in the forefront in healthcare and that's burnout. This is an especially relevant topic. I think as COVID-19 pandemic continues to rage on, and I've actually been asked to write an article for PPS impact magazine on this. And so when I went to do some research on this topic, I of course found a lot of blog posts and opinion articles by physical therapists throughout the profession on this topic, but was really surprised to find that there's really not a lot of research in physical therapy on burnout.

Speaker 2 (02:50):

And I was surprised by that because it's so frequently discussed in our profession. So eventually my literature review led me to our guest today, Dr. Ellen Anderson. So Dr. Ellen Zombot Anderson is an associate professor in the doctoral program of physical therapy at Rutgers university in New Jersey where her primary teaching responsibilities are in therapeutic exercise development across the lifespan and clinical inquiry. Dr. Anderson is a board certified geriatric clinical specialist and earned a BS in physical therapy from West Virginia university, an ma in motor learning and control from Columbia university and a PhD in health sciences from Rutgers university. She is the assistant director of the Rutgers community participatory physical therapy clinic, which is a student run pro bono clinic in Newark, New Jersey, and serves as the special Olympics global advisor for young athletes. She's the coauthor of the textbook complimentary therapies for physical therapy, a clinical decision-making approach, and has spoken internationally on physical activity, mental health and complimentary health practices. She's co-owner of yoga, Yogi anatomy, a company that provides continuing education for rehabilitation professions on topics related to complimentary approaches for managing wellbeing, health, and function. So thank you so much Dr. Anderson for joining us today on our podcast. And again, I read your dissertation and I've, I found it really interesting that you decided to tackle burnout for your PhD dissertation. So maybe summarize your dissertation a little bit, tell our listeners a little bit about yourself and how you became interested in this area of research.

Speaker 3 (04:38):

Okay, great. Yes. It's a pleasure to be with you, Stephanie. Thank you very much. Initially I became very interested in complimentary therapies and through the work that I do with my colleague, Judy Deutsche, where we published a textbook in that area, I was interested in the application, the safety and the efficacy of complimentary therapies for patient populations. And that got me to realize, or helped me realize that there is a fair amount of data that suggests these complementary therapies can be useful for our patients, particularly in the areas of mood reduction of stress, as well as reduction of pain. And so that got me thinking about using approaches such as Reiki or yoga, meditation, breathing practices for self care as well as patient care from that point. However it was determined that we really didn't know what stress was in physical therapists or what burnout is in physical therapist, because as you've identified, a lot of people are talking about it, but there hasn't been a lot of research in that area.

Speaker 3 (05:57):

And so I started to embark on trying to get a handle on what is the stress and burnout in physical therapists. My focus took me to burn out. And the reason for that is because burnout was defined by fruit and burger back in 1975. And it was based on his observations in working with healthcare providers. And what he observed is that when people work with people who are in crisis, there are a lot of demands placed on them, very different than in other kinds of work, for example. And he began to categorize some behaviors that he saw in people who were becoming more and more stressed. And then it was Nass latch who developed the mass latch burnout inventory. And so what mass latch did was kind of support the observations of fruit and Berg by saying there are three categories that we need to look at in this thing called burnout, that there's emotional exhaustion, there's depersonalization and there's personal accomplishment.

Speaker 3 (07:16):

And so when we think about just being stressed out, it's hard to know what that means because everyone's stressors are different. So what stresses you out is different than what stresses me out, you know, when you kind of come to your work with a certain constitution about what keeps you even keel and what are your triggers? The burnout goes a little bit further because it's not just emotional responses. And in this case, emotional exhaustion is that sort of physical, mental exhaustion that many people might be feeling. That's just one part of burnout. So the next part of burnout is this deep personalization. And what that means is that you kind of begin to separate yourself out from your patients. And there's this phenomenon of, of I'm sick of thinking that the patient is to blame for their problems. You know, so they brought it on themselves and some psychologists and researchers suggest that perhaps this deep personalization is really kind of a protective mechanism because you're dealing with people in crisis all the time. And then you have the personal accomplishment and that's where you feel like your, a rat in a, in a maze or in a wheel. And you just keep going round and around and you ask yourself, finally, what am I doing this for? Am I really making a difference? So the, the, the curiosity for me is, was understanding the D the difference between just job stress and burnout, and that physical therapist in fact, would fall into a category of people working with people who are in crisis most of the time.

Speaker 2 (09:28):

I think that that's really interesting that, you know, we have a defined a true research definition of burnout. I'm wondering what your opinion is on how this definition fits with these anecdotal accounts of burnout that we're seeing in some of these blog posts that people post or that TA magazine has been posting about regularly.

Speaker 3 (09:50):

It doesn't really jive a very well, to be honest with you. So when, when I see comments about burnout, I just say to myself, well, people are stressed out and, and we should honor and respect the fact that people are very stressed out. That burnout technically from a research standpoint has a different definition. And what I found through my research is I did study and survey physical therapists, both using the mass latch burnout inventory, which has the three part, but I also included the perceived stress scale. And so the perceived stress scale, I think, is a very valuable tool because as I mentioned, previously, stressors for you are different than stressors for me. And the perceived stress scale has been used in thousands of studies. And it's looked to be sort of a gold standard if you will, to get a finger on the pulse of people's stress, because it is about perception of your stress.

Speaker 3 (11:04):

And, and so what I found in my, in my dissertation was that all, although physical therapist had better perceived stress scores than the national sample that I compared it to, there was a relationship between a high perceived stress score and burnout especially in the category of the emotional exhaustion piece. And so what we, what we saw was that if therapist had high emotional exhaustion, they were seven, seven times more likely to actually have burnout. So let me tell you what burnout is. According to those three parts is if you do the burnout scale, and you're very high where you're high in emotional exhaustion and you're high in deep personalization, and then you have low professional accomplishment, you fall into the category of burnout. And so what I found was that 29% of PTs are high in emotional exhaustion, and that is consistent with what people are talking about in the blogs related to being stressed.

Speaker 3 (12:27):

Okay. The other thing that I want to know is that in a lot of studies that are being done with physicians and nurses with burnout, sometimes the headline is 50% of physicians have burnout. And what they did was that they used the burnout scale, but they focus their, their headline on the fact that it was emotional exhaustion. And so there was recently a systematic review that looked at just that is the reporting of burnout and how it's a little bit of a mixed bag now where it traditionally had been the high score in exhaustion depersonalization on a low score in professional accomplishment. But now people are reporting even just on the emotional exhaustion. So when we think about PTs and what I found was that 29% had emotional exhaustion and then 12% had actual burnout. And so that's, that's really a concern because we're talking that we have a vulnerable PT workforce out there when it comes to stress and when it comes to burnout.

Speaker 2 (13:56):

So if somebody has, if a physical therapist has high perceived stress, that's correlated with this emotional exhaustion, which is a part of burnout, but not the full definition of burnout.

Speaker 3 (14:09):

You got it, it's perfectly stated.

Speaker 2 (14:11):

So do you think that we, that our research needs to maybe reassess the definition of burnout? Or do you think that people, that we just need to get the word out there about what burnout actually is and educate people that, you know, you're not quite burned out yet? You're, you're emotionally exhausted. Here are the steps that you can take to decrease this high emotional exhaustion to prevent burnout, or what, what's your kind of opinion on that?

Speaker 3 (14:39):

Well, it would be a wonderful thing if it was so simple. But the reason why it's not simple is because people have looked at well, what comes first is an emotional exhaustion, and that leads to depersonalization followed by lower professional accomplishment. And the answer is not clear. So there are different models that have been proposed and tested to show that it can be multi-directional. And so it's not easy to say that if we manage stress, as we know stress, the perceived stress that we will have made a dramatic effect on burnout, because if depersonalization is what drives emotional exhaustion or low self-efficacy kind of low personal accomplishment, low self-esteem that type of thing in your workplace, if that drives burnout, then managing stress may not have as dramatic effect on those areas. So I, I think it's, I think it is behooves us to think about the complexities of stress and that mirrors the complexities of burnout.

Speaker 3 (16:04):

But I think that the first step is to be thinking about what are those stressors in the workplace because researchers have suggested that there's two ways to look at burnout, and that is the personal approach, so that you're more resilient to that stress, to that emotional exhaustion. And then the other area of focus should be on the work environment and the, the experiences that a person has at work. So we see that there's both sort of schools of thought that you, you make a person resilient and they will be able to handle any kind of environment. And then the, and then the counter is that if you make a nurturing, caring environment, that's conducive to good work and supporting people who are in crisis, then by that you were supporting the workers and you'll have less burnout.

Speaker 2 (17:14):

I think that those are some very interesting points. You know, this is obviously a very popular topic in our profession. Why do you think there's then we had, we've talked about that. There's not a lot of data for this. And just so our listeners know, like there's maybe a few studies, including Al including Dr. Anderson's recent dissertation, which was published in 2014, there's a couple of articles that have been published since then, but most of the research has been, was done in like the eighties and the nineties. So it's like over 20 years old. Right. So why do you think that data regarding burnout is so limited in our profession? And is there really any research going on in this area right now in our profession today?

Speaker 3 (18:00):

Yeah, I I've thought about that quite a bit, and I'm not sure why there hasn't been much, much research in the area. You can imagine that when I was working on my dissertation, I was shocked that there wasn't anything that was substantial. Everything was very old, as you had mentioned. And it was done in very discrete populations. So one was in rehab inpatient facilities in Massachusetts. Another wasn't a head injury unit in the Pacific Northwest. So very specific, nothing quite as broad as a national sample. Why, I don't know. I, in general, though, the efforts in looking at burnout has been focused on nursing and in physicians and MDs. And the only thing that I could come up with is there's a difference in the way we think and do things if you're medicine versus when you're rehabilitation. And I think that in comparing some of my findings in, especially in the areas of deep personalization and personal accomplishment, is that PTs typically were scoring much lower than nurses and physicians in those two categories.

Speaker 3 (19:24):

And I speculate that perhaps it's because of the kind of relationships that we have with our patients, that because we spend more time with our patients, we get to know our patients, families, and a lot of instances that it's very hard for us to depersonalize when you really spend a lot of time with someone. And that may also contribute to the fact that PTs score better than people in medicine, in the area of personal accomplishment, because although things may be crazy in your, in your practice setting, the fact that you can see a difference in the individual clients and patients that you see may in fact be reinforcing for that personal accomplishment.

Speaker 2 (20:16):

So is your belief then based off of what you found in your research, that kind of the difference between say physical therapists and nurses and physicians, which are more studied than what our profession is that we have better really, you know, longer lasting relationships with our patients and get because of that, we get a lot more accomplishment. Whereas physicians and nurses are more short term relationships with their patients. And so kind of those better scores and deep personalization and in personal accomplishment kind of help us save us from being burnt out. Like maybe our physician and nursing colleagues is that a,

Speaker 3 (20:57):

That is my hypothesis, but I haven't tested it. But that in looking at some of the publications in physicians of, of all different practice settings they are scoring typically higher, interestingly, except for those in mental health fields. So that may be a situation, two fold. Number one, is that a person working in mental health may actually have more skills to deal with their own stress and burdens. But they also may be spending more time with their patients because of the kind of therapeutic relationship that would occur in, in mental health.

Speaker 2 (21:44):

I think that your hypothesis is a very logical one, because if you think about, so if we, if we look at those studies from 20 years ago, obviously our profession has changed a lot. I mean, healthcare in general is just always changing. So, you know, right now student loan is at an all student loan debt is at an all time high wages for physical therapists are basically the same as what they were in the nineties. And the two thousands, we continue to experience decreases in payment. We have rising productivity expectations in order to maintain that bottom line. And so a lot of these factors are kind of cutting into our ability to form these relationships, so to maintain those good scores and depersonalization, and to have that personal accomplishment. But I'm interested in potentially knowing your opinion on how you think these factors have impacted the number of physical therapists affected by burnout.

Speaker 3 (22:43):

Yeah, I think that it has one of the, one of the findings that I observed in my research and that others have observed in medical populations is that younger therapists, younger physicians have higher rates of burnout than do older practitioners. And it's speculated that it's because the more seasoned therapist or physician has learned how to manage, right. They've learned how to manage sort of the, the game, if you will. They've also learned strategies for self preservation. So that gets us into that twofold area again, right. The personal, you know, wellbeing, and then the institution as something separate, I think it be worth it to take a look now, even compared to five years ago, with all the things that you've described, they were occurring five years ago when I did my dissertation, but then along comes higher expectations for productivity.

Speaker 3 (24:01):

And now, you know, let's throw in a worldwide pandemic onto that. Right. And so I think that what we've, what we'll, what we will see is that institutional changes that people may not have been able to keep up with because it's happened so rapidly over time, or it's sorry, that's weird. It's happened so rapidly within a short period of time that I think it would be worth looking into what changes have occurred in perceived stress or burnout. Within the past couple of years in physical therapy, because I would predict that those numbers would be greater than they were back in 2014.

Speaker 2 (24:51):

Well, I mean, that leads me beautifully to my next question is how do you think COVID-19 has contributed to burnout in physical therapy amongst physical therapists?

Speaker 3 (25:01):

Right. So when, so, although I didn't ask the question in my survey about what's causing you to be burned out or, you know, identify things that are stressors in your life. What I know, what I know from the literature is that when people in healthcare feel as though they don't have control of the situation, or they cannot contribute to good patient care effectiveness and efficiencies that the burnout rates are higher. So there is something to be said about this time in COVID where in our physical therapy world, we went from non essential to essential. We went from, you know, not doing rehab to doing nursing care. I colleagues of mine who were sent to the Mork colleagues of mine who worked security desks because in order for them to keep their job, they needed to say I would do assigned duties. So if we know that having little say about your work environment, little, say about how much time you spend with patients or what your responsibilities are, or what responsibilities you can delegate to other people, we know that that's contributing to burnout then hello, because that's exactly what happened to the physical therapy profession during COVID.

Speaker 2 (26:39):

So you teach at Rutgers what types of what types of instances of burnout or stress have you experienced amongst your students who are now like fresh into our profession and the students that are maybe still in PT school? How have they reacted to this COVID-19 pandemic in relationship to burnout or perceived stress?

Speaker 3 (27:04):

Right. So I think that we, we probably have cooked two cohort of students, the ones that graduated in 2020, who did a big sigh of relief because, because of in our program, the amount of weeks and hours they had got in for clinical experiences was complete by the time that they started to be pulled out of their clinical rotations. So all of our students were able to reach a level of competency and entry level so that everyone graduated in 2020. So they were like, just so relieved the group that is scheduled to graduate in 2021 have been dealing with the stresses, the traumas that come with changing responsibilities and different expectations because of COVID. But I think that by and large, they've had excellent clinical instructors, so kudos to the physical therapy profession and that they have been able to take the challenges in stride in part, because of the support from the institutions and their clinical instructors.

Speaker 3 (28:30):

I think that the students that are engaged in academic work, their stressors come from the fact that they know that they are in a program that's delivering information very different than the previous year and their hands-on experience has been truncated. And, and that, despite the efforts of the faculty to give them all the experiences that they normally would have in person that we are limited by the COVID restrictions of our university. So what we've, what we've attempted to do is to speak about the virtues of tele-health. We have some testing opportunities for students to engage in tele-health and improve their skills with communication and observation. Also giving directions watching movement from like you and I are right now from across the screen. And I do think that that is something that many therapists are learning. There's many courses and, and many workshops that you can do for best practices in doing telemedicine. So I think some of our students will be better equipped coming out because they have had some work in that area.

Speaker 2 (30:09):

So we've talked a lot about some of the different stressors that potentially could lead to burnout, but do you think are the main causes of burnout amongst physical therapists?

Speaker 3 (30:19):

Yeah, I think number one, I think autonomy is, and, you know, we got out from under the physician prescription. But if you think about autonomy from many practices in which the productivity demands is so high that you feel as though you've lost some sense of autonomy, and that comes from not being able to perhaps schedule your patients based on their needs. So, you know, if 30 minutes session versus 45 versus an hour so that contributes to a decrease in, in autonomy, which we know is that, which is a stressor when it comes to burnout. The other thing that is a big factor is redundancy. And it can be primarily in documentation where, you know, we've all experienced that you fill out one form, then you fill out another, then you have to do this chart and so on and so forth.

Speaker 3 (31:20):

You have this information in four or five different places, and that contributes to burnout because what happens is you feel as though you've imparted your professional opinion and you've made your professional observations, and that should be good enough. And you know what, Stephanie, it probably should be good enough. The fact that we have to, you know, regurgitate it in three different ways for different purposes is, you know, sucking the life out of people. All right. So the other thing that happens is that acknowledgement of credentials and continuing education and bettering yourself when that is not honored and respected by an employer or by a setting that contributes to burnout. And so in the physician world, they talk about having their board certifications. And we could also think about that in physical therapy as well. So even if you've got staff that have qualified or are now OCS is, or sports, clinical specialists is they need time to maintain that expertise.

Speaker 3 (32:35):

They need to do continuing education. They need to see the right patient caseload. They need time to do some outcome measures so that they can maintain that level, that high level of expertise, and that needs to be respected and time needs to be given to those professionals. Otherwise you can see an erosion of professional accomplishment. So it, it's not from my, my work, but from the readings that I've done in other professions, you know, predominantly medicine and nursing, these are the institutional things that contribute to burnout. And I can see that how that can they can have a big role in physical therapy as well.

Speaker 2 (33:23):

So I recently did a very unreliable and bias social media study pool on this topic asking you know, what, which physical therapy setting is burnout most prevalent. And I had 147, a sample size of 147 on, and I was kind of surprised by the results, but here were the results. 48% said private practice, 23% said, hospitals, 24% said skilled nursing facilities, and 5% said home health agencies. Do you think based on kind of what your research showed and based off of what you've read and potentially what your alumni have said, do you think that there is a higher rate of burnout amongst physical therapists in certain settings? And if so, what settings do you hypothesize put people most at risk for burnout and how can leaders within those settings decrease the rate of burnout amongst their employees?

Speaker 3 (34:25):

Okay. So I don't have to hypothesize because I actually have the data that was not part of my dissertation. So I will share that with you now. All right. So the winner in the burnout rate is skilled nursing facilities at 24%. Okay. followed by home a home care at 14% closely followed by the hospital outpatient department at 13% and private outpatient at 12%. So 12, 13, 14%, you know, sort of in the ballpark, but the standard, our skilled nursing facilities. And in, in a statistical analysis that I even still don't remember or can explain the one that stands out is truly statistically significant difference are those people who practice in skilled nursing facilities. And I mean, I would have to say that that number is probably in a higher, I mean, look what our colleagues in skilled nursing facilities had to deal with with COVID.

Speaker 3 (35:39):

You know, people were not being able to have visitation by family members, right. Trainings for going home sometimes were done via zoom sometimes in person for maybe five minutes. But think about that, think about all of the subacute rehab, people who didn't have family support when they're, you know, they're following surgery. They've never been in that kind of situation before, and they had to do that totally alone. And the demands that were placed on the rehabilitation staff and the nursing staff to keep moving forward with subacute care, nevermind all of those residents in long-term care that needed attention. So it, it back several years ago, it was still ranking pretty high as a stressful burnout written place to be long-term care. And I think it's still gonna sort of be at that level if not higher, what can they do?

Speaker 3 (36:50):

I still, I still have to go back to having compassionate supervisory support that there needs to be an understanding on how stressful and difficult it is to work with people who are at risk and people who are in crisis. And with that compassionate understanding supervisor comes a system that optimizes the physical therapist clinical decision-making professional opinion and allows therapists to continue to impact people's lives as positively as we do and not be burdened or, you know block or have a blockade set up through unreasonable demands and expectations. I think that the other the other idea that I didn't speak about earlier also is this sense of fairness and justice, and that comes from also the supervisor and, and the institution, and that it appears that when there's good transparency by knowing what everyone's case load is by knowing what the expectations are and that everyone is contributing to a a great unit or a great facility and that there's rewards and acknowledgements.

Speaker 3 (38:37):

And sometimes it doesn't have to be an actual bonus or reward. Those are nice, but sometimes it's just the acknowledgement. And at the same time that there shouldn't be any kind of punitive action on people who are not able to accomplish the same benchmarks. So I'll give you an example of something that happens in medicine quite a bit is that physicians who work in clinics are, have their appointments, you know, done by a scheduler, and they will have an income based on bonus based on how many people that they see. But what happens is when people cancel, they don't see anyone and there's no one there to fill in that spot. So physicians are, who are in that situation, feel like I'm not pulling my weight, but it's no fault of my own. And now I'm also being penalized because I don't have that slots filled. So I can't generate a ticket if you will, in order for a charge to go in, and yet it's by no fault of their own. And so we need to be thinking about ways in which physical therapists can have some participation in systems that supports everyone in that work environment.

Speaker 2 (40:17):

Do you have any advice on any of those systems or any thoughts behind developing those systems?

Speaker 3 (40:24):

I don't actually, I think that those are for, for different minds than mine right now. And I bet that there's plenty of people in the private practice section who have looked into different types of systems that include participatory type management strategies.

Speaker 2 (40:48):

I think you're probably correct on that statement, Dr. Anderson and, you know, most physical therapy facilities, including private practice, we're moving towards using data to make decisions. So how, what advice would you give to private practice owners? How can they use data to measure burnout amongst their employees?

Speaker 3 (41:09):

Yeah, I mean, I think, I think one of the the easiest tools to use is actually the perceived stress scale. It's by Cohen, it's free, you know, there's plenty of places where you can find it online and know how to score it. And one of the reasons why I, this is because I've done the perceived stress scale with groups of therapists who take continuing education courses with my partner and me and they are often surprised at what their score is. So some who thought they would score really high on this perceived stress scale, realize that no, they really didn't. And those who thought, you know, they were getting along pretty okay. When they went through those questions, they're like, Oh, I didn't think I would score that high. And so it, it leads to a conversation about that personal side, right? So what are you think that your stress, but your perceived stress scale kind of comes out a little bit low.

Speaker 3 (42:22):

So what are you doing in your life? How do you approach your day? What are the things that you do to manage your health and wellbeing? And I think that facilities that make that part of the culture will do really well with being able to use some of that information from the perceived stress scale, not where they're collecting the data, but they're increasing the awareness of their employees and the people that work together. And it opens up the opportunity to have a conversation about the stressors at work, the stressors at home, and how people can support each other and how people are coping with their stressors.

Speaker 2 (43:09):

What advice or solutions do you have for private practice owners or any, or organizational leadership on managing burnout amongst their employees once they kind of figure out some of the data points that you mentioned previously?

Speaker 3 (43:23):

Yeah, I, I think that one of the things that has come out in some of the literature is the fact that when you're working with highly intelligent people. And so remember that burnout came from people who were working in healthcare, right? They, they are licensed healthcare providers. They often have advanced degrees. They often have specialties. One of the keys is to give people a voice regularly. And then what is also been found is that when people are given a voice and suggestions are made for changing in the environment or something that could help greater efficiency, that the response from the administration is that I will look into that and then come back with information to either support that idea or to say at this time, and in this situation, that idea won't work. And here are the reasons why, but one of the things that's very detrimental is when people share thoughts and ideas, is that the first response they get is we can't, or no, without any kind of real honest investigation into the suggestion or recommendation. And so I think that that's a very sound place to start and trying to have a clinic or a facility that is going to be resilient against all of these forces that are going on in healthcare and have a happy and healthier staff.

Speaker 2 (45:23):

What about employees? What type of advice do you have for employees who are maybe close to, or are experiencing burnout?

Speaker 3 (45:32):

Yeah. institutional change takes a very long time, and sometimes it can be really frustrating, particularly if you don't have those empathic caring supervisors who are going to sort of beat the drum for you. And so you have the chance to turn to yourself. And what we know from some work site studies that have focused on healthcare providers is that breathing practices and meditation are two strategies, which help people be able to manage their stress effectively. And the idea is that you practice those things so that when you need it, you can use it. So, you know, you could always think, well, like when I get really anxious or whatever, I just stop and I take some deep breaths. Oh, okay. That's great. But when do you, do you always have an opportunity to like, just stop, pause and like take your deep breaths? No, you, you have to anticipate that this is happening and you have to be really good at pulling that up very quickly. And that comes from a regular practice. And I think that in general, we know those practices are really good for managing the balance of the sympathetic and parasympathetic nervous system. We know that those practices help increase heart rate variability, decreased blood pressure, decreased heart rate. And so it's not, those are strategies that are not just great for managing stress, but they're also great for managing your overall health.

Speaker 2 (47:27):

Well, Dr. Anderson, this been a great conversation. I know that I have learned a lot and I'm really looking forward to using some of this information to write my article. One last question that I want to ask you, that we ask everybody on this podcast is knowing where you are now in your life and in your career. What advice would you give to your younger self?

Speaker 3 (47:53):

Huh. I think, I think to my younger self, well, Hmm. Okay. There's two, there's two sides to this sword. One is that if I wanted to be more accomplished, I would say in my career I would have focused earlier on, on a line of inquiry or a line of research. However, not having done that. I can't say that I have a lot of regrets and I have dabbled in a lot of things so that you, you saw from my bio, that I have a lot of different interests and I don't do anything with a half effort. So, you know, a lot of research went into the book. A lot of research went into my being the advisor for young athletes for special Olympics. You know, there's, there's, I haven't really ever fallen into anything. I feel as though I've put a lot of effort into that and, and all of those parts of who I am. I enjoy immensely and I wouldn't want to give anything up. So my advice is if I had a clear career trajectory, I should have focused more on one area. But I don't know if that was really me to begin with.

Speaker 2 (49:34):

Yeah, don't we all want to have one area that we want to focus on and have a very clear trajectory. I think of 2020 has taught me anything. It is, that is not something that's going to happen most of the time. Well, I want to thank you so much, Dr. Anderson for joining us today on the podcast, and thank you so much for your time. Thank you to our, thank you to our listeners for listening to another episode of healthy, wealthy, and smart, and hopefully you will stay healthy, wealthy, and smart.

Speaker 1 (50:10):

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

Apr 5, 2021

In this episode, Co-Founders of Survivorship Solutions, Jillian Schmitt and Kristin Carroll, talk about Cancer Survivorship and the need for Caner Rehab Education.

Today, Jillian and Kristin talk about the prevalence of cancer, the importance of competency in cancer rehabilitation for all rehab clinicians, and compiling educational courses from leaders in the field.

When should cancer rehabilitation start? Jillian and Kristin tell us that learning is not enough, hear about the value of mentorship, and Jillian and Kristin’s community of clinicians, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “Cancer is not just one type of cancer. Cancer is not just what you’re seeing on the outside, there are physical changes on the inside as well.”
  • “One thing that physical therapists have to keep in mind is that 100% of physical therapists, at some point in their physical therapy career, will see someone with cancer.”
  • “If you want to stay on the bus, get competent and elevate your skillset to everything, not just cancer rehabilitation, but add that as another skill in your pocket.”
  • “If you are a clinician or a therapist, it really is your ethical responsibility to take care of every patient that comes through the door, regardless of what their past medical history is. If you are not confident and competent in taking care of oncology patients, get that way. There’s a solution for you. Educate yourself, feel comfortable, feel confident, take care of your patient the way you should.”
  • “For administrators and leadership teams, you really want to know that your team can take care of this population. If you do not have something in place that is ensuring that your clinicians and rehabilitation teams are really competent at taking care of these patients, you need to get that way, and you need to get that way pretty quick because the regulations and requirements from the very top levels are requiring that you do that.”
  • “If your oncologist is not talking to you about function and what’s happening to you during your cancer journey and how that is going to be mitigated, or how you’re going to have a rehabilitation therapist of some sort as part of your team, ask for it. It needs to have this bottom-up push as well.”
  • “Think big, be brave, and just go for it.”
  • “Keep being a sponge. Keep learning. Don’t be afraid to try new things. When you’re starting to get burned out, try something else. Keep learning and keep growing, and eventually you’re going to find something that just wows you and really makes you change not only your career, but your personal growth as well.”

 

More about Kristin

Kristin has been in clinical care and leadership roles within the Boston and Hartford healthcare systems for over 30 years. For over a decade she has focused on elevating her oncology specific practice with Klose coursework in lymphedema, oncology and breast cancer rehabilitation specialty courses through Julia Osborne and the American Physical Therapy Association (APTA); Academy of Oncologic Physical Therapy, and earned completion certificates in Chemotherapy/ Biotherapy Agents and Radiation Therapy from the Oncology Nursing Society. She is planning to sit for the 2021 Oncologic Certified Specialist Examination.

Kristin has been a mentor, clinical coordinator, and educator at both the system and collegiate level. She continues to serve as an educator through her role as an instructor within Survivorship Solutions ’clinical education course: Core Competencies in Interdisciplinary Cancer Rehabilitation, contributing to guest podcasts on Breast Friends Cancer Support Radio, Mama Bear Cancer Support Radio Talk Show, and The OncoPT Podcast, contributing to Alene Nitzky’ s book “Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care”, and as invited speaker at the International Breast Cancer and Wellness Summit, and the American Congress of Rehabilitation Medicine National Conference 2020.

She actively supports and is involved in the oncology community as a member of the American Congress of Rehabilitation Medicine Integrative Cancer Rehabilitation Task Force, Connecticut Lymphedema Consortium, local and national chapters of the American Physical Therapy Association (APTA); APTA Academy of Oncologic Physical Therapy, Hospice and Palliative Care Special Interest Group, and serves on the board of the APTA Connecticut Oncology Special Interest Group as Program Coordinator.

Kristin received her Bachelor of Science in Physical Therapy from Northeastern University.

More About Jillian:

Jillian is a licensed physical therapist with over 20 years of experience in patient care, clinic development, management, and consulting within the fields of oncology, orthopedics, pediatrics, ergonomics, and corporate health. She studied biochemistry and business management at the University of Texas at Austin, and received a Bachelor of Science degree in Healthcare Sciences and a Master's degree in Physical Therapy from the University of Texas Medical Branch in 2001.

Much of Jillian's early career focused on orthopedic and pediatric physical therapy intervention, specializing in complex, limb-salvage rehabilitation programs, spinal dysfunction, and sports medicine. Later, she turned her attention to program development, clinic start-ups, and management within the corporate healthcare industry. For the past six years, she has consulted in the implementation and optimization of survivorship services and cancer rehabilitation programs within national healthcare organizations.

Jillian maintains professional licensure in physical therapy and participates in continuing education programs and certifications within oncology and other specialties. She serves as a contributing and presenting team member for the American Congress of Rehabilitative Medicine (ACRM)'s Integrative Cancer Rehab Taskforce and is a member of both the Education Section and Oncology Section of the American Physical Therapy Association (APTA). She also participates as a member of the Hospice and Palliative Care Special Interest Group (SIG).

Jillian regularly contributes to podcasts, journals, and other professional publications related to oncology, healthcare, and business, and she participates and contributes regularly within the entrepreneur and small-business community of the Chicago-land area, including SCORE mentorship and women-led business groups.

In 2016, Kristin and Jillian founded Survivorship Solutions, LLC., an education and consultancy firm dedicated to supporting clinicians and healthcare organizations in implementing high-quality cancer rehabilitation and survivorship services.

The company collaborates with national and global experts in oncology, survivorship, and rehabilitation to grow team safety and competencies in oncology knowledge and evidence-based care.

 

 

Suggested Keywords

Physiotherapy, Learning, Cancer, Research, PT, Health, Therapy, Oncology, Survivorship, Healthcare, Education, Training,

 

Recommended viewing

https://vimeo.com/485402119

https://survivorshipsolutions.com/p/core-competencies-in-interdisciplinary-cancer-rehabilitation-2-0

 

To learn more, follow Jillian and Kristin at:

Website:          https://survivorshipsolutions.com

Vimeo:             https://vimeo.com/survivorshipsolutions

Facebook:       Survivorship Solutions

Instagram:       @survivorshipsolutions

Twitter:            @survivorshipsol

                        @KCarrollPT

                        @JSchmittPT

LinkedIn:         Kristin Carroll

                        Jillian Schmitt

                        Survivorship Solutions LLC

NetHealth Webinar: 

Rehab Therapy Outpatient Services 101: How to Expand into the Home or Assisted Living Facility.

Subscribe to Healthy, Wealthy & Smart:

Website: https://podcast.healthywealthysmart.com

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

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

SoundCloud: https://soundcloud.com/healthywealthysmart

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

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

 

Read the Full Transcript:

Speaker 1 (00:00):

Hey, Kristin and Jillian, welcome to the podcast. I'm so happy to have you guys on

Speaker 2 (00:07):

Or happy to be here.

Speaker 3 (00:09):

Thank you so much for having us on today.

Speaker 1 (00:11):

So today we're going to talk about cancer, survivorship. This is something that I've spoken to, one of your colleagues, Dr. Nicole Stout with, but before we get talking about that, what I would love to know is how the two of you came together to create survivorship solutions, the how, and the why behind it.

Speaker 2 (00:31):

So, Kristen and I knew each other before we started the company together for a couple of years, we, we previously worked for another organization and had similar roles and that was to implement cancer rehabilitation, service lines within healthcare systems. And Kristen and I really connected during that time. And we really enjoyed working with each other. We valued a lot of the same things. And so once we left that situation or once that situation of our, our, you know, once that's working together no longer happened for that particular company, we decided that we were great together and that we would we needed to continue the work. And so we started survivorship solutions together

Speaker 3 (01:21):

And Julia and I are both physical therapists and I have a special, I've been working with oncology patients for over 12 years. And even though we're both PTs, we both kind of had different soap boxes and what we were so passionate about. And Jillian has a love and just a savvy for business and growth. And you know, I just love to educate and things like that. So together, you know, just our, our strengths and our passions just forged us forward to create this, this company to, to continue to help healthcare organizations, but also individual commissions that, that really just needed to get more information on how to take care of people with cancer.

Speaker 1 (01:59):

Yeah. And that was my next question is where, where was the gap that, what was the gap that you guys saw that you were like, Hey, if we can put our heads together and create this, we're really going to help fill that gap?

Speaker 2 (02:11):

Right. Well, you know, for me personally, it was I was not a cancer rehabilitation therapist for most of my, my clinical career. I was in orthopedics and I th the opportunity to begin working in cancer rehabilitation actually came about it was pretty unexpected. I received a phone call from a very good friend of mine and also therapists I would school with. And I've been in practice for 15 years and she said, you know, I think that this would be a really good opportunity for you, you know, you, you've married sort of this business. And I, because I had opened clinics and I had done a lot of the, the business part of it. And but I really loved clinical practice. And I also had a very personal situation occurring in my life, or one of my loved ones was experiencing the cancer journey and really having a lot of issues and a lot of problems that I was really familiar with. But I, you know, like weakness and numbness and things like the things that physical symptoms, but I was just kind of watching through this lens and like, all right, well, that's like what I do every day, but why isn't somebody helping him? So it was all these three things that kind of came together and took me out of my orthopedic world pretty quickly and thrust me into the cancer rehabilitation world, which I had thought, I mean, admittedly been very naive of until that happened.

Speaker 3 (03:43):

Yeah. And I was working in an outpatient center and had surgeons come to ask if I would become competent to learn how to take care of breast cancer patients. Cause they were breast cancer surgeons. So I went to Olympia DEMA course and I learned all about lymphedema. And then I came back and I saw a breast cancer patient and I was all excited to use my new education that I just learned and she didn't have lymphedema, but I was like, Oh my God, what do I do with her? I mean, I learned all about lymphedema isn't that cancer rehab isn't. And so Julie and I learned quickly that in order to really become competent, to take care of people with cancer, you have to travel around the country at your conferences and online and, and do all sorts of things to get there. But a lot of it was just disease specific, like just breast cancer. So how do you learn how to take care of everybody that has all different kinds of cancers and all the different problems? So we felt that it really was our ethical responsibility as we were working with healthcare organizations to make sure that if we were going to implement a program, we had to make sure the team really was confident and competent to do that. So how we created education to go along with that implementation.

Speaker 1 (04:54):

Yeah. Excellent. And, and I will say that people who, like, I know people who've been diagnosed with cancer and as of yet only like two of them have gone to physical therapy. One of which was because I said, you have to go to physical therapy, she had a double mastectomy. And I said, tell your doctor that you want to go to PT afterwards. And she was like, but the doctor gave me this list of exercises. And I said, no, no, no, no, no. Tell your doctor, you want to go to see a physical therapist after this and, and sh afterwards she was like, yeah, I I definitely needed a PT. And so I think the issue here, and we'll get into that, we'll get into this conversation in a little bit, but you know, the issue here is that cancer is not just one type of cancer. Cancer is not just a, what you're seeing on the outside, but there are physical changes on the inside as well. And that's where being a knowledgeable physical therapist on, on the rehab of people diagnosed with cancer is so important, but let's talk about cancer in particular. So cancer itself can affect anyone true or false. That's absolutely right. Yeah, definitely. And so let's talk a little bit about the, this sort of prevalence of cancer and what that means for us right now,

Speaker 3 (06:31):

Almost 17 million cancer survivors in the country. And so that is all different ages, you know, doesn't matter which sex, all different kinds of cancers, definitely cancer is not discriminant. And so you talk about the gap in care. And Andrew Chevelle is, is kind of huge in our cancer rehab world and does research. And you know, she talks about the 83% of general cancer survivors have problems that really require rehabilitation and take it to the other end where women sorry, excuse me, general cancer metastatic or stage four, they have up to 92% of problems. So obviously somebody that has a chronic cancer condition is going to have more and more problems because they are receiving more and more treatments. And so the percentage of people that actually get rehabilitation is only about 30% according to, to her study. So that's, you know, that's a huge gap in care wizards.

Speaker 3 (07:25):

It's 83% of general cancer survivors or the 92% of our metastatic breast cancer patients. That's a huge gap with 30%. So when we're looking at that, if you're young and you're diagnosed with cancer and you have treatment, you're going to grow up to have perhaps problems, you know, as you get older. And so, you know, these people are inside our clinics already. And sometimes it's a little tiny past medical history. That's checked, you know, on their, on their form and we see cancer, but yet we're a little bit afraid sometimes to ask a little bit about what that is. And, and even I do that when I'm in a private room with my cancer patients that I'm treating them, I have no problem talking about what they went through, but on an open clinic. And I see that little word cancer, sometimes I, I will say, Oh, well, you had cancer. What kind did you have? And you know, but we really have to have these conversations. What kind of cancer did you have? What kind of treatment did you have because it really can impact the treatment that you are providing your patient, whether they're a pediatric patient, you know, an inpatient and outpatient adult really doesn't matter what the setting is. It really could depend on what your care plan is going to be.

Speaker 1 (08:41):

And Karen, you, you had mentioned that you said you asked, can anybody get cancer and can this affect everybody? And absolutely. And I think what's, what's really interesting is that healthcare professionals, you, myself

Speaker 2 (08:56):

Included, we don't necessarily automatically think about like the, the functional consequences of having cancer, even though we see it. We're so we have this new normal instilled in us that we sort of expect cancer patients to not have normal function or not be doing well. And it just really to be part of what the expectation is once you get that diagnosis. And even me, even somebody that has worked in therapy for a long time and having a person very close to me, experiencing physical symptoms, I still, it was almost like a, it was just sort of like an out of, Oh, you know, like I didn't really make sense to me why he wasn't getting it, but it wasn't sort of this, well, this is a person that needs to have therapy. That connection wasn't, wasn't quite there yet. And I think that that's true for a lot of clinicians.

Speaker 2 (09:49):

They say, well, we, we don't see cancer patients, but but w w what Christina likes to say, well, yes, you actually, you have, and you do you see them probably every day on your schedule, there's such a high percentage of people that cancer at this point, that if you're seeing any population in ortho population or a neuro population or whatever in your clinic, you have seen patients that have either current or a previous diagnosis of cancer. And so you are, these patients are coming into our clinics already, and people are just not really making that connection.

Speaker 1 (10:23):

Yeah. I remember when I spoke to Nicole, she said, one thing that all physical therapists have to keep in mind is a hundred percent of physical therapists in, at some point in their physical therapy career will see someone with

Speaker 2 (10:36):

Absolutely, absolutely. Probably this week. Yeah. And like, you know, it's, it's not, it's not when, or, or it's, I mean, like it's very, very soon because patients also don't necessarily think about the fact that they have a cancer diagnosis and it's something that they really need to kind of put, put front and center when they are going to rehab. So maybe they've had a knee replacement or they've had some other traditional rehabilitation problem, like a BA like back pain or whatever they go to PT for. And they had that pesky, you know, cancer diagnosis 10 years ago that colorectal cancer, but they, they got it and they got the third, but so they don't really, but you know what, those things that happened 10 years ago with that diagnosis and the medications that that patient had and the treatments that that patient had are actually going to impact the way that they heal in, in physical therapy. And so I think the patient doesn't understand the significance of it. And then the clinician doesn't really understand the significance of it. And it makes a huge impact in how well that patient is gonna, you know, do and how, and in the course of their therapy, it really should kind of direct the course of their therapy and and predict how well they're going to be able to, you know, certain, certain things that should be in therapy and certain things that should really not be done in therapy should be based on that.

Speaker 1 (11:57):

And something that as you're saying, all of this, that kind of struck me is that in physical therapy, you know, we are expected to have the competency to treat people with a total knee replacement, low back pain post-stroke Ms. But you guys have traveled around the country. You've spoken to many physical therapists, is that clinical competency in cancer rehab there amongst the physical therapy profession. And this is a silly question, but is it essential?

Speaker 3 (12:35):

I do. I think it was definitely not there. I mean, there are therapists that are very skilled at providing lymphedema treatments, and there are therapists that are very skilled in targeting certain kinds of breast cancer. But I think one of the things that we think, what I think about is that the things that people going through cancer treatment, it's kind of like an anticipated decline, right? Like we kind of know that they're going to feel like crap when they're going through chemotherapy. And I think that maybe, and I had this assumption that once their chemotherapy is over, they're going to be fine. And I think a lot of the providers think that as well, we kind of know that they're not going to do well during treatment, but I don't think that a lot of people know is that they don't do well even after treatment and that six months and years later, they have these effects.

Speaker 3 (13:24):

And because there are one in eight women that get breast cancer, and there are so many men that get prostate and other lung cancers are, are breast cancer women, and are prostate men have to take medications sometimes for five and 10 years, that affects their musculoskeletal system that affects every ortho therapist. If they're treating these people that are in their clinics. So there may be a general awareness, but I think there is kind of pick and choose, like you make it a lung cancer patients that you're treating for weakness. You don't have to treat weakness, you don't to treat balance issues, but you may not really understand what the chemo regimen did to the patient, why they're having those. So I think explain the why around it helps to decrease the fear that some therapists have of treating, because I sure was afraid when I saw my frail bald patients walking in, I was really afraid I was going to hurt them. And I didn't feel safe to take care of them because I had one month of DEMA course, and I wasn't. So we kind of wing it, right. Because there's not really many resources out there. Right, right.

Speaker 2 (14:36):

Back into my schoolwork and looked and to see what oncology criteria like curriculum that we had gone through when I was a student. And yeah, I mean, it was so minimal. It was less than a week was one core, like within one class that wasn't oncology focused. It was, I mean, the amount of information that clinicians were getting in school and professional programs was very, very minimal. And of course that's more than 20 years ago when I was in school. But even now even now I would say that there was a huge percentage of of clinicians that take our course who are new grads. They just got out of school. So we know, and we've communicated with them. Talk to them. This is not in their curriculum. They are not learning this in school. Otherwise they would not be seeking out some of this information that they know is really important anyway. And that's physical therapists, occupational therapists, anybody that's in allied health or are seeing patients really needs that they need to have this foundational, basic knowledge that makes them safe and makes them competent to care for these patients. And so it is a little, I I'm sure the education, maybe at some point we'll catch up, but it hasn't yet.

Speaker 1 (15:56):

Yeah. And, and I'm sure it also depends on what's on the MPTE, but that's a whole other thing and let's, we won't get into that, but we know that certainly exists when it comes to educational curriculum in schools. Yes. At any rate I digress. Let's talk about, let's talk about when should rehab physical therapy, occupational therapy start. So someone is diagnosed with cancer. When do they start their rehab?

Speaker 3 (16:27):

The rehabilitation starts at diagnosis and that's when the American cancer society. And so many of our, our industry regulators recommend that it started and it start from diagnosis all the way from end of life or end of care. And, you know, we compare this to kind of our other service lines, but, you know, somebody is having a knee replacement they're coming in for prehab, right. They're coming in for education, they're coming in for strengthening before they do that. And it's, it's no different for a patient with cancer. They need to be armed with what they are going to go through. Not only the education to help decrease their fear, but also the problems that they are going to incur, understanding that we have the skillset and the tools to be able to support them throughout that journey. And I think the other thing that rehab teams don't realize is that general clinicians that don't have specialties really can treat the scope of most of the impairments that people have. Just like we all can you know, balance and numbness and tingling and strength issues and fatigue, and just, you know, the list goes on and on, but if you have a pelvic health issue or if you have lymphedema, then we triaged to our, to our specialists

Speaker 2 (17:35):

And, and best practice really dictates that when you're going to begin any type of a treatment or any type of incur, any type of or undergo any type of surgery or anything like that, it's really to establish a baseline. And in cancer, there's really, it's, it's very important to establish a baseline because we know pretty, pretty well that cancer treatments are going to cause problems. They're going to exacerbate existing problems. And so if we can add diagnosis, capture what that baseline is for that patient and monitor and survey that patient and make sure that that patient is not there, that their existing, their preconditions or existing deficits or impairments are not getting worse or that new ones are not popping up. That really is best practice because we know that if we can see something pop up, you know, and catch it immediately, it's going to be a lot easier to take care of and to recover from or to prevent even then, if it's something that we don't, you know, that we don't look for until after treatment is over, maybe, you know, the patient is having a lot of functional problems that are really obvious.

Speaker 2 (18:50):

If you just wait until then it's going to be a lot harder to intervene and it's going to, I mean, and this is it's gonna be a lot more expensive. I mean, something that may take just an education and maybe one visit and rehabilitation from the very onset and the very beginning even something, you know, just as you're going to have this, you're going to have a lumpectomy you're going to guard you. You know, let's make sure that when this happens, you're going to continue to do range of motion within a certain, you know, limitation, but that the patient knows that that can later prevent like three months of a frozen shoulder. Right? I mean, like we know that this, these things happen all the time and it's easy to just kind of get in there from the beginning. So best practice is, is at the very beginning at diagnosis, patients should definitely be at least screened for impairments and informed that rehabilitation is part of their medical care. They should expect it, their patient should walk in knowing that rehabilitation is part of their medical team. Yeah, absolutely.

Speaker 3 (19:52):

And this is, and this is something that Nicole Stout talks a lot about in her research has called the process perspective surveillance model. And that is, you know, screening patients before each intervention. So we know kind of what we call each medical touch point. So whether they're having surgery or chemotherapy or radiation really being screened before each of those interventions. So like Jillian said, we can kind of pick up on those impairments when they're acute in nature, that's really important.

Speaker 1 (20:19):

And so let's talk about cancer rehabilitation education. I think we've already established that physical therapists do not get an adequate amount of cancer rehabilitation education in school, and you may not get it on the job either, depending on where you work. So couple that with millions and millions of people getting diagnosed with cancer every year rehab should start at the point of diagnosis. So let's talk about the education around it, because if that is the case, and now it is recommended rehab start at the time of diagnosis. And there are tons of PTs in this country and not many know how to deal with this. How do we educate physical therapists in a robust manner so they can help with these patients?

Speaker 2 (21:15):

Well, I think that things are kind of catching up here. It's been established that cancer rehabilitation is important and it needs to be part of cancer patients cancer care. And we have national regulatory agencies and different sort of top level drivers that are encouraging and really requiring organizations to provide cancer rehabilitation. So we have a lot of these companies that are starting to recognize, all right, are people that are in house already need to be doing this. And then from the clinician's perspective. And, and I can say this as a, as a physical therapist, if, if my boss had come to me in my outpatient clinic and said, okay, we're going to have a bunch of oncology patients come in the doors now. Because there's these guidelines and we're going to see this influx of patients and you guys are gonna be treating these patients.

Speaker 2 (22:15):

I would have been like, okay, like I would have been really nervous about it. And so we, we still sort of were getting that response as organizations are starting to implement some of these policies that are requiring that their organizations provide these services. So we're also getting this sort of searching from these clinicians, like, all right, I'm going to see cancer patients. And when I go online, I see like a billion, different CU courses for different types of, I mean, I can be different specialists in this or a specialist in that, or I can take this or I can take that. What I really want to know is how can I be safe to see these patients coming through the door. I don't, but maybe cancer is not there. And you know, what, what they're interested in, they don't want to specialize in it.

Speaker 2 (23:03):

That's fine. And so they don't want to spend thousands of dollars on specialties and weekends, but they do want to be safe and they want to know. And so Chris and I kind of came at it from that perspective, like, all right, we're gonna, we're gonna say, we're going to get more referrals in your clinics because of these guidelines, because it's the right thing to do because research says that cancer patients need it. But what's really important to us is that your clinicians feel competent. They feel safe. How can we create the education that your, your clinicians are gonna feel like they can have anybody land on their schedule and that's going to be fine because that's going to make them feel comfortable. And what that's going to do is going to make their bosses feel comfortable there. The leadership is going to know that their entire Rhea team has a competency and anybody can kind of come through there and that their service is going to be very similar from facility and location location.

Speaker 2 (23:48):

So we, that's kind of where we started with. We weren't, we didn't, we didn't want to make a course that was going to make somebody a specialist. Those are out there and they're awesome. And we work with all those people that make those courses. So we know they're awesome. We wanted to create something that was respectful of somebody's time and their money, and, and really want to just pull the most excellent parts of all those specialties into one spot so that a therapist could go through it and be pretty confident in their leadership can be pretty confident that they were that they were gonna be able to take care of these patients as they come through the doors.

Speaker 3 (24:23):

Yeah, Kristen, and then I, I was live and then I was living in the cancer rehabilitation world. So I knew a lot of the experts and the leaders in the field from just attending their courses and conferences like Nicole, Nicole Stout, and Julia Osborne. And, you know, just all of these amazing people that really aligned with the same mission and vision that Jillian and I both had to spread this education. And, but what was missing was a comprehensive online platform. And, you know, I I'm sitting for the specialty exam in February, but I'm an expert in certain things, but I certainly not the expert on everything. And so Joanie and I said, you know, when we're learning, we want to learn from our role models, right? Our peers and our colleagues who respect in the field. So we went out and we asked them, you know, will you help us create this education?

Speaker 3 (25:18):

And they all said, absolutely it's really important. And why it's important is because we have to get it in the hands of people quickly. I, it took me 12 years to kind of get all this information. We don't have that kind of time because we have almost 17 million people that need this care right now. And these patients are in the clinics and, and they need it. You know, they're, they're just people that want to do marathons and, you know, raise their children and go to school and do all the things that everybody else does. So how do we get it into the hands of people? So we went out and they created this, this education, and then we went and got it approved recently for continuing education credits. So it really is an amazing compilation of education that spreads a blanket over all different kinds of cancer, disease types and all the impairments. But it isn't just for somebody that wants to be competent and confident. Cause I went through it myself and I learned a lot of information and I've been doing this for over 12 years. So it really is also for clinicians that are interested in cancer rehabilitation that work in cancer rehabilitation, but are also experts because they will learn about a lot of things that there are no courses for like pharmacology. There are no courses for pharmacology, right. They're out there right now for to learn from

Speaker 2 (26:39):

It's really for the whole team. Yeah. And so when, so let's

Speaker 1 (26:44):

As a physical therapist I go through, through this chorus, I'm confident, I'm competent. And is it like, okay, thanks. I guess I'm, I'm, I'm good now. I don't need anything else. So what happens after this sort of ed, you have this experience with you guys and you're, you know, relatively confident and competent is, is that where the learning ends?

Speaker 2 (27:12):

No, I, I, I really love that you asked that question actually, because this is what I, this is my soap box. You know, we all, all of our presenters for our course, they all have their soap boxes. They're all specialists about what they think is the most important. That's why our education is awesome. We, you know, we went to the specialist, we said, give us 30 minutes, you know, or, or whatever that you think is the most important part of your specialty that you think all general people should know, and then they bring it in and that's, what's in the core. So you kind of get the best of everything and what the specialist actually think the general therapists really need to know about certain things. But we did recognize absolutely that once you have, this is acumen or you, this information about, you know, cancer rehabilitation and you have got to be able to communicate with others that have the same information that, that are there in the same world.

Speaker 2 (28:02):

Because even though there are going to be a lot of patients that are starting to come in in the future right now, it's a little bit of a small world. It's kind of a, a small world in regards to who is in cancer rehabilitation. And we know this because we go to the conferences and we see the people that come to the different lectures and the presenters. And we know that this is kind of a small world because we see that a lot of the same people over and over again. And, and so the education is really important, obviously for Kristin and I, we have it updated constantly by the presenters. Each one of them is responsible for their segment so that we know if legislation changes, if there's evidence that comes out, something happens where their presentation or their part of our education needs to be updated.

Speaker 2 (28:42):

That's going to happen in pretty, pretty much in real time. But how do we answer our students' questions later? How do we grow their interest or their confidence beyond just an online course and the way that Chris and I have been doing that, as you know, we've worked with clients and we've sort of built this community within our own clients, that they reach out to each other all the time and communicate in that way. They know they've got other people that are doing the same thing, implementing the same types of interventions or screenings or things like education. And so they can connect with each other. And that's great for those clients. But we've really recognized that there is there is a need for a community where people could really discuss their patients, discuss their experiences, discuss their education and grow from there.

Speaker 2 (29:32):

And so that's actually something that we're working on right now really hard. And we, we already, you know, it's rolled out for our clients right now. So it's just a matter of being able to make it more of a public forum where people can, they they've got this, they've had the education. So they kind of were speaking the same language, at least at a bare minimum. And then they can discuss and communicate. And what's nice about it is that we've got all of our partners who have created our course, like Nicole Stout and Mary Lou Valentino. And some of these others who are very reputable, well-known that created part of our course for us. And they're all in there like, heck yeah, we're going to be part of this conversation. We want to be part of this community. And so our vision of course, is that we can have discussion groups and different opportunities where people can get their questions answered about either about the education or applying that application, that education to real life scenarios. How can they get that feedback and that comradery that they're going to need to feel even more confident in this industry. That's why we have, that's why we have great relationships is that they all want to do this. They all know this community is important and it's not a big ask. It's not like, Hey, can you talk to a bunch of therapists that really think this is important? They're I mean, they're, they're all in it. They're all in. So

Speaker 3 (30:51):

Being an Island is, is kind of scary. And like you said, you take that education and then you go back into your clinic or your place. And for people that are working in rural communities, they may be the only person that is taking this education. And we're all really busy people in our work lives and our home lives. And I think one of the hardest things for me as a clinician and a business owner is what do I need to know right now? You know, there's so much research that comes out. And so that's how we also wanted to support with, with workshops. And you know, what is the need to know research that you need to know that's coming out today? You know, you can't afford to fly all over the country and go to all these conferences. Well, guess what, we've tidbit from all the conferences that now that's out there, that's pertinent to you so that you understand what's going on out there in the world without having to do that.

Speaker 3 (31:43):

And so it's you know, it has meant so much to Gillian and I to work with all of the partners that we have. All of the organizations that we work with are so passionate. We've met clinicians that are passionate. I've never met anyone that has not been exposed to cancer in some way, whether it's personally a friend, family, somebody, so everyone is connected by it. Nobody doesn't want to take care of somebody that's going through this. So it's really, how do we all kind of work together to support each other? That if you have questions kind of there in a non-threatening way. Certainly, you know, when Julia and I first met Nicole Stout, we were, you know, at, at, in section meeting and she was standing over there and, and, you know, Julie was like, I'm going to go over there and meet her. I'm like, no, no, it's Nicole Stone. You know? And I was so intimidated by her and because she was a big wig. Well, yeah, but when you meet her, you go, you meet her and you learn that she has the same passion and mission and commitment to people that you do. And, and she's so accepting and welcoming that, that really went away. And I felt like we had to really offer that to everybody else so that they could acknowledge that these people are, are very willing and receptive to helping.

Speaker 1 (32:58):

Yeah. Yeah. She's fabulous. Plus, I mean the shoe collection, I mean, I mean, can we just be envious of her shoe collection? And so, but yeah, she's, she's fabulous and what she does for the, for the physical therapy world oncology in particular. But I think the PT world as a whole is, is huge. As a student, she might, people might be intimidated by, by that. I mean, we were, but I think that that's what we're trying to do is as we're breaking down those, those barriers for our students, and we're saying, Hey, look, you know what your course is awesome as taught by an awesome person. And here's an awesome person that you can ask that question too. Yeah. Yeah. What a wonderful opportunity to give to your students to, to have to have those collaborations and those relationships, which in, in my, in my eyes, relationships are everything they're key. And, and that's the thing for me that keeps pushing this profession forward. As we wrap things up, I'm going to ask each of you. So what would be your big takeaway that you want the listeners to come away with from the talk today?

Speaker 3 (34:09):

I think one of the biggest things that I learned was actually back at CSM. And somebody said that as physical therapists, we are medical coordinators of care and is our ethical responsibility to really be able to take care of everybody that comes into our care. And he said, you know, what, if you're not competent to treat everybody get off the bus because you're bringing our profession down. You know, we have autonomy. Now we can have people coming into our clinics without physician referrals. So we have to know this many, many PTs can order x-rays and things like that. So my take home message is if you want to stay on the bus, get competent and elevate your skillset to everything, not just cancer rehabilitation, but add that as yet another skill in your pocket so that when that patient comes in, you can either treat them or you can triage them. A stroke patient comes into my clinic. I can evaluate them and educate them, but I might triage them somewhere else so that they get more targeted care. So that's, you know, I just want everybody to get on the bus. Yeah.

Speaker 1 (35:20):

Awesome. Jillian. Well I think my takeaway that I would provide it really depends on the audience on who is listening. So if you are a clinician or a therapist like Kristen, it really is

Speaker 2 (35:38):

Your ethical responsibility to take care of every therapy. Every patient that comes through the door, regardless of what their past medical history is you should be able to provide the highest level of care for that patient and as therapists. And we all know you have the heart of a therapist, you want to do the best for your patients. So if you are not confident and competent in taking care of oncology patients, my takeaway to you is get that way. There's a solution for you, educate yourself, feel comfortable, feel confident. You take care of your patients, where you said there's a solution for you. I'm an action girl, but my takeaway for administrators and for leadership teams of your organizations is you really want to know that your team can take care of this population. And when you do something, when you do something and you want to be sure that your team is competent, you put forth these standards and people have to meet these standards.

Speaker 2 (36:31):

And so my, my takeaway for then is that if you do not have something in place that is ensuring that your, your clinicians, that your rehabilitation teams are really competent in taking care of these patients you need to get that way and you need to get that way pretty quick because the regulations and the the requirements that are coming down from the very top levels nationally are requiring that you do that. So it's not just an ethical thing on the clinician side. It really, and, and also this is a new patient population or not, not a new patient population, but this is a patient population that is going to expand. We're going to see a lot more on ecology patients. And so that is an opportunity to reach out to sort of almost a new I don't want to call it a market cause I don't like to call people a market, but it is, it's a new, it's a new market for, for those administrators and most leaders.

Speaker 2 (37:28):

And then the takeaway, of course, if we have patients listening or, or relative caregivers coast survivors is what we call people that are in the lives of, of a person with a diagnosis of cancer. Ask for it. My takeaway is that this is part of your medical care. You should be, if you're not, if you're, if you're on ecologists, your provider is not talking to you about function and what's happening to you during your cancer journey and how that is going to be mitigated or how you're going to have a rehabilitation therapist of support as part of your team. If somebody has not said that to you yet ask for it because it needs to have this bottom up push as well. And it seems so logical when you talk about it. But again, you know, you gotta look, you gotta understand your audience and who are you talking to? What language are you speaking? Yeah.

Speaker 1 (38:16):

Excellent. All right. So before we get to where everyone can find you, I have last question, it's the question I ask everyone. And that is knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad?

Speaker 2 (38:33):

I would tell my younger self or anybody that is kind of starting out in their career and they know they're doing what they love to think big, think big and be brave and just go, just go for it.

Speaker 1 (38:48):

Excellent. Kristen,

Speaker 3 (38:50):

I think that I would tell my younger self to just keep being a sponge, keep learning. Don't be afraid to try new things, you know, when you're starting to get burned out, try something else, which is what I did. I kind of kept jumping around and I found I was passionate about each of those things and just keep learning and keep growing. And eventually you're going to find something that really wows you and really makes you change not only your career, but your, you know, your personal growth as, as well.

Speaker 1 (39:23):

Excellent. Very good advice all around. So now where can people find you? Where can they find the course? What's the name of the course? Give me all the details.

Speaker 2 (39:31):

Great. but you can find us@survivorshipsolutions.com. That's our website and our courses on our homepage. So they can just click, click on the link, they'll see the education and they'll see some of the other, you know, consulting services and things like that that we also provide. But and certainly there's contact page. They can reach out to us. We're happy to, to have conversation with anybody.

Speaker 1 (39:59):

Perfect. And what about social media? Where can people find you follow you, et cetera?

Speaker 3 (40:03):

We are all over social media. We're on LinkedIn. We're on Twitter, on Instagram and I forgetting what's the other one, Facebook both personally and professionally where we're both on there. So maybe you can find us there.

Speaker 1 (40:17):

What are your handles?

Speaker 3 (40:19):

Our business handle is survivorship solutions for LinkedIn and for Twitter. It's survivorship Sol.

Speaker 1 (40:26):

Perfect. Excellent. And we will have the links to all of this at the show notes for this episode at podcast on healthy, wealthy, smart.com. So if you want to get more information on the course, follow them on social media become if you're a physical therapist out there listening, and you want to become competent and safe to treat patients, cancer patients, which we now know, we all will at some point then definitely check them out. So Kristin and Jillian, thank you so much for coming on. I appreciate your time.

Speaker 2 (41:03):

Thanks so much for having us. It's been our pleasure.

Speaker 3 (41:06):

Thanks, Cara. It's been fun. Thanks so much.

