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May 2, 2022

In this episode, Aalborg University Professor, Prof Michael Rathleff, talks about his role at the upcoming WCSPT.

Today, Michael talks about how he organized the congress, creating tools for clinicians to educate their patients, and his research on overuse injuries in adolescents. What are the barriers between the research and implementation in practice?

Hear about the mobile health industry, exciting events at the congress, and get his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “The clinicians out there have a hard time both finding the evidence, appraising the evidence, and understanding [if it’s] good or bad science.”
  • “There’s a lot a clinician can do outside of a one-on-one interaction with a patient.”
  • “It’s our role to understand the needs of the individual patient, then make up something that really meets those needs.”
  • “It’s okay to say no. You have to make sure to say yes to the right things.”


More about Michael Rathleff

Prof Michael Rathleff coordinates the musculoskeletal research program at the Research Unit for General Practice in Aalborg.

The research programme is cross-disciplinary and includes researchers with a background in general practice, rheumatology, orthopaedic surgery, physiotherapy, sports science, health economics and human‐centered informatics.

He is the head of the research group OptiYouth at the Research Unit for General Practice. Their aim is to improve the health and function of adolescents through research.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injuries, WCSPT, Education,


IFSPT Fourth World Congress of Sports Physical Therapy


To learn more, follow Michael at:



Twitter:            @michaelrathleff


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




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Read the Full Transcript Here: 


Hello, Professor Ratliff, thank you so much for coming on the podcast today to talk a little bit more about your role at the fourth World Congress is sports, physical therapy in Denmark, August 26, to the 27th. So, as we were talking, before we went on the air, we were saying, man, you're wearing a bunch of hats during this Congress, one of which is part of the organizing committee. So my first question to you is, as a member of the Organising Committee, what were your goals? And what are you hoping to achieve with this Congress?



I think my role is primarily within the scientific committee. And one of the things we discussed very, very early on was this, like, you know, when you go for a conference, you go up to a conference, you hear a bunch of interesting talks, and you feel like, I'm motivated, I'm listening, I'm taking in new things. But then Monday morning, when you see the next patient, it's not always that all the interesting stuff that you saw, is actually applicable to my patient Monday morning. So we wanted to try and emphasize more. How can we use this conference as a way to translate science into practice? So the whole program and the like, the presentations will be more about clinical applicability, and less about more p values and research methodology. So not that the research is not sound, but there'll be more focused on how can we actually apply it in the context that were working. That's why also, we had the main title of translating research into practice, which I think will be hopefully a cornerstone that people will see, well, if there's really interesting talk about, it could be overuse injuries in kids, which will be a lecture that I'm having, then they'll also be a practical workshop afterwards to kind of use that what's been presented, and then really drill down on how we can use it in in clinical practice. So the goal is to, to get people to reflect in your network, but also take a lot of the things and think, Wow, this is something that I can use next Monday for clinical practice.



And aside from a lot of lectures and talks, you've also got in informatics competition. And so could you explain that a little bit and why you decided to bring that into the Congress?



Yeah, so this was a major, not a debate, but an interesting discussion on how we can even in the early phases of the conference, when people submit an abstract, make sure that the abstract can actually also reach more end users target audiences for that case. So we decided that people actually had to submit an infographic together with their the abstract. So normally, you send in like, 250 words, for a conference, but for this conference, we wanted them to submit the abstract, but also the visual infographic to go along with Olympic Well, am I making an infographic that is tailored to patient? Is that a patient aid that I'm trying to make? Is it something that's aimed but other researchers? Or is it clinicians, so they have to tick off? Which box Am I infographic actually intended for? So when the audience or the participants come and join the conference, they can actually take these infographics for those that want to print them they can use in the clinic afterwards, just another layer of trying to make some of this research more easily communicated to the audience, but also, the things that can be used in clinical practice, like some of the people have submitted abstract, have some really, really nice infographics that I expect will be printed and hang on, on a few clinic doors around the world afterwards, I hope.



And when it comes to dissemination of research and information from the clinician, to the patient, or even to the wider public, where do you think clinicians and researchers get stuck? Like where is the disconnect between that dissemination of information as we the information as we see, and by the time it gets to the consumer or to let's say, a mass media outlet? It's like, what happened?



Yeah, that's a big a big question. Because it's almost like why are we not better at implementing new research into our clinical practice? And I think there's heaps of different barriers. We've we've done a couple of studies, something new was also in the pipeline where we look specific, get the official context, and we can see that this barriers in terms of understanding the research, that's actually one of the major barriers that the clinicians out there have a really hard time both finding the evidence, appraising the evidence, and also actually understanding is this good or bad science. And then you have the whole time constraints on a clinical practice because who's going to pay you to sit and use two hours On reading this paper, and remember, this is just one paper on ACL injuries. But in my clinical practice, I see a gazillion different different things. So how am I going to keep up with the with the evidence? Is it intended that I'm reading original literature? Or how am I going to keep up with it? So I think there's a lot of different barriers. But at least one of the ways I think we can overcome some of these barriers is that researchers climb out of the ivory tower and think of other ways that we can communicate, research, evidence synthesis, it could be infographics, it could be sort of like decision age for clinical practice, at least that's one of the routes we're taking in terms of also the talk I'm giving at the conference that we're trying to think of, Can we somehow develop AIDS that will support clinical practice something that scene but the physiotherapist something that's aimed at the patient, that will sort of make it easier to deliver evidence based practice? So we've done one, one tool that's being developed at the moment is called the Makhni, which is something that can assist clinicians in the diagnosis, the communication of how do you communicate to kids about chronic knee pain? How do I make sure that they have the right expectation for what my management can be? And how can we engage in a shared decision making process. And we have a few other things in the pipeline as well, where we want to, to build something, build something practical that you can take in use in clinical practice to to support you in delivering good quality care, because just publishing papers is not going to change clinical practice, I think,



yeah, and publishing papers, which are sometimes wonderful papers. But if they're not getting out to the clinicians, they're certainly not going to get out to the patients and to people, sort of the mass population.



I completely agree. It's a bigger discussion, I'm really focused on how to reach clinicians, because I see the clinicians as the entry point to delivering care to patients and parents and, and the surrounding surrounding community. But if you think of, like wider public health interventions, we have the same problem as well. And also we create this sort of like, No, this inequality in healthcare, but that's another



line, although there can of worms. Yeah, we could do a whole series of podcasts on that. Yeah, yeah. And I agree with you that it needs to come from the clinician. So creating these tools to help clinicians better educate their patients, which in turn really becomes their community. Because there's a lot a clinician can do outside of just a one on one interaction with the patient. And so having the right tools can make a big difference.



Like in, if you look at a patient that comes to you for an ACL injury, or long standing musculoskeletal complaint, they're going to spend maybe 0.1% of their time together with you and 99.9%, they're out on their own. And I think it's important that we when we're one on one with them, sort of like make them develop the competencies so they can do the right decisions for their health in the 99.9% of the time that they're out there alone, when they're not with with us, I completely agree with you that there's a lot of things we can do to make them more competent in thriving despite of knee pain, or shoulder pain or whatever it might, it might be. And I think that's one of the most important tasks, I think, for us as clinicians is to think about the everyday lives they have to live when they leave us and say see you next time.



Yeah, and to be able to clearly communicate whatever their diagnosis by might be, or exercise program or, or any number of, of 10s of 1000s of bio psychosocial impacts that are happening with this person. Because oftentimes, and I know I've been guilty of this in the past, I'm sure other therapists would agree that they've this has happened to them as well as you explain everything to the patient, and then they come back and it's, they got nothing zero. And it might be because you're not disseminating the information to them in a way that's helpful for them or in a way that's conducive with their learning style. So having different tools, like you said, maybe it's an infographic that the patient can look at and be like, Oh, I get it now. So having a lot of variety makes a huge difference.



And I think you touched on a super important point there that patients are very different, that they have different learning styles, they have different needs. And I think it's our role to enlist Send the needs of the individual patient and make up something that really meets those needs. So more about listening, asking questions and less about thinking that we have the solution to it, because I think within musculoskeletal health or care, whatever we call it, some clinicians would use their words to communicate a message that might be good for some other patients would prefer to have a folder or leaflet. Others would say, I want a phone, I want an app on my phone, something that's like learning on demand, because at least that's something we see regularly. Now that we have the older population that wants a piece of paper, we have the younger population that wants to have something that they can sort of like, rely on when they're out there on their own one advice on how do I manage this challenging situation to get some good advice when you're not there? When I'm all on my own? So, so different?



Yeah, and I love those examples. I use apps quite frequently. And I had a patient just the other day say, Oh, my husband put this, the app that that you use, because I was giving her PDFs, and she's like, Oh, my husband put the app on my phone. Now it's so much easier. So now I know exactly what to do if I have five minutes in my day. So it just depends.



And I think the whole like mobile health industry, there's a lot of potential there. But I also see, at least from a Danish context, that there's a lot of apps that is very limited. It's not not developed on a sound evidence base, or it's just sort of like a container of videos with exercises. And I think there's a huge potential in like thinking of how can we do more with this? How can we make sure that it's not just the delivery vehicle for a new exercise, but it's actually the delivery vehicle for improving the competencies for self management for individuals? I think there's, yeah, I'm looking forward to the next few years to see how this whole field develops. Because I think there's really big potential in this.



Yeah, not like you're not doing enough already. But you know, maybe you've just got your next project now. Like, you're not busy enough already. So as we, as you alluded to a few minutes ago, you've got a couple of different talks you're chairing, so you've got a lot going on at the World Congress. So do you want to break down, give maybe a little sneak peek, you don't have to give it all away, we want people to go to the conference to listen to your talks. But if you want to break down, maybe take a one or two of your topics that you'll be speaking on, and I give us a sneak peek.



I think the talk that will be most interesting for me to deliver and hopefully also to listen to is is the talk that I'm giving on overuse injuries in adolescence, because I think it's we haven't had a lot of like conferences in the past couple of years. So it will be one of these talks will be meaty in terms of of new date, and some of the things I'm most interested go out and present is all the qualitative research we've done on understanding adolescents and their parents, in terms of what are the challenges they experience? How can we help them and also, we've done a lot of qualitative works on what are the challenges that face us experience when dealing with kids with long standing pain complaints, we've developed some new tools that can sort of like, help this process to improve care for these young people. And I really look forward trying to Yeah, to hear what people think of, of our ideas and, and the practical tools that we've that we've developed. So that's at least one of the talks, that's going to be quite interesting, hopefully, also, we're going to actually have the data from our 10 year follow up of so I have a cohort that I started during my PhD. They were like 504 kids with with knee pain. And now I follow them prospectively for 10 years. And this time period, I've gotten a bit more gray hair and gray beard. But this wealth of data that comes from following more than 500 kids for 10 years with chronic knee pain is going to be really, really interesting. And we're going to be finished with that. So I'm also giving a sneak peek on unpublished data on the long term prognosis of adolescent knee pain and at the conference. So that's going to be the world premiere for for that big data set as well.



Amazing. And as you're talking about going through some of the qualitative research that you've done, and you had mentioned, there were some challenges from the physio side and from the child side in the patient and the child's parents side. Can you give us maybe one challenge that kind of stuck out to you that was like, boy, this is really a challenge that is maybe one of the biggest impediments in working with this population.



I think I think there's multiple one thing that I'm really interested in these in this moment is the whole level of like diagnostic uncertainty and kids, because one of the things we've understood is that if the kids and the parents don't really understand why they have knee pain, what's the name of the knee pain, it becomes this cause of them seeking care around the healthcare system on who can actually help me who can explain my pain. So so at the moment, we're trying to do a lot of things on how we can reduce this, what would you call diagnostic uncertainty and provide credible explanations to the kids and then trying to develop credible explanation for both kids and parents? That's actually not an easy task, because what is a credible explanation of what Patellofemoral Pain is when we don't have a good understanding of the underlying pathophysiology? So there, we're doing a lot of work on combining both clinical expertise, what the patient needs, what we know from the literature, and then we're trying to solve, iterate and test these credible explanations with the kids. And yeah, at the conference, we'll have the first draft of these, what we call credible explanation. So that's going to be at least one barrier one challenge, I hope that some of the practical tools we've developed can actually help



i for 1am, looking forward to that, because there is it is so challenging when you're working with children, adolescents, and their parents who are sort of call it doctor shopping, you know, where you're, like you said, you're going around to multiple different practitioners, just with their fingers crossed, hoping that someone can explain why their child is in pain or not performing are not able to, you know, be a part of their peer group or, or or engage in what normal kids would would generally do. Exactly. Yeah. Oh, I'm definitely looking forward to that. So what give us one other sneak peek? Because I know you've got the, you're also chairing a talk on the first day. But what else I shouldn't say I don't want to put words in your mouth. What else? Are you looking forward to even maybe if it's not your talk, are you looking forward to maybe some other presentations,



I'm actually looking forward to to the competitions we have as well, because I've had a sneak peek of some of the research that's been submitted as abstracts, and the quality is super high. So both the oral presentations but also the presentation that the best infographics because they'll also get time to actually rip on the big screen and present their infographic. And I look forward to see how people can communicate the messages from these amazing infographics. And I think these two competitions are going to be to be a blast and going to be really, really fun to, to look at. And amazing research as well. So I really look forward to the two events as well. And then of course, oh no, go ahead. No, I was just talking about look forward to meeting with friends and new friends and be out talking to people once again in beautiful new ball in Denmark in the middle of summer. It's hard to be Denmark in the summer. We don't have a lot of good weather, but Denmark in August is just brilliant.



Yes, I've only been there in February. So I am definitely looking forward to to Denmark and August as well. Because I've only been there for sports Congress when it's a little chilly and a little damp. So summer sounds just perfect. And I've one more question. Just kind of piggybacking off of your comments on the amazing research within these competitions. And since you know you have been in the research field, let's say for a decade plus right getting your PhD a decade ago. How have you seen physio research change and morph over the past decade? Have you seen just it better research coming from specifically from the physio world?



I think it's the first time someone said it's actually more than a decade. So, but that gives me a time perspective. But yeah, I've actually seen that. My perception is that physiotherapy research in general but also sports physiotherapy research went from being published in smaller journals we published in our own journals to now there's multiple example of sport fishers performing really, really nice trials that have reached the best medical journals that have informed clinical practice. So I think we see this both there's more good research Basically out there. And I also see that we've moved from, like a biomechanical paradigm to being more user a patient center, we see more qualitative research, we see that physiotherapist, sport physiotherapist, they sort of have a larger breadth of different research designs, they used to tackle the research. I think, like looking even at the ACL injuries, if you go back 10 years in time, looking at the very biomechanically oriented research that was primarily also joined by orthopedic surgeons to a large extent. Now, today where fishers have done amazing research, they understand all the the fear of reentry, they're trying to do very broad rehabilitation programs, ensuring that people don't return to sport too rapidly. And and also understanding why they shouldn't return back to his board now developing tools that you can use when you sit with a patient to try and and educate them on what are the phases, we need to go through the next nine to 12 months before you can return to sport and so on. So I think I'm just impressed by, by the research. And when I see the even the younger people in my group now, they start at a completely different level when they start their PhD compared to what we did. So I can only imagine that the quality is going to improve over the years as well, because they're much more talented, they're still hard working. And they have a larger evidence base to sort of like stand on. And they already from the beginning, see the benefit of these interdisciplinary collaborations with the whole medical field and who else is is relevant to include in these collaborations? So yeah, the future is bright. I see. Yeah,



I would agree with that. And now as we kind of start to wrap things up here, where can people find you? So websites, social media, tell the people where you're at.



So I think if you just type in my name on Google, there'll be a university profile at the very top where you can see all my contact information. Otherwise, just feel free to reach out on LinkedIn or Twitter, search for my name. And you'll find me, I try to be quite rapid and respond to the direct messages when, when possible, at least



perfect. And we'll have all the links to that in the show notes at podcast at healthy, wealthy So you can just go there, click on it'll take you right to all of your links. So is there anything that you want to kind of leave the listeners with when it comes to the world congresses, sports physiotherapy or physical therapy, sorry.



Be careful not to miss it, it's going to be one of these conferences with a magical blend of practical application of signs, it's going to be a terrific program in terms of possibilities to to network and engage in physical activity, whatever it's running, or mountain biking, and with an amazing conference dinner as well. So I think it's, so this would come to be one of one of the highlights for me this year. So and I think the whole atmosphere around this conference is also that if you come there, as a clinician, you don't know anybody, that people will be open and welcoming and happy to engage in conversation. There's no speakers, that wouldn't be super happy to grab a beer or walk to discuss some of the ideas that's been presented at the conference. So I think it's going to be quite, quite good.



Yeah. So come with an open mind come with a lot of questions and come with your workout clothes. Is is what I'm hearing?



Yes, definitely. Definitely.



And final question, and it's one that I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self, and you can pick whatever time period your younger self is.



So I think in if I had to give myself one advice when I was in my sort of like, MIT Ph. D, time coming towards the end, I would say to myself, that it's okay to say no, you have to make sure to say yes to the right things because it's very easy to say yes to everything. And then you create these peak stress periods for yourself that would prohibit you from from doing things that is value being with friends or family and so on. You don't have to say yes to everything because there will be multiple opportunities afterwards. So practice in saying no and do it in a in a polite way. People actually have a lot of respect for people that say, No, I don't have a time or I'm I'm going to invest my time on this because this is what I really think is going to change the field. And this is my vision. So So young Michael, please please practice in saying no.



I love that advice. Thank you so much. So Michael, thank you so much for coming on the podcast. And again, just a reminder, I know we've said this before, but the World Congress is sports, physical therapy, we'll be in Denmark, August 26 and 27th of this year 2022. So thank you so much for coming on the podcast and thank you for all of your hard work and getting making this conference the best it can be.



Thank you, Karen, thank you for the invitation to the podcast.



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

Apr 25, 2022

In this episode, Owner of Access Physical Therapy, Clarence Holmes, Jr, talks about generational differences in physical therapy.

Today, Clarence talks about burnout, the idea of value, and the different ideas of pay structure. Why is the measurement of productivity problematic?

Hear about the promise of mentorship for lower pay, the problem of toxic positivity, and finding the better way in each new generation, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “The reason why things are fluid and changing with every generation is because there’s always a better way.”
  • “We have to be open to that better way.”
  • “No one loves PTs as much as PTs love PTs.”
  • “It is so heathy to have a full well-rounded conversation that points out the bad and the good, and you don’t have to finish with a positive statement in a conversation.”
  • “Get comfortable with being uncomfortable.”
  • “It’s become an expectation in this country to overwork.”


More about Clarence Holmes, Jr

Dr Clarence Holmes, Jr is a native of Cleveland MS. He attended Mississippi State University for his undergraduate studies and received his Doctor of Physical Therapy degree from the University of Mississippi Medical Center in 2014. Dr Holmes then completed an orthopedic residency with Mercer university in Atlanta GA in 2015. He has worked in various settings to include sports/outpatient orthopedics, acute care, and the state jail system. Now, he owns and operates Access Physical Therapy, a concierge cash based physical therapy practice in the Atlanta metropolitan area. He also works as a staff physical therapist with Kindred At Home.

Dr Holmes has been involved with APTA at various levels to include 2 terms on the Student Assembly Board of Directors, delegate for the state of Georgia to the House of Delegates, and currently serves as a board member for the Georgia Foundation for Physical Therapy.

In his free time, he also owns and operates The Travel Doctor, a full service travel agency as well as tackling small woodworking projects. He also scuba dives and enjoys traveling the world with his beautiful wife, Turquoise and their golden retriever and chihuahua/terrier mix puppies.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Burnout, Generational Differences, Productivity, Mentorship, Improvement,


To learn more, follow Clarence at:


Twitter:            @matterundrmined

Instagram:       @caholmes6

Facebook:       @clarenceh3


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 

Hello, this is Jenna Cantor with healthy, wealthy and smart. I'm really excited. I am interviewing Dr. Clarence a Holmes Jr. Just wrote on Zoom, or we're doing the interview. And Dr. Clarence who said, just call me clearance. I'm like, Okay, hi, Clarence, said that he works with home health and is the owner of a concierge cash based practice, which everybody who listens knows I'm cash based. I'm like, Yeah, hello, Conrad. I love that so much. Let's serve our people, our patients. We are coming on because we met at a conference. And there was a discussion on generational differences in physical therapy. And Clarence had some real interesting thoughts on this. And I was like, this is a podcast in the making. So I approached him right away. And I said, Can we do this topic and a podcast? And fortunately enough, he said, Yes. Like a proposal. It was beautiful. So here we are talking about generational differences in physical therapy. I think this is a really, really important topic. Now. I just let's just start diving in to one we're saying general racial differences, everyone, please don't refrain from getting offended with how we, how we try to describe this, because this is one we're differentiating between ages. And I saw I saw individuals struggling with that trying to be appropriate. So if we do say anything in our descriptions, inappropriate, feel free, please absolutely correct us. But be nice, because we're doing the best we can. But this is a very important conversation. So we'd rather take the risk in in really diving into the topic. So yeah, just let's all be nice. Okay. So regarding generational differences, I'm assuming that we're talking about the more seasoned crowd, people who have been around for a long period of time, compared to newer people in the physical therapy. Oh, right. Correct. Am I missing anything? Or is there any other way we need to define it?



No, I mean, and honestly, you're talking about me when you said if you recognize people being uncomfortable, trying to differentiate between these these generations, in conversation without trying to fin that was me at our conference. I didn't want to say the boomer generation, I didn't want to say the millennials simply because a lot of people tie a lot of negative connotations to those. And we're



also missing Gen X, because Gen X is actually the y'all are the youngest practitioners right now. Not millennials. Yeah.



Yeah. And I think there's a lot of similar Z



is Z. Oh, my God, ie, Z. Oh, my gosh, I missed the letter in the alphabet. Yeah. It might



be x. I don't don't hold me to it. But But, but yeah, so that was one. But But no, you captured it perfectly. I do think there is a a riff between the older generation and the younger generation to just put it put it lightly. Yeah. Just simply because and I mentioned it in the conferences that the older generation are the ones who are owning these practices, traditional practices. And the younger generation, our generation are the ones who tend to be more of the employees. And that's natural. But what's what's unnatural? Well, this is also natural to have some generational difference was unnatural is the riff, the, the battle that kind of comes along with it, and how we respond to it. So



yeah, so let's, yeah, I love that. Let's do what we're aware. I was very interested. Let's go back and and just do one general generational difference at a time and then if we okay, I feel like that's what pops in our head for now. And that's it. That's great. So one, just named one at the top of your head one Gen. Gen. Oh, my gosh, why is this? So? General? generational difference, let's start with one.



So I mean, there's two big ones that stick out to me. One is just this idea of pay structure. And specifically in the PT realm of, of how long has someone been here? versus what is this person doing for my company? And the best example I can give is me personally, of working in a job my first job post residency. I'm an ortho I'm a lover, or I will consider myself an ortho PT, even though I work in the home health arena, and the concierge cash base, I will consider myself an orthopedic physical therapist. My first job post residency was at a private practice in Atlanta, and I was paid the least amount of all the therapists across the entire company, which was four practices in Atlanta. But I was the second highest producing therapists in the company. And so, you know, generational differences comes down to the old way of doing things was, who has the most experience, they get paid the most? My personal opinion is, that's not logical, we're, I'm a logical being and a lot of my generation are, if it doesn't make sense to us, we're going to be vocal about it. And it didn't make sense to me that I was producing one paper, more money, better outcomes than the majority of the therapists and I was paid the least, that's one major win. And it kind of feeds into the second you asked for one, but this kind of feeds into it. Younger generations, older generations value loyalty. You know, they expect somebody to come in and work for them for 10 to 1520, almost 30 their entire careers. And my generation just, we're not happy, we're going to move on. And so that puts a lot of responsibility on the employer to find out what makes us happy. And sometimes that just doesn't, that doesn't translate well.



Yeah, I see where these connect, let's focus on the first one, because that is a really good, interesting point, I have definitely mentored some dance PTS who are burnt out, and they are in a situation where, Oh, Gosh, darn it, what is it productivity, productivity is measured. And that has been very problematic for them, because they'll come in, and they see that they are, they know, they're getting paid less. But they're not more because in your case, you actually saw the data, but they're seeing the, they are seeing the exact number of patients as a seasoned professional, there, and they're just they don't understand why they're getting paid less, if they're seeing the same amount, then they were there, they would imagine, I would be seeing less patients, then that would make more sense, you know, but no, that's not the case. And therefore, that income would still be it is assumed that income would still be made. So it's almost like they're being profit, they're more of a profit is being made off of them. They're exhausted, you know, but they're not getting a lighter load to feed that exhaustion, that adjustment, they're getting treated just the same. And so they don't understand that pay difference when they come in. And I'm going to bounce off this a little bit more because of what the reasoning so it's going to get a slightly off topic, but I'm always okay with that is the promise of mentorship as a reason for why they are paying less that can be a reasoning behind it, which still, there are some clinics that actually provide mentorship, but the majority of them do not actually provide that mentorship, so it's more verbage. Or they have some sort of automated system, that's there maybe videos or something. So there, it's not really an extra effort. It's something that's already there that can help streamline what's going on. Especially if you're in a place that measures the productivity. You can promise it as a as a somebody owns a clinic, however, who's the physical therapist, and how much time do they actually have to really mentor? So if there really, it doesn't make sense, right? This reasoning of oh, why, you know, and these are generational, different thoughts, but for I think that's what you're hitting is that the younger generation will speak their minds and say, hey, you know, they're not getting that mentorship, they're not getting that value for them to go. Oh, that's why then because they get oh, you know what, I'm getting great mentorship, kind of like where people think residencies, getting great mentorship that get one in paying less I get it. I totally get it. That's not the case. No, no, in a lot of circumstances.



Seven years, I think I've been out seven and a half years for a PT school. And I've never been in an environment outside of residency that that had any type of formal mentorship. But you're correct in that I've have had several interviews with several companies that have promised mentorship because that was important to me. I kind of did less the reason I worked at the job that I did that I'm mentioning in this in this interview. This conversation. The reason I took that job, and I knew I was getting paid less than I was worth. Um, the reason I took it was because my clinical manager and the only person who was more productive than I was a personal mentor, who was my was one of my direct mentors in residency. And so I saw it as an opportunity to continue getting mentored. And so I'm getting an exchange of additional mentorship. I will take less pay.



Okay, yes. And your, your through your apps, you're like, Oh, yes, yes.



Correct. But there was no formal mentorship. Now, I did continue work with this guy. I did learn a lot from him. But there was no formal.



That's a big, that's a big deal. It's not exactly,



exactly. And there's no when is the end point? I mean, when is the point where I say, Okay, I've received enough mentorship now I'm ready to get paid. Okay. Right. There has to be some kind of trade off there. So. But you're absolutely correct that that is there is a common promise of these employers to employees, younger, generational PTS, of mentorship, in exchange for, you know, lower, less than ideal pay, but is delivered upon.



Right, right. And I think that's the thing, because there's different ways to work around depending on the clinic, and everything that can happen in these rooms for negotiation. So when these different mindsets come into the room, for it to work out, but you got to follow through on both sides. One is providing the mentorship and the other side is accepting, that's what you accepted, and knowing that owning that. So, but it can be I mean, you know, what I was about to go into different things you can negotiate, but this is not a lesson on negotiation. So I'm going to skip over that. So yeah, when you when you are going into a clinic, I feel like that is a way to potentially solve the problem, but it's just not being solved right now. It's it's still, these gentlemen are the we have people who own these businesses who are getting annoyed about the the younger generation talking about money, but then they're not looking at, they're not really listening and taking in what is being said, because it's it's a block that we can get our own bias on how we lived our lives. And, and we need to get out of ourselves. I say that, as a practice owner, myself, we have to always work to get out of ourselves all the time, in order to better listen, to be with the changes of the world. And the reason why there are changes, but the reason why things are fluid, and it's always changing with every generation and so on, is because there's always a better way. Right? And we may not answer to it. But But there's always a better way. And and you got to figure out, you know, what's what's going to if you really care so much about keeping them around for a long time. And that's, that's a big deal for you. And absolutely, totally get that it's great to have somebody there for a long time, then what is it that they care about? What is it that they care about? You know, and how do you and then if you want to do something that is not financial? Because your your clinic can only afford so much? What are those intangibles that you can bring to the table? Or even the physical therapist coming into work for them? What are those intangibles, and that's where you can really come to the table for a better exchange with those generational differences. I think, you know, and,



you know, and one of the things that you kind of touched on is that we have to be, there's always a better way, and we have to be open to that better way. And I think that's where we run into an issue of when a younger generational PT says, well, this doesn't make sense to me, I want this amount of money. That's not us complaining. And I think that can be perceived as, as as, as a complaint, US whining, because we were known as the whiny generation. We you know, we complain a lot and what compared to what we're told is that we complain a lot, we're whining, we're never satisfied. And it's not that we're whining. It's not that we're sad. It's just that we grew up in the information age, we know what the PT next was making. Well, we know what the average PT makes. And so we come to the table and ask for this. It's not as whining and it shouldn't be perceived that way and we shouldn't be promoted as the whining generation is annoying. Having the information available to us and trying to benefit on or not even benefit just just be pay. We're given what we're worth. You know, we're rainbows and clouds profession. I mean, we we are a just a happy, just beautiful people and we just love people love everybody. And we're so happy go lucky and lovey dovey and I love that about us. But one thing that we do tend to forget is that the word can mean that we are healthcare practitioners first, but this is also a business. We have to be sustainable, to be able to provide the jobs for our employees, we have to be fulfilled in our careers to be able to provide the care the level of care that our patients deserve. And some of the ways that we do that is to ensure that our employees are happy. Somebody brought up at the conference, the idea of valuing your employees. And value in itself. I think, for us as this lovey dovey profession means so many different things, but value in itself as a word is a financial word. What is the value of me as a a physical therapist? I know my financial value, if you cannot meet that, as you've already touched on, if you can't meet what I'm asking for what else can you meet me, meet me halfway meet me with increase vacation days, maybe with an increase a formal mentorship program. We're supposed to meet and you're supposed to meet me where I am as an employee. And so I think that's where there's a big barrier as well. And that sometimes we're a little bit too focused on intangible things where a lot of or several of us are looking for tangible benefits in my generation. So I think that's a big riff. And it's a it's got to do with our identity crisis in our profession that I said this at the conference. Nobody loves pts. As much as PTS love BTS. And that's our issue as as a profession that we have to address. And I think that kind of that kind of flows over into this this generational difference. Oh, my God, it does. It does. Absolutely. Absolutely. And so that's, you know, I don't want to get too deep here, but I want I actually



want to bounce off you because, yes, because they popped in my head earlier. And I was like, I just let the idea, you know, because I just want to listen to you. But yes, it's the Pete, the best thing to T PTS, you know, and there's nothing wrong with us, the more seasoned professional that I mean, yes, ever. When I say this, I know they're seasoned. Like, I know, they're sick, we're not perfect. But the C's, they they live on this rainbows and clouds. I'm just saying, I know, it's a harsh way to say it. I hear I hear what I'm saying. But whatever I'm gonna say it. And then we have where the younger generation, I think it's Gen Z, because Gen X is before. So okay, so we have the Gen Z, and the millennials are newer in the profession. And they're not afraid to point out things that they think are wrong. But I think then with that in mind, I think from higher up there is toxic positivity. And I think that's where that comes in. Where it's pushed upon, you cannot say anything bad. But then we lose this honesty and transparency in what's going on in the communication. And, and God forbid, something bad is said, you know, boy, and guess who's on social media, everyone? So if you're talking about, you know, like, oh, there's younger people are complaining. Facebook is older people, man, Twitter is older people. Like there's some younger on there too. Yeah. But like the hotspots to be at are tick tock and mostly ticked in my opinion. Tick tock. Yes. And then I think I never looked at the data. So yeah, but I think Instagram is secondary, but that also has to do with like, how I like to watch the videos personally, I can I can scroll through the Tick Tock thing and then I can go to Instagram Instagrams a little bit not as smooth I go back to tick tock okay. So um, but but that's you know, that's where it's so far talking about all the younger they all they do is complain that's, that's all ages baby. That's all ages, we all we we all like don't I think it is so healthy, to have a full well rounded conversation that points out the bad and the good and you don't have to finish with a positive statement in a conversation about it's okay to end in a gray area. It's okay to end in a dark area and both see it you know, yeah, that is I don't have a solution. Like that's actually that's not a good thing. It's okay. But we but this toxic positivity puts anybody going through anything on the spot if you're anybody who might be oh gosh, dealing with somebody who is has poor health in your family and you can't talk about it or mention it at all and you're yet to put on this face. I get it. That's you know, I'm putting in air quotes professionalism, but professional professional only means literally other profession. Everything else is defined by you. Or defined by me. So literally, that's all perfect. Like everything else is like up in the air up for grabs. however you interpret it. So the you know, took like, place these these random rules on what professionalism, professionalism is from that point on is is purely subjective. And that's where that toxic positivity comes in. Yeah. And then in then we get these risks these butting heads, because everybody has different core values, which is great. And I think that is a huge generational difference and where we lose and miss out on opportunities to listen and hear more.