Speaker 1 (41:08):

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

 

Apr 2, 2021

In this episode, Founder of Science PT, Dr. Erik Meira, PT, DPT, talks about his campaign platform as the President-Elect of the American Academy of Sports Physical Therapy, and the many components of this platform.

Today, Erik talks about his roles within the academy over the past 15 years, his formal 5-year strategic plan, creating an executive board separate from the executive committee, and creating a research agenda. What is the overarching vision for the academy?

Who is on the executive committee, and how is the executive board chosen? Erik elaborates on organisational structures and boundaries, and embracing the tenets of Diversity, Equity, and Inclusion, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “If you look at any 1 or 2 year period, it’ll look like things are getting done, but when you look over a longer period of time, you’ll see a lot of what gets published kind of has a circular nature to it.”
  • “You have to build the boundaries of your sandbox, and then let the person play in the sandbox.”
  • “Not every great presenter is a great leader, and not every great leader is a great presenter.”
  • “Not everybody wants to keep progressing and keep pursuing, and somebody stepping back should not be slighted and that should not be seen as a negative.”
  • “Somebody turning something down today does not mean that you shouldn’t offer it to them tomorrow.”
  • “Nobody can be you better than you. Remember that. And that goes two ways - remember that the person that you’re talking to is also not you. They don’t have a brain that works like you, thinks like you, and sees things like you, and they’re trying to be the best person that they are as well.”
  • “We all have different perspectives, and that’s okay.”

 

More about Erik Meira

Erik Meira is a consultant physical therapist in Portland, Oregon. He is a Board Certified Sports Clinical Specialist and an NSCA Certified Strength and Conditioning Specialist with extensive experience in the management of sports injuries at many different levels. He also created and oversees the PT Podcast Network.

The son of an engineer and a school teacher, he developed a love of science at a young age often running home experiments comparing/contrasting the effectiveness of products such as detergents and preservatives. Before beginning physical therapy school he studied philosophy and psychology while geeking out on chemistry and physics courses. Although he follows medical science professionally, he is a fan of all fields of science, particularly particle physics and astrophysics.

He began his rehab training at the University of Florida where he had the opportunity to be a student athletic trainer with Gator Football. After finishing his physical therapy degree, he moved on to The George Washington University Hospital in Washington, DC where he overhauled the patient education program and became a physical therapy adviser to the GWU Medical School. After moving to Portland, OR he started his own private practice Elite Physical Therapy & Sports Medicine now called Black Diamond Physical Therapy. He also founded and directed the Northwest Society for Sports Medicine, a group of regional sports medicine providers who provided continuing education, professional support, and community outreach in the Pacific Northwest.

Erik is extremely active in the American Academy of Sports Physical Therapy (AASPT), currently serving as the Representative at Large on the Executive Committee. In 2008 he helped initiate, organize, and then chair the Hip Special Interest Group. From 2012-2019, he was the Sports Section Program Chair for Combined Sections Meeting (CSM) for AASPT. He has authored several articles and textbook chapters, and has lectured at conferences around the world sponsored through the National Strength and Conditioning Association, American Physical Therapy Association, and the National Athletic Trainers’ Association, covering topics such as the hip, knee, shoulder, exercise prescription, returning athletes to sport, science application, and ethics in practice. He is a frequent consultant to professional and collegiate sports teams and individual professional athletes.

 

Suggested Keywords

AACPT, Campaign, Opportunities, Strategy, Learning, Sports, Physiotherapy, Research, PT, Health, Therapy, Architecture, DEI, Diversity, Equity, Inclusion, Problem-Solving,

 

To learn more, follow Erik at:

Website:          https://thesciencept.com

Podcast:          https://ptinquest.com

                        https://ptpodcast.com

Instagram:       @erikmeirapt

Twitter:            @erikmeira

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

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

 

Read the Full Transcript Here: 

Speaker 1 (00:01):

Hey, Eric, welcome to the podcast. I am happy to have you on.

Speaker 2 (00:06):

Thank you so much, Karen. It's a, an honor to be here.

Speaker 1 (00:10):

I know it's so nice to see you, even though we're not in person, hopefully one of these one of these years, maybe next year fingers crossed. We'll be able to see each other in person.

Speaker 2 (00:20):

Yep. Fingers crossed for sure. Yeah. I'm looking forward to it. It's I can only do so much zoom. I so much prefer being in person with people to do to do conversations and to do a teaching as well.

Speaker 1 (00:32):

Oh yeah. Teaching is, I mean, what a, it's just a whole different ball game when you're on zoom or whatever platform you're using. So Eric, today, you're on the podcast to talk about your campaign platform. So for people who don't know, Eric is a present elect candidate for the American Academy of sports physical therapy, which is part of the American physical therapy association. Did I get all that right?

Speaker 2 (01:05):

Yes, that's right. We're one of the academies, one of the components of the AP TA.

Speaker 1 (01:09):

Right? So you are here to talk about your campaign platform. So I'm going to hand the mic over to you and I want you to let the listeners know what are the components of your campaign platform?

Speaker 2 (01:24):

Sure. I, I, I really appreciate that. Yeah. So first to clarify, some people have the question, what's the difference between a president and a president elect and for the for the American Academy of sports, physical therapy, the AAS PT our president is elected to serve one term as the president elect. So kind of the president and waiting under the current president for one year, so that the transition is smoother when that happens and then they serve a three-year term after that. And so a little bit of my background is I've, I've been involved in I've been involved with the Academy for, for, you know, well, over a decade, I've been in leadership positions within the Academy continuously for the last 15 years. And so that's everything from just being a member of a, of a committee moving up to, I founded a special interest group.

Speaker 2 (02:17):

I then was the chair of a special interest group moved on to be the, the section programming chair. So I was involved with all of the the academies program at combined sections meeting did that for about six years. And then the last two years I'd been serving on the executive committee as a representative at large. So I have a, I have a huge history with this Academy and a lot of the things that a lot of the changes that have been made over those last 15 years, I've been very involved with and really trying to move things forward. And so one of the reasons I'm running for, for president elect at this point point is to try to kind of complete the mission, so to speak and, and really help set the Academy up for, for the future. We're, we're coming up on 50 years of, of existing as an Academy.

Speaker 2 (03:08):

Or as a component, we used to be a section like most of the other components. And now what I'm looking for is, you know, what's the next 50 years look like, are we set up for, for that future? So the first thing that I'd like to, I actually have five points that I'm highlighting for my campaign. The first one is I would like to create a formal five-year strategic plan that systematically, it gives us something to systematically work towards for our goals over time. And, and so, you know, the Academy has traditionally had strategic planning as a component of what it does, but it has never actually put forward a formal announcement to the members to say in five years, this is where we would like to be as, as a target. And that's something that I think can be really useful for, for a component to have to give a little bit of guidance to.

Speaker 1 (04:05):

And if, if you are elected, how will you go about implementing that?

Speaker 2 (04:10):

Yeah, so a five-year strategic plan. So currently the executive committee does a strategic planning meeting once a year to set basically the agenda for the next year. And so what this would be is actually sitting down and going over where would we want to be in the next five years? And that would be a process of, of actually first, you know, surveying the members, talking to members, trying to get that information of where are we going to go, want to go pitching ideas to the members, to get some feedback from that and then putting it together and setting it forward. And, and again, you'll notice it's a five-year plan. Our terms are only three years. And so that's kind of the point is something that outlives any one executive committee and is something that really is looking to kind of go past that one.

Speaker 2 (04:57):

One of the other points that I'm kind of looking at exploring is creating a separate executive board separate from the executive committee, which is an organizational strategy that a couple of other components have used as well, but it's also very common in associations in general. And so the idea there would be you know, I, I see this in the future as being something that the executive committee would work to create a five-year strategic plan. And then that would be reviewed by an executive board who would then have potentially have voting power to to approve such a plan and, and look at going through implementing the strategy.

Speaker 1 (05:36):

And so can you tell the listeners what, what is made up of the executive committee, who is on that executive committee within the organization, and then how would that executive board be chosen?

Speaker 2 (05:52):

So right now the Academy just has an executive committee and a lot of times within the Academy, they use the term executive board and executive committee interchangeably. And that's not always the case necessarily. So our current executive committee is made up of five elected positions. They are the main elected positions of the Academy. The other elected positions are our nominating committee. And so these are the elected officials. There's five of them and they, they make all, they do all the decision-making for the Academy. And that's, I mean, that's great. You want people who are voted in to be making the decisions you don't want, just, you know, all appointments across the board like that. And so the problem that that sometimes can create is, you know, they get into, they can get into the weeds of dealing with the nuance and the details and all of these things.

Speaker 2 (06:44):

And a lot of times decisions, especially in a large component like ours sometimes they're very nuanced, complex, challenging. They're not easy to kind of educate out on a sound so to speak. And so what an executive board would do first off that would be made up of all of the members of the executive committee would also serve on the board. But then you add additional members that are representative of the rest of the Academy to allow additional conversations that would happen like once a year, for example, of all right, we've been working on a bunch of stuff for the last year. Here's what we're going to bring forward. And again, this would be, this is how it's working towards our five-year plan. This is the, these are the issues. Here's a really tough decision that we're up against that we've had lots of conversations we brought in outside consultants.

Speaker 2 (07:35):

We've, we've had again, conversations after conversations, and now we need to convince the board that this decision is the right decision. And the example here would be well, if that board disagrees, this is where again, these are things that would have to be figured out in designing a board. Would they have the authority to block an executive committee or would it just be, Hey, we're just going to go on down on record that we don't think this is a good idea. And the board, you know, is, is doing this alone. And again, just, just being a little more transparent with that. So those other members, you would want it to, you know, you think of all the different components of a, of an Academy. And, you know, we have, like, we have practice, we have research, we have education within our Academy, we also have early career professionals.

Speaker 2 (08:26):

We also have diversity equity and inclusion as its own part of it. And then we have our SIGs as well. So I could see a representative from, from, you know, all those different committees. So, you know, practice research these could be, the chairs would sit on that and, and there could be a conversation about whether or not those would become elected right now, they're appointed positions and then and DEI and early career professional. So we get all of those voices having a strong voice and then maybe a, an at-large position, which could be a SIG chair, or a couple of SIG chairs could serve in that role there. And, and then, you know, they kind of get that opportunity to be heard, but again, it's still kind of behind closed doors, but it expands that ability to have those conversations out and, and get more advising for an executive committee.

Speaker 1 (09:18):

Got it. And, and because the you've got the, these people on an executive board that are part of these different sections within the Academy, I would then imagine that you can get some more input and feedback from the members. So it sounds like, and you can correct me if I'm wrong. You're trying to allow the members of the Academy have a bigger voice in the decisions made by the, by the executive board.

Speaker 2 (09:43):

Exactly. Cause one of the issues we have is, you know, we have an Academy that's, you know, seven between seven and 8,000 members in any given time during the year, there are definitely fluctuations and all being represented by five people and five people that, you know, yes, they were elected their position and they do know a lot of people within the Academy. They can go talk to those people, but then you have a tendency of just talking to the friends of the executive committee, for example. And so the more, the more kind of diverse voices you can get into the conversation the better. And, and again, if you have an executive board that has a very unified voice, well, that's a very strong position that you would be taking as opposed to a more divisive type position than these would be things that would probably have to have more of a conversation.

Speaker 1 (10:28):

Okay. All right. I like it. Let's move on to, you've got, you said you had a, a couple of things within your plan. So we talked about a five year strategic plan and executive board. What else?

Speaker 2 (10:40):

So the other thing I'd love to see is creating a research agenda and that would be to kind of lay a roadmap for the research needs of our members and explore our ability to drive this research potentially through some Academy funding as well. And so, you know, research and science, that's something that I hold very dear. I it's, it's you know, pretty much everything that I kind of geek out about, you know, in particular. And I hear a lot from, especially our early career researchers, but then other researchers as well, especially the ones that are running smaller labs of of how a lot of times, it's hard to know what is kind of useful information from clinicians or what the true path is to get to what we want to know. And then I hear from the clinicians on the other side, you know, I've been practicing over 20 years and there's a lot of things that I don't feel like we've made much progress much real progress over my career and, and it can get kind of frustrating.

Speaker 2 (11:35):

And, and what I mean by that is if you look at any one, like, like one or two year period, it'll look like things are getting done, but then when you look over a longer period of time, you'll see that a lot of what gets published kind of has a circular nature to it. So they, they're kind of revisiting some of the same questions, not really doing a very thorough job of answering that. And what I mean by that is a lot of times, you know, a group will have, it's like, look, we only have one study that we can do. We're going to try to answer as many questions with this one study as we can. And what ends up happening is it's so diluted that they don't really answer any question really thoroughly for the future. And again, this is looking for where are we going to be 20 years from now with this information?

Speaker 2 (12:20):

I understand that small steps are frustratingly slow, but that's where we actually make a difference long-term. And so creating a research agenda would basically take clinicians X are some of our researchers. And then ideally also methodologist that they're, they're what we call meta scientists. So people who study this study the science of studying information. And so making sure studies are designed appropriately making sure that replication is being set up, making sure that a study isn't biting off more than it can chew. And so in a research agenda can lay out here are the next five steps that we need to see to go towards what we're trying to get done. And then researchers can look at that. It can be published publicly, and they can look at that and say, Oh, I can actually step in right here. And the thinking here is if you have a large Academy kind of endorsing that these are studies we'd like to see done, that should increase the value again from the publishing side where journals would look at it and say, Oh, well, you know, this is a study that was very well executed.

Speaker 2 (13:24):

That answers the question specifically that was asked by an Academy. This is going to be cited in future studies. This is something we'd want to publish. So kind of putting those incentives kind of on both ends of it.

Speaker 1 (13:36):

Got it. So kind of using the Academy as maybe a jumping off point for ideas for future studies, given the input from the members and what they're seeing clinically and what they would like to see, continue on in the research.

Speaker 2 (13:49):

Yeah, exactly. And so part of that too, is, you know as a clinician, you might say, you know what, I would just love to have an answer to this right here. And it may seem really simple to the clinician of, I don't see why that's a hard thing to answer. And that's where the research community can go, come in and say, all right, well, if you want to answer that, you actually have to start with this very simple question way over here that you're not even thinking about. And so we're going to start there and lay the path so that clinicians can also see where are we on this path to see what do we know and how does this actually develop over time? And I think that that's a huge value both for, for the practitioner and for the researcher,

Speaker 1 (14:27):

Right? And, and on the research side. So obviously the clinician side. Great. Cause we're getting some of what we're seeing every day put into the research from the researchers side. It's Hey this is what we're seeing. You get an endorsement from the from the Academy and maybe it will maybe it will allow you to have a greater chance of being published. I don't know. That's not that I'm not phrasing that in the best way. You could probably phrase it better.

Speaker 2 (15:01):

Put it is, I would say that it makes their research more translational. So it's showing that. And, and so, and I think this is something that researchers sometimes struggle with where they're, they're trying to kind of dress up the clinical application side of things to make it more clinically applicable. So it gets that, that, that, that translation, but by doing that, it actually kind of dilutes their, the quality of the study, so to speak because there's certain looking at too many things. And so by getting that opportunity for the research community to say, Hey, it may not look clinically relevant yet, but it's going to be. And so then they're part of that clinical relevance as a package. So instead of one study trying to answer everything, you would have a suite of studies that actually lays your foundation for, for gives you a good foundation for knowledge.

Speaker 2 (15:57):

And, and I'd like to stress. I mean, there are plenty of, of research labs in our profession that are doing this themselves and doing a phenomenal job of that. And this wouldn't necessarily be for them. It's just, we have a lot of questions to answer. And there's a lot of, of again, some of these smaller labs and early career researchers that are looking to jump in and, and, and even some, you know, research clinicians who are like, Oh, I can, I can do a 10 person study that answers this one little, very finely asked question. If it's laid out for me, I can then take that and run with it, or simply just do a replication of it.

Speaker 1 (16:36):

And how does this look practically running through the Academy? How does this happen

Speaker 2 (16:44):

Here would be, you know, somebody would bring it forward an idea, for example, and there would be, you know, we do have a research committee they would start organizing around a couple of research questions and right off the bat. And, you know, I posted this on my blog this idea around a research agenda and I did get some people actually contacted me through my contact form saying, Hey, this sounds really awesome. Are you thinking about, you know, a return to play after ACL? It's like, well, sure. Are you thinking about Achilles repairs? Sure. Again, it's we lay out the agenda and the idea here would be that they would also be living, breathing documents, so to speak that would be revisited every year or every two years. And Hey, where are we? The idea, you know, you lay it all out and then as things get done, you know, you things get checked off the list, so to speak it just gives us a way to have kind of a repository for, for thoroughness that I think is often beyond the scope of a, of a large lab.

Speaker 2 (17:42):

And this is where, you know, even large labs can step in and say, wow, there's a ton of basic science work that got done by lots of little entities. Now we're going to swoop in and we're going to collect 500 subjects and we're going to now do an effectiveness study based off of all of the solid foundation that was laid out for us. So we didn't have to do year after year of sequential studies. We have a base of studies that we can now just move forward.

Speaker 1 (18:11):

Got it, got it. So you're looking at this from the Academy standpoint as being a repository of ideas that early career researchers, clinician researchers, smaller labs can go in and say, Hmm, I think I can, I think I can handle this. I'm going to pull this out and I'm going to see what I can do. I'm going to try and create a study.

Speaker 2 (18:30):

Exactly. And this is also one of, some of our really, you know, big, big names. So to speak. Researchers can look down and go, no, no, no, no, no. That's, that's not how you design that study for something I can use. I would need you to also do this here. And then our research committee and our methodologists might even kick back to them and say, Oh, I understand that what you're actually doing is adding another study in between not necessarily trying to do too much with one study. And so again, this is where it's creating a sounding board that all these people can have these conversations.

Speaker 1 (19:01):

Got it. Okay. All right. I think I understand it now. Thank you. Sorry for asking so many questions.

Speaker 2 (19:07):

No, no, of course. And then ultimately, you know, the name of the game is almost always funding. So if, if we can then set up some, some grants, for example, to say, you know, we want to, we have money set aside to pay for this next step. And then, you know, people can pitch the ideas to us. We can do like a register report process where we would review the study before it was even starting to collect data to say, Oh, this looks beautiful. We're going to, we're going to give you money to complete this.

Speaker 1 (19:35):

Got it. All right. Sounds like a plan. Okay. So what else is on your platform?

Speaker 2 (19:42):

So another thing I'd like to see is creating more structure to our organization. So something that, you know, as I mentioned, we just had the four, you know, executive committee members, and then we've had other we've had committees over the years, as I've said, I've served on a lot of those. But a lot of times what ends up happening is that everything ends up having to go through the executive committee for final approval for every single step. And, and I understand the need for that. I mean, these are the elected officials, these are the ones making the decisions, but when you get to a Academy, as large as ours, it kind of can start to smack a little bit of micromanagement and making it that if you've ever been in a, in an environment where you're feeling micromanaged, it really feels like your hands are tied, your creativity is stifled and you can't really give to the, to the institution if you're in that situation like that.

Speaker 2 (20:33):

And so the way that that gets solved is actually to have better defined roles that people are stepping into. So our, we have a new membership engagement director, Jamie little, who's just absolutely phenomenal. And he's been with us for the last year. And one of the things that he likes to point out is you have to create, you have to build the boundaries of your sandbox and then let the person play in the sandbox. But you, you give them a lane to be in so that they feel confident in what they're doing and feel supported in what they're doing, not just giving them like a very vague instruction and then say, then come back to me and show me what you got. And then I'm going to change everything anyway, but really empower them to say, Hey, here's, here's the goal.

Speaker 2 (21:23):

Here's generally what, you know, what your role is to say, like the chair of the practice committee or the chair of the education committee. And, you know, let's see what you can do. And you know, as long as it's not too far out in left field, we're going to support, support that all the way through. And so since I've been on the executive committee, we've expanded the leadership opportunities for our SIG members. So SIGs used to just have a chair in a, in a vice chair, and now they also have a practice lead and education league, a membership league, and a communication lead, all opportunities for people to step in and take leadership roles and allows us to to let people demonstrate what they can do in the Academy. And I mean, the beauty of it is I, these people, when they step into these roles, I don't know who half of them are. I've never heard of them. And I think that is awesome. That's not me trying to think of somebody to fill this role. That's somebody who stepped up and said, I want to do this role. And of course, some of them are not going to do very well, but a lot of them are really going to demonstrate who they are and what they can do. And it's an opportunity to to let our members really kind of, kind of contribute to the Academy.

Speaker 1 (22:35):

Yeah. And it also sounds like you're developing a bit of like a leadership development pipeline.

Speaker 2 (22:40):

That's exactly right. Yeah. And that's where, you know, and that, that gets to the final. One of my points is and embracing the tenants of diversity, equity and inclusion, and make sure that that applies to all of our members and our future members. And that's going to ultimately make our Academy a better overall. And again, this is the thing that, you know, people get, they get hung up on. And again, diversity equity inclusion typically noted as DEI is kind of the popular initialism that's used now. People get hung up on, Oh, well, that's referring to minorities. Oh, that's referring to gender. It's like that also refers to early young professionals, older professionals people who otherwise don't, you know, quote unquote fit into the to the, the, the club, the cliques, so to speak. And we just want to make sure that we're embracing of all the different voices that are within our Academy and make sure that they, they feel they feel represented and they feel seen.

Speaker 2 (23:45):

And so, you know, you mentioned leadership development. That's definitely one part of it. And a lot of components, a lot of times leadership and, and presentation. So like getting up at a conference and speaking a lot of times they're kind of shoved together as the same thing and not every great presenter is a great leader and not every great leader is a great presenter. So we don't want to fault people for being really strong on one, but not so great on the other. And so we want to create two opportunities for the, the face of our Academy, which is our leadership and our presenters to develop as, as again, as leaders. And then as people who are getting into more of the education side.

Speaker 1 (24:29):

Right. And like you said, they don't have to be the same person that's right. So you can speak on behalf of the Academy, let's say it's at CSM, or maybe even an international conference, something like that as, as a representative. But it doesn't mean that you're the president of the Academy, nor does it mean because you're on the executive board, you get to speak at these different places. It has to be something that is earned, not just given for the position that you're in.

Speaker 2 (24:59):

Yeah. And so that's, that's another definition of diversity is playing to your strengths. So not trying to make one person do everything, but try to find the best person for that job regardless of who they are. And it may be that they're really good at one thing, and they're not so great at other things, instead of trying to shoe horn them into things that, that they're not gonna Excel at, let them really shine where they, where they can shine. And, and again, you know, we're an Academy between seven and 8,000 members. We don't need to have one person doing everything. It's really an opportunity that lots of people can step up and fill different roles. And, and I think that's just, it's just great for all of us.

Speaker 1 (25:37):

Absolutely. And it also makes people feel like they're wanted. Yes. Yeah. And that's important because there's nothing worse than not feeling wanted.

Speaker 2 (25:47):

The other thing too is, you know, I'm a, I'm a big data guy, big analytics guy. And so one of the things that we used DEI in particular for, and this was a little over a year ago when we put together a task force to look at it. And that, that was the mission of the task force was to see what do our demographics, how do our demographics break down along gender and along race race identity. And the simple thing is you can just look at those numbers of the membership and then how do our leaders break down by gender and by racial identity. And then how do our presenters break down in the same way? And so in some respects, we had very, very good matches you know, specifically CSM presenters were pretty well representative specifically in gender, not quite so much when it came to race.

Speaker 2 (26:50):

So we're able to say gender is pretty well addressed from the CSM side. Now that doesn't mean there's, there's not future issues or not some issues still to be solved, but it looked much better for example. But then when we looked at leadership and we looked at some of our other, other events, we had some bigger issues around that specifically. And so, you know, a lot of people will say, Oh, so, you know, are you saying that you know, some of your leaders are racist or massage? Monistic, it's like, no, that's not how this works. What it means is that there's something at play here that is restricting equity and inclusion because of all things being equal, it should balance itself out in that way. And, and, and again, looking at the way CSM programming was selected it was intentionally set up to try to increase the number of submissions in and then trying to go strictly based off of the merit of the submissions and the quality of the speakers and not trying to read into it anymore.

Speaker 2 (27:52):

And it kind of organically started to sort itself out. And so this is where, you know, when we look from leadership, well, if you have an Academy of 7,000 plus people, and you only have five elected positions, a couple of nominating committee, a couple SIG chairs, there's just not a lot of opportunity for people to step up and have a path to leadership. And so that's why we expanded the leadership opportunities within our SIGs. Again, a little more low risks low stakes opportunities for people to step in demonstrate their, their abilities. And then if they want to pursue further, they have an opportunity. And that's the other thing to remember is not everybody wants to keep progressing and keep pursuing. And somebody stepping back and saying, I don't want to do that, is that should not be slighted. And that should not be seen as a negative either.

Speaker 1 (28:40):

You, I was just going to say that, darn it. I was just going to say, then that person can make the decision if they want to continue further, is this for them? Is it not? But it at least gives people the opportunity to make that decision for themselves.

Speaker 2 (28:57):

Yeah. And not only that, when, when talking from a leadership perspective, what leaders have to understand is that somebody turning something down today does not mean that you shouldn't offer it to them tomorrow. And so you may offer somebody an opportunity. They'll say, you know what? I just don't have time for that right now, I'm going to have to pass. And, you know, a lot of times people are advised, you know, never say no, because you never know what it's going to lead to. It's like, okay, well then it's, you're just encouraging people to take on way more than they should be doing. And then you end up with a handful of people doing everything. And so a good, a good developing leader is someone who recognizes, you know, I'm not in a good spot right now to take that on, to do it justice.

Speaker 2 (29:37):

So I'm going to pass for now. But then when another opportunity comes around, you know, bring it back to them and, and keep, keep asking. That's cause a lot of times, you know, especially when we talk you know, women in the workforce in particular, a lot of times they may be, you know, stepping back a little bit with you know, child-rearing and things like that. Which, which honestly, I don't understand why men wouldn't be doing the same thing, but this is where they may not want to be engaged in that way for a year or two, but then they need the opportunity to step back into it. It's not a matter of, Oh, well they just say no to stuff. So we don't ask them anymore. That's not really fair to people.

Speaker 1 (30:17):

No. And that's, I think it's so important is to remember that you have to ask because a lot of people feel like maybe they're not smart enough. They don't know enough people, but boy, they really want to try and get involved, but no one really asked them. Yep. So if you don't ask someone, you may be missing out on some great opportunities that that person can bring to the table. Great ideas. So I'm a huge fan of just asking and then if they say no, then you circle back and you ask again, and if they say, no, you keep circling back and circling back. That's what I did as part of the nominating committee for the private practice section. It was just a lot of circling back, a lot of conversations and sometimes long conversations, you know, because it's not like if someone says, Oh, no, I don't want to. I'm always like, okay, tell me why. Tell me, you know, tell me more, tell me what the barriers are now and what might that look like in a year or two, just so that we have, you know, a good also repository of people who we know want to serve this Academy or the section or component or whatever you want to call them.

Speaker 2 (31:34):

Yeah. And that's where and I like how you, how you put that at the asking the question of, okay, well, you know, can you explain why not now, again, assuming it's not a personal issue. And they may say, you know, I'm, I'm just not really good with this one part of that job. And it might be, Oh, we can get somebody else to do that. You know, that that's not a problem. As a matter of fact, there's another opportunity for another person to step up into a role. And so, you know, hearing them out from that perspective. I remember when I took over as programming chair for CSM, we greatly expanded, you know, we went from, I think it was eight or nine sessions that we offered at CSM. And then I took over and it was like 36. So it was like full, you know, big explosion.

Speaker 2 (32:19):

And it was more, a matter of APA had always offered us that, those number of slots and we just turned them down. We just wanted to do one every, every block and not program against ourselves. And I was like, Hey, if they're going to get us a spot, I'm going to throw people up there. And it was difficult the first year because we didn't have enough submissions to support that, but I wanted to set the precedent. No, no, no, we are going to do this. And so I then had to get on the phone and walk around at conferences and say, Hey, can you submit something on this, this or that? Or why aren't you submitting something on this, this and that. And the most common answer I got back was, Oh, I didn't, I didn't know that, that anybody wanted me to submit something like that. I didn't know that you guys were interested in that. It's like, no, yes, we are definitely interested in that and pleased and trying to lay things out. And then of course stressing that. There's a difference between me asking and me accepting, you know, a lot of times it's just, Hey, give me some missions so that we have something to work with here. And we don't have to accept, you know, necessarily the same speakers over and over, but because of that opportunity to do that.

Speaker 1 (33:24):

Yeah. Amazing. And now, Eric, what would you say when looking at this platform? So we have five-year strategic plan, creating research agendas, expanding organizational structure, creating an executive board and embracing the, and progressing the tenants of DEI. What is sort of the over arching vision in your mind for the Academy?

Speaker 2 (33:49):

So what I'm trying to do is really set things up for and the term that I've been using since I came on as, as representative at large, as well as my big thing is, is architecture. So I'm trying to set up kind of a scaffolding for our members to inhabit and to, and that is set up in such a way that the Academy can move forward into the future with the ability to be adaptable as things are changing, but also to be strong at the same time. And, and that's something that I think having things laid out, you know, I mentioned five-year strategic plan. That's where I would start. And then I would love to see, you know, a 10 what's the 10 year strategic plan. What's the 20 year strategic plan. I mean, that was something that, you know, we just passed a 2020 which, which turned out to be a different year than I think we were anticipating.

Speaker 2 (34:38):

But back in 2000, that was vision 2020. That was the APA made a strategic plan of where we want to be in 20 years. And I think people forget how important strategic planning is. You know, there's a lot of decisions that happen in the course of a year within any organization. And a lot of times there could be three or four perfectly acceptable, you know, courses that could be taken you know, decision courses that can be taken on one of those, you know, big decisions that need to be made, but one of them may support the strategic plan down the road better so that when you're making that next decision, it's going to build off of the previous one, as opposed to just solving the problem that's in front of you. And so making sure again, kind of like that research agenda, making sure that what you're doing today is something that can be built upon tomorrow.

Speaker 2 (35:33):

We're never finished. It's never the end. It's never, we've just solved it. It's how does this set us up for the next thing that we're going to be doing, you know, down the line and, and intentionally laying that out. And, and so some people will ask, well, w w so, so how locked in is this five-year plan? It's like, no, it's, it can be amended as we go. I mean, that's, that's kind of the whole point of it. It's just that we have some sort of a vision going forward with that. And so again, it's more trying to set things up, not for me, not even for the, our, our younger members, but for the members that haven't even joined yet that they have a path through their career, through our Academy, that our Academy supports them every step of that way. And they feel like they're involved as they go through.

Speaker 1 (36:22):

Yeah. And if 2020 taught us anything, it's that amendments are probably needed on any five-year plan. So if it's locked in, it's locked in and it can't be changed, then we're all in a lot of trouble.

Speaker 2 (36:33):

Exactly. Right. Yeah. Everything has to be flexible.

Speaker 1 (36:36):

Yeah. Everything needs some fluidity to it these days. That's for sure. Well, Eric what, what are the things that you want the listeners to take away from this and to think about the possibilities of you being president of the Academy?

Speaker 2 (36:53):

Well, what I would say is you know, I was elected as a representative at large a couple of years ago because I'm, I'm a regular old member. I don't have a PhD. I'm not a, you know, I have not taught in a S you know, as a school or anything like that. Not academic, not a researcher. I owned a private practice for almost 20 years. Just sold it. I work with patients day in and day out. I'm not, again, I'm not conducting research, I'm not doing these things. I do continuing education. I talk to a lot of physical therapists. I do a lot of mentoring across across the country and across the world with other sports physical therapists. I know this world inside and out, and what I'm trying to do is bring forward an entity that supports that.

Speaker 2 (37:50):

Ultimately, it's not that it supports the researchers. It does support the researchers, but that's not the mission. It's not supporting the clinicians either. It does support the clinicians, but that's not the mission it's to support our patients, to make sure that they get the best service possible by supporting our researchers and our clinicians and doing it in such a way that it's integrated in such a way that makes our members feel like they are getting a back and forth conversation with the Academy, which is made up of all the other members. So it's everybody talking across each other. Everybody communicate communicating everybody working together towards some common goals, trying to make their careers, what they want it to be setting it up so they can hand it off to the next generation to make it what they want to be as well.

Speaker 1 (38:40):

Excellent. Sounds wonderful. And now it does, it sounds great. Now, Eric, where can people find you if they have questions or comments or they just want to say hello?

Speaker 2 (38:52):

So probably the easiest way is well, the, the, the most comprehensive one is just going to the website that I run, which is called the science, pt.com, all one word, the science PT, make sure you put the at the beginning. And that's got links to my Twitter account. My, I have an Instagram account although I'm terrible at it. If you want to see an old man hitting something with a rock, that's pretty much what I do on Instagram. But definitely available for the most part on, on Twitter. But there is also a contact form on my website that if you have any questions, you can click on that, right on the homepage. There's a, a button that's, that's a link to my campaign page. And so you can go there and, and everything that we've talked about, I have a blog post and individual blog posts for each point that I highlighted going into more detail.

Speaker 2 (39:41):

And also as I, you know pointed out in this conversation, there are things I don't have answers for. I'm just talking about where I'm thinking of pointing things and then getting information and seeing is this something we can work towards, and maybe it's something we need to revise or change and do differently. But these are just my thinking from what I've seen from all my years of service, things that I think are very doable, very possible within our current means within our current support, within our current structure to really set us up, to grow into the future. And so just that website probably is, is the the most comprehensive spot.

Speaker 1 (40:18):

Perfect. And then before we go, last question, which I didn't tell you about, I probably should have done that. I think you'll be fine. I think you can handle it. So knowing where you are now in your life and your career, what advice would you give yourself as the new grad as that, you know, young, young, professional,

Speaker 2 (40:37):

You know being flexible, being adaptable is, is always the biggest thing be patient for probably the best lesson that I've learned is that nobody can be you better than you. And remember that. And that's, that goes two ways. Remember that the person you're talking to is also not you, they don't have a brain that works like you and thinks like you and sees things like you, and they're trying to be the best person that they are as well. And so the more that we can support each other to both be better at all times, I think is huge. And I think that's something that you can carry in with your patients when you're working with them of being compassionate, to understand that, you know, it might be easy for you to get up every morning and do a 30 minute run, but that might be like torture to the person you're talking to. And it's not their fault. They're not lazy, they're not wired wrong or whatever. It's just the way they, and we have to be supportive of, of that. But then that's also with our colleagues when we're trying to have conversations around things as well, to, to understand that you know, we all have different perspectives and, and that's okay.

Speaker 1 (41:47):

Absolutely. And what wonderful advice. So Eric, thank you so much for coming on and sharing your platform. I'm sure myself and the listeners really appreciate it. So thank you

Speaker 2 (41:58):

So much for having me. I really appreciate it. You're doing a great job with all of this.

Speaker 1 (42:02):

Aw, well, thank you. That's very kind and everyone, thank you so much for listening for tuning in, have a great couple of days and stay healthy, wealthy and smart.

 

Apr 1, 2021

In this episode, Co-Owner of Champion Physical Therapy and Performance, Dr. Mike Reinold, PT, DPT, talks about his platform in the running for President-Elect of the AASPT.

Today, Mike talks about the ‘why’ behind his campaign, what he’s going to focus on as president, and how to make the academy more accessible and inclusive.

What is Mike’s vision for the academy? Hear his thoughts on adding value to the academy members, his plans to provide networking and mentorship opportunities, and his advice for his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “I’m going to judge my success of leading the academy, if in the end of my term, you clearly asked the members ‘why are you a member of the AASPT?’ And they have a very clear and distinct answer.“
  • “The most important thing we need to do right now is to re-brainstorm the mission and the vision of the academy to make sure that we’re doing one thing: we’re focused on the goals and objectives of the members.”
  • “I’m pretty certain at this point that everything I’ve accomplished in my career is because I specialised. You need to start general, but if there’s something you’re passionate about, every second of down time you have, learn how to be the best at that. Just be absolutely amazing at something.”

 

More about Mike Reinold

Mike ReinoldMike Reinold, PT, DPT, SCS, ATC, CSCS, C-PS is a world renowned and award-winning clinician, researcher, and educator. As a physical therapist, athletic training, and strength and conditioning coach, he specializes in all aspects of sports performance and rehabilitation. Mike is currently the Co-Founder of Champion PT and Performance, in Boston, MA, and Senior Medical Advisor for the Chicago White Sox after years of working at prestigious institutions like the American Sports Medicine Institute, Massachusetts General Hospital, and as Head Athletic Trainer and Physical Therapist for the Boston Red Sox. He has authored dozens of publications, lectured at national conferences, and has an educational website and podcast at MikeReinold.com.

 

Suggested Keywords

AASPT, Physiotherapy, Research, PT, Health, Therapy, Healthcare, Education, Mentoring, Training, Networking, Sport, Athletics, Election,

 

To learn more, follow Mike at:

Website:          https://mikereinold.com

Facebook:       Mike Reinold

Instagram:       @mikereinold

Twitter:            @mikereinold

YouTube:        Mike Reinold

LinkedIn:         Mike Reinold

 

Subscribe to Healthy, Wealthy & Smart:

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

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Read the Full Transcript: 

Speaker 1 (00:01):

Hey, Mike, welcome to the podcast. Happy to have you on.

Speaker 2 (00:04):

Hey, Karen, how's it going? Thanks again for for having me on your amazing podcast. I F I F I, I remember being on in the past

Speaker 1 (00:13):

So long ago. Yes. It has been a long time, but here we are. We're back.

Speaker 2 (00:18):

That's what happens when we, when we're, we're both veterans we'll, we'll call it. We're both veterans. We, we, we did this in the past, but, but yeah, no, honestly, like big kudos to you for keeping this going and doing such an amazing job with it. Thanks for having

Speaker 1 (00:31):

Any time. And we'll talk about your podcast a little later, but now, you know what it's like to be cranking out episodes on a weekly basis, right.

Speaker 2 (00:39):

And staying up with it, right. It's like, it's a way of life now for us.

Speaker 1 (00:43):

It is, it is. That's why there's like a hashtag podcast life, I think on Instagram or something. It's, it's a thing. It's a thing. So today you're here because you are running for the president elect position for the American Academy of sports, physical therapy. So I wanted to have you on to talk about why you're running and what your platform is and what you hope to do if elected. So let's start with, what is the why behind your running.

Speaker 2 (01:13):

And I love that. That's how you started this off, because that's how I start everything off. Right. If we don't establish our why, right. Like what's the point of even coming out. But a lot of people, they, they, they don't focus on the end. Right. They focus on just doing the day to day. So I love that you started off with a Y so I'll, I'll be honest with you. This is something I've been thinking about probably for the last, I don't know, several years or so. I never felt that it was the right time for me. I've had a lot of my mentors pushing me to, to run in the past and the past elections. And yeah, I mean, trust me, it's really humbling to know that the majority of past presidents of the Academy are all pushing me to run and, and kind of, you know, it's really an honor to be nominated by them, right.

Speaker 2 (02:03):

Like, you know, Mike boy, Kevin Willett, George Davies, Tim Tyler. I mean, it's Melissa gigantic of past presidents that were kind of nudging me to do it, but I was resistant for awhile. And I think that was a good thing because at that point in my career, I don't think I was ready. And I don't think I would've, I would've done the Academy justice for what it needed. Right. So I was kind of resistant for awhile. You know, I, I started a private practice. I have like four jobs, right? Like we all do, right. Like to an extent, you know, I'm flying, you know, to, to work with the white Sox. I, you know, private practice doing all these things with the educational stuff. So for me, it was always like, it wasn't the right time, but things have changed a little bit.

Speaker 2 (02:44):

And I humbly say this now. And I, I really came to this conclusion the last couple of years of my career. I, I really believe I'm on the descent. Right. And don't you think at some point in time, it's, it's all it's about, okay. I am now on the decent portion of my career and I've completely changed my focus on trying to help others succeed. And I can't wait to see the people that I work with surpassing me. Right. Leapfrog me just like we did, like when we were 20 years ago in our career. Right. And that, that kind of point. So I got, so my why right now is that I am completely shifted towards more of a leader right. In a leadership type position with my career. So both educational, both with my, my companies and with the organizations I worked for that, I thought it was a great time to do this so awesome that I've been getting nudged by, you know, such, such amazing people, but I didn't feel it was right until, until now. And I think now I have the time I have the energy, I have a little bit of the head space to now be able to, to focus on this and it's time to give back and it's time to help the next generation. So that's my why.

Speaker 1 (03:56):

Yeah. And that's, I think it's really important for anyone listening. If you are thinking about being of service, whether that be to something, to a section or whatever you want to call them Academy of the AP TA that, you know, you have the head space and the time. Right. Because you just don't want to be saying, yeah, sure, sure. I'll do this. I'll do that. And then guess what, what happens if you get elected and you don't have this space, you don't have the time. Well, that's just not the way to, to enter into, be of service to others. And like you said, you're at that point in your career, at least it sounds like what I got from what you said, that you really want to be of service to others, that you've kind of, you're, you're content, you're happy within your career and probably the time of your life and everything else that you can now do this for others.

Speaker 2 (04:48):

Right. And, and I'm, I'm very eager. Right. I had a lot of good mentors in my career that helped open doors for me, but don't get me wrong. Like we need to be the one stepping through those doors. You have to have the energy and the effort to do that. Right. But for me, it's about opening doors for others. Right. And I saw how much the Academy helped me early in my career, and I really kind of want to do that. Right. And you know, it's funny, Mike Delaney and I were just talking about those. So Mike's running for vice-president right now as well. So I'm myself for president him for vice-president. And we are so similar with our, our beliefs and everything that we have, that we were like, let's team up to try to, to do this. So that way we can really give back and help.

Speaker 2 (05:29):

And we both said this. We said, if, if we don't get elected at this point in time, we actually think that our time, our window will pass. Right. At that point in time, we'll probably be in our fifties. Right. And I am not sure that we would be the right people to lead the Academy at that time, because we want to still be relevant. We still have students. We still work with like clinicians and educate all, all around the country, the world, right. Where we still are in touch with them. I'm not sure if I would be the right leader six years from now or seven years from now, it was probably one of the next election. We would be open if I would be the right leader for that. I, I, I'm not sure. Maybe I would be more out of touch. So Mike and I both said, I think this is our window. If we're going to do it, it's probably now or never.

Speaker 1 (06:14):

Okay. So let's talk about your platform. What do you hope to accomplish as, as president, what are things that you really want to focus on?

Speaker 2 (06:24):

So I, again, I love, I love how you start with the why, and then, and then you talk about, you know, what you want to accomplish. I love that because to me, it's not, it's not about coming up with like a list of things I want to do. What I want to do is I want to flash forward six years or whatever it may be. Right. I hopefully would get reelected if I get elected the first time. Right? So we'll say three years to be conservative maybe, but flash forward. And what I want, what I want to know is I'm going to judge my success of leading the Academy. If in the end of my term, you clearly asked the members, why are you a member of the American Academy of sports, physical therapy? And they have a very clear and distinct answer, right?

Speaker 2 (07:10):

That to me is going to define my success. Because right now, the number one thing I'm hearing from people, both veterans in this field, people in the middle of their career, early career professionals, students, they, they ask, why should I join the Academy? They don't know what they get out of it. Right? And it's, it's one thing to just be a part of a group. But the question always is, what's the value? What am I going to get out of that? So that's how I'm going to judge our success as an executive committee at the end of this, is, is it very clear that we achieve the objective that you know, why? And I think the most important thing we need to do right now is I think we need to rebrand storm the mission and the vision of the Academy to make sure that we're doing one thing we're focused on the goals and objectives of the members.

Speaker 2 (08:00):

It's not about me, right? It's not about my ideas, my initiatives, what I want to get. It's not about me or my legacy to me, it's about what the members get out of it. And I think it's actually pretty simple. I, I looked on the website, I'm just trying to like dig out like the mission statement. Right. And it's very like corporate, right? Very like, like very about like, you know, advocacy and like, you know, making, you know, sports, physical therapy like prominent, right? I actually want to see the mission statement changed the simply the American Academy of sports, physical therapies here to help you specialize in sports, physical therapy, right? You are going to become a specialist now because we're not learning stuff like this in school, we shouldn't be learning stuff like this at school. It was very hard to be, to graduate as a new grad and be a very well-rounded proficient physical therapist.

Speaker 2 (08:44):

Right. But if you want to specialize, if you want the best education to learn everything you need about to become a sports physical therapist, if you want to stay cutting edge, right. If you want opportunities and networking, to be able to become part of this group. And more importantly, if you want mentorship with some of the best people out there, that is why you joined the Academy. And I know right now, a lot of people say that all the time is I'm not sure what the benefit of my membership is, and that's why people drop off. And that's why people don't renew is they're not getting enough out of the Academy. So that's what, that's what I want to achieve. And that's how I am going to grade our executive committee. If, if we do get elected is at the end of this, if it's very clear, have we achieved our mission, that the members know that our whole goal is to help them specialize in sports and to get a job in sports. Right. I think that's what people want in sports. That's a big, big things is an advanced orthopedics. This is sports it's different, right? So that that's, that's kinda, that's kind of what, what we hope to accomplish.

Speaker 1 (09:47):

And how, how would you go about doing that? What changes do you think need to happen to number one, help more people join the section? Cause I know it, it is hard, you know, I'm part of, I'm part of the sports section I joined a couple of years ago. I let my orthopedic one last. So I left the orthopedic and I joined sports. And I'm also involved in the private practice section. And I know it's something that we're always trying to think about in the private practice section is how can we get more people to join? What are we missing here? You know, how can we be more inclusive? So how can the sports section be more inclusive to get those people in, to get them from what it sounds like you're saying, mentorship, education, jobs and just fulfillment within your career. It sounds like

Speaker 2 (10:40):

Here, and this is what I think it is. The past leadership has been amazing. Right? And the stuff that even the current board has done in this last few years is really evolved, right? So there's tarnished take the next step with technology and all these other things. They're doing a really good job with that sort of thing. To me though, I, I really think we need to refresh just the vision a little bit. And I want to reevaluate all of our decisions in all of the things we provide. And just answer that simple question. Does this help you become either become or become a better sports physical therapist. Right. And I think, I think we need to take a step back. Sometimes it's not about what we think is cool or what we think is a list of objectives. It's about how do the memberships actually get value out of the Academy.

Speaker 2 (11:26):

And I think that's, that's the biggest thing we're going to do. So that's a little bit of the vision, but we're going to reevaluate everything, right. There's, you know, one of the big ones is education, right? One of the big ones education and staying current with, with research, right. So recently just in the last year or so the Academy got rid of one of the free benefits of being a member was access to the international journal of sports, physical therapy. And I think that was one of the biggest reasons why a lot of people were members, right. They got, they get access to a free, very well like established journal. Right. So they took that away from the membership a little bit. And again, I just wonder why, I mean, if the reason you join is to, to learn and stay current about being a sport, physical therapist, I don't want to take away benefits.

Speaker 2 (12:11):

Right? Like there's, there's gotta be a way we do that. Right. so I, I, you know, there's, there's, there's a ton of different avenues, right? Like you said, it's hard to go over this and just like a quick like kind of podcast, but I think it's about like networking opportunities. Cause it's all about who, you know, in this world. Right. But for me, it's about education and mentorship, right? We have some amazing clinicians that are part of this Academy that we need to learn from and that we need to go work with. Right. So we have residencies, we have fellowships. Those are great well-established things. Those are large, those are daunting, right? Like, like that's a big commitment, both time and finance for you to go do one of those things. We need to have more accessible opportunities, either online or shorter term, those types of things.

Speaker 2 (12:56):

I think we need to leverage, remember sports, physical therapy. That's where my background comes in. That's all I've done. My whole career is work with pro athletes and stuff. Right. Is how do you get a job in pro sports? How do you get a job in the MLB or the NBA or the NFL? Right. We need to leverage our, our connections. Like I'm friends with people in all these leagues, the PTs and all these leagues. And I've reached out to all of them. And I said, we need to start collaborating more. What if we have joint education sessions? What if we have mentorship opportunities where you come to spring training with me for eight weeks. Right. And who do you think is going to get a job when a physical therapy job opens up now in major league baseball, somebody that's just off the street with a good resume or somebody that's actually done a mentorship program with somebody already established.

Speaker 2 (13:40):

So that's part of the things that I think that's what I bring to the table is these connections and sports. And these are the things I've done. Like I, to me, I feel like I am I'm representative of the membership. I'm a clinician, you know, we treat our butts off. Right, right. And we're still working with people, you know, all the time we published clinical research, right. Impactful clinical research that have great implications that everybody wants to learn from. Right. We teach this to everybody after we publish it. Right. So we're on the trenches. We're working with the pro athletes. We're working with the collegiate athletes. Like I want to give people the opportunities that I've been fortunate to have. And I think that's a big part through networking, mentorship, education. I think those are the three big areas that are really push.

Speaker 1 (14:24):

And I really loved the mentoring aspect or Avenue of that. Especially like you said, maybe some online options and things like that. Obviously during COVID these things have become more and more prevalent, but I think it also does well for members who may be don't have, don't have the finances. They don't have the resources to let's say, even travel to a continuing education moment or even go to CSM. So I think to make things more accessible to all members or to people who want to become a member, right. Cause you may have someone out there is like, I'd really like, want to be part of the sports section. But man, I don't know if I can, like you said, do a residency or fellowship, which can be very expensive and time consuming or maybe they're a later in life PT and they have a family that they have to care for and they can't go off for 12 weeks or something like that. So I think to have those virtual options would be really great. And, and for me, I think it would be something that would really generate some interest in the section.

Speaker 2 (15:38):

Yeah. And that's my wheelhouse. Right. And that's what, that's what we did. I mean, it's funny. Like I stumbled into online education. Like I don't even like 12 years ago now. Right. Remember where the we're the old ones again, Karen. Right. I stumbled into that and have all these online courses now. And I did it for one simple reason. I was unable to travel around and teach. Right. Because I, I was now in getting a new baby. Yeah. Well, no, I was, no, that was before that I was in professional baseball. Right. So meaning like I worked 24 hours a day, seven days a week. I can't take a weekend off and be like, Hey, I know you guys have a game tonight, but I'm going to go teach a course in Louisiana. Right. Like they couldn't do that. So I got in that, but then yes, then you get you, and now you add family on top of that, right?

Speaker 2 (16:23):

Like, yeah, that's a big deal. So, so I started teaching online to kind of scratch that itch for myself, to keep giving back right. And sharing and educating and men that it's amazing how many people around the world you can touch by, by doing it online. And again, we need to catch up with that and just shows again, like, like, you know, the current state of even like the AP team totally. That they don't, they don't even have a way to a good, solid way to be able to offer continuing education credit for people with online courses. It's a mess. It just shows you how, like it's a, we're, we're getting a little outdated. I think we just need to refresh the vision for modern day, you know, this next generation of VCPS and people that want to get further along in their career, we need to meet them where they are.

Speaker 2 (17:06):

And not just assume that like some of the old standards that they've done. Right. And I think that's why bringing some new vision to the board is helpful. Right. I mean, the board has been pretty consistent for a long time. Right. The board has been quite academic for a long time right now. Right. There's not a lot of clinical leaders that are in the trenches, like working with athletes every day. I think there should be both, right. Like, don't get me wrong. I think we need both. We need clinical and academic in there, but I think we need to collaborate on that because I do think there's different perspectives if you know, depending on what you do all day. So I'm pretty excited for those things. Cause I actually think that's going to make a big impact. And, and again, I just think like the benefit of being a member is going to skyrocket. You have all these opportunities.

Speaker 1 (17:51):

Absolutely. I agree. And now before we kind of wrap things up, is there what would you like the listeners to kind of take away from the discussion? What is your main point?

Speaker 2 (18:05):

Yeah. vote for me now. I'm just getting abs. No, in all honesty, I'm like, I, I'm pretty humble about it. Like if, if, if I'm not elected, like I, it's not a big deal to me. I CA I can't wait to continue to continue to contribute to the Academy and help people. Right. For me, it was like, this is the right time to kind of give back and to be able to do that. I think my experience, I think I've done what a lot of people join the Academy to try to also accomplish. I've been there. I've done that. I understand what they're going through. And I'm, I want to get the Academy back to helping exactly, exactly. Achieve your goals. And that's it, it's about the member. It's not about me. It's about the membership. So yeah, and I think that's it.

Speaker 2 (18:47):

And you know, again, just just you know, also throw up Mike Malaney again, as vice-president, because I humbly, I can't do this by myself. Right. We're all busy. Like you're busy, I'm busy, we're all busy, right. This is a team effort. And I think in some fresh vision of people that have this clinical background, like Mike and I, and I've been, I've been big sports PTs our whole career, like adding that to the current board that's already in place, I think is going to be quite a nice dynamic that is going to really help lead this Academy in the future.

Speaker 1 (19:19):

Excellent. And now let's talk a little bit more about you. Where can people find you, your, your podcast website, anything you want to share?

Speaker 2 (19:29):

Awesome. I'm easy to find, right? So I'm just Mike ronald.com. If you want to learn a little bit more about this election and the process with that, you can go to microsoft.com/vote, and there's some info on there that you can, you can get I have a podcast, I have a blog, you know, kind of blot for over 10 years. So there's like a thousand articles on there. So people always ask like, where should I, where should I get started? I'm like, well, you got a lot to catch up on. Right. There's a lot of articles out there, but yeah, no, I'm easy. I'm on social media. Like I just, I really am at the point in my career where I want to help others. So I, you know, we try to hit every, every channel we can to, to have the most impact. So, so yeah, just head to my website, there's a lot to learn on there. And and like I said, Mike reynolds.com/boat, and you get a little bit more info about this election.

Speaker 1 (20:14):

Excellent. And last question. What advice would you give to your younger self knowing where you are now in your life and in your career? What advice would you give yourself as that fresh face? New grad?

Speaker 2 (20:28):

You know, this is, this is actually funny because I, I just wrote this to my, to my newsletter last week. Right. It was kind of funny that I literally, I just wrote this last week and I just wrote like the next one for this weekend, that's going out this weekend. But I, there was one thing I accidentally did in my career that I stumbled into that I, I it's become clear now that that is what we should do. And I said, like, I am pretty certain at this point, everything I've accomplished in my career is because I specialized ready. And in this week's newsletter, I actually talk about like how to, how to arc your career path that way to do that. But like, I remember early in my career, like I got, I got some heat from some other physical therapists that I was too specialized.

Speaker 2 (21:13):

Right. And you were like, no, you need to be generally, like, you're not good with neurologic injuries or something. And I'm like, all right. But like, for me, like getting really good at one thing helped me achieve all the goals that I wanted to get to, to get a job in professional baseball, right. To win a world series, right. To, to open my own clinic, to open my own gym and sports performance center. Right. It was all because I specialize in something. So we need to be general, you need to start general, but if there's some your passionate about say, it's like soccer, football, whatever sport it may be. Right. You just, every second of downtime, you have learn how to be the best at that. Just be absolutely amazing at something. And I think that was the biggest key to my career is overhead athletes and shoulders, like in baseball.

Speaker 2 (21:58):

Like I just, I got super lucky that I engulfed myself in that environment and became a specialist in that. Right. And again, just, that's another thing that the Academy needs to do, and it needs to help people that want to get super specialized in one thing to be able to do that. So I think that would be my biggest thing right now. You know, it keeps evolving as we, as, you know, as we get older, but I think right now is for an early career professional is master the basics, but follow your passion and make sure you are just, you're putting your extra grind and hustle into like, become the best you can at that side. And then it'll grow, you know, grow over time. And then when you're lucky like us, Karen, and you're a little bit older, you, you go to work one day and you're like, gosh, I just have, I have six baseball players today. That's all that's on my schedule. It's like, it's pretty cool. You know, I played catch three times yesterday. Right. Like that's kind of cool. I got, I got paid to play catch. Right. That's kind of cool. So, yeah. So I think that would be my biggest advice really for the early career professionals. That would be good.

Speaker 1 (22:58):

Well, what, great advice. Thank you so much. I don't think I've heard that one yet. And I think that's a great, I think that's great. And hopefully that will help some of our students and younger clinicians as they try and figure out and navigate their career. So thank you so much and thanks for taking the time out and coming on today. I really appreciate it.

Speaker 2 (23:15):

Thanks for having me, Karen. You're the best. This is awesome. And I appreciate it. The LC in the future, I'm sure fingers crossed

Speaker 3 (23:22):

One day. We'll actually be able to see each other in person, right.

Speaker 1 (23:26):

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

Mar 29, 2021

In this episode, CEO of Julie Wiebe Physical Therapy, Inc., Dr. Julie Wiebe, PT, DPT, talks about running and pregnancy.

Today, Julie talks about running/exercise and pregnancy, creating baselines, the research around female running form, and she busts some pregnancy myths. When can you return to running after pregnancy?

What is Julie’s definition of ‘postpartum women’? She tells us about structuring exercises around their daily exercises and goals, pelvic health education, and she gives some advice to clinicians working with postpartum runners, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “Landing mechanics are affected by what’s happening north.”
  • “Let’s understand what they looked like beforehand so that we have a better idea of how to help them find their way back.”
  • “Just because you had a baby doesn’t mean you should be in pain and weak for the rest of your life.”
  • “Listen to what’s happening, but learn to interpret it.”
  • “If your 10 minutes is spent running and that’s your goal, you’ll do it. But if I say you’ve got to lay down on the ground and do rehab exercises that make no connection for you, you’re not going to be motivated to do that.”
  • “Pelvic health does not mean that you have to be clinically prepared to do internal work. It just means that you’re treating the musculoskeletal of someone who happens to have a pelvis, which, last I checked, is everyone. You don’t have to be certified as a women’s health specialist, but you can get information, read books, watch videos, take courses so that you are competent in treating a woman postpartum that wants to get back to running.”
  • “The pelvic floor is not the only gatekeeper that creates pelvic health. It is a component of multiple body systems, and we need to understand that those systems affect the way the pelvic floor acts and behaves. The pelvic floor itself needs to have attention directed at it, but when we talk about just the pelvic floor, it isolates it away from relevance to other areas of care.”
  • “Learn to ask questions, and ask questions that make you uncomfortable. You will get more comfortable with it, and understand that what you’re trying to do is open a door of communication.”
  • “When you read the conclusion in research, is there any other explanation that could’ve come to that same conclusion based on what you’re seeing?”
  • “We need to start broadening our lense, and I think we’re broadening it to look at females as not just little men.”
  • “Instead of thinking of learning as this linear thing, include and transcend. Instead of it being a linear line, let it be concentric circles.”

 

More about Julie Wiebe

Julie WiebeJulie Wiebe, PT, DPT has over twenty-four years of clinical experience in Sports Medicine and Pelvic Health, specializing in pelvic/abdominal, pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness and sport after injury and pregnancy, and equip pros to do the same. She has pioneered an integrative approach to promote women’s health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations (ortho/sports medicine, pelvic health, neurology, and pediatrics). A published author, Julie is a sought after speaker to provide continuing education and lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes through telehealth and her clinical practice in Los Angeles, California.

 

Suggested Keywords

Physiotherapy, Pregnancy, Research, PT, Health, Therapy, Healthcare, Education, Training, Postpartum, Running, Exercise, Pelvic Health, Conversation,

 

Use the code: LITZY for 20% off the following courses from Dr. Wiebe:

 

Treating and Training the Female Runner (or Any Female Athlete)

Foundations + Running Bundle A

Foundations + Running Bundle B

 

Running Rehab Roundtable Live Broadcast

https://www.crowdcast.io/e/runningrehab

 

To learn more, follow Julie at:

Website:          https://www.juliewiebept.com

Instagram:       @juliewiebept

Twitter:            @JulieWiebePT

YouTube:        Julie Wiebe

LinkedIn:         Julie Wiebe

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

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

 

Read the full transcript: 

Speaker 1 (00:07):

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

Speaker 2 (00:39):

The host, Karen Litzy and today's episode. I'm really excited to round out our month all about running injuries and running rehab with Dr. Julie Wiebe. She has over 24 years of clinical experience in sports medicine and pelvic health specializing in pelvic abdominal pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness in sport, after injury in pregnancy and equip pros to do the same. She has pioneered an integrative approach to promote women's health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations, or at those sports medicine, pelvic health neurology, pediatrics, a published author. Julie is a sought after speaker to provide continuing education lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes to through tele-health and her clinical practice in Los Angeles, California.

Speaker 2 (01:48):

So Julie's amazing. And in this episode, we talk about some myths about running while pregnant and in the postpartum. And of course, the question that everyone always asks Julie is how can we return to run after pregnancy? So Julie answers that question and cause a lot of really helpful hints for practitioners to look for when evaluating postpartum women and those postpartum women, those runners can be anywhere from six weeks to six years, 16 years, 20 years after having a child. And she also encourages clinicians to think critically, to look deeper, to have a framework for evaluation, to try and, and, and get a baseline to ask your patients to film themselves while they're running or exercising so that you can understand what they look like when they're doing what they do. There's a lot of variables to post to running post-pregnancy and Julie really runs through all of them.

Speaker 2 (03:01):

So I want to give a big, huge thanks to Julie for coming on the podcast today and sharing all of this knowledge. And she also has a discount on the course. So she has a course on running a postpartum running. So she has a course for the listeners. So all you have to do is enter the promo code Litzy that's L I T Z Y my last name for 20% off treating and training the female runner. And just to be clear, this is for professionals, not for individuals. So this is for clinicians. So a huge thanks to Julie for that. We'll have all of the information, including links to everything in the podcast at podcast dot healthy, wealthy, smart.com. And tomorrow you can catch Julie live along with Dr. Ellie summers, Dr. Chris Johnson and Tom goom for our live round table discussion. That's tomorrow, March 30th at 2:00 PM Eastern standard time.

Speaker 2 (04:10):

If you can't make it still sign up because you'll still have a chance to get your question answered by the panel, and you will still get to watch the replay any time you want. And listen, this is a deal. It is $25 for four of, in my opinion, some of the best minds when it comes to running injury and rehab. So sign up today. If you're listening to this today, sign up today because you have until probably, I don't know, it starts maybe until like quarter to two tomorrow, which is March 30th to sign up for our live round table discussion. Again, that's with all four guests from this month, Ellie summers, Chris Johnson, Tom goon, and Julie Wiebe. So sign up to day. Hey, Julie, welcome back to the podcast. I think this is like your third visit to help you well, yes, thank you for sharing your platform with me again.