Correct, correct. And that's where the issue becomes. I spoke on generational differences, as in the context of what is leading to burnout in early career professionals are the career pts. And I spoke on generational differences as one of the things that I thought was a key key difference. And one thing to note to note is that this isn't specific to pt. It's not burnout is not specific to PT, these generational differences is not are not just specific to physical therapy. This is a doula globally, this is definitely an issue in our country. There are, you know, I'm gonna make this a political conversation. But you know, there are, you know,



whatever all's fair game when you're with me,



you see, there's a group of people that believe that, you know, there's no, this is the greatest country on Earth. And that this is there, they would, they would know, they would not live anywhere else. And to say anything bad about our country is anti American. And then there's another generation that says, this is a good country to live in. This is, hey, I'm happy to live here. But there's a crap ton of issues that we need to address to make this country as great as it could be. And so that is, I say all that to say that there is no, I don't think we solve this issue. I don't know if there is a solid solution to the issue. But as I stated before, I do believe there are pptx, specific generational difference issues that we can address. And we should address. And as long as everybody is willing to hear each other out. Yeah, compromise, which is kind of where my conversation was with with the gentleman at the conference that we spoke about earlier. I had an opinion, but I heard him out. And I still don't agree with him. 100%. But I can identify a little bit more with where he's coming from. And I think that's key, I think it's important to have these conversations get uncomfortable with being, you know, get comfortable with being uncomfortable. And have these uncomfortable conversations to say, yes, these are the issues we have with your generation. These are the issues y'all have with mine. Where is that common ground? You know, is they always is, like you said better than we are? And so So, you know, I don't know, I don't know, I'm not the visionary, I see that you I can't give you the solution. I



don't know where I know, it's just to have a conversation. So that's all we're just having a conversation about this, which I think is great. You know, to get your minds and everyone's minds to start to think you know, are there you know, generational differences and everything. And be careful as you listen, it can be very hard because we there are a lot of people we're going to people help, we're a service business. And with that we get these people pleasing mindsets, where we can lose ourselves. And I would actually say definitely big time in the younger, newer generation. And in order to please the generation that has been around longer, we don't listen to ourselves and just agree it's okay to disagree. It doesn't mean you have to disagree. But really keep challenging yourself to get more and more in tune with what you believe in. And greater conversations can happen, greater solutions, greater growth and progress between all of us can happen, which is so cool. And it may not happen overnight, where you feel comfortable to talk about it. But keep I definitely agree with what you're saying. It's just if you can just keep even if it's a little bit challenge yourself a little bit more every time to just, you know, get there, you know, not easy, not easy. No. I love it. Any any other generational differences that you think oh, Jenna this or have we reached kind of your like, those are kind of the main ones where we



Yeah, no, I I do think those are my, you know, very inter intertwine those two that I talked about. I don't think that as as a this is sort of like a final word if you Yes, yes. I do think that specifically to this country, we value overwork For example, I, you know, I think that we value the the clinician or the co worker, not just in PT, but in general, we value the person who does the things that they're not required to do as a part of their job. That's what we use to determine who is who's that shining employee, who's the one that that goes above and beyond. Right. And it shouldn't be that I mean, for example, I remember, at this same job, we hit a low point, we hit a low point, always in January, it's an outpatient clinic, deductibles reset, so we're January, it was a low period, had a lot of openings on my schedule, so that everyone else and I was sitting in and getting caught up on documentation, going over some things with my mentor, learning new skills, in walks the owner, are asked, What are we doing? I tell him, you know, I'm trying to learn some things. And he says, Well, why don't we are marketing? I say, What do you mean? He said, you know, your patients, your schedule is low, why aren't you are out, you know, getting us new clients. And I'm like, that's not my job. Is that is you are the employer, you hired me to see the patients that frequent your establishment. Okay, I'm not the one to go out and beg these physicians to send us, okay, how much begging you do, the deductibles reset, that's going to be a phenomenon that happens every single year. So, but that's what the expectation from some employers have. Yes, I hired you to see patients and turning the documentation on time. But in also, I expect you to do these things, these these things that I didn't tell you about in your interview, but we expect you to do these things is become an expectation in this country, to overwork to do things that are not required to view and that is how we measure our employees and not on the job that they do. If you see all the patients on your schedule, go home on time, get your documentation in on time, and it's all you did for the rest of your life as a PT you'd never be promoted and you know in traditional practices so I say that's that's another generational thing is that I think we older generations value overwork working you all you need to be busy all the time. And we value we being the younger generations, a healthy balance of work and home life. I think that is another riff all of these are intertwined, but I think that's a another riff that's that's that's causing an issue, not just in our not just in our profession, but but across this whole country.



Now, yeah, definitely. I love it. Thank you so much for coming on to talk about this. If you are listening to this podcast, and you have some other ideas and stuff, feel free to write in the comments, just keep the conversation going. I think it's always good to just talk about it. And then And then if you're somebody who's about to go in for job interviews, write these things down for you to consider what you're going to bring to the table for your negotiations track on both sides, what was discussed in that interview? So it's very clear. If things come up that are that we're not included, it's so you can have a better chance of being on the same page. Yes, you're correct. We didn't bring that up, or you know what we need to make sure we bring that up, because that does come up, the more we can be on top of that transparency in the communication can better help address generational differences right off the bat, do keep in mind seasoned professionals owning your own practice when these students are graduating, they have a very low sense in general sense of self worth. So for the overwhelming majority, they usually jump at a job faster than they should. Because they are so excited. Anyone wants them. And that is a big thing that happens often at clinics. So just be aware of that them saying yes doesn't necessarily mean they were listening to what they wanted in the first place. Because they feel so grateful that they were not rejected, they were accepted. And that takes over everything. It helps it feeds into them eliminating what their core wants are because they struggle with self value. Alright, that's it. Where can people find you on the social or email, whatever you feel comfortable with sharing.



So I laugh when you say the old people are on Facebook and Twitter because that's really what I use is



and I'm in that category. So I feel comfortable saying



I'm not a Snapchatter I do have an Instagram. My Facebook name is just mine. That's what I'm primarily on. That's where I'm most entertaining. Book



is it clearance a home's nobody's claiming homes, clients homes,



parents homes as well. I'm the one that's scuba diving in my photo.



If it changes to hiking, everyone's gonna get confused.



I know why it's not going to just all my photos are nice. And then my instagram name is CA Homes six ca h o l mes the number six. Oh, I



love it California. You're not from there. But it's fun to say. Wonderful. Thank you so much for coming on. Everyone. If you're listening, please be nice. Be nice. Yeah, you can communicate but be kind. If there is any possibility that what you wrote might be in a way interpreted in a mean tone. Don't write it. I just don't I don't see. Like, honestly, it's just why and I'm not being toxic positive. I'm just being real. Like it's only going to just why why? Like go speak to your legislative representative about it, you know that you can actually make changes. Alright, that's it. Thank you for coming on.

Apr 18, 2022

In this episode, President of IFSPT, Luciana de Michelis Mendonça, talks about her research and the upcoming World Congress of Sports Physical Therapy.

Today, Luciana talks about the importance of the WCSPT and the results from her research. Why are organisations like IFSPT important?

Hear about why sports PTs are important in injury prevention and reduction programs, pre-season assessments, implementing prevention programs, and get Luciana’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “We should assess our athletes to make the most amazing tailored prevention program.”
  • “Injuries happen, but if you can decrease the time that the athlete is spent outside the game, then that is a win for the team.”
  • “Warm-up sessions with the physical therapist were the methods used to prevent injuries.”
  • “Be lighter, less stress, [put] less pressure on yourself.”
  • “I am where I am because I’m good at what I do.”


More about Luciana de Michelis Mendonça

Luciana is a professor in a federal university in Belo Horizonte (Brazil) and develops research in the field of sports physical therapy.

She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organisation of physical therapy services for the Rio 2016 Olympics and Paralympics Games.

She was the first female president of the Brazilian Society of Sports Physical Therapy (SONAFE), in a country with many restrictions to women's participation in sport and politics. Since 2017, she has been an executive director of the World Physiotherapy subgroup International Federation of Sports Physical Therapy (IFSPT) and is now IFSPT's president.

She is committed to enhancing the dissemination of sports physiotherapy good practice and knowledge globally and to increase equity in sports physiotherapy.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Prevention Programs, Exercise,


Recommended Reading

  1. How injury registration and preseason assessment are being delivered: An international survey of sports physical therapists
  2. How injury prevention programs are being structured and implemented worldwide: An international survey of sports physical therapists

Sign up for the Fourth World Congress of Sports Physical Therapy

To learn more, follow Luciana at:


Twitter:            @luludemichelis

Instagram:       @lucianademichelis


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here:


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 Karen Litzy. And today I'm very honored and excited to have on the program Dr. Luciana de mckaela Mendoza. She is a professor in a Federal University in Belo Horizonte in Brazil and develops research in the field of sports physical therapy. She has participated in the last four IOC world conferences on injury and illness in sport with poster and workshop presentations. She was involved in organization of physical therapy services for the Rio 2016 Olympics and Paralympic Games. She was the first female president of the Brazilian society of Sports Physical Therapy in a country with many restrictions to women's participation in sports and politics. Since 2017, she has been the executive director of the world physiotherapy subgroup, International Federation of sports, physical therapy or ifs PT, and is now IFSP T's president. She is committed to enhancing the dissemination of sports physiotherapy, good practice and knowledge globally, and to increase equity in sports physiotherapy. And in today's podcast, we will talk about some of her research into injury prevention and the role of sports physiotherapist in those programs. And of course, we will also talk a lot more about the fourth World Congress is Sports Physical Therapy, which is happening in Denmark this August 26, and 27th. That's 2022. So if you want to find more information about that, you can click on the link at podcast at healthy, wealthy To find out more about the fourth World Congress is sports physiotherapy, again, taking place in Denmark. So we will talk a lot about that. And we will also get a sneak peek of some of Luciana has talks there. She's speaking and she is moderating. So she's got her hands full for sure. So I want to thank her for coming on the podcast and everyone enjoyed today's episode. Hi, Luciana. Welcome to the podcast. I'm excited to have a conversation with you today. Hi, Carrie. Thank you very much for having me. Yeah, it is my pleasure. And now before we get into the meat of our interview, can you tell the listeners a little bit more about you about your history in sports, physical therapy. And as I mentioned, you are the current president of ifs pts. You can talk a little bit about that as well. So I will hand the mic over to you.



Okay, Karen, so I'm from Brazil. I'm a sports physiotherapist and I graduated in 2003. So I'm 20 years as a physiotherapist. And I'm also a professor in diversity here in Brazil. I'm based in Belo Horizonte. And



I started to work. Since the as a students and sports team, I wanted to do physical therapy because of sports. I am passionate about it. And I, I started in this political scenario in the Brazilian society of sports, physical therapy. And I started it was in 2016, it was the year of real to tastic significant part Paralympic Games. So it was a really big challenge. I also work in the physical therapy services during the Olympics and Paralympic game here. And I started being part of the Executive Board of the IFSP CI in 2017. So I learned a lot during the presidency of Anthony Schneider's in Christian torborg. And now I have this big challenge to be IFSEC. President so I'm balancing this actions related to if activity and also with teaching and also research about sports, physical therapy. And my research is mainly directed to injury prevention, and also injury risk profile. So I think that's perfect. And can you talk a little bit more about IFSP T and kind of the importance of having these organizations and what they what they do, what are they there for



Yes, so the International Federation of Sports Physical Therapy is a subgroup of the word physiotherapy. That's our main our mother organization. So as a subgroup, we have to engage countries all around the world that have specific group related to sports, physical therapy to join the IFSP team. So nowadays, we have 34 member organizations in the SSP T. And our main mission is related to disseminate good practices, support research on sports, physical therapy, of course, and also promote actions to support our members, the whole community. So improve the practices around the world. And also it's a good it's an important way to connect with people. So I think the most amazing gifts that I had, being in IFSP T board is to network with people around the world. So it's a really



important way to have our professional, our profession, organize it. And so I probably will be in the presidency for the next four years. That's the plan. Yeah, that's, that's amazing. And one of the things that, like you said, as part of the organization is networking, and we'll say this will probably repeat this a couple of times, but the Fourth World Congress is sports, physical therapy is coming up August 26 27th, of 2022 in Denmark, and obviously, you will be there and you are a part of several presentations.



But like you said, your research is around injury prevention and assessment in sports, in sports. So can you talk about why the sports physical therapist is an important component of these injury prevention programs or injury reduction programs?



Yes, I just want to stress that, yes, the Congress of sports, physical therapy, it's important action that IFSP t also have, we are one of the main organizations, the main sub groups of world physiotherapy that deliver International Congress. So we have the first one in Bern, the second one Belfast, the third in Vancouver, and now illegal in Denmark. So I, I went to Belfast to Vancouver, and now I will be enabled for sure. So



I'm sorry, Carrie, I forgot your question. Oh, yeah. No, so my, my question, like I said, you're doing you're doing a ton. You'll be doing a ton in Nyberg. But one of the things that I know you are talking about is about your research that centers around injury prevention, and something that you're passionate about as if the sports physical therapist should really be involved. So why is that?



Yes. So I always thought that the main action as a sports physical therapy in a sports team, of course, I should be aware that, for me, I need support all athletes available to the coach to the head coach to train. So for me, it's, it was always a good time to have like the physical therapy department, empty without athletes there, because all athletes should be on the fields playing and training.



So for me, prevention was always important action that we as therapists should be aware of. So I, when I finished my PhD and start to be a teacher in university in Brazil, I started to wander, especially after I started to work in the IFSP. Board, I started to wonder if the prevention, the role that the Sports Physical Therapy had in prevention, and I know that how this works in Brazil because I was sports physical therapist and the volleyball team and soccer team. I was wondering if it was like the same, or I was wondering if it should be the same. Or if we are here in Brazil, we're doing like similar things that other professionals data around the world. So I have a sabbatical year in 2020 and I went to Belgium to work with Eric FitPro.



I was there in Uganda, the University of Ghana, as a visiting professor. And we started to develop a surveying to understand what role the sports physical therapists had in injury prevention. So I will talk about some of our results, we have two papers about this survey that were that are published in physical therapy in sports. And this helped me to have



sort of idea about the role. And we have really interesting information about this, that, of course, I will share here in this podcast, and also in the World Congress of sports, physical therapy. And also we develop a Delphi design to establish a consensus on sports injury prevention programs. So this is also an interesting



study that we could deliver an IFSP participated to, with this Delphi study linking



people from different countries. So I'm really excited to talk to you about this caring and say something that should make people a little bit curious and participate in the Congress. In Denmark. Yes. So when can can you give us a little bit of info, you don't have to give it all away? Of course, people can go and read the the



published papers, but in this



in this study, you had, how many people? What did you find? How did you do it?



So yes, for sure, I can share some of the data that we had the papers are published. And also you can indicate for your audience, I can send you the links. It's important, I totally understand caring that sports injury prevention area, we need to move forward related to research, we need to understand a lot of things. But I think it's interesting to understand what the professionals what the sports physical therapists are doing, because this can bring up some questions for future research. So



on the survey, we



we had 414, sports, physical therapists participating around the world. So I think we had like, people from 32 countries. So I know that the amount is not so high, we could have more people participating, but it was delivered in 2020, during the pandemic. So this is one thing that I should stress because, yes, we had 32 countries participating, but I, for sure, I expected to have more people there. But we had questions in this online survey that was related, link it to the synchronous sequence of prevention that were Matalan delivered, and maybe it's the the most use it, model or to make decisions about prevention. So we ask it if this sports physical therapists participated on injury prevention, sorry, injury registration. It's common here, Brazil, but I didn't know if my colleagues in other countries participating in the injury registration. We also asked if they assess it, the athletes to build the prevention program. So if they did, for example, preseason assessment, that's the more common way at least in Brazil. So I was curious about that. And also, I we asked about their prevention program. So if the pieces participated in this action or not. So about equal registration, the first thing this I think this is an amazing result, because we had more than then 80% of the sports physical therapists that participate in this study, were responsible for me to reverse the situation. So we can now say that maybe the sports physio are the are the person like more important more responsible to properly register injury in their sports team? So this brings brings up a lot of other questions. So for example, maybe we should IFSP T should deliver some actions to maybe



increase the knowledge and maybe the competence on this matter on our community. Because of course, if we are responsible for this, we want to do an amazing job. So it's, it's interesting. And it's good also to exchange some experience and learn from good examples. So this is really good. And we also ask about the main barriers.



So for sure now register the injuries. So more than a half of this physios said that lack of time in their routine was the main factor to not properly register injuries. So maybe we need to discuss also about the sports physio routine, inside the sports team. I think we talk we should talk more about this, especially in conferences that we can get together a lot of professionals from different countries, and we can learn from their experience.



So can I move forward? You have a comment about registration? Nope, I think I think that's good. And I do like that. You said, Hey, maybe this is a chance for us to get together learn from each other. Because perhaps there are ways to streamline this that people just haven't thought of that other people are doing. So you're right. It's a great opportunity for sports organizations, like if SPT to bring sports physical therapist together and say, Well, wait a second, some of you are doing this with some of you aren't. And if it's a lack of time, what can we do to give you a structure that can streamline your process? Yes, exactly. And it's one thing that here needs to be done. We just We can't like, Okay, I'm not going to register injuries, because how can I be sure if I'm going to prevent the injuries if I'm not registering? So if you're not registering, is it like they didn't happen?



Yes. And another another thing that is really interesting, what is the injury definition? That is sports, physical therapists are using my understanding, we can select different definitions, because this maybe rely on the sports modality.



But we need to talk more about this, I think we should



exchange and learned and maybe from this, maybe if aspartate can deliver some guidelines, I don't know, because it's one of our missions. Also to make the FSB T is the main resource for the Sports Physical Therapy community. So I think we will maybe in the future, we are going to have more actions based on the findings of so I'm really excited about this. Okay, so let's move on to preseason assessment. So how many are performing? And what are the barriers? I know that this is this, topics of little bit controversial, I know that we have a group that thinks that we should assess, and another group of sports physio, or research thinks that we, we don't need to. But our survey shows that 77% of the participants perform preseason assessments in their athletes.



So 222 sports fields, said that they do. This is amazing information. And I didn't expect for this high percentage.



And I was happy because I believe that we should assess our athletes to make the most tailored, most amazing tailored prevention program for our athletes. I know that this is a challenge. I totally understand this. But if I think about myself as a sports, physical therapy, if I'm working in a sports team, I will like I will do my best to assess the athletes and try to deliver



into an individualized prevention programs. So but we have like, opposite side here because only 30% of these sports physical therapists that do preseason assessment, customize the provincial program bases in the results of the assessment.



So this is a point that we need to understand better. We need to understand what is happening. Why



They sports fees you give energy to assess the athletes, but they don't apply the results to build the prevention program.



So we didn't



ask it like specific questions about this. To understand this, we only asked about the barrier. So the main barrier



that was indicated to not before assessment, it was lack of structure and organization of the sports team.



So about half of the participants indicated this barrier.



I understand makes sense, but I'm not sure if this barrier explain 100% of the reasons to not perform the precision assessment. And I think maybe this is also relied on the evidence that we have related to these. We have big discussions about injury prediction probability. So maybe we need to make some advance in research about this topic. And maybe we need to talk more about this to make more like have this issue more clear to everyone, specially the clinician.



Because I think so now, it's my opinion. Okay. I think we need to assess our athletes, and maybe maybe even the process of assessment should be discussed. Because if we, if we are here in a roundtable with sports, physical therapists, and we ask how you assess your athletes, which tests do you select, probably carrying, we are going to have different answers. So I don't I'm not sure what this means. It means that we don't have standards. We don't have like a protocol. Should we have a protocol? I don't know. But what I know is that we need to talk more about this. Yeah, I mean, oh, go ahead. Sorry. No, no, I just like, I just want to say that I was really happy with the the results that sports fields with a majority is performing a preseason assessment. But on contrary, I was I get a little sad to see that not like 1/3 of them are really applying the Results to Build provincial programs. And yeah, and so I brings up a couple of questions for me, and that is, have you seen preseason assessments? Decrease injury, are they and again, this goes on? I think what you just said that sort of prediction and probability. So if you do a preseason assessment, does that predict less injuries? I don't know. Have you seen? What are your thoughts on that?



Thank you for asking this caring, I think



preseason assessment. The main propose is not to predict injury, they may propose is to identify those athletes with more susceptibility or probability to get the injury and then we can act before this happened. I'm not saying that if we perform a preseason assessment and beta prevention program on the results, our athletes not going to get into I'm not saying that injury, always going to happen sports, but we can, for example, decrease the severity.



So if I have one athlete that I can, for example, I apply the stars question balance test, and I see that this athlete have a really low stability, functional stability in the lower league. So I can include in their provincial program, exercise to improve the stability, and maybe he will, he will, like have the ankle sprain, but I can decrease the severity.



So I will decrease the time loss. I will make this athlete more available to the head coach at the end. That's my reasoning on preseason assessment. And I think there is a misconception about this issue also. Right? Because I think, you know, if we're playing devil's advocate, some people may say, well, the preseason assessment isn't going to eliminate injuries. Why am I why am I doing it? Right? But like you said, injuries happen. But if you can decrease the severity if you can decrease the time that the athlete is spent out of the game



Yeah, then that's a win for the team. And it's a win for the coach in the organization. But if only 30% If if you have all of these sport physiotherapist doing a preseason assessment, then only 30% customize the program. Now we have to come up with some incentives for that physiotherapist to customize



the program for the athlete. And again, that may be like you said resources available to them, if it's one person and 50 players,



that it's difficult, you know that that's that that's quite difficult. But



I can understand how this can be a very frustrating part of research, because there's a lot of moving parts. And it's not just the sport physiotherapist, who has all best intentions and at at the heart of, of of their work. But there's a lot of external factors that need to come into play. But



I do I also like your that idea of being on a round table with sport physiotherapist and saying, Well, what do you do? What do you do? And maybe like you said, I don't know if a protocol is right, but maybe some sort of a roadmap where you have some basic assessments, and then you have the freedom and the ability to get creative, but to have certain certain things in there that makes sense for that sport?



Yes, I totally agree with you. Here in Brazil, I have a lot of colleagues and friends that came from the Brazilian society of sports, physical therapy. So we talked a lot in exchange a lot. So I, I myself, I have my challenges related to really delivering the prevention program that I i understand that would be like the best thing to do. But of course, this also relies on the relationship with the head coach, district parenting coach. So it's a lot of factors variables that we need to understand. And that's, that's really individual. It depends on the context of each sports team. So that's what I when I say that maybe we don't, we will not have like a protocol, because it depends on the sports team reality. But I agree with you that we can give maybe some roadmap to help everyone to organize better, considering the context, right? Yeah, exactly. Exactly. Oh, that's yeah, that's that really opens up a can of worms for people. That being said, let's move on to prevention programs. So what did you find with that?



Yes, so about the prevention program, we see that warm up.



sessions with the physical therapists were the methods more use it to prevent injury. And I think about warm up this was already expected because it was one roadmap that FIFA 11 Plus gave to everyone, not only for soccer, we have evidence on basketball, handball players. So FIFA 11 Plus really helped in this maybe this



basic organization, and how to deliver some preventive action in a more easy and accessible way. So I think it's really interesting that this survey, like confirm that one map, it's a really good strategy to include the provincial probe on athletes routine, because the athlete will need to warm up. So we have this moment, and why not. So instead of make the athlete do like,



whatever exercise or just running on the field, why not to be more specific and includes exercise that the athletes really need to do based on the sport modality.



Epidemiology. So for example, we know that in soccer, we have a lot of famous hamstring strain, we have a lot of ankle sprain, knee sprain. So why not to include some melodic at the size it some balance exercise? I think this is a really



important action that every old sports physical therapist needs, so be engaged and participate and about the individual sessions with the sports physical therapists. It's important to us and then I really expected some information around this



because we know that we have some time zone athletes that need a specific exercise that needs to be delivered by the physical therapist. So I was happy to say this because this was the methods more use it more indicated by our participants. And above the barrier, we saw that lack of time in athletes routine was the main barrier to perform the provision. This was indicated by 66% of the participants.



Of course, I expected results. And that's why warm up, it's important action because this is already in adults routine, we don't need to change the routine to include one more time and period to do



the exercise related related to prevention. So again, carry I don't know if this only this area only about athletes routine, we can understand why we can't perform major prevention. And as I said, Before, I understand the challenges. I think it's not easy. But I think it's a wonderful, it's a wonderful action that sports physical therapists participate. And it's really, of course, important for our athletes health, not only performance, because we have evidence that provincial programs also increased performance. But also I'm concerned about athlete's health, we need to, of course, help the athlete because no one wants to get into it. So this is really, it was really important.



For information that is the also indicated and these information helped us. So sort of build the questions related to the consensus, that was our second step during my experience in Ghent University with Eric.



Right. And so at W CSPG. You're going to show some data about the Delphi consensus, so you don't have to give all that away, people can go to the conference to hear more about that. But if you want to give a little preview, now's your time. So you what are the main topics investigated?



So about our Delphi, we organized the consensus in three parts. So the first part was related to how the thesis should plan the provincial programs. So this planning was about the information or the reasoning to develop the injury prevention program. So this is interesting, because we have information that, for example, sports, physio, use the reasoning related to biomechanics, or the base decision only on evidence and injury, Epidemiology, or athletes, injury history. So we have this kind of information and result and this is really brings up some discussions. So I hope that on the conference, I can, we can have this moment to discuss about our information, our data. The second part was about the organization. So how work environments before the implementation, how this affects the delivering the injury prevention programs. And the third one is about the implementation phase that I know that there is a lot of discussion and research, we have a specific we have specific groups of research that really go deep in this matter of implementation. So in this third phase, we identify barriers and facilitators to implement the injury prevention programs, and also related to compliance, if visibility. So this is how we organize the Delphi. It was a huge amount of work from all the core authors that participated in this study, and really happy that we can now say that this is accepted in physical therapy in sports generally, we can now really disseminate



this information, and I'm really happy to be part of this. Yeah, well, congratulations because that is a ton of work. And again, if people want to learn more about this, then you can come to Nyberg August 26 27th The Fourth World Congress is Sports Physical Therapy in Denmark.



And I mean, who doesn't want to be in Denmark in the summer? Right? I mean, amazing. Yeah, this will be my first time in Denmark. So my I am excited. So of course, no Denmark, but also to meet my friends from Sports Physical Therapy community, specifically before this, sorry, after this pandemic. Yeah. So I really miss my friends. And I really excited to talk more about injury prevention. And so our consensus results, and exchange and networking with everyone there. Yeah. And where can people find you? If they have questions? If they you know, we'll have the links to the studies that you mentioned in the show notes. So if people read that, and they have questions, where can they find you?



Yes, Carrie, so I am on social media. So I have my Facebook profile, Instagram, it's with my name, no change at all. And also in Twitter, is Lulu the chalice so you can find me there. And we can keep talking about information. IFSEC. I invite everyone for be like in the World Congress of sports, physical therapy, it's in August. So I'm really excited to be there. And I hope to see you there all for caring. Yeah, I will be there. I'm looking forward to it. And now final question that I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self? Good question. Okay. So maybe, first, I would say to my own self, congratulations, you are an amazing woman in you accomplished a lot.



For sure, I never thought that I would be where I am now. As IFSP President working in federal, probably the most important federal university here in Brazil. So I'm really happy. If I could give her some advice should be be more lighter, less stress, less pressure on yourself, Luciana.



But at the end, we don't don't care if this increased pressure or stress, help in a way.



me to be here where I am. Or if I could go through this path. Be more.



I don't know light. I think the word is like, Yeah, I think so. And, and I love the fact that you said you know, you would congratulate yourself. And I think celebrating wins and celebrating what we do are things that women don't often do. Right? We're always sort of congratulating others and putting others up, but we never sort of congratulate ourselves and celebrate our wins. And, and I think if I were to go back and tell my younger self, something that would be it, like stop making yourself smaller so that other people can be bigger. It's a constant exercise. I didn't accomplished my winnings, my victories so often, but now I can see clearly that I am where I am, because I'm good in what I do. So perfect. What a way to end the podcast. I think that's great. So again, people can see you live in Nyberg, August 26 and 27th. At the fourth world, Congress is sports, physical therapy, you again will have the link on the conference and how to sign up. And we certainly encourage everyone to do that. Like you said, What a great way to meet up with colleagues to get some really great information and be in a beautiful place while you do it. Yeah, exactly. And on August 25, five, we are going to have a network session delivered by FFTT. So we are going to have also this moment to get together and exchange. Perfect. Is there anything else? You know, you're the president? So is there anything else that we missed? Talking about the conference that you want to let people know is is also happening? We are going to have an interesting conference because it's going to be I think the first World Congress of sports, physical therapy that we're going to have specific moments to do sports in the program. So we are going to have this more serious moments to talk more about our practices and research but also light moments to practice sports and be more friendly there. Yeah, so basically bring your workout clothes is what you're saying. Yeah,



Oh, yeah, that's exactly perfect. Perfect. And I don't think I mentioned that when I spoke to Katie so I'll be mentioning that moving forward that bring your sneakers bring your workout clothes, that traditional



well here in the US for whatever reason, people like always wear suits to these things.



So don't don't worry about the suits, but definitely bring your workout gear. Yes. Perfect. Perfect. Well, Luciana, thank you so much for taking the time out today and coming on to the podcast to talk about all the great stuff you're doing. Thank you so much. My pleasure, Kara. Thank you so much, and everyone thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.



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



Apr 15, 2022

In this episode, Nigerian Sports Physiotherapy Association Founding Member, Ummukulthoum Bakare, talks about her important research and advocacy of sports physiotherapy.

Today, Ummukulthoum talks about her research on women’s football, the issue of compliance and adherence, and the next steps in her research. What are the challenges for women football players, and how are they mitigated?

Hear about her experience advocating for sports physiotherapy, her presentation on The Unbreakable Young World Athlete, and get her advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Passion will drive you.”
  • “The increase in projections of the numbers of registered football players has skyrocketed by the participation of women in football.”
  • “Coaches need to understand that they can be empowered to take charge.”
  • “You don’t have to think of injury prevention as this thing that is separate. It needs to be integrated.”
  • “Nothing is impossible. If you can dream it, you can do it.”
  • “The sky isn’t the limit anymore.”


More about Ummukulthoum Bakare

Ummukulthoum Bakare is a Doctorate Candidate in Sports Physical Therapy at the University of Witwatersrand in South Africa. Her research is focused on women’s football and injury prevention.

She is a founding member of the Nigerian Sports Physiotherapy Association and is active in disseminating the FIFA11+ injury prevention programme in her native country and across Africa. Her passion has centred around the sports of football, basketball, and para-athletes and injury prevention. She received her Bachelor of Physical Therapy and her Master of Physical Therapy from the College of Medicine, University of Ibadan, Nigeria.

Ummukulthoum has worked as a physical therapist since 2001 and has won several awards for her service locally, regionally, and internationally. She is a member of the Medical and Scientific Commission of the Nigeria Olympic Committee and an Associate Editor for the British Journal of Sports Medicine.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Sports, Research, Injury Prevention, Women’s Football, Empowerment, Advocacy,


Third World Congress of Sports Physical Therapy


To learn more, follow Ummukulthoum at:


Twitter:            @koolboulevard

Instagram:       @koolboulevard


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


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, welcome back to the podcast. I am your host Karen Litzy. And in today's episode, I'm really honored to welcome UMO cooltone Bukhari she has a doctorate candidate in Sports Physical Therapy at the University of Witwatersrand in African South Africa. Her research is focused on women's football and injury prevention. She is a founding member of the Nigerian sports physiotherapy Association, and is active in disseminating the FIFA 11 Plus injury prevention program in her native country and across Africa. Her passion has centered around the sports of football, basketball and para athletes and injury prevention. She received her Bachelor of physical therapy and her Master of physical therapy from the College of Medicine University of Ibadan in Nigeria UMO kooltherm has worked as a physical therapist since 2001, and has won several awards for her service locally, regionally and internationally. She is a member of the medical and scientific commission of the Nigeria Olympic Committee, and an associate editor for the British Journal of Sports Medicine. So in this episode, we give you all a sneak peek of what she is going to be speaking on as one of the guest speakers at the fourth World Congress of Sports Physical Therapy, which is taking place August 26, to the 22nd 2022 and Nyborg Denmark. If you want more information on the WC SPT conference, head over to podcast at healthy wealthy Click on the link in the show notes under this episode. If you can, I highly suggest signing up and joining us in August in Denmark. So Lumo coutume is just one of many speakers that we're going to be highlighting over the next couple of months. We have a great conversation today about the unbreakable Young World athlete which she will be speaking about Nyberg. So everyone enjoyed today's episode and be on the lookout for more speakers coming up in the next couple of months. Hey, Katie, welcome to the podcast. I'm really happy to have you on.



It's lovely to be here, Karen. Thanks for having me. Yes. And like I said in the intro, gosh, you are a real rock star in the physiotherapy world. So you are a founding member of the Nigerian sports physiotherapy Association. You are a member of the medical and scientific commission of the Nigerian Olympic Committee and an assistant editor for the British Journal of Sports Medicine. And so that leads me to my first question is How important do you feel these associations are for the profession?



Thank you, Karen. It's is really very important, especially from my side of the



of the continent where we have very limited resources. And it's always a good opportunity to connect with other colleagues from around the world. When we first started the the Nigerian sports physiotherapy Association, were just a handful of people who, you know, came together to say, look, if we did start an association like this, it would help us be able to connect with other colleagues and associated other associations from around the world. And then we connected with IFSP T, which also given us a lot of opportunity to connect with the rest of the sports PT world globally. And that has kind of enriched us over the years. And I'm happy to say that Nigeria was also the first African country to be affiliated with IFSP T. And we still have a great relationship till today. And I'm also actually, I think, the first African and the IFSP T board. The executive board. I was elected in 2019 in the last Congress in Canada, for the Nigeria Olympic Committee. That took a lot of work because it's actually by appointment. And over time, it had only just been physicians. There hasn't been any room for physios to get on board, but I think for somehow I just kept well with the National Society. I'd be the Nigel site of physiotherapy, I just kept pushing to get on visit



ability for physios get us to get, I mean, get the Olympic Committee to also organize specialized training for physios and all of that, and I was doing all this work, making sure that where they were conferences happening, I wanted them to, you know, support people to attend and all that, and a former vice president of the Olympic Committee, and as I look, I think you'll bring your loved one on board. And I'd like to nominate you to be on the on the medical commission. And I was like, Okay. And



when I got in, I was the only female and I was the only physio. But I am glad that we time a lot of things have changed. Because one of the key things I'm passionate about is to give room to allow upcoming and early career sports medicine stakeholders, be it physio psychologists, you know, doctors, physicians, but give room for the younger ones to be supported and, you know, have access to all the IOC courses and things like that. So I it's been, it's not been an easy journey, but I think you can change a lot more from the inside than the outside. And that's, that's why I took on the assignment. And so far, so good. It's, it's worked out. Yeah, it's slow. But it has worked out a bit. Yeah, amazing. And I was going to my next question was going to be what, what has it been like for you to kind of be the first to have a seat at the table? Right, the first woman which I'm not surprised, and the first physio to kind of have that seat at the table, what has that been like for you? And what lessons have you learned?



Um, to be honest, it was not a really easy thing to do, especially when you are in the middle of about, you know, 12 other people who, and you probably also are the youngest. Let me add that, even though I don't consider myself young, per se, but in that tool,



I was the youngest. So but I think luckily, I What sort of helped me was that I spoke with the chairman. And I told him Look, this is



this is the ideas that I have. And I feel like I know there's a lot of work that needs to go on behind the scenes, I'm happy to do all the heavy lifting, or writing and all that, but we need to push for more things to achieve our mandate. And he was very happy with that. And later, a lot of a lot of the other board members just felt like Okay, it looks like we have somebody who's willing to do all this heavy lifting with you know, writing proposals and stuff. And we just kind of make things work. And somehow they just realized that I wasn't really doing it for any self. For myself, as it were, I was trying to get us to have a better a wider ecosystem for sports medicine resource, be it physios, doctors, you know psychologists, pharmacists, nutritionists and stuff like that. And so far, so good. We've we have quite a sizable number of young, early career people coming on board, a lot more people are not interested in sports, physio and all that. And which is because before now, nobody really wanted to do sports physio, they felt like,



you know, you're, you're never going to be rich. Like you're always just



the government is always owing you money. And so why are you a physio per se but then I tell them that look, passion will drive you it is just a calling and you really need to understand that.



What can in any another prefer in any other specialty or physio? It's quite rewarding as a sports physio as well, if you if you're driven by the right



circumstances. So yeah, it's not going to be easy, because half the time you'll find yourself like a fish out of water, especially being a female



where you're working multisport settings and you have to work with male team and all of that you have to hold your own. But it's it is rewarding. And yeah, so yeah. And it sounds to me like some of my students. Yeah, some big lessons. There are one, being willing to put in the work and to opening the door so you can help bring other people in. It's not opening the door for yourself and closing it on everyone behind you. No, no, because there definitely has to be a transitional plan. What is the sustainability of whatever you're doing? Because at the end of the day, your time is going to come and go. So who are the people that you're empowered to continue that journey, the vision and to be able to achieve



you know, the end goal of making sure that there is that continuity, and that you have, you know, so they pay forward and they can



didn't pay forward until, you know, for as long as as needed. And we would have a big pool of sports physios because I can tell you that Nigeria is over 200 million people, and maybe about 10 million active Lee involved in sports at a competitive level. And we still don't have enough physios to cater for that number.



So there's still a lot of work to be done. I can't do it alone. It's a collective team effort. Yeah, I mean, you have to increase the capacity. Exactly. Right. So that that all of these 10 million people, which is a huge number of people cannot be seen by estimating. It could be more, right. Definitely. Yeah. So obviously, you don't have the capacity for all of that. So if you can open that door and bring in a lot of like enthusiastic, like you said, physios, physicians, psychologists, nutritionists to help you continue to build up the capacity of a sports medicine program across the country, you'll be able to reach more people. Exactly. And that's what it's all about. And now, let's talk about your research. So you've got this passion of building up the capacity for sports medicine in Nigeria, let's talk about your research, which I know you're also passionate about. So I'll hand it over to you.



Okay, so I'm currently working in women's football. I mean, it is what it is because women really don't get much attention for anything, even in football, and for research specifically, as well. But as we all know that the



increase in projections of the numbers of registered football players has skyrocketed by the participation of women in football. And we know that for women's for women, we are more or less we have certain



certain factors, that puts us at higher risk of injuries. We know football has burden of you know, contact injuries and all that but can reduce the injury rates of non contact injuries. Now, because women I hire, that when population were what areas due to biomechanical factors, biological factors as a result of hormones and stuff, biological become biomechanical because of, you know, pelvic hip ratio, you know, being at higher risk of ACLs. So you want to be able to minimize that risk. And how to do that is to actively engage in injury prevention. So trying to bridge the gaps, especially in a low resource setting where we don't really have much human resources, infrastructure and all of that, and people still want to play football. So my research is trying to bridge the gap with the population of women playing football, and the use of an evidence based, comprehensive warmup program, which is the FIFA 11. Plus, it is a basic injury prevention program, but it works. But it's not going to work if people don't know about it and compliant with using it. So it's trying to find out what are the challenges in the setting? And how can we mitigate these challenges to be able to improve compliance and adherence, and be able to achieve injury prevention goals, because even on a global scale, compliance, and adherence is a big issue with anything. So, um, since we also know that we have to always tailor things to the broader ecological context, or whatever we're doing. It's not one size fits all, because you have to figure out what are the things that can work in this setting? How can we adapt that can we adjust certain things and whose responsibility is going to take the leadership of the injury prevention philosophy, how this behavioral change is gonna affecting? So this is this is a research that I was working on, or I'm concluding at the moment. And I'm really excited because now I think FIFA also is doing trying to do a lot of stuff for women's football. So hopefully, that can help. You know, in the next five years, we'll see women's football going to a different level than we are right now. Yeah. And you know, as you're talking about that and talking about the resources or lack thereof, it really makes me think I'm in New York City. I'm in the United States where we have an abundance of resources, and people still don't comply with injury prevention programs, right. And so I can't imagine being in



In a part of the world where you don't have the the manpower, the end all of the things that we have here, yeah, yeah, in order to make these programs stick.



Exactly. So this is one of the things that I found out is, along the course of my research, is that coaches need to understand that they can be empowered to take charge, rather than coach to see me as a medical person, like trying to take over their job, I'm not trying to take over your job, I'm only trying to help the team so that he can have more players available for selection and team can do better because at the end of the day, it's inversely proportional, the less injuries in the team, the more the team, you know, can can can progress and be successful. So at the end of the day, I think the messaging also matters, the messaging about, Okay, Coach, if you do this, you're going to have more players available for selection. And when you do have more players available for selection, then your team has a better potential to fight for the title to get to win a trophy. And when that happens, you get a bonus or something in your pocket. And it all everybody sort of it's a win win situation when your players do or injury free. They have longer carrier carrier longevity and so many other things. So the reason begins to change, you know, begins to change and at the end of the day. And then another thing I say to them that look, you don't have to think of injury prevention as this thing that is separate. It needs to be integrated. And there is no flexibility to adapt



and just integrate, it will still work. The most important thing is that you are committing at least twice a week for these exercises to be done. And you will see the difference that it brings to your team. Yeah, it's all about incentives. Right? How can you how can you meet the people where they're at with the incentives they need? And like you said, it's all about the messaging? Yes. Okay, wait, mindset changes, right. And that kind of takes us into I think what you're going to be speaking about at the fourth World Congress is sports physiotherapy, which takes place August 26 and 27th of this year in Nyborg, Denmark, and that is the unbreakable Young World athlete. So talk to us a little bit about that, and a little bit about your presentation. We don't give it all away, of course, you know, we want people to come and see you live, so we're not giving it all away.



We can dangle some highlights out there.



Okay, so the first thing is, I think that right now, everybody knows the potential of sports. So



everybody wants to start young. Now the pressure there on the young athlete is to begin to perform at a professional level at a young age. And that impacts a lot of things in terms of because you know, the type of dedication that you need to, to perfect, whatever sport that you're doing. And, you know, many parents and guidance, everybody wants, oh, I want my child to be Cristiano Ronaldo, I want my child to be messy. Now the pressure is much on these kids. And one of the biggest challenges that then these the burden of having to deal with that kind of pressure, whether physically, psychologically, and every other thing that makes up these young athletes would really be a huge load for young athletes out there. How can we balance that? Now, I will be talking from the perspective of law resource where I'm coming from a lot of many people.



In the developed countries, they have a lot of support for young athletes. And be it nutrition wise psychology, and so many other things that you we don't have the luxury of that. And many times, the kids who just want to play like they don't want to do anything serious or anything like that. But there's still the pressure and demand on them to excel. Because people see that if you if you're a good sports person, or you're able to make a break in either football or basketball, which is one of the top spots in Nigeria, then we can change our economic situation. And that helps us out of poverty, and all this kind of and all this type of thing. So I'm just going to be talking from that perspective of low resource and how the young athletes



as much as you want to encourage sports participation, but there has to be that striking balance to enable them to succeed



That's a lot of pressure on a young kid.



Yes, yeah. Yeah. Well, I mean, I know I'm definitely looking forward to that talk in Nyborg. Is there anything else that you're working on projects moving forward? Anything you're looking forward to in the future, whether it's future research, speaking gigs, getting more involved in in the profession as a whole? What do you have coming up?



Okay, so I'm trying, I'm rounding up my doctorate right now. So hopefully, I can get a postdoc position as well to continue to work in women's football.



That is what I'm hoping for the next maybe six months there about, but other projects that I'm passionate about involves power athletes, I'm very, very passionate about walking with our athletes, because also they too, were like a minority



group. But I see that they are really the super humans, you know, with everything. And with the limited resources and everything you can think of the still strive very hard I want to get on on the world stage. They are the ones who put Nigeria on the on the on the map for medals, because I was with the team in 2016, in Rio, and



we won eight gold medals, set new eight world records.



So I feel like yeah, there's a lot more that I want to learn. And



I'm also trying to do some technical courses. And



there's something called classification for power athletes, where it's like, you're trying to make sure that all the athletes are classed,



in in the desired classes that they can compete on a level playing ground. So apart from the technical officials, they also need the medical people to come and do all the assessments of you know, movement, muscle power, and all these things, just to be sure that, okay, we have classes athletes properly, and they can compete without having undue advantage over the other colleagues in a similar category. So yeah, so I think that's really the next thing that I want to do. It sounds amazing.



Some of my students trying to move on to postgrads. I've just provide them some of my own shares, some run experience, support them along the way as well. And so that's, that's what I think I'll do. Amazing. Well, it sounds like you have a busy time coming up and doing really, really great work. So congratulations on all of that. And now where can people find you? If they want to reach out to you? They have questions. They have thoughts, where can they find you?



Okay, so you couldn't find me on social media? You'll see on Twitter, it's at cool Boulevard.



And it's also the same handle on Instagram at cool Boulevard. So and that's cool with a K, correct? Yes. K with the K Yeah, yeah. And we'll have all of that information and links directly to all of your social media in the show notes for this podcast, so people won't have to search too far. And now as we wrap things up, one last question that I asked everyone, it's knowing where you are now in your life and career, what advice would you give to your younger self?



Um, nothing is impossible. If you dream it, you can do it. So just surround surround yourself with people who will always find your flames. People will always ginger you to keep going. And I think, you know, the sky isn't the limit anymore.



You can keep going so that I'll give to my younger self. Excellent advice. And just if people want to see Katie speak in person, like I said a little bit earlier, she will be speaking at the fourth World Congress is sports, physical therapy, August 26, to the 27th of this year, 2022 and Nyborg, Denmark. So again, we'll have a link for that as well. So you can go on and take a look at the whole program and sign up and come to Denmark in the summer, which I'm assuming is going to be great. I've never I've only been there in February when it's pretty chilly and snowy and rainy. So I'm excited for I'm excited to go. And I'm excited to listen. I have never been to Denmark. This will be my first time. So yes, I am looking forward to meeting you. And the rest of the delegates from around the world. Yeah, it's gonna be great. So Katie, thank you so much for taking the time out and coming on today and talking about all the great work you're doing. We are all inspired. So thank you so much. Thank you for having me.



and looking forward to see you soon. Yeah and everyone thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.



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


Apr 11, 2022
In this episode, Physiotherapist and Sports Injury Researcher, Kerry Peek, talks about sports injury research and the neck.

Today, Kerry talks about her research into sports injuries, developing training programs, and evaluating feasibility and adherence to programs. How can greater neck strength assist in reducing head and neck injuries?

Hear about measuring neck strength, defining “normal” neck strength, and get Kerry’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “You wouldn’t send an athlete out without doing knee exercises, and yet we do it quite regularly with the neck.”
  • “We need to do some isometric exercise but with ballistic intent.”
  • “I don’t think isolated neck exercises is going to give you the best bang for your buck.”
  • “The best exercise is the one they’re going to do.”
  • “We need to make sure that the research in this space is high-quality research.”
  • “We need to be more critical in the way that we apply research in neck strengthening.”
  • “If you’re really good at designing exercise programs, get creative.”


More about Kerry Peek

Headshot of Dr. Kerry PeekDr Kerry Peek (PhD) is a physiotherapist, behavioural scientist, strength-and-conditioning coach, and sports injury researcher with the University of Sydney. She has over 20 years of clinical experience in both Australia and the UK working with many athletes across a range of sports, age groups, and playing levels, including elite athletes in football (soccer), rugby, motor racing, American football, and athletics.

Her current research is focussed on mitigating sports related head and neck injuries and has just completed a project on neck strengthening and heading funded by a FIFA Research Scholarship. Kerry has presented to the UEFA medical committee and assisted in drafting UEFA's heading guidelines.

Kerry is the Chair of the New South Wales State Council for Sports Medicine Australia.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Research, Injury Prevention, Neck Strength, Exercise, Training,


Recommended Reading

  1. The Effect of the FIFA 11 + with Added Neck Exercises on Maximal Isometric Neck Strength and Peak Head Impact Magnitude During Heading: A Pilot Study
  2. Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review
  3. Purposeful Heading in Youth Soccer: Time to Use Our Heads
  4. Higher neck strength is associated with lower head acceleration during purposeful heading in soccer: A systematic review
  5. The effect of ball characteristics on head acceleration during purposeful heading in male and female
  6. Heading incidence in boys’ football over three seasons
  7. The incidence and characteristics of purposeful heading in male and female youth football (soccer) within Australia
  8. Neck strength and concussion prevalence in football and rugby athletes 


To learn more, follow Kerry at:

Website:          Kerry Peek

Twitter:            @peek_kerry

ResearchGate: Kerry Peek


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read The Full Transcript Here: 

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



Thank you so much for inviting me.



And just so people get our connection, I was in Monaco for the IOC conference, and I went to one of the platform presentations, and you were discussing your research, and I found it to be fascinating. So you do a lot of work with the neck and head and I just absolutely loved it. I loved your presentation. I learned so much about it. And then as I dug deeper into you, I realized that you and my friend Evangelos Pappas, there was a connection there. So I texted Evangelos. And I said, you know, Carrie peak? He said, Yeah, I'm like, Oh, cool. Could you like, tell her that? You know, I really liked her presentation, because I was like, and, and I'm, I'm sitting right behind her. I don't know if he texted you that you're like that. It was like a psycho or something. I'm like, I'm sitting behind her.



He did text me that and it was just really funny to have this funny conversation between Australia and we're in Monaco, and you're American. And yeah, saying, oh, Karen sitting behind you make sure that you introduce yourself. Yeah. After the presentations are finished.



Yeah, that was funny. But I loved your presentation. So now I can't wait to talk about your research on this episode. So I'll just kind of throw it over to you to talk about kind of the body of your research and why you chose the topic that you did.



Yes, I am. I'm a physiotherapist. And now a sports injury researcher and I started in the early 2000s, working with Don gatherer, who is the former England rugby physio, and was the Chief Medical Officer The is the Chief Medical Officer. Sorry, I'll start that again. So yeah, so I started as a physiotherapist, I graduated in the late 90s. I graduated in the UK and I worked with Don Gajraj, who was a real mentor to me, and he was the former England rugby physio and also went to two Olympic Games. And he'd really developed a practice which specialized in neck rehabilitation. And this was an area that I don't really remember studying an awful lot at university, like we did manual therapy. And really, as soon as you got patients pain free, they were free to go like I don't remember really doing a lot of neck exercises. And so we had lots of players that played rugby, we had OpSite athletes, and we had Formula One drivers coming into the clinic, who had had a history of head or neck injuries. So concussion, which wasn't really talked about much in the 90s. But looking back, a lot of them work and cast. And we started doing a lot of rehabilitation, and I really am an exercise based physiotherapist. I really like doing manual therapy. And so it was just fascinating to to really come from that perspective to see, okay, what's the mechanism of injury? And how can we replicate this, you know, doing various exercises are really sports specific. I then moved to Australia and had children and got distracted bit by doing other things for a few years. And it wasn't until my son as an eight year old was heading a football, that I thought, actually, we should probably be looking at neck exercises in this cohort, considering they're using their head to you know, deliberately redirect the ball. And that really sort of got me down this, I suppose research rabbit hole, because at that time I was doing my PhD. And since then I've moved to the University of Sydney. And so really what my research is focused on now is how we can mitigate sports related head and neck injuries.



And so of course, you know, my next question is, what is the rationale for why training the muscles around the neck can play a role in reducing sports related head and neck injuries? Because, boy, it seems like some low hanging fruit right doesn't cost a lot of money, easy to implement. So what's the rationale there?



So I mean, first of all, I want to say that I don't think that next month is going to solve every head and neck injury. You know, I think it's part of a multifactorial approach where we will look at more changes and look at, you know, whether that's body checking or collision. But it when we're talking specifically about neck exercises, I mean, the notion that greater neck strength can reduce head acceleration, particularly during heading or during collision sports is that stronger, stiffer, next, increase the coupling of the head to the body, and then help to stabilize the head on contact. So whether that's body contact or head contact, and so really, we're looking at the stiffness, which is the ability to resist defamation, and then the strength which is then you know, being able to increase neck stiffness. And so it is really that coupling between the head, neck and torso.



And how do you explain this to a patient that you're giving these exercises As to increase neck stiffness, because I know a lot of people might think well wait a second, I don't want my neck to be stiff. So how do you can? And I love that you define that? Would you mind repeating it? Because I think it's really important. And how do you explain that to a patient.



So I tend to explain to my patient by using sort of the picture of a bubble head, so I do call them bobble heads. So you've got this figure, and then this head that moves really freely. And you think if you, if you nudge the, the head, it wobbles, you know, quite a lot. And so that's a lot of head acceleration, even if you touch the body, the head will also move. And so if you think if you are being tackled in sport, or you're heading the ball, then there's a lot of head acceleration there. And we use sort of head acceleration, we measure it, you know, with inertial measurement units, thinking that you know, this, if the head is moving a lot, the brain is moving a lot. And so if you can reduce the amount of head acceleration by increasing the strength and the stiffness between that bubble head and that fixed body, then that's a way to hopefully reduce some of the movement of the brain within the skull.



And that makes a lot of sense. And I think that is a great way to say that your patient, because they'll better understand what you mean by neck stiffness. Because I can just see, like, eyes getting wide, like, I don't want a stiff neck. But you're like, Well, when I wait a second, that's not what we're saying, We want you to be able to the neck is still mobile, but we want you to be able to accept those forces when they're placed upon you. Right?



Exactly right. And, you know, we know that head injuries and things are getting more prevalent in, in sport, and whether that's because of increased reporting, or whether it's just because the athletes are getting fitter, faster, stronger. And so some of the hits that you see in American football, and in rugby league and rugby union, I mean, they're horrendous. And, you know, if you've got this head that is really not well connected to the body, and you're being hit by a, you know, 100 kilo athlete, then that's such a vulnerable component. And I think that the neck, really working in this space, it's the last area of the body that we routinely exercise, you know, you would never send an athlete out, whether they're that's a prevention or whether they're post injury, without doing the exercises, you know, you wouldn't have an ACL and say, right, there's no pain there, off you go. And yet we do it quite regularly with the neck.



Yes, very much. So. And now when we're talking about strengthening the neck, how do you measure this, the strength of the neck.



So there are lots of ways that you can measure the strength of the neck. And a lot of these different methods have been shown to have good reliability. My issue is whether they're valid, and they're valid within particular sports cohorts. So when you're looking at assessing neck strength, I mean, generally, when you're looking at any assessment of muscle strength, there's reasons why you do this, you might be using it as an outcome measure. But generally, you're doing it to inform the load that you will input you you will apply when you're then exercising. So when you measure neck strength, it has to have some carryover to the position that the athlete is going to be in for their sport. And it also has to have some carryover to what you're trying to resist. So in with the neck, for example, you're trying to resist lots of head accelerations. So generally, you need to assess the neck using isometric or maximal isometric contractions, because you want to resist movements. Most sports are upright, you know, they're running, jumping, walking, running, and, and so you need to be upright when you test them. If that's how you're also going to exercise them. Now there may be differences. So if you're a rugby forward, you're going to be in a scrum position. So there may be reasons why you want to replicate a scrum position to test an athlete. But some measurements of neck strength are done in a supine and prone position. And these can often give you very different neck strength profiles, to when you actually assess somebody's upright. And there's problems if you are assessing someone in supine or prone, but you want to exercise them upright, because because you just don't know what the actual maximal strength score is in that sport specific position. So the way that I mentioned extreme is that I get them fixed in a seated position because I can standardize that position much better. And I use a break technique. So this is really looking at eccentric loading in an isometric position until you can break the contraction, I guess, of the neck. And this is shown in lots of different areas of the body that a brake technique will yield much higher scores than a mate technique. And so again, if you're using the brake technique, particularly because you're generally trying to keep the head and neck still when there's contact placed on the head or body, and then that is sort of like an eccentric load. So this will give us our maximal score, for which Has the flexes extensors left or right side flexes. And then this gives us a much better maximal result that we can use for percentage of one rep max when we're thinking about load.



And are you using a handheld? dynamometer? for that?



Yes, I probably should have said that first. Yeah, but I am using a handheld dynamometer with a load cell in series that's placed on the head with a with a head harness. And so yes, you do incrementally load that.



Yeah. Nice. And now, how, how do we know what normal is? Like? What's a normal strength profile for NEC? And and then how do we know what's normal for a position within a sport?



And that's a great question. Because when you when you look at the literature that's out there, the first thing I always do is I look at what was the method to assess neck strength. And if it is in a lying position, then I take the results slightly with a pinch of salt, because they too tend to give you a different neck strength profile. So there are a lot of studies particularly in rugby that have been tested using the same method that I that I use. And this was first developed by by Don gatherer. So it's not any great surprise that I use that because we used in clinic for a very long time and tested hundreds of athletes. But now having moved into that research base and had a look at all the different ways that you can test neck strap, it's still my preferred method. And so we've tested rugby athletes, we've tested football players. And what we're generally finding, and this is sort of consistent with the literature. And what we expect a neck strength profile to look like is that the extensors should be the strongest. So if you look at a result, and the extensors are not the strongest, is it related to the testing technique or the position that they're tested in? Or is there a problem there, so it isn't an injured population, that might give you something that's a bit different. So extensors should be strongest flexors are generally the weakest. And side flexors will sit somewhere in the middle there, depending on the population. So in rugby and American football, you often do want to have the side flexes to be stronger, and a lot stronger than the flexes. So they tend to have a very wide sort of neck radar if you were to plot this on a graph. Whereas if you have football players, for example, because of the conditioning from hitting a ball, they may actually have quite strong flexes. So I always have a look and plot the results on a radar. And then I also calculate the flexure to extensor ratio to see what that looks like. And so in the literature, normal is often considered around point six of a flexor extensor ratio, but I have seen it as low as point five as high as point seven. But I always think if in a sporting population, if it's below point six to me, that's that's honestly a red flag, but it's certainly a yellow flag.



It's problematic, or can lead to can lead to more problems. Yes. And where can people if they're wondering like, hey, where can they find the method that you use to strengthen? Is there a paper? Is there something you can point to because we can sort of put it in the show notes?



Yeah, so I do detail the the method for assessing neck strength and a paper that we published earlier this year in sports medicine. So we looked at the neck strength of football players, adolescent football players from 12 to 17. And then we implemented an X strengthening exercise program and to see whether by strengthening the neck this actually had an impact on reducing head acceleration during heading, and we found that it did so that the neck strengthening method is is detailed in that paper.



Perfect. So we'll have that paper, we'll put it in the show notes a link to it so that people can read it at their leisure. Now, we talked about why you're looking at it, how you're evaluating it, what does a training program look like?



So that's, that's really interesting as well, because I think, because there's not a lot of published literature on neck strengthening, I think you tend to find that you have different camps of people, some that are very pro neck strengthening, and that that certainly is myself. And, you know, a bit like you were saying earlier is that it's low hanging fruit, you know, why wouldn't we try and strengthen it because the potential gain is huge, and it wouldn't not strengthen any other area of the body. So I kind of think what, you know, why wouldn't you do it? But on the back of that, we also have to think what's the best way to strengthen the neck and I think some people are quite negative towards neck strengthening, because some of the papers that have been published, the exercises that they use are sort of self resisted exercises where they're pushing against their forehead and holding that and doing isometric holds. And a number of studies have shown that this doesn't really have an impact, it may not even impact in which increasing strength and it may not have an impact in reducing injury risk as well. And that makes sense. You know, I don't implement those exercises because When you're talking about reducing something like concussion or heading in football, those hits happen in fractions of seconds. So we don't need to have high insurance of the neck or just isometric control over a long hold, what we need to be able to do is fire those muscles really, really quickly. And so we've been playing with some neuromuscular exercises. So it isn't our paper that was published in sports medicine, but I'll try and describe it, but you're kind of in a setup position, but you're rolling backwards and forwards, and you're trying to stop your head from hitting the ground. And so the idea from that is really to try and contract the neck flexors really quickly if the heads in neutral, and then we turn the head to the side and the other side, and we do the same exercises. But the idea is that you've got that anti gravity strengthening, but you've also got, you know, you're trying to stress the muscles to fire really quickly. And that's what they have to do. So most of the the literature that is talking about neck strengthening is sort of indicating that we need to do some sort of isometric exercise, but with ballistic intent, and that's the bit that is often missing, for most of the neck exercises in the literature.



Yeah, and that's the exercise you described in Monaco, sort of, for people, if you've ever taken Pilates, it's rolling, kind of like rolling like a ball is kind of what that's kind of, you know, that's, that's at least what I got from it. And I remember I got back to my room, and I was like, we're gonna try and see what happens here. And it is it not as easy as it sounds.



No, and, and it does, it does work the net quite hard. And you can see it, you can see the net contractions in somebody else that's doing it. But the way that we sort of played with this exercise, and I will just credit to bursting, but also, we meet on a regular basis. And we talk about neck exercises. And he's also widely published in the neck strengthening arena, and was part of this paper as well. But what we were trying to do was come up with an exercise that use no equipment that didn't take long. So these exercises take 90 seconds. And that could be added to an existing neuromuscular program. So in this case, we added it to the part two of the FIFA 11 plus. And this is really important because I actually don't think isolated neck exercises is probably going to give you the best bang for buck either. I think we need to integrate it into, you know, other strength and conditioning programs. And again, this is sometimes where you see in the literature that they're just adding neck neck exercises without thinking about, or what is that neuromuscular control to the trunk as well. And how are we stimulating that?



Yeah, that makes so much sense to not just do things in isolation. I mean, gosh, especially when you're talking about athletes who rare? There's not many athletes that do things in isolation?



No, no. And and I think that that's just really important to get that adherence as well. Because if they think it's an add on program, and it's going to take ages and 10 minutes to an athlete is actually quite a long time when they're doing so many other areas of the body, that if we could integrate it into existing programs, or integrating into multi joint movements, then it makes sense to them. And it and it's, it's it's integrated. It's not an add on.



Right? Because of course, as we all know, as physio therapist, one of the hardest things through a rehab process is the patient that doing the rehab. Right, so the best exercise is the one they're going to do. So if you explain it well. And you integrate it, you're more likely to have that patient do the exercise. Have you found that? Have you found difficulty patients adhering to the program?



So, so we didn't, we did, we did look at the evaluation of feasibility. So my PhD is actually on adherence to exercise. So it was something that was really at the forefront of my mind when setting any exercise intervention, that we need to have some sort of process to evaluate it and see whether the, you know, the players and the coaches found it feasible, and did it take too long could they see the benefits of it, and it's generally scored really, really highly. And I think that is the fact that we tried to just minimize the time that it took that it was complex. So you know, the youngest athletes were sort of 12 years of age, and you know, they all understood what they needed to do, but also to make it you know, applicable to their sport. I think that's really important.



And what are your thoughts on different kinds of strengthening you know, we see things on YouTube people will see things on YouTube and I don't mean to go down a rabbit hole on that, but you know, tying weights around their head bands around their head doing things with bands and weights with movement of the neck. What are your thoughts on that?



So there's certainly some crazy stuff on on YouTube or Tik Tok and I think that's not necessarily specific to the neck. I just think that again, what you've got to try and do and, you know, I think exercise therapists, whether that's physios or exercise physiologist that do exercise really well, they understand the sport and they understand the mechanism of injury. And so if you're going to add a weight to your neck, you've got to think, Okay, well, how am I adding the weight? And how is it replicating, you know, the risk of injury, or what I need to do within my sport. And so if you're in a crouch position, which I've seen in lots of videos, where they've got a head harness, touch the neck, and then there's really, really heavy weight at the end. And I kind of think, why you're doing that, what's that for? And maybe in the scram, maybe that's applicable, but you know, I can think of very few reasons why you would need to do that. And when they hang weights off the top of their heads, you know, you think of that, you know, that axial loading that they're doing. Again, why would you want to do that?



Yeah, I don't know. That's why I asked, and so we got an answer. I don't know, I really do not know why you'd want to do that. But now now listening to you talk about your research, it just makes so much more sense to integrate it in a neuromuscular based exercise, you know, integrating it with other muscles within the body and making sure that it makes sense for the position and the sport of the person. Yeah, absolutely.



And I think this is about knowing, knowing your patients, knowing your athletes, and, and if you apply that sort of methodology for any exercise, you know, whenever you see someone, so I've been invited to do some work with the RW F here, so the Air Force, and I don't know a lot about PILOTs, but you just go in here, talk to the pilots, and you say, okay, so what do you do? And you know, when does your neck hurt? And? And how long are you in that sustained position? And how much G force are you being exposed to when you're in a fighter jet? And you just kind of start to understand, you know, what, what's happening to this person? And how is that potentially, you know, making them at risk of injury? And then how do we need to train those muscles in a way that stimulates, you know, what they're exposed to as part of their job or part of their sport? I mean, you do that with every other joint of the body? You know, I think we routinely do that. But we just need to do it at the neck as well.



Yeah, and great advice. And now is there anything as you know, throughout our conversation today that we didn't touch upon, about your research, maybe about your PhD work that you think would be audience would really love to hear more about?



Um, I think that it's important. I think it's important than I think I sort of said this a bit earlier on that, we really need to make sure that the research in this space is really high quality research, and that we understand, you know, the mechanism of injury, particularly things like concussion, that we don't think that neck strength is going to solve everything. But you know, when we're reading papers, it's understanding, you know, what method did they use, you know, are the results actually believable, or didn't the way that they measured neck strength have given you such an unusual profile that actually shouldn't read any further in the paper, or it's just not applicable to your athletes, for example. And so I think that we need to be much more critical in the way that we apply research in neck strengthening. And I think that, although I'm very passionate about next trend thing as an intervention, you know, I don't think we should overplay what we can potentially do in this space, either. It's just part of our toolbox, but it's not going to be everything.



Yeah, there. It's not the panacea for all ills having to do with head and neck injuries.



That's right. And I think that if you don't understand about how to integrate a neck strengthening program, I mean, I'm very happy for people to reach out to me, but, you know, talk to people and, you know, as I say, critically appraise what's going on. And I think, you know, if you're really good at designing exercise programs, get creative, you know, have a little bit of a play of what you're trying to do. And I think that's often how we get really innovative in the way that we approach exercise programming as well.



Yeah, and it also sounds to me like there's not a one size fits all. Approach, exercise or program. No,



I mean, I think there's things you don't do. And then everything else is kind of open to Yeah, depending on your athlete. So yeah, don't hang away off your head.



Yes, that is fabulous advice. And now as we start to wrap things up, I'm going to ask you the question that I asked everyone, and that's knowing where you are now in your life and career. What advice would you give to yourself as a new grad right out of physio school, your younger self?



I think that's a great question. And I don't regret anything that I've done in my career, but I would say that I've probably come to really specializing in neck strength is a bit too late. So we started in the early 2000s. So my first paper was published in 2005. And as I say, I got distracted doing other things. And I wish I'd continued with it. And I didn't partly because I was having children, and I'd moved to Australia and just life got in the way. And when I came back to it in the probably about 2015 16. So 10 years later, and nothing had moved forward, really. And I just thought that was a really missed opportunity. And so I if I could go back in time, I would probably, yeah, I would probably want to squash those 10 years into maybe 18 months.



Well, that would be pretty amazing time traveling. So where can people find you? If they have questions, they want to follow you on social media, where can they go.



So the best place to find me is on Twitter. So I'm at peak underscore Carey, I don't tweet about anything other than my research. So that's the best place to find me. And then you can always drop me a message through there. Otherwise, you can probably find me via Google, at my email address at the University of Sydney.



Perfect. And just so everyone knows, we will have a link to the papers that we've mentioned today. So if you want to read up on those that don't worry, they will be in the show notes at podcast at healthy, wealthy, smart, calm. And Carrie, I want to thank you for coming on. Like I said, I really loved your presentation in Monaco, which was just a short snippet of kind of the amount of things that we talked about in the podcast today. So thank you so much for taking the time out and coming on.



No, thank you actually went to your presentation in Monaco as well. And you've informed a lot of what I do as well about, you know, I think that most research is quite ego driven. And I'm not an exception to that. And we think that if we publish a paper that somebody is going to read it and we're going to change the world. And that rarely happens because players and coaches don't read research. And so your presentation was about you know, engaging with the media and doing a lot more in the social media space. And that really hit home to me that we have to try and bridge that gap if we can to translate research to practice. So no, thank you.



Oh, well, that's nice. I'm glad to hear that I will pass that along to my partner Osman, as well. So thank you for that. And again, thank you for coming on. I really appreciate it. And all of you listening. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

Apr 4, 2022
In this episode, Owner amd Founder of Goldsmith Therapy Solutions, Dr. Philip Goldsmith, talks about value based purchasing in home health.

Today, Dr. Phil talks about the pros and cons of value based purchasing, and prioritising results over productivity. How will value based purchasing in home health turn out?