Speaker 2 (05:11):

I appreciate it. Of course. And, and this month, the month of March, we're talking all about running, running injuries, running rehab, and I know something that you're passionate about is caring for the postpartum woman that returned to running after giving birth. And, and we'll also talk a little bit about running while pregnant. Right. So I think that there are, there's a lot to cover. And so we are just going to, we're going to zoom right through this unintended since we're on zoom. But let's start first with running while pregnant. I feel like there's a lot of myths around running while pregnant. I don't know that it's understood very well by many people, including clinicians as well as the pregnant women. So I'm just going to kind of throw it over to you and let you just kind of talk about the, the running pregnant woman.

Speaker 3 (06:14):

Yeah. You know, and I think I think that regarding running and pregnancy, I mean, that's our focus, but really exercise and pregnancy. We still have, we are limited in our understanding of all things. Related to that I think we are started, we have information about things like cardiovascular response or, you know, some of those pieces of the puzzle. But in terms of the musculoskeletal, the neuromuscular, the response of the female host inter like how is that impacting the mom's body systems. Right. and I think that where we are struggling to have a lot of research there in part, because it's hard to find women that are willing to be participate in research. And then there's also a lot of, I, you know, we have to be protective of them. We have to protect them. And so, so it's this, you know, we want to honor that stage of life, but we also need to research it.

Speaker 3 (07:13):

So so I think we are struggling to, to understand all that, but we're starting to get more and more attention on it, which is awesome. As far as pregnant runners go there's only a few studies that I'm aware of that actually look at the pregnant runner and and of those one is a case study and one is on five women. So we have very limited understanding of what exactly goes on, but there were some themes. So I'll just share some themes. One is that in, in both the studies, they were, they were followed, the women were followed throughout the pregnancy changes were seen in all of the women on how they continue to run through the pregnancy meaning. And particularly the one with the five women, they all did something different, which is the variability is what we're seeing now.

Speaker 3 (08:07):

Everybody's bodies individually adapted differently. But the through line for them was there was a loss of pelvic and trunk rotation. So when we think about that pregnant runner, this is the way I've started describing it. The belly covers a ton of joints. Like it goes from the thorax to the pelvis. It it's basically, it takes all of these reciprocating joints and it turns it into a unit joint. Like it's one big joint, it blocks motion. So it reduces pelvic and trunk rotation. And so it limits, and then it forces them to rotate elsewhere. All of these are adaptions to help them continue to move through space appropriate for pregnancy and running. But when they go into the postpartum, they carry it with them. And that was what happened in both of these studies. They found that at six months for the woman who was the case study, and then at six weeks postpartum for the women, the five women in the other study, they held onto these, these some of these variables into the postpartum period and where that's significant is that women are given that okay by their doctor at six to eight weeks.

Speaker 3 (09:19):

This just like, you can just start doing your thing again. But their understanding is I got to just lose weight and get a flat belly. What our understanding needs to be is we need to understand what's changed for them. Biomechanically neuromuscularly emotionally, you know, fatigue, stress, like all of we have to understand all of those pieces and help them restore their interrelationships. Neuromuscularly biomechanically to be more like their baseline in order to prepare them for return to run. Like it's not just, okay, let's get him stronger. It's how do we help them restore that efficiency in their patterns that they lost, but no one realizes they lost it. So six years later, they show up to an orthopedic office and they have some of these running injuries, but how much of it is related to the compensations that they carried into their postpartum. So that's sort of a, an entry point into our conversation.

Speaker 2 (10:17):

Yeah. And that's, that is so interesting. And it makes sense that they would carry that over because our brain has is plastic and it's going to adapt. And our our sense of where we are appropriate susceptive sense is going to adapt to that. And it just doesn't end because the baby's not inside you anymore.

Speaker 3 (10:40):

Correct. And you're pulling it off, like in your mind, like you're still pulling off running, like you're actually running. So it, the understanding of what has changed is not understood globally. And I think like, I mean this, the running study related to the five runners that I mentioned, and that was from 2019. So this is, you know, relatively hot off the presses in terms of clinical understanding. So our job clinically is to help restore reciprocation that's really, and we understand the reciprocation is so important for all sorts of pieces of the puzzle for running. And one of those things is actually reducing ground reaction forces, getting our center of mass over that lead leg. Reciprocation is a huge piece of that. And so understanding just that, if that is all you walk away with today, understanding that you're a female that has a postpartum is postpartum, meaning they have a pregnancy in their history when you're working with them related to it, running injury.

Speaker 3 (11:39):

If it has a ground reaction force components like a knee or anything, you should be looking North of the border, not just foot strength, not just cadence, not like you have to look North and understand, are they actually reciprocating? Where's that reciprocation coming from? Because when you have a unit joint of the lumbar spine in the lower, the only thing that's left is like TL junction and above. So that's where they're reciprocating is way up high at the chest. And if you watch Fumo runner, that's what they're doing. They're punching the sky, it's all up, up, up, up chest high. And it's, that's the pattern that they partially developed during the pregnancy to continue running and pregnancy. There's nothing wrong with that. It co it's an appropriate compensation, but it does. If you don't restore actual reciprocation between the trunk and the pelvis, that's what you're looking for. And if the woman is in gripping her abs, cause she wants to get flat abs again, that's a UDA joint, it's a uniform engagement of the abdomen is what most women hang on to, or try to do while they're running. And that continues to keep their reciprocation high. So it's like understand what's going on North of the border for these women, versus just looking at things like landing mechanics, landing mechanics are affected by what's happening North so

Speaker 2 (12:59):

Well that's so, yeah, that is so interesting. And now I'm going to be, you know, in central park watching all these women to see, okay, are they just running with their, from like the thoracolumbar junction up? And then just having legs move like a cartoon character or are they actually getting excursion and rotation through the trunk?

Speaker 3 (13:19):

Amen. Yeah. And then we're getting into summer, right? I mean, I'm here in California, so we're gonna be able to see people's abdomens. And the thing that I, my cue for my clinician friends is what's going on with the navel. Like if their navel is staying straight, dead, straight, the whole time they're holding their abdomen. So stiffly through their run, that they aren't reciprocated. Like they can't be like, that's an indication that's a quick and dirty clinical sign that you can see that that means the reciprocation is likely coming up higher. And then it'll sort of clue you in and you'll see it. And they're, they're the ones punching high in the sky. They've got ribs flared up, like it's sort of, and that's a lot of our female runners. And it's a lot of our women that have never had children because they're holding their abdomens.

Speaker 3 (14:03):

Cause that's what they think they're supposed to do. And we also have studies that have shown us that stiff abdomen when they had men jump off a height actually increase their ground reaction forces. So it makes sense it's part and parcel, right? Like, you know, we just got to sort of brought in and I think that's my hope when I talk about stuff like this with my ortho and sports medicine, friends and colleagues because that's really, I'm a sports medicine, PT, I'm not a traditional pelvic health PT, but is to broaden our lens and add these ideas into our differential diagnosis. Like we need to start thinking about how these things are affecting. Some of the things we look for in sports medicine. Like we understand to look at how ground reaction forces what's happening, but we don't often this into our thought process. Like how, why is that a typical running pattern for women? It's not just because we have brought her hips and Q angles and, you know, blah, blah, blah, look North, look North with me. There's more going on for these women. And and we have some strategy pieces that we could add into our thought process to help them

Speaker 2 (15:13):

Yeah, amazing coming in hot, right out of the gate pair with a great tip for everyone. So thank you for that. And one one question that I want to ask, just so the listeners really understand when you talk about postpartum women, can you define what that means?

Speaker 3 (15:32):

I'll give you my definition. Sure. It doesn't necessarily mean that it is the definition. But I consider anyone who's ever had a baby. And, and here's what I'll say about that. I think technically it's the first year that might be kind of more of a technical thought process. And that's mainly because I started learning this backwards when my, on my patients who were 35 and 45 and 55 and 65. And they still look like me. This is million years ago. Now when I was at postpartum early postpartum, like the way that I was using my body and it was creating issues for me, they were using their bodies that same way. And they were like, well, they had grandchildren at that point. And so once we start understanding, yes, it's a normal process that women go through, but our job is to understand what they went through and help them find their way back to efficiency and effective use of their structure and their systems and their like I D I was Chris. I love that Chris Johnson talked about their ecosystems, like, you know, like looking at all of those pieces for them and understanding our job is to help them get back to their baseline, their individual baseline. Cause my torso is this, like this with this link legs. Some people have long legs short, let you know, like to understand that. So my, one of my big pushes I hope to achieve at some point is to get baselines, like, let's start getting baselines. I was women. Yeah, go.

Speaker 2 (17:09):

I was just gonna ask that you, you beat me to the punch. I was just going to say, so if someone is coming to me as a woman who is a runner and she had a child would say a year ago or two years ago, even how do I know what her baseline is?

Speaker 3 (17:27):

Correct? Well, what I do is I have them try to bring me film from prior to the injury. So these are for women that haven't had babies or like what they look like running prior to having a baby. And again, so many women have said to me, well, I leaked even before I had a baby when I ran. So then you might find stuff in their running form that might help explain that like Mabel's that go straight ahead? You know, things like that. But it does give us sort of an understanding of, is the running form that we're seeing right now, is that speaking to why they're having the injury, the, whatever it is, or is this the running form they've always had and they used to run without any difficulty. Like, you know what I mean? Like, so for me, that's how I started to create their baseline.

Speaker 3 (18:15):

Even if I can't see what they look like. And a lot of women will, like, when we talk about diastasis, like, you know, something like along those lines, which I might have to define for the audience, but some women will send me pictures of them in a bikini from like their early twenties. They're like, Oh my gosh, you're right. I actually had a line down the middle, but I never gave it any thought because my belly was flat. But now that my belly is not flat, you know? So it's like, that's where we can start to kind of get some comparisons for baselines. But one of my goals is to reach into the medical community, meaning the obstetricians and the midwives and the nurse practitioners. If any of you are out there is to say, let's start creating baseline. You're the first contact for some women they'll come in for a prenatal visit or something like that. Like, let's get some baselines, encourage them to take video. How will they're lifting how they're running? You know, how are they doing these things that they want to get back to afterwards so that they have a library of their own baseline? Like let's understand what they look like beforehand so that we have a better idea of how to help them find their way back.

Speaker 2 (19:18):

Yeah. Yeah. Great answer. Thank you. And so we've talked a little bit about this return to run after pregnancy. And I know you said that is, that's what people want to know from you. How do I go back to running after I had a baby and you know, everybody wants a protocol. If you could do this, then do this and this then do this. Right? Right. So when someone says to you, when can I start running after I had a baby, what is your answer?

Speaker 3 (19:50):

My answer is, and everyone hates it. It depends, but I tell them what it depends on. And so, and that's what it does get a little tricky in a situation like this, because these are some of the variables that I want to know. So my, whenever I get a question like that, my favorite is when I get it from a practitioner, what should I tell my patient who wants to get back to running? And I'm like, okay, well, my, my response to you is I actually wrote a blog like this. Like, and I always get, Hey, quick question. And I'm like, it's not a quick question. It shouldn't be a quick question. You know, did they have a vaginal delivery? Was it traumatic? Did they have forceps? Did they have a Syrian? Was it, you know, did they have bed rest? Were they on bed rest?

Speaker 3 (20:29):

If you're on bed rest, no, you're not gonna start running right out of the gate. You're like, you know, like there's so many variables there was it a complicated pregnancy? Was there, you know, what's been happening to them during the recovery process, have they, you know, are they having postpartum depression? You know, what's the you know, what are all these variables that they're experiencing? Where are they having postpartum depression? Or are they depressed or having baby blues, partly because they've lost their exercise program. Like what, what are all of these variables that we're looking for and what was their athletic capacity before? What is it now? Or what are their goals? Cause I like to make goal specific recommendations. So those are some of like, those are just that's scratching the surface, but I don't want to make it sound like this is an inaccessible population to work with because you don't know what all those things are.

Speaker 3 (21:19):

But what I usually talk to my patients about is I understand their goals and then I break them down and we start preparing for them. So my program for you needs to prepare you for what you want to do. And I need to understand the demands that you're up against. If you want to run, I need to prepare you for impact. I need to prepare you for endurance. I need to prepare you for power and possibly change of direction, depending on what you want to do. Trail runs and jump over rocks and things like that. Like I need to prepare you for what it is you're going to be up against. And part of that preparation is looking at your form, giving you great form twos, helping you build in new form, creating an interval program, getting you impact ready. Like there's, it's not just, I need you to do some curls and tell me stuff and some cables, and now you can run.

Speaker 3 (22:10):

And I think that that's, but that's a typical postpartum recovery program, but it isn't a prep for return to run. I need to teach you to reciprocate. I need you to strengthen into those reciprocal movement patterns. I need you to do single leg work. I need you to do single leg loaded work. I need you to do single leg impact work. You know, I gotta get you practicing some of those pieces. Then I know you're prepared. And if you're leaking or having pain or having an I give you these things we're looking for while we're doing the prep work, we're just not quite ready. We need to modify those things. Keep giving you opportunities to build capacity and strategies for the kind of work you want to do. I'm going to build that back into your system so that you're ready. And if you're, again, if you're symptomatic during all the prep work, we're just not quite ready for the actual events, but let's figure out what still needs to be tweaked and what needs work. You know what I mean? And then like, let's start with elliptical, let's start with hiking. Let's start with things that don't have impact. If we're not, if we're having symptoms with impact, like sort of really parse, what's still creating the problems so that we can troubleshoot that. And then, and then get you back into interval prep, walk, run. You know what I mean? Like it's yeah. So it's yeah. So that's running, that's more running specific.

Speaker 2 (23:27):

Yeah. So if you're not, it's not like, okay, the doctor gave you the all clear at six to eight weeks depending. So I'm just going to give you a walk run program. And that's what you will do. There is a lot more building because like you said you to monitor, you want to give people their program, you want to monitor their, their reaction to it, their symptoms, and then make the necessary adaptations that you need to make and use your clinical judgment. Because we know that there's not a whole lot of research around even returned to run after pregnancy. There's not a lot of research to that, correct?

Speaker 3 (24:05):

Yeah. We're getting, we're starting, we'll give credit where you know, we're trying, but we, yeah, we have a lot of work to do. We need to figure out there's a lot. We need to understand just basics. But, but like some of the things that I, I I'm trying to create like little things, people can remember, like prepare, then participate, monitor, and modify. Like just keep get like put those pieces together for yourself. Cause some people don't have access. That's the other thing, like if anyone out there doesn't have access for whatever reason to the practitioner, like you are, you have a lot of power by knowing what to monitor for knowing it's not normal to have pelvic pressure or leaking or pain while you're running. It's not normal. Like we want you to feel good while you're running and you know, just cause you had a baby, does it mean that you should be in pain and leak for the rest of your life?

Speaker 3 (25:01):

Like that's an incorrect, like I think we did. We say we're going to bust myths. Like that's a myth D please don't buy into it. So yeah, and I think I lost your question in there somehow. Did I? No, no, no, no. Boston my own head. No, not at all, but it is. It's like these, like what else? You know, and then follow the other thing I try to tell people is follow your success. If it seems to be that you're having more symptoms on the flats, but you're okay if you are going uphill, which is not unusual because it sort of helps you have a better running form automatically. Then let's walk the flats, run up the Hill. You don't like listen to what's happening, but learn how to interpret it. I think that's what I'm hoping clinicians can be, is really great interpreters of what's happening with the patient standing in front of them so that they can they can be better guides.

Speaker 3 (25:54):

I mean, that's really ultimately what we're doing. We're guiding people through their process because everyone's process is going to be a little bit different. It should be. And I would love for, I would w I went a hundred percent with lots of over the protocol, charge everybody 10 books now, but it doesn't exist because everyone is different everyone's path through pregnancy is different. That one study we have was so fascinating. All those women did something different to get through the pregnancy running. So, so we, we were just learning, right. We're learning about, about everybody's path through, through all this stuff. So how can we guide them? And I think monitoring modifying, progressing not gradually in a scared way, but in a smart way, like, Oh, we tried that. That was too far. All right. So backing off a little bit. Let's try this. Let's modify, modify, keep adapting. So I don't know. Now I'm going down a whole nother rabbit.

Speaker 2 (26:48):

No, no, no, that's it. This is all, this is all amazing. And I, and I really think the listeners will, we'll definitely come away with, you know, the, the monitor and make it adaptations and watch and listen. And also, like you said you sort of referenced Chris Johnson, sort of talking about the whole ecosystem. So again, I think it's important to when you are sitting down with this patient for the first time, you know, you have all these questions, but then your other questions are, well, how old, how old is your child? Do you have more than one? What are your responsibilities at home? Do you have a nanny? Are you a single mom? Are you working? What are your time constraints? Like, because all of that feeds into what kind of program you can give this person, because they may say, Hey, listen, I have 10 minutes a day to do some exercises. And, and what happens a lot is people think I only have 10 minutes a day. It's never going to work. Right. So how do you get around those with your clients?

Speaker 3 (27:51):

I usually use their exercise program is their fitness program, whatever it is, like rather than ask them to stop. I, and so, I mean, we're talking early postpartum versus someone who's maybe coming back two years later. Right? So you know, I try to integrate, my goals have always been, or my path has always been about building brain strategies, neuromuscular. So then I'm teaching them how to re-establish. Some of the, the, the, so let's talk early postpartum things get kind of funky in terms of how components of the central stability Central's control system operates. I'm working on helping them reconnect and implement it into their function. They have to take care of their kids. If you're lifting your kid, we're going to do it in a way that sort of pulls in the brain's going to use all these components to help them start, to learn, to be reintegrated into your movements, just movement going up the steps.

Speaker 3 (28:50):

Guess what steps is just like running. We're going to actually, if your goal is running, I'm going to make going up and down the steps with your laundry hamper or your baby as your prep for return to run. But we're going to do it super low impact. We're going to think it through. We're going to have to, like, we're going to rebuild that reciprocation through walking up and down the steps. We're going to, you know, match it to your function right now. But if you're two years out and you're, it's a different ball game, I'm going to use your running as your program. I'm going to adapt your running and keep you below your symptom threshold or make it look a whole heck of a lot like running so that you're motivated to do your, if your 10 minutes is spent running and that's your goal, you'll do it.

Speaker 3 (29:32):

Do you know what I mean? But if I say you got to lay down on the ground and do these rehab exercises that make no connection for you, you human, emotional, or your brain to your goal. You're not going to be motivated to do that. So I have always broken down their exercise programs, if they are CrossFitters or going to gym or whatever it is, show me three exercises that you like to do. Yoga, Pilates, whatever it is, what are three things let's implement these ideas and strategies under something that you enjoy, because I know you'll be compliant. And then they know you're listening. That therapeutic Alliance is there, like out of the gate, you want to help them get to their goals,

Speaker 2 (30:11):

Right? So it's, it's like, you can take things they're already doing and modify, adapt it, allow them, give them the tools they need to implement. What will help them in that exercise. And ultimately perhaps help them get back to their running or whatever it might be. Okay.

Speaker 3 (30:31):

Break it down, break it down and then build it back up. That's got it. That's a pretty straightforward way to do it with any athlete. It doesn't have to be running. But you got to know what they're up against. So I, if I am not familiar with something, I just say, show me, I don't know, show me what that is. And I don't know the words, I'm the first one to admit it, but I can't remember what that, can you just show me that and they'll sh and then you can break it down. Like, I think that's, to a lot of people's barriers to working with athletes is they don't feel comfortable with the sport. And then of course we have, you know, members of our community that say things like, well, do you lift, do you even run? I know. And it's like, like, it's really I don't, I don't surf and I will never, my first surfer when I moved to California, you know what I did, I looked at YouTube and I looked at, I watched, I watched videos.

Speaker 3 (31:30):

I looked, I tried to understand what are the physical demands of surfing, but that didn't mean I couldn't help him. You know what I mean? Like, don't get me started. So anyways, so I think that it intimidates because also like, that would mean that men couldn't work with female athletes too. Like, cause you don't have a vagina. Like that's, it's a, it's an illogical argument and it makes me mad. So anyway, surfing is I that's one of the examples that I use because I don't surf and I never will because I'm afraid of sharks. So we w w your job, our specialty physical therapist should be movement analysis. That to me is a pretty basic part of our definition. And I know that you can at least pick out efficiency. Do you know what I mean? Like, you can pick out efficiency and I use video, like crazy.

Speaker 3 (32:19):

Have them bring you videos of them. Weightlifting have them bring you videos of running, and then you can slow it down. Look at it, really carefully. Look at it at home before you stand in front of them, start to break it down, look online. What is a clean and jerk, and then ask them to send you a video of a clean and jerk compared them and start to pick out where it's different. There you go. You know what I mean? Like, I think that we create this barrier for clinicians to be able to participate in this kind of care if we make it unattainable because they don't actually participate in it anyway. Yeah.

Speaker 2 (32:56):

Listen, I could not agree more. I think that's the dumbest dumbest argument against a qualified physical therapist, seeing the person in front of them, because what if you're the only physical therapist for 50 mile radius? What are you supposed to like, sorry, pal. I'm not an Olympic lifter can help you.

Speaker 3 (33:17):

Yeah, it's so stupid. It's so stupid. Well, and it's really the other thing too then is it's also important to sort of highlight and carefully and kindly and respectfully say that's also how pelvic health is understood by so many. Well, it's not, that's not my department, but it's physically inside the woman standing in front of you. It's part of her department. So like, you may be the only practitioner for miles and you are the only person that understands the human body, the way you do as a physical therapist. It behooves you to start understanding some of these processes. When we start to talk about our differential diagnoses for runners is to understand what is happening, what, how might this have affected what I'm seeing clinically? And then it's not, it's not pelvic health, like in this movie way, it's pelvic health as a, it's a, it's a friend to helping you understand what's going on with these patients.

Speaker 3 (34:16):

So, so again, like in the same way that, you know, folks get scooted away from participating with female athletes or athleticism, we don't want to scoot them away from pelvic health because it's scary or UV, or it's not their department. Like we need to open those doors broadly and say, let's, let's skill everybody up. Let's equip everybody, the pelvic health community to understand fitness better, and the fitness community to understand pelvic health better. Like let's everybody come to the middle and not create barriers inside the community to those things. Like, let's appreciate the perspective that we each bring so that we can optimize the care for our patients who don't have resources to go down, you know, and with telemedicine creates new opportunities until unless we can't do it nationally. Right. Can we have a talk about that?

Speaker 2 (35:08):

Yeah. I would love to have a talk about that. Like maybe every, every licensing board across the country, again, it's so stupid because we take a national exam, but we're only licensed in anyway. Yeah. We could have, we could have a round table on that one. But you know, what you said is really important about so for the physical therapist or even other health professionals listening pelvic health, it does not mean that you have to be clinically prepared to do internal work, right? No, not necessary. And it just means that you're treating the musculoskeletal health of someone who happens to have a pelvis, which last I checked is everyone. And so, and so you should, you should be able to do that. You may not ha you don't have to be certified as a women's health specialist, but you can take get information, read books, watch videos, take courses so that you are competent in, let's say for the sake of this month, I'm runners treating a woman postpartum that wants to get back to running.

Speaker 3 (36:25):

Right. And there, and that's, and I think that that's partially, I mean, to just be fair, I think we all learn pelvic health in a very isolated way in PT schools. You know what I mean? So I think that there's been a huge change in the conversation in the pelvic health community over the years. And it's just starting to get out there in, in other ways. So it also behooves those of us. And again, like I find myself always serve in the middle of these worlds. Those of us who communicate it in a way that's relevant to like, let's be communicating in a way that is enticing to learn more. Like, I want those to gain those skills and and understand it in a way that is relevant. And I, and so, yeah, so we have a lot of work to do to the physical therapy educational programming to start to build it into models a little bit differently, so that it's under some of the other side a little differently too. Right. So it's just, we're all we're evolving, but it is true that it has classically been defined that way. Right. Like, right. And so I think so anyway, yeah. So I, I agree with you, there's a lot we can do there. And it's also like, can you at least talk about like, and to have some ability to do that is important, you know, so,

Speaker 2 (37:45):

Yeah. And, and hopefully people like yourself and maybe podcasts like this and other podcasts that are out there will really help clinicians. And non-clinicians, you know, your, your, your gal that, that just had a baby. Who's like, I, I don't know what to do. How, what do I do? Yeah. You know, I just had someone contact me today who is eight months pregnant and she's starting to have a little low back pain. And she said, you know, should I just go to the doctor or should I just go to any PT or what should I do? And and I was like, Oh, I'm so happy that she's reaching out for a physical therapist, you know? But a lot of people just don't even know that that's an option. Right. So,

Speaker 3 (38:32):

Yeah. Cause the messages, while you're pregnant, low back pain, you're pregnant, you know? And, and so it's really, there's a lot of education that needs to happen, but I do think you know, so much of it is around I'm trying to think of a good way to say this, centering the woman as like that, those concerns just because they're common. I hate the common. Not more, it's not, I hate that. I get it, but it's also like, it just always has been, but that doesn't mean that's how it should be, or it has to be moving forward. Like I think we're starting to get more female researchers, myself trying to do that too, to help, you know, we're trying to have females asking questions for females and to the credit of this one particular, he will never know. I should write him a note, but like I had a conversation once with a running researcher.

Speaker 3 (39:28):

And I was like, did you think about the fact that that lady was probably in continent? Like he had just done something at CSM and he goes, that would never have crossed my mind. And I, and he wasn't like a poopoo that couldn't possibly be a variable. He was like, it looks like you need to start doing some research. And it was, it was literally like the last nail in the coffin of me, like meeting that, like I knew I wanted to go that direction, but it was one of those, you know, those really landmarking conversations that just sort of are like, w wait, wait, wait, wait, wait, I'm point. Knowing what I'm doing, like cooking you in the right direction. Yeah. It's to say, you know, this is you, you understand it. And I think that's, you know, again, you know, we talked a little bit about clinical utility and research, like trying to ask the questions that women need to ask, you know, so we need for your eight month pregnant lady, we got to get better information to her and to people that can care for her in her local community.

Speaker 2 (40:25):

Yeah. And, and again, you know, we talked a little bit about this before we went on, but, you know, asking the right questions, asking questions, asking simple questions. Because as, as we've spoken about the research for even simple, for simple questions is not there. So before we went on, Julie was saying, you know, we don't know what the pelvic does when we go to sit to stand, what is it doing when we're walking? We don't, we don't know what's happening in the pelvis and the pelvic floor and, and, and articulations above and below. So how are we supposed to know with certainty what's happened when you're running or when you have impact or jumping? So I think these, like you said, these smaller questions need to be looked at and researched, and then hopefully that body of work can build up to something much more clinically.

Speaker 3 (41:15):

Yeah. We need to sort of, we need to build in the basics and, and, and, and we're working like there are teams working on that, like we have, and we're using computer modeling as a way that this is starting to get there because we can't the issue. And also, I really want to make something super clear before we get moving. This direction is one of the things that I'm trying to be really careful about is not just talking about the pelvic floor, but to talk about pelvic health, because the pelvic floor is not the only gatekeeper that creates pelvic health. And it is a component of multiple body systems. And we need to understand that those systems affect the way the pelvic floor acts and behaves and the pelvic floor itself, you know, needs to be, have attention directed at it. But B because when we talk about just pelvic floor, I think it isolated away from relevance to other areas of care.

Speaker 3 (42:05):

So I just want to be clear on that. So but we don't know what its behavior is. Cause we can't see it. We can't put a, you know, it's just, we are, but we're starting to get new ways to be able to understand it better through a technology advances. So we're getting there, right? Like, so that's been a barrier to understand this better in in the dynamic, in dynamic activity. And we are seeing computer modeling as an option to help us start to understand this a little bit better, but that modeling is usually done on like an N of one. One of my favorite studies is a computer modeling study, but it's with something, I can't remember the title now off the top of my head, but it was something like, you know computer modeling of pelvic, the pelvic floor during an impact activity and an athletic female or something like that, or for female athletes.

Speaker 3 (42:52):

But then it literally says in the methods section that the woman they chose wasn't athletic and I'm like, well, crap. Okay. But I mean, it gives us, it gives us new insight. We'll take it. But I would really like to see it on someone who is an athlete, because, you know, we want to understand all of those variables anyways. So, you know, we're just trying to get there, but we haven't always, we can't visualize the pelvic floor in when we're watching a runner, but we can watch it's relationships. We know it's related to the glutes. We know it's related to the pelvis and the low back and the abdomen and diaphragm, we can watch all those other relationships. And we're really good at that in ortho, in sports medicine. So there's all of these interrelationships that we can watch and understand that a little bit better and differently, but you know, there's elements of what's going on there today. I am grateful to our pelvic health community for their capacity to treat directly.

Speaker 2 (43:49):

Yeah, yeah, absolutely. And now, before we start to wrap things up what I'd like to ask you is for, let's say the clinicians that are listening to us right now what, what is your best advice to those clinicians who are working with, let's say female runners who are postpartum at any point postpartum, whether it be six weeks, six months, six years, what have you,

Speaker 3 (44:22):

Oh let's see. That's kind of a loaded question, but I think it would be to learn to ask questions like that would be my best advice, like, and ask questions that make you a little uncomfortable. You will get more comfortable with it. And understand that what you're trying to do is open a door of communication. Like create a conversation around this with your athletes. Here's what we know, which is not much, but my understanding is after you've had a baby or two, it affects your running form and you can hang on to those changes six weeks, six months, six years, whatever, wherever they are, unless we actually look at them. So I'm wondering how that as part of your medical history is affecting what you're doing, but along with that often comes problems with how you're activating your abdomen. Or you might have a public health consideration like leaking when you're running or painful sex constipation.

Speaker 3 (45:24):

Like there's other problems that women have that are under the public health realm. You know, and so so I'm going to ask you, so have them in your intake form, have them, you know, are you comfortable having a conversation with me about that part of your life and your experience? Cause I'm wondering how it might be affecting what we're seeing here. We understand that there's an interrelationship with learning. The research is limited, but, and if you're not comfortable talking to me, understand that, you know, it is something that I think might be a variable. And so I'm going to actually at least try to incorporate your pelvic floor and your diaphragm and some of those interrelationships into our programming. But I also have someone down the street that you can talk to a few, be more comfortable. I just want to open that door, like open the door to a conversation.

Speaker 3 (46:07):

Like if that, if nothing else, if they aren't comfortable, you also should be skilling up to understand these components. How do you, what should, what do you see in a typical postpartum runner start looking for navels, start looking, going to central park, whatever it is, start to pay attention to these other variables and serve to give fit, give it new. Meaning like I, cause I read a lot of running research and athletics like sports medicine research and the meaning that it's attributed that is attributed to it is often based on what we've understood in men or like a strength based model. Like, well, they're just there post your chain. Isn't strong enough. Well, my question is why, why would every freaking females post your chain the off? Let's put that. Let's start thinking about that. That's the kind of questions I want to ask. Like the why we're seeing that as our common, it's not just structure, it can't just be structured because women aren't all structured the same P S all women do not run it into your tilt.

Speaker 3 (47:08):

Like they don't, what do you mean? Come on. Nobody does the same thing. All of us. Like it can't be. So it's like with what we've put this meaning on it and if you're postpartum or you're pregnant, you're you have an anterior tilt. Well, we have to have research has shown us. That's not true. So it's like, and then I don't know how you can overstride and inter tilt at the same time. Like, we need to really think about that because, but we've always, that's sort of the lens. And so everything gets filtered through it to the point that we exclude, like other, like, instead of thinking, Oh, well, this can't be the explanation. Let's ask other questions. It's this becomes the definition. Does that make, am I making sense? A hundred percent. Yeah. So it's like, how do we start say, okay, that's we didn't get to the bottom of it.

Speaker 3 (47:57):

What other questions can we be asking? And and, and to start to look at women, not just women, men too. So it's, it's like, how can we start to ask our questions a little bit differently? How can we start to and really it's to look for the, why's not, what is, why, why in the world are we finding this with all of our female athletes? Could it be the way that we've trained them to suck their stomachs in all the time, since they were 12 and 10, you know, like how could that possibly affect an entire generation of, of participants, right. Let's start looking at this, you know, so yeah. So I love her. Yeah. I mean, we brought up Eric Miura prior, so we'll throw him a little shout out here, but I wanna, I, I heard him speak at a conference.

Speaker 3 (48:45):

I don't even know time has no meaning now, but and one of the things he said was I, which I love was talking about with research. When you read the conclusion and research, is, is there any other explanation that could have come to that same conclusion based on what you're seeing in the light? And I thought that's so smart because sometimes I'm like, Oh, yay. My biases, my biases, whatever affirmed. And, but I, but so he was referring to that related to the research, but I think one of the things that I keep trying to think through for myself, and I think would be a really wise way for all of us as clinicians to think about it is what are other reasons why they responded to my treatment? What are other reasons that they could be experiencing this problem that has nothing to do with what I've always understood?

Speaker 3 (49:28):

You know what I mean? And I am sharing my bias. Like when I look at a female runner, I'm not like, Oh, that calf looks weak. I'm like, Oh, wow. Look at their central control system. Cause that's, you know, that's my lens. So I, you know, so I want to be open to understanding all of that other stuff, but I already, I already learned all that stuff. And this piece is something that isn't being considered by a lot of permissions. And so, yeah, so again, we need to start just broadening our lens and I think we're broadening it. I hope to look at females as not just little men and the problem we have wider pelvises, estrogen, and Q angles. Like there's other things happening for us that, that are not explained by those things. You know what I mean?

Speaker 2 (50:13):

Absolutely. Yeah. Thank you. This was awesome. Now, where can people find more information about you, more information about your, you have a running a female running course, where can, yes. Where can, where can we find all of that?

Speaker 3 (50:32):

I am at Julie PT and I have discovered that you can misspell my name and still find me. So it's J U L I E w I E B E P t.com. And I have, I do have an online course that was recorded from alive lives online opportunity. So it does have that flair that feel, but it also has the questions, which I love. And, but I also have lots of free resources in terms of blogs, videos. I do a lot of podcasts and have a newsletter to let you know about when opportunities are coming up. Like this one and what's coming up for us this next week to be a part of the round table. But but yeah, and I'm on all the socials

Speaker 2 (51:19):

You're everywhere. Thank you so much. You're all over the place in a good way. Not in a bad way, in a good way. So thanks so much before we sign off, I'll ask you the same question I ask everyone, and I probably asked you at twice or three times already, but we'll ask again, you can keep giving the same answer I want growing and learning. So that's true, but that's true. Yeah. So what advice would you give to your younger self? You know, what I'm going to share?

Speaker 3 (51:49):

It's funny. I was just thinking about this before we got on, but, and this is something that I've learned during the pandemic and and it's from Aaron Nyquist just, but he was referring to the spiritual, but I'm going to relate it to our walkthrough. Learning is instead of thinking of learning as this linear thing that I learned this, and now I know this, so that's stupid. I learned I'm making it on my hand. No one can see me. I forgot it was on a podcast, but instead of it being linear, which is so much of what ends up happening in our rural this dichotomy, Oh, well, biomechanics is stupid pain. Science is everything like, instead of it becoming linear in our thoughts is to think include and transcend. And instead of it being a linear line that it'd be concentric circles. And I was like, Oh my gosh, if I could be a learner like that, always if I had started my thought processes that way, like, wow, that would have been important for me as a person growing, but as a clinician growing to like that, instead of it becoming these battles that we get between these dichotomous, like VMO and like Karen, you remember BIMA, well, remember BMO, but instead of these like dichotomous thought processes, let's see, what can we continue to include?

Speaker 3 (53:05):

And then how do we transcend it doesn't mean that what we used to think was horrible and versus stupid. It's like, how do we keep building on that in concentric circles versus this linear thought process? So, yeah, so that was, that was just on my mind today.

Speaker 2 (53:19):

What wonderful advice it's like, it's like a reverse, it's like a reverse funnel. Yeah. Yeah. It just keeps getting brought. Our perspectives should broaden our questions should really never be answered. Like we should never get to the end of that. Do you know what I mean? And I just, I, anyway, it was a really just as so much has changed and, and it's been a really challenging year for all of us. I thought it was a, and we're headed back to a new transcendent, normal that I hope will bring a lot of changes for all of us. You know, I just, it was, I, I think it's a really important perspective as clinicians to, so I thank you so much for sharing that and thank you for spending the time today and tomorrow. I know, and tomorrow is our round table with you and Ellie and Chris and, and Tom.

Speaker 2 (54:08):

And I was saying like, gosh, to have the four of you on like one stage is like, Holy crap. I can't even believe it. So thank you for that. And so everyone you can find out how to join us all by going to podcast dot healthy, wealthy, smart.com. I mentioned it in the beginning, in the intro as well. So Julie, thank you so much. I appreciate you and appreciate your, your knowledge and your insight. Well, thanks so much for having me again, Karen. I appreciate it. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and stuff.

Speaker 1 (54:38):

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

Mar 22, 2021

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Chris Johnson to discuss empowering runners through rehab. He is a Seattle-based physical therapist, performance coach, speaker, and multiple-time Kona Qualifier. 

 

In this episode, we discuss:

  • Is resistance training needed for runners?
  • Are training errors to blame for running injuries? 
  • How can clinicians guide the decision-making process around pain and return to running?
  • Chris's best advice to be a running injury expert. 
  • How can the profession of Physical Therapy be thought of as your best friend in healthcare.
  • The importance of being present and curious.  

 

Resources:

 

More About Dr. Johnson: 

Chris JohnsonChris Johnson completed his undergraduate studies at the University of Delaware, where he earned a bachelor of science with distinction while completing a senior thesis in the physical therapy department under Dr. Lynn Snyder-Mackler. Chris was a member of the varsity men’s tennis team, scholar athlete, captain in 2000, and recipient of the Lee J Hyncik award for excellence in athletics and academics. He remained at the University of Delaware to earn a degree in physical therapy while completing an orthopedic/sports graduate fellowship under Dr. Michael J. Axe of First State Orthopedics. Following graduation, he relocated to New York City to work at the Nicholas Institute of Sports Medicine and Athletic Trauma of Lenox Hill Hospital as a physical therapist and researcher. He remained there for the ensuing eight years until 2010 when he opened his own physical therapy and performance facility, Chris Johnson PT, in the Flatiron District of Manhattan. In May 2013, Chris and his wife relocated from New York City to Seattle to pursue a more active, outdoor lifestyle. In addition to being a physical therapist, Chris is a certified triathlon coach (ITCA), three-time All American triathlete, two time Kona Qualifier, and is currently ranked 16th (AG) in the country for long course racing. Chris is also extensively published in the medical literature and has a monthly column on Ironman and an elaborate youtube channel.

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

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

 

Read the full transcript here:

Speaker 1 (00:00):

Hey, Chris, welcome back to the podcast. I'm so happy to have you on in our month. All about running and running injury and running rehab. So thank you for carving out the time.

Speaker 2 (00:11):

It's fun to be back it's it's always a pleasure to connect with you. And it just snaps me back to New York city and I still don't know how we never crossed paths when when we were both there, but here we are, and I'm glad we connected and also happy women's history month. You're someone who's sort of spearheading a lot of great stuff in this space. And I think a lot of people, especially women look up to you and that you're a role model. So things that you've accomplished and continue to work on.

Speaker 1 (00:47):

That's very kind. Thank you. And now today we're going to do a basic Q and a with Chris Johnson. So Chris gets tons of flooded with questions and comments and things like that from emails to social media. And so I thought, well, let's see if we can make life a little bit easier, reach a wide audience and get some of these questions and concepts under control for you and out to the public. So let's start with a common question that you get is all is kind of around resistance, training and running. Do you need it? Do you not need it? I know that's a really broad question. So I'll throw it over to you around the the, the concept of resistance training and

Speaker 2 (01:40):

Yeah, and it's a, it's such a great question. I think that everyone's default answer is, you know, basically resistance training is a Holy grail for runners. And I do think it, it has its place, but I think that there are a lot of gaps in the research. And is it something that I prioritize myself as well as in working with the athletes I coach? Absolutely. But I think that anytime you're working with the runner, the primary goal is to get them into a rhythm with their training and to establish consistency of training. And then you can consider to start layering things in this is assuming someone's training and they're healthy. They have no remarkable past medical history. I, I think that, you know, the answer to that question differs especially if we start to get into master level runners who typically have a remarkable past medical history because most of these injuries and conditions go under rehab.

Speaker 2 (02:41):

You and I both know that as clinicians. So I think that a lot of the resistance training may just be cleaning up sloppy rehab that perhaps they didn't get around to addressing things at the tail end of the rehab. So there's a quote that I love, which is, you know, resistance training is really coordination, training under load. So, so yeah, I do think it has its place but it should be there to support our running, into build our capacity to run, but I've seen a lot of people get it wrong and they end up whether it's, if they're racing, they go into races where they're a little bit sluggish or they're carrying some residual fatigue. I've seen people get injured in the weight room if they're not perhaps if they're, you know, younger and more green. So yeah, I, I do think it has its place, but like everything you have to approach that, that runner athlete on an individualized basis and just understand where they're coming from.

Speaker 1 (03:40):

And in your experience, working with runners, what are the biggest barriers to resistance training for runners? Because not everyone has, you know, access to the same equipment and time and everything else. So what, what have you found to be the biggest barriers to resistance training?

Speaker 2 (04:00):

I think a lot of runners are intimidated by it unless they come from perhaps a multi-sport background where they've spent time in a weight room. I think right now with the pandemic, obviously resources and equipment or gyms are not as accessible or gyms opened in New York city right now are on a limited basis.

Speaker 1 (04:22):

They're open on a limited basis. I think you have to make an appointment a certain times and things like that.

Speaker 2 (04:29):

Yeah. And then I think that when people do get to the gym, they may not know what to do, and they may resort to something that they see on social media, some of the time, which might be fine. But I think that with running running has predictable performance demands. So it shouldn't be a mystery in terms of what we're trying to do. We're trying to challenge the calves, quads, lateral hip. And we're also we're not layering this in a ton. We're layering it in maybe twice a week on average. So but yeah, I think a lot of runners lack direction, and that's something that, you know, I try to put out a ton of content online. So people start to see how I'm approaching it. And I'm trying to essentially synthesize the literature and translate it to to just the everyday runner.

Speaker 2 (05:18):

And I think that there's also this element of rhythm and timing with running and that doesn't always get addressed through resistance training. I think perhaps a little bit more since some of Ebony Rio's research, but again, that's really in the rehab sector space talking about tendons, but I think that a lot of the TNT work or the tendon neuroplastic training work just has such salience to resistance training programs as well. So anytime, you know, people work with me, they're, they're going to get accustomed to using a metronome. It's just one more factor variable that I think that we can control for when we're prescribing. I

Speaker 1 (05:58):

Love the metronome. I love it. Love

Speaker 2 (06:01):

It easy. After a while though, I

Speaker 1 (06:03):

Give to everyone, even with my, even with my younger athletes, they get it, you know, and actually with those younger athletes, I'm talking teens, it's using the metronome, although they're like, Oh my God, I have to listen to this again. But it is actually good to give them a little bit of discipline around the, around the movement, around the exercise. But I love, I love the metronome. I have my patients like download the metronome, get used to it when you're exercising. I know it can be a little monotonous, but I think like you, like you said that with the research of Ebony Rio and others, I think it gives people, I don't know, like a, a little bit more discipline around their training.

Speaker 2 (06:49):

Yeah. I use it a lot when, if I'm giving someone calf raises something like a rear foot elevated split squat. If we're basically doing like a three zero three where it's like down on three seconds, up on three seconds without pausing yeah. It helps to maintain this rhythm. And a lot of the times I'll stop the exercise when they break that rhythm. Because it's telling me that, you know, maybe we're starting to reach the upper end of their abilities for that given exercise.

Speaker 1 (07:18):

Right. And we all know that three seconds to one person is very different to another.

Speaker 2 (07:22):

Yeah. Well, and this is what, you know, when Scott Morrison talks about anchoring and I just did that Instagram post on, you know, stop being awake or start to anchor. I'm starting to realize I'm becoming a dissenter. But you know, that's where the metronome comes in. And I've played with this so much. I mean, my, my neighbors probably think I'm crazy because I'm like out front with a metronome going, and I'm doing all these weird exercises. Well, weird to them.

Speaker 1 (07:49):

What sort of things do you implement to get over the barriers? Well, you just answered that. Anything else that you may implement to get over barriers to resistance training for runners? Like, like you said, in that runner who is very intimidated, maybe never used resistance training before.

Speaker 2 (08:06):

Yeah. I mean, I, a lot of the times when patients show up to my house, I mean, I'm working out of my garage. We have a space on our property, you know, when they arrive a lot of times I'm deliberately training. So they see what I'm doing and they see that this is a normal part of my routine. And then they get a lens into my racing background, yada yada. And so I want them to realize that this is something that is normal. And I think in a lot of running circles, and I think this is starting to change that it's not prioritized to the extent that it is. And maybe I'm just getting older because, you know, as a master athlete, it's amazing having dealt with some patellar tendon issues, like my body craves resistance training, where if I don't do it, I start to sort of get reminded. My knee feels so much better after I load it and load it relatively heavy. Now you have to be cognizant for reasons I mentioned before, in terms of like, you're not going to want to do a bunch of heavy squats. If you have a race coming up you can keep your body under load, but you need to be a little bit more calculated with your exercise selection as well as your dosage.

Speaker 1 (09:12):

Yeah. And, and that's where I think working with a coach or therapist or someone who understands understands one resistance training and two race training and how you can kind of blend those together is really important. And now sticking with training, let's talk about training errors. Can we just blame everything on training errors? Is that, is that an okay thing to do now? Or am I, is that not good? And I say, I say that with a wink for those people who are listening.

Speaker 2 (09:40):

Yeah. I mean, I think it's a convenient thing to do, but I think that I'm going to get myself in trouble here. I think it's a little bit lazy too. In, in, I think that having lived in New York city that you realize the life load factor, right. You know, there's different stressors in New York, between loud noises, you know, smelly things, you know, financial stressors in crowded spaces, you know, maybe your sleep has fallen by the wayside. So you may have a training program that's very sensible. And, and then all of a sudden you have something come up. I think to one of my, I'm an athlete who I'm working with right now, and this guy's just been just so tough and durable. And recently things have started to take a turn in a bad way. You know, he, he lost his mom.

Speaker 2 (10:38):

He's been having to contend with that. He's had some other job-related issues and and then he he's come down with the patellar tendinopathy and his training didn't change that much. And we actually dialed it back a little bit and it just shows it sometimes all of these other factors, you know, play such an important role in the overall being or totality of that athlete. So, you know, I, I, I think that we'd be much better off calling them ecosystem EHRs where perhaps there's a disconnect, but I think that we have to be careful, always blaming it on training. And I, I get the point, I think that, you know, from a, from a research standpoint, maybe the reviewers are requiring the authors to, to present it in that manner. But I just think there's a lot more moving parts. And I find myself having worked with a ton of athletes over the course of my career, being an athlete that you have to really be in touch with your ecosystem.

Speaker 2 (11:39):

And I don't know who first came up with that word. I know Greg uses it quite a bit, but I think it's something that, that is great to consider. And anytime I start working with an athlete, I have a conversation and it doesn't end during that initial consultation or phone call, but I'm saying, tell me about your life. What was it like growing up? You know, what, what was your relationship with food? You know, what kind of sports did you play? You know, were you in public school? Did you go to private school? What was college like if you went to college, you know, what's your current situation? Are you single? Are you married? Do you have kids? Are you a single parent? You know, I need to capture all this information and that's just scratching the tip of the iceberg in that conversation's never ending. So I feel like the more I know where people are in life, the easier it becomes to start putting down sensible workouts on paper and make sure when you put them down on paper, they go and pencil nodding.

Speaker 1 (12:34):

Yeah. I love that. Getting deeper into those questions and, you know, we had a conversation a couple of weeks ago with the surrounding a female athlete on clubhouse and Tracy Blake, who is just fabulous. I don't know if you're familiar with Tracy. She's a physical therapist in Canada. She's worked with a lot of professional athletes there, including their Olympic volleyball team. And she was talking about questions to ask. And I think oftentimes this is sort of floated over kind of skimmed over by a lot of PTs because we asked, tell me about, tell me what happened, what happened with your injury? Tell me what happened here, not the questions you just said. Tell me about your life. Are you married? Like Tracy said, you know, a question she always asks is, do you have children? Do you have pets? What, cause that gives you an idea. What are your responsibilities throughout the day? Yeah,

Speaker 2 (13:29):

I always say, you know, look, give me a lens into your situation and let the conversation unfold from there. And I think, you know, whether you're a physical therapist or coach, I think all physical therapists or coaches, whether they realize it or not, you know, you're, you're trying to basically capture that ecosystem. And to, to just have, you know, talk to people about, you know, I just have a candid chat with folks and from there, then we can start pulling levers.

Speaker 1 (13:59):

Right? Cause then you're getting a, really, a more holistic view of this person. And then you can say, okay, they have two small children they're working from home. Their kids are being at school, school, they're at home. They don't have the time to spend two hours a day between training and running and everything else. And how can you make things work for them? Is that about right? Yeah.

Speaker 2 (14:25):

And I think that any, any time a patient or athlete consults us, they're looking at us as an agent of change and the true agent of change is themselves. And it's trying to help them plot out their own course. And maybe you, you know, you're shining a light on the path here and there, or making sure that they don't step into a pothole along the way. But that's something that, you know, I find myself more and more. I have any expectations to, I don't do things to people. I sit there and troubleshoot with them. And, and I think that that's what we, as physical therapists are phenomenal with. And not only do we have the skillset, but a lot of times it most of us have positioned us to have the time to do that. And you can't rush that process. So but yeah, we're, we're not in a system that incentivizes that, you know, you don't get paid to talk to people, you get paid to do things to people. And that's the fundamental problem with, for the reimbursement structure, for people who are in network. I mean, you and I are a little bit spoiled in the sense that when we're providing care, it's just ourselves and the patient, but that's, I think that needs to be the standard or approximate the standard. Yeah.

Speaker 1 (15:41):

And isn't it like amazing when that aha moment comes as you're sort of talking through things like you said, troubleshooting, and the patient goes, Oh, wait a second. I can do blah, blah, blah, blah, blah. Or, Hey, maybe that I didn't even think about that. Maybe that is contributing to XYZ.

Speaker 2 (15:57):

Yeah. And I, that's a lot of motivational interviewing and sometimes, you know, I was talking with a couple of people yesterday. Sometimes people who've already arrived, you know, if we're, if we're discussing surgery, you know, I think our goal is to always try to help people avoid surgery, but sometimes people are just dead set and you say, look, you know, I get the sense that you've really just you've arrived at the fact that you're going to have this surgery. Am I correct in saying that, and you know, if that's what you've elected to move forward with, this is your decision. What questions do you have about the surgery? You know, and, and then you may start getting into a conversation and say, Hey, can I, can I share my experience? You know, this happened to me with my clavicle. I was in Hawaii, we'll be traveling to Argentina to speak.

Speaker 2 (16:44):

My wife was pregnant. We had a little one, I was going to have to do a lot of physical tasks. And I'm like, I just need the surgery. I didn't have it on my right shoulder when I, my clavicle fracture. And I was just dead set. I'm like, I'm in Hawaii, there's a competent doc. This is not a super involved procedure, like a soft tissue procedure of the shoulder hip. And I had this and I could have been kicked myself for doing it in hindsight, but no one would have talked me out of that at the time. So sometimes people have to learn through their mistakes and sometimes that can be a tough pill to swallow, but that, that patient ultimately controls that decision. So sort of bobbing and weaving, but,

Speaker 1 (17:25):

And, you know, you just led perfectly into the next topic I wanted to cover. And another question that you get asked often and that's, and that is surrounding pain and pain and decision-making, so we, you, I feel like you led perfectly right into that. So let's talk about how we as clinicians and practitioners, where our role is when it comes to pain and decision-making for that client or that athlete.

Speaker 2 (17:53):

Yeah. It's it's one of the first things, if not the first thing that I discussed with people I did a book chapter for this it's called clinical care of the runner. Dr. Harris. Who's a physician at university of Washington was the editor. And he asked if I would read a chapter on training principles. And I essentially said, the first thing that we needed to discuss is someone's relationship with pain and what their understanding of it is and how they approach decision-making in around pain. Because if you're running, you're going to be dealing with pain at some point, you know? And and I think people have an inaccurate understanding a lot of the times. So, and I think sometimes we, you know, I'll use an analogy that Mike Stewart or you used which I think is brilliant. You know, sometimes when we're out training and we're driving through a school zone, right?

Speaker 2 (18:48):

School's in session, the lights are blinking, slow down. All right. Sometimes you may be driving through that crosswalk. School's in session lights are blinking and you have a crossing guard. Who's standing in the middle of the stop sign. Maybe that's a case of someone's dealing with the bone stress injury. So you need to really hate that. Other times you may be driving through that school zone. It's a weekend, no blinking lights proceed as is usual. And I think that's a good way to think about training, but you know, you and I both know that if someone has a lower limb tendinopathy, you know, we want to monitor their pain and understand how it's responding as a function of a particular training session, whether that's a run, whether it's a plyometric training session or a heavy, slow resistance, but we don't want to shut that person down in it.

Speaker 2 (19:37):

As much as we in our profession may be, high-fiving each other thinking that we're doing a good job of this. Most of the people that consult me, even people perhaps worked with me in the past for short periods of time. They still, when they experience pain, they assume damage and inflammation. And what do they do? A lot of times they, they they'll resort to taking anti-inflammatories and here we go. I mean, this is a, this is where things go South. So I think it's just important to say, Hey, what sense do you make of this? You know, what do you, what are your reservations? Are you okay working through some pain? And I think from there then the stage is set to proceed. But with a lot of, I've worked with a lot of master athletes and they're, they've had a history of lower limb tendinopathy.

Speaker 2 (20:23):

I know that with my left knee, that, you know, I, I worked through almost a year of pain, but I never stopped training. And I was just sensible in how I was staggering, my workouts to afford appropriate recovery time. And and also just knowing how college and synthesis behaves. So yeah, I think that people have a, a skewed understanding and it's also something very personal, but yeah, if you're working with athletes, it's a critical conversation to have. And I do think that this is where I know Ellie was on talking about bone stress injuries, that if you are remotely concerned about a bone stress injury, and it involves a high risk site, like zero out of 10 pain is the goal. Most other instances, I'm a little bit more cavalier, but if I know, if I see some of the signs that I would associate with the bone stress injury, especially if we haven't had imaging, I'm going to be conservative as hell. Yeah.

Speaker 1 (21:19):

And I think it's important to, to note that understanding the runner and that's where understanding the ecosystem comes in and understanding, especially for bone stress injuries, where those high likelihood of those injuries occurring. So it also like you have to know your stuff as well is what I'm getting at when it comes to runners and, and having that conversation around pain can be uncomfortable for that runner or for that person. Cause you may have to dismantle a lot of long-held beliefs. So how do you go about that with your, your athletes?

Speaker 2 (21:57):

I just asked everyone who who connects with me. I say, can you give me w what, what's your understanding of your situation? You know, and I think runners, a lot of times may not come clean if they're dealing with pain, because if they go to see a healthcare professional, they're going to be concerned that they're going to get shut down work. Perhaps they interpret it as a sign of weakness. If they're out on a group run, they don't want, want to be the one complaining. So I just say, Hey, you know, what's your understanding of your situation? And no one's ever asked him that. And that's when the conversation unfolds. So, and I think the way people respond is going to be different pending the person, the situation. But I think it's remissive anyone who's working with a runner or an athlete if they don't ask that question. I feel like I started to answer your question, but I don't know if I do.

Speaker 1 (22:48):

No, you did. That's exactly what I wanted. That's exactly what I wanted to hear. Cause I want the listeners to get as much of this like great little tidbits of information from you as they can. And you know, all of the questions, the questions to ask the patient that you've given so far, I think are great jumping off points for any therapist, regardless of whether you're working for, with a runner or an athlete. But that question of give me the, let me know, what is your understanding of what's going on? And that opens up a whole lot of doors for you. And then, you know, as the therapist, you have to be well versed in the science behind pain and, and how to talk to people. And, and of course it's a whole other conversation, but you know, I think what you're highlighting here is that you can't wing it.

Speaker 2 (23:36):

No. And I think sometimes, you know, I had a question from a third year DPT student who watched a presentation. I gave at some and they're like, Hey, I feel like I'm starting to ask the right question, but then I don't know how to respond and follow up. And and I think that, you know, you can't rush this process if you're in, if you're a young clinician that you're going to get better at this through reps, through life experience and just through sort of being in the trenches with people. But you know, the other thing I tell folks is I say, look, you're a smart person, you know? And I, you know, when I first acknowledge the fact, I think it's good that you're being proactive and addressing the situation, but left to your own devices. What do you feel like you, you need to do to get on the other side of this and they start to formulate a plan and I do, I don't need to do anything.

Speaker 2 (24:27):

I just need to pose these questions and say like, I think that's pretty sensible, you know? Are you okay if we nudge a little bit and you start to basically prepare them for the fact that this plan has got to be progressive, if we're talking about getting them back to running, because they have to get back to a low-level plyometric activity. And I just love these conversations. And, you know, people ask me, they're like, where you learn motivational interviewing. And I'm like, I lived in New York city for decade. I'm like, I just talk to people and I have no agenda. I'm just curious, you know, it drives my wife crazy. Cause if we're ever out in public this happened yesterday. I went to, I had to get a new watch because my watch crapped out and this guy was checking out some watches and we just got to talk to me. And my wife was looking over at me, like, where are we go?

Speaker 1 (25:12):

Your wife is looking at her watch, like, come on, Chris, get it together

Speaker 2 (25:18):

And things off the shelves.

Speaker 1 (25:21):

But it's true. I think that, you know, asking good questions, motivational interviewing a lot. Yes. There's a lot of books. You can pick any book on motivational interviewing and read it and it will definitely give you some insight, but it's the more you do. It's the more people you talk to and not just your patients, anybody, the more you talk to anybody, it will help you be a better motivational interviewer. And the more that you listen and like really listen and start to formulate it's practice. I guess you start to formulate your follow-up questions in your head as you're listening. And again, it's just practice, practice, practice.

Speaker 2 (25:57):

Yeah. And it's, it's fine. I think that it takes on a slightly different flavor as a function of, you know, what generation the person's coming from too, you know? So but yeah, it's just fun to help troubleshoot with people and to really get them to trust in themselves. Because most of the, the folks that consult me, I mean, they're endurance athletes, namely runners and triathletes these days, and they're going to manage their situation conservatively. Sometimes I feel like they need to be talked off the ledge. If they're going to opt for a more invasive procedure, if that's not really appropriate or perhaps an injectable of some sort. So, but yeah, getting people to trust in their body and and not drag them in for therapy all the time, you know, and I, I have to prepare people for that to say, you know, how do you anticipate this is going to go?

Speaker 2 (26:49):

And they're like, well, maybe I'll see you two to three times a week for six to eight weeks. I'm like, who's footing that bill. No, no, one's good. Yeah. So I say, you know, but this, this requires a lot of work on us on the back end because when I write an email, I mean, email, I wrote to this person yesterday, it was basically like, you know, two pages and cause it, kids dealing with the bone stress injury, the parents don't really understand the implications of it. He's going to be running competitively in college. And, and I think that he was under the notion that he was going to be back to running in four weeks. And I'm like let's talk about more like four months. And I lay this out and I'm like, you know, I know this is probably a little bit, you know, overwhelming, or you weren't expecting to hear this. What are your thoughts on this? You know, to engage him, to just know where he is after I've presented this information and he got the memo. But that's, that's a tricky thing about bone stress injuries is people fall under the, you know, the idea that they're just gonna take a couple of weeks off and plugged back in.

Speaker 1 (27:49):

Yeah. Yeah. And again, that's where you, as a, as a therapist and a coach comes in and helps the decision-making you're ultimately, you're not that runner, you're not that athlete. So you're not the ultimate decision maker, but your job is to give as much information and, and your professional opinion as to their situation as you can.

Speaker 2 (28:14):

Yeah. And I, I think that it traces back to that question is like, what are your expectations or questions around this surgery? I mean, this is a very involved procedure. They're putting you under anesthesia and they're cutting your body open. Never we'll frame it like that, you know, when I'm working with people. But you know, I, I rehabbed all of these people after these very involved, soft tissue procedures of the shoulder when I was in New York, coming from Dr. Nicholas in his staff. And yeah, I'm like, this is going to be six months to a year before you feel like your, your shoulder is like firing on all cylinders.

Speaker 1 (28:47):

Yeah. Yeah. I had, I had a complex soft tissue shoulder repair and it was a year anyway, we can go on and on when it comes to a patient mindset, fear, trepidation, everything else. I think that's for another podcast. But I think you definitely got across the decision-making process on behalf of us as a therapist or coach and how we can influence that process for the patient.

Speaker 2 (29:12):

Yeah. And I think that if patients aren't on board, I mean, if they are around muddy water where there's a sinister situation and they start sort of dilly-dallying, I think that we need to really put our foot down his therapist too and say, look, you know, you've consulted me and here are my recommendations or here's my professional advice. And if you're not going to take it, let's just, let's just part here. And sometimes we don't need to do that a lot, but I think sometimes we drag our feet as clinicians and we need to, we need to put our foot down if we have to protect that person from themselves, because we can't get tangled up in that mess. I can't think of the last time that's happened, but it has happened over the course of my career.

Speaker 1 (29:57):

So those, I mean, those are sticky conversations to have, but for the safety, I mean, our job is to protect that, protect our, our athlete, our patients. So if that is our job, then you have to have those sticky conversations. Yeah. And that's it. All right. So I think that was thank you for that conversation on decision-making and hopefully it sparks plant some seeds in our listeners here. And now we'll go on to two more questions that you usually, that you get the easy ones. You will we'll breeze through these too. These are easy. How do you become a runner running injury expert To how many times do you get that question? How can I do what you do?