Hear about OASIS assessments, the difficulties of working with insurances, and get Dr. Phil’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “It looks like value based purchasing in home health is going to be a good thing.”
  • “Home health therapists are probably, unfortunately, some of the worst offenders at underdosing strength training.”
  • “Professional communication is where the good are going to be separated from the bad.”
  • “Most of the private insurances base their policies on payment on what Medicare does.”
  • “You’ve got to be involved with advocacy if you want to see change.”


More about Dr. Philip Goldsmith

headshot of Dr. Philip GoldsmithPhilip Goldsmith, PT, MSPT, EMT, DScPT, COS-C, is the owner and founder of Goldsmith Therapy Solutions, a provider of high-quality management, consulting, and clinical solutions for home health providers.

Dr. Goldsmith has been a practicing physical therapist for more than twenty years, with experience in home health, skilled nursing, and outpatient orthopedic environments.

Dr. Goldsmith received his BS in Health Studies from Boston University in 1996, his MSPT from Boston University in 1998, and his DScPT from University of Maryland School of Medicine in 2011. Additionally, Dr. Goldsmith has extensive experience in leadership and financial management of small and mid-sized not-for-profit corporations and has won more than $200,000 in grants for public safety organizations with which he is affiliated.

Dr. Goldsmith lives in Hanover, PA, with his wife and son.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Results, APTA, Home Health, Value Based Purchasing, Insurances, Advocacy,


To learn more, follow Dr. Phil at:



Twitter:            @pgoldpt

APTA Home Health:


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 

Alright, let's go. Hello, healthy, wealthy and smart. I am Jenna canter here with the Dr. Philip Goldsmith, who we're going to refer to as Dr. Phil, don't you love it? I'm so grateful to have Phil here, because he has a small business owner who runs a business in which he provides Oh, I'm gonna mess this up. And I'm so excited to where he brings stuff to the home health people and they're happy and they smile and say thank you. Without it and I get it.



That's pretty close.



Would you mind summarizing in that perfect sentence you just said a second ago of what it is you're more details on your business, like



elevator speech. It's called Goldsmith Therapy Solutions. And I provide high quality clinical consulting and management services to the home health industry.



I love it. And that's an elevator speech we all need to have you know for each of our own individual businesses, anybody who interviews with me knows I don't spend too much time going into the bio stuff because that will just be in the people can read it and then Wounaan go oh my gosh, I love Dr. Phil, you know, look at this. Wow, incredible. We are going to dive right into the topic which I know nothing about. I'm a cash pay cash based out of network PT working with performers. So I'm going to ask all the base questions to fully understanding the situation so everyone can better get on the on the same page with this apparently, and I I'm, I'm not saying it's not but just for me, it's new, apparently topic that's like a hot topic, and that is value based purchasing in home health. I know nothing about it. So let's talk about what is that? What is the value? What is that



value based purchasing is Medicare's new payment model for certified home health services provided to Medicare party beneficiaries.



Why is that important right now,



because it's different, how Medicare is moving away from the you go do a visit or provide a service and we pay you for a service to a model where they pay you based more on your outcomes, and how good a job you do at taking care of those Medicare beneficiaries that have chosen to avail themselves of your services.



That sounds great to me from a physical therapy standpoint, because that's what we care about. So how was this? Let's start with how this is good. And then we can go how this is potentially something that could get in the way of providing care to people fully. So how is this good?



This is good, because it removes a lot of the artificial drivers that were skewing utilization. Meaning, excuse me until about three years ago. The more visits you the more therapy visits you made, the more money you got. And that was unfortunately driving practice patterns and everybody Medicare, not Medicare kind of agreed. This isn't working. Yeah, yeah. And



because that's about productivity, not about results. Yeah.



Right. And it was it was too much widget counting, and a lot of home health agencies were making a lot of money on providing therapy visits that weren't necessarily necessary. Hmm, Mm hmm. So, you know, the the interim step on the way was this thing called pdgm that we're in now where it's all based on functional states and diagnoses? And that's about it.



Yeah, it's not nothing to push getting them to where we need to get them or to protect them from getting worse. If we're talking about home health. Yes, yes. Okay. Okay. So then let's talk about where this could potentially be problematic.



So the, the concern is, are you comparing apples to apples, meaning they're dividing the agencies up by state by geography and buy large versus small volume, to try to make apples to apples. But the big issue is, this system works literally by robbing Peter to pay Paul, somebody is going to make money. And somebody is going to lose money. So the other people at the other end of the scale can make money.



Where could you go and give some details on this? Because I'm not really following on on how this could be? Yeah,



Medicare is gonna say, Okay, we're gonna take all of the large volume agencies in the state of Pennsylvania. And we're gonna line them up by the outcomes we've chosen, they haven't told us the outcomes yet.



Deciding what the outcome what outcomes matter,



they are in the process of that now, who are the consulting



with doctors?



So there is what's called a technical expert panel, and we could do that alone. The concept of technical expert panels could be its own podcast, where basically they bring in people in the industry and ask them, What do you think is important? Um, do they pay them? They cover their expenses, do they? Do



they start to get a financial interest to sway certain ways and their responses? Okay, okay.



They're representing their industries. So, you know, they can, I could volunteer to be on a technical expert panel. And my job is to bring the perspective of the physical therapy industry. Hmm. They also do us, you know, these big beltway consulting firms that you hear so much about, and they have policy wonks that work at CMS that do this stuff. A lot of its actuaries accountants and lawyers? Because one of the big rules is this is supposed to be budget neutral, meaning the pot of money doesn't change. It's who gets how much of that pot changes, specifically, the agencies that are the bottom performers, they're going to lose it as much as 5% of their reimbursement, so that the top performing agencies gain 5%. See,



there we go. That's where I think a financial interest could sway what people say, because this could be less money towards their industry. Well, it's problematic,



home health in general. I mean, this is, it's already, you know, you're already getting paid a lump sum for the care of each individual. And that varies based on those clinical and diagnostic factors that that I talked about before. Right. The scuttlebutt is,



I don't, but I just need to highlight that. I know I love that you said scandal, but this is great. That means rumors, love it scuttlebutt, I'm going to start using that every day.



One of the big outcomes they're going to look at is readmission to the hospital, did you keep your patient out of the hospital? Because that costs Medicare more money. And they're gonna look at functional outcomes, like transfers and ambulation. And there may even be a patient satisfaction component because did you know that Medicare mandates patient satisfaction surveys in most settings, you get those annoying Press Ganey surveys? Because Medicare says Thou shalt, and they track those, and those are actually publicly reported data.



That's actually great. I think the patient what their happiness is everything. Yeah, I think that's great. That's, yeah. Okay. Okay.



So it's your secrets here.



So it's it sounds though, like it's a bit of a gamble on where things are going to lie. And what's going to be decided on what these outcome measures are? That sounds like the biggest concern, what are these outcome measures that we're going to be using? Because if we're talking about movement stuff, you



aren't talking about movement stuff. But, you know, they've already established that all of the measures, the outcomes that are going to be looked at are either Oasis based Oasis being the clinical assessment that's done in homecare at a minimum every 60 days. Okay, Mission recertification discharge, hospitalization, return from hospitalization. That standardized assessment gets done. I have



a question about that, actually. And this is just from my own experience, it's a completely different audience that I work with. So when I'm working with my performers, I'm reassessing every single time I work with them. I'm a niche practice, though. I'm, I'm small and keeping it small. And so therefore, they get like real top, you know, I know them inside out what's going on in their lives and stuff, so I can best help them. So that is very, very specific. And and I'm lucky to be in that position. So when you're saying 90 days, that sounds like a long time for like a formal reassessment. I believe in oh, gosh, PT, school, it was it was a matter of like two months. So is it because of the the age where things may take longer to see results? Why it's a 90 day spot? Like, why is that? I'm honestly asking, it's not for judgment, I'm trying to be very transparent on my own bias. So I can learn



that every 60 days, well, every 60 days, that OASIS assessment gets done. However, that doesn't change, that your state Practice Act still applies that you may have to reassess every 30 days or every 10 visits or every 14 days, whatever your state Practice Act says, and Medicare still has the every 10th Visit reassessment requirement in home health, where they expect you to be using objective functional measures, and looking at your plan of care and your goals and saying, Are we getting where we need to be,



which is what we do in physical therapy. That is we're always asking ourselves that question.



Okay. This is more of a you know, it's more of a big picture thing. Yeah. Okay. For example, the emulation question. There's independent, there's independent but needs a one handed device independent but uses a two handed device can walk but need supervision at all times. And then there's a couple of answers for wheelchair bound, or bed bound.



Yeah, I'm not familiar with this, but I'm learning as you're talking about, is there anything about risk of falls because that's like the big a big one.



They look at that from a process measure standpoint, meaning they ask you, did you assess for fall risk, and there's criteria given a multifactorial objective. So really, it's got to be a two pronged thing. They're not looking at the results. They're looking at. Did you do it? Yeah.



Yeah. Is there room for? And this may be you don't know, because this is a bit of mind reading. As far as you know, right now, is there room for measurements for neurological disorders where we know that things may they're going to decline over time? You know, are immune immune? Am I saying the wrong thing? I think he's doing the wrong thing. But is there room for that where they have a health situation where things are going to decline? We know that but we're trying to keep them functioning their best as they're going through their process?



The answer is yes and no. Okay, the questions and answers don't change. What changes is, they can tease out by diagnostic grouping and by what they call risk adjustment, where if your agency has a high population of clients with progressive neurologic disorders, that's the the term in favor now. Okay, thank you, they're going to risk adjust your statistics to reflect that, meaning, we see that you have a larger population of people who probably aren't going to get better. And we're going to do some statistical mumbo jumbo in the background to adjust for that. But that doesn't change the answers that the clinician is using. Okay. There's no, I have to pull a different document because I have a different diagnostic group. There's no, I answer these questions for this diagnosis. And that questions for that diagnosis? Yeah. Yeah, the people who very much a big picture of



the people behind the scenes, I think I know the answer this question, but I'm still going to ask it, the people behind the scenes who will be assessing the the progress progress, and, you know, if it's fitting, looking at the outcome measures and what we need for that patients, are they medical professionals? Are these just people who are trained to work for this company? Who are the Who are these people?



So field clinicians who work with clients answer the oasis for each client, the agency, then submits it electronically to CMS. And the risk adjustment is baked in to the computers at CMS that process all this information.



Also, it's a computer thing. It's all very,



and that's part of the reason the assessment is somewhat limited in big picture. Yes, it's a it's a computer thing. Ah, it's a i. i, maybe maybe not. But it's a lot of higher level statistics. That's way above my head.



Right, right. Yeah. Oh, wow. That's what this is so negative for me to say, but what an easy way as a person in CMS to point away and go, Oh, no, it's the system's. That's what they computed. Like, I can't. I'm like, Who created it? Who designed the code? Fine. We'll look at the code person I need to understand. Okay. Okay. So, I mean, it just sounds a little bit like a trip to Las Vegas, where you studied a little bit. So you know, a bit about gambling, you say, let's say you're very educated about that, and you but it's still gambling? You don't really know. I don't know, I just I,



you know, it's, it's pretty well known how they do the risk adjustment. You know, it's just the statistics of how it's done is pretty high level, but we have a good feel for what they're risk adjusting for and what questions they used to do the risk adjusting.



I mean, do you think the physical and physical therapy industry home health for this, because that's what we're focusing on? Do you think what the way we have things set up now, the way I mean, that's the whole point is to be measuring their outcomes? That is literally what we're doing all the time. Do you think we're pretty safe with this adjustment? If anything, it'll probably be for the better if you're just overall? I mean, because we did the good versus the bad. Where do you think it's, it's gonna turn out for us?



It looks like value based purchasing a home health is going to be a good thing. It is going to reward you for doing your job well, and being aware of your outcomes and delivering good health. Quality physical therapy that drives the outcomes? Yeah, there's going to be, it's going to challenge the physical therapist and the PTA to work at the top of their license and to collaborate with the other professionals. Because some of these measures don't happen in a vacuum for lack of a better term, they don't happen unless you're working as a team, and everybody's on the same page. Yeah. And that's really that interprofessional communication is where the good are gonna be separated from the bad.



Yeah. This isn't my world. Oh, continue,



there's, you know, definitely the agency is going to have to be very aware of their outcomes and their data. And the understanding of that data is going to be huge. Yeah. And I can tell you, that there are consulting firms and companies, and that can look at those outcomes at a clinician level. And they're going to tease out high performing clinicians and low performing clinicians.



Yeah, yeah. Yeah. And I'm assuming that's where the concern is, what is, oh, I'm gonna backtrack to actually what I was originally thinking of asking. What is the hot talk on the streets regarding this? What are the big things that other physical therapists and people in the industry are going like, hey, about it? Or do we already cover those things?



We've covered a lot of it. I think there's a lot of optimism around this. Because the more recent changes over the past couple of years, starting in October 2019 really pulled back on the number of visits. We were seeing clients. And some of that is real. And some of that is artificial. Yeah. And it's gotten me up on my soapbox a number of times, because home health therapists are probably, unfortunately, some of the worst offenders at underdosing strength training. Oh, yeah, you want to get me started? Don't get me started.



Yeah, yeah. So it's, it would force that that push, I would love. It



forces us to understand how to deliver strength training, how to deliver the most the best outcomes we can in in fewer treatments.



Yeah, how to get trust, motivation.



really gotta understand you've got to be a high performing clinician, yeah. To survive in this market. Yeah, because a home health agency literally cannot afford to have lower performing clinicians that can't deliver the outcomes. Yeah. And a lower number of visits.



Yeah. Yeah. Absolutely. Absolutely. I definitely get that. So I I mean, I'm all about the outcomes. I've had people a different dance physical therapists asked me about how I do my outcomes and it really does depend on my patient and everything but I have a very I have a special circumstance you know, like I'm very lucky to have this niche that I have. i There are from an outpatient not out push out. Yeah. Out not outpatient. Wait, I'm getting so confused. Ortho. From an ortho standpoint, I'm calling because I'm not, I'm not home health. So I'm just like trying to get back to my my world. There are definitely I'm gonna choose my words specifically. So if you are a person who does own a clinic, that sees a lot of patience, you are a mill, there is no way to paint that there is a reason why there is a name for that. That's like saying, I, you know, I was you know, born from two Jewish parents and I grew up I have my Bar Mitzvah and then and like, I still observe Passover, and then be saying, I don't I'm not Jewish. Like what? Like, no, I'm Jewish, you know. It's very weird comparison. But whatever. That's what I chose. And I'll go with it. We



get to the point of mills.



I've always thought that the it was because of the problem with insurance and reimbursement and it's one of those like chicken or the egg kind of thing. What happened first, which I use in defense for any clinic. I'm like, hey, they're trying to figure out how to get reimbursed but at the same time, does in this horrible circle of terrible reimbursement trying to communicate what you did and everything, and people are trying to make money, which is fine, it's okay to want to make money Hello. Is



we as a profession do wrong to allow an industry to devalue our services like that?



It's because when trying to guess this is me, because I'm not a network. So, but from what I've seen, it's it's clinics trying, they're doing their best to report what they're doing. They outcomes with the patients, while at the same time speaking the language that the insurances say, they will reimburse. And then also these insurances saying they're going to reimburse, but they're not actually reimbursing, then there are administrative staff calling over and over again, fighting to get those reimbursements, you know, getting better at that. So that's why you have certain people working on the at the front desk, and then and so then they increase the number of patients during that time, because while they're gambling per patient on honestly, this is how I look at it for a patient on getting that reimbursement. Through, you know, the paperwork we've we've been trained to do to report outcome measures and everything. They're not they're not getting paid for it. They're fighting to get paid even on the basic level. So I think, but I don't know what happened first if insurance happened first, or, and, or the, you know, provision of the services, and they decided for it to be a lot of people that's the chicken or the egg thing. I mean, I'm sure somebody could look up the history, but I think that's where people just say, Oh, the healthcare system is messed up needs to be fixed. I, that's where I kind of lean back on to kind of be fair to everyone. Not that there has to be a middle ground. But I mean, that is kind of the truth. If I owned a big business, you're constantly you're like, Okay, I've hired this, these EMR systems, you know, we're we're gonna track and write down things. I hope this is the right system. Okay, this one's not working. Let's do a new one. And then you have your clinicians going, Ah, dang it, we have a new one, I have to readjust. But it's because we're trying to do it. Honestly, we're trying to do it legally. And then insurances just go, now, we're just not gonna reimburse you, we're not gonna explain why. And we're gonna be difficult to get in contact with to discuss and figure things out. So I don't know it's a random tangent, I'm sure people will go be like, Jenna said something wrong. I'm not the person to attack here. I'm just speaking. If you have problems, go talk to the insurance companies and figure it out if you already know how it works. But that's kind of how I look at it being problematic in the Ortho world specifically, because there is a lot of measuring of my brain out there. There's a lot of measuring of what was the word that we use, the more patients you see.



Counting widgets, counting widgets.



It happens, it does happen at the larger clinics. But yeah, can you I mean, I'm not saying I'm not saying I'm not saying I agree with it. But also, can you blame on? You know, like,



you started this to make money. I get that, you



know, but, but I mean, what I am in the business to hear, I mean, that's what I'm doing my own thing, is it easy to do what I'm doing, is it easy to get the patient Oh, my God. But that's I that's where I put my energy where I put my energy. But I feel like what is happening in the home house, like, Oh, my God, this is hilarious, full circle, but I'm going to connect it, it's going to be amazing. Feel like the Home Health what you're doing with pushing that pushing forth. The outcomes, I would love that I would, but I would love to actually be that not than just saying that. We love their beat. Let's make it all about the outcomes. And honestly, I feel like that's what we've been trying to do the whole time. It's just people aren't. insurances aren't saying there aren't following through with it, what they say they're going to reimburse, they say, We can reimburse up to this amount. It doesn't mean anything. It's horrible. So I would love there to be fixing in that way.



And I think someday Medicare will come around to a value driven system for outpatient therapies. And until Medicare does, nobody else will mean, Medicare very much still drives that bus.



Yeah. Wow. I never realized that. That's yeah. How do you know how do you I mean, honestly, asking, How do you know that they're the ones driving the bus?



Because most of the private insurance is based their policies on payment on what Medicare does,



because they're so huge. Yes. Mm hmm. Oh, gosh. Not saying it. It's easy to say there's no easy road.



That's where all the that's the root of all the CPT codes and everything else. Medicare needed a common terminology to wash claims through a computer to pay people. Let's boil everything down to a five character code.



Right, right, right. Wow. Huh? She's What a hot mess. It just gives me a headache thinking about all of it. I don't like it. It makes I need cake. Or pizza. Oh, not chocolate though. My dad loves chocolate cake. Are you a chocolate cake person?



I am a chocolate person head on.



We only put like chocolate cake is so different from chocolate bars come on.



Yes. But they both have their merits



F No. Disagree? Absolutely not. All right, if you are a person that if you would handle your stress from chocolate cake, just as much as chocolate bars. Okay, your team Dr. Phil. If you're like No, chocolate, just chocolate actual chocolate, your team? Jenna. I'm interested to see if there's going to be any written debate on this or discussions I'm sure there already has, which is why you were meeting Dr. Phil was like, let's do this topic. And like, I don't know anything about this, which is good. I think it's good because then I get to learn everybody else who listens gets to learn. And oh, I'm going to just say this just because I am not a fan of meanness. Don't attack either of us in this discussion. If that's in your if that's in, if that's in your intention in in hearing this and your response, oh, just at this as a message just for you get out of here. Well, we got to be better together, we need to be able to have these discussions, talk about it, totally fine to speak on your concerns about it or all that stuff. But we're just attacking each other that is not helping out the patients at large. This is about the people we serve. So we're discussing this to see what's going on to better understand what's going on. If you are in an estate, you are close to somebody who is in legislature, the then do talk to them, or see if there's a pre written letter from a PTA right now regarding this through their app, if you're in a PTA member or see if you can get a hold of that letter through a friend or something or I'm sure it's honestly on their webpage for you to easily access to advocate sending a letter to fight this or fight for it, whatever it is, because there's there's positives and negatives and everything. I mean, sometimes there's you know, it's leaning one way, obviously, but we got to just take action. If you want to see something you got it don't just reply on here take action. Well, I just gave so many different messages and one thing at the end, but that's okay, I'm fine with it. Any last words you want to say on this matter that you that we haven't covered? Dr. Phil?



I think the take homes are twofold. You just said the first one. You've got to be involved in advocacy if you want to see change. Second, value based purchasing, like we're talking about it today is just in the home health arena right now. It is what Medicare wants to bring across the board across all settings. And, you know, they don't they want to get away from fee for service. They want to get away from ID to units. If they're x and a unit. If they're X, a unit of East M and A unit of manual therapy and you need to pay me for it. They want to know a client walked in your clinic with this problem. They had these issues that we're able to quantify. And at the end of it, the client left our clinic and the issues were gone and here's how we've quantified it. That's what they want to be able to pay you for. And if you can't be excellent with that. You're not going to have a successful practice 510 years from now.



Thank you. Thank you so much. Where can people they wanted to get in contact with you Where can they connect with you on either social media or email?



I am P gold PT on Twitter. I do have a personal Facebook. I am not fancy or cool enough to have Instagram or Tik Tok or any of those. I have LinkedIn. My email is Easy it's P gold The other place that's really easy to find me is if you go to a PTA home on the leadership page, you'll find my name. Currently the treasurer of APGA Home Health formerly known as the Home Health section. And in two weeks in two days I become the President



didn't say that at the beginning. I was like, I wonder if you want me to and you didn't say bring it and bring it out? So yes, this is a person. This is a person who's very involved with fighting and spin keeping on top of what's going on for home health. So thank you so much, Dr. Phil, for coming on for your name. I love just saying Dr. Phil over and over again. And just sending you the biggest hug from afar. We got a meet at a conference recently and you are a gem. Thank you so much, and everyone send love to Dr. Phil for for his time.

Mar 28, 2022

In this episode, Sports Physiotherapist and Researcher, Loïc Bel, talks about his experience as an up-and-coming sports physiotherapist and researcher in the industry.

Today, Loïc talks about complexity and uncertainty, clinical work and mental health, and the importance of having a team around the patient. How does Loïc deal with imposter syndrome?

Hear about Loïc’s experience in Monaco, why he decided to keep getting more degrees, his thoughts on Physiotherapy Associations, and get Loïc’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “You can’t just use one factor to influence the whole situation. You have to accept the complexity. You can’t control everything.”
  • “Nobody puts the bad stuff up on social media. It’s only all the successes.”
  • “To be successful, we have to fail.”
  • “Sports and physical activity as a whole is one of, if not the best, tool for health.”
  • “As health professionals, we have to think about what we do, because it has a cost on society.”
  • “Knowledge a collective thing.”
  • “Don’t give up and don’t blame yourself.”
  • “If you believe in your profession, try to get involved.”
  • “Communication is everything.”
  • “Try to ask yourself more questions. Don’t think that everything you learn is true, even at school. Question things a lot more.”


More about Loïc Bel

Loïc Bel is a physiotherapist since 2.5 years ago. He graduated with a Bachelor degree in physiotherapy in Switzerland and is now in the last semester of his Master Degree in sports physiotherapy, also in Switzerland.

He currently works in an outpatient clinic in a small city in Switzerland for 3 days a week, and during the other 2 days, he studies in Bern towards his Masters degree.

He is currently involved in the ‘Commission for the Promotion of Physiotherapy’, that is a branch of his regional physiotherapy association. He is also a board member of ‘Le Réseau’ – which can be translated as ‘The Network’, which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity.

On an international level, he currently is a board member of ‘Long COVID Physio’ as an education co-director.

A recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Ducrest, Nicolas Mathieu, and Mario Bizzini. The paper was about injury prevention in sports related to performance. Injury prevention is a subject that he tries to develop an expertise in, and he really fell down the rabbit-hole during his Bachelor graduation work that developed into that paper.

His professional goals are to end his Master Degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Injury Prevention, Sports, Exercise, Research, Knowledge, Education, Mental Health,


Read the paper:

Lower Limb Exercise-Based Injury Prevention Programs Are Effective in Improving Sprint Speed, Jumping, Agility and Balance: an Umbrella Review


To learn more, follow Loïc at:

LinkedIn:         Loïc Bel

Twitter:            @bel_loic


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


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 Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and increasing referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a new offer. If you sign up complete a marketing audit to learn how digital marketing solutions can help the clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net forward slash li T z y to sign up for your complimentary marketing audit today. Alright, so a big thanks to Net Health now on to today's podcast. So my guest today is like Bell. He's a physio therapist since two and a half years ago, he graduated with a Bachelor degree in physiotherapy in Switzerland and is now in his last semester of his master's degree in sports physiotherapy, also in Switzerland. He currently works in an outpatient clinic in a small city in Switzerland for three days a week. And during the other two days he studies in Bern towards his master's degree. He is currently involved in the commission for their promotion of physiotherapy, that is a branch of his regional physiotherapy Association. He is also a board member of labor. So and I'm sure I butchered that, which can be translated as the network which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity. on an international level. He is currently a board member of long COVID physio as an education co director. Our recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Newcrest, Nicholas Matho, and Mario Barzini. We talked about that paper in this interview, and it was about injury prevention in sports related to performance. Injury Prevention is a subject that he tries to develop an expertise in and he really fell down the rabbit hole during his bachelor graduation work that developed into that paper. His professional goals are to end his master degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention. And in today's episode, we talk about a little bit more about the IOC conference that was back in November. And also we talk about clinical uncertainty, mental health of new graduate physio therapists dealing with imposter syndrome, and the importance of our physiotherapy association. So a big thank you to Luke for coming onto the podcast and being so open and honest and sharing his experience as a newer graduate in the physiotherapy field.



Hey, Lloyd, welcome to the podcast. I'm so happy to have you on and it's so nice seeing you again after it's been a couple of months since we met in Monaco. So welcome. Yeah, thanks for having me. I'm really happy to be to be here enough time to. Yeah, and I'm, I'm so excited to have you on to talk about.



We'll talk a little bit about your experience in Monaco and your big takeaways from that and tell me your what what you thought and what your takeaways were. Yeah, it was it was a last minute chose to go to Monaco. And, and don't forget that actually.



It was the second big Congress for me. So it was a bit of euphoria. I went to Geneva when there was the World Congress to So second bit Congress on sports physios. So kind of specialization I'm doing right now. And it was it was bigger than I thought it would be actually. And it was really hard to do some take home, because there was so many things to, to take with so many new ideas, maybe so many new ideas about all ideas that were totally deconstructed. So that was a goal of mine to go in. And be like, Yeah, I want to unlearn what I what I had learned during school and during my students. And I know we discussed it together quite quite some time about the takeaway. So there was one word that came a lot during the Congress. I think it was the context, context matters. So you can have



The best exercise you can have the best the best plan you can have the best program you want. If people don't do it on buying it's, it won't matter much, actually.



I think one big thing is that maybe we don't know, as much as we think we did. It discussed it with a smart non on a recent Muscats podcast to



lots of talk, discussed some things that we thought we knew. And maybe they don't work as planned, or they don't work



in the nation an efficient way, like we started did. And it was a great, great symposium on the complexity, like everything interacts, you can't just use one factor to to influence the whole situation you have to you have you have to accept the complexity, you can't control everything. And, and yeah, you go home and you don't really know what to do anymore. You don't really know if if you did things right, you don't really know if you will do things, right. So that's kind of the takeaway I took from like for me.



Yeah, and I would agree, I left like God, I feel like I don't know anything and stuff that I didn't know, I had now have to sort of deprogram myself to



reprogram with new information and new research, which, I mean, if you asked me that's a sign of a good conference. Yeah, I said the same. If I, I'd be pretty, pretty sad to go to a conference and go with only a big confirmation bias, you know, like, Okay, I did everything right. That's fine. So it's a good thing. Yeah. Like you learn something, if you unlearned things. So yeah, it was great.



Yeah, I agree. And let's, let's kind of dive into this idea of complexity in practice. Right. So like you said, there's so much more to an injury than just the injury, right? So if someone has an ACL injury, it's more than just the physical rupture of an ACL and then knee. So can you talk a little bit more about complexity in practice, whether it be your personal experience?



And and how you tolerate that uncertainty in the clinic? I mean, if if we speak about Monaco, the big thing was when when you come home is Watson, how do I apply the things I learned? And what I feel like when I when I go to Congress is or to any symposium that speak about research, I'm always like, Yeah, but in research, we control so many things. We want to control the most things we can to better understand the mechanism. And then you arrive in practice, and it's the chaos. You can't control everything you've gone through in research.



I have a pretty young conditions, I ended school like two and a half years ago. And every time I discussed the topic with some more experienced clinicians, they always answer with the Yeah, experience helps.



Yeah, but what do you do when you don't have, you don't have that much experience, you have to build some. So you try to rely on research, you tried to, to you try your things, basically, you have some tools, try to use your tools.



That gives you some idea when you try what should be best practice in research. But sometimes it doesn't work as planned, and you have to deal with it. So you try to adapt. You try to modify things a bit. And you have to go with intuition sometimes. And



yeah, it can be a hard feeling to deal with. I mean,



I tweeted like, a few weeks ago about that, because I had a rough day, I really have a rough day. Like I had three patients, it didn't go as planned. We had to go back to the search, and we had to discuss things. And it's really exhausting. I feel like to come home and nothing worked as planned. You go like with 1214 patients a day. And this tree will stay on your mind like the whole evening the whole evening. You don't know you're just thinking about how could I help? What's next try to plan for you and for them.



Yeah, I don't know we can you can deal with it. You have to acknowledge that it can happen. And you have to. Sometimes you have to take a step back and be like, yeah, what did I do? Did I do something wrong? Or not? Because maybe you did nothing wrong actually. And how could I figure out a new strategy to to advance and do better? Yeah,



It sounds to me, like what you do when you have those days, and we all have them where you're like, I'm a loser, like, I can't help anyone, no one's getting better, what am I doing? But that instead of going back and sort of wallowing in it for the whole night, I think you can wallow for a little. But it sounds to me like what you do is you kind of reflect on that re reassess how you did things, and really look at what can I do differently? I don't want to say better, but what can I do differently. And if it's something, then you always have another time to try. And if it's, you know, I think that I did what was appropriate, then maybe it's let's go in and have a deeper conversation with this patient, you know, let's see what other part of this complex person in their ecosystem will allow us to move forward. So that's what I got from what you just said that you really take that time to kind of reflect, reassess, and then move in the next day, or the next time you see them. So they agree, and complexities are also about how it works with the with the other colleagues to other professions around the patient. So you have to reach out for other people, you have to discuss things with them. And you have to you have to explain what you did you have to, to also be confident about what you did. And and that's that can be quite confronting to, to do. So. Yeah.



Many things to deal with. But in the end, you have to go forward and keep on keep going.



Absolutely. And you know, as a newer ish grad,



you know, you kind of



knowing what you don't know. And maybe knowing what you do know, how do you sort of keep putting one foot in front of the other because I'm assuming imposter syndrome may come up



every once in a while. So what do you do to keep moving forward? And maybe what advice can you give to let's say, a new graduate that's graduating tomorrow, given the experience that you have over the past couple years?



You're right, it happens from time to time. And and I mean, social media don't don't help with that. I think, as a whole, yes. Because there are lots of success story. There are not much stories about failure. Well, I mean, here's the thing. No, nobody, nobody puts the bad stuff up on social media. It's only All successes, right? So you have to take that step back and be like, yeah, maybe maybe they fail to. And to come back to Monaco, there was a great great one. That was about the biggest mistakes. So did a motor compress was something about learn from our biggest mistakes. So it was with Yvette for Heigen Carolyn, a bullying Caroline Emery to.



And I think it was great to have like to be in a Congress with what you can call like, a camera like her from speakers in the world about injury prevention, and, and, and hear them like, we failed. But we kept on moving. We kept on trying. And we did really, really better and we try every day to do better. So it was one good thing is that for once there was there were people that acknowledge that they failed, but they kept on going in and it was it was yeah, they deal with things with the tools they had at that moment and that you can't have everyday data you you want at every moment. So you have to try. And another thing I'd say is that personally, I try to really reflect and reflect on on on what I don't know I try to Yeah, we can speak a lot about metacognition and and identify your knowledge identify your lack of knowledge in some in some topics, so I try to identify my weaknesses. And then I try to read because I can't just be with patients 24/7 So I have to read about them and and and try



that said so I said I see the things



there's a quote I like that that say what I believe is a process rather than a finality. I don't know who Who is this this from but I like it a lot like you have it never stops you have to keep on moving don't stay like in a stone try to tie traveled. Yeah, and that's how I said things. Yeah, and I I missed that talk at Monaco. Now, I really wish I went to it on the



You know, yes, we failed at these things, learn from our mistakes. And I would argue that the most successful people in the world have failed more times than they've been successful. Right? Because they're taking chances. They're putting themselves out there and, and they're making mistakes, learning from them and then pushing forward, which can be your stepping stone to success. Yeah, I'm a pretty firm believer that to, to be successful, you have to fail. Because if you just have success, I mean, first of all, it's not realistic. But I feel like if there was only on the success, and you couldn't fail,



you'd stop working. You don't anything to do anymore. You. You're not on this planet. So yeah, I think that's you. But every, every failure you have is a small break towards the Big House of success. Basically.



I couldn't agree more. And you know, in talking about all of this, you know, we're talking about failures and imposter syndrome and not knowing, and you're in a clinical setting, you're working with people. With all of that on your mind, it can certainly take a toll on your on mental health as a clinician. So what what do you do? Or what advice do you have when it comes to that clinical work? And mental health? Your own mental health?



Yeah, so I feel like we have a really demanding job, from a psychological perspective, because like I said, sometimes you fail, you have that bad day, and you come home, and you're like, Yeah, rethink, everything is worthless. So you have to do to overcome that. And with that, you have to, to add all the pressure about knowing things, because patients want answer answers. So you have to know things, you're the professional they want, they want to know, as sometimes you don't.



Now to, to put less pressure on me, I am honest with the patient, when I don't know, at the beginning, during my internships, I was always trying to find the right answer. And sometimes I didn't have it. And I try to find the thing to say. And now I feel like yeah, it was really unethical. First of all, and



no idea, say, I don't know, but we'll try to figure it out, basically. And one phrase I do, I do say a lot, when situations are complicated is that we'll try to improve the best we can. But I don't know until when we can, until what level we can improve, we'll figure it out. But maybe it will be only only a small portion and, and you'll have to try other things and physiotherapy.



And basically, you have to take care of your mental health and health professional for that. So I'm not ashamed to say that I wanted to psychologist and I discussed this topic, too. I didn't go for that. But I discussed it because it was really taking a toll sometimes my on my health. And now I learned to take a step back to be honest with the situation and discuss



discussing with patients and be open to criticism from patients to isolate them, you can tell me if if something isn't right, will change what we do. Finding yourself and being confident enough in yourself to say I don't know, is very, very beneficial for everyone involved, because you don't want to make something up.



Right. So if you don't know, I think what you said, you know, I don't know, but let's figure this out together. I'll look up some research, we'll figure this out. And if we can't figure it out, then I think it goes into another topic that you wanted to cover. And that's having this sort of entourage around the patient. Right? Because it's not your the two of you aren't on an island together, and there's no one else around, hopefully.



So can you talk a little bit about the importance of that, that team or that entourage around the patient? Yeah. So I think that I'm really lucky because



I met some awesome people in Switzerland during my studies and when I went to congresses,



I can mention someone It's Susan God that was in Monaco too.



She she's she's helping me on a daily basis. Basically. I'm often writing to her and and some other colleagues, some of the friends and colleagues that are my age we try to we try to figure out stuff together too.



I think



we are in a profession where



You can't have all the knowledge and some people already belt, some strong knowledge on some specific topic. So when I have a situation, for example, with Suzanne from with the shoulders, I write to her, because she's the experts in my, in my network, she's the expert on shoulder, so I don't hesitate to, to to write her to ask the patient if I can take, for example a video of or picture of the problematic I have. And I asked, I tried this, I tried that I have this situation right now. It's not have evolving, it's yeah, it's it's staying the same. We don't find a way to, to overcome the situation. What do you think about it, and then we discuss it and, and sometimes she she has some really great things that I never would have thought about. And I do the same with with friends.



I have some friends with my part time studies. They have the same problem as me. Sometimes they write to me and I try to help sometimes they do say I do thing with them. And sometimes nothing comes out from it. But at least we tried. And



and yeah, I try to do the best with the tools I have right now. And I feel like they are getting sharper every month, every year. But right now, yeah, it's not the best strain to get the tree with the knife the moment sometimes so. So yeah, it's gonna get better.



So what made motivates you to kind of to keep going and keep learning and keep sharpening those tools?



Right now, I think that's the first thing is that I want to help the people I work with, I don't I don't often tell the term patient. I think I work with people not with patient, they're productive. So yeah, I want to help them. So that's, that's one of the reason. And the other reason is that I don't like not know, to not know. So big. So I'm really curious. And I want to know, and yeah, again, you have to cope with not knowing but but I try to dig it always a little deeper and try to understand the mechanism of what I do have of I don't know, special battleship or stuff like that.



These are the two things, I'd say, drives me the most. And then I fell into sports physio. And I was like, yeah, it can be fun because I, I always liked sports. And I always did some. But it was also because I believe that sports and physical activity as a whole is one of the if not the best tool for health. And you have to understand what you do. I mean, we speak a lot about sickness size, about active therapy, you have to understand what you do. If you just give some exercises and you don't know what consequences can be.



Again, it's not the best gear you can provide. I feel like so I don't I don't like and it happens sometimes. But I don't like when people go home and they and they come I don't know, two days, three days after the treatment. And they tell me Yeah, I was feeling horrible for for two days. Because we because I did something that was too much volume or too intense. I don't know. But yeah, basically, that's it. And I feel like you have to be a Swiss knife, you have to add some tools to your toolbox. You have to add communication, for example. That's that's one that's the most important tool in in relationship



with these people and, and personal experience, I feel like is a is a big driver, too. I feel I felt right when I went to the psychologist and I could discuss and I could communicate. So



understanding what it feels like yourself, drives me to do better for the people that come to. I think it's it's important.



Yeah, and I'm so happy that you said communication is I would say the communication is most important any relationship period. That's true, whether that be personal professional, client patient, it is number one, and that that is a skill that can be learned. You know, there are books, there are classes that you can take on how to be a better communicator.



But I think it starts with knowing what you know, and being able to admit what you don't know and learning more. So kind of everything that you said throughout this podcast, I think really comes down to that piece on communication and it's huge. I'm so happy that you brought that up. And on that note, we're going to take a quick break to hear from our sponsor and be right back with more



when it comes to boosting your



Next online visibility, reputation and increasing referrals. Net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net forward slash li tz y to sign up for your complimentary marketing audit.



Why move on to higher and higher degrees? Right? So for you, why do a master's degree in Switzerland when a bachelor degree is enough here in the US? We had started with a bachelor's, I went to a master's. Now we're at a doctorate level clinical doctorate. So why move forward through all of that when Hey, maybe if a bachelor's is enough or a master's was enough, why why keep pushing forward on the degrees? I think it's a big topic in Switzerland too, because we have the other countries around us that all go to the master degree level, we are maybe one of the only country left in Europe that doesn't ask for a master's degree to be in the clinic, maybe I don't know not the last bit. We're not like in the best situation right now. And that's that's me. That's me, critics from our colleagues and other students in PT school actually, to to that I wanted to go further. And some some told me that I wanted to prove that I was better than them, or that I wanted to be paid more, so I can be paid more. I can't ask for more money, because I got a master's degree. So these are not the reasons. But the main reasons from me with were like when I went into my internships, during my degree, I was really feeling clueless. And I felt like I didn't have the tools to do anything.



I was a big, big, big manual therapy for years. For three years at school until the I was lucky in the last year there was the Geneva Congress, the World Congress in Geneva, and I went to the to the conference from Peter Sullivan and Jeremy Lewis. And it really blew my mind. And I was like, that's what I want to do. And it really changed my perspective on things. And I was like, Yeah, I want to upgrade my skills, I want to get a better understanding of everything. And, and that's, that's what drives me, it drove me in the first place.



provide the best care.



And I think you have to, like I said, to better understand that. And I feel like, as health professionals, we have to, we have to think about what we do, because it has a custom sort of site society, basically. And I was happy to go to that conference, because I realized what I what I participated in, when I was only providing passive, passive treatments. And now I think it's like I have to participate in reducing the costs. I have, it can be by by encouraging people to move more it can be by maybe avoiding a surgery, you can you can have ACL conservative treatments, more and more, it becomes a big bigger trend than before. And that's how I see things right now. And



one other things with the master degrees, that I like to research and you have to have a master degree to do research in Switzerland. So you I mean, you don't have to, but it's way easier with a master's degree. And I always wanted to add my break to the brick house because I really liked doing my beach law, graduation work. And I think that knowledge is a collective thing I published with the with the colleagues of mine, Mario pizzini, the kilometer in France and UK recently the my first paper and I don't feel like it's only my paper. It's like we did this. We did it us for and it's only for people that come and add just a break to injury prevention and non subject so



that's what I want to do. Basically I want to I want to add Matt, just my break. I don't want to be remembered for it. But I want to help things move on and go further. And domestically. We can help me understand the research better and help me to understand how to conduct it's basically so that was one of the reasons and



As, as a young clinician



research I rely a lot on.



And if we speak about the funnel model from



evidence based practice, you have best evidence on the top. You know, it's better than me with the conference at that spot physio. So I think that's that's an agreement.



Research is at the top. Great. But if you can't read research, you can't use it. So that's that's one of the reasons.



Yeah, well, I think that's a fabulous reason. And just so people know, we'll have a link to the paper that you just mentioned in the show notes at podcast at healthy, wealthy, smart, calm. So we'll have a link to that. Do you want to talk briefly about what give give the abstract, if you will, of that paper? That's exciting. By the way, congratulations. Thank you. It was I worked on it during my master's degree during two years, I didn't think it would last this long to publish it. But we finally made it. But the idea was, was that



was that we thought that injury prevention programs for the for the lower limbs could improve performance. And the we evaluated that through a numpy review. And the logic behind it is that



we have a big utterance problem with these programs. So how could we improve the utterance and there was a talk, we can come back to Monaco, again, about never mentioned prevention, we only speak about performance, you know,



it's it's the main driver of sports, affiliate sports. And I'd say even off amateur sports, you want to you want to win. So how do you sell it to these guys and women's? So elite athletes, athletes wanna want to be the best. So performance is a key things.



So it was the logic behind it. We want to we wanted to explore that. Does it affect performance, just by doing these programs? And we can say it has, it has an effect, it doesn't have the best effect. I think



you better trend for performance than doing these warm ups, for example, if you want to improve performance,



but it's, you can you can say that it could help. But I think more on on not much level, not knowledge level, it won't be strong enough stimulus for them.



Excellent. Well, thank you for that quick, abstract, or quick synopsis of that paper. And again, it'll be in the show notes for this podcast. Now.



As we start to kind of wrap things up, I'd love to talk a little bit more about physiotherapy association. So we have in the United States, the American Physical Therapy Association, we have world



confederation of physical therapy, which was that was hosted in Geneva a couple of years ago, I was there as well. Do you think they're important? Do you think they serve a purpose? Or no,



I think they are a big key to, to promoting our profession. Actually, I don't know how it is in other countries actually, with the with the contact with the public with maybe the politics too.



But they out. I mean, you can you can go and ask the politics and the public everything that you want. If you only one, it won't work. If you come as a group, and with tons of people, maybe it will change things. And that can come back to to the master degree. Step. Two, we need people with an expertise to push the job. And that can be made through associations. We have to actually make the knowledge and then we have to do a diffusion of knowledge. And that's a great way to help people we see so many things that are



pseudoscience on I don't know a low back pain for example, that goes to the public maybe that's if we could promote what we think is best care and what would help people it would it would be great and I think we have to do it as a group as an association, our gateway for that. And I'm on the I'm a board member of the local zoo that can be translated as the network



I'm one of our I'm one of the if not the youngest, and with the less experienced in the group but



we want to promote like physical activity for for health. We want to regroup every everyone you don't have to be a physio but everyone working in sports in



In movements, and oh, by now and go and promote that for everyone. And



and I'm also on the commission for the promotion of physiotherapy,



in my region, Switzerland, so we do, we do some, some really versatile stuff. So we are going to public conferences for everyone to attend. So we want to disseminate knowledge in an understandable way for everyone. So we invite speakers, and they tried to keep it short and simple for everybody to understand. And we have some more professional conferences.



For example, we did one a year ago, a small workshop with Darren brown on long COVID. It was not really discussed at that moment. So I wanted to have people in Switzerland health professional,



better understand they had the occasion to discuss with Iran for like, nearly an hour. And



he answered every question, and I Big shout out to them. Because he He's He's amazing. Everything he does seem to push. Yeah. Everything it does. Yeah. I don't have any words to describe him. Yeah, I don't have amazing, but yeah, that's the thing I think we have to do. And again, it's about accumulating, and if diffusion, you have to accumulate the knowledge, you have to defer to big diffusion to concern people. And I couldn't have done it without an association. And it's rich, it's stretched, maybe, I don't know, 120 feet do



that could treat lung COVID patients better. And that wouldn't just use exercise.



To try to to improve things, skirted codes, wasn't everything. So it's important to have that and it's it offers a big platform to reach public your wants. So that's why I think that you have you have to go in this association. You don't have to agree with everything. I don't agree with lots of things in the Swiss physical physiotherapy Association, and quite vocal about it. In my regional Association, I say that I don't like lots of stuff. And I tried to make things move from the inside. Not always easy. But you have to try. But yeah, the problem with that is that I'm on the board with the Huizhou. I'm on the board with the promotion of physio, I'm I don't do much to be honest. I'm on the board from long COVID physio to. And that's can be tons of projects, actually.



With all the side projects with the clinic,



with my students who have to write my thesis, I only have a few months left, and I'm crawling compare workloads right now. But yeah, you have to deal with it. And that's, that's kind of the situation right now.



Yeah, I mean, I agree with you on Darren Brown. He's outstanding. I interviewed him for the podcast about lawn COVID. And it was a wonderful interview. We're going back and forth. And I finished I said, Do you have notes in front of you? He's like, no, yeah. He's like, That's, like, yeah, I met him in Geneva, at the Indaba. Part was where everyone can come and just speak, and there were topics, didn't have a clue on the topic. And it was like you everything.



And at the end, I discussed with him and I was like, yeah, do you know something on the topic? And he was like, no, no, I was just going with the flow and okay.






he's just like that. He's, he's, he's an awesome speaker is a wonderful person, and I can't, I can say, Yeah, and it's more about him. That's only praises for him. I agree. I'm with you. I have 100% only praise for that man. And I think he's, he is pretty remarkable. And what a great asset to the profession of physiotherapy. And he has that ability to disseminate information to the public very well. So he knows how to simplify things, not dumb them down, but simplify them to make the average person understand and that's a very special skill. And I think he has it inherently so that he can sleep good. Yeah, it. Yeah, it's a great skill to have. Okay, so now that we're really wrapping things up here, what would you like for let's say two or three times



takeaways of our conversation to be for, let's say, younger physical physio therapists or even physiotherapy students that you can impart to them after being out in the world for the last two and a half years or so. Yeah, the first one I think would be



don't give up. Could it be an advice? I don't know. But don't give up and don't blame yourself could be a good one, I think



you have, I think that you have to deal with the situation with the tool you have at the moment you live it.



Sure, that's now some situations I had like two and a half years ago, I would deal with them better right now. And some that I have right now, I will deal better with them in a few years. But you only have these tools in your toolbox right now. And try to do your best and don't blame yourself you fit doesn't go like you planned it would go if it doesn't go like you would have liked to go.



You can you can fail then like we said it will help you change the way you do it the next times. And you'll do better. Basically, that would be the first I think



with that with the mental health. So don't blame yourself because don't take a toll on it.



I think it's important.



But to be a second ones.



Get involved. I think if you believe in your profession, if you believe in physiotherapy, if you believe in health movement communication, tried tried to get involved. You don't have to do every project like like, I think I do, or like I think many people that came on that podcast do, I think you you should choose. Just quick on that. I think that maybe we have culture and physiotherapy where we think we have to accept everything. Don't do it.



Better, choose the projects, better choose to and do it, do them greatly. And then choose eight and fed them. Choose your projects, but try to get involved. If you if you believe in it, try it, try it, it will be worth it, you will meet some awesome people, you will make some connections and it will be worth it in the end. Anyways. So I think there's that and I think that's that maybe



maybe to come back on that we should find a way to to propose these projects to young clinicians as at least into a salon. We don't have anything to anything to get them involved. Maybe we should find a better way to propose the projects to to ask them. I think they have an I have a fresh vision on lots of things. And I think that's one of the reasons why we should we should have younger clinicians come in and express themselves. Because we live in an era where things go really fast. And if we only have the same old people that do it for 50 years, maybe that won't make it.



And let think I don't know, actually, what would be the last thing? Do you have an idea?



I mean, I think what you said was great, the only thing I would just like to reiterate from this conversation. So the big thing that I took away is that communication is everything. And that really finding a mentor finding, like you said an entourage of people to help you sharpen those tools. Those are my big two takeaways from, from our discussion today. And finally, I always ask, but you probably just answered this, but I'll ask it anyway, since I asked everybody is knowing where you are now, what advice would you give to yourself as a new grad? So not random? New Grad, but you yourself going back in time? What would you say to yourself? So as a new grad?



I'd say accept, say, say no to lots more things. I say that because sometimes I get really overwhelmed, overwhelmed with the things I do.



I think I would say that. And if I go back in time even more, maybe like in my first year of PT school, I'd say try to



try to ask yourself more questions.



Don't think that everything you learn is true even at school.



Question things, lots more, even even if it's teachers, even if it's school, a question things, it's not always the best, the best that you learn our school question lots of things.



Excellent advice. And now where can people find you if they want to follow you? They want to ask you questions they want to get in touch where's the best place for them to reach you? It could be kind of on like on social media, where wherever is best for you. I think that Twitter is the best for everything physio related. You can go on what is it like Bell B, L underscore like, Oh, I see.



I think it's the best way. Oh, by all by email, if you text me on Twitter, it's my DMs are open. I think I can give you my email if you perfect problem. I think I don't think we need to give give your email.



Yeah, well, we'll we'll stick we'll stick to the Twitter app for now. So people can find you on Twitter, we'll have a link to that. Well, I want to thank you so much for coming on the podcast and you know, as a newer ish grad, if you are indicative of others in the field. And I think the future of physical therapy is looking really bright. So I want to thank you for coming on and for sharing all this great information with us and your takeaways from Monaco and everything else in between. So thank you for the invitation. It was really great. It was fun. I had lots of fun, at least it's got my pleasure. Good. That's all I liked to hear my pleasure. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Lloyd for being so honest and open with us about his experiences as a newer grad physio therapist and of course, thanks to Net Health. So again, they have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net forward slash li tz y to sign up for your complimentary marketing audit today to get your clinics online visibility, reputation and referrals boosted



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

Mar 21, 2022

In this episode, AAPT President, Rob Tillman, talks about leadership and diversity in physical therapy.

Today, Rob talks about being a leader, effective delegating, and the problem of bad advice by industry leaders. How Does Rob balance his life?

Hear about Rob’s journey to where he is today, advocating for diversity, and the shortfalls of the industry, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “You can’t get anybody stronger by giving them opioids. You can’t correct biomechanics by having somebody on muscle relaxers.”
  • “Change doesn’t happen overnight. Attitudes can happen overnight. Mindsets take a little bit longer to change.”
  • “Competency burns down barriers.”
  • “The key thing in business is to manage as many variables as you possibly can.”
  • “Not only do we not have diversity when we’re looking at the body types we have to work with, we’re not having systemic diversity at all in medicine.”
  • “You can treat everybody fair, but it’s impossible to treat everybody the same.”
  • “The outcome is when you get them back to doing what they want to do in their lives.”
  • “The best leader shows people how to do it.”
  • “There’s a difference between believing in something and living something.”


More about Rob Tillman

Rob Tillman is the president of Ortho Rehab & Specialty Centers. In 1986, he received his degree in physical therapy from the University of Missouri. Rob immediately saw the need to attain a level of clinical competence that would allow him to effectively address the complex needs of his patient population. With this in mind, he enrolled in a post graduate residency training program with the Sorlandets Institute which later became known as the Ola Grimsby Institute. He is a Fellow of the American Academy of Orthopedic Manual Physical Therapy and American Academy of Physical Therapy.

Rob attained the highest level of clinical certification available in the field of orthopedic rehabilitation. Since then, he has received international recognition for his research on the lumbo pelvic system and has written benchmark works on the thoracic and cervical regions, as well. Rob has presented at several national and international conferences on a wide range of healthcare-related topics. He is also a recognized authority in the arena of sports medicine, having been credited with the rehabilitation design and training programs for many professional athletes and organizations including professional baseball, a Superbowl MVP quarterback, an NBA championship-winning power forward and a four-time golf world long drive champion.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Rehabilitation, AAPT, APTA, Priorities, Education, Diversity, Leadership, Advocacy,


To learn more, follow Rob at:

Call the office: 501-975-4040



LinkedIn:         Rob Tillman

Facebook:       Rob Tillman


Subscribe to Healthy, Wealthy & Smart:


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Read the Full Transcript Here: 


Hello, this is Jenna cantor. I am here with the ROB Tillman who is currently the president of a PT and also is in charge of the ortho rehab and specialty centers. He is just a top physical therapist in the profession. We got I had the major pleasure of meeting him in person for the first time at the APTA 100 years Gala. Was it 100 years? It was, yeah, yeah, we were all dressed up, I got to freak him out with my excited energy, because I was so excited to be meeting you, Rob. And I, by luck convinced you to come on this fun ride and do this interview with me on healthy, wealthy and smart. Thank you so much for agreeing to come on. My pleasure. It same. It absolutely is just wonderful. So um, I would love to just start with if people could learn more about how you got to these leadership positions, start from wherever you feel comfortable. But I would love to hear how you got to now. I mean, you're heading these things. Of course, I mean, so many things. So please share.



Well, to be honest with you, I I didn't really seek to be president or leader of anything. I just really wanted to I went to physical therapy school and I wanted to do sports medicine. So I learned that while I was trying to do sports medicine and orthopedics most patients have that come to an outpatient physical therapy clinic have neck or back pain. So I decided to go ahead and learn something about how to deal with neck and back pain. So I did a residency with a group called Restore Landis Institute, which is now the older Grimsby Institute for four years and did a residency and passed by competencies and became what's called a level two manual therapist by the Norwegian standards. And I think it's still the highest level of competency, internationally recognized in orthopedic manual therapy, started teaching courses, and orthopedic manual therapy after I gained my level of competency and start working with the group was held South back then it was the world's largest healthcare Corporation geographically. And I started troubleshooting clinical operations, and learned how to do the administrative things. And then next thing you know, I'm a vice president. And then I'm a senior vice president, and then they have their accounting scandal. And then, so I started my own company about 18 years ago. And all the while while I'm doing my, my, my core competencies and working, you know, to make a living and moving up in the in the company I was with. I'm at a group called the American Academy of physical therapy that was established about 30 years ago. And



it was in 1989. Yeah,



it was it was a black folks that had concerns about access to physical therapy, school and quality care in the black community. And I learned about them through who is now my best friend, Leon Anderson, the third, his dad, Leon Anderson, Jr. is the founding president of the American Academy of physical therapy. And I just really started teaching what I had learned to the group and expose them to the specialty of manual therapy, and I just kind of hung around and enjoyed myself with them because that's the first time I really experienced unconditional love, professionally, in physical therapy, because they just made me feel welcome. A lady who's deceased now named Diane Ellsbury. I call her my PT mom. She'd says, Hey, Rob, baby, how you doing? And just hug me and just what do you need anything? Are you taking care of yourself? You're not working too hard. Are you just like an auntie type thing. And then I became more involved in the operations and joined a committee called the innovative services committee. And innovative services was that's exactly what it does. It does cool and innovative things like create programs, we established a navigation program for mentorship for for our young folks coming through an advocacy wing that was concerned about practice acts and access to care and licensure issues and things like that. In the process, I somehow got appointed to the Arkansas State Board of physical therapy. So that's how I ended up wearing these hats. And while I'm on the board and Arkansas State Board of physical therapy beginning about 1617 years ago, I'm currently still on the board. And it's it's rewarding. It's rewarding. It's a lot of work, but it's rewarding, and I'd rather be at the table than not be at the table for a lot of the things that are going on because our profession continues to evolve. The physical therapy profession continues to evolve. And as an E involves then we have to be able to apply the clinical concepts that we are. In general learning in physical therapy school. State practice acts can hinder your ability to perform the things that you've learned if you're not careful. So we really have to make sure that all of the practice extra current and access to physical therapy is available because we are the most green profession. In healthcare. It's all hands on care and exercise. You can't get anybody stronger by giving them opioids. Okay, you can't correct biomechanics by, you know, having somebody on muscle relaxers, you know, it's kind of hard to strengthen somebody while on muscle relaxers also, by the way, but as we're looking at all these things that I'm doing at the same time, it's just when people ask me to do something, I don't want to be the person that's complaining about things not being done appropriately. I want to be the person that's kind of like a catalyst, or at least an advocate or participant in moving things forward and making things better. And sometimes you don't get paid for. Okay, but but, but that's why I love the Academy because it's the service academy. It's, you know, it's a place to come and serve and love the people that you're with and be loved, have a positive attitude and move some things forward.



I think sometimes people get caught up into looking at the AAPT or the APTA as something that needs to serve them. The APTA is also a giant service group. If we look at it appropriately, and as we come together, and share concepts and ideas, the current leadership of the APTA has done a lot better on sitting down and really trying hard to understand the challenges of the black community, just so my my hat's off to past president, Sharon Dunn, and also the current president, Roger Ver, and, and Justin Moore, the CEO, and Carmen Elliott, who's vice president over Dei, I think that they're really putting their best foot forward on working towards things. I think that we all have to be patient, and monitoring the progress as we do blend initiatives and work together on things. Because change doesn't happen overnight. attitudes can happen overnight, mindsets take a little bit longer to change as far as our train of thought. But behavior patterns take a lot longer than that, and coordinating behavior with other groups and other people take even longer. So I've learned to be a bit more patients in my practice, and my working with folks. And I've also learned that not everybody that doesn't understand the EI or the hardships that other groups are having. They're not all necessarily opposed to other folks doing well, or what somebody would call a racist or something like that. They just don't get it. And sometimes people want to get it. And those are the ones that we have to engage in conversation with and share ideas and have our thick skin on, to work together on things and not be so easily offended because we've all got pasts. I try not to be so easily offended and angered by things. But also, I have still pretty good intolerance of people that are in denial about other people's hardships. That's a little bit tough to be in full denial about other people's hardships. And there's current legislation that's going through several states that actually don't want America to tell America's full story. Because some people aren't comfortable with hearing about America's past and some of the impressive things that have taken place in this nation. But while we're deleting some truths that need to be spoken about America's past, we're deleting the chance for especially when in this case, black people to tell our kids and society in general, the challenges that we've had, and the reality of how we got to where we are and what we need to do collectively about. So that's another thing that's happening in today's society, but I do believe in general things are moving forward. As far as being president of the Academy, I never wanted to be president of the Academy. I wanted to be the guy that shared the cool clinical stuff. And just got to hang out with people that were just loving folks. I became chair of the innovative service committee. When BV Clemens retired, one of our founding presidents. He was later President second president of the Academy. And when he retired and took a step back, I took over the innovative services committee. And then I was asked to run for the director position, which the innovative services committee reported reports through the director director's position. It's now under the director, our current director, Renee crater Dr. Crater, great lady. Man few years ago, they asked me if I would consider being president of the Academy. Are you sure you want to do that? But my skill set on big A former officer in a large company and my background and all the things that I've been working on and still doing, including being on boards and things like that fit the skill set that was needed for the president at that time. And again, I'm humbled and honored to serve as the president of the Academy. I've done it for the last three and a half years, I can't wait to get the next crew of people trained up and ready to take over as we're pushing forward on things. But right now, it still currently fits my skill set and and and I hope that the academy is satisfied with my leadership and innovation and my quirky ways of dealing with things but it certainly has been my pleasure still serve as president of the Academy.



I'm so everything you shared, i Nobody sees me. But I have this very excited smile, listening and everything. And I love hearing things. In your own words, you are a very, very humble individual and the amount of service you have provided to the physical therapy profession at large. Thank you.



So it's my pleasure. It's my pleasure. It really is. It doesn't even seem like work.



Right? And and that shows anyone who works with you, like I've known you for a blink of an eye. I mean, it's been, gosh, half a year now. Yeah. But like it from for you are so kind you know how to like enter a room, whether it's on email, or text or whatever, in the friendliest way. You are. So I find you to be so approachable. And very, as a leader, it's still no denying what your position is. I just really think you are really, you said, I love what you bring to the table. Love it, just enjoy very much. Yeah, from the from the amount of time I've known you. How do you handle things with being what doing what you're doing? And I've never asked you this before. And that life balance, you know, people talk about work life balance. How do you do that? From what I've seen, you have specific times, you're like, I am not replying back, which is great. Could you talk about that a little bit more where you kind of set boundaries and stuff. So that way, you're able to handle everything and not overwhelm yourself.



Sometimes I My wife's a surgeon, she's a breast cancer surgeon, the Chief Chief of breast cancer at the University Hospital here. She's comfortable multitasking and doing a bunch of stuff. I really want to make sure I'm a perfectionist and whatever I put my hands on. So if my attention is split, if my attention is split, I know that I'm not going to do the thing that I'm working on, as well as I could. So I do one thing at a time. I do one thing at a time. When I'm in clinical notes. Sometimes I can reply to a text sometimes I can't. But I want to make sure when I fix a problem, that problem that has my undivided attention, my total undivided attention and I'm giving it my best that I possibly can. As I'm trying to resolve the issues that I have in front of me. I love that I feel



like it's a very attainable way to approach life rather than just going just one thing at a time. Do that. Good. All right. I love that. I've actually even been doing that this week. Not even purposely because you said but now I'm going to be like Rob said this I'm inspired. I've been doing that this week where I I had it upon me to finish up the project we're working on together and I was like nope, let's hone in and now like it's at a really good spot you know now and then I moved on to it. I've already moved on to other things because again,



that's it's because even in relationships if I know I'm doing the best I can with that relationship even if it goes awry. At least I know for sure I did the best I could with it. Oh I love that. I love that so much that way you don't have any regrets. Yeah, yeah, yeah, it



makes me think of what that tattoo that that tattoo where it says no regrets but regrets is spelled in properly regards because I love that I kind of want I'm not into tattoos but if I got one it'd be either Disney or that. I love that so much. So now as when you are a leader of a as a leader of a PT how is that different from being a leader at a clinic? Like a clinic owner? How is that different?



I'll say it's the same it's just the objectives are different. Objectives are different. Okay. Now when when you're dealing with a clinical situation it to me if you're doing it the right way you're focused on your outcomes. Yeah. I'm not in a silo to where you know the orthopedic surgeons are upstairs and they own my my practice you They're gonna send me patients regardless of company, you know, so we're outcome oriented. And we get the things that are a little bit tougher than the guys that have the automatic referral that own their own PT practice. I've learned that competency, burns down barriers. You know, people don't care if your margin, if you know what you're doing and they got back pain, they're going to come and see you. That's true, that's true. But key thing in the key thing in business is to manage as many variables as you possibly can. Because they're variables that you can't manage. So being timely looking professional, okay, incompetent, having the tools that you need to get people better. I mean, how many PTSD see that, that work for a group that owns the practice that doesn't even have the tools to get the outcomes that they need, and they're working with the only resistive equipment they have is exercise to me. You know, you have to have what you need. And I'm our chief proponent of physical therapists independent practice, but I'm also a huge proponent of us owning our own businesses. And not working for groups that own you.



Yeah, we do. Uh, you know, I really see and feel what you're saying there, I have my own practice. And there's a lot to be said, because we all shine in a different way. We're all doing evidence based, but when we're able to come through as a as the autonomous decision maker that we've been trained to be, we can really help those patients, we can be a best service. I truly do believe that.



Yeah, I think so. But, you know, by the same token, we have to go the next step, and do what's defined by the way that the APTA is going, and the different academies and specialization. Oh, yeah, I've heard somebody give the worst advice at a three state meeting once and I'm not going to get the states because it might tip it off, it will. But this guy stood up and said, to the students, when you graduate, don't worry about training anymore. You already know enough, you know, you know, everything you need to know, to really make it. And I sit there. And then I asked the question, I said, Well, I think that the APTA is going towards specialization. So how does this fit in with that, but I know darn good. And well, after serving a four year residency in orthopedic manual therapy, that I'm a far better and more competent clinician. Also, you know, even being a co author and co author in some textbooks and defending my my thesis internationally at the First and Second World Congress on low back pain. It helped me to learn more, always active clinician, because I've learned more. And I have a more diverse patient population, because I'm a specialist in orthopedic manual therapy that's paid his dues. And and I believe we get superior outcomes when you go through residency training. Of any comment. Yeah, of any kind. So that was the absolute worst advice I've ever heard anybody give some young kids right out of school.



I think there's been a lot of advice out there that can be off, but I definitely think that's really, it's off. I'm thinking you got me thinking of I grew up as a ballerina. And ballet is impossible to perfect, however, that every ballerina is trying to perfect it what we're doing with our lines or bodies, you know, it's definitely out of the anatomical positions. And when you first start out like that, you learn all the dance steps, you learn all that, does that mean? I'm done? No. I'm always taking class, I'm always working to get better. And I learned so much from my life as a ballerina, I was pretty intensively in it at one point for a good portion of my life. And I learned the importance of always learning, always practicing and having to be passionate about it. Because if I wasn't passionate about it, I wouldn't be showing up and putting in my best. So having that background and then going into physical therapy as my new profession. Definitely was in line the idea of, of course, I'm always going to be learning Absolutely. What Why would that would make me the worst person to work with if I was start in one year of Tottenham?



No, I'm haunted by what he said. But it motivated me to teach something different to people in that. Yeah. With me, because I hear somebody saying something in full. He said it in full sincerity. He really didn't think anybody need to learn anymore. Yeah, but that's terrible. So let me go and teach people why they need to learn more. Yeah. Because especially when you're minority or a woman, you had better have it together. If you're out there on your own, you have better have a superior product because you're not in that good old boy network. Well, you're an outsider, also, if you better do it better.



Yeah, it's yes. And also If we're going off that you're going off with the research at the time that you learned it, we did not do diverse bodies, we do not have diverse bodies in research, we are massively lacking that, you know. So we need to be open and ready and seeking and creating more of that information to learn from to better serve.



I'm glad you're saying that because not only do we not have diversity, when we're looking at the body types that we have to work with, we're not having systemic diversity at all in medicine, because different people, the guy named D'Amato wrote a book a long time ago called Eat right for your blood type. And he talked about how different types of blood types have different types of foods that they can metabolize, and using their systems and have it not function in a fashion that's detrimental to the person. And lo and behold, different people can eat different things and perform differently. I'm gonna type O blood time, I need dense protein. Some people that are more of a type A blood type may not need as much dense protein, they may be able to make it by carb loading and eating pastas and things like that. If I eat a bunch of pasta before I go into an athletic endeavor, I'm going to suffer versus somebody else may be able to metabolize that and move forward with it. So everybody's different. And I think we're just now getting to the point to where we're paying respect to the difference in the different physiologic physiologies that different people have. And it just so happens that certain physiologies are grouped together in different ethnicities. Yeah, and because of because of that, because of that, then we have we have an evolving ability to specialize care to specific individuals. Yes. When When, when it's all mainly designed for just one certain group, or one certain physiology. Mm hmm. Body Type one certain athletic performance level?



Yeah, no different different, different, different, different levels of stress and anxiety, depending on what your background is. The stress and anxiety, someone gets the food, the blood type, that all affects healing. Yes. And it can definitely take away from the exercises they're doing.