Speaker 2 (30:41):

Yeah, I it's, I, I love getting it it's flattering. You know, and, and it's something that it was sort of, I looked back and all, I, there, there were a couple of defining moments in my life. And one was when I was told that I'd never be able to run again. You will never run again. Right. I heard that a couple of times from very world-renowned orthopedists. And I think that's what ultimately put me on a trajectory to do this. And I never ran competitively when I was younger. I probably should have been channeled into a little bit more of a, a running program, but I was always playing sport, different sports, you know, from skateboarding to soccer, to tennis, to baseball, to basketball, to lacrosse, to, you know, rollerblading snowboard, like you name it. I played it. And except football, just because my high school didn't have a football team.

Speaker 2 (31:39):

So I always relied on running to help me in sport. But I feel very fortunate in hindsight that I never started really formal distance running until I moved to New York city around like maybe 24, 25. But I, I think that when I started getting into triathlon is when I started working with a lot more runners. And I think when I started distance running, that was around the same time and it's just a fun bunch to work with. And I think that initially I was overconfident and it got to be frustrating when I'm like, geez, this is a healthy person. Like I would send them out. I'm like, Hey, I think you're doing good. And they would come hobbling home. Or they would call him and be like, Oh, I blew up on that run. And I'm like, why are these people blowing up on these runs?

Speaker 2 (32:25):

Like I thought they were doing a good job. And then it just really forced me to stare at myself in the face and say like, what do I need to be doing to really help these people? And, you know, I started reading a lot of the research. I started spending time around runners. I started speaking a lot with this fellow Bruce Wilke, who was sort of like a savant with running who unfortunately has since passed. But I started to really get a handle on running and not only on running, but just the mindset of runners, how they approach training how they've sort of just been dismissed by the medical community. Because you're like, Oh, here's a runner here comes another crazy runner. And then you start to realize that runner, when someone tells you they're a runner, you don't have other athletes.

Speaker 2 (33:09):

When you meet someone, you know, you could meet someone, you could meet a world-class athlete and they may not come claim that the fact that they play a competitive sport professionally, or they play a professional sport until you talk to them, runners like I'm here, I'm a runner, you know? And so they really stuff, they go through an identity crisis. So you have to look at this from so many different lenses. You have to understand the performance demands of the sport. You have to understand, you know, just running communities. You need to understand that these people's identity revolves around their running. So they become fragile when they're not running. So I just loved the challenge of, you know, addressing all these different factors and and it helps that I, that I'm still training and racing competitively because I sort of go through, I think a lot of the same struggles and challenges that they face so I can speak to them.

Speaker 2 (34:01):

But I think that if people want to go, go in on running as a young clinician, coach running is having a moment go all in, right. We saw an uptick and running with the, you know, with the pandemic. And I think that if you're going to work with runners, you don't want to say like, Oh, I do general outpatient orthopedic, orthopedic rehab. It's like, no, my whole practice revolves around running. You know, people are like, they come to me because they know that, you know unfortunately I've had a pretty rich experience in terms of my, my didactic training. And, you know, when I was getting reps under my belt in New York city. So I feel like now I can look at things through a very global lens when a runner presents and we can troubleshoot most of the time, I'm seeing people for one, maybe two sessions. But I think that that running rehab is challenging in a lot of different ways, but if people have a, an interest go all in,

Speaker 1 (35:02):

I think that's great advice. And I also really liked that. You just mentioned, Hey, I'm not seeing runners three times a week for six to eight weeks. You know, I'm not, this is not how I'm, I'm, I'm building my practice. And I think that's important to let people know, because I think a lot of newer graduates or students might be thinking, Oh, this is going to be great. I'm going to be working with people several times a week for six weeks. And then they're all better. Not so much the case when it comes to running injuries.

Speaker 2 (35:31):

Yeah. And their runners just seem to perpetually get these niggles and aches and pains. But, you know, I, I, I think it's doing a disservice because if you bring someone in, if you say, Hey, look, I need to see a couple of times a week for the next six to eight weeks. You know, someone told me that I'm like, man, I must have something serious going on. So I just say, Hey, look I'm not concerned. Anything sinister is present. I want you to be sensible. You're around muddy water, but carry on. All right. In calling me if you need me. And I think that they're like, wow, I've had people reach out and are, you know, this person told me they were running five to six days a week and their quads were a little bit sore. I'm like, Oh, you're good, man.

Speaker 2 (36:10):

You don't need to see me. You know, I said, and I asked him some, some more involved questions, but I'm like, you don't need to see me. That's a really empowering message, you know, because the person's like, Hey, I'm here ready to pay you. And you're telling me that you don't want to see me. I, one of a guy who's become a good friend of mine. He was dealing with some hip pain. He was in a bicycle accident and he had some films in between x-rays MRR because of a woman who who's pulling out of a parking lot, had collide with him for whatever reason. And you know, and I got a lens, you know, I saw his power profile on his bike. I saw the lifts that he was doing because we were training at the same facility. And he's like, I, I need to come and see you for physical therapy.

Speaker 2 (36:52):

I'm like, no, you don't. I'm like, I'm watching you lift, man. You don't need to come and see for, you know, let's, let's just chat. If we cross paths here and he's become a very good friend, he, he always jokes. He's like, you're the only PT you've told me not to come and see you. He's like all these other people are like trying to get me in and get me on these programs and tell me, I need hip surgery and PRP and yada, yada. So, but you need to know that nothing sinister is going on the flip side of the coin.

Speaker 1 (37:19):

Right. And that's where experience comes in and confidence as a clinician comes in as well. And that takes time. So you're not going to be, so what I'm getting is if you want to be a running injury expert, go all in, read the research, do the things, take the classes and take time. It takes time and leave your ego at the door.

Speaker 2 (37:39):

Yeah. And I think the patterns will become, they'll become pretty straight away in terms of where runners are getting into trouble. You know, where are these injuries are manifesting? And, you know, I, I think that most of it is being disconnected or out of touch with your ecosystem and not laying down programs that sort of reflect your ecosystem and realize that target is always moving. Right?

Speaker 1 (38:03):

Yeah. Yeah. Excellent. Okay. Final question of our interview here. And again, it's, it's an easy one. So, so we talked about this ahead of time. This is an easy one. So, well, how do I even phrase this in looking at the profession of physical therapy, what can we do better to define what we do and kind of stake our claim on what we do as a profession?

Speaker 2 (38:37):

Yeah. I still am organizing my thoughts around this. I went into physical therapy because I thought it put me in the best possible position to help troubleshoot with people through a conservative approach. And I think that the challenge we have is physical therapy is a very tricky thing to define. And I think that where we're ultimately, and this is a quote from Jen Shelton, who was you know, in born to run, she was a young gifted ultra runner at the time. I don't know what she's up to these days, but she's she's a trip in all great ways, but she said physical therapists are your best friends in healthcare. And I think that we're well positioned to be the first line of defense because we're trained across such a broad through such a broad range. So, you know, you may see us working in cardiopulmonary capacity.

Speaker 2 (39:40):

You may see us working in wound care. You may see us working in a neurologic geriatric with geriatric population. You may see us basically with working with pro sports teams you know, pelvic floor. I mean, it's tricky when you have all these moving parts, but I, I don't think that we've defined who we are as a profession, to the extent that we need to. And and I think that's why a lot of other people end up defining us sometimes in good ways sometimes in bad ways. But I think that it's sort of like, you know, I'm in Seattle, I'm going to use a microbrew example. You know, you have run of the mill rehab. And I think some people lump physical therapy ended up, but physical therapy to me is sort of like a microbrew, right. We need to tell people what to think about it.

Speaker 2 (40:34):

We can't let them conjure up their own ideas. We need to really define who we are as a profession. And and I, I don't think we've done that yet. I think that we're, we're getting there, but I don't, I don't think we've done a really good job defining physical therapy. Cause if you ask people, you know, people are like, yeah, I've tried physical therapy and we know the same, the response, it's a heat ultrasound TheraBand. And it's always funny when people connect with me, they're like, this is so different from like what I expect to physical therapy to be. And I'm like, well, what did you expect it to be? And it was generally the response is what I just mentioned. And they're like, you just helped me troubleshoot and in sort of the seamless way. And, and that's what I think we do.

Speaker 2 (41:21):

We triage and troubleshoot. But we look at things through the people who I really respect in life. They're able to look at challenging situations through multiple lenses. And I think that that's how we're trained as physical therapists. And I think that that's why we're in such an incredible position to troubleshoot with people. So I don't know why you've got my gears grinding even more. And I, I, I think about this morning, noon and night is, you know, how do we better define our profession? So we don't let people conjure up their own ideas of what it is, because I think a lot of times if they've had a bad experience, that it becomes very skewed in physical just saying physical therapy doesn't capture it.

Speaker 1 (42:09):

Yeah. I agree with that. And so what can we do as a profession to change that? I agree it needs to be changed. And I agree we need to be the ones out in front talking about what we do and how we do it and why we do it. So when, when you think about that, what sort of ways can we be out in front and take control of the narrative?

Speaker 2 (42:33):

I mean, I think it needs to be orchestrated. And I think that that's, that's a major challenge right now. Because I think that is a profession we're a little bit more fragmented than, than one might think. So I think that we have to have a lot of people come together from different sectors of the field and have have a long, hard staring in the mirror and talk with each other to try and arrive in a definition for what we do. And I think it's a really challenging thing, but I think it's something that is very important, but I think also individuals like yourself where you start to represent the profession. You know, I try to do the same thing. I think that holds a lot of weight too. So I, I think it, you sort of have to take a multi-pronged approach.

Speaker 1 (43:23):

Yeah, yeah. So you have to take that 30,000 foot approach by having a lot of people from different areas come together and give that wide umbrella. But then from a micro position, individuals can also be out there and trying to, to change, to make a change.

Speaker 2 (43:40):

Yeah. And and I, I'm confident that we're going to do that. I don't know. I feel like I'm in my early forties now and I'm starting to become more reflective in life. Right. And and really think about, you know, a lot of things, one of which is a profession and, you know, I just feel like a pig in poop having landed in this profession because I'm such a diehard PT, but I also, like, I feel like the perception of physical therapy needs to change too.

Speaker 1 (44:09):

And, you know, I will say that I do see it changing slowly. I mean, this is a big ship to turn and I'm talking from a societal standpoint. And I say that because I see more and more in mainstream media, whether it be on television, print, blogs, podcasts, et cetera, that journalists are now reaching out to physical therapists. Whereas they would have reached out to a trainer, a chiropractor, a yoga instructor, or something like that when it comes to their articles on everything from training to, I just did an interview yesterday about pillows, you know? So it seems like, well, what, why would they reach out to a PT about pillows? You know, but it's nice that they are reaching out to PTs about things like that. And things about training and things about COVID rehab and, and long haul COVID patients, you know, physical therapists are now being part of that conversation. I'm seeing that more and more from main street, main stream journalists. So I feel like that's a good sign.

Speaker 2 (45:12):

Yeah, for sure.

Speaker 1 (45:14):

A good sign, for sure. And, and also showing that journalists are open to hearing from different groups. So I always say to physical therapists like contact your local newspaper, if you live. And, you know, I'm from a small town in Pennsylvania contact that local newspaper asked to write an article, ask to, you know, be a contributor, get onto your local news stations find, cause that's, that's the way the general public finds out, you know, on social media, there are some people like yourself and others that have great social media followings and are putting out great content designed for the consumer. But a lot of physical therapists on social media, probably myself included do social media posts for other therapists. So it's a little different, right.

Speaker 2 (46:01):

Yeah. And I think that's okay. And I think it's

Speaker 1 (46:03):

Okay. Yeah. But I think we, it could be broader.

Speaker 2 (46:07):

Yeah. I just, I think that when I work with folks and I, I'm not alone here, but when people start getting a lens into my thoughts on a particular situation, if they're like, Hey, I have some calf pain, they call me on the phone. They're like, they may be an athlete. And they're like, Hey, I have some calf pain, but a great example. This guy reached out to me the other day. And he was dealing with what he was told was an Achilles tendinopathy. And he was under the care of a physician and other rehab professional outside of the profession and I'll leave it at that. And when he came to see me, his primary complaint was he was starting to lose coordination in his left, lower extremity on the run. And he started to feel more disjointed on the bike. This isn't an Achilles tendinopathy.

Speaker 2 (46:54):

He may have symptoms that, you know, that are consistent, but that's not what's driving. So, you know, you start to think of, okay, well what could this be? You know, is there something going on maybe like from a differential diagnosis, you're starting to run through like, Hey, is he's telling you this, like okay, is this unilateral? Is that bilateral? You know, is there any loss of sensation, strength, power you know, is this, like if we just start asking a different set of questions, you know, could this be a runner's dystonia? Could it be something like multiple sclerosis, it could be ALS. So you have to, when someone says, Hey, I have this complaint, we're asking in terms of what's running through our mind and the questions we ask, they're very different. So I'm going to start challenging him from different coordination tasks.

Speaker 2 (47:44):

I'm going to take them through lower quarter screen. I'm going to get a lens into his running. You know, I'm going to understand how an Achilles tendinopathy would present if he's not having issues doing calf raises. And he's able to sit there and jump in place. I'm like, you're killing is, is pretty, pretty good, man. You know? So for whatever reason, there's this timing issue in his Achilles is probably seeing a different or an unaccustomed rate of loading that, that he's not withstanding from a timing perspective. So, you know, he's someone that probably ultimately needs to consult a neurologist, right? So why is no one told him that for a year? And they're telling him that he needs to do a more aggressive form of scraping and he's a candidate for a PRP, excuse my language, but that. Right. So this is where our role is just so critical because we sit, we spend an hour with people or at least, you know, a lot, and we, we can sit there and troubleshoot with people and really get them into the right hand. Why is no one ever he's like your assessment makes so much sense to me. And so many examples. Yeah,

Speaker 1 (48:51):

Many, many examples. Well, Chris, this was great. What a good conversation. I think there's a little bit of got a little bit of everything in here, and hopefully we answered a lot of w V a lot of the questions that you get on, on a daily, weekly, monthly basis. So thank you so much now, where can people find you?

Speaker 2 (49:11):

I can't tell you no,

Speaker 1 (49:13):

I'm going off social media now.

Speaker 2 (49:17):

Instagram is good. I'm just at Chris Johnson, the PT, and I'm in the process of revamping my website and that should hopefully be done at some point in the next couple of weeks. And and that's gonna really just, I think, make it easy to understand what some of my offerings are and how to sync up with me. And yeah, for folks, if, if you want to sign up for a crazy newsletter please join my newsletter. It's a little bit of reverence. So I'm preparing it now in, in good ways. So,

Speaker 1 (49:49):

And how can they sign up for your newsletter? That'll be on the website and Chris Johnson, pt.com or Zara and PT.

Speaker 2 (49:56):

Chris Johnson, pc.com. Yeah. Going back to my roots,

Speaker 1 (50:01):

Go keeping it simple. Right? Well, this was wonderful. Last question, knowing where you are now in your life and career, what advice would you give to your younger self now that you're, you're pondering, you're pondering life in your early forties.

Speaker 2 (50:18):

Oh, stop taking yourself so seriously be present with people, equally people, power, power, your phone off, and and be present with people. And for folks who are who are coming to see you understand that a lot of what brings about changes in what helps people are these non-specific effects, you know, during a clinical interactions. So don't feel like you need to have this gnarly didactic knowledge. That's going to come in time by continuing to read the research, spending time around other mentors or clinicians. You respect taking courses from them. But if you can just be present and engage with someone, take a genuine curiosity in their situation, that's going to do wonders and and yeah, take the pressure off yourself.

Speaker 1 (51:07):

Excellent advice. Excellent. And I thank you so much again, Chris, for taking the time out. And we will see you in a couple of days next in a week or so for a round table discussion, which I also think will be phenomenal. So thank you so much.

Speaker 2 (51:22):

Yeah. Thanks again for having me on Karen and keep up the great work. It's fun to, to just sort of follow your, your journey and calling me if I can do anything to support you.

Speaker 1 (51:31):

Thank you so much. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and smart.

Mar 15, 2021

In this episode, we have Tom Goom with us again to join us with our running injuries and running rehab talk this March. Today we will be talking about acknowledging types of persistent pain in our athletes or runners.

He talks about the bigger picture on persistent pain and its other connections, differentiate this persistent pain versus series of acute flare ups, where we should focus the treatment, and navigating injured athletes return to their sport and many more.

 

Key Takeaways

  • we mustn't lose sight of the bigger picture. And actually, I think sometimes we do need to acknowledge that it is more of a persistent pain state, and not necessarily a series of flare ups of acute injury.
  • Gritting your teeth and pushing on through isn't always the right answer… we do need to know when we need to back off a little bit.
  • Focus on getting you well and ready to race rather than rushing you to get through a particular event when you've got a whole life of running ahead of you.
  • Try and see if you can recognize when you are looking at a more persistent pain state and to try and really get to know that person and the bigger picture and what's driving that

Suggested Keywords:

Pain, athletes, running, persistent, bigger picture, acute injury, symptoms.

 

More about Tom Goom

Tom GoomTom is physiotherapist and international speaker with a passion for running injury management. He has gained a worldwide audience with his website running-physio.com and has become known as The Running Physio as a result! Tom remains an active clinician committed to providing high quality, evidence-based care.

Social media handles:

Twitter: @tomgoom

Instagram: @running.physio

Website: Running-physio.com

 

Resources:

Running Injury and Rehab Webinar

NetHealth Webinar

 

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Read the Full Transcript Here: 

Speaker 1 (00:01):

Hey, Tom, welcome back to the podcast. I'm excited to have you on today.

Speaker 2 (00:06):

Thanks for having me back. I really enjoyed it. Last time we took proximal hamstring. Didn't we last time it was a good chat

Speaker 1 (00:13):

We did. And now this time you are part of the month of March and this month we're talking all about running injuries and running rehab. So what we're going to talk about today is persistent pain in these athletes. And I know this is something that you're seeing more and more of. So let's dive in what let's talk about as physical therapists or physiotherapists. Do you feel that we're acknowledging these types of persistent pain in our athletes or in our runners? Or are we just thinking, Oh, well, you know, they have this tendinopathy or this strain and it's just keeps recurring. It's just like a, it gets better and then becomes an acute injury again or this back pain. Oh, same thing. It, it kind of goes away and comes back. So what, what is your opinion on that? Are we acknowledging persistent pain in these athletic populations?

Speaker 2 (01:20):

Yeah, that's a good question. I think maybe we D we do look at it a bit more, like you're saying, we just kind of see it as a sort of repeated acute injury may be large rather than seeing it as a persistent pain problem. And I think that's because in part, when we see people with persistent pain, part of our, of our advice and our management is for them to be active. So if you've got someone to come see seeing you, that is actually already sporty, they're already active that, you know, you kind of think, well, what else needs to be offered here? And I think sometimes we don't really think about the sort of psychosocial practice in sporty or active people, because they're not obviously fear avoidance, especially if they're keeping their sport going. So we, we tend to go down the route. That's perhaps a bit more biomedical isn't now we looked at biomechanics, we look at strength and conditioning and these all can be valuable, but we mustn't lose sight of the bigger picture. I don't actually think sometimes we do need to acknowledge that it is more of a persistent pain state and a, not necessarily a series of flare ups of acute injury.

Speaker 1 (02:24):

How do we differentiate this is persistent pain versus a series of acute flare ups.

Speaker 2 (02:30):

Yeah, I think there's going to be an overlap between those things. We know that people with persistent pain that isn't necessarily stable with change can change quite a lot. People go through periods of quite severe flare ups as well. I think it's about sort of looking at the bigger picture and looking at the connection between things like pain and load. So in, in an acute injury situation with something like tendinopathy, quite often, there is quite a clear load pain relationship. It hurts when I load it. It doesn't hurt when I don't, I'm in a more persistent pain state. We might actually see that that relationship becomes a lot more blurry that the pain may well flare up when load hasn't changed or the pain may remain present. When there isn't a great deal of loading going on. So we start to see a bit of a breakdown of that connection between load and pain. And perhaps you start to see other aspects influencing symptoms, you know, lack of sleep, stress, fear, et cetera. We see other sort of types of behavior creeping in there as well around maybe avoidance coming in. So now they are backing away from their sport. So I think that's something we need to have a lookout for particularly that lack of relationship between load and pain and then exaggerated pain response as well.

Speaker 1 (03:48):

And when we're looking at these more sporty athletic people are runners how do they differentiate from say maybe our non sporty or non-running population?

Speaker 2 (04:01):

I think that there will be some definitely some, you know, some crossover between different people in different groups. And I really would, you know, w I use the term athlete, but I, I have a really broad definition of that. Someone, someone who wants to be regularly sporty and active fits that category for me. So I'm not necessarily necessarily when I say athlete referring to an elite athlete, competing at a high level, this, this can be people that want to be running three or four times a week, that really comes in that category too. But I think they can have, you know, similar concerns to someone that's not sporty around pain and damage, for example. So they might have similar concerns there. They might both have quite high life load which is a term I quite like this, somebody mentioned in one of my courses recently.

Speaker 2 (04:49):

So, you know, this is where you've got lots of stress going on with, with work and family life this kind of Highlife load that plays upon your pain. And they may also both groups have poor recovery. So, you know, athletes may not be brilliant sleepers non-athletes may not be brilliant. Sleep is too, they might not get much downtime much emotional recovery. So there can be quite a lot of of overlap. I think perhaps where they differ is they may have quite different goals. So I think it's, I see Mike might have wanted to go back to running half marathons, marathons, ultra marathons, and beyond potentially. So that might be quite a different goal to non-athletes that want to be more functional with day to day activities or lower level activities, perhaps like walking distances and perhaps something that we do see in athletes.

Speaker 2 (05:38):

That can be different though. Again, we see this in non-athletes too, is they may be a bit more inclined to push through pain. Most of us that have done sports at any level will know that pain is quite often a normal part of sport. And to some degree we do have to work with it. If, if we stopped every time, something we we'd never really, really do sport for very long, but this isn't necessarily always the right approach, gritting your teeth and pushing on through. Isn't always the right answer. And it's not always obvious that that's the case, but sometimes actually we do need to know when we need to back off a little bit. I'm an athletes particularly really highly driven athletes may not be quite so good at recognizing when they need to back off.

Speaker 1 (06:21):

Yeah, that's for sure. Especially if, like you said, they've got this goal of, I want to run a half marathon and marathon or an ultra to be able to, to have to abandon that goal due to pain, persistent pain or injury is, can be very devastating. Right. So how do you, how do you navigate that with your athletes and with your runners, especially with a more persistent pain, how do you navigate that? Very, I would say very sensitive goal or topic with these, with these runners or athletes.

Speaker 2 (06:58):

Yeah. It's not, it's certainly not easy. I think it's it can be challenging. I think wherever possible, we want to try and invite them to review their expectations and goals. So that it's not necessarily us being prescriptive and saying, this isn't realistic, or you're not going to achieve this, but if we can help them have slightly more fluid expectations of themselves and slightly more realistic goals, the ideal world then is that they then come around to the idea that perhaps this marathon they've got on the horizon, if it's not realistic for them, that they can set a different goal with it. And th this is one of the things, again, sometimes with, with higher level athletes, certain personality types is that being, being able to persist is a good skill, a good good thing to have, you know, and you need it when you get to sort of modulating 19 in the marathon and your legs are heavy.

Speaker 2 (07:50):

And, you know, you've got to keep going to hit your target. Tom, you need that in the time. You've got to have that level of persistence. And, and for that to be at least a little bit rigid because you you've got to, if you're going to achieve that goal, you've got to keep going, but to keep going at a certain time. So at times that rigid persistence is useful, but if you apply that all the time when circumstances are changing and your expectations are rigid, it doesn't really work very well. So for example, with the situation's changed, you're now in quite a lot of pain, you're struggling with day-to-day activity. This marathon is, is a lot closer now than, than we would, would like it to be. Ideally we have to try and encourage them to be a bit more fluid there and say, okay, well perhaps what we need to do is change that goal a little bit.

Speaker 2 (08:37):

Let's push it a little bit further down the line, give ourselves a bit more time and helping them see the positives of that decision can help. So you all often say to them, well, you know, if we can, if we can move this, you know, a few months down the line or let's go for a half marathon or a 10 K, it's going to take the pressure off you. You're not going to feel like you're constantly chasing your tail because you're trying to catch up with the training. You're not able to do. You're going to be able to focus on the rehab side of things. You're not going to feel so much pressure, and we can really focus on getting you well and ready to race rather than rushing you to get through a particular event when you've got a whole life of running ahead of you.

Speaker 1 (09:15):

Fair, very fair. And, and I think that's great for clinicians to hear, because I think that wording is very sensitive to the, to your patient and also gives them the goal gives them that aspirational goal that they can eventually get to. So I think that wording was great. Thank you for that. Now here's a tough question. And, and I don't know all the answers to this one, but in your opinion, and in your experience, what do you feel may be driving persistent pain in these runners or athletes?

Speaker 2 (09:53):

Well, we had us, that's a good question. Isn't it? A million dollar question and I would acknowledge I don't, I certainly don't have all the answers with this, and I don't think the research does yet either because it's an area, you know persistent pain in athletes isn't brilliantly well researched. So I think there's a lot that we can, we can learn about this, but there's a few things that would, I think, would spring to mind here. So I think beliefs are important. So and this is, can be beliefs around what the pain means. And then they, you know, what the pain means is if it's, if it's a sign of damage if they think it means they need to stop their exercise altogether, how they feel their body's gonna respond to exercise when they have pain that continuing to run, for example, will that be more harmful for them?

Speaker 2 (10:38):

It can be around beliefs around training too. A lot of people will feel that unless they're pushing themselves a hundred percent in every session it's not worth doing. So that can be quite difficult then for them to pace themselves and modify their training because it kind of all or nothing really. I think one of the things that I'm realizing more and more over the years working with with people and athletes is if they are quite heavily reliant on the sport for their mental wellbeing, then that can have a bigger impact too, because they might be using that, that sport to help them with their mood or anxiety or depression. So if they can't do their sport, it increases the impact of the injury. And I think it increases the fear associated with that because they're losing this coping strategy, they're losing physical fitness, they start to worry about the future.

Speaker 2 (11:27):

And I think maybe that links in with pain science, because it increases the threat that this injury has, and that has the potential then to have a knock on effect in terms of the pain and increasing pain severity and things. And a lot of these things are interlinked. I think training behaviors go hand in hand with that, you know, tending to push yourself hard all the time, boom, or bust, things like that. I think there's also a lot of stuff that we might not necessarily, we see like negative messages from others. So other other athletes, sometimes coaches, health professionals, unfortunately I'm so pumped. Sometimes we can be responsible for that life. I've treated lots of runners. Who've been told that they should never run again, for example, by various different health professionals. So we need to be aware of that. I think Google might have a lot to answer for I don't, I'd love to know. I think you've been Dr. Google doc to goo exactly. I don't, I don't know many situations where someone's been worried about something and put it into Google and felt better.

Speaker 2 (12:31):

What you find is the worst case scenario from it, which does amplify, you know, it does amplify people's worries. And that's actually something as a clinician, I would check in with your patients about what what'd you do when you worried about this? Did you go and Google it? What'd you find when you Google it? How does it make you feel? Because quite often they'll find the worst case scenario and I feel a lot more worried. So we want to discourage them from doing that, come to us. If you've got questions about your care, that's what we're there for really. So there's a lot of things that also impact of the injury, perhaps not being fully addressed. So you know, looking beyond the kind of physical impact of the injury, but the loss of the social side of the sport, the loss of their identity around sport the effects, as we said, it might have on mental health.

Speaker 2 (13:18):

There's lots of other things that go alongside the injury that often don't get talked about. And if they're not addressed, I think they can amplify it as well. And then the final thought I would add to this is perhaps if not had really particularly appropriate rehab it may be, it's been very focused on pain and not really focused on function in maybe that it's not been progressive and it's not really looked to address their rehab needs, lots of stretching and foam rolling and, you know, ice and, but no real kind of planning and progression in that.

Speaker 1 (13:50):

Okay. So that leads me to the next question as clinicians, where should we be focusing our treatments? Good segue there.

Speaker 2 (13:57):

Yeah. I like the connection. You've done this before, I think. Yeah. Yeah. I think, I think he's got to start in the first session with trying to develop an understanding for that person, if we can help them to, to understand their injury. And it takes time to build on that, but really make that part of that first session and give them the opportunity to share their story in that first session and also to air their concerns. You know, I really think we want to make the focus of these treatment sessions on the patient and their needs, not necessarily a kind of a list of things we need to tick off to do in a session because there is actually research showing that quite often, people whose needs aren't really identified we can be quite dismissive as clinicians. So we want to get in there right in the early, early stages and say, you know, what would you really like to, to from, from your treatment?

Speaker 2 (14:52):

What are your concerns? What are you particularly worried about here? What would you really like us to help with? Because we can start with that. I think that helps us form a good, strong connection. We can really help them understand the injury and build on it from there. I think that alongside shared goal setting, I think big PA plan of I'm a big fan of collaborative working you know, so you're working towards their goals. How can we help them achieve those goals together? And again, get a good idea of those in the first sessions. And it is part of the reason I really love working with rhinos is because many of them have a goal. Even if it's just, they want to get back to running 5k, you know, great, brilliant. It's a measurable goal. We can start the planning towards that pretty much from, from session one.

Speaker 2 (15:37):

And then we do want to have some progressive rehab because they're all gonna be psychosocial factors. In many cases, we've talked about, you know, beliefs to address perhaps poor recovery load management to talk about that quite often, there are physical needs as well. So we need to address those if there's a lack of strength or control or range and address them in a progressive way, as opposed to just loads of stretching and rolling, and then we can start to do a graded return to sport when, when they feel like they're physically and psychologically ready to engage in that.

Speaker 1 (16:10):

And what are some, some examples that maybe you can give of the types of diagnoses or the types of patients that you're seeing coming to you with persistent pain, you don't have, we don't have to go into, you know, the specifics of how you treat XYZ, but what are some things that you might be seeing in your patients coming to you with persistent pain?

Speaker 2 (16:36):

So I, I do specialize to some degree in tendinopathy. So we will see a lot of patients with long-standing tendinopathy lots of patients with proximal hamstring tendinopathy, because that's particularly the area I've researched in. But it will say Achilles tendinopathy issues as well. See people with low back pain and hip pain as well, falling into this category people with persistent patellofemoral pain syndrome persistent bone stress injuries, like medial tibial stress syndrome. So it's do see quite a mix. And, and many of those will have been treated first and foremost in quite a kind of biomedical model. I think,

Speaker 1 (17:16):

Yeah, so I think I just wanted to ask, cause I think it's important that clinicians out there hear like, Oh wait, you can have a persistent tendinopathy problem. You know, you can have like, Oh, I, I wasn't aware. I thought, you know, after let's say proximal hamstring after a year of rehabbing, if that kind of comes back, Oh, it's probably just like a muscle strain. It's probably not that tendinopathy again or, or not again, but it continuation of that. Absolutely. Yeah. And

Speaker 2 (17:50):

To give you a clinical example then, because we talked a little bit about how the connection between load and pain can be blurry about how that may, we may see an exaggerated response. So to give you an example of that proximal, hamstring, tendinopathy patient that I've been working with who will not be able to sit for more than maybe 30 seconds because that will really cause a flare up in their symptoms. Now we can see then that's a, that's a really exaggerated pain response. And the average person sits for somewhere around six to seven hours a day. So not to be able to tolerate even 30 seconds of sitting because there's pressure around that that tendon is, is an exaggerated pain response. And that person's pain will fluctuate not necessarily in line with load. So there'll be days where her symptoms are much worse and she doesn't really know why it's not because she's run a long distance or done anything different.

Speaker 2 (18:53):

The fluctuations in activity levels might be small in the range of a few minutes here and there. And yet the pain response is really exaggerated. And again, I talked about sort of beliefs and things go going into, you know, going into this area. And when we talk to this particular person about her beliefs, you can see she's very concerned that sitting damages the tendon and therefore that adds to the threat value associated with the city. She's very fearful of sitting when you ask her to do it, you can see she's really reluctant, but also we need to acknowledge why it really hurts. It's really hard for a long time. So there should be no judgment and our pie, we should be reckless. Yeah. This is really difficult. This is having a huge impact on this person's life. Can't if you can't sit down and even to have a cup of tea or to watch a move at the end of a long day, what should we eat dinner? Like that's big. So I think we have to recognize that as a persistent pain picture and with aspects of tendinopathy in there that we can manage, but just seeing it, like you say, as, Oh, it's just another flare up of the proximal hamstring tendon. We were missing that bigger picture, I'd say.

Speaker 1 (20:01):

Yeah. And that was a great example. Thanks for that. And now, you know, when we talk about running, we talk about athletes. So one thing they all want to do is they want to return to their sport. So can you talk to us a little bit about how we navigate that, how we prepare these people to return to their sport and what that, what that sport may look like?

Speaker 2 (20:24):

Yeah. I think, I think maybe we start, if we can, by seeing if we can reduce irritability a bit where possible. So if we think back to that lady, I was talking about Verrier to boost symptoms at the moment. So if I go straight into a greater return to running, I think that's probably going to be a little bit too much to start with. So in many situations we may we say, okay, let's see what we can do to reduce the symptoms and irritability helping someone understand their pain and that it's not a sign of damage can help helping them work out a list of things that may help to reduce their pain. Maybe particular exercises that help simple things like, you know, using heat or ice if necessary, but trying to give them strategies and work with them. So they've got a little bit of a list of things that can turn that, that pain volume down a little bit, and we're placing them in a bit more control, reducing that threat value.

Speaker 2 (21:17):

And then we can start to work towards that graded return to sport. And again, if we want to plan together because we really want the person to be in the driving seat and us maybe just helping, you know, being a bit of a satnav along the way to keep them on track. So we've had this recently really lovely runner I've been working with who in the first session said to me you know, what she'd like to do is first of all, build some strength then increase her cardio fitness by bringing in a bit of cycling and swimming. Then she wanted to bring in some, some impact and some plyometric exercises before doing a graded return to running. And I thought immediately, brilliant, this is fantastic. This person has a great plan.

Speaker 1 (21:57):

And they find this woman,

Speaker 2 (22:00):

I met wonderful one, and this, this is someone with a lot of experience in sport. Who's also studied a sport of science, so knows the topic really well, but that's a fantastic plan. Let's go with that plan and just help the person with their plan there. So, and we might follow quite a similar plan to that for, for patients. You know, we try and calm things down where we can, we build some strength to try and address some of their physical needs. We bring in some cardiovascular exercise to build some fitness up. We start to introduce impact because it can build impact tolerance, but it also is often a a way of developing some power. So perhaps some plyometric exercise to restore power, which is often neglected in rehab. And then we start to do a graded return to running and that's then where we got to try and work with them around their goals and also work with them around pain. And that can be a bit of a barrier.

Speaker 1 (22:53):

Yeah. And so how much pain is acceptable? How much is too much? Yeah.

Speaker 2 (22:59):

Like our pain scales you know, sort of scoring pain out of 10. And I, I would say there's actually quite a few studies that have done that quite successfully. So I think there's some value in that. But what we've talked about with these pain groups is that the connection between load and pain, isn't very clear and the pain response is exaggerated. So if we're guided purely by pain, we are going to struggle a little bit, I would say with these patients. So I would tend to say that the patient needs to decide what they feel is acceptable, and we provide some, some guidance. And we need to try, and if we can look at longer term trends, then now patients quite understandably might get very focused on day-to-day pain fluctuations, but it's actually more the long-term in pain over the, over the weeks and months that we're a little bit more interested in.

Speaker 2 (23:49):

And we also perhaps need to recognize that there are almost two slightly separate goals here, improving function and improving pain. If you're seeing improvements in function and pain, hasn't changed, that's still a win because you're doing more. In fact, that's quite good when, because you're doing more and your pain doesn't get worse, but patients often won't see that as a win because understandably they may want that pain to go away, but we can often folks first will say, okay, well, let's start with what you feel is a manageable level of exercise. Let's work with it consistently. First of all, and then gradually build as long as you feel the pain is, is an acceptable level. And sometimes what we tend to see then is over time, they're able to do more and more, and then gradually that pain does subside because they're able to do more.

Speaker 2 (24:39):

They're more confident they're starting to get their life back. The threat value of the pain is starting to go down, but that takes quite a long time. So I think quite often, wherever possible, placed the focus a bit more in function and just save the patient a few phone that feel that it's manageable. It's acceptable. This is fine. If it's too much, if it's not manageable, we'll dial it down a little bit, but we want, if we can to stay consistent with exercise, because otherwise we're going to have a lot of beam, bus tear will build you up and stop they'll drop and stop. We want to just see, can we keep you ticking along, even if it's at quite a low level

Speaker 1 (25:13):

And do you have your patients keep a log or a journal or some way so that they can see, Oh, I was doing this. I started with Tom on March 1st and here it's April 1st. And this is what I was able to do Marsh. Now this is what I can do in April. My pain's around the same, but look at how much more I can do, or maybe my pains a little less. Or do you, how do you keep track of all that? Do you give that to the patient to help them with their own sort of locus of control? And are you using the pain scale? Are you saying well, what is your pain March 1st? Let's compare that to April 1st. Let's compare that to March 1st.

Speaker 2 (26:01):

Yeah. I would try and see if we can monitor that goal activity because it's important to be able to see that they're improving and they're progressing towards their goal. If you've got quite a specific goal, like running a 5k in order to get that, you've give it a C you know, how, how far you're able to run. And that's the simplest question. How far can you run now? But that can be it could be steps for day. If someone's wanting to build up their walking, it could be minutes rather than miles with any activity, really. So I think it's a good idea to try and monitor what people are doing. I do, I do use the pain scale a little bit. It depends on, on how comfortable the person is with it, whether they like using that. I tend to perhaps make it a little bit more simple and just say, is your pain mild, moderate, or severe sort of break it down into those into those three sort of different categories, really.

Speaker 2 (26:58):

But the thing is with pain is there's so many different aspects of it. Are we talking about average pain day to day? We talking about peak pain. What did the pain get up to is it's at its highest, we're talking about pain frequency. So how often you've had that pain during the day, are we talking about pain distress, which I think is almost a separate thing. How distressing are you finding that pain? So if you're especially worried about it, that pain often will be more distressing, even if the severity isn't necessarily higher. Do you see what I mean? So I think, I think where possible we focus on the golf function and we, we try and take that focus off pain a little bit because as well, you know, if patients are monitoring it every day, that drawing that focus on pain every day, and they're asking ourselves, how much does it hurt?

Speaker 2 (27:47):

Even some patients have no one used the term morning MRI. I used to get up in the morning and do it, do a sort of stretching test on his Achilles. That was what he called his morning MRI to test the Achilles out and see how he thought it would be that day. We don't really want to do that. To be honest, we want to focus on what your valued activities let's really try and bring them back in, build those up and keep a kind of a little casual, casual notice of pain, let pain tell us if it's too much, if it's breaking through, into your attention and in telling you it's too much, that's probably when we need to act, if you're looking for it, if you're, if you're kind of really questioning, is it worse today? I'm less concerned about it.

Speaker 1 (28:26):

Got it. Yeah. So you don't want them to, you don't want your patients to be waking up and be like, wait, do I feel, do I feel more pain today? Weight you're you're well aware that you have pain.

Speaker 2 (28:38):

Yes. Yeah, absolutely. I think that calling is focusing on the pain as well. It's quite, it's quite a normal thing to do. I think we've kind of pathologized it a little bit. But I think actually it's understandable for people to do that. There's another layer of context around the pain and what it might mean and what that might mean for your, for your future. So I'll give you an example from myself. So I have I have psoriasis and I have nail bed changes with psoriasis and that increases the likelihood of you developing cirrhotic arthritis. So a couple of weeks ago and surfing on Twitter and someone posts a link to a research paper that says new studies shows link between nail bed changes and severities, psoriatic arthritis. And I start thinking, yeah, my fingers are a bit sore today, you know, and that's one of the areas where you can get psoriasis, arthritis, changes in the joints and the fingers.

Speaker 2 (29:41):

And then I throw it comes back a little bit later that day and for a few more days afterwards, and now I'm sort of noticing like achy thumbs hands are a bit stiff in the morning. And if I allow myself to keep focusing on that and measuring that and worrying about that, it would be understandable that that could become really quite a worry for me, because then you think, well, is it cirrhotic arthritis? That's been, that's known to actually affect the joint and perhaps even damage the joint. And if I've got nail bed changes, that means it can be very severe. And what impact would that have on my life? And these are all just normal things that we have as, as people, as health professionals that know quite a bit about pain. So I think we can acknowledge for someone who's not a health professional.

Speaker 2 (30:25):

There's probably a lot of that going on, particularly the pain's been there a long time and pains is a real nuisance because it can, you can kind of like stop worrying about it. And then, then you have the pain and it kind of reminds you and goes on about you and that can start worrying prices over again. So it is hard. And I think sometimes it's health professionals, we think like, well, I talked to them about their pain and I reassured them that pain doesn't damage tech. But that if you think that that is enough to wipe out that concern, we are. Yeah, but we may need to be consistent with that message several times. And we might need to encounter that worry coming up several times and to try and help someone contextualize their symptoms and to see that not what they're fearing, but what really is going on.

Speaker 2 (31:18):

And to look at a bit the now of how symptoms are. So with my hands, you know, I don't have any of the classic signs of cirrhotic arthritis. I don't have swelling. I don't have a loss of joint range. I've actually been tested for psoriatic arthritis and it was negative. So it was trying to contextualize it and see the reality is I've just turned 40 and I've got slightly stiff fingers. That's the reality. So let's focus on the now and what is real for you now and not what you fear might be coming up in the future.

Speaker 1 (31:47):

Yeah. And that's something that I say to myself every time I wake up and my neck's a little stiffer sore, you know, my upper back feels a little sore instead of my, what I used to do is, Oh, okay. I better not go to work today. I better just relax. Let me get a heating pad. Let me just, I don't want to do anything. I should probably just lay down. And these are all the things I used to do. And so now when I wake up or if I do have a flare up of neck pain or something like that, now I'll just say, okay, I know nothing is seriously damaged. I have the MRIs to prove it multiple. And you know, these are just things that I have to continually say to myself. And I think I'm pretty well versed in, in the science behind pain and, and even working with people with persistent pain. I mean, I do it every, but even for myself, I have to continuously sort of recite these mantras to myself in order for me to get through the day when I have a little bit more discomfort or pain. So the struggle is there, you know, and I think imparting that and telling that to your patients, especially your runners with persistent pain. I think that can be very powerful.

Speaker 2 (33:07):

Yeah, absolutely. And, and recognizing, as I said, the bigger picture of knowing the person and, and the things that make them make up them as a person. And if they are, for example, running to their mental wellbeing, what, what, what is the, the thing that, that they're running to help? And how does that link to their pain? Are they running to help anxiety? In which case are they someone who is perhaps going to struggle with negative thoughts about chain, and they're going to be drawn into ruminating about those negative thoughts about pain, and they're going to be looking for reassurance that those thoughts, you know, jumping on Dr. Google, I'm finding actually it makes it worse because they see all the negative outcomes they're afraid of laid out on a web page. So if they are someone with, with that, then they, they may need more, more help with that. They may need to, you know, you may need to work with a mental health professional to help them work with those thoughts and to find ways perhaps to not get drawn into that ruminating pattern and to look for other coping strategies, we show it to them. The long-term can be useful because they're less reliant and upon the sport, because they actually learn perhaps a slightly different relationship with that, with their thoughts and from that, then can help that their mental wellbeing.

Speaker 1 (34:22):

Yes. I agree with that. And Nelson, before we kind of wrap things up is there anything that we missed or that maybe we flew by a little too quickly that you want to elaborate on? And if not, what would be your best advice to a clinician that is working with AF that is working with people with or athletes with persistent pain problems?

Speaker 2 (34:54):

I think in terms of things we might have missed, I just would say that there's a, there's a nice paper from Halon as torn in 2017 that's well worth a look, which is, is actually looking at things a little bit more in terms of pain in athletes. And there's, there's quite a nice quote in that that I'll just briefly read now if that's the case. So they say even low level inflammation, for example, linked to sleep deprivation, ongoing stress and load exceeding the tissues capacity can reduce the athlete's mechanical nociceptive threshold sufficiently to make normal mechanical demands of sport painful. So that sort of Lincoln into this bigger picture stuff saying here, actually, if we're not recovering enough, or the load is excessive on the tissues, it's actually going to have an effect potentially on sensitivity know nociceptive threshold.

Speaker 2 (35:49):

So this is where it's quite important for us to see the bigger picture. They also say in that paper that the, the link between tissue change and pain is thought to reduce over time. So if you've got someone with very persistent symptoms, years' worth of pain, you should already perhaps be suspecting that this is probably not just going to be driven by the tissues. I mean, when is there ever a situation where pain is, but, you know, it's probably going to be a bigger picture here that we need to identify. And I think that's probably one of the key messages to take from what we've talked about. Hey, really, you know, you, you start right with the first question is perhaps just to, to try and see if you can recognize when you are looking at a more persistent pain state and to try and really get to know that person and the bigger picture, and what's driving that because then I think you're going to get better results with them and then try and see if we can work gradually towards their goals and just keep them on track with it and give it time.

Speaker 2 (36:45):

It will take time, you know, this, the patients I'm seeing, we're looking at at least six months, probably a year of working together because there's so much to work through. I think we sometimes say, Oh, we reassured them about their pain. Give them some exercises away. They go, it's not really like that. You know, it's going to be lots of ups and downs. We're going to have to stick with them for a while and just keep chipping away, but you can get some really good results with people and you can get them back to the sport that they, that they love. And that can be a really, really big thing for them.

Speaker 1 (37:13):

Yeah. that's a great way to to end our conversation here. One, one question, what was the, who's the author of the paper from 2017?

Speaker 2 (37:26):

I think it's Hamline at all. I believe it was in the but I can find a link to it for you to put in the, in the show notes, if you would.

Speaker 1 (37:36):

Perfect. That would be great. And I will look it up as well. But thank you for that. Now before we finish our conversation, where can people find you? If they have questions?

Speaker 2 (37:48):

Yeah. Come and say hello on on Twitter, I'm at Tom goo or an Instagram ad running dot physic. Also I've got my website, which is running-physio.com. So yeah, come and say hello, ask questions and things. So it's good to chat.

Speaker 1 (38:03):

Perfect. And last question. What advice would you give to your younger self knowing where you are now? And I know we've, you said this before is, and I have to say something different. Now you get a chance to give yourself a second piece of advice.

Speaker 2 (38:16):

Oh, good question. Oh now that I'm thought 14 spending a bit on top, I'd, I'd say really enjoy your hair while it's there. Yeah. now I don't know, in all seriousness, I think I would probably sort of say you know, really make sure that you kind of value value, that things are important in life friends and the family, you know, always, always try and put those things first because ultimately they're, they're the things that are most important for us. And I think a lot of people already know that and I've learned it, especially during COVID, but I think there's a lot to be said about, you know, focusing on family and friends and things first you can still have a very fulfilling career and things, but I think that that's the important, the important stuff. That's what makes, makes life great. Really

Speaker 1 (39:08):

Excellent advice. Well, Tom, thank you so much for coming on to the podcast again and sharing all this great information with us. I really appreciate your time. Thanks for having me back here. And it's been really good pleasure, pleasure, and everyone. Thank you so much for listening. Have a great week and stay healthy, wealthy and smart.

 

Mar 8, 2021

In this episode, Founder and Host of Entrepreneurs on Fire, John Lee Dumas, talks about the 71000-word, 17-step, 273-page success roadmap that is his first traditionally published book.

Today, JLD talks about the launch of his book, The Common Path to Uncommon Success, and we get to hear a few of the 17 foundational steps to success, and we hear about identifying what we want to achieve, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “The online experts in this world... will lead you to believe that the path to uncommon success is “secrets”, “hidden”, maybe it’s “complicated.” It’s none of those things. All of them [successful entrepreneurs] have taken what has turned out to be a very common path to uncommon success.”
  • “Freedom is one simple word, but it’s so hard to attain.”
  • A few of the 17 steps to uncommon success:
  1. Identify your big idea. “So many people are living and acting in a weak, pale imitation of somebody else’s big idea.”
  2. Discover your niche. “Identify, within your big idea, an unserved opportunity.”
  3. Create your content production plan.

 

Suggested Keywords

Uncommon Success, Roadmap, Process, Entrepreneurship, Wealth, Prosperity, Freedom, JLD, Entrepreneurs on Fire,

 

More about John Lee Dumas

John Lee Dumas John Lee Dumas is the Founder and Host of Entrepreneurs on Fire, an internationally-acclaimed award-winning podcast with over 1 million monthly listens and 7-figures of annual revenue. To date, he has interviewed over 3000 of the world’s leading entrepreneurs, including Gary Vaynerchuck, Barbara Corcoran, and Tony Robbins.

His first traditionally published book, The Common Path to Uncommon Success, is an amalgamation of the lessons learnt from the over 3000 interviews he’s done.

Get the book: https://uncommonsuccessbook.com

 

To learn more, follow JLD at:

Facebook:       John Lee Dumas

Instagram:       @johnleedumas

Twitter:            @johnleedumas

YouTube:        John Lee Dumas

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

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

 

Read the Full Transcript Here: 

Speaker 1 (00:01):

Hey, JLD welcome to the podcast. I am so excited to have you on

Speaker 2 (00:06):

Fired up to be here. Thank you for having me and listen. You've got a beautiful cat. I've got a beautiful dog. They might make a Paris's in this interview who knows

Speaker 1 (00:15):

It is possible. And I have to say, this is like a full circle moment for me, because I have always as a podcast or looked up to you for your podcasting, for your show entrepreneur on fire 3000 interviews. I mean, that is, that is amazing. And, and for all the listeners out there that is not easy to do. And now you've got a new book coming out. Your first traditionally published book. How exciting is that?

Speaker 2 (00:47):

Listen, I'm fired up. This is a combination of the 3000 plus interviews I've done over the last decade. I've interviewed some of the world's most successful entrepreneurs over the years, and I've learned from every single one of them. I mean, every one has been my mentor and I've been able to distill their genius down into what has turned out to be 71,000 words of my blood, sweat, and tears. Cause it took me 480 writing hours to write the 71,000 words, the 273 pages that comprise this book. But I couldn't take a single word out. This is a definitive 17 step roadmap to financial freedom and fulfillment. So if that's interesting to you, this book is your guy,

Speaker 1 (01:34):

Which is amazing. So it's the common path to uncommon success, the road to financial freedom and fulfillment. And you know, you, as we know, have been very successful online entrepreneur, but let me ask you a question. Sticking in that online entrepreneur have people been lied to by the quote unquote experts in the online business world.

Speaker 2 (01:59):

Listen, the online experts in this world. There's a lot of fantastic ones that are doing amazing things out there. And there's some not so fantastic individuals out there who will lead you to believe that the path to uncommon success is secrets. It's hidden. Maybe it's complicated. Listen, it's none of those things I've seen over 3000 successful entrepreneurs and I've interviewed over 3006 successful entrepreneurs. And I've seen that all of them have taken what has turned out to be a very common path, a very common path to one comma success. Now, by the way, it's hard work. It is absolutely hard work, but it's a common path. It's not secret. It's not hidden. It's not complicated. It is a very, very clear, very common path. And it's not something that, again, these so-called gurus that will try to, you know, sell you some key for $1,997 and 97 cents. Like, listen, that's the answer. The answer is clear. The content is out there. I've done over 3000 interviews. You have individuals like Karen and others who have done interviews. There's great content out there to be had. And I could tell you right now, just go listen to all 3000 of my episodes, but that's tens of thousands of hours or is distilled down into one book, 17 steps, 273 pages. And it's there for you. That's the common path to uncommon success.

Speaker 1 (03:29):

And when you look at success and we look at financial freedom and fulfillment, what, what do we really want to achieve here? What does that mean?

Speaker 2 (03:38):

So this is what I've really identified. That individuals really desire in life. Freedom. Freedom's one simple word, but it's so hard to attain, but think about it when you're free every single day to wake up and to do these three things, do what you want, where you want with whom you want. What else is there in life? Like when you can literally say, I get to do what I want to do, where I want to do it with whom I want to do it. I have that freedom. That's happiness, that's success. That's what people want. And this is what so many people have been able to achieve. You know, unfortunately, a lot of people don't think that's possible and they will never be able to achieve as a result. But those type of people don't listen to podcasts like this. So I know I'm talking to the right individuals right now. It's there. It's possible. It's, it's, it's a, it's a common path to your version of uncommon success.

Speaker 1 (04:38):

Now, you know, you say in the book, it's a 17 step roadmap. Most people will give you five steps or maybe eight steps, right? So what, what is the 17 step roadmap? If you can give us a couple of little snippets or details.

Speaker 2 (04:54):

So here's the process it's like when I interviewed these 3000 plus now individuals, and I've been able to really boil down and distill down the core foundational elements that all successful, aren't new or share in common. There were 17 of them. Like I wish there were 18 or 16. I like even numbers, but listen, it was 17. I couldn't take one away. I couldn't add one. It was just simply 17 foundational steps. And I was able to put them in a chronological order. And before me, I had the 17 chapters of the book and a step-by-step format, 17 steps to financial freedom and fulfillment. And let's go over a couple right now. Number one, this is where most people get it wrong, by the way, identify your big idea. Keywords, your big idea. So many people, Karen, they are right now living and acting in a week pale imitation of somebody.

Speaker 2 (05:53):

Else's big idea. They're like, Oh, look what Karen did or John. And they're having success doing these things. Let me just do that. And then they wonder why they're not successful most because they're a week pale imitation of those people that are trying to copy. They're copying somebody. Else's big idea. That person, it's their big idea. It's their zone of fire. That's why they're successful because they're living in their zone, a fire. You need to sit down maybe for the first time in your life, by the way, and really give yourself the time, the space, the open bandwidth to really come up with and identify your big idea. And your big idea is out there. Your zone of fires out there and chapter one, listen, it's not just words on a page. There are exercises. I teach you how exactly you get to your big idea.

Speaker 2 (06:42):

And that is a super critical part. That by the way, most people will die. Never even knowing what their big idea is because they never took the time to sit down and identify it. And it doesn't even take much time, which is the sad and scary part. But here's the thing here. If it was just that simple to identify your big idea, it would be one chapter in my book. And there were just be one chapter in my book. There's 17 steps. So there's a lot more to it than I than identifying your big idea. Let's just jump to step two. And then we'll skip a little ways ahead to, to show you any part of the book as well. But once you have your big idea, people are like, Oh my God, I'm so excited. Like I have my big idea. Let me go all in on this.

Speaker 2 (07:22):

That's a huge mistake because guess what? Your big idea is a great idea. And other people have had it too. And there's competition. That's out there crushing your big idea, which is a good thing because that's proof of concepts. That means that your big idea really is proof of concepts, but you can't right now launch against entrenched competition that's out there. So instead you go to step two, which is discover your niche. That means you're going to identify within your big idea, an un-served opportunity, a void that needs to be filled, that you can be the best solution to that real problem within your big idea. That's how you win. Like Karen, when I launched a podcast, that was just this broad idea, but then I was like, well, I'll launch a business podcast. That's a little more niche. Okay. It's still kind of broad.

Speaker 2 (08:14):

There's a lot of people there. Well what about an interview business podcast? Okay. There's like seven or eight other interview business podcasts. What about a daily interview? Podcasts of the world's most successful entrepreneurs, zero other competition. The day I launched entrepreneurs on fire, it was the best daily podcast interviewing entrepreneurs. It was the worst daily podcast interviewing entrepreneurs. It was the only daily podcast interviewing entrepreneurs. Like can't you see, like, that's why I won at such a high level. How can you be the best? Sometimes it means being the only, or it means niching down till you look around your competition is terrible. So you can kill them immediately. You can beat them up. That's how you discover your niche. Then of course, there's step three, four, and I take you all the way through and beyond. Let's skip forward right now to step seven.

Speaker 2 (09:09):

So every chapter in this books, an average of a three to 5,000 words, this chapter I wrote and I wrote and I wrote, and I wrote 13,500 words. By the time I finished this chapter, step seven, chapter seven, creating your content production plan. That is why we've won financially at such a high level because our content production plan is amazing. And I say that because it took us 10 years to get here. It's stunk at first, but now it's amazing. And I poured it all into this chapter and it is phenomenal and it's listen, it's not easy to emulate, but it's all there for you. And you will see after reading this chapter, why we're winning at such a high level and frankly, you know why you might not be because likely your content production plan is nothing in the same realm of what we have just like ours.

Speaker 2 (10:06):

Wasn't in this realm, obviously when we launched back into, you know, almost 10 years ago now, so that's just a glimpse of three of the 17 steps. And we have actually a bonus chapter called the well of knowledge. And it's a really cool chapter is chapter 18, a bonus chapter. And that's just the best pieces of advice, mentorship, inspiration, motivation that I picked up over the years. I just dropped it into this chapter. And this meant for you to really just take your ladle, dip it into the well of knowledge every now and then when you need it, when you need a little bump, a little boost. And man, that chapter is really cool because it's not meant to just read all at once. Like go there, consume it. One passage to passage, get the kind of inspiration you need, then get back to work. That's the process

Speaker 1 (10:56):

Amazing. Well, I mean, I don't know about anyone else listening, but I am so excited to get my copy, which it releases on March 23rd. So tell us, tell all the listeners here a little bit more of the details of the book launch so they know where they can get their copy.

Speaker 2 (11:11):

So listen, all the magic is going to be happening over at uncommon success. Book.Com, uncommon success book.com. You can head over there. You'll see the personal endorsements from Seth Godin, Gary Vaynerchuk, Neil Patel, Erica Mandy, Dorie Clark. You'll see a video of me describing more details about the book. You'll see. The first chapter is there for free just to read, to consume it, to see kind of like, well, how my writing process is plus the five bonuses that come with the pre-orders. So do not wait until March 23rd. You want to pre-order this book because it is amazing what we've done for these five bonuses. Just one of them, by the way, I'm to your door. All three of my journals, the freedom mastery and podcast journal. I'm literally shipping to your door at my expense. Well, drop them all. If you live in the United States of America, outside of the U S I'm going to give you the digital pack of all three immediately they're beautiful fillable versions. They're awesome. And there's four other insane bonuses. You can learn more about those other bonuses@uncommonsuccessbook.com.

Speaker 1 (12:21):

And I, I ha I will say congratulations are in order already. Cause an Amazon I checked today is already a number one bestseller on Amazon and it's not even out yet. And for the listeners, I am going to be giving away five copies of the book and you'll find all the details on my Instagram page. So check that out. Cause I will be giving away to five lucky winners, five copies of this book, because if you just go on to the website and read even the first chapter, you're like, man, I get it. You know, and I, and I also love the fact that you're vulnerable, that you're saying, Hey, this didn't happen overnight. And that's what a lot of people think. And that's what a lot of people sell. And it's so refreshing to see people out there experts like yourself saying it's hard work, it's work, but you can do it. So you're welcome. So I want to thank you so much for coming on the podcast. And one more time, where can people find all the info,

Speaker 2 (13:21):

Uncommon success, book.com, check it out a lot of great stuff there. And once again, much appreciated.

Speaker 1 (13:30):

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

Feb 22, 2021

In this episode, sports physical therapist specialist, Dr. Alli Gokeler, talks about motor learning.

Today, Alli tells us about the process of motor learning, how patient autonomy is advantageous to rehabilitation, and how to motivate patients. How does Alli measure motor learning outcomes? Alli elaborates on his on-field rehabilitation model, and the importance of incorporating cognition in ACL injury rehabilitation.

Alli talks about RTS from a motor learning perspective, how to continue motor learning on the field, and he gives his younger self some advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • Alli defines motor learning:
  1. “In order to acquire motor learning, you need to practice. If you don’t practice, you can’t learn something.”
  2. “The learning process itself cannot be measured directly. It’s only something you can measure indirectly.”
  3. “What motor learning should result in is: it should lead to relatively permanent improvement of motor skills.”
  • “Be careful how you interpret this process. Quite a few clinicians have a tendency to provide feedback because they intuitively try to correct a patient.”
  • “Be a little bit patient with your patient, because learning takes time. Don’t interrupt the learning process too soon.”
  • “Motor learning, as well as learning a language or math, is a non-linear process.”
  • “One of the strong drivers of learning is intrinsic motivation.”
  • “We provide our patients with a significant amount of autonomy, which means the patient gets a certain level of control over the exercises.”

“Providing autonomy during rehab enhances learning.”

  • “Around 70% of people prefer to receive feedback after a good performance of an exercise. What happens in most clinical situations, with all good intentions, we typically give corrective feedback, which typically means you didn’t do something according to the standards of the therapist. This may affect their motivation.”
  • “If you look at the brain activity of someone that is instructed to do something, or the brain activity of a person who has some control over what they’re going to do, you have completely different brain patterns. When you give them some control, they are much more engaged, and this is a prerequisite in order to learn something.”
  • “If you want to be certain that learning has taken place, you need to measure, otherwise you can’t be sure that the patient has learnt something.”
  • “If you’re good at something, it’s not challenging anymore. If it’s too difficult, then it’s overreaching.”
  • “One-on-one training is not what’s needed for a football player. They are team athletes.”
  • Alli’s on-field rehabilitation model:
  1. Neurocognition: Reaction time, decision-making, selective attention, inhibition and working memory.
  2. Motor component: Strength, range of motion endurance, and speed.
  3. Sensory: Visual, auditory, and environmental factors.
  • “We need cognition during our motor control, and if we only work on pre-planned activities, we miss something from the on-field situation.”
  • “An ACL injury isn’t just a peripheral injury, but it’s also a neurophysiological lesion, and that needs to be considered in rehab.”
  • “With colleagues that work with paediatric patients, some of the motor learning principles that they use could be very beneficial for us working with orthopaedic, sports-related injuries.”

 

Suggested Keywords

Motor Learning, RTS, PDCA, ACL, Rehabilitation, Neurocognition, Therapy, Physiotherapy, PT, Training, Injuries, Sport, Wellness, Health, Recovery, Injury-Prevention,

 

More about Dr. Gokeler

Dr. Alli Gokeler has 28 years of experience as a sports physical therapist specialist.