Or give you a specific example of that, I'll give you some with COVID. With COVID. They're finding the people that get most sick from COVID have low vitamin D levels. Okay? Now, black people can't synthesize vitamin D, vitamin D is actually more of a hormone than it is a vitamin. Okay. And when you're exposed to sunlight, your body synthesizes its own vitamin D, which is a vital hormone for the basic function of your system, in your in your body. Okay? Well, black people can't synthesize as well, because we have more melanin in our skin. And the melanin reflects the sunlight. And so we have to have an increased exposure to sunlight to have the appropriate vitamin D level. Well, everybody was told to stay home for first three or four months during COVID. And lo and behold, black folks died at a higher rate than everybody else did. Okay, sky like, wet, your black folks have a more problem with high blood pressure, isn't it, and we eat the same thing that everybody else eats. But just so happens that affects us differently. And it may be because certain ethnic groups can't metabolize that metabolize the same foods the same way that other folks can. And so I think as we look at those things, and be more specific with it, we can teach through the whys. We're talking about, you know, masking up and what to do to not get COVID. But we're not telling people in specific you need to have this number of these nutrition nutrients every day. Okay, to where your system is more healthy. And your hydration level needs to be exactly this. I think that we could have done a far better job and still can have telling people what they need to have in their systems to be healthy.



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I agree. I absolutely agree. And for me, I I haven't even gone into the nutrition stuff in massive detail with my patients and now you're opening up another door I've actually been getting into cognitive behavioral therapy, right now learning about that not to become a therapist, not at all. But to better compliment how I communicate with people who could do well with it or watch out for trigger words, all that kind of sensitivities. Because the individuals I find my patients really do open up to me a lot. They have been through or going through some of the most jaw dropping things in their lives. And yes, that affects their healing. So I need to make sure I'm not triggering them. By my, the way I speak, if anything, complimenting a journey of healing, as we are working towards a healthier, healthier movement, decrease pain in their life. So yeah, yeah, I definitely get it from from where I've been with the anxiety stuff. Yeah,



you're dealing with people in their complexity. Journey, people that deal with people in the same with patient care. Now, let's go back to them. You know, zoom out zoom. And you've heard me say that, Oh,



I love that. Yeah.



So the deal is, okay, let the we've zoomed in so tightly, let's zoom out so that we can see everything again. And now let's zoom back in. Because, you know, you can teach a kid how to hit a baseball, and he can hit every type of baseball pitch at every speed. But what if he gets hit in the ribcage? Oh, you don't want to get hit the ribcage again? Right? So is that going to alter his ability to perform? Well, if he's so afraid of getting hitting and hurting, then it may be in the back of his mind that he's gonna have problems. So you know, it can alter his performance. So yeah, but the mental aspect of performance of any time. You know, my daughter suffers from anxiety disorder. And and it's hard. But we have to work through it. Because, you know, let's let's be sympathetic to us. But we need to be more patient with some folks and see what we can do to integrate them into a functional position in society. You can treat everybody fair. But it's impossible to treat everybody the same. Ah,



amen. Amen. All right, I'm going to switch completely into another because it just popped into my head. And I was like, oh, I want to ask regarding leadership. I was talking with another business owner, she's actually new to owning her own private practice. And, and then there's another person who's much more seasoned with his pride, like, yeah. And he said, I'm working on delegating more. And further, and I cringe, because we like to really Oh, that is that's it? How could you talk about your journey with delegation, because as you get, you know, the more of the leader, the higher leadership position, you do have to delegate more. How do you do you know, like,



Well, yeah, yeah, but here's what needs to happen is you've defined your clinical product, okay? You have to replicate that product, either you have to do it or somebody has to be able to produce the same clinical product that you produce. And it just so happens with mine. It's it's specific care in orthopedics with a high level of differential assessment of Neurophysiology histology and Arthur kinematics, and the appropriate prescription of hands on care and exercise from that. So if somebody comes to work for me, especially in the main office, they're not going to have their own patient load for six months. Until they go through the readings. And they they learn the basic clinical practice for dealing with an upper cervical problem, a lower cervical problem, ribcage issue. Problem with a hyper lordotic spine, a problem with a hyper mobile spine, problem with pelvic issue, be it internally, as far as pelvic floor issues, or biomechanically, when the sacred tubers and sick response ligaments are a little bit loose, and they can't withstand the normal loading. But they should be able to, they have to be able to do all those differentials in there to be a predictable application based upon that assessment and diagnosis, to where we're replicating the outcomes that we need to replicate with patients that present with those pathologies. And that takes time. So now let's go back to the guy that says that the students don't need to learn anymore. Well, they're going to get their lunch eat. All right. There are guys out there that then and ladies that have been doing this forever, that have the highest level of competencies, that'll run them out of business. If the playing field is indeed level, and there's access to the same level of referrals, and getting a good outcome doesn't mean that a person comes and says, Well, I hurt when I'm riding a bike for a long period of time. Well, why don't you take a walking instead? Now that's not an outcome. The outcome is when you get them back to doing what they want to do in their lives. Yes, that's it not modifying their life but getting them back to doing what they want to do so that they can maintain the quality of life that they desire, not telling them that well, if it hurts to bend forward, quit bending forward. No, that's not. That's not an outcome. Right? Right. modification.



Yeah, yeah. And it's so interesting you say that, because always learning, I have my practice where I'm 100% virtual. And that happened from the pandemic, I was not expecting that, and my performers love it for access everything. And it got me very into, you know, I'm not going to go into the details of what I do. But regarding outcome measures, I literally, that's what we very intensely focus on what they ultimately want to do not just like, oh, I have no shoulder pain, you know, they want to know if they can do this arm movement. And when they dance, you know, every time can they do that without having to worry about it. And then we get them there. And that is why I have a massive increase in satisfaction, because we are fully getting them to that to that their specific goals. I love them for



that. I'm very, very slow to accept praise for anything that I might do. Because the patient's the one that's got to do most of the work at the end. In the very end, and you're really is only as good as your last patient. You're only as good as your outcomes. Say that you are, yeah, doesn't matter how much you walk around talking about how great you are and how smart you are, if the patient didn't get better than you fail?



Well, because it's not about us. It's not about us,



it's about them, it's about getting them better, you know, and that is the most rewarding thing. You know, like, it's, it's,



I've built my company, we've got five facilities now. But it's one patient at a time, one outcome at a time. And most of the patients that we get come by word of mouth. Nice. Yeah. So you just get after it and handle your business and maintain and be a good steward of the opportunities that come to you. And take care of people the way that you'd want to be taking care of yourself. But back to the point of leadership. Yes. Your best, the best leader shows people how to do it, instead of trying to do



Yeah, and that's a skill. That is a skill. Oh, well,



the funny thing about it is I've always gone to church, and I've you know, I've always gone to church, and different people have different ideas of spirituality and religion. But there's a difference between believing in something. And living something. Yeah. Okay. There's a big difference in believing something and living something. And I go to church now, the preachers, my brother in law, and I was kind of skeptical because my sister in law married this guy, and he's preaching, I was like, you know, just because you got to church doesn't mean I'm gonna be hanging out at church on time. That's such a good guy. He's such a good guy, and he lives it. So now I went from saying that to actually being a part of the service every Sunday and doing devotion at the start of service. So you know, if somebody sees you living something sincerely, and not saying one thing, and then doing another and behaving in a way that's totally outside of what's your professing in a crowd, and I think that's a lot. That's, that's what a lot of people away from spiritual base. Community, is, people are observing what people are saying. And then they're observing that person's application of what they're saying. And seeing if it adds up. And a lot of times that, yeah, you know, a lot of times does, yeah, and I think that's led to a whole lot of skepticism and a lot of our religious organizations. Yeah,



yeah. Actions do speak louder than words they do. It's just like, exercises,



exercises. Think about it. Think about it, you know, you know, the only Torah or Qur'an or Bible that people see in public are the behaviors of those people that profess those religions a lot of times, hmm. So, you know, are we living testimony to the Torah, or the Quran or the Bible? Are we are we living testimony to because if we were as diverse as we are with religious beliefs, if it's obvious that we're living, right, you know, everybody, I think would get along a whole whole lot better if the Pharisees were zeroed out. Yeah,



yeah. But that's where that's where you you jump in for this leadership and for all this volunteer work, because you want to start being the change you want to see in the world and be rather than just being an outsider. Like, let's take action for this change, which I so appreciate that about you.



Well, I just I'm slow to accept it. But if I do, I'm all in. Yeah, yeah. If I do, I'm all in. Yeah. It's It's It's humbling to be asked to serve in a leadership role of any form of any form, to be called upon to serve because that means somebody thinks enough of you to ask you to think about doing something and being an agent of change or or a vessel of service. Yeah, and that's what I always think about my wife gets a lot of a lot of requests to serve as well. And so we're very understanding of one another's roles. When we're asked to do things that might eat away from our our family time.



Yeah. Yeah. Kind of hard. Yeah,



it's rewarding. It's rewarding. I love that.



Thank you so much for coming on. I know this can inspire so many people. Just when you speak if you ever are at an event and you see Do not be afraid to approach Him, He is the nicest human. Like, go say hi. Ask questions, everything like you're like, Oh, God, no, I'm gonna get



this better than others.



Well, yes, you are still human. Of course, of course. But you're very good at communicating that you're like, Hey, you said that with me. You're like, now's not the time. Let's connect another so we did, which was incredible. So yeah, it definitely just a great leader to know to learn from and just, you're just good people. So just thank you for being you.



Thank you. Thank you for having me. Yes. Turned out to be the way that you wanted it to be this time.



Oh, my gosh, this is all every time. I feel lucky.



We'll do it again, if we need to. Oh, my God, I



would love to. And then, um, how if people want to reach out and connect with you? What is the best way if somebody wants to reach uncle? Oh, I want to I want to ask them a question.



Well, they can call the main office here in Little Rock 501-975-4040 Or you can look us up on our website at ortho rehab comm and leave a message there, somebody will check it.






Thank you so much. And also don't forget about the American Academy of physical therapy. If people are curious about that. It's a wonderful service based organization designed to deal with healthcare disparities in the face of black community, but we're trying to help everybody, but our leg laser focus for us is to work with the black community and then try to help everybody else as we can.



I love it. Thank you.

Mar 14, 2022

Episode Summary

In this episode, Co-Founder of Aivo Health, Melissa Farmer, talks about the mind-body approach to treating chronic pain.

Today, Melissa talks about the mind-body approach, getting patients to be more receptive to the mind-body approach, and how practitioners can recommend psychological care for chronic pain. How can psychology work to treat people with chronic pain?

Hear about the gaps in chronic pain measurements, the psychology behind farming pain out, the Aivo Health App, and get Melissa’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “The body and mind aren’t separate. They work together, they interact, and that impacts the experience of someone who lives with chronic pain.”
  • “Just because we can’t measure it with an existing tool, doesn’t mean it doesn’t exist.”
  • “A patient saying that they’re in pain is all the proof that you ever need to believe that they’re in pain.”
  • “We all have a collective responsibility to empower people who have been living with chronic pain.”
  • “One of the most powerful tools for pain relief is between peoples’ ears.”
  • “Your identity is not your accomplishments.”


More about Melissa Farmer

Melissa Farmer is a veteran chronic pain researcher-turned-entrepreneur. During her graduate studies at McGill University, she trained with a world-class multidisciplinary team at the chronic pain center founded by pain research legend, Ronald Melzack. She earned a doctorate in clinical psychology and neuroscience. Dr. Farmer went on to pursue postdoctoral training with neuroimaging pioneer Vania Apkarian at Northwestern University, where she specialized in brain imaging of hard-to-treat chronic musculoskeletal and pelvic pain.


In 2018, she left academia to co-found Aivo Health, a startup with Vania Apkarian and a chronic pain patient/entrepreneur. Their mission is to bring insights from the top tiers of pain science directly to people living with chronic pain.


On twitter, Dr. Farmer has an international following of influencer physiotherapists who appreciate her ability to translate basic pain science research into understandable language.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Chronic Pain, Psychology, Treatment, Mindfulness, Meditation, Therapy, Trauma, Pain Relief, Mind-Body,


To learn more, follow Melissa at:



LinkedIn:         Melissa Farmer

Twitter:            @Farmer_MindBody


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


Hey, Melissa, welcome to the podcast. I am so happy to have you on I have heard raving reviews from Sandy Hilton and Sarah Haig about you. So it's great to have you here.



Thank you so much, it is a pleasure to be here with you. And today we're going to talk about treating patients living with chronic pain from a mind body approach. So before we get into the meat of the interview, can you define what a mind body approach to the treatment of chronic pain is? Sure, a mind body approach to the treatment of chronic pain acknowledges that we are embodied in these, you know, this skin, muscle bone, that we feel emotions in our bodies, that sensations have emotions that are attached to them. And it also acknowledges that all of these conscious experiences like pain and chronic pain arise from the brain. So they're conscious perceptions that are shaped by our thoughts and emotions and feelings and past experiences. So it's an acknowledgement that the body and mind are separate, that they work together they interact. And that impacts the the experience of someone who lives with chronic pain. And now here's here's the hard part as clinicians, what can we do to help our patients be more receptive to this approach when it comes to pain management, because chronic pain, any clinician will tell you is not an people living with chronic pain, excuse me, it's not a it's not an easy road. So what can we do to allow our patients to be more receptive to this? Because oftentimes people will say, so you're saying it's all in my head? And that's not hopefully not what we're saying. So got it? Oh, not at all. So one of the most powerful things I think, that we as clinicians can start with is a simple statement, I believe you, which is something that many people with pain don't ever hear. And it can be such a powerful statement, because then instead of coming to an appointment with, you know, evidence that they've prepared to prove that their pain is real, you know, tests, scan results, etc. You push all that off the table, you say, I believe that you're in pain right now, and I'm ready to help you. That's, that is, I think, one of the first pieces of resistance that we can remove, just by validating their experience.



And I think especially whenever people have lived with chronic pain, and have seen many, many, many, many doctors, they get used to this feeling that they need to



convince the person in front of them that their suffering is real. And if we just if we



if we get up that out of the way, just by acknowledging that common humanity, I think there's there's one level of resistance that's removed quite quickly. And what about providers, or medical professionals who our education, whether it be formal education school, our clinical rotations, has sort of trained us to look at scans and say, Oh, this is it. This is what's causing it. So what can we do as providers to? To break us out of that, if it's in the scan, then that's, that must be what it is. Do you know what I mean? Mm hmm. I think getting in touch with some humility. So crepe is a great way to start. Because one of the issues with scans and test results is that these are things that



scientists and the medical professional has decided these are measurable, objectively accessible, indices that we've all sort of mutually agreed, indicate that something you know, there's some sort of structural abnormality or whatnot. In other words, we're testing to look for what we know might exist. Another way of saying that is that we're only testing for the things that we've thought about before, and that we know how to measure and there's a lot of things that we don't know about and we don't know how to measure. And just because we can't measure it with an existing tool, doesn't mean it doesn't exist. And, you know, from a basic science perspective, right



My background is in basic science of chronic pain, we do not know a lot about chronic pain mechanisms. And so having sort of the humility to recognize that



the nervous system is incredibly complex, the brain is incredibly complex, there are many things we don't know how to measure, and it doesn't mean that they aren't there,



we tend to cling to tests that reflect our particular training. And from a patient perspective, what that means is that they get different types of snapshots. For instance, if someone has



lower back pain, they may get MRI scan to one, you know, from one doctor, if there's comorbid, visceral pain, which could be referred, for example, they might get a colonoscopy from another doctor, each of every every, you know, we've talked about silos before, you know, in the general field.



Each of these silos have their preferences for these different tools, and they all provide small snapshots. And it's sort of like the, you know, the blind men feeling on different parts of the elephant, you know, that really handy metaphor, just because you're a trunk expert, or you're a, you know, a, an, an elephant foot expert doesn't mean that you're able to see the entire picture. So Humility is a great attribute. Yeah. And where do you think this kind of false dichotomy between the body and mind originates from? Is it that, you know, Decart Deyan? Theory, you know, that happened centuries ago that we continue to accept? Or is it that we put more weight to the objective and less weight to the subjective? Or is it both? Or is it all the above and more,



all of the above, for sure, especially in the pain field, Decart has, he said, really strong influence, and he suggested that the body is like a machine. And you can sort of causally identify almost like a, you know, knocking down a line of dominoes. A cause effect, cause effect cause effect. And that's how you understand a more complex organism. But



what he, he sort of, it's interesting, he, he essentially said that, you know, like the body, the material, it works on different rules than consciousness. And he sort of made this blanket statement that we all accepted. So in a sense, relying on the words of a philosopher 400 years ago, is the basis for our logic today is a little a little surprising. But it's something that many people haven't questioned. And, unfortunately, in the, in standard medical training,



I'm sure you're familiar that like, especially in Northern America, in medical school, they receive anywhere between four and 11 hours of pain education,



there isn't enough time to go into the depth, the proper depth that this subject deserves. So I think that it's a, unfortunately, a reflection of these overly simplistic heuristics that medical professionals and other practitioners receive.



That that just doesn't do justice, to pain at all. Yeah, and like you said, because pain is so complex, because pain is an emotional and



physical state



that I think people are always looking for the answer. I know, patients are always looking for that one doctor, that one test that one scan that will say, Oh, this is it. This is the problem because people like logical things, right? People like well, point A, here's the problem. I can do B and I will end up with C feeling better. But when it comes to chronic pain, we can't look at the body and mind as separate. And I think a lot of people do and that does really is a recipe for some really ineffective treatments for pain. So what what can we do if a patient comes to us and they have sort of accepted that their mind body and mind are totally separate? And their kindness I must have done something I've got I've had this pain. I you know as a practice, I'm sure you've heard it. I hear it all the



Time, I'm sure I did something again, or I must have done something to flare it up. So how can we respond to that in a way that's accurate and helpful.



One of my beliefs, and this may not be a popular belief is that



the body has done nothing wrong, whenever it creates chronic pain, the body and mind it that chronic pain isn't a mistake.



And I say that from a scientific perspective, because whenever I've studied the mechanisms from the nerve ending on the skin, you know, whenever pain signals or nociceptive signals are transmitted from the surface of the skin, to the spinal cord to the brain, the body is naturally designed in a way that amplifies pain signals. So amplifying pain is how nature works. And it works that way. Because pain is a really important thing to notice. Pain is a primary reinforcer. And that means, by definition, it's aversive, you don't need to condition or to pair it with anything for an animal or for a person to try to avoid something, it's painful. And that's why it's always sensory and always emotional. It's always aversive.



And whenever, you know, as I've studied chronic pain populations over the years, and I've looked and really considered and reflected on the biological changes that I see all of these, these mechanisms that sort of turn up the volume of pain, whether it's at the nerve and the surface of the skin, or in the spinal cord, or in the brain, they're all there for a reason. And it's because the signal is incredibly evolutionarily important to respond to.



And the division happens in the brain where once it gets to the brain, and creates a emotional memory, or a fear memory. That's whenever the brain adapts and changes in response to that incoming signal. So in a sense, that's the point where the brain begins to adapt to accommodate the pain in someone's life, rather than just being passively responding to the environment. And that's one of the



one of the main features of chronic pain, where it's no longer just a, you know, whenever you see a patient to



has pain that still increases and decreases in response to external stimuli. That's a great sign because it means that the nervous system is still really closely linked with the environment. Once pain fluctuations start to vary independent of the environment, that means that it's become



more hard coded into the nervous system.



So that whenever I see patients who you know, who do have pain that's responsive to seeing the environment, I congratulate them.



But again, the idea that



it's adaptive to remember what causes pain means that it's also adaptive to create pain memories. It's also adaptive to change how you move in relation to pain. And it's adaptive, to feel depressed, and to feel anxious. Those are all completely normal, understandable responses to pain. And the



thing that isn't as natural and healthy is the inability to go back to baseline after you've hit that new state. And one of the reasons is that whenever you have chronic pain, so many experiences during your daily life, reinforce that cycle that you don't have many opportunities to learn what the lack of pain is like.



And something this is something I call relief learning. So it's natural for us to pay attention to periods of escalating pain. It's something it's a skill that can be learned to pay attention to periods of pain relief. And that's something that a lot of patients don't naturally do. And it's something that



if you don't come at it from a brain perspective, you might not see the importance of it. But anytime pain is decreasing, or it's lower than it normally is. That's the time that you should be focusing on positive emotions, relaxing the body, learning new skills, that's optimal learning time. So of that, one of the reasons I bring that up is that the the brain even though it's responsible for creating this chronic state



It's also the key to changing it and shifting back and reversing to the pain free state. The plasticity of the brain is is just a never ending thing of beauty. Absolutely. Absolutely. Well, now let's talk about, because it sounds like, and I love what you just said, it sounds like we're really focusing on sort of psychological care, which is part of care for chronic pain. And I love something that you wrote in that if mind based treatment helped my pain, then my pain must not be real. Hmm. Right is maybe something that might be in the back of someone's mind someone living with chronic pain are in the forefront. So how, how can



psychological care? Whether that be CBT, or mindfulness, or you know, there's a million different kinds of, I'm sure scientists, psychological care. So



how can people use psychological care, but not D legitimize their pain experience, not make them feel like, well, if, if this helped, then



my pain wasn't real, because if it were real, then that injection would have taken it away, or that movement or that stretch, etc, etc.



One of the things about trading



one of the things about psychology is



that sort of inherent in this illusion that the mind and body are separate



is that



whenever you have a new experience, there are measurable neuronal changes in the brain, there is a physical change that occurs, there is a measurable change that occur that occurs, even if you know we don't have the tools right away to measure it.



psychological changes are biological changes. And there's what 4050 years of science that reinforces that. So just because a psychological treatment can help doesn't mean that it isn't biological, it just reinforces that this source of the biological change is different from what you expected it to be. So I know that a lot of people with pain



you know, if for instance, their lower back hurts, or if a certain limb hurts, they assume that the source of the pain must be in that body part.



And although this is getting a little high up,



in terms of mechanisms, one of the reasons why we can even tell where our body parts are, is that there are maps in the brain. For instance, you know, one of the examples of this is the homunculus. But there are actually four different maps in different parts of the brain, that help us understand where our body is in space, and where our hand is where our lower back is. So you don't know where your lower back is, unless your brain helps you decipher where in the body map it is. So, you know, in multiple levels, this this idea of separation is really artificial, it really doesn't serve the experiences of people with pain.



I understand that.



Also, that one of the reasons why patients may adopt this kind of thinking is because they're



trying to work with the perspective of the provider who's treating them. If the provider has these assumptions, patients naturally, just to adapt, they have to play the same bowl game they have to in you know, they might do this through Google searches, or educating themselves on the web, or looking into pain, neuroscience education.



In order to be heard, I need to study the way that this is described online and in the literature, I need to be able to talk to my doctor in a way that they can understand.



And even that



even even that point where it's like I need to interpret my internal experience into something else so that someone else will believe me, I feel is sacrificing their internal experience of pain. No doctor



I almost think that like



a patient saying that they're in pain is all the proof that you ever need



to believe that they're in pain. You don't need a test. I really believe this. And so much the point that you know, I've I've I worked with Dr. Vani up caring for many years. The reason why his research



has been replicated so many times and has been published in such higher to high tier papers is because he looked at the patient's perception of pain and mapped brain signals to that perception.



He listened to the patients from the very beginning, he didn't say, Well, you have to finish the standardized questionnaire. And that'll tell me, that'll be the way that I measure whether your pain is there or not. He had a moment by moment, measure of pain intensity that he used to extract the signals from the brain during these brain scans. And that's how he found his fantastic findings that have been replicated again, and again, by different by different groups. And those are the findings that reinforced that as pain becomes more chronic, the brain regions that are correlated with the perception of pain change from sensory related regions early on, to emotional related regions within a year. In other words, after a year of living with pain, emotional brain regions are correlated with the sensory perception of pain.



Another way of saying that is that the sensation becomes emotional.



And that isn't saying that it's not real that saying that it's so real, you can measure it on a brain scan, you can see the pictures, you can replicate it across studies. It's that real?



So I feel like I've sort of No, no, gone in a few directions to answer your question. But



all all patients,



all we need to do is take patients word for their pain, we don't need any extra evidence that it exists, we just need to take them seriously. And to reinforce that, it's not your fault that you have this pain, you did not cause your illness, your body was doing exactly what it was designed to do exactly what we would expect a healthy person's body to do. It's not your fault. So let's, let's work together and find



your own path to pain relief learning. Right. And obviously, everyone's path is different and individualized. And I think we can all agree on that. There was something that you had said,



as you were speaking, that popped something that caused me to think that sometimes I don't know if you've seen this, but is it easier for patients to sort of farm their pain out to sort of third person their pain, versus first person their pain, meaning they may describe it, or they may listen to the way the doctors describe it, and not think of it as their first person pain, but think of it more as third person. And I'll give you an example of what I mean by that. So I have a long history of chronic neck pain



during my 30s, like, literally, the decade of my 30s For the most part. And I had I was giving a keynote talk a couple of years ago. And so I joined a speaker salon, or speaking group to help with this talk. And it was about they wanted me to talk about my experience with pain. So I went out there and I started it like imagine a patient walked in and had all these symptoms, right. And the woman who is not a clinician, a health care practitioner in any way. She is a writer, director and speaking coach, her name is Tricia Brooke. She said, Well, hold on a second. I'm gonna I'm gonna stop you for a second. I said, yeah, yeah. What is it? She's like, Is this about you? And I said, Yes, it is. And she's like, Well, why are you talking about it in the third person?



I said, Oh, well, because at the end is the big reveal that it was me and she's like, people know, it's you. You're up there talking about it. Like so why don't we change it to the patient and change it to me. And I started and within five minutes, I was crying so much I couldn't continue.



And I was like, This is why it's not first person because it was so hard. For me it was a lot easier to sort of third person it out or farm it out. And then going through this for eight weeks, I was finally able to get through the whole talk and someone came up to like, you know, I really liked those parts when we were first doing it when you were crying a little bit. I'm like, that wasn't part of the bit. That wasn't a bit that was me not being able to talk about my experience with pain, because it's emotional and sensory. So the although at this point now I had not had pain in years. To the extent I had it when I was speaking about it right, but to your point



The emotional attachment was still there.



So what do we do with that?



That's such a great






I think it's self protective. Initially, whenever just just as you described, it's self protective and that you live with the pain every day.



It's a way to distance yourself from the suffering.



So on one hand, I understand 100% Why people do that. And in a lot of the patients that I've seen, over the years have done that too.



I think that



something that comes up for me right now, is that the words that one person uses for their own pain are the most therapeutic words that they could






In that, engaging in the pain memory, from a psychological perspective, is one of the things that allows you to change that memory.



And I kind of wasn't planning on going here. But it's, it's an opportunity.



One of the reasons why psychological approaches to



chronic pain care have the potential to be so effective is that if pain is an emotional memory,



we know from 20 years of basic science, neuroscience, that emotional memories can be fundamentally change. There are rules, there are very clear rules.



The rules are you revoke the memory, on purpose as fully as possible.



You ideally introduce some type of contradictory experience something surprising, because that really makes the



the brain state more salient, it makes the brain pay more attention to what's happening. And then within three hours, you induce relief, psychological relief, deep breathing, I've worked with patients where we administered propranolol under the guidance of their you know, their doctors, but deep breathing is enough. And that if you are able to induce in sort of controlled conditions, these experiences where you fully experience pain, how it is for you, using your words, the emotions that come up in your body. That is how you fundamentally changed the memory structure of chronic pain.



Fascinating, you can do that in little bits across time.



Under more controlled conditions, you can do it in one big whammy exposure session.



Interesting, I think I did it in little bits over an eight week period in front of an audience



in front of a very safe audience of 14 amazing women. And you were also in a sense, potentially reshaping your pain narrative, as you're going through this, too. So you know, per Gillette Abelton.



You know, working with the pain narrative, and changing the meaning of the pain story over time is one of the another way that



that your pain story itself can be really therapeutic. Yeah, yeah, it was. It was wild. But it's it's a good example, I think of how even though I had not had pain for years, but the emotional attachment to it was so strong that I couldn't even get through a paragraph of this talk without crying. I was like, I think I need to come off the stage. And then each time it got, you know, it took more and more time, I guess before I would have like a really emotional response. But I have to say since then it was like,



like a weight off my shoulder. You know, and this is years after not years, maybe like six years after I really had more consistent chronic pain. So it was years and it was it was years after the pain had the chronic pain had subsided.



That's interesting too, because it suggests that there's a larger memory structure underneath there that even if the sensory aspects have been remodeled, the emotional attachment can still remain. And so in a sense, perhaps



that experience helped to heal the entire memory structure in a way that it you know, it wasn't quite complete just with the sensory pain being gone. Yeah, yeah, maybe it closed the circuit a little bit, so to speak. But anyway, it was it was highly, that's fantastically effective. But it just goes to show and again, I wasn't working with a professional perhaps if I were maybe I would have closed that circuit a little earlier. Or maybe not. Maybe this was the time, we don't know, too many questions to answer. So it's just right, you didn't just write for us at the right time. So, you know, just goes to show that when we're when we are treating chronic pain, we need to target the brain. Right? I think you need to have psychological care. So what do treatments look like? Obviously, reminding the audience that everyone is different, and everyone is individualized. But what are some examples of how psychology can work with people with chronic pain?



Well, so there are a number of evidence based approaches.



So cognitive behavioral therapy is one that everyone knows about Acceptance and Commitment Therapy, Mindfulness Based Stress Reduction, even pain, neuroscience education for some people. And whenever I think about these things that I typically look at the biases of the person in front of me, is the person in front of me a highly logical, rational type of person, I'll direct them to cognitive behavioral therapy, are they more embodied emotional person, they might be more open to mindfulness meditation approaches, or Acceptance and Commitment Therapy.



I think, especially people who have been in the healthcare system, go around for years and years and have some trauma related to being a chronic pain, patient benefit from pain, neuroscience education, just because it helps them get a better understanding of what they've been working with. So in a sense, you know, we have sort of a number of different tools that we know of in the literature, and adjusting each tool based on the the worldview of the patient is the best way to go. I think that's such a great way to look at it. And what advice do you have for let's say, physical therapists, occupational therapists who are working with patients with chronic pain? What is your advice to us to recommend psychological care? How, how can that conversation initiate?



And what is the best way for us to refer out?



I think that one of the best ways to initiate the conversation is by expressing empathy, and compassion, it looks like you're really having a tough time with this.



And from what you've described, it seems to impact many areas of your life, I see that you feel anxiety, I see that you've experienced some depression, I see that this stresses you out,



have you thought about support some sort of psychological support? To help you through this, that's, I think one of the most open ways that that this can, this can happen and a lot of physical therapists that I'm that I've interacted with, have taken it upon themselves to learn some of the psychological purchase, because it's almost



because they've sort of found themselves in the position of being the psychologist whether they liked it or not, or whether they had the training or not. And I've really admired a lot of the physical therapists that I've interacted with, because they've gone extra steps to learn what it is that they might need to know in order to provide better psychological care, as you know, as a physical therapist.



However, there are lots of times whenever the degree of distress or the degree of suffering, it is beyond training, you know, the training that you might have as a, as a physical therapist. So that's whenever it's time to bring in a professional



in terms of identifying



the optimal type of treatment or making referrals. That's very tricky of because there aren't a lot of pain psychologists in North America.



Even if I were to come up with a list of them, a lot of them that I know of are in academia and the people that



are in sort of the private sector. They have that specialization just



because they have lots of experience there. So it's, I kind of, I don't have, I don't have many suggestions. In this case, I do have a suggestion of a tool that I've helped to develop, that could supplement that in a way.



But in terms of finding the optimal,



as per the optimal psychologist, I think it would come down to therapeutic alliance. And that's something that each person has to feel out for themselves. And that, okay, you have a person who's highly rational, logical CBT might be the thing for them, have them talk to three different suggests they talk to three different people who feels right.



Because I'm a firm believer of therapeutic alliance, in the larger sense. And the the foundation of therapeutic alliance was best articulated by drum Frank, in his book, persuasion in healing. And one of the things he described is the healer suffer relationship. And one of the core tenants of the healer separ relationship, the healer believes that they can heal, the suffer, believes that the healer can help them. And they come together and interact with a number of rituals together, that are intended to relieve the suffering. So if you have someone who's on your side, even if they don't have the right training, but you trust them, you feel like they get you, that's more therapeutic than their training proper.



And that's, it's it's tricky. But for instance, even just talking on the phone for 15 minutes, to three different practitioners is enough to be able to get that feeling. Yeah, that's great advice. Thank you for that. And now, as we wrap things up here, what would you like the listeners to take away from this conversation? If you could wrap it up in a bow? What would that what would that present look like?



I think



we all have a collective responsibility to empower people who have been living with chronic pain.



And I think that,



you know, based on our conversation, one of the most powerful tools for pain relief is between people's ears. And I really think that that's the most empowering approach as well. And that I, at my core, I don't believe that we, that people need to rely on



doctors or medications or even approaches nearly as much as their own brains.



I, I know that it's difficult to get access to tools and psychological approaches that enable that. One of the things I'm doing,



you know, just from a, from an entrepreneurial background, is working on tools that will help people with that. But the key to long term pain relief, is teaching people to attend to patterns of pain relief, and what really feels like even if it's just a few moments every day. So my overall bold statement would be the key to your pain relief is paying attention to whenever the pain is less whenever you have time, to enjoy things in life to engage in positive emotional learning. Those are the keys to pain relief, because the more you focus on those moments during the day, and the more we encourage our patients to focus on those moments, the better they'll get, and the more quickly they'll get better.



I love that. And now where can people find you? What do you have going on? What's coming up? Let us know. Yes. So one of the things that I've done in the past few years after leaving academia, thank goodness, is I co founded a startup with Vanya, up Korean and a chronic pain patient, make Mika Michalak. So he's an entrepreneur, finished entrepreneur who has had chronic pain himself. And we



created a tool that is essentially insights from Bonniers research in an app form.



And it contains Mindfulness Based CBT exercises and tools that I wrote, and pain neuroscience education that I wrote. So in a sense, it is a expert created tool that is designed to give all of these insights directly to a patient without them having to rely on doctors or any formal care.



Because one of the apps Oh, the app is



Ava health app.