In 1990, Alli graduated with a degree in Physical Therapy from the Rijkshogeschool Groningen. Following his graduation, he worked in both the US and Germany as a physical therapist. In 2003, he earned his Sports Physical Therapy Degree from the Utrecht University of Applied Science. In 2005, he started a PhD project at the University Medical Center Groningen, Center for Rehabilitation.

He is a researcher-clinician and a clinician-researcher with a passion for multidisciplinary injury prevention. He has over 40 peer-reviewed publications, and he regularly gives lectures worldwide. In his free time, he loves to do mountain biking.

 

To learn more, follow Alli at:

Facebook:       Motor Learning Institute

Instagram:       @motorlearninginstitute

Twitter:            @Motor_Learning

YouTube:        Motor Learning Institute

Website:          https://www.motorlearninginstitute.com

ResearchGate:           https://www.researchgate.net/profile/Alli_Gokeler

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

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

 

Read the Full Transcript Here: 

Speaker 1 (00:07):

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

Speaker 2 (00:37):

Welcome back to the podcast. I am your host, Karen Litzy and today's episode is brought to you by net health. So net health is hosting a three-part mini webinars series on Tuesday, March 9th, entitled from purpose to profits. How to elevate your practice in an uncertain economy after 2020. I think you're going to want to sign up for this. So you're going to hear from a panel of guests that have over 50 years of combined experience working in the PT industry sign up will begin tomorrow, which is Tuesday the 23rd, February 23rd for this mini webinars series. So head over to net health.com/litzy to sign up once again, that's net health.com forward slash L I T Z Y. So check it out and sign up now. Oh, and it's free. Okay. So this whole month we've been talking about ACL injury and rehab. So today's episode is with Dr. [inaudible].

Speaker 2 (01:41):

He has 28 years of experience as a sports physical therapist specialist. In 1990, he graduated with a degree in physical therapy from I'm not even going to pretend to try and pronounce this. So you can just go onto the podcast website to find out where he went to school. Cause I'm not even going to attempt it following his graduation. He worked in both the us and Germany as a physical therapist in 2003 here in does sports physical therapy degree from you trick university of applied science in 2005, he started a PhD project at the university university medical center, grown again, center for rehabilitation. He is a researcher, clinician, and a clinician researcher with a passion for multidisciplinary injury prevention. He has over 40 peer reviewed publications and he regularly gives lectures worldwide in his free time. He loves to mountain bike and you can check out more from him and his research@motorlearninginstitute.com.

Speaker 2 (02:46):

Okay. So today we talk about just that we talk about motor learning. So the process of motor learning, how patient autonomy is advantageous to rehab, how to motivate, how to measure low motor learning outcomes on field rehab models and the importance of cognition and ACL rehab. And we talk about Allie's brand new model for Mona motor learning, which will be out hopefully in a month or so. So a big thanks to Allie. And of course, thank you all for listening to this month on ACL injury and rehab. Hey, Alli, welcome back to the podcast. I am happy to have you on once again.

Speaker 3 (03:31):

Thank you for inviting me. Yeah. It's been awhile pleasure to be here today.

Speaker 2 (03:34):

Yes. And so, as people, if you've been listening to the podcast, you know, that this month has been all about ACL injury and rehab. And so what better person to have on the new to talk about kind of the rehab process after an ACL injury and your specialty, which sort of motor motor learning. So the first thing I want to ask you is can you define motor learning?

Speaker 3 (04:02):

Yeah, that's it, that's a very good question. And I I've taken three, I think important aspects of motor learning that I think are relevant for clinicians that listen to this podcast. The first one is in order to acquire motor learning, you need to practice. If you don't practice, you can't learn something and that may be pretty straight forward, but I still think it's important. The second one, and that's a little bit of a vague one, but the learning process itself cannot be measured directly. It's only been some been something that you can measure indirectly. And I I'll touch back on that a little bit later. What I mean by that? And the third point is what model learning should result in is that it should lead to relatively permanent improvement of motor skills. And last year I gave the example of writing how to ride a bicycle for this year.

Speaker 3 (05:03):

I thought, Hey, maybe skiing is a good example. And so if you've taking ski lessons as a teenager and you became quite proficient in skiing, it could be for many different reasons for job or any other reason that you haven't been going to the Rocky mountains, but at the age of, let's say 35, you have some time again, and you have some financial resources and you'd, Hey, let's spend the week again in Vermont or the Rockies and maybe a little bit of rusty at the beginning, but perhaps after a day or two, you get the hang of it again. So this is I think a great example of what motor learning means. It means that you acquire something and it sustains over time. Now that needs to be distinguished from performance. And this is, I think one of my key messages that I would like to point out to clinicians when you work with your patient in the clinic and you have your patient doing an exercise.

Speaker 3 (06:11):

And this relates to my second point is that motor learning is not directly observable. What you see in the here and now is performance. Now I get, I can give you two examples. So let's say you have a patient after an ACL injury six weeks post-op and you want to have your patient work on balance, not patient number one comes in and stands on one leg. And actually what you're seeing, you're very happy, very stable not any excessive movements is able to maintain balance for 30 seconds. Okay. You're you might be happy with that. Now, your second patient comes in from the same surgeon, also six weeks post-op and when you have this patient perform the same exercise, you see that a patient sometimes needs to take the hands of the hips or needs to hold onto something, or puts the other foot down to maintain balance.

Speaker 3 (07:16):

And from these two examples, you may draw the conclusion that the first patient has better motor skills and has better learning potential. And the second one has poor motor skills and is not such demonstrating good learning potential. We don't know. We only, we only know that performance in patient one is better for sure. Performance in patient B is not as good for sure, but that doesn't mean that the dis says anything about the learning potential. In fact, it may be that the learning potential in patient one is, or has already been reached because this is at the max of his abilities, various for the second patient with poor performance, there may be a large learning potential. So that that's that's I think very important. And what you need to consider as a clinician is be careful how you interpret this process, because what I know from my early days, and also when I teach courses, is that quite a few clinicians have a tendency to provide feedback because they would intuitive to literally try to correct patient too, because you see that it's not able to maintain balance.

Speaker 3 (08:40):

So we need to say something. So we will usually do that in with feedback. And we typically do this with corrective feedback. And my second take home message would be, be a little bit patient with your patient because learning takes time. So maybe unless you feel that there is an unsafe situation, but if that's not the case, let the patient practice and re evaluate in the week or in two weeks time. But don't interrupt the learning process too soon. Because when I go back to the skiing example, remember when you haven't been skiing for for like 15 years or when you started to ski, it, it, it was probably something like this first day, quite difficult. Second day, still difficult. You might even get frustrated third day, no improvement. However, on the fourth day snow not being able to ski ski lift is closed.

Speaker 3 (09:55):

And on the fifth day means there was no one day without any skiing lessons on the fifth. There you go out again, Hey, and all of a sudden you feel like, Hey, I I'm, I'm better than I was on day three, although you haven't practiced in the day in between. So this is what I mean, learning is not only happening as you practice, but there's also some processing afterwards going on in your brain that helps to acquire those motor skills now. And if you interrupt that process like vote by providing a lot of corrective feedback you may actually, although with all good intentions, I don't want to disqualify that, but maybe it's better to leave the process happening and evolve and then provide feedback later on.

Speaker 2 (10:50):

Yeah. It kind of reminds me of have you ever heard the term helicopter parent? So it's the parent that's always hovering over the child, making the decisions, not allowing them any autonomy for themselves. And so it reminds me of that helicopter therapist who's on top like, Oh, I see that if you use the example of balance, Oh, I see that you struggled a lot with your balance. Why don't you try and do this? Well, why don't you do this, try this, try this, try this. And, and in that as the therapist, are you taking away the autonomy for the patient and what kind of, how can that affect the outcomes for that patient?

Speaker 3 (11:31):

Yeah, that's an excellent point. Karen C motor learning, as well as learning a language or learning math is a nonlinear process, which means how you learn how to ride a bicycle was probably different from how I learned it. So, but what we typically do as clinicians, we have this, this, this clinical guidebook in our, in our mind map that we think based on our experience or based on our beliefs, how we need to guide our patients from simple skills to more advanced skills from single task skills to do a test skill, whatever. However, we don't know how this patient is actively engaged in this process, actually, by example, that you were provided the, the patient is directed by the, by the parent or, or the child is directed by the parent and is actually a passenger. Now, I think one of the strong drivers of learning is intrinsic motivation.

Speaker 3 (12:41):

So what role do you give your patient if you direct them, where to go, what to do, and also you give them corrective feedback are these all strong drivers for self-organized learning? I'm putting a question Mark behind it. So people need to think about them for themselves. I can tell you what we do in, in, in our clinical situation. And that's based also on our research we provide our patients or in ACL injury prevention, we provide a significant amount of autonomy, which means an athlete or a patient gets a certain level, not complete control, but a certain level of control over the exercises. So they can choose, for example, out of 10 exercises, they can pick three exercises that they would like to do on that particular day, in an order they would like to do. And we know from a substantial body of research that providing autonomy during during rehab enhances enhances learning.

Speaker 3 (13:59):

And I can tell you this from a research point, but it can also give you a brief insight from a recent survey that we've done among patients that completed their rehab. And we sent them an open questionnaire about their experience in in the entire process of rehabilitation. And one thing that two things that really stood out were a positive environment, a positive environment with relatedness of the therapist towards the patient, and not as a patient, but as a person that's quite important. So it's not a ne it's not an ACL patient. No, it's, it's, it's a person with an ACL injury. That's quite, quite, quite an important distinction. And the second thing that stood out was and you, you touched on that before is the autonomy some self-control over the rehabilitation process. And this was a qualitative study that we did my PhD student while surveilling ran the study.

Speaker 3 (15:10):

So it's not something that I'm just saying as a scientist, but this is also what we get back from our patients. And when we ask them so going back to the clinical situation this is what we apply also by providing our patient with the opportunity, instead of me always providing the feedback I'm asking them, or I'm giving them the opportunity please let me know when you want me to give you feedback. That is a great example of of autonomy, the thing, easy question. Yeah. And, and, you know, what's, what's, what's what's quite important to understand is if w if we think how humans preferably like to receive feedback if we, if we, if we ask a healthy population and the same applies to to an injured population, it turns out that around 70% of the power of the people prefer to receive feedback after a good performance of an exercise, what happens in most clinical situations with all good intentions? I really don't want to question that, but we typically give corrective feedback, which typically means you didn't do something according to the standards of the therapist. That means that maybe seven out of the 10 people that you provide feedback to may not really like this, and this may affect their motivation. This may affect their learning potential because they like to receive feedback when something went well, they, they conversely they already know when something didn't go well and they don't need us to rub it in or to remind them they already know.

Speaker 2 (17:15):

So you, you touched on a word that I was just going to ask you about, and that is motivation. So why is motivation key in motor learning?

Speaker 3 (17:28):

If you look for example, at the brain activity of a person that is instructed to do something, or you look at the brain activity of a person who has some control over what they're going to do, you have completely different brain patterns. And I can tell you that the second one, the second example, when you give them some, and when they can choose, they are much more engaged, and this is a prerequisite in order to learn something.

Speaker 2 (17:59):

Yeah. And, and I think we can probably all look back on our own personal experiences of learning, whether that be academic learning, or learning a physical task. I think we all like to have a little bit of control over that versus just have stuff thrown at us without our IM without our input or without our thoughts on it. So I think that makes perfect sense. And now, so we spoke about how motor learning is, non-linear why motivation and autonomy is so important. Now let's talk about, we've got this patient with who had an ACL repair and they want to get back to sport. They, they are, they are ready mentally. So we'll put that to one side. They're ready mentally. So let's talk about the return to sport from a motor learning perspective.

Speaker 3 (19:02):

In my opinion, return to sports is we first need to define what we mean. And I think the 2016 consensus meeting gave us some leeway in that direction. And I think one of the most important things that stood out is that it's a continuum. It is not one moment in time. And I think what I read in the literature often is is that it's such a that coma to choice yes or no at at six months or nine months, whatever you're, you're, you're, you're believing in. I think what we need to understand is certainly in light of the high number of secondary ACL injuries, particularly in the young population, in, in, in pivoting type sports, that's number one. But also the second one is that, you know, only, I think a disappointed percentage of people reach their pre-injury level.

Speaker 3 (20:00):

So their performance is not up to par. So do those two factors. When we, when we look at that, I think it all starts prior to the surgery. So the rehabilitation, I think is one of the key factors that we need to, that we need to consider anything that's left. Unaddressed will show up even in higher magnitude, after the ACL reconstruction, which was the second trauma to the knee. And, and then in, during the entire rehabilitation process, something very simple. And I can't stress that enough if, if walking is not normal and how do, how do many clinicians assess a normal gait pattern? They usually ballpark it, but, you know, even a slight deficit of five degrees is clinically meaningful. And now, now just follow some logical sense. If you're walking is not normal, what do you think will happen with the running?

Speaker 3 (21:01):

W what do you think, what would you expect? How, how the squat will be executed by the patient and how will the single leg up will be done or a drop foot, a good jump. So that's why I think that all these elements from a motor learning perspective, and also we'll touch back on that a little bit later, of course, sound strengthening program, you know, no question about it, very important, but I think it is, it is very important to also incorporate the model learning process so that we make sure that the patient is learning or relearning those motor skills, but Mo and I can also stress enough. It's also important that we as clinicians really, really measure and boarding and, and I, we just completed and published a study among Flemish physiotherapist. And one of the things that came out of this study is that many don't use the evidence-based principles, meaning also they don't use two criteria as they don't assess and in order, and that's also coming down to model learning. If you want to a certain that learning has taken place, you need to measure, otherwise you can't, you can't be sure that the patient has learned something.

Speaker 2 (22:22):

And how do you, what are some examples that you can maybe give the listeners of how you measure these motor learning outcomes? Because I think that's important to let people kind of wrap their heads around that. And on that note, we're going to take a quick break to hear from our sponsor and be right back

Speaker 4 (22:41):

On Tuesday, March 9th, net health is putting on a three-part mini webinars series entitled from purpose to profits, how to elevate your practice in an uncertain economy after 2020, you're going to want to sign up for this. You're going to hear from a panel of experts that have over 50 years of combined experience working in the PT industry, signup will begin tomorrow for this mini webinars series. So head over to net health.com/litzy to sign up once again, that's net health.com forward slash L I T Z Y.

Speaker 3 (23:16):

Yeah. So I use, then that's something from, from the business that you probably know that the PDCA cycle, the plan do check act and the P and the plan, which means you do a baseline test. So first you need to let's say balance. So there's the patient have a balance deficit yes or no. You can use the star balance says you can use th the balance error scoring system. That's your baseline test. Now, it's up for you as, as a physiotherapist with your clinical reasoning. Does the patient need an intervention to target a balance? Yes or no, or are we happy with, but let's assume now there is a balance deficit. Now we go to the do, which means what is my intervention? So my intervention could be, I'm planning to do balance training for four weeks, with two therapy sessions in the clinic, and four sessions at home consisting of those and those exercises.

Speaker 3 (24:21):

And then AF in between I'm doing an interim evaluation, is the patient going on track as I'm expecting or not? I can still find tune my my intervention program, a training program. And then I do a final assessment after, after two weeks and preferably even one little bit later on as well to make sure that the effects of the balanced training are really sustained over time. Remember what I said about riding a bike or skiing and that's a very simple procedure you can use. It doesn't take a lot of time but it's, it needs to be integrated in your daily practice because if you don't measure, you don't know.

Speaker 2 (25:09):

Yeah, absolutely. And I love that. I think people can get behind that PDCA cycle and cause, you know, PTs love things that are regimented and you know, things that sort of follow a plan. So I think this is a really easy, and I think people can get behind it. And I also think that it will keep your patient on track and keep you on track and organized versus just like throwing whatever up against the wall and seeing what sticks, if you measure it, you're, you know, you're, you kinda know where this patient is going and that makes all the difference.

Speaker 3 (25:51):

Yeah. Which, which th that's a good point that you I, I forgot to mention it actually in the, in the, in the planning cycle, I'm incorporating my patient. So I'm discussing the baseline tests and I'm asking in my patients, so you have a balanced deficit. What do you think is needed for you to improve your score? What do you think is could be if you score eight out of 10, so zero would be no balanced error. 10 would be the maximum errors that you can acquire. So you have an eight, what do you think is reasonable to achieve in two weeks time, for example, and then the patient could say, yeah, I think I'm I can reach a seven. Hey, that's the interesting information. Why, why are you so conservative? Why can't, why can't you challenge yourself from, from an eight to a four, for example?

Speaker 3 (26:42):

So I always creating this interaction with my patient. You know, I can in conjunction with, with, with me and my patient, I can set goals that, and that's quite important as well. That need to be challenging for the patient, because if you, if you already a good or something, you're not challenging and it's not challenging anymore, if it's too difficult, then you then it's overreaching. But it, it has to be something that the patient sees. Okay. I really got to put some effort into this is again, which is, again, something for important for learning.

Speaker 2 (27:22):

I was just going to say that I said from a motor learning standpoint, if you do nothing that gives a substantial challenge to your patient, are they really going to see the benefits of those exercise or of your plan? Exactly. Yeah, yeah. Yeah. That makes perfect sense. Okay.

Speaker 3 (27:45):

And also going back to to the first example where the two patients with the balance exercise, if, if I give my patient an exercise, it is usually an exercise that creates difficulty for them. So if I see a perfect demonstration, then I'm kind of thinking, yeah, what is the learning potential here? So I purposely make the exercise a little bit more difficult right away. And I explained that to them, I'm explaining to them, don't expect to, to master this exercise today or tomorrow. And I always give that example of, of riding a bike and, and a lot of patients like that because, Oh yeah, I remember that I fell down quite a few times and and that that's in ACL rehab. It's, it's more or less the same process.

Speaker 2 (28:37):

Yeah. And, and I also want to switch, well, this isn't really switching gears just moving forward. So yes, we know that return to sport is a continuum you've got returned to sport and returned to performance, different things. And one of the things that I spoke about with Nicole [inaudible] is the importance of on-field rehab. So I know that's something that you're also passionate about. So do you want to kind of tie that into what, what therapists can do on field to continue to foster this motor learning within their sport, whatever that sport may be?

Speaker 3 (29:20):

Yeah. I think that's, that's something that's underappreciated and, and maybe that's because we haven't really integrated the motor learning processes in our rehab. And one of the things that we have to consider is when you observe your patient in the clinic and you a certain motor behavior, that's all what it means. It stems down to the interaction between the environment. The task at hand could be a jumping exercise, could be a single lag, actually, whatever. And, and, and, and to behavior that you're seeing. So there is a task athlete, environmental interaction, which means the movement that you see from that interaction only is valid for that interaction. You cannot extrapolate a jump landing strategy from a box in a physiotherapy clinic. And imagine how this athlete would play lacrosse or American football or soccer. It's completely different game, completely different worlds.

Speaker 3 (30:37):

So I think that's where one of the main reasons why single leg hop test and accessed by, by, by Kate Webster and, and, and Tim, you, it were shown not to be valid predictors of secondary ACL injury, because a hop test is something completely different than how an athlete performs on the field. So, in, in, in that regards I think we need to take the patient to the field and to see how the patient is performing based on that interaction that I just refer to the tasks, the environment, and the athlete interaction. And then you get meaningful information where the, where that patient is is add, which for example also means that one-on-one training is not what's needed for a football player. They are team ball athletes. So you need to do something with the ball. You need to be on the turf and you need to do something with teammates

Speaker 2 (31:43):

That yes, when you're working with someone with a team sport, you have to have those other I don't want to say distractions, but you know, other people, a ball scanning a field versus just going one to one with you.

Speaker 3 (32:02):

Yeah. And we, we've just completed an analysis of 47 non-contact ACL injuries in Italian professional football. Just this work that I've done with Francisco Della Villa from the ISO kinetic group. And what we did is we, we looked at the injury mechanism through a different lens and what we the lens we use was a neurocognition lens. So we looked at the inciting events that happened before the ACL injury took place, because so far the literature is predominated by the dynamic valgus collapse. And I totally agree. I totally agree. However, it doesn't tell you what led to the injury. It just tells you what the end point is. That's dynamic velvets now. And what we've done now is what are now some typical events occurring during a match play in which a non-contact ACL injuries took place. And we took two neurocognitive factors. One is the selective attention. So are you able to maintain attention to the relevant information in this regard and filter out irrelevant information? And the other one is, did we see some impulsive behavior of defenders? And they were running into a situation in which basically the attacker waiting for them to approach. And then at the last moment, they made a deceiving action that the defender did not entail.

Speaker 2 (33:40):

And now in the very small timeframe,

Speaker 3 (33:43):

The defender had to change the movements in a timeframe that you don't have enough time to coordinate those movements well. So if you think about this as a framework, how injuries may happen, we also need to consider this framework, how we integrate that in our rehabilitation process. And this is what I do from day one. And certainly this is what I do re related back to your question for the on-field this framework we use for the on-field rehabilitation. And I've created a model for that.

Speaker 2 (34:19):

Yeah. So I was just going to say, I know that you've created a model and it's going to be published soon. So let's talk about what that model is. And if you can kind of walk us through that, that would be great.

Speaker 3 (34:31):

So the model is consists of three main pillars. The first one is neurocognition and neurocognition, you need to think about reaction time. Decision-Making selective attention, as I mentioned before, but also your ability to control impulsive behavior. That's called inhibition. Can you, can you change your intended movement? Yeah. That's something to control your impulses. Very important. Working memory is another aspect. So those are the neurocognitive components. Then we have the motor component, and I think that's where most physios will be quite familiar with. So we think about strength, range of motion endurance speed, things like that. Yeah. That that's, that's I think pretty straightforward. Then we have the sensory part. So in the sensory part, we can have the visual components so we can alter the visual input, maybe quite relevant for ACL rehab as Dustin grooms has already shown. And also my colleague and part of borne, Tim layman has demonstrated that with EEG, that the patient may have some visual reliance, but also things like, do you have your patient do training with shoes on is, are you playing on the hard surface, soft surface lighting conditions, auditory information.

Speaker 3 (36:06):

Now those three factors, neurocognitive motor, and the sensory part. What I did in my model, I created like a gauge, so I can create an exercise combination in which I have a relatively simple motor skill. So not so demanding, standing on one leg, for example, but what happens now, if I, and more cognitive load, for example, by having them do math subtractions, or working on the synaptic sensory station by doing motion tracking. Now I can see what the influences is of an added neurocognitive load on my motor art, because those three shape my functional movement coordination. Likewise, I can turn back. My neurocognition lit and stay with the same exercise and do now something on the sensory part. And this is what we all do as clinicians. So we do a single leg balance exercise, and we have the patient stand on on the, on the foam surface, or we have them close their eyes.

Speaker 3 (37:14):

So we already doing this, but I think the model can help you. How do I plan my exercises within one rehab session? And I'm changing that from week two week. And why would this be important? Well, first of all, we all always need to consider that we have, we need cognition during our motor control. And if we only work on pre-planned activities that, that are often in happened, we miss something exactly what you pointed out already from the on-field situation. They have to perceive a lot of information. They have to process that information and then execute the movement. And here's where cognition comes in. And we do this by being aware of that, we can use these gauges. What we do is we actually create a rehab environment that we call in part a board. And we call that an enriched environment in which we constantly provide different stimuli to the patient.

Speaker 3 (38:22):

That means the rehab from week one to week two is not the same, which means variation, something new, something I haven't done before. Again, this could already motivation so significantly, and I can tell you from experience, patients love this. The second benefit would be since you're providing different stimuli, you actually confronting the brain every time with a new situation and the brain has to find solutions. And this is I think very important also from the motor learning perspective that we need to consider to enhance the neuroplasticity of the brain, because an ACL injury is not just a peripheral ligamentous injury. It is also a neurophysiological lesion and that's, I think, needs to be considered and rehab.

Speaker 2 (39:19):

I mean, I, I have to say for me, I really liked this model because it, it gives you a great way. Like you said, to plan out your session so you can maybe enlarge the motor component one day or take it back another day, do more, neurocognition move that back, do more sensory, do sensory motor, maybe not so much neuro do a little bit of all three. So it's sort of like, I just sort of see the Venn diagram, just expanding and contracting with all three of those bubbles, which I think is really great. And like you said, it gives you, it's almost from a therapist standpoint, a clinician standpoint, I feel like it gives me permission to play around and come up with some fun things and be a little more original.

Speaker 3 (40:06):

Yeah. And I think what it also does it, it, it may help you as a therapist to get a better understanding where some underlying deficits may be because we only, we T we typically like to measure the outcome. So let's say I'm doing an agility course, and I'm just looking at at the time. And then I see, Oh, the patient is not so fast. So I need to do more training. Well, what you could maybe do is try to untangle a little bit and to see if the patient from the motor perspective has all the necessary requirements in order to be fast. Maybe there's a deficit there, but let's assume it's not the case. So all, all the strength, all the rate of force development, all these parameters are satisfactory. That must mean that there's something else in the system that can't cope with the demands. And that could quite well be that there is an underlying neurocognitive deficit, and this may help you as a therapist to work more on those neurocognitive elements with the intended goal that the patient becomes faster, but maybe not so much, but we're doing more plyometrics and, and doing more speed now working on the neurocognitive aspect.

Speaker 2 (41:30):

Yeah. So it's, it's a, a treatment as well as an evaluative tool to kind of see where some deficits are and how you, you and your patient together can plan to move forward. Sounds great. When when will this be widely available?

Speaker 3 (41:49):

I hope we have it out in a month, the time from that pending on, on the, on the publication process, but please stay tuned.

Speaker 2 (41:58):

Okay, perfect. And we will let, we will let people know. I will put it on social media when that is out. So that sounds great. Well, I mean, thank you so much for coming on and talking about this, I've been taking copious notes. I think this was great. Before we get into where people can find you, I have one last question and I ask everyone this, and that's knowing where you are now in your life and in your career. What advice would you give to your, to your younger self?

Speaker 3 (42:23):

Good question. I think what would have helped me if I would have spent more time in the neurological field, I think in, in what I still see, or with colleagues that work with pediatric patients, I think some of the motor learning principles that they use could be very beneficial for us working with more orthopedic sports related injuries. That's something I did not understand back then, because my interests were solely in the, in the sports domain, but in retrospect, I should have spent more time in, in the neurological and pediatric field.

Speaker 2 (43:04):

Great advice and great advice for anyone who is maybe at that starting point in the sports or orthopedic rehab world and trying to figure out, Hey, what is there something I'm missing here? So I think that's great advice now, where can people find you and find all this great stuff, all your great info.

Speaker 3 (43:24):

All right. So we have a website from our company and our company's serves as the hopefully as the intermediary between academics and the clinical field. I, I work in both fields. I'm, I'm a clinician, I'm a researcher. And with our platform, actually our community model learning Institute, we want to create a bridge between the academic field and the clinical field, because I think we can all improve, but we need to find each other and we need to speak the same language and have respect mutual respect for one another. And if we engage in in such a culture by exploring, by facilitating one another, I think we can create a lot of new things and approaches with the overall purpose to help our patient. This website will be updated in a month from from now. So we will we will be offering completely new courses, which are also have the opportunity to get coaching from us. So it's not frontal education, but we offer for every course participant to receive life or written feedback on their progress during the course, because our premise is that we want to create a course in such a way that you can apply it into your setting after you've completed the course.

Speaker 2 (44:58):

That sounds amazing. And we will have links to to the website. We'll have also put the link up to your research gate profile so that if people want to look at some of the papers that you mentioned today, they can just go there and see all the papers that you have authored and co-authored do. I think it would be really helpful. And if people want to find you on social media, where's the best place to reach out to you there

Speaker 3 (45:26):

Would be Twitter, Instagram, or Facebook.

Speaker 2 (45:30):

Perfect. And what are the handles if you know them off hand motor learning Institute. Perfect. Perfect. Okay. So thank you so much. And like I said, I will have everything available up on the website at pod podcast at healthy, wealthy, smart.com. So Allie, thank you so much for coming on again. I really appreciate it.

Speaker 3 (45:55):

Thank you, Karen. And I really want to say, thank you so much for setting this up. I think this is exactly what we also stand for, that we create a platform in which we can exchange our ideas. We can ask one another question that that's the best way I think, to move forward. So really thankful for you to organize this and yeah.

Speaker 2 (46:16):

And so everyone, thank you so much for listening. Have a great couple. I have a great week and stay healthy, wealthy and smart. Well, a big thank you to Allie for coming on and sharing all this great information about motor learning as it relates to ACL injury and rehab. And of course thank you to our sponsor net health. So remember on Tuesday, March 9th, net health is putting on a three-part mini webinars series entitled from purpose to profits, how to elevate your practice in an uncertain economy. You're going to hear from a panel of guests that have over 50 years of combined experience working in the PT industry, signups will begin tomorrow, which is February 23rd for this mini webinars series. So head over to net health.com/ let's say to sign up once again, that's net help.com forward slash L I

Speaker 1 (47:04):

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

 

Feb 15, 2021

In this episode, 3rd Year DPT Student at Rosalind Franklin University of Medicine and Science, Briana Zabierek, talks about her DPT Study Guide.

Today, Briana tells us about her experiences in PT school and the frustrations that led her to start the DPT Study Guide. How is the DPT Study Guide helping students? How does Bri find the time to do it all while still studying? She elaborates on the future of the DPT Study Guide, what students can expect to find in the guide and current developments.

Briana tells us about how the DPT Study Guide is compiled, finding her entrepreneurial interest, and she gives her younger self some valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • How Bri manages her time:

Change of pace: Set a timer for 45 minutes. Put all notifications off, and just zone in on your work.

Master a topic, then move on: Be comfortable bouncing between topics. Master the main ideas before moving on to another topic. Don’t try to do a whole topic in one go.

  • “The long-term goal is not just to provide products and merchandise, but to really make it a place where you know you’re stepping into a simplified version of PT school.”
  • “If you have the passion for it, and this is something that you believe in, then you can make anything happen.”
  • “You don’t have to be an entrepreneur to make these opportunities possible for yourself.”
  • “Take more breaks and realize how valuable those can be for hitting reset with your mind and focus, and also make time to have some fun.”

 

Suggested Keywords

PT, DPT, Study Guide, Health, Prioritizing, Studying, Entrepreneurship, Efficiency, Physiotherapy, Time Management,

 

To learn more about Briana:

[caption id="attachment_9507" align="alignleft" width="150"]Briana Zabierek www.melissa-manzione.com[/caption]

Bri was raised in Lockport, IL. In 2017, she graduated with a BSc from the University of Nebraska-Lincoln, Double Majoring in Nutrition, Exercise, and Health Science, and Nutrition Science with a Minor in Psychology. She is currently studying toward her PhD in Physical Therapy at the Rosalind Franklin University of Medicine and Science, with her graduation expected in May of 2021. Her mission statement: To serve, encourage, and equip patients and students in reaching their full potential.

 

 

Follow Briana at:

Facebook:       @dptstudyguide

Instagram:       @dptstudyguide

LinkedIn:         Briana Zabierek SPT

Twitter:            @dptstudyguide

Website:          https://dptstudyguide.com

                        https://dptstudyguide.com/downloads

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

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

 

Read the Full Transcript Here: 

Speaker 1 (00:01):

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

Speaker 2 (00:05):

Thank you. Thanks for having me. Sure.

Speaker 1 (00:07):

And we'll give a shout out to Dr. Sarah Hague for putting us into contact with each other and telling me all about the great work that you're doing with DPT study guide. And we're going to talk about that today. So before we talk about the guide itself, why don't you share with the listeners, your sort of personal experiences with PT school, which you are still in your third year student at Roslyn Franklin. So share a little bit about your personal experience with PT school and maybe some of the frustrations that came up for you.

Speaker 2 (00:41):

Yeah, yeah, absolutely. So first and foremost, I think every student kind of encounters a little bit of a roadblock just starting out between my roommates and just our class itself, we had some pretty good comradery to begin with. And so I always felt that that was a good option to at least discuss, you know, areas that I maybe was struggling with or they were struggling with and just kind of have this like melting pot of different ideas and different ways that we could all just get the job done and kind of figure out what we need to know for exams. But as time went on, I think we all kind of fell into our own little like habits and patterns and maybe a little bit what we're comfortable with. And then what I realized was when I think it was about like the middle of middle or towards the end of first year we had our neuro unit and that is kind of where everyone hit a wall with our study habits and just retaining the information and just kind of collectively as a class, we were making our own separate study guides and they would be like these super, super long word documents.

Speaker 2 (01:56):

And I'm talking like 50 plus pages full of yeah. Like eight point text. And I was kind of like attached to them. Like we all would get on like our Google docs and like start typing up information and it just became really overwhelming. And so what I realized was like, I kind of have an opportunity for myself and for my colleagues is to just simplify things a little bit like I was getting sick of kind of going through the PowerPoint slides that were, you know, 120, 150 slides long and just little snippets of information on each. And so I kind of just took a step back and, and saw an opportunity to really simplify things, not just for myself, but something that I thought would be helpful just to transform any student's education going forward. And it was in again, late in our first year when I was inspired by different cash based physical therapists and kind of exposed to that world and realized that there was an opportunity for me to step into like a neat niche position. We kind of get started there kind of with like a side hustle. So that's kind of where everything stemmed from, and right now it seems to be going pretty well. Just looking forward to kind of like sharing the experience.

Speaker 1 (03:13):

Yeah. And so tell me a little bit more about the guide itself. Can you kind of give an example of a section of it and how it helps other students? Right.

Speaker 2 (03:26):

So one thing that I definitely picked up on when I started posting the information on Instagram, which is my, my primary platform that I use was trying to get the main points of any kind of lecture or chapter into about like eight to 10 pictures on Instagram. And so what I wanted to do was share that information to simplify things for followers and students in general. But the guides themselves are focused around that idea. So kind of finding information that is most relevant to clinical practice and then finding information that's most relevant for board exams, meaning safety, or, you know, most basic like phases of cardiac rehab, pulmonary rehab and stuff like that. And I, I always felt like I mentioned kind of going through so many chapters, so many pages, so many slides it was getting exhausting, trying to figure out what I needed to know. And so the whole point of the study guides is to just really get to the meat and potatoes of everything. And then if you need to find something to reference later on, that's when we obviously go back to our PowerPoints in our articles.

Speaker 1 (04:35):

And how are you simplifying or sort of taking out those pieces that you described for the meat and potato pieces. Do you have a system as to how you extract that information from these lectures or is it a group effort? How is that being done? A little,

Speaker 2 (04:54):

A bit of both. I, like I said, we collaborate a lot as friends and classmates throughout the years. And then I really actually took the advice from Dr. Sarah Haig. So another shout out to her, she mentioned just go back to the objectives, whether it's the lecture that you're sitting in, in PT school or it's the textbook chapter that really lays out a good I don't know, six to 12 main ideas, and then I go back there and try and figure out, okay, what information from this chapter, can I really pull and fit it into these like umbrella topics? So that's kind of where I started at. And then some of the samples that I have up on the website to reflect like, okay, let's just put the fancy details away. And what do I need to know if I'm seeing a patient or if I'm seeing these questions on a board exam

Speaker 1 (05:45):

And what has the response been from your fellow students?

Speaker 2 (05:50):

So my class, my classmates are really excited about it. I post a lot of daily questions in, for board exams and they're excited to see it, they've moved their head ideas themselves to start an Instagram just for studying purposes. And then having that collaboration aspect has been really helpful. So I'll even get messages from a few of them saying that, Oh, well, you know, this is something that I haven't gone over yet. So I appreciate you kind of like pushing me to review it and, and stuff like that. But even from complete strangers, like how much support I've, I've gotten has been overwhelming almost, especially with trying to handle studying for boards and preparing for my final clinical rotation overwhelmingly positive. And I kind of attribute that to the field itself. I think going into a profession where we're, we're taught to care for others and put others first and all those ethical principles people are just really grateful to have an opportunity where they can see the information and either like bookmark it and kind of synthesize it right away instead of having to go through all like the dirty work themselves.

Speaker 2 (06:58):

So it's been overwhelmingly positive and I just want to shout out to everybody who's following along. I appreciate the support,

Speaker 1 (07:05):

And now you hit upon something that I want to dive a little bit deeper into, and that is time. So where are you finding the time? Because I know that I hear from a lot of students that they feel overwhelmed. There's not enough time in the day to begin with. So do you have any tips or tricks that maybe other students or even practicing clinicians can learn as to how you parcel out your time to be able to do all of this?

Speaker 2 (07:33):

That is a great point. It has taken me probably the last three to four years, even before PT school to figure out what works best for me. And kind of even coming to the realization of, you know, you, you do need to manage your time before I would be a little bit of a procrastinator. As in like I would, I would start a project and then I wouldn't really finish it. And I was like, okay, well I've already started it. So I'll get to it later. It's almost like more of a, a productive procrastinator, I guess. And so what really has helped me is a change of pace. So I know I don't remember the exact name of the timer, but you either set 45 minutes or 30 minutes where you're just zoned in notifications are off. And you're just focusing on that topic for a little bit.

Speaker 2 (08:21):

And then also mixing in a variety. So in the beginning of PT school, I would try and get through all of my lectures that we had that day, the same evening. And that was just that wasn't going to happen. I tried my hardest, but it was just wasn't going to happen. So what ended up doing was bouncing between topics, even if it feels a little bit unnatural. What I've noticed with my classmates and with myself is we want to just master a topic first, before we move on. And I think the most helpful tip that I can give is to really just be comfortable with bouncing between things and just mastering the, the main ideas before moving on to another topic, because the more that you get caught up in the details, the more you're going to kind of lag and again, procrastinate going to other topics. So that is first and foremost, give it some variety, mix things up and then really set a timer. And then lastly, like I said, just taking a peek at the objectives of the lecture and the chapter is really going to tie together, you know, what you need to pull away for clinical practice or, or board examinations.

Speaker 1 (09:28):

Yeah, because I think so often we can sometimes get lost in the weeds and we don't pick our heads up to see those bigger pictures. So I think that's really great great advice for students and for physical therapists alike. So now we know why you started DPT guide and now have a better idea of what it is. So my next question is what, what is the goal for you of the DPT study guide

Speaker 2 (09:58):

First and foremost, I, I want to make it a community. I think the longterm goal is to be not just to provide products and merchandise, but to really make it a place where students and practitioners alike can come and just review without any, I dunno, egos or preconceived notions or anything like that. Just coming into a place where like, you know, you're, you're stepping into just a, a simplified version of PT school or PT practice. So that's the ultimate goal is just making a community for people to come together and not, not entirely making it about DPT study guide, but making it about the appreciation and respect for physical therapy itself. I do a lot right now on the page about daily, weekly posts covering a variety of topics, as well as sharing a lot of other students, other clinicians work that they are doing to promote the profession, promote their small businesses. And so that's, that's kinda, my, my longterm goal is to just make it this safe space, I guess, for PT students and clinicians alike.

Speaker 1 (11:12):

And now is this something that is meant to help people pass their board exams? Cause I just want to make sure that we're kind of differentiating so that people, especially students that are listening if they want to get this guide or get these guides from you, is this something that's like, you're gonna pass your boards if you do this. Cause I don't want there to be any information there.

Speaker 2 (11:36):

Right? Absolutely. My first line of products is geared towards the board exam, especially the MPTE. I think long-term, I would like to branch out and see, especially in Canada, my boyfriend is Canadian. So you kind of giving some respect, a little shout out there too. But first and foremost, yeah, it's going to be focusing on the MPTE and then down the line I would like to extend it into just clinical practice, you know, how things have evolved from our standardized examination to how things are in the clinic or in the hospital.

Speaker 1 (12:10):

Got it, got it. Okay. So what can people expect? What if I, if I am a student and I want to download this, what can I expect to find,

Speaker 2 (12:23):

Do a lot of aesthetics? So I try to pull in like I said, the information that is relevant to both clinical practice and board examinations by kind of seeing where the attention is going to be in terms of like the mind's eye. So transitioning from what we made in school during our first year with those 50 to 60 page documents with just white background, black text, it's really hard to find the information that you think is going to be important. And kind of just simplifying it into basic examination procedures, basic interventions phases of rehab medical screening, laboratory values. And like I said, kind of the meat and potatoes of everything that PT is just so that students don't get overwhelmed with the details. It's going to be like bright and bold big ideas and then kind of like,

Speaker 1 (13:21):

Got it, got it. And, okay, so now we have a better idea of where you would like this to go. So tell me, what else do you have in development? What are you thinking that you can add to this? And it looks like, so what I mean, when you're on the website, it looks like it, the addition to it is, can be infinity. So I think it's important for people to know that it's not like you go onto your website and it's one big gigantic guide. Right, right. So where do you see this going? What do you have coming down the pipeline?

Speaker 2 (14:08):

So first and foremost is getting out both PDF copies and paper copies of the study guides. And then once I feel like that has a pretty steady response rate, then I want to transition into maybe even tutoring one-on-one video instructions or even student courses where they can go through maybe a differential diagnosis and orthopedics or differential diagnosis medication review in neurology and even down the line. This is like probably five years from now. I have a very invested passion and pain science, and so kind of pulling those things together and offing offering courses for professionals and students alike. So I, I have high hopes. I think it's going to be a little bit of a learning curve and seeing what the demand is for students and professionals when the time comes. But I, I have full intentions to continue to grow with the demands that are out there for students and professionals.

Speaker 1 (15:16):

Awesome. And now, you know, this is obviously very entrepreneurial and which is very exciting. So where did that spark come from? Because not everyone has that kind of entrepreneurial spirit and nor do you need to have it to be an excellent physical therapist, but where did that come from for you

Speaker 2 (15:38):

First and foremost? I have to, again, shout out to a dear friend of mine. His name is Travis. Robertson. He is, he was a third year student when I was a first year student. And like I mentioned, during that neuro unit where things kinda got a little hazy with studying, he mentioned to me that like, you know, why don't you just take a chance and see what the market is out there? He was very invested in cash based physical therapy at the time. And so then I started looking into, I mean, all the major ones, Aaron LeBauer was first and foremost, Danny Mada, Jared Carter. I actually even kind of more on like the female entrepreneur side of things is when I found obviously Karen Lyndsey and Dr. Hague more, just more opportunities to see what those people were doing in their own journeys.

Speaker 2 (16:28):

And so he really inspired me to just take a peek at what's out there. The more that I learned about cash based businesses, owning your own PTP clinic, the more I realized that there's different opportunities with side hustles with other income streams. And that's when I, I kind of took my passion for simplifying PT studies into like the study guide form and realizing it's going to take a little bit of effort upfront. But you know, if you have the passion for it and if you feel it's like, it's something that you believe in and fit that this is truly something that I believe in, then you can make anything happen. Like you said, you hit the nail on the head. You don't have to be an entrepreneur to make these opportunities possible for yourself.

Speaker 1 (17:11):

Yeah, no, definitely not. Definitely not. As long as you can stay organized and motivated and at some point reach out for help. I know not necessarily in the beginning, but you know, as time goes on reaching out for help when you need it is always a great thing as well. Well, it sounds like you've got, it sounds like you've got everything under control. I think you might be more organized and, and, and you've got your, you know, what together, more than I do. So I may, I'm a little so now what, where can people find you? Where can they find the guide? Yes.

Speaker 2 (17:58):

So the website is plain and simple DPT study guy at.com. I also run primarily the Instagram account, which is the handle is DPT study guide. And then that same handle you can find on Twitter and Facebook. If you're interested in connecting to me personally I do have a LinkedIn as well, and that would be my first and last name Breeza Barrick. So we can connect there too, but yeah, everything is easily accessible from the website and from Instagram page.

Speaker 1 (18:30):

Awesome. And, you know, just so you know, it's also very easy to download and it is very pretty and it's very organized and looks very it looks great. So I highly suggest if you're listening to this, especially if you're a student and even if you're not, if you want to brush up on your open and closed pack positions for all your joints, definitely a check out to DPT study guide.com. Now the last question is something I ask everyone it's knowing where you are now in your physical therapy student journey. Normally I say, in your life and career, what advice would you give to yourself right out of PT school, but why don't we say, what advice would you give to yourself maybe before you started physical therapy school to where you from, where you are now?

Speaker 2 (19:16):

Oh, that's a great one. Looking back, I would make more time for breaks. I feel like students are way too hard on themselves in terms of, I need to be studying 24 seven. If I'm taking a break, it makes me weaker. It makes me less smarter or whatever the case may be. Take more breaks and realize how valuable those can be for just hitting, like reset with your, your mind, your focus. And also just making time to have some fun. I, I really feel that our class emphasize that a lot because we were also motivated to perform as best we could on test exams and really trying not to sweat the small stuff. Obviously, like I said, the whole goal of it was to let's focus on the big picture and maybe try and make it a little bit easier on ourselves throughout the way.

Speaker 1 (20:11):

Excellent advice. Excellent. Well, Bri, thank you so much. You are absolutely wonderful and makes me very excited for the future of our profession, knowing we have people like you getting ready to graduate and enter the workforce. So thank you so much for coming on the podcast.

Speaker 2 (20:29):

Yeah. Thank you so much for having me. I really appreciate it.

Speaker 1 (20:32):

My pleasure, and everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and smart.

 

Feb 8, 2021

In this episode, Director of Rehabilitation at OL Reign, Dr. Nicole Surdyka, talks about on-field rehab after ACL injury.

Nicole is currently the Director of Rehabilitation at OL Reign, one of the founding clubs of the National Women’s Soccer League, NWSL, which is one of the best professional women’s soccer leagues in the world.

Today, Nicole shares her 5-phase on-field rehab strategy, and the decision-making process in return-to-play and return-to-performance. What are the criteria that Nicole looks at to determine progress to the next phase of rehab? She tells us about delaying return to sport to reduce second-injury risk, the return to sport continuum and how to define it, and the use of the StARRT framework for the return-to-sport decision-making.

Nicole gives some valuable advice to her younger self, she tells us about integrating rehab with team activities, and communicating with athletes and coaches, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • Nicole implements on-field rehab in 5 phases.

Phase 1: Simple, pre-planned, linear movements. The focus is on quality of movement and cleaning up movement technique before moving on. Typically includes walking marches, walking lunges, side shuffles, and jogging. Nicole starts this at 70-75 quad strength limb symmetry index.

Phase 2: Pre-planned direction-changing movements. Typically includes accelerations, decelerations, sprinting, and change direction.

Phase 3: Adding reactive tasks without a soccer ball. Direction-changing with an element of reacting to an external event. Nicole starts this with at least 80% quad strength limb symmetry index.

Phase 4: Soccer-specific movements. The reactions are done in context – with a soccer ball.

Phase 5: This phase should look like a modified training session.

  • Delaying return to sport: each month that you delay that, there’s a 51% reduction in second-injury risk, up until the 9-month mark.
  • Return-to-participation: When athletes are participating in their sport in a modified way – participation with certain limitations on activities.

Return-to-sport: When there is no longer any medical reason to limit an athlete’s participation – “cleared to play”.

Return-to-performance: There are no restrictions and athletes are training to become better at their sport.

  • “Be patient. Every experience is valuable, and you can relate any experience to what you eventually end up doing.”

 

Suggested Keywords

On-field Rehabilitation, StARRT, Injuries, ACL, Sport, Performance, Physiotherapy, PT, Therapy, Wellness, Health, Injury-Prevention, Recovery,

 

Recommended reading:

Consensus statement on return to sport: https://pubmed.ncbi.nlm.nih.gov/27226389/

On-field rehabilitation Part 1: https://pubmed.ncbi.nlm.nih.gov/31291553/

On-field rehabilitation Part 2: https://pubmed.ncbi.nlm.nih.gov/31291556/

 

More about Dr. Surdyka: 

Dr. Nicole SurdykaNicole is currently the Director of Rehabilitation at OL Reign, one of the founding clubs of the National Women’s Soccer League, NWSL, which is one of the best professional women’s soccer leagues in the world.

Nicole is a physical therapist and strength and conditioning coach. She played Division 1 college soccer at St. John’s University and then went to Emory University where she got her Doctor of Physical Therapy Degree. Throughout college and PT school, Nicole coached youth soccer and worked as a personal trainer.

After PT, school Nicole worked in various outpatient orthopaedic and sports medicine clinics before starting her own practice in 2018 where she worked with youth to professional athletes. Nicole specializes in on-field rehab for soccer players to help bridge the gap between rehab and sport performance. She is passionate about the return to sport process and how we can make better decisions for athletes returning to sport after an injury.

Nicole has a website where she writes blog posts on rehab for soccer players, has eBooks available on specific injuries, teaches continuing education courses, and has presented at CSM and other national and international sports medicine conferences.

To learn more, follow Nicole at:

Website:          Nicole Surdyka Physio

Facebook:       Nicole Surdyka Physio

Instagram:       @dr.nicolept

LinkedIn:         Nicole Surdyka PT

Twitter:            @NSurdykaPhysio

YouTube:        Nicole Surdyka

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

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

 

Read the transcript here: 

Speaker 1 (00:00):

Hey, Nicole, welcome to the podcast. I am so excited to have you on.

Speaker 2 (00:05):

Thanks. I'm excited to be on.

Speaker 1 (00:07):

So this whole month we're talking about ACL injury and ACL rehab, and you are an expert in both. So I'm really excited to have you as one of the guests this month. And today we're going to be talking about something that is really your zone of genius, and that is the on-field rehab, a rehab techniques, I guess, that helped to bring that player back to performance. So can you talk about what is the on field rehab like?

Speaker 2 (00:45):

Yeah. So I guess it's a concept that I, you know, I was a soccer player. I was a youth soccer coach, and so I always kind of felt in the back of my mind when I was going through PT school, like, Oh, wow, I could blend. Like, if, if we're trying to get this adaptation or build up this physical attribute, we could do that through soccer. And so it just made, it was something that made sense to me trying to incorporate the sport as much as possible, but where it really all clicked and came together. For me, it was actually at the isokinetic conference that I went to a few years ago in Barcelona. And actually your previous guest on this in Arundale was the one who talked me into going. So that was great. And I saw a presentation by Matt Thorpe about on-field rehab. And of course he and Francesco via have published two different articles in WSPT on this, but kind of seeing that presentation really yeah, tied it all

Speaker 1 (01:42):

Together and made me have that aha moment

Speaker 2 (01:44):

Like, Oh, this is a thing I can make this happen. And so really what it is is it helps to bridge that gap between the gym-based rehab and then sending the athlete back for their sport. Because if you think about it, there's so much of a difference between doing a drop vertical jump in the gym and then landing from a head ball on the field. Like not even just physically that's different because the surface is different. Your shoe wear is different. The weather obviously is different, but there's also different things in your environment to make decisions based off of, and react to and respond to. So where are my teammates in space? Where is my opponent? Am I going to have a contact or an indirect contact, a perturbation while I'm in the air that I have to land on? Funny, where do I have to redirect my Ron to afterwards?

Speaker 2 (02:34):

And you can only prep for that so much in the gym. And at some point you really need to get them on the field and do in a controlled way, what they're going to have to do when they're playing with their team again. So on-field rehab. The way that I implement it is really based off of Matt, Matt backdoor, Ben for Jessica, Davey is research and there are papers on it, which is phase one, really simple pre-planned linear movements. And so that can start fairly early. They say in their paper that they want to start. When the athlete has 80% quad strength, limb symmetry index, I tend to start a little bit earlier than that. Typically, when I'm having athletes jog, then they can be doing phase one. So things like walking marches, walking lunges side shuffling is okay in this phase, jogging anything that the athlete is has pre-planned, it's a pre-planned movement and it's just linear.

Speaker 2 (03:34):

So no changes of direction yet. And in this phase, we really focus on quality of movement. And we start to address here before they move on to more complex tasks we address are they moving efficiently? And are there things we need to clean up with the technique of their movement? So something like a high skip or a walking March, are they getting a lot of trunk lean? Are they yeah. Are they kind of like looking like Gumby out there? And so we need to clean that up a little bit, and this is the phase that we can really take the time to do that. So again, I like to start this pretty early. Typically I want them to be at least 70 to 75% quad strength, limb symmetry index. But the, just as a caveat to that, the paper by Francesco and met, like they're up says 80%.

Speaker 2 (04:27):

So just be aware of that phase two, they then move on to being able to change direction. Everything is still pre-planned. So we can take those linear movements from phase one and make them a little bit more intense. So we can start working on reaching towards accelerations decelerations, maximum speed. So we start to work on sprinting here and exposing them to high-speed running on the multi-directional staff. We can have them do anything pre-planned so no reactive tasks yet, but they can start to cut decelerate, changed direction, all controlled everything throughout the unfilled rehab program is control first. Then we build volume and intensity. So after phase two, we can progress them to phase three. Now for this, I definitely want them to be at least 80% quad strength, limb symmetry index. And I would love for them even to be closer to 85% and depending on how they look functionally.

Speaker 2 (05:29):

And so this is when we start to add reactive tasks. So now change of direction tasks, but with a reactive component. So they're reacting to something external to them. So I like to mix up and I know Amy talks about internal versus external cues a little bit. And it's something that definitely is coming up a lot in ACL research with motor learning is that we want some external cues. And so that can be auditory. That can be visual. So I like to do kind of a combination of both. I'll use words that they're going to hear while they're on the field. So turn man on ball, you know, I'll use kind of those that verbiage. And then the visual is you can make it just simple. You pointing to where they have to cut to or change direction to. You can make it be, they have to follow the ball, they have to follow a runner.

Speaker 2 (06:25):

So they have to follow where the space is that you've set up with, however, you've set up the environment. So that's where we add the reactive components and they anything pre-planned they can now be doing at speed. Next, we're going to go into phase four, which is really going to be more soccer, specific movements. So now they can react with a soccer ball. So everything we didn't base three with the reactive movements is them without a ball at their feet. Now in phase four, we can add a soccer ball. So you have to turn and either dribble, dribble, or pass, or you know, you have to collect the ball and then make a decision based on what's going on around you or what the coach or the physio calls out. And then phase five really should just look like a training session, a modified training session. So I try to replicate what the team has done in their training session or what a typical team training session would look like as much as I possibly can within a more controlled environment. So that's kind of the five phases and then, yeah, and then I started to incorporate them into the team. Okay.

Speaker 1 (07:32):

So let's, I have a couple of questions. So we're just going to back up a little bit. So for most of these phases, certainly phase one phase two phase three is the player is the player alone on the field? Do they, are they working in tandem with another player on their team?

Speaker 2 (07:50):

So typically when I was, before I had my current role, I had my own practice and I would work with the athletes. So it would be me and the athlete. If they had a friend or a teammate who was available, it's always nice to add other players. Now here at LL rain. I have two athletes right now who are going through ACL rehab together, kind of they're at a little bit different spots, but I can still work together with them, which is really nice. And then I can always pull some of the other players. So, Hey, do you want to work on crossing and finishing today? Great, like come in for this session this time and I can pull other players and you can do it alone. Eventually you need to start adding other players because there's 22 people on a soccer field. And so they need to start being able to move and react to all of those different people on the field, around them. And you can still do that in a controlled fashion. Absolutely.

Speaker 1 (08:51):

I will say to, to play or one, I want you to run down to line and cut to the right as your athlete is within the midst of whatever you're asking them to do from a rehab standpoint. Correct.

Speaker 2 (09:03):

Exactly. You can say, okay, you're going to run up and defend them. I want you to force them to their right. You know, so that way I have that person has to go to their right, so you can control for it. Whereas in a game you can't tell them, or an even in a practice session with their team, you can't say to all the other players on the field, Hey, when you go and defend, so-and-so only for, for her to her right foot, okay. That's never going to happen, but in that nice in on-field rehab, you can control for those things. And

Speaker 1 (09:31):

The other question I have was what is the criteria for entering phase two?

Speaker 2 (09:35):

Good. So, and answering into any onto three high program. I mentioned the quad strength, limb symmetry index, but also there should be no joint pain or a fusion. They can have some muscle soreness at times if they had a patella tendon graft they can have some patella tendon pain. I'm okay with that. Hamstring graft, if they have hamstring pain, I'm okay with that. But, and then also no joint laxity. So I'll typically just do a Lockman's anterior drawer test, as long as those are negative and there's no joint fusion, then we're good to go. Now it's progressed through each stage, subsequent to that, as long as they're able to do those movements with control, and there's no increase in joint pain or a fusion during any of those stages, then I can progress them. Although I still want to bear in mind, like we're not just going to do walk like phase one stuff.

Speaker 2 (10:27):

And then it's like, Oh, they felt good. Okay. Now we can do phase two. Like I still want to make sure that we get a couple sessions in and it's always going to play back into the overall big picture of where they're at in their rehab. You know, we're still doing a gym-based strength program at the same time that we're complementing with on-field rehab. So it that's where it kind of the the art of coaching takes in a little bit. And you just need to understand where your athlete is and if they still need more time in that area before moving on. Got it. And

Speaker 1 (10:59):

I know this is a question that a lot of people constantly ask when it comes to ACL, what is the timeline? Right. You know, cause you're always here. You don't want to return to play for a year for 10 months, nine months, a year, two years. So as you are going through these phases, are you also taking into account where they are in that rehab continuum or in, you know, post-surgical so how do you question

Speaker 2 (11:26):

W so it's kind of the, the short answer to that question is we can go back to some of the research that's been done by the Delaware Oslo cohort, so that, Hey, grandam over at Oslo and Lynn center Mackler at Delaware, and they've shown that delaying return to sport each month that you delay that there's a 51% reduction in second injury risk. And really the whole thing of this is when we're sending out fleets back to sport after an ACL reconstruction, our goal is to not allow that to happen again, right? The rate of a secondary injury is so high that there's obviously a flaw in how we're sending athletes back. So I think that most athletes go back too soon. And so each month that we delay up until the nine month Mark and at nine months, we, after that, we don't really see that level of reduction in, in, in second injury risk.

Speaker 2 (12:22):

Now for a youth player, who's not really in a rush to get back. I will probably never let them go back before a year. I just, there was no reason it's not worth the risk. They're agreed so much more likely to have another injury. And like, why have two ACL injuries in high school before you even get to college? Right. If the goal is to, is to play in college, you're better off missing your entire junior year of high school to just rehab and then be really strong for your senior year. As opposed to feeling like, Oh, I have to show college coaches. I have to go to all these college showcase tournaments, which I know is, is pressure on the athletes, but what does it, do you any good if you go back and now you do it again and you miss all of senior year as well, right then by college, like that's not going to happen for you. Right. So more of the professional athletes, there's a little bit more pressure, it's their livelihood. Right. So I'm okay with moving or even college athletes. I'm okay with moving closer to nine months, but I will never go before that, unless I have somebody like an Adrian Peterson who is just one of those outliers, then they have to give me a really good reasons to let them go back.

Speaker 1 (13:33):

Okay. And this actually flows perfectly into the next topic I wanted to talk about. And that is that decision-making for return to performance, right? So we've got the return to play. And even if you want to talk a little bit about that distinction between return to play and return to performance and talk a little bit about what your your decision-making

Speaker 2 (13:57):

Is like. Yeah. So to talk about that continuum a little bit, and actually I just had a meeting with our coaching staff here about that to make sure you're on the same page about these definitions. And so how I define them is based off of the return to sport a consensus statement for that Claire and was lead author on where the return to participation phase is when, or end of the continuum is when athletes are participating in their sport, but in a modified way. So I have a couple athletes now who I say, I look at what the daily session plan is for, for the training session. And I'll say, okay, this athlete can do the technical warmup and they can do the [inaudible], but I don't want them doing the two V twos because it's too much deceleration cutting, et cetera. So they, that counts as returned to participation because they're participating, but I'm still putting restrictions or limitations on them.

Speaker 2 (14:53):

So anytime there's any kind of modification or restriction or limitation there in returned to participation, when the medical, when there are no longer any medical reasons to hold an athlete back, that's when they're in return to sport. So that's what I would define as saying like you're quote, unquote, clear to play, right? Is that I'm not putting any restriction on you, if you are not being selected for playing time or for your starting position. That's because the coach isn't selecting you, not because I'm holding you back, but then beyond that, because sometimes an athlete's not going to really be satisfied with that outcome, right? If you're used to being the starting center forward and scoring a goal, a game, and now you're cleared, but you're not being selected into the starting lineup, or you're not being selected to the game day roster, or you are, but you haven't scored a goal in five games.

Speaker 2 (15:44):

Now you're not performing at where you were prior to your injury. So there's no medical reason to hold you back, but maybe you're not playing as much or playing as well as you would like to be. And that's where we transition into return to performance. So return to performance is there's no restrictions on you, no medical limitations or anything holding, holding you back from a rehab perspective. And now we're training to get you to being better at your sport. And I think those are really important distinctions to make, because a lot of times athletes or coaches, and actually it will be back and cleared to play, but coaches like, well, why isn't she as fast as she used to be? Why isn't she scoring goals? Like she used to be? Is she still hurt? It's like, no, it medically fine, but we're just not at return to performance yet.

Speaker 2 (16:33):

So then to to kind of decide when to send an athlete back for each of those things, I tend to look back to the on-field rehab program and how that is structured. So I'm a big fan of integrating the team, the athlete into team activities as often, and as much as you possibly can. So if they're able to do the technical warmup with the team, I'm putting them in there because, and that would technique that would typically be if they're in stage two, right. Cause it's going to be mostly pre-planned change of direction tasks, maybe some accelerations D cells, depending on, on what the warmup looks like. Sometimes there's reactive components. And so that sometimes takes just a conversation with the performance director or the SNC coach or the sport coaches, just to say, what is involved in this? And then, you know, but if you, if that athlete is able to do those things and they've done them with you and an on-field rehab program, send them back into the team.

Speaker 2 (17:33):

Cause that is just to me is another level of like the cognitive awareness and their ability to see what's going on on the field, around them and adding more athletes into the mix that they have to interact with. So I'm a big fan of that. So I'll typically have them in that return to participation phase for a fairly long time, like a few months before I say, okay, you're good. So, and the example right now, I have an athlete, who's doing portions of training sessions, but I probably won't like clear her quote unquote, clear her to play in a game until somewhere in the middle of April. Right. So she'll be,

Speaker 1 (18:16):

Is she about like six months then? Post ACL? Yeah. Yeah. Yeah. Okay. Yeah. And I think it's important to mention all of this because oftentimes a lot of physical therapists and I, this is not to throw our profession under the bus or anything, but a lot of physical therapists tend to be a little bit more restrained. They won't want them to go onto field. They won't want them to do this on-field rehab until they're at 90%. Right. And or until the doctor clears them to return to play well, you can't just be cleared to return to play. And you've only done a weight training program, proprioception, maybe some motor control stuff and then throw somebody on a field.