So if you go to www dot Evo, you can learn more about it. And one of the one of the things that I it's a real conviction of mine, the science that's needed to heal chronic pain exists today.



You know, this is work that Vanya has been doing for years. And the time that it takes to sort of for that knowledge to trickle down to clinicians and to, you know, clinical guidelines, is 10 to 15 years. And one of the reasons why we decided to do this was because if it exists today, patients deserve to have it today.



So it's, it's a labor of love.



And I invite anyone listening to this podcast, to recommend to check it out yourself, to recommend it to your patients. And to contact me directly at Melissa at Ava If you'd like some more information about how to use it to help your patients. I'm very open to that. I love it. And we'll have the link to that in the show notes at podcast dot healthy, wealthy, smart, calm. And again, that website is www dot A i V as in Victor Oh Just so people have the spelling of that.



And now one last question that I asked everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self, let's say a fresh face out of grad school or maybe undergrad wherever you want, wherever you want to take that starting point.



I would say Melissa,



you're either identity is not your accomplishments.



Think about what



drives you what creates the most passion in you. It's to help people get better. And to support people while they're healing.



instead of chasing after the shiny ego cries that other people applaud you for take a step back and focus instead on what makes people feel better now make choices to help people heal.



Now, don't worry about long term research because long term research won't help people now.



I love that advice. Thank you so much. This was a wonderful conversation. I always learn such I always learned something new. And this was a lot of new so I want to thank you for coming on. Thank you so much for having me. And I really appreciate it was wonderful and everyone thank you so much for tuning in. Again. If you have any questions for Melissa you can reach her at a vo help calm and have a great couple of days and stay healthy, wealthy and smart.

Mar 7, 2022

In this episode, Dr. Jenna Kantor talks with Dr. Drew Contreras about the rigors of working as a PT for the President of the United States. 


More about Drew Contreras:

Drew Contreras, PT, DPT, SCS  – received his Master of Physical Therapy from Gannon University in 1998 and his Doctorate of Physical Therapy from the University of North Carolina at Chapel Hill in 2008.  He is board an APTA board certified Sports Clinical Specialist since 2003.  His professional interests are sports medicine; manual therapy; blood flow restriction; bio-technology; musculoskeletal injury prevention, diagnosis and rehabilitation as well as human performance optimization.  

Serving over 20 years on active duty as a career military officer and practicing physical therapist within the US Army & Department of Defense, Drew has served in a number of settings and military units throughout his career before his retirement in 2020. He spent his early career at Ft Benning, GA and then moved on to Ft Bragg, NC.  His skills were put to work extensively in 2006-2007 during a 15 month continuous deployment during Operation Iraqi Freedom where he was the first physical therapist to serve in sustained combat operations with the 82nd Airborne Division. After returning Drew moved to Washington DC to work at the Pentagon Health Clinic where he served as the Director of Wellness and Physical Therapy.  During this time he served as a consultant to the White House Medical Unit and was then chosen as a by name selection by President Obama to serve as the first ever full time physical therapist at the White House.  There he served as the Physical Therapist to the White House Medical Unit and President of the United States Barack Obama from 2010 until the end of the administration in 2017.


To learn more, follow Drew at: 

His Website



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Read The Full Transcript Here:

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, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and referrals, net Hills Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using NET Health's private practice EMR, be sure to ask about his new integration, head over to net forward slash li T zy to sign up for your complimentary marketing audit today. All right onto today's episode, Dr. Jenna Cantor is back and today she is interviewing Dr. Andrew contrary us he received his master of physical therapy from Gannon University in 1998 and his doctor physical therapy from the University of North Carolina at Chapel Hill in 2008. He is board certified sports clinical specialist and has served over 20 years on active duty as a military officer and practicing physical therapist within the US Army and Department of Defense. He has served a number of settings and military units throughout his career before retiring in 2020. After retiring drew moved to Washington, DC to work at the Pentagon health clinic where he served as the director of wellness and physical therapy there. During this time, he served as a consultant to the White House medical unit and was then chosen as a by name selection by President Barack Obama to serve as a first ever full time physical therapists at the White House. There he served as the physical therapist to the White House medical unit and President of the United States, Barack Obama from 2010 till the end of the administration 2017. He has worked with a wide variety of government officials as well as police and law enforcement agencies. And today he's going to talk a little bit more about his experience. And it just goes to show you that there are so many options and so many settings that physical therapist can work in. So I think Drew and I think Jennifer great episode. Hello, this is Jenna canter so honored to be hosting this podcast for healthy, wealthy and smart. I am here with Dr. Drew Contreras who just said Just call me Drew. And I was like, Oh, that's so cool. So Drew or gesture is one you want to get his autograph when you know what he has done. This is the the physical therapist for Brock Obama and Michelle Obama. And then the current president and first lady, which is just not and as soon as I learned this, and then got to hear him speak at a conference. I was like, this is somebody that I am desperate and enamored, inspired by must feature on this podcast. And I approached him a complete stranger. At this conference, I sat right next to him dinner and as he didn't know me, and he said, Yes, this superstar said yes to doing this podcast. So Drew, thank you so much for agreeing to come on to this podcast. My pleasure. Right, like






is I appreciate the kind words thank you very much. Absolutely. And that's how I'm going to be approaching this this podcast as a young professional in the physical therapy industry that saying, How did you do this? How did you get to this point, and we're just talking about executive medicine here to really understand point a point B, I feel like from the conversations I've had with people outside this podcast, there isn't one way to eat a Reese's. It's not some clear pathway if you want to get this way you you're gonna fit in this box and it's very much like the performing industry. It's like there's no it's not one agent that's going to get you that movie. So we're here to just hear hear your story where where you got started and how that led to such a



prestigious and how honor what an honor, I have a position to get to do. Yeah, um, so I think that



I think that regardless of like what you're pursuing, right, whether



That's, you know, working in executive medicine or like you said, working with a performing arts group or, you know, working with a traveling band or a sports team or whatever, right, I think the thing that people



really de emphasize, which is the exact opposite of what should happen is, you need to be really, really good at what you do. Right, there needs to be no question that you are exceptional about what it is that you provide. And I think that people get lost in wanting the end state. And they, they don't go through the process properly. Right. So just just to be blunt, right? Like, if you've got, you know, 18 months of experience, you probably shouldn't be the person on the sidelines on a high contact sporting event, who's the only person that's available? Right, that's probably not the best plan. And likewise, right, like, you probably shouldn't be the sole healthcare provider on a plane someplace when like, you barely really know what you're doing it. So I think that people get confused with, in order to get to the end state, right, I need to go through these, like, I need to know somebody or I need to, I need to have a, like you said, there's a person who will get me there.



The only thing that will ever get you there is is being exceptional what you do, right? Because when you start talking about things, especially like executive medicine, you have to realize that the people that make it to this point or this level up are exceptional at what they do, right. And they have made a living off of calling people out on the BS card. Right? Like, they know when you are not exceptional at what you do, because they they've seen it for so long. So if you're not at least there, right, if you haven't found your, your, your apex of your skill set, it's not a place you want to be. Right. So first get there, right, get really, really good at what you do. And then if that's if you've made it to that point, opportunities will unfold themselves, right? If you're prepared if you're really good at what you do. So I think that's the best thing I can say to people is, like you said, there's no, there's no cookie cutter path to getting into this, as there shouldn't be right, because it's certainly not for everybody.



Yeah, I think that's really well said, and I want to tap on the assessment of what it means to be good at what you do. And this is my opinion, but I'm going to put it in here. And then I would love your thoughts. But don't base your success off of other PTS opinions based off of other patients opinions.



I think we really mix that up. I think we really do. And it's just not everyone. What are the patients saying? What is your success rate? There are the ones that if they do get do they come back to get I would base it off that I think we worry too much about what our



comrades that's the word that's in my head right now are thinking. I think you're absolutely right. Right. Like if



I think there's a difference between



external validation, right, which is kind of what people say about you. And that can be rewarding, right. It can also be incredibly destructive, but but it can be rewarding for some people. And that's different than than defining



a level of expertise or level of success. Right. That should be pretty objective. You should be able to measure that with clinical outcomes. You mean, like you said, even just sheer recommendations and referrals from existing patient? Right, or sources? Right. That's it. That's a better



litmus test than who said, what about you on Twitter? Yes, yes, yes. Or if you're, if you're there a different way. So what about you or say you go to a conference like CSM, and everybody has been in this industry for certain periods of time. And when we create relationships with people, the ones where we are really more connected to we just generally bond with just like our friends in life outside of the business? Are even if they're not, you're not friends with the right people. It doesn't mean anything. It doesn't mean anything. I have a friend who just got on Broadway, she had zero friends who are on board, you know, like, she wasn't like, let me see of friends on Broadway, but not like close, close. You know, I just I think we can get stuck in that. Like, I'm associated with them. So therefore, like I can't, in the, like I said the reality is, even if that association gets you a conversation or a phone call, right? It won't sustain you for very long. Yeah, yeah, absolutely. What is the schedule and



Life, like in regards to when you're doing such a high profile job? Yeah, you know, I bet



I think I would average it out to people would call me get a hold of me at least two or three times a month and say like, they wanted to be the White House physical therapist, and I finally got it down to like, okay, um, that's, that's great that you're interested, I need to know, if you're okay with this, you will not have any vacation days throughout the year zero, you can never buy a ticket. That's non refundable to anything, you must be okay, giving up attending any sort of family event, kids sporting games, whatever it may be.



In the event that you actually do get to go on vacation somewhere, you must be okay with it, they call you you have to leave immediately and come back. If you're okay, with these basic things, we can have a conversation, right? And most people immediately are like, well, that's not what I wanted. I just wanted to fly on a jet. You know, and, you know, have people think that I'm, you know, in this prestigious environment, like



all these things come in a price, right? It's, it's not, it's not an easy price, right? I will forever



hold Brock Obama responsible for the fact that we both started there with black hair, and ended up with gray hair.



super stressful environment, it's long hours, it's unpredictable at times. chaotic, and it's just not an easy place to to exist in, if you aren't already comfortable in your own skin, right? So to basically understand is that



your professionalism has to supersede what your personal goals are, or your personal life is if you're going to be successful in that environment. And that's just the level of dedication that it takes. When you say professionalism. Would you mind defining that? Because professional means of a profession? And so that can be very vague. Yeah, I think that it means right.



I think that it means that you need to be willing to put forward



your best on any day in any place, and do the best you can for those patients, or those people that you're serving. And it's really, you know, kind of a, a selfless service attitude that would make you successful. And that's what I mean by professionalism. Right? It has to come first, right? It doesn't matter if you had, you know, plans to do a thing, or you were supposed to be going out to dinner with your spouse or whatever, right? Like, that's the level of professionalism that's expected. Absolutely. I like thank you so much for that. I was thinking it was singing, it actually really reminded me of swings on Broadway, they have a very similar situation, except they're not the main person, but they have to be available at a moment's notice. So just like and during the Christmas breaks that the leads or the ensembles take, they're the ones that jump in, and if anything comes up, they're the ones that are, I mean, if I want to say somebody who truly has probably the least brake, in the run of a Broadway show, it's the swings. So that's it. That's just where my brain went. because theater is my background theater is my sport, my sport. Absolutely. So I like that. That's so interesting. And, and I think it's always good to know the full picture of what it means to do something. I'm going to compare it to Broadway and musical theater because that's what I know. It reminds me when including myself when you first graduate school and you're a performer, singer, actor, dancer, you're like, oh, I want to make it on Broadway. However the schedule on Broadway, it's six days a week, one day off, the main holidays you are going to be performing that's when you have the most people attending. You're going to miss on so many things that go on in your life for being dedicated to the Broadway show. So knowing that you're going to miss so much of life not just a little like a lot like your nephew's events, whatever you're going to miss everything. And in in your downtime the days that you have one show your whole day is revolved subconscious or consciously around putting on your best performance that night so you have to be careful with your energy everything because that is there that is your main job that's your main go to so it it really does sound so reminiscent of that you got to have a passion for it as much I do think there's a little bit more selfish and that's okay to be selfish. It will regarding performing because you are a person who loves applause loves that stage and everything you are of course giving I would say it's like



5050 But I do think it would be different compared to the physical therapy job that you're doing. Because the only reason why and we discussed this before, the only reason why we can even say your name in association with a be with these people is because they have publicly said your name, you know, and that's that's an end. But if you didn't have that we would not that's that would we would be doing all this other words to go around it appropriately, you wouldn't talk about in the reality of it is



another, I was doing something else. And somebody asked me, they were like, What would you consider one of the biggest achievements that you've done professionally? And I would say that



until after 2017. Right? Nobody knew who I was and what I was doing. Right. And that was that was my goal, right was that nobody knew that. I was a White House physical therapist, nobody knew who I was where I was at the things I was doing, because that was the job. Right? The job wasn't to be. It's not it's not the world's business. Right. Right. And then so, and I think that that's fair. Right. I think then that and I think that that's really important. And then so like you said, you kind of have to understand that like,



the people who are concerned with the trappings, right with, like, what do I get out of it? Right, will be severely disappointed. And executive medicine, because that should never be what it's about. Right? It should never be about what are you getting out of it? Because if that's the case, you know, you won't be doing it for very long, right? There's, there's a saying in the in the Gulf PT community is, you know, if you want to be around a long time, you don't want to be around all the time. Right. And basically, what that means is like, you should not be trying to be, you know, the inner circle person. Right? You shouldn't try to be the best friend of these, these high profile individuals, if your goal is to, you know, be of service and do your job for a long time. Because you because that's just not the way it works. Right. So that's just kind of a reference point that I, I found, just like you said, very similar to performing arts, right. It's just kind of there's there's parallels and all these different sub communities. I mean, it really goes back to just loving truly loving what you do, and it's okay, if you don't, it's okay. Not every job, or every specific thing is meant for everyone. That's why we have so many different options and more options keep popping up after the pandemic now.



Yeah, you have to love what you do. You have to love what you do. See, I love being the center of attention, because I'm a performer and a physical therapist. So I know, right off the bat, that couldn't be for me, because for me not to be able to be like them. And the way that I was in like, doing a whole photo shoot there trying out different heels for the photoshoots. All that stuff. Like that would be the I would be the worst person because I'd be mourning getting to do that. It's so right. So there's always the question, people would ask, like, Oh, can you do this there? Or can you do that? Or can you do this? And the answer is always you can do whatever you want on your last day. You want today to be your last day. Feel free to do that. Yeah. Yeah. I mean, it's HIPAA compliance. I mean, that's the biggest thing. It's a HIPAA compliance. And then we have people they're just taking care of the United States.



That's such a high level. It's such high level, you know, I mean, wow, wow.



I was wondering for you, because it's this level of executive medicine is very



high profile. There's a lot going on there. I'm not asking for details behind the scenes. That's none of our business. But I'm, I'm curious about how it affected your stress levels and your anxiety while there and how you manage that during that time to make sure you were able to be fully present and helpful, even though it may have kind of fallen on your shoulders a little bit. And on that note, we'll take a quick break to hear from our sponsor and be right back with Drew's response



when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about this new integration. Head over to net forward slash li tz y to sign up for your complimentary marketing audit.



You know the best way



to kind of describe that



Is is, I think that it's important to surround yourself with, with people that are understanding of your situation, right? Because because



it's inevitable that you will have conflicts or that you'll have to back out of things, right. And if people don't understand your situation and the level of service and dedication you have, they just think you're selfish, right? So like the, I'm sorry, I know, I said, I was gonna come to your barbecue, but I just can't, I can't make it now. And, and I need you to be okay with that, and may not provide you an explanation of why. Right? And that's a hard thing, right? And you will find out pretty quickly, like, who, who's accepting of you and who's not? Right, because because most people will just stop inviting you to things right? Or they'll just, they'll just cut you out of their life. And there's some degree rightfully so. Right.



So I think it's just important to make sure that you surround yourself with that. And if you're a person with the family, right, like, this has to be an honest conversation that you have upfront.



This is not something that you kind of tiptoe around or like, make it up to you. Like, you'll be saying that forever, you'll never make it up, right? It just needs to be an acceptance of like this is this is part of what's acceptable.



And that's not like you said, That's not for everybody, right? It's absolutely not for everybody. So I just think that in order to be able to perform at a sustained sustainable level, right, for a duration, not just like,



once, or like, twice, right, but to continue to do that, you have to accept that. So I will. Another thing that comes to mind is, I once saw an interview with Michael Jordan, who is, you know, arguably one of the greatest basketball players of all time, regardless of what you think. Right? And Michael Jordan was interviewed and, and, and he said, you know, what's, what's it, what's difficult about it, and he said, you know, people who want to be Michael Jordan for a day or a game, you know, like, of course, I'd love to be Michael Jordan for a day or a game. But being me for a season, right? Or for a year, or for a couple of years of a championship run year after year after year, right? The commitment and sustainment that that requires, like, people don't want to do that. Right. And that's what I would say to people to like, it's super cool to work at the White House for a day for a weekend. Right, right. But do it for do it for a year, or an administration. Right? Or be stupid enough to come back and do it again. If somebody asks you, right, like, that's, that's a whole different level. Right? So it's super exciting. You know, it's interesting for for a weekend or a day or whatever, but like, but long term, right? Like, it's a commitment. Yeah, that makes me think of certain roles. I'm always going to bring it back to theater because that's my brain. It makes me think of Elphaba in in Wicked or Vita in Aveda, where Aida and Aida where they are literally doing like vocal aerobics, they don't stop singing. So when they are outside of the show, from



what I've learned, and especially if you're talking about a Broadway one, so they are doing what is it seven to eight shows a week, they get the one day off, they are not talking much outside of that show. If you want to reserve like or if they do they know what they can and cannot handle. Because the amount of singing. Elphaba I've learned is such a difficult track because of how you're, you're going from one part even if you're not in a scene for a moment you're rushing doing a costume change it's it's a very non stop role. So if you are looking to lose weight, no,



no but it so it just makes me think of that, you know, different things can cut you out of living your life, which is why I've always said I would love to do Elphaba at a regional theater for three weeks.



done done like like he's like Michael Jordan said for temporary. I think it's so good to take in this perspective and take things in as a whole. We were talking when we met the group was discussing how really understanding in this is a bigger picture thing but really understanding what physical therapy is before you even decide to join the profession as a big deal that needs to be much more transparent. And we can sit there and see all these shiny other things like oh, I want to trade for Broadway or I want to do executive medicine or oh, I want to work for this sports team. But really asking yourself all the tough questions on what goes into that? Well, I mean, if you're talking about money, great, but like, Have you ever had money and then like how fast did that money go? Did it really make you happy? So many so many things on that.






the details of the job will that will you enjoy that? That's your life. You're going to spend the majority of your time on the job not



off the job. So you got to make sure it's something that you like and really do your due do your due diligence in that. But I think it can be very difficult to give and provide the full picture to for anything. I don't know, I don't really know, have a clear way to make it clear.



I think that



I think that like part of that, I think is our own fault is PTS, right? I think that the general public struggles to understand what we do as a whole, right? It's, it's easy to do it in in subsets. Like it's easy to understand. Okay, well, I was on crutches. And I had a cast, and then I had to see a PT because my ankle was broke, right? Or the, you know,



mom had a stroke. She's in rehab, she sees a PT every day, so she can get better and come home. But the hard thing is like,



the professions bigger than that, right? It's, it's more and we've overcomplicated it instead of really kind of simplifying it down. Because the reality is right. What do PTS do? Well, we help people do whatever it is they want to do. And we get them back to or allow them to do the things that they want to do.



And that's it, that that's the that's the big selling point of it is, if you're not interested in doing that, I'm, like you said just about every day of your life, this is not the right profession for you. Right? Like, if you thought that, well, I would, I will have a very nice car, and I will have these set hours and I will you know be able to do these things like you're going to be miserable hate because I think that people didn't get into the profession for the wrong reasons, just like any job. When eventually, right? It will be taxing to you. And if you're not down with whoever that person is, it's you're talking to and working with, if you're not okay with, I'm here to get you to where you want to be. So that whatever that thing is, whether that's walking your kid down the aisle at a wedding, whether that's going on a hike, again, whether it's walking the dog, right or like putting your shirt on by yourself, right, whatever those things are. Now in a handstand, of course,



like if you're not okay doing that,



we're never going to be happy with with what PT does, right? So I think that that's the thing that people need to kind of understand if I wish, if I had anything to say to anybody who's listening who's like thinking about it, think about that. Are you okay with doing that, that be your role in life? And if that is not appeal to you, you need to find something else. Yeah, absolutely. Absolutely. It really is a



job board, you're of service, but you have to love being of service in this manner. Like if it doesn't feed your soul, like then how, like no money can ever pay you enough. It's never never enough. It'll never be enough. And that's okay. That's okay. It's I take like, exactly, you got to figure out what you love. I feel pretty lucky. Because I went into school, dreading that I was going to school and I felt like public embarrassment in the musical theater world because I entered school as a quitter. Because that's what it looks like, like, I'm leaving my profession. And so I had people offering me get professional gigs while I was in my first year of school. And I was embarrassed. Meanwhile, other people were posting and going, Oh, I started up in school, because it was a prestigious school and everything. And I was like, quiet for the first at least a year, if not more about what where I was.



I mean, it's all perspective. But then I learned I got a sometimes don't just take that one experience. And for me, I had that which was beautiful, seeing how it can change people. And yeah, yeah, but if that doesn't work for you, it doesn't work for you. I love that. Yeah, so for you. In executive medicine, I don't know if you know, the data on this. I don't even know if it exists. But is there kind of an average of how, how long medical professionals usually stay within executive medicine? Or is there kind of like, usually it's about five or 10 years or something just because it is such a commitment and you're talking about family and all these things. Just wondering, I think that there's a there's a there's it is a



Oh, I think there's a short hump and a long term home. I don't think there's a lot of people in the middle. Oh, interesting. Yeah. I think that if most I would probably say two thirds right. It's a short



I don't know. I'm guessing you know, five to seven year experience, right? The people



Do that short. Yep. And then



yes, yes. I think there's nobody that's kind of in that like seven to 15. Year. And then I think you get another the the last third is in the 15. year plus right. So wow, a career choice, or have made that shift for whatever reason. In that direction. I think they kind of stay there.



But I don't think it's, yeah, yeah. I don't think it's a mid career thing. It's either a stop along the way, or eventually it becomes your, your pathway. The business side, I have a real dorky question here. It's not dorky. And because there are people who be curious, I'm curious about documentation. For some reason, I feel like it's gonna be theirs. Let's compare to a Rite Aid receipt versus a CVS receipt. I feel like it's probably a CVS receipt, am I wrong?



Here's what I would say. Right?



If you treat everybody the same, and document the same, you're always okay. That's it. Right? In, that's where you have to be, again, like you got to be good at what you do. And you got to be very comfortable with that, right? Because



you people, you'll be second guessed right, there will be consultations with other providers. That's just the nature of executive medicine, right. And so you need to be okay with what you're doing. And documentation is part of that, right, making sure that you're you're very clear about your plan of care and the things that you're doing and why you're doing them.



But if you, you know, if you do it the same, it doesn't matter, right? It's universal precautions, right? If you if you do it the same no matter what you're good to go. So that that'd be my two cents on that. And then we also think it might differentiate and regarding plan of care, because we're talking about exercise adherence, which is something that physical therapists are was talking about, it's one of my biggest passions is getting exercise. And it's so great when it works.



For your patients in general, that have a high anxiety life, lack of sleep life, how do you achieve that adherence in a realistic way to get results? Does that make sense? I'm trying to generalize, even though every patients different, but this is we're talking about a very specific level of high stress. Right? I think that you have to understand that when you're working in this kind of subset, the biggest commodity for people, their biggest asset, the thing that is the most valuable to them is time, time is their most valuable asset, right? It's not money, it's not, you know, I have stuff do I have, you know, it's not the resources of equipment, or what, like, it's time, their time is very valuable.



And you have to, you have to be a good steward of that, right? You have to respect that. And so you have to,



you're not going to give somebody you know, a printout with 15 exercises, that's going to take an hour and a half for them to do and tell them to do it three times a day, right? Like, this is not how this how it's gonna work. Right. So I think that if you understand that concept, in build your plan around that about what is the most effective thing I can do with you, or this amount of time, which is limited, and then you have to understand that that's, it's finite, right? There's not It's not unlimited, that there's a million priorities that are trying to take that time. And if you are, are good about using it and understand that it's a limited resource, then they'll appreciate it.



I just realize you have unusual, wonderful access to collaboration over there. And I started to think about food. Could I mean, you could No, here's, here's No, there's a purpose, because digestion, if their digestion is off, that actually can have a big effect on their healing process. Have you had opportunities to collaborate with the the shatter? That is so cool. Oh, that is like the best. Right? And again, right, like you, you have to get the most value out of the things that you can write. And it's really interesting in this world is that like, it's, it's usually a matter of making sure that you know, that people are meeting the caloric minimum, right that there because again, they're so busy, or figuring out what is the more effective way of doing this or how can we provide the requirements despite a busy travel schedule, right, or all the other you know, things that are demanding and then right and then also right, like, yeah, work with chefs nutritionist. Work with other



With personal trainers, massage therapists, you know, other health care providers like you just so cool. Like you're part of the bigger picture.



If you're there for that it'll work itself out. Yeah, it sounds like I mean, I'm sure there are discussions that have to happen. But it sounds like the dream collaboration because you have access to literally everybody in the picture that you would want to be present in the picture there. That is just so cool.



Like, Oh, yes. Oh, God, if I said that to any of my performers, hey, can you connect me with your, your nutritionist or your chef, so I can work? And be like, Are you kidding? Get out of here.



But wow, that's that's really, really cool. That's, that's getting the opportunity for next level. Next level stuff. Um, I was wondering if you have any fun memories from your first day on the job without getting specific about the individual, but just any? Yeah. So. So the very first day,



you know, I'm working with President Obama, right. It's a



White House is an interesting place, because



there's the work areas, there's were offices and whatnot. But then there's also an area called the residence, and that's where the family lives. And it's off limits to the staff, like people don't, nobody goes into the residents. That's their home. Right. So I was going to see the President and



in order that we were going up through to the president, so we get into their private elevator, right. And it was, you know, people that Oh, my God, he's getting in the elevator with them. And I didn't know any better, right? So I just, I just introduced myself to him. He's like, okay, hey, come with me. We're gonna go on the elevator and go upstairs. And, you know, I'll get changed up and then we'll go start work. I was like, Okay, great. So I come in the elevator, and he's like, you know, Hey, man.



What part of the island are you from? And I was like, I'm sorry. He's like, You. You're from Hawaii right? Now, in context. He's Hawaiian. Right? And people probably can't see me, right. But, you know, I'm absolutely a Pacific Islander. And I said, Actually, man, I'm from Cleveland. And he was like, wait, what? I said, Yeah, I'm, I'm from Cleveland. He's like Cleveland. And this was big, right at the time, where LeBron James had just left Cleveland to go to Miami. And if anybody knows anything about Obama, he's quite the basketball fan. So he turns to me and says, Cleveland, ah, that's too bad about LeBron. Like, without, like, I just met this man. Like, and, and so like, you know, growing up in Cleveland, like, I immediately got defensive. And I was like, well, that's too bad that Chicago sucks and everything. Right? So like, immediately, like, and then I was like, oh, oh, I'll be shooting that right. Like, but like he put, I just was completely caught off guard and put me on my heels. And I got defensive about clean. He was like, looked at me, and was like, we're gonna be okay, like, we're gonna get along. All right, right. So that's great. Then people always ask, like, What are you talking about? What you know, what things and things I would tell people is, like, we talked about three things for the majority of our entire interactions, sports, weather, and kid. Those are the three topics that we could talk about, if the conversation ever went somewhere else, right? My answer was usually, like, there's probably somebody who could talk about that, but it's not me. But you mean, referred to. And I think the weather is going to be crappy today, right? Like, and I kind of focused on that right to make sure that I was doing my job, right. And those topics we kind of came to through through just general conversations, these topics are safe and easy for us to talk about, and allowed him to be a patient and allowed me to be a clinician. Yeah, because if you want into anything else, Woof woof. Yeah, yeah. Yeah, too much. That's really cool. I like I like how you found a way to be sensitive and helpful with that sensitivity, you know, to give a human a break.



For real Oh, that's so magnificent. I think this is perfect. We're going to end here thank you so much for coming on. I'm not sure if there is is there a way for people to reach out to you and contact you if they wanted to? I don't know somehow connecting you can probably the easiest way for the general audience is just find me on on social media. Right? You can find me on Twitter, you see on Twitter. Yeah. DC underscore PTS easy to find me. You know, and eventually I'll, I'll look at it and get back to people but that's probably the easiest way for Pete for this audience to get a hold of me if somebody you know, is interested or just wants to you know,



Here's something else let me know. Thank you so much for coming on and looking forward to people. Hearing this interview I have learned so much and grown so much and honestly just left very, very inspired. Thank you so much drew for coming on. Thank you. A big thank you to Jenna and drew for a wonderful interview. And of course, thanks to Net Health for sponsoring so again they have a new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net forward slash li tz y to sign up for your complimentary marketing audit so you can boost your clinics online visibility, reputation and referrals. Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy And don't forget to follow us on social media

Feb 28, 2022

In this episode, Founder and CEO of CARR, Colin Carr, talks about commercial real estate for healthcare professionals.

Today, Colin talks about the top mistakes healthcare providers make with their office leasing, the financial side of real estate transactions, and important considerations when making decisions on lease agreements. Should business owners buy their space or lease their space?

Hear about how and when to negotiate, the importance of having representation, and hear Colin’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • The best time to negotiate the lease is typically 12 months before it’s going to expire.
  • “If you were serious about capitalising, you would’ve engaged an expert.”
  • “You should not be telling the landlord anything that hurts your posture or position.”
  • “When it comes to real estate, talk to real estate professionals. Don’t talk to other doctors about that stuff if they don’t know what they’re doing.”
  • “Realise what’s on the line. If you make a mistake in it, the world’s not going to end, but it will cost you hundreds of thousands of dollars in additional payments that you could have avoided.”
  • “Surround yourself with the most successful people that’s you can get around.”
  • “There’s no substitute for hard work.”
  • “Work it as hard as you can and then learn from your mistakes.”


More about Colin Carr

headshot of Colin Carr Colin Carr is the founder and CEO of CARR, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to help them achieve the most favorable terms on their lease and purchase negotiations.
Colin has been involved in commercial real estate for over two decades and has personally completed over 1,000 transactions. Colin educates thousands of healthcare professionals, administrators, business owners and students on an annual basis through national meetings, conventions, study clubs, associations, universities, and webinars.


Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Commercial, Real Estate, Negotiations, Representation, Leasing, Finance, Business,


To learn more, follow Colin at:


LinkedIn:         Carr Healthcare

Facebook:       CARR

Instagram:       @carrhealthcare


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read The Full Transcript Here: 


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



Glad to be here.



And so today we're going to be talking all about commercial real estate for healthcare, healthcare practitioners. So this is something that you've been doing for quite some time now since 2009. So before we get into the top mistakes healthcare practitioners make when it comes to their office space, can you give us the quick version of how you got into this space working particularly with health care professionals when it comes to their commercial real estate and office needs?



Yeah, absolutely. So started in 19, Managing apartment complexes back in East Lansing, Michigan, little bit away from where I grew up, moved to Colorado, my early 20s started managing some mid rise, high rise complexes, downtown Denver, and I got into brokerage about 23. And I worked for a gentleman that did a lot of large national retailer. So Walmart's Wendy's blockbuster. And that's how I got into brokerage over the years, I started doing more industrial, more office. And a couple years in, I started doing medical office buildings and working on hospital campuses, Class A medical buildings, and just fell in love with working with healthcare providers. And after a number of years of doing that, I realized that the healthcare industry was one of the largest, most unrepresented segments and all of all of real estate, you know, every time there was a listing, there'd be four or five brokers trying to get that listing, whether it was office or medical. But when it came to actual doctors running around town trying to find space or trying to negotiate, I didn't see anyone doing it. So I've made a focus made an intentional effort to start helping more healthcare providers, and then in 2009, launched our company.



That's excellent. And as most health care providers can say, we did not go to school for any of this stuff. I can say, as a physical therapist, I didn't go to school to understand how to negotiate commercial leases, and office space and things like that. So having professionals with the best interest of the healthcare provider in mind is so incredibly helpful. And I'm sure you're quite busy. But now let's get to what are the top mistakes healthcare providers make with their office space and their leasing needs, so I will hand it over to you.



Okay, so we'll have a couple there's, there's more than a few. The first mistake that healthcare providers make is they don't know when to start the negotiation. You've got healthcare providers that are trying to negotiate with two, three years left on their lease, and there's no leverage, there's no incentive for the landlord to do anything for them, the landlord knows they're locked, and they're on the hook in that lease contract for another two or three years. And so they have no posture, they have no leverage. Other side of the coin is they try to negotiate when there's two, three months left in the lease. And the landlord is assuming that they're not paying attention. They haven't hired representation. They don't know the market, they're behind the eight ball. And so you can start the transaction too early. And it's a it's a sign that you don't know what you're doing. And you can start it too late, which is a clear sign you don't know what you're doing. And either scenario, the landlord is gauging how serious you are. How savvy Are you? Do you have other viable options? Are you willing to move? Do you really understand the market? And are you going to fight hard for the terms that are commensurate with the type of property with the the market you're in with the economic climate? Or are you just bartering or bluffing? Are you just hoping for a better deal and guessing? So starting the transaction at the wrong time? That's a that's a big one right there. And



where and where is the sweet spot then? So it's like, it's like, what is that? Is it the the three bears? Goldilocks and the Three Bears like one bed was too soft, one was too hard to kind of have to find that sweet spot in the middle. So when it comes to negotiating, when should healthcare providers be thinking, Alright, now it's time to reach out to my landlord and start this process?