Speaker 2 (18:56):

Yeah. And I've seen that way too often.

Speaker 1 (18:59):

Yeah. Yeah. And so it's, I think that I'm really happy that you're saying like, Hey, you know, at six months they can be with the team, they can do some things. It just, it sounds to me like it's a lot of communication and collaboration from the, all of the stakeholders, right?

Speaker 2 (19:14):

It is, it does take a lot of communication. And we have twice a day meetings, constant emails, constant communication about where each athlete is. And then, you know, there is things that come up that we have to adapt to, like this was the training session plan. And this athlete was going to be able to do this amount of load that day. And then based on what was happening in the session, the plan changed. And so we have to adapt to that. And then we just supplement that with it with more on field work, you know, if they weren't able to do as much in the session with the team, then I just will take them to the side and do more work with them on the field. Now I will say that this is a lot easier to do in a team setting. And now I didn't work in a team setting for most, all of my career up until very recently.

Speaker 2 (20:01):

And so what I did in that situation, working in an outpatient clinic, that doesn't mean that this doesn't apply to you because you can still use this. And so what I used to do is whatever I would see my athlete do in the clinic with me or on the field with me, I would say, okay, I want you to go do this in practice with your team. So I want you to do the dynamic warmup with your team and then that's it. And then report back to me if that felt okay for them, then I'll say, okay, you can do any technical drill. You can do rondos, you can do, you know, possession style games but no contact. You can be neutral player. And I'll tell the athlete that depending on their age, I'll also tell their parents I do or did before I was in my current, always try to reach out to their club coach or their high school or college coach and let them know what the restrictions were. I understand sometimes we don't get responses when we reach out. I didn't always get responses when I reached out. But as long as you talk to the athlete and or their parent about that, and just make it very clear to them, like you can do this, you can not do that and then have them report back. But I, my rule of thumb was I wanted to see them do that type of activity with me before I had them do it with their team.

Speaker 1 (21:18):

Makes sense. And, and I think it's also important to note that just because you work in an outpatient clinic, doesn't mean you can't take these athletes onto a field. I live in New York city. I see patients in their home. I have a 14 year old who had a ACL rupture and subsequent surgery. And when she was 12 she's 14 now. Wow. Yeah. And we still got her out onto a field, got her. We went to the park, we did as much as we could on field. And sometimes that was just me having to be the defender or setting up cones and having her do stuff. But I think it's really important that if you work in an outpatient clinic, don't kind of wall yourself in with the walls literally. Yeah, exactly. You can take them out onto a field somewhere. I mean, if I feel like if I can do it in the middle of Manhattan, then people could probably have a much easier time doing it in places with more space.

Speaker 2 (22:15):

Yeah. And I would even get like, I've worked in clinics where the only space we had was the parking lot. And maybe that's where we did that. Or again, you can always say like, okay, I've, we've done the 11 plus warmup in our, in our gym based sessions. So you can go do that with your team now. Or we've done some volleying and passing and moving, you just need 10 yards of space. Right. We've done that in the clinic. So now I want you to try that with your team, or can you go in the backyard with your mom, dad, sister, brother, whomever, teammate, friend. And I want you to do these types of exercises in your backyard, you know, like have that be their AGP instead of having them do straight leg raises for six months. I mean, I have that either ETP.

Speaker 1 (23:06):

Yeah. I had my patient probably much, much to her. Neighbors' dismay, but we would be in the hallway of the building. Yeah. Or go into the basement of a building. I see a girl now for she's a softball pitcher. We go into an empty storefront. That's kind of attached to the building. I mean, you make it work, you know, you just have to

Speaker 2 (23:29):

Exactly. And like, if you can't find a way to make it work, you have to ask yourself, should I really be working with this type of athlete? Right. If you can't find a way to give the athlete what they need to get back safely and appropriately, then maybe that's not the setting, the athlete to be seeing you.

Speaker 1 (23:47):

Right. So it's you do the, I call it the blessing release. Oh yes. More, you need more space, you need XYZ. So I'm going to release you to someone that can, can finish the job if you will.

Speaker 2 (24:01):

Exactly. And that takes, like, I feel like in all walks of life, like just not having an ego is such an important skill set to have. And just saying, I know that there's so much more that can be done for you. And I know that there are too many limitations on me to be able to do this. So here's someone who can help you and you should move on to this person.

Speaker 1 (24:22):

Yeah. Yeah. And I think that's fair. And again, patient centered. And when you think about that return to sport, decision-making a lot of Claire, our Dern's work is that patient centered decision returned to sport decision-making. And so what you just said is exactly that. And so I think it's important for people listening that it may not always be you. Yes. That is such an important point. Yeah. Now, is there anything that we missed or that I glossed over that you're like, Oh man, I really wanted to make this point. Did we hit everything? Yeah. We hit everything.

Speaker 2 (24:57):

The only thing I would add is just as something for people to maybe go look up and learn more about is in that consensus statement, they talk about the start framework and that's what I use to guide my return to sport. Decision-Making right. So it's really just a simple needs analysis. What are the demands that this athlete is going to have to face and are they prepared for those? And yeah. So the start framework is a really great method. It's what it's literally what I use to help guide decision-making because it doesn't just look at, like, it looks at the tissue health, it looks at the demands. It also looks at what are some modifiers of those. So is it preseason? And so we can err on the side of being a little conservative or are we in the playoffs and this is one of our star athletes and we need them on the field. And so we're willing to take a little bit more risk. So yeah, I think that that's a really important framework to utilize because it provides you with that context that surrounds the kind of the risk reward ratio.

Speaker 1 (25:59):

Exactly. Yeah. And that's what I said to my, this 12 year old, who's now 14, but you know, she, we waited a year, at least a year for return to sport and then COVID hit and that night Oh yeah. Which I have to say, I wasn't mad about two years, you know, that's awesome. But you know, like what I told her was exactly what you she's like, Oh, do you think I can like play in this, you know, showcase she's an eighth grade. Yeah. No Roland showcase. And I was like, listen, here's the deal. Can you do this? Yes. Will you be at your best? No. Are you going to college? Is if this, what? And I said, it was like, if this was your senior year and it was the last game

Speaker 2 (26:45):

Sure. Have at it, you know,

Speaker 1 (26:47):

But it's not, so you're not going to do it. Are we in agreement there? And, and that's the hard part, right. Is trying to say to like a 12 or 13 was 13 or 14, 13 maybe was, do you want to play in high school? Yes. Would you like to play in college? Yes. Well then you don't need to do this exam because we're not taking any unnecessary risks and that's kind of, how did that start framework is looking at that context and I'm sure you have those difficult conversations all the time.

Speaker 2 (27:15):

All the time. Yeah. It, and especially after something like Nazi has already been cleared by a physician or previous physical therapist or athletic trainer or whomever, and then it's like, Oh no, I know that you were cleared, but we'll, you are certainly not ready. And just having that conversation can be difficult, but as super important, because all they're going to do is go right back. And the likelihood of them getting another ACL injury within the first year or two is pretty substantial. So sometimes scare tactics, work a little in that regard.

Speaker 1 (27:46):

And it's not, it's just, you're just being honest. Yeah. Like you can't like, you're the professional, you're the expert. They're the patient they're going to you because you're the expert. Yeah. Right. And so you have to be honest and you have to be upfront and you have to give them all of the options that they have and looking at things realistically, because just, you know, people say, Oh, runners, they just want to run. Well, it's the same with any sport soccer players. They just want to play soccer, football, I just want to play. And so there there's a lot of mental gymnastics that can happen in one's brains in order to justify doing that.

Speaker 2 (28:21):

Definitely. I think athletes actually appreciate that when you say like, like maybe in the moment they're frustrated, but it's not with you. It's just with the situation. And I think that makes it easier to swallow is that like, Hey, like they appreciate knowing that you're taking that context into consideration. Like, say like, Hey, if you're going to get re-injured, it's going to be in the championship game, not in a preseason friendly, like what sense does that make? And I think they do for the most part, appreciate that and understand it. Even if, again, in the moment it frustrates them a little bit. Yeah.

Speaker 1 (28:51):

I mean, there's a little bit of disappointment, but you know, something it's upsetting

Speaker 2 (28:56):

Templating moment. Get over it. You'll be fine. I feel the same. Exactly. I've never said that, but in my head I'm like, you'll be fine. You'll be to sign. Yeah. Like 10 years. That's fine. If you do it again and have to go through another year of this

Speaker 1 (29:09):

Exactly. Like 10 years from now, you're not going to be like, man, I didn't get to play in this showcase when I was in eighth grade.

Speaker 2 (29:17):

Yeah. Definitely not. It doesn't make sense.

Speaker 1 (29:20):

So I think thank you for bringing up that start framework and we'll try and get links to all of this and put them into the show notes so that everyone if you're looking for those papers on on-field rehab, the start framework and the consensus, we'll get all those and put them into the show notes. So you one click and everybody can read all of them. So Nicole, before we end our talk is the question I ask everyone. And that's knowing where you are now in life and career. What advice would you give to your younger self?

Speaker 2 (29:51):

I would definitely tell myself to be patient. I came out of school thinking like, okay, I just want to work with athletes. You know, I have to find a place where I can just do that. And anything else I do is a waste of time. And what I will say, what I would tell myself is that every experience is valuable and you can relate any experience to what you eventually ended up doing. Even working with a, you know, if it working with the elderly population that has nothing to do with working with athletes, but teaching them a new skill. If you can teach it an older person, who's never worked out a new skill, you can teach an athlete, a new skill, right. It's somebody who's like coordinated and strong and athletic as opposed to an older individual who's never worked out before. So I think that I would tell myself again, just be patient there's value in every experience and yeah, you'll, you'll eventually get to what you're looking for. Just take it, take things in stride and learn from each experience.

Speaker 1 (30:56):

Excellent advice. Now, where can people find you on social media? I think you've also got an ebook available. So give us all the goods.

Speaker 2 (31:03):

Yes. So you could to reach out to me. I'm I'm on social media. Instagram is at Dr. Nicole PT. My Twitter is at Encirca physio and my website is Nicole Serta, physio.com. I have a blog there that I grew up on this. I'm going to try to write more. I took a little hiatus. You had,

Speaker 1 (31:28):

I had a major change of life yourself from California to Portland and a new job. And so I think we, we understand we'll give you

Speaker 2 (31:40):

We're in the middle of a pandemic. So yeah, I think somewhere in the middle of the Vietnam, I just kind of lost a little motivation there

Speaker 1 (31:48):

With you all.

Speaker 2 (31:51):

Okay. It's okay. There's no need to like, feel guilty if you're in the same boat, cause I'm right there with you. But yeah, I will be writing more on that blog. I have actually a couple of different topics on the blog. One is just kind of rehab of soccer related injuries. And then I talk about some of the social issues related to soccer, things like racism and soccer and inclusion and diversity and things like that. And then also I have this little fun part. That's kind of just for me as a little self-indulgent, but life lessons that I've learned through soccer. And so that's on there as well. I also have some eBooks on my website. You can get to just by going and Nicole Serta, physio.com and it's under the eBooks tab. So on an ACL injuries, ankle injuries maybe hamstring injuries too. There's a couple on there now. Awesome. yeah, that's it. Excellent. Well, Nicole,

Speaker 1 (32:42):

Thank you so much. This was great. I great addition to our month on ACL injury and rehab. So I thank you very, very much. Thank you

Speaker 2 (32:52):

For having me on carrying this. When I graduated PT school, this is the first PT podcast I started listening to. So it's awesome to be on it. It's come full circle. It truly has. Yes.

Speaker 1 (33:04):

Well thank you and everyone. Thank you so much for listening. Have a great week and stay healthy, wealthy and smart.

Feb 1, 2021

Episode Summary

In this episode physical therapist, biomechanist, and researcher,Dr. Amy Arundale talks about how to decrease the risk of ACL injury. 

Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher.  Amy is transitioning to a new role as a physical therapist at Red Bull’s Athlete Performance Center in Thalgua, Austria.

Today, Amy tells us about injury-prevention programs, communicating with different stakeholders, and helping empower athletes through education. We also get to hear about her recent publication on Basketball, Sports medicine, and rehabilitation. How does motor-learning, creative thinking, and problem-solving relate to ACL injuries?

Amy tells us about implementation and compliance with injury-prevention programs, internal versus external cues as they relate to injury prevention, and the gaps in the research, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “We’ve got great information. We know these programs can work, but for them to work, you have to do them.”
  • “You may be a physio, and you may have this injury-prevention knowledge, but you don’t have to be there for this to happen. It’s just as effective for you to run this program as it is for a coach or a parent to run it.”
  • “It’s exciting to see where this next generation is going to be because I think we’re going to have some athletes that are more empowered to know more about their body.”
  • “We need to be better at reporting our biases, looking at our subject populations, and funding and encouraging studies outside of ‘the global North.’”
  • Giving yourself the space and kindness to recognise that you don’t know everything and make it a point to learn more is good therapy.

 

More about Amy: 

Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher. Originally from Fairbanks, Alaska, she received her Bachelor’s Degree with honors from Haverford College. Gaining both soccer playing and coaching experience throughout college, she spent a year as the William Penn Fellow and Head of Women’s Football (soccer) at the Chigwell School, in London. Amy completed her DPT at Duke University and throughout gained experience working at multiple soccer clubs in the US and Norway. Amy applied this experience working at Balance Physical Therapy providing physical therapy for the Capitol Area Soccer Club (now North Carolina F.C. Youth) and the U23 Carolina Railhawks. In 2013, Amy moved to Newark, Delaware to pursue a PhD under Dr. Lynn Snyder-Mackler. Amy’s dissertation examined primary and secondary ACL injury prevention as well as career length and return to performance in soccer players. After a short post-doc in Linköping, Sweden in 2017, Amy joined the Brooklyn Nets as a physical therapist and biomechanist as well as The Icahn School of Medicine at Mount Sinai Health System as a visiting scientist. Currently, Amy is transitioning to a new role as a physical therapist at Red Bull’s Athlete Performance Center in Thalgua, Austria. Outside of work, Amy plays Australian Rules Football for both the New York Magpies and US National Team. 

Amy has also been involved in the APTA and AASPT, including serving as Director of the APTA’s Student Assembly, a member of the APTA’s Leadership Development Committee, chair of the AASPT’s Membership Committee, and currently as a member of the AASPT Diversity and Inclusion Committee.

 

Suggested Keywords

ACL, Injuries, Recovery, Injury-Prevention, Learning, Sports, Physiotherapy, Research, PT, Rehabilitation, Health, Therapy,

 

Recommended reading

https://bjsm.bmj.com/content/54/21/1245  

 

To learn more, follow Amy at:

Instagram:       @squeakyedgar

LinkedIn:         Amelia (Amy) Arudale

Twitter:            @soccerPT11

 

Subscribe to Healthy, Wealthy & Smart:

Website:  https://podcast.healthywealthysmart.com

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

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

SoundCloud: https://soundcloud.com/healthywealthysmart

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

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

 

Read the Full Transcript Here: 

 

Speaker 1 (00:07):

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

Speaker 2 (00:38):

Hey everybody. Welcome back to the podcast. I am your host. Karen Lindsay, and today's episode is brought to you by net health net health therapy for private practices, a cloud-based all in one EMR solution for managing your practice. That's right. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus a lot more in one super easy to use package. Right now, Neta health is offering a special deal for healthy, wealthy, and smart listeners. Complete a demo with the net health team and get $100 towards lunch for your staff. Visit net health.com/ [inaudible] to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y my last name very, very easy now onto today's episode. So what we're doing with the podcast this month, and really every month going forward is we're going to have several guests that are all going to talk about one topic in various forums.

Speaker 2 (01:40):

This month, our topic is ACL injury and rehabilitation. And my first guest is not only an incredible physical therapist, a great researcher, but also a great friend of mine. That is Dr. Amelia, Aaron Dale, or Amy Arundale. So Amy is a physical therapist and researcher originally from Fairbanks, Alaska. She received her bachelor's degree with honors, from Haverford college, gaining both soccer, playing and coaching experience throughout college. She spent a year as the William Penn fellow and head of women's football at the Chigwell school in London. Amy completed her DPT at Duke university and throughout gained experience working at multiple soccer clubs in the U S and Norway. Amy applied this experience working at balanced physical therapy, providing physical therapy for the capital area soccer club. Now North Carolina FC youth, and the U 23 Carolina rail Hawks. In 2013, Amy moved to Newark Delaware to pursue a PhD under Dr.

Speaker 2 (02:40):

Lynn Snyder, Mackler Amy's dissertation examined primary and secondary ACL injury prevention, as well as career link and returned to performance in soccer players. After a short postdoc in Linkoping Sweden in 2017, Amy joined the Brooklyn nets as a physical therapist, the biomechanics as, as the Icahn school of medicine at Mount Sinai health system, as a visiting scientist, currently, Amy is transitioning to a new role as a physical therapist at red bull's athletic performance center in Austria, outside of work, Amy plays Australian rules football for both the New York magpies and us national team. She has also been involved in the AP TA in the AA S P T, which is the American Academy of sports physical therapy, including serving as director of AP TA student assembly, a member of the AP TA's leadership development committee, chair of the AASP membership committee, and currently as a member of the AASP T diversity and inclusion committee.

Speaker 2 (03:37):

So what do we talk about today? All about ACL's right. So we talk about injury prevention and risk mitigation programs, how they work, what the pros and cons are how collaboration is so necessary amongst all stakeholders and why exciting new research that includes motor learning principles, creative thinking, and problem solving, and are there gaps in the literature and what can we, as clinicians and as researchers do about those gaps in the research. Now, the other thing Amy has so generously done for our listeners is she is going to give away one copy of basketball, sports medicine in science. This is a book that she was involved in as an editor, and it is over 1000 pages. The book is massive, it's huge. And she's going to give a copy away to one lucky listener. So how do you win that copy? All you have to do is go to my Instagram page. My handle is at Karen Lindsey, and you will find out how to win a copy of basketball, sports, medicine, and science. Again, that's go to my Instagram page at Karen Lindsey, and we will give this book away to one lucky listener at the end of the month of February. So you have the whole month to sign up for this. So a huge thanks to Amy and everyone enjoyed today's episode.

Speaker 3 (05:04):

Hey, everybody, welcome back to the podcast. So this month we're going to be examining ACL injuries and ACL rehab. And my first guest this month to help take us through the ACL Mays is Dr. Amy Arundale. So Amy, welcome to the podcast. Thank you so much. We're starting up at the beginning of the year with the A's with it. I didn't even think about that. Yes. But then next month we go right to running and just skip everything else in between. That's fine. Excellent. So Amy, before we get into sort of the meat of the episode, what I would love for you to do is tell the listeners a little bit more about some of your more current research projects, things like that. So I will hand it over to you. Sure. So I'm just finishing

Speaker 4 (05:58):

Up as a physical therapist and biomechanics at the Brooklyn nets. So I've been working clinically with them and then doing a little bit of kind of in-house research as well. And then on the side have been working on a few different projects. The biggest one right now is starting the revisions for the knee and ACL injury prevention me Andrew prevention, clinical practice guidelines. So those were originally published in [inaudible] in 2018 and clinical practice guidelines get revised every three years. So 2021 we're due for we're due for a revision. So that's my, the biggest project I've got going right now. And a few other things working with the United States Australian rules, football league on some injury surveillance and injury prevention, particularly on the women's side. And I'm getting ready to move to Austria to begin working for red bull and I, which I'm really excited about that.

Speaker 3 (07:04):

Amazing, amazing. They all sound really like really great projects. And since you brought up injury prevention, let's dive into that first. So there are a lot of injury prevention programs. So can you talk a little bit about those programs in general, and then talk about really, what is what's really key for injury prevention in our athletes when it comes to those programs?

Speaker 4 (07:34):

Absolutely. So there's a range of different programs that have all been published on and some of them are probably a little better known than others. The FIFA 11 plus, or what's now known as just the 11 plus maybe the, one of the most notable it actually came out of a program that was called the pep program. So the 11 plus was kind of aimed at soccer players, although it has been tested in other athletes and it's considered, it's kind of a dynamic warmup. So it has some dynamic stretching and some running, some strengthening, neuromuscular control, some balance exercises within it. And most of the programs that we see that have been researched are similar kind of dynamic warmups and include a variety of different things that help athletes kind of get warmed up. So some of the other ones that have been published on include the control or knee control program coming out of Sweden at the microburst and the ACL prevention in Norwegian handball has had some great success and great literature.

Speaker 4 (08:47):

There's the harmony program and then the sports metrics programs a little bit different. It's actually a program that was designed to be kind of a in and of itself. So it's a three times a week, 90 minute per program, primarily plyometric based. So it's a little bit different from the other programs, but has also been successful. So we've got a number of these programs that we've seen to reduce knee and ACL injuries in particular. And most of them actually have been quite successful at reducing just injuries as a whole. But the key components that we see in particular being important for ACL and knee injuries are that these programs have a strength component. So they're building strength, particularly in the hips, the quads, the hamstrings, but also in the core. So it kind of proximal in like terms of like hip and core strengthening, being important plyometric component seems to be important. To some extent a balance component may be important, although that's kind of questionable as to like how important that is. And that's one of the things that we still need more literature on is how do these components interact and influence each other? Because we seem to know what we think is important, but how much and how those different components interact. We still don't know as much about.

Speaker 3 (10:25):

And when we're talking about these programs, I would imagine some of the most difficult aspects of them, especially if we're looking at a younger population. So your high school, even collegiate athletes is doing them. Yup. So can you talk a little bit about implementation and compliance with these programs and how to instill that into these players and teams?

Speaker 4 (10:57):

Yeah, I think, you know, we've got, like you said, we've got great information. We know these programs can work, but for them to work, you have to do them. And that implementation piece, you know, whether that be in clinical research you know, we talk about that gap between research and clinical practice. We really see that here in ACL injury prevention. And part of that also is it's not just physios in implementing where we've got a whole range of stakeholders, whether those be the athletes themselves, to coaches who are often running training sessions to parents who really have to kind of be bought in to teams and clubs as a whole. Because if you have a culture that kind of instills the importance of doing a prevention program, then it's going to kind of, it may benefit in kind of trickling down. And that's also a wider culture as well.

Speaker 4 (11:58):

Social media scene pro teams do it. There's all sorts of layers to this. But what I think implementation really takes is identifying with that athlete or that team what's what are barriers what's important? What do we feel is, is most important? What's not as an important, and then coming up together kind of, kind of with a collaborative strategy to overcome what are those barriers? So we know information and knowledge kind of that buy-in is important. Why the why, why are we doing this in the first place? But then there's also some of the actual practical pieces of your athlete might not want to do an exercise lying down in the grass because that grass might be wet. They're going to be wet for the rest of their training session, wet and cold for the rest of their training session. So I think it has to be a really collaborative effort.

Speaker 4 (12:59):

And each in each situation that solution may look a little bit different. We've got some really kind of interesting information coming out. For example, the 11 plus has now a couple of studies on breaking it apart. So taking some of the pieces, for example, taking the strengthening pieces and putting them at the end of training sessions. So coaches often complained that, you know, these injury prevention programs take too long and when you've only got the field for an hour, they don't want to give up 20 minutes of their training session to do this program. So now let's take, maybe we can take this strength piece out. I means, all right. So maybe it's 10 minutes warming up at the beginning. That's probably a little easier for a coach to swallow. Then as we're cooling down, maybe we're off the pitch where we get everybody together, we finished those strengthening components. So we're still getting the entire prevention program done with that training session, but it's split up. And so thinking creatively like that are some of the ways that I think we can do a lot better in our implementation, rather than just saying, do this, here you go. Why aren't and then coming back and saying, well, why aren't you doing it?

Speaker 3 (14:18):

Right, right. Oh, that's, that is really interesting that and what is, does the research show that splitting it up is still as effective?

Speaker 4 (14:28):

Yeah. From what we know thus far, it does seem to be as effective. I think there's some other projects that are starting to look at, can you actually do that strengthening piece at home now there's other pieces that, you know, compliance at home, remembering doing those exercises the right way that could come into play there. But as of right now, what it seems like splitting it up does seem, seem to be splitting it up. At least within a training session does seem to be as effective.

Speaker 3 (14:58):

Excellent. And so aside from time and constraints on like you said, wet grass, things like that, what are some other common barriers that you have seen or that the research has shown to be a barrier to doing any of these? The above mentioned prevention programs.

Speaker 4 (15:21):

Yeah. I think coaching education is a really big one. So whether there's a few studies in Germany that we're just looking at a coach's awareness of the 11 plus and for a program that's kind of sponsored by FIFA, you know, it's promoted as kind of this soccer warmup, you would think that coaches would be kind of aware of it. And it's, it's very quite, it's actually quite surprising how few coaches are, are aware of it. Part of that is it's not in their coaching education. So at least in soccer, as coaches move up, what kind of within the ranks and, and in higher level teams, they've got a complete licenses, just like you have to complete a license to be a physio and complete continuing education in soccer coaches do to getting that program into that coaching education, I think is a really important piece.

Speaker 4 (16:18):

But then there's also the piece of helping them understand, again, coming back to that, why, you know, yeah, you want your players to be available. You don't want your players injured. And that's not just a, an immediate fact, but helping them understand the long-term implications, especially of something like an ACL injury, this is not an injury. That's just going to mean you don't have this athlete for a year. This is something that's going to affect how they play long-term it's gonna affect their knee long-term it could affect their career. So this has long-term implications. Buy-In also can come from kind of some of the performance effects, the stronger, faster, more talented athlete that's that there are some of those performance effects coming potentially from performing some of these injury prevention programs or injury prevention or injury risk medic mitigation programs that can help buy in.

Speaker 4 (17:22):

And then if we just look at Google would cut straight to the chase, is coaches want to win oftentimes and money. If you've got more players available, we know more players available equals a more successful team. And even Holly silver is actually in some of her dissertation work looked straight at the more you do the 11 plus the more successful the NCAA division one men's team was. So there's, there's she, she actually was able to draw a connection between doing the FIFA 11 plus and winning that those are the types of things that oftentimes coaches will latch onto and say, yeah, I want to win. Or clubs will say, yeah, we want to win. We want to do that thing that makes us that, that next level that makes us better at the higher levels that keeps us earning money.

Speaker 3 (18:18):

Okay. Exactly. So from, from what it sounds like is to get these programs implemented is you need a lot of collaboration from everyone, from all the stakeholders, whether it be the coaches, the trainers, the physios, the players, the owners, when we're talking about big league teams and, and with our younger, our younger subset of athletes, parents, coaches, and the kids themselves. And, and I guess communicating the value of these programs depends on who you're talking to, which is why, if you're the physio communicating the program, you really have to have a different set of communication bullet points, if you will, if you will, for each person on the, within that team, because you're going to talk differently to a parent than you are to an owner of a team, or you're going to talk differently to a coach than the player or the parents. So really knowing how to, how to talk to those stakeholders is key. And I think everything you just said will kind of help people understand how to have those different conversations with different people.

Speaker 4 (19:26):

Yeah. And I think there's all the other piece that some of those conversations is really empowering them. So there's the education piece and helping them understand, but there's also the empowerment piece that you may be a physio and you may have this injury prevention knowledge, but you don't have to be there for this to happen. It's just as effective for you to run this program as it is for a coach or a parent to run it. And we have, there's some good data on that that coaches can run really effective injury prevention programs. And so helping them kind of take on that role and say, yeah, no, I, I feel confident in taking my players through this. I feel confident in knowing why we're doing this there. I think that's the second piece too, is that it kind of empowerment piece, and maybe it's a player, maybe it's a captain that, that needs that education or that kind of empowerment as well.

Speaker 4 (20:31):

I think the generation of players that's growing up now is going to be very different from the generation of players say that you and I played played with we didn't understand or really have much of this. Whereas I think there's some really, there's some kids growing up now who are growing up with some amazing knowledge. And I think also coming with it, hopefully some better strength, some more and more neuromuscular control than maybe we had coming through puberty as well. So I think it's exciting to kind of see where this next generation is going to be, because I think we're going to have some athletes that are just like that more empowered to know more about their body. Maybe have a little bit more control maybe even coming with also potentially better talent who knows, who knows? Yeah. TBD to be determined. So you mentioned a little bit about motor learning. So let's dive into that a little bit because there is new research that includes motor learning, problem solving creative thinking. So what exactly does that mean in relationship to ACL injury?

Speaker 2 (21:51):

No, we're going to take a quick break to hear from our sponsor and we will be right back net health therapy for private practice as a cloud-based all in one EMR solution for managing your practice. That's right. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus lots more and one super easy to use package right now, net health is offering a special deal for healthy, wealthy, and smart listeners completed demo with the net health team and get a hundred dollars towards lunch for your staff visit net health.com/lindsey to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y.

Speaker 4 (22:38):

Yeah. So I think it's a really exciting area. And I think we're really just kind of tipping a little bit of the iceberg. People are starting to pay attention to some of the work that's coming out. And I think it's, it is really exciting and in the kind of prevention realm what we're seeing is people kind of pointing out that the programs that we have, we know we kind of have some principles of motor learning, but the programs in injury prevention that we have haven't really paid much attention to them. So at a very basic level one of the things that has been talked about from a motor learning perspective for a while now is internal versus external cues. So we know that giving an external cube, giving an output outcome focused, Q2 and athlete is going to help them keep that motion kind of more automatic. They're not going to be thinking about like, I need my hip in line with my knee in line with my toe and foot, my knee. Can't go too far over my shoe laces. I need to sit down.

Speaker 3 (23:50):

That's a lot to think about. Yeah. You can't

Speaker 4 (23:52):

Play a sport while you're thinking about all those things. Yeah,

Speaker 3 (23:55):

Yeah, no, no.

Speaker 4 (23:58):

So when that, if that cue is external or is outcome-based suddenly that athlete's much, much more, much better able to pay attention to the soccer ball that's flying past them or getting ready to, to bat.

Speaker 3 (24:13):

And can you let's if you wouldn't mind, just so people have a better idea of what an internal versus an external cue is. Can you give an example of, let's say a situation we'll use soccer as the example and give an internal cue and then give an external cue so that people can differentiate.

Speaker 4 (24:34):

Yeah. Yeah. So maybe, maybe we'll do say we're doing like a single leg squat, similar to what I, what I just said. So an internal cue might be, I want you to keep your hip, your knee and your foot all in one straight line that external cue might be giving them a we'll say a pole that's lined up in front of them and you might not even tell them what they're, what what's going on. Maybe you've got a pole in front of a mirror, so that's poles running vertically and they're, they're they're we, we just set them up so that their foot's in front of that pole and they're doing that single leg squat. So now you've got a visual line in front of them. You're paying their, their attention is going to be on that visual line. As they're doing that single leg squat, suddenly you see that they see that like, if their hips pretty far adducted or their knees collapsing in, you've got a line you can say, focus on that line. I'm going to focus on that line. Got it. That one, it isn't their body. Other cues, maybe like giving analogies I want you to think of your body as a column or that's, that's not a brilliant one. But you know, things like that. So analogies are helpful for external cues. They're also we'll get in, I'll get into that in a, in a sec, cause they're actually another,

Speaker 3 (26:10):

Go get into it, get into it.

Speaker 4 (26:12):

So analogies also bring in another piece of motor learning, which is called implicit learning. Again, kind of having that internal picture of what emotion should like should look or what that motion should feel like is implicit learning. So you've got external and internal, external internal cues, but you've also then got kind of implicit learning. So a great example of implicit learning is when you ask, you know, a really athlete to explain what they do on the court or on the pitch. And a lot of times they can't put words to what they do. And that's, that's kind of a good example of maybe implicit learning is they've got, there's no rules set to that learning. There is no order. It's just, I've got this internal knowledge, internal picture internal kind of motor memory of what, what that is. And I just execute that.

Speaker 4 (27:11):

I don't think about it. And so with those, all of my attention can stay to the game. I'm not thinking about how I'm moving. I'm just, just, just kind of to the game. So pulling those back to prevention are kind of injury prevention programs have said, here's a video or here's a picture. This is good. This is bad. Or they've given kind of implicit our internal cues. So those internal cues are those, keep your knee, your hip and your foot all in one straight line where we may benefit and where we might be able to bolster. Some of those programs is by adding some of these, these motor learning pieces at the very basic level, adding external cues, maybe adding some analogies or some implicit learning. Another, another way you can facilitate implicit learning is through dual tasking. One of my favorite things reading through some of the literature is in studying implicit learning. A few authors have taken novice novice golfers, and these novice golfers have, have to go and put, and while they're putting they basically yellow letters.

Speaker 4 (28:35):

So you literally just be out there like trying to learn to put you, you don't. I know how to put, you may not even get any directions, but you're just out there kind of yelling some letters, because if you have to generate letters, you can't be entirely focused on that pudding. So there's that aspect actually, of having two tasks going on at once. That means not all your attention can be on one of those tasks. How does that help? How does that help the movement? Yeah, so, so that's a very good question. What it means is, as you're learning, it it's like harder, but yeah, once you get to that kind of point where you're comfortable, you're able to execute that movement. It's an automatic movement, it's unconscious, it's automatic. And when we put that in the context of sport, that means that movement is happening without the athlete thinking about it and their attention remains, remains elsewhere. Their attention can remain on the game, that's going on the ball, that's flying at them. You know, that random thing that just flew by them that wasn't the ball and wasn't part of the game, but could be that perturbation, that in another situation could be distracting enough and could lead to an injury situation. Potentially.

Speaker 3 (29:58):

Got it, got it. Yeah. Like I, and you and I have had this conversation before, because I have a young athlete and we're doing, trying to do incorporate some of this stuff. So one of the things we're doing is I'm having her do some unpredictability drills with clock yourself, but we're trying to do them in Spanish. So she has to say things in Spanish as she's doing them. So that she's a little do. So she's accomplishing this kind of dual tasking. And, and I will also say it's fun. It's fun for the patients, fun for the therapist. And they kind of understand while they're why they're doing those things. And then every once in a while, just like throw a ball at her and see what happens.

Speaker 4 (30:42):

And you put this in the context then of some of those injury prevention programs and coach buy-in. So let's put Bali's in with single leg squats, but, but you know, squats and you jump into a header. There's already a little bit of some of that in some of the programs, but the more we can get that ball, some of those technical skills involved mix them potentially in with some of the movements that we're working on, maybe that might help with some of these, this kind of adding in some of this motor learning piece. Now I say all of this, none of this has been tested yet to change any of these programs we're really doing or to kind of, we need to go back and test them. And so, you know, this is where I say this, but it is kind of hypothetical, but in thinking about it, as well as we're kind of trying to overcome some of those barriers, that 10 minutes, that we're not, maybe we're at 10 to 15 minutes where we're trying to convince a coach to do something.

Speaker 4 (31:49):

Coaches are going to buy in a lot more. If there's a, if they can build some skills into that or they can see the sport reflected in it, rather than it just being kind of this abstract quote unquote injury prevention program. So can we get some of this dual tasking, can we get some of this kind of real world kind of environment type demands and challenges integrated in with some of those pieces that we're trying to build from a neuromuscular standpoint, can we mix them all together and end up with a maybe potentially more beneficial outcome?

Speaker 3 (32:26):

Yeah. And, you know, as you're saying all of this, it's kind of opening my mind up into these programs as being these living, breathing programs that aren't set in stone and that have the ability to change and morph over time as research continues to evolve. And I think that's really exciting for these programs as well, because you don't want to have these programs be thought of as stale because then that's going to not help with your buy-in.

Speaker 4 (32:55):

Yep. Yeah. And that's one of the complaints that you sometimes see about some of these programs is all right, so my team's done him for a season. They've all mastered, you know, all my players have mastered this program. They're bored of it now. And the likelihood that every single one of your players has mastered every single one of those exercises is that we'll put that into question, but we'll put that one on the side, but yeah, if you're doing the exact same program, the exact same exercise, every single training session for multiple years, yeah. Your players are going to get bored of it. And so are these, some of the opportunities where we kind of help with that buy in where we make it a little bit more creative, where we help kind of with some of those implementation pieces to make it more interesting to make it more long-term and to, to really help with people wanting to do them.

Speaker 3 (33:50):

I think it's great. And now we're, we've spoken a little bit about research here and there. So let's talk about any gaps in the research. So, I mean, are there gaps in the research? I feel like, of course, but are these gaps something that can't be overcome?

Speaker 4 (34:09):

No. All of the gaps that at least dive I'm aware of, and I'm sure there are more I just finished writing a paper alongside Holly and grant the Mark. So Holly silvers and, and Gretta microburst for the journal of orthopedic research. And, and one of the things that we did was kind of go through the literature and identify some of the gaps.

Speaker 3 (34:35):

What were, what were they, you don't have to say all of them, just give a couple of a couple of the big ones,

Speaker 4 (34:42):

But one of the big ones is a lot of our literature is focused on women, which is important, but in total numbers, we still have more ACL's happening in men. So we need more research in men. A lot of our research is in soccer and handball. There's a lot of other high-risk sports at there. So there were focused kind of on team sports but there is some pretty high risk team sports, something like net ball play ball volleyball have very high ACL injury numbers, individual sports things like gymnastics and wrestling. And those are also Tufts sports to come back to they're very high impact or they're very MBA. They've got some crazy positions that you don't see. So individual sports, I think have quite lacked outside of skiing. Skiing's got a lot of attention. One of the biggest ones that I think for me is really important is we don't have good reporting of the subjects and the diversity within the research that we've done.

Speaker 4 (35:51):

So most of the, the research that's been done has been done in the U S some in Canada and in Scandinavia, or at least in Europe as a whole, there's been a few studies that have been in in Africa. But we even within the studies that we have in the us and Europe and Australia, we don't, none of them have reported any of the, like really the, the, the race or ethnicity of the athletes who were part of them. So those may have implications and Tracy Blake did a amazing BJSM blog that was kind of a call to action for researchers. And it's one that I'd love to echo here that we need to be better at reporting our biases looking at our, our subject populations and funding and encouraging studies outside of kind of we'll call it quote, unquote, the global North. I think that's, that's a big gap that we need to fill and we need to be more aware of.

Speaker 3 (37:01):

Excellent. And on that note, we are going to wrap things up, but what I would like you to do is number one, is there anything that we didn't cover or anything more that you want to add to any of the subjects we covered?

Speaker 4 (37:16):

Ooh, I know you always ask this question and I always have never prepared for it.

Speaker 3 (37:23):

Well, you know, cause I don't want to like skirt over something and then the guests at the end is like, I really wanted to say this. And she just ended the interview.

Speaker 4 (37:32):

Think of it probably right before I go to bed. Probably.

Speaker 3 (37:36):

I can't think of anything right now. Okay.

Speaker 4 (37:39):

Excellent. Excellent. For any readers who haven't read Dr. Tracy Blake's BJSM post definitely go check it out. We'll put the link in.

Speaker 3 (37:47):

Yeah. Yeah. We'll put the link into the show notes here. So you can read her blog app over at BJSM and I agree. It was it was very well written and it was a really nice call to action and or call to awareness. Yes. Yeah, yeah. Right. Maybe not call to action, but certainly a call to awareness, which is step one in the sequence of actionable moves. Definitely. So yes, she's a gym. So now before we wrap things up I'll ask the same question to you that I asked to everyone and knowing where you are now in your life and in your career, what advice would you give to yourself as a new grad? Let's say like not new grad PhD grad, but new

Speaker 4 (38:36):

Duke grad, new, new grad coming out of Duke PT school. I'm trying to think of what I said the last time I was on.

Speaker 3 (38:46):

Well, don't say it again. No, I'm just kidding.

Speaker 4 (38:48):

Well, yeah, that's what I'm worried about saying the same thing again. I think what I said last time, but what is my like big thing is being more gentle on myself. When I came out of PT school, I started work. I was the first new hire new grad that they'd hired. And so I was working alongside some just phenomenal clinicians, but they had the least experience, one head, like 15 years of experience. And I came out of school, unexpected myself to kind of treat and operate on the, kind of the same experience level that they did. And I it's just not possible. So I've spent a lot of time kind of beating myself up. And so it takes a lot of reminding even now that like, I still have, you know, I've graduated in 2011. So I'm coming up on 11 years of experience and it's still not a lot in a lot of ways. So being gentle on myself that I don't have to come up with, you know, everything on the spot that I don't don't necessarily have the experience to know or have seen everything or every course or development. And so being okay with that and being gentle and allowing myself to be, to, to just be where I'm at is, is I think

Speaker 3 (40:08):

It's wonderful advice. And just think if you thought you did know everything, I mean, how boring number one and number two, you'd never move on for sure.

Speaker 4 (40:18):

Yeah. Yeah. Right. So

Speaker 3 (40:20):

You're stuck. You'd be pretty stuck. So giving yourself the space and the kindness to say, Hey, I don't know everything. So I'm going to make it a point to learn more is just good therapy. It's just being a good PT, being a good physio, you know, otherwise you're just stuck in 2011. I mean

Speaker 4 (40:41):

Gotcha. Yeah. 11 wasn't bad, but I'm glad I'm not stuck there.

Speaker 3 (40:45):

Yeah. I mean, what a bore, right. You'd be like so boring as a PT cause you would never advance.

Speaker 4 (40:51):

Yeah. So your ex

Speaker 3 (40:54):

Excellent advice. And now where can people find you on social media and elsewhere?

Speaker 4 (40:59):

So I am on Twitter at, at soccer, PT 11 I'm on Instagram at squeaky Edgar. I will note that's actually more personal but follow me anywhere cause you'll get some great, great adventures. And those are my primaries social media.

Speaker 3 (41:20):

Excellent. And before we hop off, can you talk quickly about basketball, sports, medicine

Speaker 4 (41:26):

Science? Oh yeah. I forgot to talk about that in my projects.

Speaker 3 (41:30):

Yeah. Let's talk about this quickly. Yes. So

Speaker 4 (41:34):

Was honored to be a part of an editorial group that just completed. I just got a book out. It's an ASCA public, a publication on basketball, sports medicine and rehabilitation. So it's a quite the book. But I say that because it is over over 1100 pages if I remember correctly. So it's, it's a, it's a, it's a chunk of a book. But we are, I've got an extra copy of it. So one of our allowed visitors really be getting a copy. Okay.

Speaker 3 (42:15):

Well Amy, thank you so much for coming on. I really appreciate your time.

Speaker 4 (42:19):

Thank you so much for having me. It's always fun.

Speaker 3 (42:21):

Everyone else. Thank you for listening. Have a great couple, have a great week and stay healthy, wealthy and smart.

Speaker 2 (42:28):

A big thank you to Dr. Amy Erindale for coming on the podcast today. And of course a big thank you to net health. Again, they have created net health for private, for net health therapy for private practice, which is a cloud-based all in one EMR solution for managing your practice. One piece of software that handles scheduling documentation, billing reporting needs. Plus a lot more. If you want to check it out, there's a special deal for healthy, wealthy and smart listeners. Complete a demo with the net health team and get a hundred dollars toward lunch for your staff. Visit net health.com/glitzy to get started again. That's net health.com/l I T Z.

Speaker 3 (43:09):

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

 

Feb 1, 2021

In this episode, Owner of Sisu Performance and Physical Therapy, Dr. Ellie Somers, talks about bone stress injuries, specifically in female runners.

Today, Ellie tells us about differentiating between the male and female runner, and she elaborates on a subjective and objective exam of a bone stress injury. We learn about the most vulnerable sites for a bone stress injury, the misconception about the severity of the diagnosis, and the strategies Ellie uses to get women on to strength and flexibility training programs.

Ellie talks about the concerns that many people have after a BSI, and she gives her younger self some valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “Female runners have a lot of particular and special needs and considerations when talking about evaluation from a physical therapist perspective, as well as from a communication standpoint, that need to be considered.”
  • “When you’re getting someone into your clinic, you don’t want to make assumptions about their circumstance.”
  • Things to consider in a subjective exam for a bone stress injury:
  1. Is the patient grasping why they got into this situation? A bone stress injury isn’t necessary about the shape of their body or foot, it’s a result of limitations of their dietary intake.
  2. Their menstrual cycle. This can be an uncomfortable conversation for many clinicians, but it is a required question for a subjective exam.
  • “If a runner is coming to you explaining that they think they sustained a BSI because of their pronated foot or because they were wearing the wrong shoes, we’ve missed a huge piece of why bone stress injuries actually happen.”
  • The most vulnerable sites for a BSI: The femoral neck, the first and second metatarsal, and the anterior tibia, among others.
  • The objective exam:
  1. Palpation, single-leg balance, and walking.
  2. More explosive movements. These include the single-leg hops and taking steps up or down.
  • “You can still be stressing bone and it’s going to heal. When we don’t stress bone enough, it could theoretically take longer and put that bone in a more vulnerable position.”
  • “Women athletes are more prone to lower bone density than male athletes are.”
  • “Runners kind of have this misconception that running itself actually strengthens bone. In reality, it doesn’t really strengthen bone as much as we’d like to think.”
  • “History of bone stress injury is the number one risk factor for new bone stress injury.”
  • “There’s no rush. You have your entire life ahead of you to work and refine. As long as you’re working on something, you’re working towards it.”

 

Suggested Keywords

Running Injuries, Rehabilitation, Therapy, Physiotherapy, PT, Training, Injuries, Sport, Wellness, Health, Recovery, Female Runners, BSI, Bone Stress Injury, RTS

 

More about Dr. Ellie Somers

Ellie Somers

Dr. Ellie Somers is a physical therapist, run coach, weightlifting coach and the owner of Sisu (pronounced see-su) Performance and Physical Therapy in Seattle, WA. She also serves as the team physical therapist for the women’s United States Australian Rules Football Team. As a private practice owner and coach, Ellie specializes in work with women athletes, specifically runners and field athletes.

 

 

To learn more, follow Ellie at:

Email:              ellie@sisuwolf.com

Facebook:       Sisu Performance PT

Instagram:       @thesisuwolf

Twitter:            @drelliesomers

YouTube:        Sisu Sports Performance and Physical Therapy

Website:          https://sisuwolf.com/resources/e-books/return-to-run (FREE gift!)

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

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

 

Read the Full Transcript Here: 

Speaker 1 (00:01):

Hey, Ellie, welcome to the podcast. I'm happy to have you on. Thanks for having me, Karen. So this month we're talking all about running injuries. Just so people coming onto the podcast is the first time you're listening this year, sort of changing up the format each month is a different we're focusing on a different topic. So last month was all about ACL injuries. This month, we're going to concentrate on running injuries, which is why Dr. Lee summers is here. And today we're going to be talking about the female runner. So Ellie, my first question is, are female runners, just little petite male runners, and it should be treated as such.

Speaker 2 (00:38):

Well, obviously the answer to that question is drum roll, please. No, yeah, yeah. I think female runners have a lot of particular and special needs and considerations when talking about evaluation from a physical therapist perspective, as well as from a communication standpoint that need to be considered.

Speaker 1 (01:02):

And what kind of, can you kind of differentiate that male runner from the female runner? What are kind of some of the big differences that if you are a physical therapist, a run coach, even a personal trainer, a strength and conditioning coach, what are some things that we need to be aware of in the female runner?

Speaker 2 (01:20):

You know, the way that I think about this, I actually think about it from a bio-psycho-social perspective. So what women are exposed to in our environments, in our engagement with other human beings, with social dynamics and things of that nature is very different than what men are typically exposed to. I also think of it as you know, generally speaking in terms of adaptability, women and men have the same traits and characteristics, but certainly things that need to be taken into consideration for women include our biology and physiology more specifically our menstrual cycle and hormone cycle. So I tend to think of it as a very holistic thing. And what are the things that female runners might be exposed to that set the stage for certain types of injuries or pain experiences that maybe male athletes aren't or are less likely to be

Speaker 1 (02:22):

Right. Got it. And so now let's take a common injury that you may see in a female runner, and let's talk about what you would how you would go about your subjective exam, and then we'll get into objective exam and some possible treatment options, but let's take a bone stress injury, pretty common in female runners. So first talk about, well, actually, let's talk about why is that common in female runners?

Speaker 2 (02:54):

That is a great question. Lots of there's probably a lot of nuance to answering that question. I think theories abound and I'm thinking of those series. I think that the primary thing that we get exposed to as female athletes is how do I want to phrase this considerations about our body and in the run community? I think it's a lot more pervasive for women athletes. So not only are women on the whole exposed to messages about their body, that they need to be smaller, that they need to be thinner in the run community itself. Women are then also exposed to this concept that you'd need to be in order to get faster. You need to be thinner. And that sets the stage for eating disorders and diet restriction and limitation that can lead to bone stress injury.

Speaker 1 (03:55):

Got it. Okay. So obviously very sensitive subjects. So the subjective exam becomes all the more important. So walk us through maybe how some questions that you would ask and kind of how you would asking keeping that sensitivity of this may be a person that's experiencing maybe some eating disorders or experiencing some body image body image issues. So walk us through your subjective exam.

Speaker 2 (04:27):

Yeah. So I think it depends on what they're coming to you for and what you know already. So depending on your clinical setting, you might already know they're coming to see me for a bone stress injury. And this person may have already seen a physician and had the imaging done at which point you may not need to dive into a lot of detail there, but I think what you want to try and capture is is this person grasping why they got into this situation. And I think as a clinical provider, that's working to reduce risk, prevent air quotes around prevent these types of injuries. You need to understand that this person knows that bone stress injury isn't necessarily a result of the shape of their body or the shape of their foot. It's the result of really limitations on their dietary intake. So when you're getting somebody into your clinic, you don't want to make assumptions about their circumstance, but I think it, it behooves you to start to ask questions around, you know, do they understand why they got this injury?

Speaker 2 (05:40):

And if their answer to you is while I was over-training, you might want to start to dig deeper and figure out if you can fill any gaps and holes there to help them understand that fueling strategies are a big contributor to these injuries. So subjectively there's that piece to cover. Then I think you also have to think about how do I want to say this their menstrual cycle basically. And I think for a lot of clinicians, these topics can be very uncomfortable, hard to, to talk about, hard to ask questions of, but when you're doing a subjective exam, this is a required question to be asking, what is your menstrual cycle? Like, are you having regular and normal periods? When did you start your period? At what age, if you're not comfortable asking these questions in a face-to-face manner, or you don't think it's appropriate for you, then they definitely need to be included on your intake forms. And you need to be reviewing your intake forms before you see that person in your clinic. So those would be, I think the two primary things that you need to sort of start to get a picture of, because if a runner is coming to you, explaining that they think they sustained a BSI bone stress injury because of their pronated foot or because they were wearing the wrong shoes, we've missed a huge piece of why bone stress injuries actually happen.

Speaker 1 (07:17):

And I really do like including that on your intake paperwork, because then even if, whether you're uncomfortable asking that question or not, or you are comfortable either way, I mean, either way, quite frankly, you should be comfortable asking that question. I don't care who you are. You're a physical therapist, you're a healthcare provider. That's a question you should be very comfortable asking because it is part of their medical record. And part of, of like can be part of the reasoning behind these bone stress injuries. But it also gives you if it's on your intake form, it also gives you more information so that when you are in your subjective exam, you can perhaps hone into that and you can even say, Hey, listen, on my on the intake form, I noticed that you're not having like regular periods. Can you tell me a little bit more about that and that's it.

Speaker 2 (08:16):

Yeah, exactly. Yeah. And I think all it will show you is, is this person having energy demand issues? You know, we know that if you've lost your period or you're having irregular periods, it can be a very clear objective indication that your energy in is not matching your energy out. And it's what we would call somebody suffering from low energy availability or in the, the more maybe more like broad terminology would be relative energy deficiency in sport. And this can cause a host of different and problems. And the last thing you want to do as a clinician or provider is I think miss that, especially in a female runner, because it just sets them up for recurring bone stress injuries, or recurring injuries. And that cycle will just repeat itself.

Speaker 1 (09:11):

Yeah. Now, okay. So you've asked those questions. Are you asking questions on how much are you running? How often are you running? Have you picked up your mileage and things like that? Is that something that you're asking as well?

Speaker 2 (09:25):

100%, because a lot of the times people who are training for a new distance of an event, right? So if I have a person who's like I was training for my first marathon, they might have sustained a bone stress injury as a result of some of that increase in strength in training while also maybe not matching that with their fueling. So it helps you get a picture of what this person is training for and why they're training for it and how much training they have. And then you can move forward from there with a more practical plan as a physical therapist on how we're going to strategize a graded return to activity.

Speaker 1 (10:07):

Got it. Okay. Any, what else are you asking? What else do you need to know from this patient,

Speaker 2 (10:19):

Everything else that you would need to know in a physical therapy exam? I think you know, I think for a lot of folks, these injuries are scary and they've disrupted their lives to a great degree. A lot of these runners will have to stop running for months of time. So all of the same questions you would ask, but then I would also add onto that. You want to know, sometimes you want to know, does this person have a registered dietician as part of their care team? Are they working with an endocrinologist? Have they had any blood work done to determine if they were suffering from relative energy deficiency in sport? Do they have a team of people that can help support their progression back to play? Now? I want to be clear. I don't think every single person who has a bone stress injuries requires a team of people. I think it's an ideal. And if I've got somebody who's come in, who's got a bone stress injury, and doesn't have a team of people I'm planting seeds to get them, that team. So that they're set up for success.

Speaker 1 (11:34):

Yeah, that makes sense. Yeah. And gosh, I just had a question and it was like in my head and just went it'll it'll come back. It'll anyway, it'll come back to me. I'll edit this part out. It'll come back to me. Cause it was a good one. It's there it's there. I just there's days. It's just it's. I was like, Oh, I got to ask this question anyway. If I think of it later, I'll ask it later and we'll just splice it in. No one will know the difference. Oh yes. Got it. It's back. Okay. So is there a difference when someone is coming to you via direct access, just versus someone has already been to a physician, they have been diagnosed with a bone stress injury. Let's say they had some imaging done. It has shown up where, what is the difference there? Is there a difference in your examination of this person?

Speaker 2 (12:28):

Yes, absolutely. Because, and I work primarily in a direct access capacity. So by when people come to me, they haven't typically seen anybody else. And now it's my responsibility to be able to pick up on these things and tell someone, you know, I need you to go see your physician. We need to rule out bone stress injury before we move forward. So from a purely exam standpoint, when somebody is coming to me, who is a runner who potentially has pain at a site that could be risk for bone stress injury, I need to have the evaluation skills to be able to, to rule that in or rule that out to some degree so that we can move them in the right.

Speaker 1 (13:15):

Got it. And what are those sites? What are the most vulnerable sites for a bone stress injury?

Speaker 2 (13:21):

Well, the femoral neck is one of the most vulnerable, I would say anyone who's coming in, who's a female athlete. Who's complaining of anterior hip pain. That's maybe a little bit vague and is presenting with some of those additional sort of risk factors changes in their menstrual cycle, low energy availability training, abrupt training changes. I'm starting to stew a little bit and get a little bit concerned. So that's going to be a high-risk stress fracture site, some other high risk stress fracture sites include the first and second metatarsal. And I want to say the anterior tibia as well. It's likely that I'm forgetting one, but yeah, some of those regions are considered high risk. High risk essentially means that the likelihood for healing is a little bit harder, I guess you could say.

Speaker 1 (14:18):

Okay. All right. Thank you. All right. Now let's move on to your objective exam. So what kind of things are you looking for? Are you going to say to this person, let's get you on the treadmill and see what you're doing with your run? Okay.

Speaker 2 (14:34):

That's the great part of the subjective exam because the subjective exam is going to lead me into thinking whether or not I need to test for bone stress injury before we pursue running. Right. And there are a couple of things that are going to lead you that some of which I've already talked about, but site-specific pain is definitely one of them, localized pain. Sometimes people will point directly to their pain and be like, it's right here. They can have pain in, I know femoral, neck stress fractures. They can have pain with offloading. So sometimes they'll say, you know, like stepping off of a step, I suddenly have pain in my hip. So there are things that you'll just pick up on and then you do not want to get on the treadmill at that point, if you're suspecting bone stress injury, you need to do the tests to sort of rule it out before you get to the treadmill. Some of those tests that I would do, I think first would probably be about palpation. So depending on the area, you know, the femoral neck is

Speaker 1 (15:42):

D that's tricky. That's a tricky one to help paint,

Speaker 2 (15:46):

Be able to get there with your hands, but certainly a medial tibial region or an anterior tibial region. You can palpate that with your hands. And we're looking for pretty pinpoint tenderness. From there we might get them up and then first have them walk. What's their walking look like, is there any offloading happening then I might have them do a little single leg balance. How does that feel? A lot of the times people may not have very distinct acute pain with some of these low level impact activities, right? So if they're presenting with no pain, now this sort of, I'm going to describe it as like this first level, no pain with walking, no pain with single leg balance. Now I want to get them doing a little bit of an explosive move, maybe a step up or step down and determine are they having pain with some more functional tasks? And I think the single leg hop test is a pretty, like just straight up and down. Three hops is a pretty decent maneuver for almost any lower extremity potential stress fracture site. You know, I don't know the statistics on reliability and validity, but it's one that I use very regularly with somebody I'm suspecting that. And then from there you can kind of make a determination about how you want to proceed. Typically, speaking of the folks that I work with, they're going to have pain in one of those moves.

Speaker 1 (17:20):

Yeah. And, and at that point, does it then come down to, if you're seeing them via direct access, explaining to them, Hey, listen, this is my hypothesis. Let's get you to a physician at that point. Yes.

Speaker 2 (17:34):

Yeah, yeah. Okay. Yeah. Usually I'm revealing at that point, I'm concerned for bone stress injury. I want to get you, you know, examined for that. So, and they can, you know, go to their physician that they know and that they trust. But I think it's important depending on the region that we get the right imaging. Certainly if I hip femoral, neck stress fractures suspected, I really want to push that person to try and push for an MRI. So you know, it kind of depends on your relationship with the person and where they're at on a lot of different levels, but, but that's what we're going to be going for.

Speaker 1 (18:15):

Okay. And so let's say this is someone who has already gone to the physician. They've had the MRI, this is diagnosed. So you've done your evaluation now, what do you do? I guess the question is, is, are they come, are they non-weightbearing at this point? What are, what are some things that we can do as physical therapists for these patients when they're coming in? They've already been diagnosed?

Speaker 2 (18:37):

Yeah. Well, so many of these athletes don't get referred to physical therapy in the first place, which I think is a problem. But yeah, if you are getting these people, we really do want to be loading those tissues. And bone responds really positively to stress as long as the environment is you know, a strong, healthy, robust environment as well. So depending on their level, we're going to be progressively loading those tissues all the way up into the point where they're cleared for a return to run. So, you know, squats step up step downs. If they're not cleared to weight bear, you know, we're definitely doing stuff on the table, that's just pull it using the muscles around that tissue. And even just by using the muscles around that tissue and the injury, you're stimulating bone adaptations that are positive.

Speaker 1 (19:37):

And so I guess the, the thing that might come into a patient or a therapist is, well, if I'm non-weightbearing, I don't really want to do anything with this side. Cause what if I make it worse? Right. So is it, is this injury, let's say we're talking about a femoral neck BSI, is this injury so fragile that if you're doing things in a non-weight bearing capacity, can that make it worse?

Speaker 2 (20:05):

Not typically. You know, I, I, I tend to think that people who have had BSI or are so much more resilient than they get credit for, I have had and seen, and I don't commend this necessarily. So many runners who have run through BSI and there is, there is some toxicity there to unpack that we don't need to do today, of course. But all that tells me is that you can still be stressing bone and it's going to heal. And I think what we know is that when we don't stress bone enough, it could theoretically take longer and put that bone in a more position. So in my opinion, all of these athletes with BSI need to go to a physical therapist so that they can load those tissues up. Yeah,

Speaker 1 (20:56):

No, that makes, that makes perfect sense. And I just wanted to kind of make that distinction because I'm sure if someone is told, Oh, you have a bone stress injury, you know, scary, scary, right. Very scary. And that's where I think the team comes in. Like you said, assembling this team around that, around that runner is so powerful,

Speaker 2 (21:20):

Right? I mean, gosh, I think those soft skills are invaluable when working with women who have had BSI, because so many of these runners it's like totally ruined their perception of who they are and their worth and their value. And so you have to be really good at being a kind and generous and thoughtful and considerate to that person's experience because it's still very much in a way I'm going to use the word trauma to them. And I think not everyone is going to be ready to work with a mental health therapist or work with a registered sport dietician. But I think as their support person, your job as a physical therapist is to really listen to what's going on and gain some of that trust so that you can softly nudge them in those directions and work them towards a more robust, healthy lifestyle.

Speaker 1 (22:23):

Yeah. Because you don't want this single bone stress injury to set off a cascade of other events. That could be really detrimental to them. Not only as an athlete, but just as a person.

Speaker 2 (22:36):

Right? Yeah. I mean, women athletes are more prone to lower bone density than male athletes are. I'm just women in general. Let's just use women in general and runners, you know, runners kind of have this misconception that running itself actually strengthens bone in reality. It doesn't really strengthen bone as much as we'd like to think. And all that means as women is we need to be thinking about other ways to strengthen our bones. If that's something we care about.

Speaker 1 (23:08):

Right. And that's where a good strength training program comes in for runners because I have spoken and I have treated plenty of runners and runners like to run when you tell them, Hey, you, we should get you on a robust strengthening program. It's like, what a no. So, yeah. So now let's say you're, we're still in the treatment process. So we're, we're past the, this vulnerable part of the bone stress injury. They're able to weight bear, they're able to do more. What strategies do you use to get these women on to strength, training, flexibility programs?

Speaker 2 (23:49):

Honestly I show them, I think that's like a big component of how I work with the people that come to see me is showing them what they need to be doing. And first of all, that it's fun and that it can be fun that it's not intimidating and that we can keep it really simple and easy. And it doesn't have to be a huge long laundry list of exercises to keep them healthy. And FEMA women especially are so subject to carrying, you know, a list of 20 to 30 exercises that they're doing to, you know, through the guise of staying, I'm going to use air quotes, healthy and keeping tissues healthy, and it's just way more than it's necessary. So I think part of why women, like working with me is I have been able to really speak their language, pare things down significantly. So that it's simple. It's, you know, 25 to 30 minutes, one, one to three times a week is really all runners need to, to keep that bar trending in the positive direction.

Speaker 1 (24:56):

Yeah. And I think that's an important distinction to make because oftentimes we think we have to work out five days a week and it has to be this like really complicated. I have to do a chest day. I have to do a leg day. I have to do a hamstring day. I have to do a quad day. I have to. And with all of that said, you're like, Oh, screw it. This is too complicated. I'm just going to run. Yeah, no,

Speaker 2 (25:20):

I do not blame them whatsoever for giving up on programs in part, because they're just so complicated. And for runners, we just need to keep it simple, keep it clean, keep it short and sweet and to the point and get on, get on our way.

Speaker 1 (25:37):

Yeah. Excellent. Excellent advice. Now, is there anything that we missed as far as that treatment aspect with these women with bone stress injuries, and obviously we're not going into like individual programming for an individual person because it's so varied. I'm sure. But I guess, are there X speaking of exercises, are there exercises that you do like to include with most of your runners?

Speaker 2 (26:06):

Yes. So they're getting lower extremity strengthening exercises. So, you know, a squat and a deadlift of some sort, all of my runners will give that we're also going to be incorporating and especially for bone stress, injury, plyometric, explosive exercise. So, you know, squat jumps, counter movement jumps, broad jumps, Pogo jumps. We don't have to do those in like a hit style. If that makes sense. We don't need to be like every minute on the minute you're doing this many jumps or whatever for runners, what we need to be doing is doing it to load the bones for one and two, doing it to create and foster tendon stiffness. And so I think there's a little bit of a misnomer amongst women athletes, especially that in doing plyometrics, they have to be really, really intense. And I'm of the opinion that we want your running to be really, really intense. We don't also need your strength training and your physical therapy to be to the nth degree, intense just needs to be targeted.

Speaker 1 (27:21):

Yeah. That makes a lot of sense. So you don't need to like kill yourself on your workout day and then go out and run the next day with like jelly legs. Right.

Speaker 2 (27:30):

Exactly. Exactly.

Speaker 1 (27:32):

Yeah. It doesn't make sense. It doesn't make sense from a running standpoint. It may make sense in, in another population. Yes. But you have to be specific with your population. And this is where the skill of a good physical therapist comes in to be able to tailor that program, to that specific runner and what their needs are, especially coming off of a bone stress injury. Right. Exactly. And is there a fear in the runner after a bone stress injury, and you say to them, let's start doing some jump squats. Like what lady are you kidding me? Yeah.

Speaker 2 (28:08):

Yeah. I think people are pretty forward with some of their concerns and their worries. And depending on the capacity that you're seeing them, you see it in their body language. Right. But that's why physical therapy is so advantageous because that's where we Excel is helping people understand why something is valuable and then why it's safe. So I think it's about addressing those fears, head on getting at the heart of what they're concerned about and meeting them exactly where they're at. You know, maybe if they're not ready for that, we just try something else. In the meantime, until they're building up confidence, there's not a single person that I've worked with who has had a bone stress injury that doesn't have some of those fears pop up. It is a very real piece of a return to sport on any level. So,

Speaker 1 (28:59):

Yeah. Agreed. Excellent. Now, is there, is there anything that we missed, anything that we glossed over that you feel like you want to explain to the listeners a little bit more, or do you think we've covered, you know, sort of the high level basics on how you would look at one of these patients with a bone stress injury?

Speaker 2 (29:20):

Yeah, I think we covered most of it. You know, I think in, you know, reflecting back, it's really just understanding that we don't want to make assumptions about somebody's circumstance. You don't want to assume that somebody with bone stress injury has an eating disorder. I've worked with a number of people who have bone stress injuries, who do not have what I would consider disordered eating to the level that it's clinical. They just didn't understand how much fueling might be required for their activity. So I think in your subjective and in your relationship building with these people, it's important to keep that in mind that we don't need to medicalize everyone that walks in our door with a bone stress injury, but certainly we want to prepare them better for the future. I should also add that history of bone stress injury having had one in the past is the number one risk factor for a new bone stress injury. So in your history, in your subjective exam, that's another great question to ask. Have you ever had a bone stress injury before? If the answer is yes, you're already starting to postulate that that could be a possibility.

Speaker 1 (30:33):

Got it. Excellent. Excellent. Well, this was great, Ellie. I think that you gave the listeners a really, really robust understanding of looking at bone stress injuries from the point of view of a physical therapist. So thank you very much. This was great. Thank you. Yeah, I appreciate being here. Of course. And then where can people find you?

Speaker 2 (30:57):

Yes. So you can find me on my website, www.cc wolf.com. It's brand new. I'm just going to say brand new France shine. You can also find me on Instagram handle of@theccwolf.com. And if you want to reach out to me personally, I love getting emails from folks it's Ellie, E L L I E at [inaudible] dot com.

Speaker 1 (31:23):

Awesome. Well, thank you so much. I have one final question for you and it's one that I ask everyone. And that's knowing where you are now in your career and your life. What advice would you give to your younger self? Let's say right out of PT school.

Speaker 2 (31:39):

There's no rush. There's no rush. I think, you know, as a young PT, it was like, I want to be the best now. And you have your entire life ahead of you to work and refine and you know, as long as you're working on something, you're working towards it. So there's no

Speaker 1 (31:58):

Excellent advice. I love that. So everyone, no rush, no rush to all those student physical therapists out there. Well, Ellie, thank you so much. This was great. I really appreciate your time. Thanks Karen and everyone. Thanks so much for listening. Have a great week and stay healthy, wealthy and smart.

 

Jan 18, 2021

In this episode, CEO of Fyzio4U Rehab Staffing Group, Dr. Monique J. Caruth, talks about how she, as a businesswoman, reacted to Covid-19.

Dr. Monique J. Caruth, DPT, is the CEO of Fyzio4U Rehab Staffing Group providing home health services in Maryland. She currently serves as the Southern District Chair of Maryland APTA and is the Secretary-elect of the Home Health Section of the APTA. She holds a Masters and PhD in Physical Therapy from Howard University, and she is a proud immigrant from Trinidad & Tobago.

Today, we hear what it’s like treating potentially Covid-positive patients, Monique tells us about the screening tool she developed, and we hear about the impact of the pandemic on mental health. Monique elaborates on the importance of Ellie Somers’s list of notable PTs, and she talks about her experiences of losing patients. How did she pivot her business to keep it afloat? How has her perspective as both a clinician and a business owner helped her pivot her business?

Monique tells us about obtaining PPE, offering Telehealth visits, and she gives some advice to Home Health PTs, all on today’s episode of The Healthy, Wealthy & Smart Podcast.

 

Key Takeaways

  • “We started seeing a spike in clients in mid-April when the hospitals didn’t want to discharge patients to the nursing homes; they were discharging them directly home, so the majority of our clientele were Covid-positive patients.”
  • Monique has started compulsively disinfecting all surfaces.
  • Monique’s screening tool:
    Step 1: Check temperatures every morning before seeing a patient.

Step 2: Ask questions about symptoms, traveling, and possible contact with Covid-positive people.

Step 3: Ensure PPE is worn.

  • “Gone are the days of spending extra time and doing extra work there.”
  • “One of the biggest things for therapeutic outcome is having a good relationship with your patients. Going into the home, you’re probably the only person that they’re getting to talk to most days. I saw the need to improve on soft skills and being approachable with your patients.”
  • “Some sort of contact needs to be maintained. Even though some patients may have been discharged, they would contact the physician via Telehealth visit and ask to be seen again.”
  • “Everyone deserves to get quality care.”
  • “Some people say, ‘this person probably got Covid because they were being reckless’. You can slip-up, be as cautious as possible, and still get Covid.”
  • “We’re going to see a huge wave of Covid cases coming in the next few months. With elective surgeries stopped, that’s going to be our only client population. To prevent the furloughs from happening again, I would just advise to do the screenings, get the PPE, and go and see the patients.”
  • Why don’t women get recognition in a profession that’s supposed to be female-dominated?
    “People send out stuff to vote for top influencers in physical therapy. You tend to see the same names year after year, but you never see one that strictly focuses on women in physical therapy. I see many women doing great things in the physical therapy world, but because they don’t have as many followers on Twitter or Instagram, they don’t get the recognition that they deserve.”
  • “The thing that I love about Ellie’s list is she put herself on it.”
  • “In doing stuff you have to be kind to yourself first and love yourself first. Many of us don’t give ourselves enough praise for the stuff that we do.”
  • “You can’t save everybody. When you just graduate as a therapist, you think you can save everyone and change the world – it takes time.”

 

More About Dr. Caruth

Monique CaruthDr. Monique J. Caruth, DPT, is the CEO of Fyzio4U Rehab Staffing Group providing home health services in Maryland. She currently serves as the Southern District Chair of Maryland APTA and is the Secretary-elect of the Home Health Section of the APTA. She holds a Masters and PhD in Physical Therapy from Howard University, and she is a proud immigrant from Trinidad & Tobago.

 

 

Suggested Keywords

Therapy, Rehabilitation, Covid-19, Health, Healthcare, Wellness, Recovery, APTA, PPE, Change,

 

To learn more, follow Monique at:

Website:          Fyzio4U

Facebook:       @DrMoniqueJCaruth

                        @fyzio4u

Instagram:       @fyzio4u

LinkedIn:         Dr Monique J Caruth

Twitter:            @fyzio4u

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

 

Read the Full Transcript Here 

Speaker 1 (00:01):

Hey, Monique. Welcome to the podcast. I'm so happy to have you on.

Speaker 2 (00:06):

Oh, thank you for inviting me. It's a pleasure to be on once again.

Speaker 1 (00:10):

Yes. Yes. I am very excited. And just so the listeners know, Monique is the newly minted secretary of the home health section of the APA. So congratulations. That's quite the honor. So congrats.

Speaker 2 (00:26):

Thank you very much. And

Speaker 1 (00:28):

We were just talking about, you know, what, what it was like being an elected position. I was on nominating committee for the private practice section. I just came off this year. Not nearly as much work as a board member. But my best advice was you'll you'll make great friendships and great relationships. And that's what you'll take forward aside from the fact that it's, you know, a little bit more work on top of the work you're already doing

Speaker 2 (00:57):

Well, I better get my bearings, right. So I will be on task from the one. Yeah.

Speaker 1 (01:04):

Yeah. I'm sure you will. And now, today, we're going to talk about how you as a business woman pivoted reacted to COVID. So we're, Monique's in Maryland, I'm in New York city. So for us East coasters, it really well, we know it hit New York city very hard in March in Maryland. When did that wave sort of hit you guys? Was it around the same time?

Speaker 2 (01:33):

I would say mid March, April because I had returned back to the rest of the first week of March. And then things just started going crazy. They were saying, Oh we have to be aware of COVID. But I was still seeing my clients that I had. Then we started getting calls saying that family members are worried that we'll be bringing COVID into the home. So they wanted to cancel visits. So we were getting a lot of constellations and then electric surgeries was shut down and that meant a huge drop in clients as well. Then we started seeing a spike in clients in mid April when the hospitals didn't want to discharge patients to the nursing homes, they were discharging them directly to home. So the majority of our clientele was COVID positive patients.

Speaker 1 (02:36):

And now as the therapist going in to see these patients, obviously you need proper protection. You need that PPE. So as we know, as all the headlines said, during the beginning of the pandemic, couldn't get PPE. So what do you do?

Speaker 2 (02:54):

Well, we were fortunate in Maryland that governor Hogan had PPE equipment ready at state health departments for agencies to collect. So they did ration them out. Also one of the agencies that I contract with MedStar hospital provided PPS to all the contractors and employees that were visiting COVID patients in the home. So we had the goggles face shield gowns mask, everything. There would be a specialized bag with vital sign equipment for that patient specifically that would be kept in that house and then taken back and disinfected at the end of the treatment. So we, we were shored through weekly conferences on what to do do South screenings and screening prior to each visit. So for my contractors, I developed a screening tool to ask questions if clients were having symptoms or if any family members in the home are having symptoms. And if they had exposure to anyone where COVID symptoms in the past 14 days, so we'll know what you will, that person as a person on, on the investigation or somebody who's COVID positive. So we had done the correct equipment when we go into the homes.

Speaker 1 (04:18):

And what does that, what does that look like? And what does that feel like for you as a therapist, knowing that you're going into a home with a patient who's COVID positive? I mean, I feel like that would make me very nervous and very anxious. So what was that like?

Speaker 2 (04:36):

To be quite honest, I was scared at first I try to avoid it as much as possible. But I got to a point where I needed to start seeing people or, you know, the business would go under. So you're nervous because nobody really knows how the disease will progress, what would happen. So it's a risk that you're taking. I, I probably developed compulsive disorder, making sure everything was like wiped down and clean. Even getting into the car, you know, this is affecting the stairway, the door handles double checking, making sure that they know the phone was wiped down. You know, as soon as you get in the house, after you strip washing from head to toe, making sure that, you know, you don't have anything that could possibly be brought onto the home.

Speaker 1 (05:35):

Right. And so when you say going back to that screening tool that you say you developed, what was, what was, what was, what did that entail for you for your contractors? Because I think this is something that a learning moment for other people, they can maybe copy your screening tool or get an idea of what they can do for their own businesses. Well, it's

Speaker 2 (05:58):

One that they we use to make sure that we don't have any symptoms. So checking the temperature every morning before you actually go to see a patient and asking the question, like certain questions, when, when you're scheduling a visit if they're filing in a coughing or sneezing when was the last time they got exposed or if they've been exposed to someone who traveled in the past 14 days or who's had any symptoms in the past 14 days. And so that was basically if they answered, no, then you be like, okay, fine. All you just need to do is wear the mask and the gloves and make sure that the patient that you're seeing wears the mask as well.

Speaker 1 (06:41):

Yeah. That's the big thing is making sure everybody's wearing a mask. Have you had any problems with people not wanting to wear a mask in their home when you go into treat them?

Speaker 2 (06:51):

We've had some, but most have been very compliant with, you know, wearing the mask because they realize that they, they, they do need the service. So like some patients who have like CHF or COPT that will have problems breathing while doing the exercises, I would allow them to, you know, take it off briefly, but I will step back six feet away and make sure that, you know, they get their respiration rate on the control. Then they put it back on. We'll do the exercise.

Speaker 1 (07:22):

Yeah. That makes sense. And are you taking, obviously taking vitals, pull socks and everything else temperature when you're going into the home?

Speaker 2 (07:31):

Yes. Yeah. Yeah.

Speaker 1 (07:34):

Okay. And I love the compulsive cleaning and wiping down of things. I'm still wiping down. If I go food shopping, I wipe everything down before I bring it into my home. And I realize it's crazy. That's crazy making, but I started doing it back in March and it seems to be working. So I continue to do it. And I'm the only one in my apartment, but I still wipe down all the handles.

Speaker 2 (08:02):

I would say don't lose sight of it though.

Speaker 1 (08:07):

I am. And I love that. You're like wiping down the car. I rented two car. I rented a car twice since COVID started. And I like almost used a can of Lysol one time. Like I liked out the whole thing and then I let it air out. And this is like in a garage going to pick it up for a rental place. And then I have like, those Sani wipes, like the real hospital disinfectants. And then I wiped everything down with those. And then I got in the car.

Speaker 2 (08:36):

Well, I saw it's very difficult to find Lysol here right now. So when you do find it, it's like finding gold. I know,

Speaker 1 (08:44):

I, I found Lysol wipes. They had Lysol wipes at Walgreens and I was like I said, Lysol wipes. And she was, yes. I was like, Oh my gosh. And then last week I found Clorox wipes, but in New York you can only get one. You can't there's no,

Speaker 2 (09:04):

Yeah. Care's the same thing. Toilet paper, whites, Lysol owning one per customer. So yeah,

Speaker 1 (09:09):

One per customer. Yeah, yeah, yeah. Oh, that's yeah, I was a thank God. I, I found one can of Lysol, one can at the supermarket and it was like, there is a light shining down on it and it was like glowing, glowing in the middle of the market. I'm like, Oh but I love, I love that all the screening tools that you're using and I think this is a great example for other people who might be going to P into people's homes who may be COVID positive. And I also think it's refreshing for you to say, yeah, I was nervous.

Speaker 2 (09:47):

I'm not going, gonna lie. You know, you still get nervous because you never know, like someone could be positive. And you're going in there, but you always want to be cautious because you're like, Oh my God, I hope I didn't like allow this to be touched or you forgot to wipe this and stuff too. So

Speaker 1 (10:07):

How much time are you spending in the home? Because there is that sort of time factor to it as well, exposure time. Right.

Speaker 2 (10:16):

It depends on the severity of the condition. But anywhere from like 30 minutes to like 45 minutes.

Speaker 1 (10:25):

Yeah, yeah, yeah. I know gone, gone are the days of, you know, spending that extra time and doing all this extra, extra work there, because if they're COVID positive, then I would assume that the longer you're in an exposed area, even though you're fully covered in PPE, I guess it raises your

Speaker 2 (10:48):

Well. Yeah. And, and the, in the summer, I would say, you know, depending on the amount of work that you had to do, like if you had to do like bed mobility and transfers with the patient, you'd be sweating under that gong. So you really want to want to be in there like a full hour anyway. But they were advising to spend, you know, minimum 30 minutes and to reduce the risk of you contracting it as well, too.

Speaker 1 (11:17):

Makes sense. So, all right.

Speaker 2 (11:20):

Decondition so they really can't tolerate a full hour.

Speaker 1 (11:23):

Right? Of course, of course. Yeah. That makes, that makes good sense. So now we've talked about obtaining the proper PPE. What other, what other pivots, I guess, is the best way to talk about it? Did you feel you had to do as the business owner? What things maybe, are you doing differently now than before?

Speaker 2 (11:49):

Well, as I said, I had to start seeing most of the cases to make sure that people were still being seen and like using telehealth. We started doing that. So eventually, well sky came on board to offer telehealth visits. So we were able to document telehealth visits as well. And people are responsive to those which worked out pretty well. So with some cases we'll do a one visit in the home and then do the follow-up visit telehealth. So one visit being in a home one weekend, one telehealth, if it was a twice a week patient. So that would also reduce the risk of exposure.

Speaker 1 (12:40):

Yeah. Yeah. Excellent. Now let's talk about keeping the business afloat, right? So yes, we're seeing patients. Yes. We're helping people, but we were also running a business. We got people to pay, we got people on payroll, you gotta pay yourself, you got to keep the business afloat to help all of these patients. So what was the most challenging part of this as from the eye of the business owner? Not the clinician.

Speaker 2 (13:07):

Well, you, you get fearful that you may not have enough patients to see, to cover previous expenses. So that was one of the reasons I did apply for the PPP loan. And as I mentioned to you before I was successful in acquiring that probably like around July and that, you know, cover like eight weeks of payroll, if that but it was strictly dedicated to payroll, nothing else. So everything else I had to do was to cover the bills and stuff, because that was just for payroll. Some of the agencies that we contracted for were having difficulty maintaining reimbursing. So that became a challenge as well, too. So what does that mean? Exactly. so when we contract with agencies, they're supposed to be paying us for this, the rehab services that we provide. Some of them were late with their payments as well, but I still had to pay my contractors on time.

Speaker 1 (14:19):

Got it. Okay. Got it. Oh, that's a pickle.

Speaker 2 (14:22):

Yeah, that's the thing. So that meant like sometimes some, you know, weeks of payroll, I would have to probably go over the lesson and making sure that the contractors were paid.

Speaker 1 (14:37):

And how about having a therapist? Furloughs? Did you have any of that? Did you know, were there any people, like maybe therapists in your area who were furloughed from their jobs and coming to you, like, Hey, do you have anything for me? Can you help? What was that situation?

Speaker 2 (14:54):

Yes. So I started getting free pretty among the calls about having to pick up to do work because they were followed or laid off. We currently have one contractor was working for ATI full-time that got followed. Now she's doing the home health full-time right now as a contractor we have some that are still doing it PRN, even though they went back to like their full-time jobs. But yes, we had people looking for cases to see, just to supplement the the income. Then we had a reverse situation where some people more comfortable getting the unemployment check than seeing patients at all. So, so that you had different scenarios, but it wasn't that we were in need of therapists during that time because people were willing to work.

Speaker 1 (16:00):

Yeah. Excellent. Excellent. And from the, I guess from your perspective being owner and clinician, so you're seeing patients you're running a business where there any sort of positive surprises that came out of this time for you, something that, that maybe made you think, Hmm. Maybe I'm going to do things a little differently moving forward?

Speaker 2 (16:30):

Yes. incorporating more telehealth visits. Definitely one of them and using the screening to there it helps in a lot of situations. So it makes you aware of what you might possibly be going into when you're going into the home. And I am realizing that there is one of the biggest things for therapeutic outcome is having a good relationship with your patients. So since most people aren't locked down, a lot of the patients that we do see they live by themselves, or they may just have one or two people in the home and they may possibly be working. So when going into the home, you're probably the only person that they're getting to talk to most days. So you, I saw the need to improve on soft skills and being approachable with your patients. So that was definitely a, a big thing for me.

Speaker 1 (17:46):

And how is that manifesting itself now? So now, you know, you figure we're what April, may, June, July, August, September, October, November, December eight, nine months in, so kind of having that realization of like, boy, this is this, I may be the only person this person speaks to today, all week, perhaps. I mean, that's can be a little, that can be a big responsibility. So how do you, how do you deal with that now that you're, you know, 10 months into this pandemic and yeah. How do, how do you feel about that now?

Speaker 2 (18:29):

Well, I still feel like some sort of contact needs to be maintained. So even though some patients may have been discharged they would contact the physician via a telehealth visit and asked to, you know, can you see it again? But you still maintain contact, make sure that, you know, you dropped a line and say, Hey, just following up to see if you're okay. That sort of stuff. So they, they will remember and they'll keep coming.

Speaker 1 (18:58):

Yeah, yeah, yeah. Oh yeah. It is such a responsibility, especially for those older patients who are, who are alone most of the time. I mean, it is it's, you know, we hear more and more about the mental health effects that COVID has had on a lot of people. So and I don't think that we're immune to those effects either. I mean, how, how do you deal with the stress of, because there's gotta be an underlying stress with all of this, right. So what do you do, how do you deal with that stress?

Speaker 2 (19:38):

Well, one was warmer. I would try to at least take the weekends off to go do something or those and like being around people where you can, you know, laugh and, you know, watch movies, you know, goof up, you know, I have to think about work, those things help.

Speaker 1 (19:59):

Yeah. Just finding those outlets that you can turn it off a little bit. And I love taking the weekends off every once in a while. I have to do that. I have to remember to do that. And I'm so jealous that you're just, you just came off of a nice little vacay as well.

Speaker 2 (20:19):

Well it was needed. I probably won't be taking one on till probably sometime next year, so yeah. But it was, it was definitely needed.

Speaker 1 (20:32):

Yeah. I think I'm going to, I think I'm going to do that too. All right. So anything else, any other advice that you may have for those working in home health when it comes to going to see those during these COVID times, whether the patient has, has had, has, or has had COVID what advice would you give to our fellow home health? Pts?

Speaker 2 (21:00):

Well, I know I've been hearing quite a lot of PT saying that they didn't want to treat COVID patients and they should not be subjected to treating COVID patients, but as we get more awareness of what the diseases and we take the necessary precautions, I think we will be okay. Cause everyone deserves to get quality care. And I know some people will say this person probably got COVID because they were being reckless and stuff. I mean, you can slip up, be as cautious as possible and still step up and get COVID. That doesn't mean you should be denying someone to receive that treatment just to make sure that you're protected when you do go in. Because we're gonna see a huge wave of COVID cases coming in the next few months and with elective surgeries being stopped and everything like that, that's going to be our only client population and to prevent the fools and the layoffs from happening again, I would just advise them, you know, do the screenings, make sure you get your PP and we'll see the patients. It's it's not as bad as, you know, they make it seem.

Speaker 1 (22:16):

Yeah. Excellent advice. Excellent advice. And now we're going to really switch gears here. Okay. So this is going to be like like a, a three 60 turnaround, but before we went, before we went on the air, Monique and I were talking about just some things that, that you wanted to talk about and recent happenings in the PT world, and you brought up sort of a list of influential PTs that was compiled by our lovely friend Ellie summers. So go ahead and talk to me about why that list was meaningful to you and why you kind of wanted to talk about it.

Speaker 2 (23:03):

Well, you know, for the past few years I've been noticing like people send us stuff to vote for like top influencers and, and physical therapy and stuff. Do you tend to see the same names like yesteryear? But you've never seen one that just strictly focuses on a woman in physical therapy. And I see a lot of women doing great things in the physical therapy world, but because they do not have as many followers on like Twitter or Instagram, they don't get the recognition that they deserve. For example, Dr. Lisa van who's I think she's doing incredible, incredible work with the Ujima Institute. I actually consider her a mentor of mine. She, she calms me down when I try to get fired. What's it and stuff,

Speaker 1 (24:03):

Not you. I don't believe it.

Speaker 2 (24:06):

So I appreciate her for that. So for Ellie to actually construct this list and, you know, I've, I've been observing her, her tweets on her posts for a while, and I see that she questions. Why is it that, you know, women do not get the recognition in a profession that is supposed to be female dominated. So for her to do the side, you know, it was, it was really thoughtful and needed.

Speaker 1 (24:40):

Yeah. Yeah. And you know, her shirt talk that she gave at the women in PT summit couple of years ago, I think it was the second year we did, it was so powerful. Like everybody was crying like in tears, she's crying, everyone else is crying. And that was the year Sharon Dunn was our keynote speaker. She got everybody crying. It was like everybody was crying the whole time, but crying in like in, in not, not in a sad way, but crying in a way because the stories were so powerful and really hit home and we just wanted to lift her up and support her. But yeah, and you know, the thing that I love the most about Ellie's list is she put herself on it. Yes. How many times have you made a list and put yourself on it? I can answer me. Never, never, never in a million years, have I made a list of like influential people to put myself on it? Never know. So I saw that and I was like, good for you. Good for you.

Speaker 2 (25:44):

Because you know, sometimes you, you and, and doing and doing stuff, you, you have to be kind to yourself first, love yourself first. And, and her doing that, I, I believe she's demonstrating that that is something that's that needs to be done. A lot of us, we don't give ourselves enough praise for the stuff that we do.

Speaker 1 (26:05):

Absolutely. Absolutely. It's sort of, it's a nice lead by example moment from her. So I really appreciated that list and, and yes, Dr. Vanhoose is like a queen. She's amazing. And every time, every time I hear her speak or, or I get the chance to talk with her through the Ujima Institute to me, it's amazing how someone can have the calm that she has and the power she has at the same time. Right. I mean, I don't have that. I don't, I even know how to do that, but she just, like, she's just gets it, you know? I don't know if that's a gift. It's a gift. Yeah, totally, totally. Okay. So as we wrap things up here, I'm going to ask you the one question that I ask everyone, and that is knowing where you are now in your life and in your career. What advice would you give to your younger self you're? You're that wide-eyed fresh face PT, just out of PT school.

Speaker 2 (27:16):

You can't save everybody. You can't save everybody nice. When you, when you just graduate as a therapist, you think you can save everyone a change, a wall. It takes time.

Speaker 1 (27:33):

Yeah. Oh, excellent answer. I don't think I've heard that one yet, but I think, I think it's true that having, and it's not, that's not a defeatist. That's not a defeatist thinking at all. Yeah.

Speaker 2 (27:54):

I think this year have thing come to more deaths as a therapist with patients than I have probably in the 12 years that I've been practicing. I'm sorry. Yeah, because you know, you do patients that you get attached to, you know, you have this person passed away and stuff like that. So it's good while it lasts, but to protect yourself mentally and emotionally, you just realize that you can save everybody. Yeah. I think this fund DEMEC is teaching us that too.

Speaker 1 (28:35):

Yeah. A hundred percent. Thank you for that. And now money, where can people find you website? Social media handles

Speaker 2 (28:47):

Social media handles are the same on Twitter and Instagram at physio for U F Y, Z I O. Number for you Facebook slash physio for you as well. And www physio for you.org is the website

Speaker 1 (29:01):

Awesome. Very easy. And just so everyone knows, I'll have links to all of those in the show notes under this episode at podcast dot healthy, wealthy, smart.com. So if you want to learn more about Monique, about her business I suggest you follow her on Instagram and Twitter, cause there's always great conversations and posts going on there initiated by Monique on anything from home health to DEI, to words of wisdom. So definitely give her a follow. So Monique, thank you so much for coming on. Let's see. Last time was a really long time. I can't believe it, it seems like 10 years ago, but I think it was really like three, three years ago. I think it was DSM like three years ago though. It seems like forever ago. So thank you for coming on again. I really appreciate it.

Speaker 2 (29:56):

You're welcome. And thank you for having me. Okay. Absolutely. And everyone needs to be safe. Okay. Yeah.

Speaker 1 (30:01):

Yes, you too. And everyone else, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

 

Jan 11, 2021

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Shannon Leggett, PT, DPT to talk about how to infuse yoga principles into physical therapy practice. Dr. Legget is a manually-based orthopedic physical therapist with 21 years of experience. I understand the complex nature of pain and the necessity to use a comprehensive, individualized treatment approach.

In this episode, we discuss:

  • Shannon's journey to becoming a yoga teacher
  • How to infuse the principles of yoga, not just the moves or poses, into PT practice
  • Cases studies in applying yoga principles in PT 
  • The importance of breathwork 
  • How to be more present through yoga 
  • And much more! 

 

Resources:

 

More About Dr. Leggett:

Dr. Shannon Leggett I am a manually-based orthopedic physical therapist with 21 years of experience. I understand the complex nature of pain and the necessity to use a comprehensive, individualized treatment approach. I perform a thorough evaluation looking at movement, strength, flexibility and balance, as well as lifestyle. I believe that how we live influences our ability to heal. I combine my extensive background of treating musculoskeletal injuries with my training in mind-body techniques to formulate a holistic plan of care

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

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Read the full transcript here:

Speaker 1 (00:07):

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

Speaker 2 (00:41):

Net health. So net health now has net health therapy for private practice. This is a cloud-based all-in-one EMR solution for managing your practice. It handles scheduling documentation, billing, reporting needs. Plus lots more in one super easy to use package. And right now net health is offering a special deal for healthy, wealthy, and smart listeners. If you complete a demo with the net health team, you'll get a hundred dollars towards lunch for your staff. Visit net health.com/see to get started, and you'll also get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y my last name now onto today's episode, we are going to be talking about how you can infuse yoga into your orthopedic physical therapy practice. And this is more than just infusing some yoga moves, but really infusing the background and philosophy of yoga into your physical therapy practice and to help us navigate that I'm really happy to have on the program, Dr.

Speaker 2 (01:53):

Shannon Leggett, she is an orthopedic, a manual physical therapy with 20 years of experience. She understands the complex nature of pain and the necessity to use a comprehensive individualized treatment approach. She performs thorough evaluations, looking at movements, strength, flexibility, and balance, as well as lifestyle. Shannon believes that how we live influences our ability to heal. So she has been able to successfully combine her extensive background of treating musculoskeletal injuries with their training and mind body techniques to formulate a holistic plan of care. And in this episode, we talk about just that, how to infuse yoga into your regular physical therapy treatments. And like I said, it goes beyond just some yoga poses and stretches, but really infusing the background and the philosophy of yoga in with your patient in with your patient treatments, but also with infusing your whole philosophy of physical therapy and how you work with your patients. So a big thanks to Shannon and everyone

Speaker 3 (03:00):

Enjoyed today's episode. Hey, Shannon, welcome to the podcast. I'm happy to have you on. Thanks, Ken. I'm really happy to be here. So today we're going to talk about how you have been able to infuse yoga and not just yoga the movements, but yoga, the principles into your physical therapy practice. And just for the listeners, I actually took one of Shannon's yoga classes online and it was wonderful. So thank you for having me joining. Yeah, it was great. So before we get into how you do this within your orthopedic physical therapy practice, I would love for you to let the listeners know how you yourself came into the practice of yoga. Well, it's actually kind of a funny story. I was probably in my mid thirties, which I'm not going to tell you how long ago that was. I'm not dating myself here, but I ended a relationship and I think as so many women do, it's like you either cut or dye your hair or you try something new. Okay.

Speaker 3 (04:06):

So trying to rock the pixie cut back then, like, I couldn't do anything with my hair. So I, I walked into my first yoga class of the New York health and racquet club on first Avenue on the upper East side. I know it, and there I was. And now that I know yoga, it was an Iyengar class, which is very alignment based very slow, very methodical holding poses. And I remember waking up the next day and being so incredibly sore and like a muscles. I mean, basically I should know what the muscles are, but like, Oh my God, that's what those feel like when you use them for long periods of time and the physical practice that, that sensation, that feeling kind of kept me going back for more. And then as time went on, I started to recognize the mental aspects of the practice that whatever I was walking into the yoga studio with or holding onto was kind of magically disappeared at the end of the class.

Speaker 3 (05:13):

And I am an anxiety sufferer, which I only have come to understand and realize what that was. And till like in a, within the last 10 years and yoga then became a very strong coping strategy for me. I found being connected to my body and connected to my person and putting an hour of self-care aside for me was absolutely essential. So it's definitely become one of my go-to tools to kind of handle the day in and day out stress of living, working in, in New York city. So I would think, especially now, during the times, yeah, hands down now it is. And I, and I was home for a couple of months, like everybody else. And it was, I was on my mat every single day. And then decided while I was home, I was like, well, why not see who else wants to practice?

Speaker 3 (06:14):

But yeah, so I, it has always been in the last like 12, 15 years, very much part of my life on a personal standpoint, it has led me to travel. I've met great people, I've taken amazing classes and explored studios in different forms. But it wasn't until probably within the last five or six years that I started to connect some dots professionally, right? Like how, how could this fit into what I do professionally? I, in terms of like a stretching standpoint, a strength building standpoint, yoga is amazing, but what about the body, the mind body connection. And I started to notice trends with a lot of my female patients I've been treating in Midtown for most of my career. And women would be walking into the clinic with your like standard orthopedic injuries, shoulder impingement, low back pain, and their response to an injury that would not necessarily be anything like, okay, just the pain was off the charts and difficult to get under control and not necessarily responding to what you would consider standard practice and you start to talk to them and they have fertility.

Speaker 3 (07:38):

They've had fertility issues. They've had gastrointestinal issues. They're working full time. They are full time moms too, trying to be the best they can be in both realms and self-care is last. They don't sleep well, they don't eat well. And I realized that the stress component was driving their inability to heal or meaning their ability to, you know, kind of get back to what they enjoyed. And I just was said to myself, well, how can I as a clinician kind of break into that stress cycle, how can I maybe help them Crump, you know, calm down some of their chronic systemic inflammation, how can we help them with negative thought patterns and, and whatnot. And that's not something that we traditionally are taught in physical therapy school and it, and is it my scope of practice and kind of going back and forth.

Speaker 3 (08:38):

So I started taking some continuing ed classes in the yoga world, and I've done some work with a clinical psychologist in Boston who treats her anxiety and depression patients with, with yoga and bodywork techniques. And, and she's a ton of research as to how mindfulness begins in the body that studies have shown that, that kind of short circuits, that stress response in your brain. So that kind of led me in that direction. And then I walked into my restorative yoga training, which I had never really taken, but it intrigued me. And because I just kind of felt intuitively that it was going to be the, like the last, not the last piece, because there's never a last piece, but a piece of the puzzle that I was missing. And it basically is how we can go from our sympathetic or fight or flight part of our nervous system into our rest and digest our parasympathetic sympathetic nervous system and how much our nervous system can drive, how we feel.

Speaker 3 (09:41):

And so often we have patients with chronic neck pain, chronic low back pain, like the massage, they feel better for an hour. It comes back and just this idea of chronic tension versus chronic tightness. And what restorative training does is it brings you into yoga shapes, but they're basically supported with props and it's a guided meditation and breath work. And as you move through the shape or state in the shape, you can flip the switch that vagus nerve stimulator, vagus nerve, and move into that rest and digest part of the nervous system. And I mean, in theory, like, okay, great. But four days of training and I always have neck pain, always. And I just attributed to everything we do. And that role was that from holidays and, you know, that's stressful time, but the month of December, yeah. Within four days, my neck pain was gone.

Speaker 3 (10:52):

It was incredible to me, how much of that pain was actually chronic tension and not necessarily this orthopedic tightness. So it was a kind of an aha moment for me in terms of what patients might carry. And I have used the teaching, the methodology in my treatment sessions, patients don't necessarily understand clients don't necessarily understand that they hold habitual tension. And so much of us, like when we say like, Oh, we have to relax. Like we sit down on the couch and drink a glass of wine and, you know, watch eight hours of Netflix. We're like, we're totally just chilling. But yet, like are holding our belly. Like our shoulders are up here, like clenching our jaw. Like we don't even know because we're relaxing. And part of, part of the restorative yoga is understanding where those patterns are. You get to know your body. Like for me, I'm a draw puncher, I'm a shoulder up late year. And, and, and once you understand that you kinda like kinda, I do like some check-ins during the day, like where are my shoulders? Where's my jaw. And taking a deep breath and kind of like letting that go.

Speaker 4 (12:11):

Yeah. As, as you say, this I'm unclenching my jaw a little bit. I'm a jock ledger also. So as you say this, I'm like, relax, the jaw, drop the shoulders. I am the same way. Well, it's, it's pretty amazing because it sounds like for you, and this happens, I've heard this over and over again, that it's this sort of personal experience. You have that aha moment. And then you say to yourself, well, I'm a clinician I'm trying to help people. So what can I do to improve my understanding as a clinician to help my patients? So you go, you take restorative yoga training, and then you are able to infuse that into your therapy sessions. And we were joking a bit before we went on the air. And Shannon said, well, it's not like I'm having someone who just had a labral tear, do a shoulder stand. Like that's not what it means to do, like yoga and PT. So when people think of yoga and infusing yoga into PT, I bet a lot of people think, Oh, you must do a lot of downward dogs and a lot of shoulder stands, but can you explain for a little bit more about what, what that means in, in your PT practice?

Speaker 3 (13:26):

Absolutely. I, if somebody comes in at, like, I was thinking a case, a case study, let's do I have a frozen shoulder? And how much of that again, tension versus tightness, how much of that tightness is being driven by the nervous system? So I'm, I always ask about stress levels. What's going on at home at work. You know, things that people do to, to, to maybe calm down or relax. And I might say, Hey, we're going to have a little bit of an experiment today. Okay. I am gonna prop you. We, I pull off of the blankets and the pillows and I'll put them in a very gentle chest opener because oftentimes you're doing a ton of stretching with a frozen shoulder or a lot of soft tissue work. If there's a level or component to stress or anxiety to that, that cranking is just going to cause your, your nervous system just clamp down and, and, and they're going to, you're going to get the exact opposite of it.

Speaker 4 (14:32):

Yeah, absolutely. And even like, we know if you're cranking on an arm and the, those first three to six months. No good, no good, no good. Not, not good for the patient, not good for the shoulder,

Speaker 3 (14:46):

Not at all. So I might spend a couple of sessions with a patient props, kind of guiding their nervous system into letting go. Typically the, you know, shoulders are rounded, pecks are tight, upper traps. So if I can kind of guide them into relaxing, letting go, I typically find a little bit more space. They're a little more trusting of me to like, maybe move them. Maybe I can modulate their pain a little bit. So they will be a little bit more, or a little less fearful of movement themselves because it's a big deal I'm to us are in pain and they don't want to move. They don't want to go in any direction that that is going to maybe reproduce their symptoms.

Speaker 4 (15:35):

Of course. Yeah. And, and so much goes into that sort of bucket when you're talking about pain. So there's so much that can fill that up. You know, we look at things through a bio-psycho-social lens, you know, you're asking about sleep and stress and all that goes into this, this sort of bucket. And then it gets to the point where the nervous system senses danger. And it's like, okay, that's it. We're gonna it's time. You know, the brain makes that decision. It's dangerous enough pain, right? Yep.

Speaker 3 (16:06):

We're going to fight, we're going to flight or we're going to freeze and think about a frozen shoulder, how much of that could be nervous system driven. And you know, and also too, just bringing in some of the mindfulness component of yoga, you know, the yoga sutras, which are kind of like the blueprint of yoga, the philosophy of yoga, the first Sutra is yoga is now that is, I mean, that is mindfulness. That is in the moment. That is the definition right there. So I use that idea of mindfulness or the tool of mindfulness to bring in throughout the day. Like I mentioned earlier, like doing a little check-in with yourself, oftentimes with my patients, I'll say, you know what, in the midst of your day, when you're like, Oh my God, if one more person calls me or how am I going to get these emails done?

Speaker 3 (16:54):

Or like, I have to make the train to get home to the kids. No, one's competing now. I want you to tap in or tune into your body and come back and tell me where you hold your attention. I want to know, are your shoulders up? And your ears are your jaw clincher. So often, do you hold your belly in? You think about our patients with urinary stress incontinence with low back pain. You know, I mean, if you're clenching your belly all day, that's, that is going to be, maybe unclenching will be part of the solution. So that idea of being present of checking in that is a tool I use throughout the day with my patients. That's great. And you know, with so many we're so externally focused, everything is outside. We're always 10 steps ahead. We just become very disconnected with our physical being. And I love bringing patients back into their body to teach them something that they didn't even know. You know? And I, I love when people are like, Oh my, my quadriceps. And they're like holding their hamstrings. Like we have this tool that we've been given this machine that we've been given, but nobody really educates us on how to use it or what it's about or how it moves. And I love bringing that idea of mindfulness and mindful movement into the physical therapy practice. Yeah,

Speaker 4 (18:17):

I think it's great. And the other thing, as you were talking about putting people into these different restorative poses that can then be transferred over to a home exercise program,

Speaker 3 (18:27):

Easy. I mean, honestly, like laying down on the floor, throwing your feet over the couch, the restorative doesn't even have to have props. It's basically the idea. Now don't get me wrong. The props are delicious, but the restorative is learning how to let go of that tension. As you breathe, it's letting the ground hold you up. It's letting the couch hold you up. It's letting, it's starting to kind of give into something else. You know, how much of us, like we put a coat of armor on every day, like, especially now to get through the day. And so in order to survive, we, we put on armor. Yeah. It's just in a physical structure. Yeah, yeah, absolutely. On the floor, legs on the couch, close your eyes and just breathe. And honestly, that's yoga.

Speaker 4 (19:21):

It doesn't have to be too complicated,

Speaker 3 (19:23):

Not at all. And sometimes when I start to bring things up, people like, Oh my God. Cause they think Instagram, they think poses, they think exactly very like thin, cute people, like by a pool. And it's just, it's mindfulness. It's the breath it's awareness. It doesn't have to be, it doesn't have to be twisty and credit. And I think, I think my practice is in twisting.

Speaker 4 (19:48):

Yeah. I think that's good to know, because I think a lot of people will look at yoga and they look at the show of it. You know what I mean? The spectacle, the show of, wow. Look at this person being able to, you know, do a handstand or a headstand and look at this and look at the positions. They can go, Oh, I can never do that. So

Speaker 3 (20:06):

I'm just not going to do it exactly like that. It's not for me. Or people feel ashamed and mean, especially like the, the men, they will not walk into a class because they don't want their I'd be embarrassed. And like, no one is looking at you. No one. And that's the thing I love about a studio. Like I'm an orthopedic physical therapist. I have, I'm not athletic. I love athleticism. I am not athletic. So when I love about the studio is like, I can move. I can breathe. I can exercise. No one's watching. Yeah. It's true. It's like in their own little world and that's speaks to the introvert in me like nobody's business.

Speaker 4 (20:49):

Yeah. Although sometimes I will say, if I go to a class, I will be looking at other people that being said one of the best yoga classes I ever did, we were blindfolded. All of that's extraordinary because it was a, it was a charity class for a charity called Achilles and Achilles supplies. Pairs runners who are hard of sight. Yeah. To do all different kinds of races from a 5k up to a marathon. And because the people they serve are usually blind. We did the whole class folded and I was thinking, Oh my God, I'm going to fall over because you know, vision is a big part of balance, but it was the best yoga class I'd ever taken because I wasn't comparing myself to everyone else. The instructor was giving really clear instructions and my balance was better because I was actually paying attention to myself versus looking at what everybody else was doing.

Speaker 4 (21:46):

Absolutely. And you really had to talk about a journey inward. Yeah. Right. And having to be in touch with like what your own body was doing and how you're going to assimilate. Yeah. Yeah. It was really interesting. The only weird part was the woman next to me, kept trying to hold my hand and I had to keep like, I'm like, what are you doing? And then after it, she was like, Oh, I'm sorry. I thought you were my friend. I'm like, I kind of kept taking me out of the vibe a little bit, but that is a loving community. Community is a loving community. Yes. But I really, I really loved the way I felt after that. And it, it, you know, it really got me thinking like, wow, this is something that I should be doing with my patients when we're just working on general movement is kind of have them close their eyes and really feel the movement and get into it. But now let's you, so you talked about some of the the tenants of yoga. One is yoga is now being very mindful. What other aspects of yoga aside from, you know, positioning people, restorative, what other tenants of yoga are you using with your clients or with your patients?

Speaker 2 (22:59):

And on that note, we're going to take a quick break to hear from our sponsor. And we'll be right back with Shannon's answer net health therapy for private practice as a cloud-based all in one EMR solution for managing your practice. That's right. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus lots more and one super easy to use package right now, net health is offering a special deal for healthy, wealthy, and smart listeners completed demo with the net health team and get a hundred dollars towards lunch for your staff. Visit net health.com/see, to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y

Speaker 3 (23:49):

I definitely, yes, I use the restorative, but I also use a little bit more of the, the poses, the strength building poses, the even some small sequences. I, I look at maybe look at the system as a whole, right? The fascial system, everything is connected especially my patients that sit all day. So that front body, everything is tight. Tip lecturers, chest front neck. I will give them maybe sequences of some easy poses that they can do at home to open that whole space. My runners runners don't like to stretch. They just want to run. So I always say, okay, we need to do some flexibility. And some mobility work to keep you running healthy. There's nothing better than yoga as far as I'm concerned. Thank for the buck. Especially looking through like fascial systems, you give someone a downward facing dog.

Speaker 3 (24:54):

Well, they're opening their shoulders, calves, hamstrings, low back. They're working on their core. So I love, I love the physical poses to help my runners, my sequences, my restorative, my breath work. How could I forget my breath work pranayama? Right? What's one of the eight limb path of yoga is breath work. And I pretty much teach every single patient who walks into my space to breathe. It is one of the most powerful tools that we have to connect to ourselves to calm our nervous system. But again, our low back pain patients, our neck pain patients, how many neck pain patients do we see that are breathing they're with their accessory muscles. So using maybe even to dossena another pose mountain pose, which is basically standing straight it's posture. So everybody learns to Dawson. And then from 2000, and once we get into that, that rib cage of pelvis alignment, we work on our breath and diaphragmatic breath, finding the belly, maybe then connecting to pelvic floor, especially for my women.

Speaker 3 (26:15):

So I definitely use Tadasana as my, like one point as to finding, finding a good position, finding a good home base and breath and how they can use breath work to help them with their stress response. And part of what I love is sometimes I'll teach my core patients and I don't even tell them what the breathing like. I'll tell them, listen, you know, reading is important for core, and it might with your neck pain and low back pain. So we're just, that's what we're going to start. And what I love is when a couple of visits later, they're like, you know, we feel really calm. I feel calm after I do that. And I'm starting, and I'm starting to use that like during the day. And I secretly love that

Speaker 4 (27:02):

Really giving tools that they can use throughout the day and that they can also see the difference. And we know that once people see the difference in the tools, we give them, they'll use them.

Speaker 3 (27:13):

Yes. And that's how I listen. Some people I know right off the bat that I can like infuse and introduce yoga and they're going to be all for it. Other people I know that are going to be skeptical. So that's,

Speaker 4 (27:25):

That's a good point. You bring up because a lot of people like yoga. So how do you, and so do you use then use the breath work to kind of open the Gates a little bit

Speaker 3 (27:34):

Sometimes, or I'll say, Hey, you know, the yoga has some amazing, you know, stretches that might help you with what's going on. And because they stretch multiple fascial systems, they can be very effective or, you know, not effective, but efficient everybody in the city wants to be efficient. True. So if you give them a couple of things and then they become more curious or I'll work on some mindfulness, or I will educate them, maybe how stress response can be driving their pain how having a hobby or movement can like also be an effective part of their healing process. So I, I kind of sneak it in, in, in different ways. Got it, got it. No, that makes a lot of sense. And also too, for like my, my runners, I have run a bunch of half-marathons. I did in New York city marathon in 2018, yoga is a tremendous compliment to running and read, like, it got me to the finish line. I don't think I'll ever do it again, but you never know. I've never say never, never say, never say never. So that's where, you know, anytime you tell a runner that you could help them be better, faster, stronger of they're onboard. Yeah. Very, very true.

Speaker 4 (29:04):

Now, what advice would you have to other physical therapists or other clinicians

Speaker 3 (29:10):

Who maybe

Speaker 4 (29:11):

Are interested in yoga or interested in infusing yoga into their practice? What are some good starting points

Speaker 3 (29:20):

For them? I would say, start taking some classes, yourself, understand how it makes you feel, understand the language, the sequencing the poses, you know, I, I think experience is one of the teachers. I learned by doing things in my own body and that makes me a much more effective clinician sometimes. So I would say, start taking some classes, notice the benefit yourself, listen to maybe even how yoga teachers instruct. I learned some of the best cues and best instruction from some of the yoga teachers that I have gone and work with. And starting to maybe infuse it a little bit in your sessions, in your, in your PT sessions and see how the patients respond. And then from there, there are continuing ed classes out there for physical therapists who don't necessarily want to take the 200 hour training that can learn how to use yoga in healthcare.

Speaker 3 (30:30):

Yeah. I took a, a great one threes, physio, yoga they are amazing. They're, they're great to follow on Instagram, if you want to learn a little bit more. I have, but they have they just did a class that I took, do I want to, no, it was maybe last year again, it's the whole thing of how to infuse yoga and physical therapy. So there there's plenty of stuff out there. There's plenty of PTs out there that are, that are doing this, that have Instagram pages. So just starting to follow, take classes easy. That's what I would do. It is so easy. It's easy. Yeah. I mean, I didn't do my yoga training until, you know, 2016, but I was using the poses and using some tenets like long, long before I was just from my own experience.

Speaker 4 (31:22):

Yeah. No, I love the advice to kind of take it yourself, see how you see how it feels. Cause listen, you may think you want to infuse it into your treatment and then you may take it yourself and be like, Oh, I don't, I'm not feeling this. And that's okay. You can, you can.

Speaker 3 (31:37):

Okay. Absolutely. It doesn't resonate with everybody.

Speaker 4 (31:40):

That's right. That's right. That's right. And that's okay. Awesome. So now before we kind of wrap things up, I think we, we have your one biggest takeaway is to start taking yoga classes yourself. Anything else that you want the listeners to walk away from this conversation?

Speaker 3 (32:03):

There are many modalities out there to help the healing process. And there are many practitioners that have different ideas to help you get there. And I think that I encourage people to find what works for them. And that sometimes some of the less traditional practices can be extraordinarily helpful. I mean, I think I personally think yoga is an extraordinarily powerful tool from the mind body perspective, we understand how much chronic pain does become a central nervous system, you know, issue that it's not just all biomechanical. So we do have to treat the whole person. We have to treat mind as well as body. And I think that yoga can be a very powerful tool, the combination and to, to, to seek and to try and to find what resonates and find what helps you. And to just, you know, it's not ever linear, it's not ever a straight trajectory. Healing is totally a journey and to not give up and just because you've tried one thing, does it mean nothing? Nothing is going to work, update, curious, stay active stay moving, find something you love to do. It doesn't have to be yoga, but move and movement is meditative. It's mindful. You know, the body, the body responds to movement.

Speaker 4 (33:53):

Absolutely. And now before we wrap things up, this is a question I ask everyone knowing where you are now in your life and in your career, what advice would you give to your younger self who graduated right out of PT school, a newly minted PT.

Speaker 3 (34:11):

I wish I had forged my own path earlier. I wish that I had listened to, you know, nothing has ever really fit for me until I brought yoga into my profession. It speaks to me. It makes sense to me. I wish I had, you know, when we did the webinar with sturdy, like let your freak flag fly, you know, be like, don't be like everybody else. I wish I had listened to that earlier, like towards my own path to not try to not try to fit myself into someone else's business model. Yeah. It's okay to want something different. It's okay. To think outside the box. It's okay.

Speaker 4 (35:01):

And sometimes,

Speaker 3 (35:02):

You know, what, what you think at first is going to work doesn't and then you find another tool. Totally have a huge toolbox. Yeah.

Speaker 4 (35:12):

Oh, I know. That was such good advice, you know? Cause I think so often, especially in physical therapy, as we discussed during that webinar, it's like physical therapists tend to be type a, we want to, you know, we want to be the best we wanted. We want to do good. We want to help others. And so we tend to kind of just stay in the lane totally. And are afraid to like, let the freak flag fly if you want is very hard to say, but it's true. It's true. And I thank you for reminding me and reminding the listeners of that now, where can people find you? Yes. Be true to yourself and where can people find you speaking? You can find me on LinkedIn and Instagram and what's your handle on Instagram? That's funny. That is, that is my nickname. My family, my nieces call me Shanny.

Speaker 4 (36:03):

S H a N N Y O G a P T and my C O very long. Very cute. I get it. I get it. Shen yoga, PTM, YC. Perfect. Perfect. Awesome. So people can find you there and we will have links to all of what Shannon spoke about today, resources and things like that. We'll put them all into the show notes at podcast on healthy, wealthy, smart.com. So one click will take you to everything we discussed today. So Shannon, thank you so much for coming on and talking about how to use yoga in your physical therapy practice. So thank you. Oh, thank you, Karen. It was a pleasure. I love, I love, I got to share the best of like my favorite part of the world. Awesome. Thank you so much. And everyone who's out there listening. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

Speaker 2 (37:01):

Big thank you to Shannon for sharing how she incorporates her passion, which is yoga into her physical therapy practice. And of course thank you to net health for sponsoring today's episode net health therapy for private practice is a cloud-based all-in-one EMR solution for managing your practice. One piece of software that handles all of your scheduling documentation, billing and reporting needs. Plus lots more in one super easy to use package net health is offering a special deal for healthy, wealthy, and smart listeners completed demo with the net health team and get a hundred dollars towards lunch for your staff. Visit net health.com/ let's see to get started and get access to free resources for PTs like eBooks on demand, webinars, and business tools. Once again, that's net health.com/l I T Z Y.

Speaker 1 (37:53):

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

Jan 4, 2021

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Joe, Tatta, PT, DPT to talk about using acceptance and mindfulness-based interventions to build resilience and overcome chronic pain. Dr. Joe Tatta is a global leader in integrative pain care and an advocate for the safe and effective treatment of chronic pain. He is the Founder of the Integrative Pain Science Institute, a cutting-edge health company reinventing pain care through evidence-based treatment, research, and professional development. 

In this episode, we discuss:

1. Psychological variables associated with chronic pain

2. What is Acceptance and Commitment Therapy (ACT) 

3. How is ACT different from traditional cognitive behavioral approaches and pain education?

4. How is ACT different from mindfulness, like the kind we encounter in popular culture?

5. How does ACT help physical therapists’ function better and prevent professional burnout? 

6. Dr. Tatta's latest book “Radical Relief: A Guide to Overcome Chronic Pain

 

Resources:

Radical Relief Book 

ACT for Chronic Pain Professional Training Course: 

Mindfulness-Based Pain Relief Practitioner Certification

RELIEF: and online mindfulness community for pain care.

Facebook: @drjoetatta

Instagram: @drjoetatta

Twitter: @drjoetatta

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

 

More about Dr. Joe Tatta: 

Dr. Joe Tatta is a global leader in integrative pain care and an advocate for the safe and effective treatment of chronic pain. He is the Founder of the Integrative Pain Science Institute, a cutting-edge health company reinventing pain care through evidence-based treatment, research, and professional development. For 25 years he has supported people living with pain and helped practitioners deliver more effective pain management. His research and career achievements include scalable practice models centered on lifestyle medicine, health behavior change, and digital therapeutics. He is a Doctor of Physical Therapy, a Board-Certified Nutrition Specialist, and Acceptance and Commitment Therapy trainer. Dr. Tatta is the author of two bestselling books Radical Relief: A Guide to Overcome Chronic Pain and Heal Your Pain Now: The Revolutionary Program to Reset Your Brain and Body for a Pain-Free Life and host of weekly Healing Pain Podcast. Learn more by visiting www.integrativepainscienceinstitute.com.

 

Subscribe to Healthy, Wealthy & Smart:

Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:               https://soundcloud.com/healthywealthysmart

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

 

Read the full transcript here:

Speaker 1 (00:00:01):

Hey, Joe. Welcome back to the podcast. I'm happy to have you on again.

Speaker 2 (00:00:06):

Hi Karen. Thanks for inviting me. I'm excited to be here.

Speaker 1 (00:00:08):

Yes. And today we're going to be tough. Well, let's not let's, let's roll it back for a second. So it seems like each time you've come on, we've talked about some different aspects of pain, right? We're both in that chronic pain world, we love treating people with chronic pain and talking about chronic pain or persistent pain. And we've done that quite a bit. We've talked about the psychological variables associated with persistent pain and how psychologically informed physical therapy is so important. So let's talk about which variables we should be most concerned about with regard to effectively treating pain, big question right out of the gate.

Speaker 2 (00:00:52):

It is, and it's a, it's a great place to start. And that's a question that all of us are asking ourselves and researchers are asking this question more and more and we're trying to figure out, okay, what is like the key variable? Is there one key variable that we should be paying attention to? And it's interesting if you look at the evolution of chronic pain and I think both you and I have been practicing for about 25 years. So we've really have seen things transitioned from this biomedical biomechanical model, right? And the core of that was let me figure out, let's try and figure out or identify what's wrong with the physical body. Right. Pretty easy.

Speaker 1 (00:01:34):

And then the pain goes away.

Speaker 2 (00:01:36):

Exactly. And we were all there at one point, then this bio-psycho-social model comes in and we're like, okay, there was there a psychological variables that we should pay attention to. And what's interesting is when I talked to physical therapists about the psychological variables, they bring in a little bit of that older biomedical model in the sense of how can I identify what's wrong. And then if I know what's wrong, then I can fix it. And it makes sense. And that even shows up in some of our mental health colleagues as well when they approach people with pain. So when we look at, you know, there's kind of like five big ones pink catastrophizing, can you see your phobia, fear, avoidance, depression, anxiety, those five persistently show up in the literature as variables that are associated with poor outcomes with regards to chronic pain. So you see them all the time and we have ways we can test for it, right? Pain, catastrophizing scale Tampa kinesiophobia scale, et cetera, et cetera, evolve are well aware of these. And we all use them. What I want people to consider for a moment is these are all what we would call vulnerability processes. So this is what makes someone vulnerable to transitioning, let's say from acute pain to chronic pain and they may be important and they are important, but I would like people to consider for a minute. If you flip the coin over, what's the opposite side of vulnerability.

Speaker 2 (00:03:13):

And this is really important when we think about chronic pain, because our job as professionals is not necessarily to identify here's, what's wrong. You physically, here's, what's wrong with you psychologically or emotionally. And now I'm going to fix, modify or change those variables. We want to focus on as professionals. The other side of that coin is how can I help someone be more resilient? How do I develop, build or foster a sense of resiliency. So that other side of the coin, which is really what has interested me the most, I'd say in the past 10 years is looking at those positive, psychological factors that are associated with resiliency. There's three of them. We can kind of talk about them a little bit each but there are pain, self-efficacy pain, acceptance, and then values based living.

Speaker 1 (00:04:01):

Okay. So let's dive into each of those. So let's start with pain. Self-Efficacy what the heck does that mean?

Speaker 2 (00:04:09):

Yeah. And we hear the word self-efficacy used a lot, and I want to make sure that we tag on the word pain with that because just normal quote unquote self-efficacy you can measure self efficacy, but really as a pain professional, whether you're a physical therapist or another licensed health, professional, or certified actualize professional someone's confidence or their ability and their confidence in themselves to function and figure out what the cause of their pain isn't to overcome. It is basically what we identify as pain self-efficacy. Now you can actually have good self efficacy and have poor pain self-efficacy so it's important as professionals that we look at him as, okay, how can I help someone with pain self-efficacy with regard to their rehabilitation and overcoming pain.

Speaker 1 (00:05:04):

And so say that one more time for me, I'm going to edit some of this out, but I just want to get that into my own brain.

Speaker 2 (00:05:15):

No, no problem. So paint, self efficacy is one's confidence regarding their ability to function while they experience a while they have pain.

Speaker 1 (00:05:24):

Okay. Got it. Got it. All right. That makes sense. And that is coming from someone, the long history of chronic pain. That's not easy. Can I say that? Is it okay to say that that's not easy?

Speaker 2 (00:05:41):

Absolutely. And it does go back to what I mentioned a little bit earlier, where okay. If I have pain, it's this message this signal, if you will, that something's wrong. And it's perfectly normal that your mind goes to the place of, I want to stop. I want to eliminate, I want to resolve this pain with acute pain. That's fine. With chronic pain. It's something very different. And if someone gets kind of caught up in that Whirlpool, if you will, of constantly spinning and trying to figure out, okay, what is the cause of this? And they go down that biomedical route, that's where people wind up in trouble and where they don't find a solution for their pain and why pain persists. So pain self-advocacy is interesting because it's like, okay, do I have the knowledge? Do I have the tools? I have the ability in myself, right?

Speaker 2 (00:06:36):

Because if we're not looking at vulnerability for looking at resiliency, really what we're saying is somewhere within, inside you deep inside you actually, you have the ability to contact something that you haven't contacted yet, or maybe you've only contacted a piece of it. But if I can help you with that, if I can help you along that path, if I can help you along that journey, then we can improve your pain, self efficacy. And it's potentially the research is still kind of unclear, but it's potentially the number one factor, the number one resiliency factor with overcoming chronic pain.

Speaker 1 (00:07:13):

Oh gosh. As you're, you're saying that I, in my head, I'm going back, you know, 10, 15 years to when I was in pain all the time. And yes, I was searching for that fix. And what I found when my pain started to recede, I started to feel better was that I was always looking for that external fix. When in fact I had to look into myself to see how, what I can do to overcome this and, and to kind of move forward and make the best decisions I can at the time, the information that I have and be okay with it and then move forward. And that was the thing that really helped to kind of flip the switch for me.

Speaker 2 (00:08:00):

That's right. And there's, there's two really important things embedded in what you just said. The first is, as physical therapists were very aware of pain, avoidance painted warnings is almost when I look at pain avoidance now after studying acceptance and commitment therapy, I look at painted. William says, it's too simple. So it's like, if the, you know, if you put your hand over the flame, I pull my hand away. I avoid pain. If there's a rock in your shoe, you want to walk differently or take the rock out. What you're saying in your experience, Karen, which is common in many, people's almost every single person's experience you've had chronic pain. Is that the pain persisted for so long that not only did I avoid pain, but I started to move away from everything that was important in my life. And I moved toward only those potential areas on the, on, toward the potential causes that could alleviate my pain.

Speaker 2 (00:09:00):

Now in the act that's called experiential avoidance. And again, it's a little bit different than regular pain avoidance because experiential avoidance means the entire experience. The entire capsule of my life what's encased in there is only to seek out the elimination or the control of pain. And when that happens, that's when people go down sometimes sad and sometimes very scary routes of things like surgeries that don't work and one medication or multiple medications, or we see, you know, behaviors lead to passive treatments you know, leaving work and disconnected from personal relationships, all the things that we see that our patients struggle with. So it's what you say is really important. And to try to make those distinctions for therapists, I think are also important as well, because we can skim along the surface of pain, avoidance, so to speak. But I really believe if we want to be effective with pain, we need to go on this deeper level with people looking at that pain, self efficacy, looking at pain acceptance. And then the last one looking at values based living, which is what ha, which is actually the flip side of experiential avoidance.

Speaker 1 (00:10:15):

And something that you just said that sort of avoidance becomes all encompassing. And, and I will agree. That's exactly what would happen. Like I can remember doing things like going to an acupuncturist and having them put all these needles in my ear. And then I had to walk around the plinth counterclockwise three times. I mean, when you think about that, you're like, what? But I was so desperate. Like I was doing anything and everything for that fix. When I knew even as a physical therapist that walking counterclockwise around uplift three times doesn't really make a difference. But yet here I am doing it and doing that instead of, I don't know, meeting up with friends, right. Relaxing, going to the gym. Like I was avoiding all that other stuff because I was so laser focused on finding this cure, so to speak

Speaker 2 (00:11:21):

That's right. And as you're talking to me and I'm imagining what it's like for YouTube and in that experience, and you're talking about going to an acupuncturist with which, you know, I tell people, look, if you have one passive treatment that you engage in each week as a, as a means of, stress-relief totally fine by me. I have those as well. So we're not suggesting that people avoid anything that's passive, but as I listened to you, and at first you started, well, I went to the acupuncture was for my pain, but you continue to talk what you actually revealed was most important. The real pain was, yes, it was physical, but the real pain was what, it's, what it's stolen, what it Rob for my life. Right. I think you mentioned relationships. That's kind of like, all right, there's pain avoidance here, but what's the real pain underneath that.

Speaker 2 (00:12:16):

Cause that's what I'm curious to talk to people about. And that's what I'm curious to learn about patients when they come to me and they say they're suffering and they say, they're struggling. I want to know, okay. What about your life? Do you miss? Who do you miss in your life? What aspects of your life do you miss? Because the truth is Karen. If we look at the, the vast body of research that reaction now have with regards to chronic pain, most things, no matter what it is, if you apply just one, intervention works minimally and the outcomes are not spectacular. So they're minimal and they're not spectacular. But when you start to combine different things together, then you see more moderate improvements in clinical studies and you see a change in someone's quality of life. But ahead of all of that, some of the most important outcomes that we're looking for is to look at, okay, what's meaningful in your life. And how do I help you reconnect with that? And I really believe that the resiliency processes that are out there, they exist in all of our practices and an acceptance that can move therapy kind of has a bunch of different processes that really lend well to this. But if we can engage people with these positive psychological responses and move away from the negative sodas, because people are aware that they realize they're scared, hell of pain, there is trouble.

Speaker 1 (00:13:45):

Oh yeah, yeah. When I had pain, like I totally understood. Yeah, I have it. I don't want to I'll avoid anything to have it that yes, we totally, 100% get that.

Speaker 2 (00:14:00):

Right. They realized, they realized, they think about it a lot. They realize they're a little sad or depressed about it or anxious about it. They realized that it consumes their time, but they really want to know is how do I get my life back? There's a whole chunk of my life over here. Yes. When you sit down with somebody who has pain, the first thing they're going to talk about is physical pain and that's Norma. And we should, we should make an attempt to validate that for them. But later on, as you're working on their self-advocacy and as you're working on that third week relationship, which really needs to start like the first 10 minutes of the treatments, it really does. Doesn't it doesn't start like three weeks later. What's the first five minutes. These are the questions that we should be asking ourselves. And these are the questions that we should be asking our patients to help them navigate what's happened to them.

Speaker 1 (00:14:48):

Okay. So let's, let's talk about that. So you're

Speaker 3 (00:14:52):

The physical, I'm the physical therapist, right? How do I broach these topics or these questions with the patient without offending them without coming across, as you know, you may have patients say, Oh, that's too personal. Do you know what I mean? So how as physical therapist, and this is where, you know, you had mentioned acceptance and commitment therapy, right? So how has physical therapists, can we incorporate, act into our treatment practice? How can we do this without being offensive,

Speaker 2 (00:15:34):

The best place to, and I'd like, I like the word offensive because I do believe as even though I'm a big fan of psychologically informed physical therapy, and I've talked about this on podcasts and everything, I've done books, et cetera. We have to realize as physical therapists, there's a cognitive dissonance there, which means when someone comes to see us, they don't expect that we're going to be talking about psychological variables. They don't expect that. And nor should they, we have a long, long, long way to go. Not only in our own profession, but in the entire healthcare system, before we get there.

Speaker 2 (00:16:15):

When you're talking about interviewing someone or evaluating someone or assessing someone during the evaluation, which is really where you should start to talk about values based living, there are a couple of just simple questions that you can add into your evaluation. So again, this is psychological informed care, right? We're not becoming psychologists. We're just using principles of to inform our care so that our outcomes are better. So for example, one of the most important questions, which I always get positive responses from, and people never feel taken aback by this is if you didn't have pain right now, what would you be doing with your life?

Speaker 2 (00:17:00):

And it's an open-ended question, right? What kind of weaving in like, you know, principles of motivational interviewing. It allows someone to think, wow, if I didn't have pain, what would I be doing? And you, and I may be able to, to kind of access that very easily or rapidly. However, someone who's had pain for a long time. It's like, there's been a smoke screen in front of their eyes. They're no longer able to see that. Okay. There's another aspect of life for me, somewhere that I can begin to kind of work on. Another really simple one kind of a nice metaphorical one is if I had a magic wand and I can wave the magic wand and make your pain go away, what would you do? What would you do tomorrow? Or who would you visit? Who would you go see and spend your time with? So a couple of just really simple open-ended questions that you include an initial valuation. And I recommend, you know, when people first start training with me, I give them lots of different handouts with regard to values, because you can spend a whole hour on this, but if you're new, just seeding this into your practice just a little bit, day by day or session by session. So to speak, it's a nice way for you to change because there's behavior change. That's involved for us as professionals as we start to use these new interventions.

Speaker 1 (00:18:20):

Yeah. And I think as the, the healthcare professional, the physical therapist, like you said, there is still that unconscious bias of I got to fix it. Right. So I think I would imagine you can correct me if I'm wrong, but the more patients that we see and the more that we ask these questions, the more that I think we'll be able to kind of delve into this other part of the person sitting in front of us. Because the one thing that comes to mind when you said if you didn't have the pain, what would you be doing? What if someone's like, I don't know. I can't even picture it. You just put, I don't know. I can't picture it and move on to the next question. What, what, what happens next?

Speaker 2 (00:19:11):

Well, there's a couple of different parts there. Karen. the first part I just want to mention, so physical therapist and other health professionals who work in rehab are excellent at goal setting. And in fact, I think physical therapists and probably OTs are the best at goal setting, probably in the profession, in the, in the healthcare professions. Historically, we've not been very good at talking about meaningful or value based activities. What if I told you as a professional, that it's more important to help clarify someone's cloudy values instead of setting really precise short-term and long-term goals like we've been trained. So what I'm really saying is we have to challenge ourselves and look at our own practice and say, okay, what am I doing? That's effective and what am I not doing? That's effective. Now, the reason why it's called acceptance and commitment therapy is because with regard to pain, acceptance, that's, one's willingness to acknowledge pain as part of their life experience.

Speaker 2 (00:20:15):

And with that acknowledgement, they avoid the, they avoid the attempts to control or eliminate it. Now pain acceptance is important for people living with pain, pain. Acceptance is also vitally important for practitioners who treat people with pain because of the research is clear that we don't have a really spectacular way right now to eliminate someone's pain. I'm not saying that we can't do that. I believe it does happen, but what I'm proposing. So people who are listening to this episode is that in many ways, we put the cart before the horse, and we've said, I'm going to make your pain go away first. So we have all these ways to make your pain go away. And then you'll return to life.

Speaker 2 (00:21:03):

When in essence, we have to say, let's talk about how we can start to clarify what was important to you in life. Take little steps toward that. And then with that, your pain will start to go away. They're very different messages and they're also very different ways to approach a patient. So if someone turns to you Karen and says, I have no idea. I've had pain for 10 years. It's affected me so badly. I lost my job. I've lost my personal relationships. Let that person talk about their loss because just like that vulnerability process, right? They're talking about how they're vulnerable. Well, on the opposite side of that, they're really saying, I want to, I want to maintain relationships. I want to get back to work. So allow people some room, actually many times when, when questions like that come up, this is going to sound strange to people.

Speaker 2 (00:21:56):

But I just sit there in silence. I maintain eye-contact. I maybe move a little bit closer to the person. And I just give them some space to process that and to process the, the idea that someone's asking them, someone's interested in their life beyond just pain relief. And that can be really difficult, especially for physical therapists, because we went to school. And even if you go to like DPT program websites right now, it says like, you will learn how to like resolve someone's pain. And then we get out into the world. We got out into, you know, the profession. I mean, we figure out, Hmm, maybe I'm not as good at this. As I thought,

Speaker 1 (00:22:36):

This is, this is really hard. Am I missing something? I must have, they didn't teach me this in school. Am I, what do I need to learn to do this?

Speaker 2 (00:22:46):

That's right. So the question is, you know, what, if the way to help someone contact her values is to just sit with them and allow them some space to start to think about that. Because chances are, if someone's wrapped up in experiential avoidance, they're not thinking about that on a daily basis. They're thinking about, I need to take my medication this morning. I need a hot bath. I need to take my magnesium. I need to take my nap. I need to do some distraction activities. So I don't think about pain. That's what their mind is preoccupied with.

Speaker 1 (00:23:26):

Yeah. Or yeah, a hundred percent. A hundred percent. Yeah. Everything you're saying, I'm like, yep. I can remember like, Hmm, okay. I have to figure out what pillow I'm going to use. I have to figure out how much I'm going to put my bag. So it's not that heavy. When I walk around, do I have a break during the day? Did I take Advil? Did I? Yeah. So on and so forth, but that is, that's all encompassing during your day. And, and I don't think I had, well, yeah, well, when I sat with David Butler, he's like, well, what, what would you be doing? Right. And I, my answer is, I don't know. I, I never thought about it. Right. You know, and, and, and being able to send, he did exactly what you just said. He's like, well, think about it.

Speaker 2 (00:24:17):

And I w I want to, you know, reinforce what you're saying is that for some people it's extremely difficult for them to think about it. Yeah.

Speaker 1 (00:24:24):

Yeah. It's and it's really uncomfortable and it's uncomfortable. So just think of it's in control for the patient. And you're the therapist on the other end, is it uncomfortable for you as the therapist to watch someone be uncomfortable and wiggle in their chair, so to speak?

Speaker 2 (00:24:41):

Yeah. I love that. And my response to that is empathy for the people we work with involves a little bit of us feeling uncomfortable and sharing that unpleasantness with the person that's in front of you. And in many ways we mirror people actually. So as they're struggling and suffering as a human, who cares about someone we're struggling and suffering too, because ultimately, ultimately every physical therapist I've ever met. And, you know, I've interviewed a lot of therapist. Karen, when I asked him, why did you want to become a physical therapist? And they would say, well, I want to, to help people. And if I always dig, dig in there more, there's always a story of, well, when I was in high school, my, you know, my grandfather had a stroke and he wound up living with us and I saw the PT come in the house, or I was an athlete and I had an ACL repair. And I saw all these people in this PT place and how I could help them. So, you know, there's a, there's an aspect of human resiliency built in with that. I lost my train of thought. Sorry. one thing you can try for people who are having a hard time connecting to their values, their personal values is to ask them, Hey, if I were to share some information with you about how we can alleviate pain, who would you share that with in your life?

Speaker 1 (00:26:13):

That's nice. So then

Speaker 2 (00:26:15):

It takes it off of, it takes a little bit of the pressure off the person or off the patient.

Speaker 1 (00:26:20):

Yeah. Yeah. It takes a little bit off them and puts it onto someone else. Right.

Speaker 2 (00:26:25):

Right. And in general, we all want to help other people. And especially people with pain, they really do care about other people. And they really have an interest in not seeing other people's struggle the way, the way they've been struggling. So it's a nice way to just kind of shift the conversation a little bit. And if you continue with that, what you'll eventually see kind of like in ourselves when we learn things right. And when we teach things, we actually wind up implementing it into our life in a way that's more effective.

Speaker 1 (00:26:52):

Yeah. Yeah. That reminds me of Sharon Salzberg, loving kindness, meditations. So when she does those meditations, she sort of starts with, you know, think of someone else and, you know, offer them like a life of ease, a life of love, a life of serenity or kindness. And you kind of repeat that mantra for awhile and then just say, offer it to the world and you offer it to the world. And she's like, okay, now offer it to yourself. So that you've practiced someone else you've practiced the world. And then you can turn it back onto yourself. And it's, I always felt like, Oh, this is nice. Now I don't feel bad. Wishing myself a life of ease or a life of ex you know, love or XYZ. Right. Cause I think sometimes when you, I think a lot of people feel this way. They have a hard time being kind to themselves and allowing themselves to not suffer.

Speaker 1 (00:27:50):

Even though with chronic pain, you are suffering and you don't want to be suffering yet. It's hard to recognize that in yourself. You'd rather put it onto someone else or wish that for someone else. But it's just so hard to wish it for ourselves because maybe if, if you've had chronic pain and I'm just, I don't know if this is true or not, but you can't, it's hard to see yourself out of it. Right? And so it's hard to even think of yourself, elevating yourself up to something that maybe you'll never get to. So then you'll, won't be disappointed.

Speaker 2 (00:28:25):

That's right. I, I talk about this in my book, in the, in the sense of self-compassion, which can be difficult, as you said, it's a little bit easier to be compassionate toward other people. And it can be more challenging to be compassionate toward ourselves. Where I see this show up with regard to chronic pain is people have been taught. You have to fight pain. Yes. You have to overcome pain and you see this online people even come in, I'm a pain warrior.

Speaker 1 (00:28:50):

Yeah. Right. You gotta be tough.

Speaker 2 (00:28:52):

Right. You have to be tough. You have to fight it out. You have to struggle with it. And my question really with regard to that is, okay, there's definitely some work that we have to do here. There's some effort that we have to put into this and there's some behavior change. We know that as professionals, but if you enter into a battle with pain, what kind of message is that sending your mind?

Speaker 1 (00:29:17):

You're always on guard. You're always on high alert. And that's kind of the opposite of really what we want when we're working with people with chronic pain. That's right.

Speaker 2 (00:29:25):

And even, even Karen, because I can see you on video right now, as you do that, you're stiffening your whole body up. Right. And we know that things like spasm, muscle spasm, tightness is an outcome of some of these psychological variables. We're talking about being a warrior. Imagine you see holding a gun or holding like a spear they're stiff and very contracted, right. Really what we do with act. And many of the mindfulness and acceptance based approaches is we start to soften to the idea that maybe I don't have to fight this. And that may be my fighting. This maybe the battle with this is the worst, worst, worst part of this. And if I can just let this go just a little bit and allow it to be that maybe not only will my physical body soften, but also my mind will start to release a little bit with regard to some of the things that I've been struggling with or some of the things that I've been grappling with with regards to pain.

Speaker 2 (00:30:21):

And we know that when that happens, people work toward more pain acceptance. Not only does the quality of their life improve, but as I mentioned before, or that kind of cart before the horse, that's also when pain relief happens, why does pain relief happen with that? And that's, I think it's an important point to talk about, well, we have a reward system in our brain, right? That produces its own opioids. When you engage in activities that are meaningful and important to you, it kind of, you know, twinges that reward system in your brain over meaning it makes you feel good. Right? So engaging in things that make you feel good or rewarding or engaging in things that are rewarding, make you feel good, they bring you pleasure. Right. They bring you joy. And with that, it alleviates pain. So yes, there are ways for us to help with pain control. And there are ways for us to help people be a little bit more willing to engage in their life, even with a little bit of pain and both work effectively and both work synchronistically together to help people.

Speaker 1 (00:31:35):

Yeah. I know. I always look back and think, you know, there were days where I couldn't turn my neck from side to side, like I would be crying during the week, but then on Saturdays I pitch a double header and I was a windmill pitcher. No pain felt great, really good because I loved pitching. I love being with my team win or lose. It was awesome. Even if I got like hit with a line drive or something, I just, like, I was hit with a line drive in the shoulder. Didn't bother my neck at all. Didn't even think about it, no problems doing that. Right. And people would always, that's why, when you have someone with, in my case, like chronic neck pain or chronic back pain, and you see them doing something like pitching a double header, a fast pitch softball game, well, there's no way they could have pain because they're doing this. Right. Right. And so it's, it's from what you just said for me, this was really valuable in my life was meaningful. It gave me joy. So I was able to do it with

Speaker 3 (00:32:40):

Very little, if any pain, but on the outside, people are thinking she's faking it. Right. So what, what, what do you do in that respect? Yeah.

Speaker 2 (00:32:51):

Well, I just want to what you're saying resonates well with me, it takes me back really to like the first year I was practicing, which is like 25 years ago before I studied anything about acceptance and mindfulness based approaches. And I had a, a young woman who was, she was the same age as me at the time she was 26 and she was walking down one of the beautiful tree line Brown street, brownstone streets of Brooklyn on it's on a Saturday evening and a drunk driver. Kim wants to the curb and pinned her between the car and the steps of the brownstone. And instantly she was an above knee amputee on one side and the below knee amputee on the other side. And she was a patient of mine pretty much the first, entire six months of my career, basically. And the beginning of her rehab was so smooth.

Speaker 2 (00:33:44):

It was wonderful. And you know, it was a physical therapist. We just feel good because we're helping someone walk again and we're fitting them for prosthetic limbs and we're making them stronger. And that went all really well until two things happen. Once you start to lose some weight because she was in the hospital and eating better and exercising. So the prosthetic didn't fit as well. So it was a constant struggle with the prosthetics every day. And then two, she developed a neuroma on her, on her. One of her legs, there was a period for about two weeks where she was so utterly depressed and unhappy. Cause she was in so much pain and suffering so badly. And all of us, the PT, the OT, the nurses, the psychologists, I mean, everyone went into her room and try to motivate her. You know, we use these like rah, rah, watch your tacky.

Speaker 2 (00:34:36):

Yeah. Cheer her up kind of thing. So one day I went into her room and I just sat next to her. And I said, I don't, it doesn't seem like you want to walk today because that was my job. Right. As a PTA, she said, no. And I said, okay, well, what do you, what do you want to do? Then? I said, you can't stay here. You can't stay in this bed forever. You know that, you know, eventually you they're going to send you home. And she said, there's only one thing I want to do. She said she was engaged at the time. Actually. She's like, I want someone she's like, I want to get married. And I want someone to wheel me out into the dance floor in my wheelchair. I want to stand up and I want to dance with my dad.

Speaker 2 (00:35:23):

And that's all she wanted to do. She didn't want to walk. She didn't want to walk 50 feet in a hallway with a Walker times two. Right? Nope. Didn't care about that. She didn't care about the prosthetic legs. Really. She didn't really actually that at that time she didn't even really care if she was in a wheelchair, the rest of her life. That's what she wanted that moment. So you know what we did together. Okay. Put your hands on my shoulders. Stand at the edge of the bed. I put some music on and all we did was weight shift. Now, could I have done something more therapeutic from like a physical therapy perspective? Of course I could. Was there something, was there anything that was more important to her in that moment? No. No.

Speaker 1 (00:36:10):

Yeah. And now, now given the knowledge that you now have and what we know about pain and what we know about this more value-based activities and mindfulness and act, looking back on that, what does that do for you? What does that make you think of now where you are now looking back on that as such a young therapist?

Speaker 2 (00:36:36):

Well, it makes me think two things. First I am eternally grateful for the skills and knowledge I have now that I try to share with people as much as I can. And then I also reflect on who didn't I help? Oh, that's a can of worms, right? Yeah. Who slipped through my fingers that I wasn't aware of. And that makes me reflect back on, okay, what are we not teaching licensed professionals, especially physical therapists in school, right? So the amount of time we spend on evaluating the structure, function, the structure and function of a joint is in my opinion, at this point in my career is kind of absurd.

Speaker 1 (00:37:23):

That's the word? That is. So that's the word that came into my mind too.

Speaker 2 (00:37:27):

The reason why it's absurd and not no offense against, you know, our colleagues in academia is that this is so much packed into a PT program now. Yeah. So we have to get better at, okay. What do we have to, obviously we have to, we have to understand how to measure strength and range of motion, function, et cetera. But it's perhaps most important that we learn how to motivate and change behavior.

Speaker 1 (00:37:56):

Yeah, absolutely. Because when you, when you think about pain and certainly chronic pain, but even acute pain, what does acute pain do to us as humans? And then as a result, chronic pain, it changes our behavior. It forces us to change our behavior. If we sprain our ankle, we've got a big puffy ankle. Are we going to walk and run for the next week or so? No, it's going to change our behavior. And in chronic pain, that behavior change becomes more than just a few weeks of a behavior change. It becomes an embedded behavior change into personality and into everything that we do.

Speaker 2 (00:38:39):

That's right. And the reason why acceptance I commend therapy is so important for physical therapists is because when we look at all the literature on cognitive behavioral therapy, traditional cognitive, behavioral therapy, and even pain science education, and both of those I'm I'm in favor of, and I support, but the outcomes actually may be a little better with act with an act approach specifically for the pain, the population of those living with chronic pain and as physical therapists, knowing that we function in practice settings, where we come face to face with people who are in acute pain. And if we can start to deliver some of this during the acute setting, right, then we can prevent the transition to chronic pain. And I think that's the most important. So if you're in acute orthopedics, if you are working in inpatient rehab, I mean home care, all the various places that we function, physical therapists are in the perfect position to take the brain and the body or the minds and the body put them together and help someone overcome their pain.

Speaker 1 (00:39:50):

Yeah. And, and it goes back to what you said in the beginning, it's sort of fostering that resiliency in people, and that can happen the day one, you injure yourself. You know, last summer I, I had a partial tear of my calf muscle. And the first thing that came into my mind was, well, the first thing was I felt down when it happened, I was like felt for my Achilles tendon. I'm like, okay, the Achilles tendon is there. I'm good. And isn't that amazing? Like I, anything else to me was like a nothing thing. Right. But the first thing I needed to do was I felt down, I was able to point and flex my foot. My Achilles tendon was intact. I got up, I lived up the field fine. I was like, okay, I'm good. But the next day I was like, Oh my gosh, what if this doesn't go away?

Speaker 1 (00:40:41):

What if this, because of my own history with chronic pain, it's what if this is chronic? What if it never goes away? But, and I, instead I went the next day, I went to see an orthopedist and he did kind of what you're saying. He was like, listen, this is what's going on. This is what's going happen. And he gave me out like a timeline of expectations and for me, and, and the way that I function, that was a great way to build up my resiliency to know, Hey, first of all, it's not my Achilles tendon. And second of all, this is what's going to happen over the next couple of weeks and over the next couple of weeks, what he said happened. And so I felt okay, I'm good. It's a little sore. It's a little painful. I'm okay. With the backdrop of that chronic pain history was really meaningful to me.

Speaker 2 (00:41:30):

Yeah. There are variations of informed consent, just informing someone, okay, what here's what's happening. And here's how this is potentially going to play out. Can be really, really important and powerful for someone. It can help ease someone's anxiety. It can help ease their worry and concerned about it. And as I mentioned before, these are the places where, you know, we thrive as PTs actually, especially with regard to pain. I mean, if you look at pain education in licensed health professional training, PTs have the most more than psychologists were than the other mental health professionals, more than OTs. So, you know, we're putting all these pieces together. And in fact, when you look at what are the most important factors to help someone with pain it's pain education, right? So we talked about that some type of cognitive behavioral therapy, acceptance and commitment therapy is a third wave generation, cognitive behavioral therapy. And then something related to lifestyle, probably the most important factor with regard to lifestyle is movement is exercise and physical activity. So when you put pain education together with act together with helping someone or promoting physical activity, that's probably the kind of trifecta. Those are the, that's the secret sauce, if you will, of helping someone with pain.

Speaker 1 (00:42:52):

Yeah. I, I agree a hundred percent and now let's dive in just quickly. If you can give the listeners kind of like, what's the difference? You, you sort of alluded to it now between acceptance and commitment therapy and cognitive behavioral therapy, and also the difference between act and mindfulness.

Speaker 2 (00:43:19):

Sure. All really important distinctions. Thanks for the question. So cognitive behavioral therapy is kind of the first therapy that was used with regard to people's thoughts, beliefs, and emotions around pain. Most of that work focuses on identifying or challenging problematic, problematic, or modifying thoughts. And with that, as someone modifies their thoughts, you hope that it modifies and changes their behavior. So restructuring thoughts, we've heard these words before restructuring thoughts, reframing thoughts even the reconceptualization of pain, which is a purely from like a pain education perspective. It's still a more traditional cognitive behavioral therapy model, helping someone identify their thoughts, and if their thoughts are maladaptive, how can we change those thoughts now they're important. And there's a place there for that. What I propose to people when they start to look the literature on changing thoughts, specifically with pain or the route with regard to pain, it can be quite difficult and quite sticky to do that.

Speaker 2 (00:44:29):

There's some pretty good research that shows that there's a small group that will reconceptualize their pain really early on. There's another smaller, equally small group that will never change. And then most people are kind of somewhere in the middle. So they understand what you're saying. They understand that, okay, the herniated disc in my back, isn't the only factor with regards to my chronic lower back pain. And they understand that, you know, thoughts about your thoughts about pain, negative thoughts about pain are not necessarily good, but they don't reconceptualize. They don't change those thoughts on a hundred percent. The difference with acceptance and commitment therapy and even mindfulness, they're both what they call third generation cognitive behavioral therapies, which instead of targeting these maladaptive thoughts and beliefs, we simply help people observe that they have thoughts about what's happening. And instead of changing that we help people understand or identify, recognize that they can have those thoughts and beliefs, but still continue on with the things that are important to them in their life. So it's a big distinction. It's especially challenging for physical therapist who spent a lot of time studying pain education. And there's a physiotherapist from Ireland that came into my act program and she studied pain education for a long time. And then she studied cognitive functional therapy, both two evidence-based wonderful ways to treat pain, but she found that there were some people, a lot of patients actually, that they understood didactically what you were saying to them, but it didn't change their behavior.

Speaker 2 (00:46:10):

So what's wonderful about act is that act is a behavior change model. It's really based in behavioral therapy. And there's also something nice about not having to struggle with someone to change their thoughts and beliefs all the time. It takes a little bit of pressure off the person who has pain and it takes a little bit of pressure off of the therapist,

Speaker 1 (00:46:30):

Right? Because sometimes when you try and change those thoughts and behaviors, and I don't know about you, but I've heard this when I first started you know, really studying more about pain science and, and understanding how, how pain affects people in so many different ways. And when I first would talk to people and I bet, you know what I'm going to say here? What, what would they say to you? So you're saying it's all in my head. That's right. Right.

Speaker 2 (00:47:00):

And the, you know, when that happens, people feel invalidated and it kind of takes us full circle to the beginning of our conversation is it focuses on their vulnerability. Oh, so you're saying there's something wrong with the way I'm thinking. And the truth is if someone thinks about their pain, a lot, that's 100% normal. Cause that's, that's a pain supposed to do. Pain is supposed to alert you to something that's potentially harmful or something that's dangerous. So just normalizing that everyone's mind my mind, Karen, your mind, someone who has pain, we all think all, most of our thoughts throughout the day, our thoughts about how do I avoid things that could potentially harm me, things that are potentially uncomfortable, helping people just observe that actually can be the step before even the reconceptualization of pain, because how can you, how can you expect someone? How can you help someone to target thoughts and beliefs about pain if they haven't even thought about, okay, what are my thoughts?

Speaker 2 (00:48:12):

What are my beliefs about pain? What am I thinking right now? The average person has somewhere between 6,000 and 12,000 thoughts per day. And the truth is most of them are negative because it's a survival instinct, right? We brought this through with survival instead. How can I observe these thoughts? How can I observe my emotions? How can I be getting to observe the physical sensations in my body, whether that be anxiety, whether that be physical pain and realize that I can have contact with that, but not let it impact my behavior. So that's really the biggest difference between an act or a mindful, acceptance based approach versus a more traditional cognitive behavioral approach.

Speaker 1 (00:48:57):

Yeah. Thank you for that. That is very helpful. Cause I'm sure you get that question quite a bit. So it's nice to be able to clear that up. So now let's shift gears slightly ever so slightly and talk about your new book, right? So your new book, radical relief, a guide to overcoming chronic pain. So let's talk about it. Why the title why'd you write it? Go ahead.

Speaker 2 (00:49:27):

Well, after my first book came out called heal your pain. Now in that book, I had a section called the brain and pain. And at that time, the author only gave me so much space to write about the mind, so to speak. So I had to, I had to include small sections about mindfulness and about act and in general about the mind and how the mind responds to pain. And it kind of forced me to take a very didactic approach to pain. And people would reach out to me all the time. I want to learn more about mindfulness for pain. I want to learn more about this thing. You mentioned act about pain. So both professionals and people were coming to me. So I couldn't put it in that book. And I really firmly believed that deserved its own resource because there are solid mental skills, training and exercises that are in this book, radical relief that wasn't in my, in my first book.

Speaker 2 (00:50:24):

Second is it's a little bit tongue cheek, so to speak, it's a radical idea to think that two physical therapists want to spend their Thursday evening talking about the mind and mental skills training with regard to pain. So as we said before, like there's a little bit of a cognitive dissonance in there, but we know that physical therapists have a very important part with regard to helping people cope both physically as well as psychologically and emotionally. You know, the third aspect is just in general to give people this notion that it's not a radical idea to use your mind, to use mental skills training, to use mindfulness, to overcome pain. And that can be a part of your treatment. And in fact, as you and I are sitting here counting, I can guarantee you there's someone right now, who's being treated for pain who are not being offered these types of skills and you know, you, and I think it's absurd actually, but this is still happening. So radical relief really is a short book. It's only about a hundred pages. It's a workbook that includes over 50 cognitive and mindfulness type exercises to help people overcome their chronic pain in essence. And it's also written for practitioners to use as a guide in the manual that they can use in clinical practice.

Speaker 1 (00:51:45):

Yeah. And the one thing that I liked about the book aside from, as we were talking before we went on air, it's very, very pretty all of the illustrations are quite beautiful. But I like the fact that within each chapter there's like exercises and you have to literally write things down, pen, take pen to paper, and you can do it right in the book. Or you can grab the extra sheet of paper or what have you. But I like the fact that you have to write things down because there is something to that, you know, there is something to writing to the physical act of writing something down on paper versus typing it out or just thinking about it. And so that's something that I really appreciated throughout the book.

Speaker 2 (00:52:30):

Yeah. And I learned that from my first book as my first book was a very education based approach. As we mentioned, pain education is important, but it, it doesn't do a great job of changing behavior when you get involved with act, act as a very experiential therapy. So you're not sitting across from someone like talking to them, you're actually engaging with them in a lot of different ways. So what I really found was, and people can, you know, note this down for themselves. The average person doesn't want to flip through 300 pages of a book to learn about pain. They want something that's relatively short. They want something that's clear. They want something that's useful that they can really pick up, you know, now and start to use. And I think it's the same with practitioners, right? There's only so much theory and philosophy we can think about before we say, okay, what do I do with my patient today? What am I do with patient? I have at nine o'clock tomorrow, who's been suffering with fibromyalgia for 10 years. So that's why I tried to approach this book very differently from, from the first book.

Speaker 1 (00:53:35):

Yeah. And, and before we went on air, you, you asked me if I had a post-it note to which I said, I have a large sheet of white paper and you said, no, it needs to be a post-it note. And I said, well, I have a mini post-it note, will that do the trick? So please, please tell me why I needed a post-it note and not a large white sheet of paper. And perhaps the listeners, if they have a post-it note, they can go and grab one as well.

Speaker 2 (00:54:05):

Yeah. So if everyone has a post-it note and a pen or a pencil, please hit pause and grab that and come back. But as you mentioned, Karen, it's a workbook. And you said putting pen to paper changes things, right? Because in some ways it's it's experiential. So I was, as, as I was mentioning before, we don't have a good way to change thoughts and beliefs. So with that, we have to help people relate or respond differently to thoughts and beliefs. Right? All of us have things in life, thoughts and beliefs about ourselves that are somewhat unpleasant and painful, right? Some of them are really, really horrible things about ourselves. And some are, some of them are things like, you know, not so horrible. So if you'll kind of engage in this with me, I'd like you to just reflect on yourself and your own life experience and think about one negative, thought about yourself, not the worst thought possible, but one thought that, you know, maybe on a scale of one to 10 with like one the least impactful and like 10, the worst, maybe you're somewhere like a four or five. And then I want you to write that down on the post-it note.

Speaker 3 (00:55:19):

Okay.

Speaker 2 (00:55:20):

So we can't change this thought, right? The thought is there and just rip it off a little post-it pads,

Speaker 3 (00:55:31):

Still writing. Okay.

Speaker 1 (00:55:42):

My pen's running out of ink, but I remember what it was. It's, it's half written. It's written. I just, my pen ran out of ink, but okay. We can, we can go on. It is written.

Speaker 2 (00:55:52):

I'm going to do this with you actually. So it's written there and what I want you to do is pull it off the, pull off the post-it pad. Okay. And I want you to hold it up. I don't know, maybe about a foot or so away from your knees. I want you to look at it. And in your, in your mind, I just want you to repeat the word nice and slowly, and really kind of get lost in that word just for a moment. And then as you get lost in that word, just notice if you feel anything different in your body.

Speaker 1 (00:56:37):

Yeah. Looking at the yes.

Speaker 2 (00:56:39):

Right? Okay. So you see how thoughts have an impact on how we feel now, what I want you to do is I want you to take your arm and stretch it out as far as you can go. And I want you to look at that word. And what I want you to do is I want you to flip it upside down. Now, just turn it 180 degrees and now look at it and now see if it has any less of an impact on how you feel.

Speaker 1 (00:57:07):

I mean, maybe a little,

Speaker 2 (00:57:09):

A little bit right now. What I want you to do is I want you to maybe prop it up on the computer screen in front of you, and I want you to push back. So maybe you're 10 feet or so.

Speaker 1 (00:57:22):

Okay. Go. As far as my mic, as my ear, phones will take me

Speaker 2 (00:57:28):

And then maybe just stand up as you're there and now look at the word and then notice if there's any difference in how you feel or how you relate to that word.

Speaker 1 (00:57:43):

Yeah. Maybe a little bit, now that I'm standing and people can't see me, but I think I automatically stood up in the power pose.

Speaker 2 (00:57:49):

I noticed I still noticed put your hands on your hips. Right. So would you say there's less of an impact as you move away from the words so to speak? Yeah. Great. Okay. Come back forward. So what I just did is what they call cognitive distancing. So it was a way to distance yourself, literally as well as figuratively. So now what I want you to do cameras, I want you to take that same post in them. I want you to fold it up into a little square And I want you to put it in your back pocket.

Speaker 1 (00:58:24):

Okay. I don't have one. So I'll pretend I do.

Speaker 2 (00:58:28):

Yeah. Just stick it up your sleeve there. Okay. So now you have this unpleasant unwanted thought about yourself. It's not going away cause it's in your back pocket or it's in your front pocket or wherever it is, wherever you placed it. And my question for you is would you be willing to be with that thought and to be with those uncomfortable sensations you feel on your body, if it meant you could be a more effective physical therapist or be a more loving daughter sure. Or a more supportive wife or a girlfriend, or a more effective member of your community or a leader of your profession.

Speaker 1 (00:59:14):

Yeah. I can do that. Right.

Speaker 2 (00:59:16):

So it just shows you that we can change how people relate to thoughts. We didn't change the actual thought. Still there. We can change how people relate to them, to it. And we can also show people how, okay, this thought can be present with us and I can still experience it and not feel good about it, but I can still go about my life. And what I do with patients is I have them take these thoughts. Like I have a big herniated disc at L five S one. Okay. Write that on a piece of paper, put it in your back pocket in your briefcase and carry it around with you today and notice how at times that thought wasn't even present and didn't talk to you at all. And other times maybe it was present a little bit, you thought about it, but it didn't stop you. And other times it was like a big barrier. Right. And within those three, they're really important teaching moments that we can help patients with.

Speaker 1 (01:00:09):

Yeah. Oh, that's great. Great, great. Is that in the book? So

Speaker 2 (01:00:14):

The book is full of

Speaker 1 (01:00:17):

Nice. Nice. Yeah, no, I think that's great. And, and for, you know, physical therapists or other healthcare professionals that might be listening, that my hope is that this podcast will plant a seed in them to say, you know, maybe, maybe I'm I need to do a little bit more, you know, and what can I do to do more

Speaker 2 (01:00:43):

The biggest ask the biggest, one of the great gifts that I have come across in teaching physical therapists about act is yes, it helps your patients, but physical therapists notice a change in themselves from it. Because look, we struggle with not being able to help people. We get burnt out because of it. Absolutely. We have our own personal challenges that cause us pain and suffering. So to speak that we struggle with outside of our clinical work, that this type of work becomes really important to you. And the truth is, as you know, Karen pain will show up in life. Yes, it will show up when you least expect it. And these are effective skills that I really believe all of us need to learn and adopt not only for our patients, but for us to be effective clinicians and effective professionals for us to embody them in ourselves, then we can help people with these types of aspects and these, this type of care.

Speaker 1 (01:01:44):

Yeah. I don't disagree with that. I think that's great. And you know, I was just going to ask you to sort of put a bow on this conversation, if you will, and what would you like people to take away from it? I think you gave a little bit of it just now, but is there anything you'd want to add on to that?

Speaker 2 (01:02:06):

What I want people to take away from a mindfulness and acceptance based approach to care is that there's hope in it. And that hope really resides in helping helping, giving you the skills that help someone reconnect with their life. And that resilience that we spoke about in the beginning, the hope is really what people are looking for because they feel helpless. They feel hopeless. And this work is really about, okay, maybe there's some things in your physical body we have to work on. Maybe there are some thoughts and feelings and emotions that are difficult for you. Let's yeah. Let's kind of work on those, but know that you're whole, as you are, as a human being and everything that's required to overcome this already exists in you, I'm just going, gonna help you contact that in a way that's more efficient that moves you along this path in a way that's faster. So the whole part is really important and that's really what people are coming to us for.

Speaker 1 (01:03:07):

Yeah. Yeah. That's great. And then last question or no, well, last question before we get to, how do we contact you and all that other fun stuff, but, and you know what this question is, I think I've already asked it to you like three times, however many times you've been on the podcast, but let's say knowing where you are now as a therapist and as a person and in your life and your career, what advice would you give to your younger self? Maybe not right out of college, but let's say 10 years ago, before you really started delving into working with information surrounding chronic pain,

Speaker 2 (01:03:48):

I would say, give yourself space to fail and just allow that stuff, exploration of exploring different things and realizing, Hey, I didn't do that so well, or I wasn't so great today and allow yourself, there's a lot of pressure on us as professionals to be this, you know, master healer, so to speak. And I really think it's damaging to us as professionals.

Speaker 1 (01:04:20):

And I think that can lead to burnout, all that pressure on you to be the person, the one person in someone else's life. That's going to take away all their pain or take or add this, or take away that boy, that's a lot of pressure.

Speaker 2 (01:04:37):

That's right. I, I actually, I asked therapists now, who are you to take away someone's pain. Cause really think about what that really means.

Speaker 1 (01:04:46):

Like the wizard of Oz,

Speaker 2 (01:04:48):

Right? Like, is there some like magic fairy dust that you have that the rest of us don't have? And again, it doesn't mean that we can't help people with their pain. I mean, we can alleviate some of that pain, but that's not what, that's not what we're there for. We're there to be a witness to someone on their journey to overcome whatever it is that they're struggling with. And the kind of take that into a mindfulness realm, allow yourself to be your own witness as you move through the profession and you navigate and negotiate. Okay. Here's what I'm really good at and why I want to kind of cultivate and things that I don't have to necessarily engage with that.

Speaker 1 (01:05:29):

Yeah. Well said now, where can people find you? Where can they find the book, social media websites? What do you got for us?

Speaker 2 (01:05:39):

Easy. People can go to my website. The website is integrative pain, science institute.com or one very long word, integrated pain science institute.com. The book is called radical relief, a guide to overcome chronic pain, which you can find on Amazon in most countries. If you go to either one of those two places, you'll find the book and all the information about me. I also want to plug another book Karen, in which you're involved in.

Speaker 1 (01:06:03):

Oh yeah, yeah, yeah. That's right. It's a couple of months out still. Yeah,

Speaker 2 (01:06:08):

I'm working. I'm the chief editor on a book that involves about 45 different physical therapists, some from academia, some from private practice and it's with regard to how physical therapists can use lifestyle interventions and practice that book will come out probably in the fall of 2021. And I want to plug it because it's an awesome book with, you know, as I mentioned,

Speaker 1 (01:06:32):

Amazed some amazing people involved,

Speaker 2 (01:06:34):

Amazing people. And Karen is one of those amazing people. Who's doing the chapter where she's offering the chapter on private practice, physical therapy and how to integrate lifestyle interventions into private practice PT. So yes. Check out my book, radical relief now, but look out for that book.

Speaker 1 (01:06:50):

Yeah. And you, and, and our lovely ginger garner. Yeah.

Speaker 2 (01:06:54):

Ginger Gara and I are the chief co-editors. Yeah. And then we're fortunate enough to have about 42 other amazing PTs from all over the globe actually.

Speaker 1 (01:07:03):

Yeah. Yeah. On different topics. Yeah. It's going to be cool. I'm looking, I can't wait to read everybody else's chapters. It's going to be awesome. And then social media, I think your social media is pretty easy. I think it's at Dr. Joe Tata across the board. Am I right?

Speaker 2 (01:07:19):

I've spent so much time just getting that. Yes. It's at Dr. Joe Tatta across the board. You can find me on Instagram, LinkedIn, Facebook, Twitter, all the main ones.

Speaker 1 (01:07:28):

Yeah. Awesome. Well, Joe, thank you again so much. It's always, always have a great conversation. When you come on the podcast and you make me think of a lot of things past and present, so thanks so much for coming on. I appreciate it. Thank you so much. And everyone else. Thanks for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

Dec 31, 2020

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

In this episode, we discuss:

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

Resources: 

Jenna Kantor Physical Therapy 

Newport Coast Physical Therapy

Renegade Movement and Performance 

Karen Litzy Physical Therapy

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

More about Julie, Jenna and Lex

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

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

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

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

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

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

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

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

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

Read the Full Transcript below:

Speaker 1 (00:01):

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

Speaker 2 (00:54):

I think it's been five years. Yeah,

Speaker 1 (00:56):

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

Speaker 2 (02:08):

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

Speaker 2 (02:59):

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

Speaker 2 (03:42):

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

Speaker 1 (04:54):

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

Speaker 2 (04:59):

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

Speaker 1 (05:04):

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

Speaker 2 (05:07):

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

Speaker 2 (06:00):

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

Speaker 2 (06:55):

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

Speaker 1 (07:31):

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

Speaker 2 (07:55):

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

Speaker 2 (08:52):

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

Speaker 2 (09:38):

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

Speaker 2 (10:29):

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

Speaker 2 (11:28):

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

Speaker 2 (12:04):

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

Speaker 1 (13:02):

Actually, that could be pretty helpful.

Speaker 2 (13:05):

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

Speaker 1 (14:20):

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

Speaker 2 (14:36):

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

Speaker 1 (14:41):

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

Speaker 3 (14:59):

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

Speaker 3 (16:03):

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

Speaker 1 (17:15):

I had my twins August

Speaker 3 (17:19):

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

Speaker 1 (18:11):

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

Speaker 3 (18:41):

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

Speaker 3 (19:35):

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

Speaker 1 (20:15):

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

Speaker 3 (20:30):

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

Speaker 1 (20:43):

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

Speaker 3 (21:08):

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

Speaker 1 (22:08):

And have you had pelvic health physical therapy?

Speaker 3 (22:11):

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

Speaker 1 (22:47):

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

Speaker 2 (23:34):

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

Speaker 1 (24:21):

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

Speaker 1 (25:25):

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

Speaker 1 (26:29):

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

Speaker 1 (27:23):

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

Speaker 1 (28:08):

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

Speaker 4 (29:18):

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

Speaker 1 (29:35):

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

Speaker 2 (29:57):

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

Speaker 1 (30:32):

Yeah. Human contact.

Speaker 4 (30:36):

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

Speaker 1 (30:45):

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

Speaker 2 (30:54):

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

Speaker 1 (31:06):

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

Speaker 2 (31:31):

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

Speaker 1 (31:33):

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

Speaker 4 (31:47):

Great segue right there.

Speaker 1 (31:50):

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

Speaker 4 (33:05):

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

Speaker 2 (34:00):

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

Speaker 4 (34:10):

Oh no,

Speaker 2 (34:11):

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

Speaker 1 (34:42):

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

Speaker 4 (36:28):

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

Speaker 1 (36:46):

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

Speaker 4 (37:23):

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

Speaker 1 (37:27):

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

Speaker 1 (38:10):

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

Dec 21, 2020

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

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

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

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

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

Key Takeaways

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

Suggested Keywords

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

To learn more, follow John at:

Website:          Run Kamp

Facebook:       @johnhonerkamp

Instagram:       @johnhonerkamp

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

Email:              john@runkamp.com

WaterPik Power Pulse Showerhead

WaterPik Water for Wellness Council

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Read the full transcript here: 

Speaker 1 (00:00):

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

Speaker 2 (00:05):

Thanks for having me. Yes.

Speaker 1 (00:06):

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

Speaker 2 (00:10):

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

Speaker 1 (00:20):

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

Speaker 2 (00:40):

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

Speaker 2 (01:24):

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

Speaker 2 (02:10):

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

Speaker 2 (02:51):

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

Speaker 1 (03:55):

About are most people.

Speaker 2 (03:58):

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

Speaker 2 (04:40):

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

Speaker 1 (05:12):

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

Speaker 2 (05:17):

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

Speaker 1 (05:24):

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

Speaker 2 (06:40):

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

Speaker 1 (07:30):

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

Speaker 2 (07:34):

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

Speaker 2 (08:22):

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

Speaker 2 (09:01):

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

Speaker 1 (09:54):

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

Speaker 2 (10:48):

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

Speaker 2 (11:23):

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

Speaker 1 (11:55):

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

Speaker 2 (12:28):

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

Speaker 2 (13:05):

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

Speaker 2 (13:43):

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

Speaker 2 (14:29):

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

Speaker 1 (15:09):

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

Speaker 2 (15:21):

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

Speaker 2 (16:04):

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

Speaker 1 (17:13):

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

Speaker 2 (17:32):

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

Speaker 2 (18:15):

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

Speaker 2 (18:55):

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

Speaker 2 (19:37):

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

Speaker 1 (20:07):

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

Speaker 2 (20:34):

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

Speaker 2 (21:24):

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

Speaker 2 (22:12):

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

Speaker 2 (23:06):

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

Speaker 2 (23:45):

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

Speaker 1 (24:13):

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

Speaker 2 (24:21):

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

Speaker 2 (25:09):

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

Speaker 1 (25:59):

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

Speaker 2 (26:34):

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

Speaker 2 (27:13):

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

Speaker 1 (27:45):

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

Speaker 2 (27:49):

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

Speaker 1 (28:52):

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

Speaker 2 (30:21):

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

Speaker 2 (31:07):

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

Speaker 1 (32:08):

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

Speaker 2 (32:30):

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

Speaker 2 (33:21):

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

Speaker 2 (33:58):

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

Speaker 2 (34:40):

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

Speaker 2 (35:19):

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

Speaker 1 (35:50):

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

Speaker 2 (36:02):

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

Speaker 1 (36:41):

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

Speaker 2 (36:57):

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

Speaker 1 (37:03):

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

 

Dec 14, 2020

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

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

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

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

Key Takeaways

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

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

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

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

Wheelchair Rugby: Nicknamed “Murderball”.

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

 

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

More About Dr. Griffin:

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

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

Suggested Keywords

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

To learn more, follow Dr. Griffin at:

 Website:          Rugby, Health and Wellbeing

Twitter:          @SteffanGriffin

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

Subscribe to Healthy, Wealthy & Smart:

 Website:                      https://podcast.healthywealthysmart.com

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

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

SoundCloud:                                    https://soundcloud.com/healthywealthysmart

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

Read the Transcript here:

Speaker 1 (00:00):

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

Speaker 2 (00:04):

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

Speaker 1 (00:11):

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

Speaker 2 (00:36):

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

Speaker 1 (00:49):

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

Speaker 2 (01:19):

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

Speaker 2 (02:12):

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

Speaker 1 (03:17):

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

Speaker 2 (03:23):

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

Speaker 2 (04:17):

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

Speaker 2 (05:27):

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

Speaker 2 (06:43):

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

Speaker 2 (07:58):

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

Speaker 1 (08:38):

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

Speaker 2 (09:08):

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

Speaker 2 (09:51):

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

Speaker 2 (10:43):

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

Speaker 1 (11:19):

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

Speaker 2 (11:29):

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

Speaker 2 (12:24):

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

Speaker 1 (13:39):

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

Speaker 2 (13:53):

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

Speaker 2 (15:12):

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

Speaker 1 (16:22):

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

Speaker 2 (17:38):

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

Speaker 2 (18:36):

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

Speaker 1 (19:13):

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

Speaker 2 (19:59):

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

Speaker 1 (20:25):

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

Speaker 2 (20:38):

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

Speaker 2 (21:32):

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

Speaker 1 (22:11):

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

Speaker 2 (22:27):

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

Speaker 1 (22:40):

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

Speaker 2 (22:49):

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

Speaker 1 (23:30):

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

Speaker 2 (23:45):

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

Speaker 1 (23:49):

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

Dec 7, 2020

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

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

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

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

 

Key Takeaways

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

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

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

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

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

Development – This is about owning your own professional development.

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

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

 

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

 

 More about Carson

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

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

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

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

Carson’s signature courses include:

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

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

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

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

 

Book Mention

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

Suggested Keywords

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

To learn more, follow Carson at:

 Website: https://carsontate.com

https://www.workingsimply.com

Facebook: @thecarsontate

Instagram:  @thecarsontate

Twitter:   @thecarsontate

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

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

 

Subscribe to Healthy, Wealthy & Smart:

Website: https://podcast.healthywealthysmart.com

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

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

SoundCloud:                                    https://soundcloud.com/healthywealthysmart

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

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

 

Read the Transcript Here:

Speaker 1 (00:00):

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

Speaker 2 (00:04):

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

Speaker 1 (00:06):

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

Speaker 2 (00:47):

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

Speaker 2 (01:46):

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

Speaker 2 (02:38):

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

Speaker 2 (03:37):

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

Speaker 1 (04:13):

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

Speaker 2 (04:22):

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

Speaker 1 (05:02):

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

Speaker 2 (05:09):

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

Speaker 1 (05:41):

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

Speaker 2 (05:46):

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

Speaker 1 (06:42):

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

Speaker 2 (06:54):

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

Speaker 1 (07:39):

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

Speaker 2 (08:49):

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

Speaker 1 (09:24):

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

Speaker 2 (09:30):

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

Speaker 1 (10:43):

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

Speaker 2 (10:57):

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

Speaker 1 (12:06):

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

Speaker 2 (12:33):

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

Speaker 1 (13:26):

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

Speaker 2 (14:05):

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

Speaker 1 (15:05):

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

Speaker 2 (15:08):

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

Speaker 1 (15:19):

Hm.

Speaker 2 (15:20):

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

Speaker 1 (16:40):

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

Speaker 2 (17:00):

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

Speaker 1 (18:08):

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

Speaker 2 (18:40):

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

Speaker 2 (19:40):

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

Speaker 1 (20:30):

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

Speaker 2 (20:35):

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

Speaker 1 (21:23):

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

Speaker 2 (21:44):

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

Speaker 1 (22:02):

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

Speaker 2 (22:06):

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

Speaker 1 (22:30):

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

Speaker 2 (22:44):

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

Speaker 1 (23:14):

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

Speaker 2 (23:24):

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

Speaker 1 (23:50):

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

Speaker 2 (23:53):

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

Speaker 1 (24:17):

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

Speaker 2 (24:39):

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

Speaker 1 (24:44):

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

Speaker 2 (24:57):

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

Speaker 1 (25:25):

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

Speaker 2 (25:33):

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

Speaker 1 (26:36):

Nice. Yeah. That's great.

Speaker 2 (26:39):

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

Speaker 2 (27:31):

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

Speaker 3 (28:54):

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

Speaker 2 (28:59):

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

Speaker 1 (29:47):

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

Speaker 2 (30:25):

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

Speaker 1 (30:55):

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

Speaker 2 (31:16):

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

Speaker 1 (31:52):

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

Speaker 2 (32:11):

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

Speaker 1 (32:32):

And then for social media,

Speaker 2 (32:35):

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

Speaker 1 (32:40):

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

Speaker 2 (32:47):

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

Speaker 1 (32:52):

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

 

Nov 30, 2020

Episode Summary

Are you willing to experience anything?

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

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

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

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

Key Takeaways

 

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

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

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

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

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

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

 

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

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

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

•       “This is an entrepreneur heaven right now.”

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

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

•       “Transparency breeds trust.”

•       “The secret to success is giving.”

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

•       “Don’t react; respond.”

Book Mention

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

Suggested Keywords

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

To learn more, follow Brian at:

Email: info@megbusiness.com

Website

Facebook

Instagram                        

Twitter    

LinkedIn

YouTube

More about Brian: 

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

Subscribe to Healthy, Wealthy & Smart:

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Read the transcript: 

Speaker 1 (00:01):

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

Speaker 2 (00:05):

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

Speaker 1 (00:10):

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

Speaker 2 (00:39):

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

Speaker 1 (01:19):

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

Speaker 2 (01:41):

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

Speaker 1 (02:37):

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

Speaker 2 (02:52):

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

Speaker 2 (03:33):

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

Speaker 2 (04:05):

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

Speaker 1 (05:00):

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

Speaker 2 (05:21):

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

Speaker 2 (06:02):

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

Speaker 2 (06:43):

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

Speaker 1 (07:19):

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

Speaker 2 (08:00):

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

Speaker 2 (08:38):

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

Speaker 2 (09:17):

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

Speaker 2 (10:06):

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

Speaker 2 (10:47):

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

Speaker 2 (11:28):

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

Speaker 1 (12:19):

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

Speaker 2 (12:43):

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

Speaker 2 (13:25):

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

Speaker 2 (13:58):

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

Speaker 2 (14:52):

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

Speaker 2 (15:34):

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

Speaker 2 (16:10):

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

Speaker 1 (16:47):

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

Speaker 2 (17:11):

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

Speaker 2 (18:06):

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

Speaker 2 (18:48):

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

Speaker 2 (19:24):

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

Speaker 2 (20:18):

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

Speaker 2 (21:00):

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

Speaker 1 (22:19):

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

Speaker 2 (22:40):

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

Speaker 2 (23:26):

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

Speaker 1 (24:15):

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

Speaker 2 (24:19):

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

Speaker 2 (25:00):

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

Speaker 1 (25:57):

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

Speaker 2 (26:13):

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

Speaker 2 (27:01):

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

Speaker 1 (27:24):

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

Speaker 2 (27:44):

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

Speaker 2 (28:37):

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

Speaker 1 (29:49):

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

Speaker 2 (30:07):

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

Speaker 1 (31:38):

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

Speaker 2 (32:00):

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

Speaker 1 (32:51):

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

Speaker 2 (33:30):

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

Speaker 1 (33:46):

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

 

 

Nov 23, 2020

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

In this episode, we discuss:

-Her path to advocacy

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

-State vs. Federal Advocacy 

-Traditional Advocacy vs Armchair Advocacy

-Key Contact: APTA & PPS

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

Resources:

Dr. Marko on Twitter

Dr. Marko on Instagram

Dr. Marko on Facebook

Dr. Marko on LinkedIn

Advocacy is not a Spectator Sport

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

More about Dr. Theresa Marko: 

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

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

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

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

Read the Full Transcript below:

Speaker 1 (00:07):

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

Speaker 2 (00:40):

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

Speaker 2 (01:44):

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

Speaker 2 (02:45):

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

Speaker 3 (03:49):

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

Speaker 3 (04:43):

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

Speaker 3 (05:28):

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

Speaker 3 (06:14):

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

Speaker 4 (07:28):

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

Speaker 3 (08:21):

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

Speaker 4 (09:33):

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

Speaker 3 (09:40):

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

Speaker 4 (10:40):

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

Speaker 3 (11:23):

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

Speaker 3 (12:20):

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

Speaker 3 (13:10):

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

Speaker 4 (14:18):

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

Speaker 3 (14:34):

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

Speaker 3 (15:18):

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

Speaker 2 (16:28):

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

Speaker 3 (17:16):

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

Speaker 4 (18:13):

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

Speaker 3 (18:37):

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

Speaker 3 (19:30):

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

Speaker 3 (20:15):

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

Speaker 3 (21:05):

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

Speaker 4 (22:19):

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

Speaker 3 (22:39):

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

Speaker 4 (23:06):

Have a

Speaker 3 (23:06):

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

Speaker 4 (24:19):

Are the, is the key contact program

Speaker 3 (24:22):

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

Speaker 4 (25:31):

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

Speaker 3 (26:25):

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

Speaker 4 (27:39):

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

Speaker 3 (27:53):

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

Speaker 4 (28:15):

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

Speaker 3 (28:32):

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

Speaker 4 (29:16):

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

Speaker 3 (29:24):

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

Speaker 4 (29:42):

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

Speaker 2 (30:19):

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

Speaker 1 (30:59):

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

 

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

Nov 16, 2020

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

In this episode, we discuss:

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

Resources: 

Maitri Physiotherapy, LLC

Dr. Gina on LinkedIn

Dr. Gina on Instagram

Dr. Gina on Facebook

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

More about Dr. Gina Kim:

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

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

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

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

Read the Full Transcript below:

Speaker 1 (00:01):

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

Speaker 2 (00:06):

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

Speaker 1 (00:08):

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

Speaker 2 (00:15):

Oh goodness. It's great to be.

Speaker 1 (00:20):

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

Speaker 2 (01:04):

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

Speaker 2 (02:38):

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

Speaker 2 (03:46):

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

Speaker 2 (04:57):

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

Speaker 3 (05:55):

Yeah. Yeah.

Speaker 1 (05:58):

So I,

Speaker 2 (05:59):

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

Speaker 1 (06:51):

And where is, so is Findlay college in Ohio

Speaker 2 (06:55):

And like colleges in North West.

Speaker 1 (06:59):

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

Speaker 2 (07:10):

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

Speaker 1 (08:38):

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

Speaker 2 (08:46):

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

Speaker 1 (09:38):

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

Speaker 2 (09:50):

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

Speaker 1 (11:26):

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

Speaker 2 (11:30):

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

Speaker 1 (11:34):

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

Speaker 1 (12:33):

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

Speaker 1 (13:32):

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

Speaker 4 (14:35):

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

Speaker 2 (15:23):

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

Speaker 2 (16:32):

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

Speaker 1 (18:20):

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

Speaker 2 (18:31):

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

Speaker 1 (19:33):

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

Speaker 2 (20:10):

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

Speaker 1 (20:57):

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

Speaker 2 (21:03):

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

Speaker 1 (21:20):

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

Speaker 2 (21:22):

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

Speaker 1 (21:25):

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

Speaker 2 (21:39):

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

Speaker 1 (22:38):

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

Speaker 2 (23:25):

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

Speaker 1 (24:07):

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

Speaker 2 (24:34):

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

Speaker 1 (24:54):

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

Speaker 2 (26:05):

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

Speaker 1 (26:23):

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

Speaker 2 (26:29):

Of already assumed that I was a PT

Speaker 1 (26:33):

Working there even as you were a physical therapist assistant.

Speaker 2 (26:41):

Yeah. As I said, I was a student

Speaker 1 (26:44):

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

Speaker 2 (27:01):

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

Speaker 1 (27:47):

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

Speaker 2 (28:10):

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

Speaker 1 (29:20):

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

Speaker 2 (29:45):

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

Speaker 1 (29:58):

True story. Yes.

Speaker 2 (30:00):

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

Speaker 1 (30:29):

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

Speaker 2 (30:36):

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

Speaker 1 (31:36):

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

Speaker 2 (32:06):

At medical underlying necessity.

Speaker 1 (32:09):

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

Speaker 2 (32:30):

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

Speaker 1 (32:39):

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

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