That's great question typically is right around 12 months from when your lease is about to expire. If you go outside of 12 months, again, the landlord's just don't have any real incentive to negotiate, because in their mind is I'll deal with it later. They can't go anywhere for 12 months or longer, and so they don't pay attention. But again, if you get too close, if you need to relocate, you don't have time to make that transaction happen. If you need to go to a new property, the negotiation process, the site selection that can take several months on average, you know, getting landlords to respond and negotiating the terms, getting an architect involved to look at the floor plan that takes a few months, it can take a month or two just to negotiate the actual lease contract Once you agree on terms working with the with the attorneys. And then if you need build out and you have to pull a permit or get contractors involved that can take another three or four months as well. So the ideal time is right about 12 months, that gives you enough time to handle each one of those steps that I just mentioned, but it's not too far out there.



Right. Excellent. All right. So Mistake number One not knowing when to negotiate. Now we have a better idea. What's another mistake?



Another mistake? And I'd say it's probably the top mistake. It's the do it yourself approach,



do ya probably be that would probably be was something I would do? Yeah.



Well, and there's a lot of reasons people take the DIY approach. Number one, it's typically because they're so busy, they don't know who to contact, they don't have time to do the research or due diligence in their opinion. And then it just comes up if the lease agreement shows up in the form of a landlord knocking on their door or property manager saying, Hey, listen, your lease is coming up, what do you want to do, and they just say, hey, send me a proposal. And that that starts the process of them doing it themselves. Or maybe you're looking for a new location or your first office, he started driving around, and you pick up the phone, and you start calling the listing broker landlord, asking questions, and all of a sudden, you have engaged and start the process all by yourself. The problem with this is that that is not the game plan for successful companies. If you take any national retailer that people would respect and say, hey, they do a great job, you take a Starbucks or Chipotle, they don't have some random person calling on properties or asking for proposals. They have a team of in house professionals and they utilize outsource experts that all these people do is negotiate professionally for a living. So when a landlord gets a phone call from a doctor or an office manager, no matter how well meaning that person is, the landlord is going to assume they don't know what they're talking about. And it's not, they're not trying to take shots at the person, they're just going to assume, Hey, you don't know the market, you've not want to look at 10 or 15 properties, you're probably not negotiating with three or four landlords simultaneously going three or four rounds of negotiations. And at the end of the day, if you were really serious about capitalizing and saving $100,000, on your next commercial lease, you would have engaged an expert, it's it's similar to, if you get audited by the IRS, if you don't get a really good CPA involved, you're probably not too serious about getting the outcome you're looking for. If you go to court, and someone's bringing a claim against you, or they ask you to go to mediation and arbitration, and you show up by yourself, you get your signaling, I'm probably willing to accept a much inferior result because I don't have the time, the money, the resources or whatever. And so when a landlord sees a tenant show up on representative, it doesn't matter if it's health care, or, or retail or office, they just assume that that person doesn't know what they're doing. And so that's, that's gonna cost the person a lot of money.



Yeah, so you really want to have the right professional at your side, so that you're not getting taken advantage of you're not prolonging things. And like you said, I love how you said that they're there thinking that you're willing to accept an inferior result. And as as a health care provider, or a physical therapist, like if, if someone broke their leg, and they need to rehab, well, they're not going to go to their account, and they're going to want to go to a physical therapist, that you don't want to do it on your own, because you're not going to get the right results. So same thing, right? You always want to have the right professional at your side.



Yeah, I mean, this would be much different than if a patient you know, if you talk to a patient or potential patient, and they needed to rehab something, and you knew it was an advanced rehab, and it's a time you have you have instruments, you have technology of equipment. And their response is, Well, I'm just going to head and figure it out. Like I'm going to search the web and just do some research, your response would be well, there's, there's a better game plan like you can, you can do that. And you can get some type of result or some type of an outcome. Just like a landlord knows, hey, you can you can lease a space without representation, but it's probably not going to be the most effective approach, you're probably gonna waste a significant amount of time. It's probably gonna cost you quite a bit of money. It's very similar.



Yeah, yeah. Okay, so don't know when to negotiate the DIY approach. What else? What's another big mistake?



Yeah, another big mistake. And I mentioned it briefly. It's negotiating on only one property. And this is different when you when you compare residential versus commercial real estate, okay. And residential. If you're going to buy a house or buy a condo or townhome, you go look at properties, you search online. And then when you find the property you're interested in, your agent writes a contract for you and they deliver it to the seller. If the seller signs it, you're under contract, you have the ability to cancel that contract with inspection, objections, financing, deadlines, and so forth. But you submit an offer towards one property and if they say yes, you're under contract, it's a binding contract. Commercial Real Estate works on what's called a letter of intent and loi, or a request for proposal and RFP. In either scenario, those are typically non binding. 99.9% of are non binding. There's, there's ways you can make them binding, but they're intended to be a non binding negotiation. And so in commercial real estate, the most strategic gameplan is you go look at X number of properties that meet your criteria. you narrow it down to the top three or four properties that are the best fit, even if one or two property One of your properties are the clear winners, alright, but you still negotiate on three or four properties. And you might even go two or three rounds of negotiations. The reason you do this is because it gives you the true picture of the market. You can't just go off what they're asking as a quote and lease rate on a brochure, because there's too many variables. Is the lease going to be a three year term? Or a 10? year term? Are you asking for no money for improvements? Are you asking for a couple? $100,000? Do you need a free build out period? Do you need free rent Upon moving? Or the annual increases? 2% 3% 4%? Are you going to personally guarantee the lease Are you trying to have your practice or business guarantee it, there's all these variables that are there. And so you've got to negotiate with multiple landlords to get a real feel for what the market offers. And when you do that, a couple things happen. Number one, landlords get more aggressive and competitive when they know they're competing. If a landlord thinks that this is the only property you're interested in, and you tell them, hey, this is my dream location, or you show them your cards, you're not going to achieve the best terms possible. And so being able to leverage multiple landlords against each other, again, respectfully with dignity, not you know, not not doing things in a way that's that lacks integrity, or cuts corners. But if you do it properly, you're going to know if that lease rate is market below or above, you're going to know if that's the right TI allowance, the right free rent package. And if you're getting three or four landlords to do something over here, and another, and another one over here is not one that you can leverage those against each other. And that, ultimately, is how that's one of the top ways that you achieve the most favorable terms possible.



Got at first, I thought you meant Wait, how many properties Am I getting, but it's not negotiating. It's not for you to have multiple properties. But it's for you to negotiate a single property, but through a lot of different through a couple of different landlords so that you you're kind of getting a better idea of the landscape,



you're you're gonna pick three or four properties to negotiate with, you're only going to choose one of them at the end of the day. But again, every landlords motivations are different. And so you might have two properties that you like equally, one landlord might be much more aggressive than negotiation. And if you add up all of the economic terms, you might find that two properties that appear very similar, that start out with pretty similar starting or quoted lease rates, you might end up with 100 $200,000 savings on one, or 100 or $200,000, in increased costs on the other. So just because the properties look similar, because they have close to starting lease rates, by time you actually work through all those economic terms, you can end up in a very different economic situation. Oh,



my God, I love that that is such a good tip. And I'm sure that's something I would never even think about. I would just think, well, I guess I'll just go with one property. So that is a great, great tip. Anything else? What other big mistakes and I know you said there's probably so so many, but maybe we'll keep it to like four or five.



I'll do two more of this. Okay, you quit, okay, I'm gonna kind of hinted at it. The next mistake healthcare providers make they tip their hand to the landlord, they tell the landlord, this is the property I want, or this would be the perfect space for me, or during a lease renewal negotiation, which is by which is by the way, that's the number one transaction in all commercial real estate, more lease renewals happen every year than any new office or purchase or relocation, okay? The number one mistake they make there is they talk to the landlord, landlord comes their office, the landlord might even be a patient, you know, property manager stops by and they say, Hey, your lease is coming up for renewal, what do you want to do, and the doctor says something along the lines of why don't want to move, or the space works great, send me a proposal. And again, what you have just signal to the landlord is you're not looking at the market, you're not hired representation, you don't know if it's going to be a good deal or a bad deal. And most likely you will accept an dramatically inferior deal. So signaling to the landlord again, you should not be telling the landlord anything that hurts your posture position, and they're looking for you, they're going to ask you questions, trying to get you to tip your hand. So that happens all the time. Here's why healthcare providers get into health care typically, because they want to help people. They're fascinated by the science. They're fascinated by the ability to transform people's lives to help protect lives, save lives, enhance lives. And they're not getting into health care, because they want to be a stone cold killer negotiator. Yet they're going up against landlords that are not playing games that have buildings that are worth 10s of millions of dollars. And those landlords get into real estate because they wanted to be a professional negotiator. So just be very careful what you say the best way to avoid this is to hire representation, let them talk to the landlord for you. And they will keep a very tight posture in the entire process.



Excellent. Okay, what's number five? Five, the



last one? Yep. Five. The last one is healthcare providers love talking to their peers and colleagues. And then they take that information that becomes the standard. And that's a really bad way of doing business. So So you might be in a building with with other tenants might be a dry cleaner could be another healthcare provider could be a restaurant. And they'll ask those tenants or neighbors, Hey, what are you guys paying? Or what did you get on your last negotiation, and then they share that information. But what they don't realize is they're asking people who may or may not have gotten a very good deal. We had this scenario, once we were helping a doctor in a building, it was a completely medical building two floors, six or seven doctors on one floor, six, seven doctors on the second floor, and we were talking to the doctor, we were looking at his lease, and he was significantly above market. And we said, hey, who's negotiate and what the last two or three renewals you've done? And you said, Well, I've done it myself every time. And we said, you know, how do you feel about these terms? Because this is exactly where the market is. And I said, How do you know that he goes, Well, I'm, I'm good friends with three out of the six doctors on this floor, we talk to each other all the time, we refer patients back and forth, we've we've swapped leases, everyone's paying the same thing. We're all paying $30 per square foot. And I said, well, like just so you know, their marketing space in the building, way lower than that. And we just negotiated a brand new lease on the first floor for a doctor at $21 per square foot. So you're gonna dollars a square foot above market, okay? And you haven't got any free rent your last couple of renewals. You haven't got any tenant Premadasa, renovate your space, and you're telling me you didn't get those because no one gets those I'm telling you right now, you and your three or four friends have been consulting with each other, you just have no clue what you're doing. So taking advice from somebody who is bad at negotiating or getting a really bad deal is super common. And so people share stories. They're on all these, you know, Facebook groups throughout all these threads, and everyone's sharing their experience, and it is their experience, but it might not be the best gameplan. So that's another big one we see too is talk to your friends about things clinically, when it comes to real estate, talk to real estate professionals when it comes to legal things, talk to attorneys comes to financials, talk to CPAs don't don't talk to other doctors about this. If they don't know what they're doing.



What a gut punch is, right? That guy must have been like, what $9? Over? Oh my gosh, what a Yeah, what a kick in the pants. That is. Okay, so those are really great. Five Great tips, five mistakes that people often make with their commercial real estate. And throughout that one theme certainly seem to emerge. And that is having representation on your side. So when it comes to commercial real estate agents, let's start with number one. How do you choose the best commercial real estate agent? And then how much does it cost? Because the cost is probably why people end up doing mistake number two, the DIY approach, right? Okay,



both both great questions. There's a handful of ways to find a really good real estate agent. Number one, if you're a healthcare provider, you want someone that has healthcare experience, it's very different talking to a real estate agent that focuses on million square foot distribution centers for Amazon, than it is someone who's working on a 2000 square foot physical therapy space, very different transaction. And commercial real estate, you got people that all they do is apartments, all they do is Office, all they do is retail, you want to find someone that understands healthcare that works in the healthcare space, number one. Number two, you want to find someone who's only going to represent your interests, commercial real estate, and residential real estate are known for agents that try to work what we call both sides of the deal. They're trying to represent the lammeter seller, and also the tenant or buyer, that is a clear conflict of interest. You can't negotiate for two opposing parties. It doesn't work that way. And so this is the idea of saying if somebody is suing you and you're going to court and you're asking the prosecuting attorney, if they'd give you advice, like that's literally what's happening, their client, the landlord or seller, they have a fiduciary to help that person or that group, make as much money as possible in the transaction and protect their interests, they cannot do the same for you. So you need to find someone that's not going to have a conflict of interest, someone who works in the tenant buyer side, who doesn't have listings with landlords in the area that you're looking because you want an unbiased approach with someone who's going to protect you right now. So those are two really important things. The next thing you say is, well, how do I find those people? You can search online, but typically, in any healthcare industry, you're going to have people that if you ask them, Hey, who do you know that specializes in healthcare, real estate for doctors, you're gonna have lenders that tell you, hey, this person or these people do, you're gonna have architects, contractors that have worked with these agents on a number of deals. And so there's a lot of referral partners in the industry that can weigh in on the topic. And so if you ask a handful, you should be able to get a few names very quickly, people that specialize in that area, and then what you need to do again, and that process only takes a little bit of time. It's not it's not no one's asking you to take a whole week off to spend dedicated towards that. But once you find a couple names, you need to speak with these people. You need to interview them, you need to talk them and say, what would your strategy be to help me maximize my profitability in my next transaction? How are you going to protect my interest? How can I know that you are the best fit for me? And like any other relationship or service provider, you're going to know quickly? What their responses just like a patient would say to you. Hey, how are you going to? How are you going to get me healed up? What is your game plan for me to get restored? Or to get you know, rehabilitated? What do you want to do, and you've got to earn their trust, it's the same way in real estate. And I tell doctors this all the time. If you talk to an agent, and you don't think that agent is the best fit, move on to the next one. And I mean, that's what we do for a living, I tell doctors, then if it's not us move on to the next person. Like it's, there's too much on the line for you to for you to just take whoever's there, don't settle in this area, find the person that you trust that you want to work with, that you believe has your interests in mind. And then that's how you get engaged. Yeah,



great advice. You beat me to the punch, I was going to ask you what questions to ask how do you vet and you just gave us those answers. So that was amazing. Now, let's talk about the money side of things. Because health care practitioners, yes, we get in to help people, we have our own business, it's also a business. So we want to make sure that we're maximizing our earning potential, if you will. So let's talk about one How much does it cost to hire a Commercial Real Estate Agent?



Okay, so that's one of the best parts of this entire conversation, it will not cost you as the doctor any money to hire a real estate agent. It's just like residential real estate. If you are a buyer, or a tenant residential real estate, you engage an agent as your exclusive agent, and they receive a portion of the commission from the landlord of the seller. So commercial works just like residential, again, for anyone in residential that's ever owned a house, when you hired an agent, you agreed to pay two Commission's one to your agent, and one to the buyer's agent, Sandman commercial real estate. And this is one of the biggest mistakes that healthcare providers make as well, we could put this as number six, if we wanted to, is they assume they're going to save money by not having an agent. And so they say, You know what, I'm not going to hire an agent. So I'm going to save money. But here's the reality, you're not determining whether or not a commission is paid or not paid. You're not determining what that commission amount is, when you go to a property, that landlord already has money set aside for every transaction. Even if they don't have a listing agents, they're doing it internally, they still have a commission set aside for every transaction. And if you do a deal as a doctor all by yourself, the listing broker gets a double commission, not one, but two, they double up to take both sides of it, or the landlord just keeps that money. And this is this is what happens is, you know, a lot of doctors have this like the do it yourself mentality. I always joke, it's like, every time you see a U haul moving truck, it says move yourself and save, right. But if you're moving yourself and give you a U haul, yes, you save money because no one's offering to pay your $3,000 movie bill. In commercial real estate, there's a commission set aside for the listing agent, and for the tenant or buyer's agent. And when the doctor the tenant doesn't have an agent, listing broker takes a double Commission, or the landlord just pockets that money. So it's 100% free service, it's not going to increase the lease rate for you, it's not gonna cost you money, it'll save you a significant amount of time. It'll help you avoid costly pitfalls, and it should save you a significant amount of money as well.



Okay, and that leads perfectly into my next question. So you had said earlier that lease negotiations or lease renewals, I'm sorry, are the thing that happens the most when it comes to commercial real estate? So how can healthcare providers or anyone for that matter, save $100,000? Or maybe more on their next lease renewal?



Great question. So we're gonna take, we're gonna accumulate my prior answers, and we're gonna, those are all the ingredients in that. And then here's what it looks like. So 12 months prior to your lease expiring, and you're going to look at your leisure going to figure out when you're when your dates show that you expire 12 months before expiring, you're going to start the process of finding an expert, commercial real estate agent in your area that represents healthcare, attendance and buyers that knows your industry, you're going to you're going to, you're going to call x number of people until you find the right person that you want to go forward with, you're going to engage that agent and you're going to have an exclusive relationship with that person, okay? That agent is going to take your requirement, and they're going to go to the market and we're going to find every property that meets your requirement. And they're going to whittle it down to the top three or four properties, even if you don't want to move. Even if you think that moving would be a convenient, they're still going to do their due diligence, and they're going to they're going to take their time energy and they're going to negotiate with three or four landlords simultaneously. And they're going to get to what's called best and final term so we're you know, if you were going to move to the property across the street, or down the street or across the city, you're going to know exactly what it would cost to do that, and you're gonna know what the economics would look like if you wanted to transact there. Once you have that information, you can now go to your, that agent can now go to your current landlord, and can negotiate with factual data, and with a very specific game plan. And here's why this is so important. Again, you can get this thing backwards. If you go to your landlord, and you ask them for an offer, you start negotiating. Here's the question, compared to what, how do you know if it's aggressive? You can compare it to what you're currently paying. But again, what if you're above market, and they say, well, I'll bring you down $2 a square foot, you can say why just save a bunch of money? Well, if you can move across the street don't say $5 a square foot. Or if you get a better landlord, or a better space or a larger space, you can't compare your current economics unless you are comparing them to other properties. So your agent goes, the market gets the top options negotiates, and then goes to your current landlord, and says, Listen, we brought to the market, we know what's happening. I'm a market expert, my clients now educated, and we got three or four other viable options, we'd like to have a negotiation and discussion with you, but it's gonna have to meet our criteria, because we've got two or three other properties, that could make a lot of sense for us, if you don't want to get competitive. And when landlords know that you're not an idiot, you know, you're not, you're not ignorant, you're not, you're not, you're not just gonna take whatever they give you, they come to the table with a much different approach. And when they know you're represented by an agent that is an expert, they're not going to waste their time trying to convince an expert that their deal is good if it's not good. So that that's the process. In a nutshell, there's a lot more to it than that. But that's how you get to the landlords, that will actually give you a good deal. Because at the end of the day, if you do move out of that property, they're not going to get the next tenant to pay above market, they're not going to get away with not giving them a tenant proven allowance or not giving them free rent, or trying to gouge them, because the new tenant won't take it, they'll just have go somewhere else. And so the landlord, if they think they've got you know, pushed into a corner, you have no other options, they will stick it to you. If they think that you have the freedom to move that you're willing to move, you got the help to move, they will come with a much more aggressive offer. And typically, at an average space of two 3000 square feet on a five or seven year deal. Those those numbers add up to usually a minimum of $1,000. And oftentimes hundreds of 1000s of dollars, that can be one in



your favor. Amazing. Again, having the right people in your corner doing your research coming to the table with facts and figures so that you have leverage to negotiate. All makes perfect sense. And now as we start to wind things up here, I just have a one, I think really interesting question, because I hear this quite a bit chatter on social media, when it comes to at least physical therapy business owners is do you buy your space? Or do you lease your space? So can you talk about that?



That is a great question. That's probably one of the top questions that we receive. The answer to that is you should look at both your options, don't pray determine one or the other, because every markets different, every economic climates different. And you could be in some markets where where you have multiple options to own and it's phenomenal other markets, there's not one option to own. So I mean, if you're doing real estate in a suburban Tulsa, that's different than if you were downtown Manhattan. I mean, you've got to know the different markets. What we tell healthcare providers is listen, we're going to go to the market for you and find the top properties that meet your requirements. And we're going to look at office options to lease and options to purchase, we're going to look at retail options, we're going to look at office options. And we're going to show you the top of what's available, you then are going to choose which properties that you're the most excited about. And then we're going to negotiate on three or four properties simultaneously. And then economics will tell you very quickly which property is going to make the most sense for you. If you can find a property to purchase. That's that's a top property if you love it, and the economics makes sense. We are a huge proponent of owning commercial real estate, you're building an additional asset, if you sell your practice, you can lease out the space. And typically that real estate is going to sell for more than your practice will sell for. We track this across the country, we work with 1000s of providers every year, and the real estate sells for more than the practice over 75% of the time. So if you could be an immediate to pay rent or mortgage either way, you've got to pay a landlord or or pay a company a mortgage company. So you're basically paying yourself in certain aspects of it. You got to make a payment either way, if you can own real estate and economics work phenomenal. A lot of times what you'll find is are you willing to pay more to own than to lease because of the upside. And so you might have scenario where it costs you an extra couple $1,000 a month to own and you get you have to decide is it worth that? Is it worth the extra expenditure to pick up some additional tax deductions to pick up that principal pay not every month you got to check X number of dollars go to pay down principal on the loan, your net worth goes up every month. And so we have those scenarios, if it's if it's 6000, or 6000, at least that's a no brainer at the back, right? If it's 10,000, or 6000, at least, you got a decision to make there a lot of times it's, you know, 12, or $15,000, or 6000. The least. And you have to decide which makes the most sense for your practice. And then you get in another 10, different evaluations, what's the downpayment? What's the cost of entry? What are the economic financing terms available to you? Is this space gonna fit you for three years? Or five years? Because if so, we don't want to purchase that we'd rather lease for three or five years, and then have you purchased the next location, if it's gonna fit you for the next 20 years? Again, that's a different story. So there's all these different variables, there's no one size fits all. There's there's groups that we help lease a couple spaces for that purchase, purchase couple spaces, then lease a lot of variables there.



Yeah, and and again, that's where coming together with your team makes a lot of sense, and and doing your pros and cons. But I hear that quite a lot. So thank you so much for your input on that question. And now, if you could put a bow on this conversation, what are the top things you want healthcare providers to walk away from when it comes to their commercial real estate questions?



Yeah, that's a great question. I would say, just realize what's on the line. We're not talking about, you know, did you overpay for a box of gloves, you weren't paying attached, you ran out and you know, you overpaid by $2, for a box of gloves, and you can go, you know, buy in bulk next week, or you have your supplier set, you know, whatever, we're talking about a transaction that you engage in every once once every five, seven or 10 years. If you make a mistake in it, again, the world's not going to end. But it will cost you 10s, or hundreds of 1000s of dollars in additional payments that you could have avoided. And there's a lot of other things that are on the line. Like there's economic terms, there's also business terms, what happens when you want to sell your practice, can you get off the lease, or you get stuck guaranteeing a lease for the person that buys your practice, because you don't have the right assignability class. So I would say this, make sure that you're treating your commercial real estate with the respect that it's still again, I mean, you can still do a lease, you can still stay in practice, etc. But again, the world's not gonna end. But there is a cost or a penalty to messing up here. And it's pretty high. Find a good agent, find someone that you trust, and that person will save you literally 3040 hours of your valuable time, they'll save you a significant amount economically, it's usually usually a minimum of 10s of 1000s, if not hundreds of 1000s. They'll also help you avoid complications and delays that come up all the time in commercial real estate when people are not paying attention. And then the last thing I'll say and I think this is more important than all these is that person's going to give you peace of mind. You're not going to have to wander every night you go to bed and put your head on your pillow for the next 10 years, you're not going to wander Did you get a good deal or a bad deal? You're going to know exactly what what terms you negotiate and how they compare to the market, you're not going to wander if you miss seeing a better property and you should leave somewhere else you chose, you chose the third or fourth best product in the market, he's just would have gone to market you would have known better, you're gonna have that peace of mind. So we can talk about saving time saving money, avoiding complications, delays, pitfalls, but I think ultimately, that peace of mind is invaluable. And for me, that's that's what I'm trying to deliver every time that I work with a client.



Yeah, you had me at saved 30 to 40 hours of your time. You could have ended it there. But I love having that peace of mind being able to sleep at night knowing that you really got the best deal that you possibly could because you started 12 months ahead of time you hired someone you had a team by your side. So perfect sense. So now, Collin, where can people find you? If they want more information? They have some more questions. What's your contact?



Absolutely, the best way to get ahold of us is our website. And that is car that US ca On our website in the upper right hand corner, we have a couple options on our navbar that are of importance. Number one, you can click the Find an agent in your area. We've got agents coast to coast, we represent 1000s of healthcare providers every year, and we are working, we're working literally in all 50 states plus DC. So click Find an agent in your area. And then that's a great way to start. Another thing we have is a free lease evaluation. If you want to know where you stand in the market, even let's say you signed a lease last year and you got nine years left, we can still do a free lease evaluation for you. And we'll tell you where you stand based upon the market currently, if the market corrects, as we've seen some crashes last two years, who knows what we're going to be tomorrow, let alone five years now we can update that over time. So if you want to know where you stand in the market today, in a few years, we do that all the time, we can do it very quickly. And again, we can give you the peace of mind knowing where you're at and if you're way above market, then we're gonna try to capitalize on the next transaction. If you did a good job in your last deal, again, that gives you peace of mind knowing that you're in a pretty good position. We want to protect that or reserve that in your next negotiation. And then the third thing is we have a ton of resources if you want to study up, if you want to get educated, we got literally hundreds of articles, blogs, educational videos. And if you're interested in commercial real estate because it affects your practice, and you want to know more, we will give you information that will make you the subject matter expert.



Excellent. That was perfect. Now I have one more question that I asked 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? So let's say that 19 year old in Lansing, Michigan, what advice would you give to him knowing where you are? Now?



That's a great question, I would say, surround yourself with the most successful people that you can get around. If you can get around them personally, and they'll spend time with you then do it. If you can't, then get around them through watching their podcasts through reading their books, you know, following their history. And then I would say that there's there's no substitute for hard work, you're gonna make mistakes, you're gonna fall down, you're gonna you're gonna do things that in hindsight, were less than intelligent to say them politely. But you just that's part of the process, owning a practice, you know, becoming a professional, anything in life, working as hard as you possibly can, and then learn from your mistakes.



I love it. This was so great. Thank you so much for taking the time out. I mean, I was taking notes furiously over here because I think this is such great information for certainly for healthcare providers, but I would say anyone that is looking to get into a commercial space, this was wonderful. So thank you so much. Absolute. It's been a pleasure to be with you. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.


Feb 21, 2022

In this episode, Dr. Jenna Kantor interviews Dr. Sherrill Williams about diversity, equity, and inclusion in physical therapy. 

Mabout Dr. Williams here: 

A lifelong dancer and lover of the performing arts, Dr. Williams committed most of her life to studying Ballet, Modern, Jazz, and Hip Hop. It was not until her commitment to losing 90 lbs that she fell in love with fitness, and wanted to find a way to fuse her love of dance with health and wellness. This new mission sparked a fire that led to Dr.Williams receiving her Doctor of Physical Therapy degree from New York University. Shortly after she founded Leg Up Fitness and Wellness, an online fitness company for performers that want their workout to feel less like exercise and more like dance. Leg Up's client credits include but are not limited to The 1st US National Tour of Aladdin, Hamilton, Lion King, Lizzo, Jidenna, John Legend, Todrick Hall, and Complexions Contemporary Ballet. Dr. Williams is a passionate advocate for dance injury pre-habilitation and rehabilitation and loves helping dancers around the U.S. virtually and in person.

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Read the Full Transcript Here:


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'm your host Karen Litzy. Today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net house digital marketing solutions, has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how Net Health Digital Marketing Solutions can help your clinic when they'll buy lunch for your office. If you're already using that health private practice EMR Be sure to ask about its new integration, head over to net forward slash li tz why to sign up for your complimentary audit today. And like I've said before I actually use this product it works man did a bump me up in the Google search was awesome. Now on to today's podcast, which is being hosted by the ever wonderful Dr. Jenna cantor. And in today's episode, she interviews Dr. Cheryl Williams, a lifelong dancer and lover of the performing arts, Dr. Williams committed most of her life to studying ballet, modern jazz and hip hop. It was not until her commitment to losing 90 pounds that she fell in love with fitness and wanted to find a way to fuse her love of dance with health and wellness. This new mission sparked a fire that led Dr. Williams to receiving her doctor physical therapy degree from New York University. Shortly after she founded leg up fitness and wellness an online fitness company for performers that want their workout to feel less like exercise and more like dance leg UPS client credits include but are not limited to the first US national tour of Aladdin, Hamilton Lion King Lizzo Jidenna John Legend Todrick Hall, and complexions contemporary ballet. Dr. Williams is a passionate advocacy for dance injury, pre habilitation, and rehabilitation, and loves helping dancers around the US virtually and in person. So big thank you to Jenna and to Sherelle for coming onto the podcast so everyone enjoys today's interview.



Hello, healthy, wealthy and smart. This is Jenna cantor. I'm here with Dr. Sharon Williams, and I cannot be so grateful. So much more grateful right now to be on here with you. First of all, thank you, Sharon, for coming on to talk. Thank



you. Thank you for having me. I'm excited to be Yeah,



I love it. I'm really grateful on so many levels, the one we're friends to. And I think this is where I'm starting with where I'm comfortable and where I need to expand. So I'm just owning up to this. In physical therapy. I don't know a lot of black physical therapists, like holy crap. And so you're one of my few. And when I really took account, I took accountability. And I was like, Oh my God, a few people that I know who are black. So I'm starting with people I know. And then I'll expand out to more and more and more and more and more people and increase my network. But that is sad. After calling myself out. I am really excited to be talking about diversity equity inclusion. I feel like that was a pretty good segue because that is yeah, that is legit. So let's go back. You are a new grad congratulations. Thank you. We made it. We made it made it Sherelle is one of those people who thinks big and then achieves the big. So she's a nice person to be regularly inspired by and I'm super grateful to know you Sherelle. So diversity, equity and inclusion. What rehearing that whole statement in as one what are some first thought that comes to mind when it when it comes to physical therapy? There is no wrong answer. I just want your truth.



Well, I was gonna say when you like yeah, you're like one of the few black people I know that's a physical therapist. I was like me too, girl. Oh, no, me neither. Oh, I didn't know. Yeah, um, to be honest, I think it was CSM where they had a, a networking event and I was like, oh, there is a little community of us but we're just all scattered or you know around the world. But when I think of the Diversity, Equity and Inclusion within physical therapy, you know? No, I don't want to say non existent, but it's just, it's very small. You know, when I went to NYU, you know, I did visit a few schools. When I was doing the audition process when I was



Joe and I both are performers, as well. So that's what why audition process came to her mind. That's hilarious.



When I was going through, like the interview process, and I was looking at different schools, and like NYU, you was one of the few schools that you know, I did see quite a few black people. And I had, there was seven of us in my class, and two men, two black men, which is like crazy that I'm excited about to black men. But like, you don't see it at all.



No, you don't.



And it's an it's unfortunate, because it's such an amazing field. And I'm still kind of at the point where I'm like, is it that we are not applying? Because we don't know? Or is it that? You know, they're not letting us in the door? And I haven't really figured that out yet. But I do I do feel like a part could be, we don't know. Because a lot of times I feel like especially in the African American community. And you can also say African because those communities are very different. Culturally, you know, people No, go go be an ND nd ND, ND, ND nd? Or what do we need to do to get more people of color in or black people. Because I think that's going to do wonders when it comes to the community and getting people up. And, and healthy. Because unfortunately, in our culture, not many of us, I think my generation is more, it's a lot more active, but the older generation, not move until I think when we get more more people of color in into the field, and then we're talking about it. And we're excited about it, you know, then the community will come to and we'll see, you know, more people being active. And that's just my theory. That's what I've seen based on, you know, my family when I started school, that's what I'm talking about. I'm talking about moving. And my mom is like, oh, yeah, I'll go get a trainer. Or I'll do this or I'll move or they you know, they see me we can lead by example.



This is so helpful. Because everything and what you're calling rambling I call a more clear insight into what's true in your mind regarding diversity, equity and inclusion. And it's not just one component that it there's a need to be looking upon. First of all, with defining diversity, equity inclusion for you, like it seemed as though we're talking about black people, right now, we're just in which is that's absolutely, we're not seeing it. i There were very few in my class, and I didn't think anything of it. You know, to me, the fact that there were some people who are black, there were some people who were Asian, there were some people of some sort of Indian descent was like, wow, look at us, but there could be more. I agree from what, yeah, I still as a white person, I did not feel like a minority at all. In that group. In that setting. I felt just like, you know, hey, which is Yeah. My point is, from all these little things, let's start separating out different things that you were mentioning, first of all, with getting people in getting people into the profession, how did you get reached?



I, to be honest, I sort of think I got into NYU, praise God, I did apply to like 13 schools. I only got into NYU, and I honestly think it's because they had an interview process. Because on paper I didn't have like a four Oh, and I had some C's and I had to retake some classes. But when you get me in person, I can tell you and and why you happen to have an interview process and and I was able to shine in that way. And I think that speaks volumes. I hope that maybe other schools can adopt that because sometimes our paper with we don't, you know, I mean like but that doesn't have anything to do with, you know, how compassionate we are or how smart we are what will be Be like as, as a physical therapist, especially based oh my god, we had the GRE, I



didn't do the grade on that either. It's interesting, you're saying that because everything on paper only shows part of the picture. So when the schools are making it like that, and they're just looking at paper, I mean, right there, we are automatically going to be leaving a lot of people out, because our school systems are not equal. Yeah, what people are learning are not equal. So if you're just going off of what they happen to be born into, we're really cutting people off. We're really, really cutting people off from opportunity, and therefore, just continuing the cycle of a lot of whiteness in our field.



And something that I saw that I think would be also be great, like, okay, let's say we don't have time for the interview process, some of the HBCUs. Or if you don't know, historically black colleges and universities, they did like a video, like you had to send in a video and answer a prompt. And that way you get you get to show yourself. And I thought, you know, that was that was great. You know, I mean, it's something that could also be adopted by other schools. To give us a chance, you



know, I mean, absolutely, I think I think that that's a great idea as a way to be the change be the change. I don't know if you've ever heard this where it's, you know, God, it's a very I don't like this rhetoric, but it's the one where people are saying, not everyone, but people are saying, Oh, well, now people are just getting in because they're black. Can you share some thoughts to that? Because for so you know, I have an angry look on my face and Sherelle rolled her eyes. We're not shy about that. All right, would you mind response to that? Because, I mean, it angers me, but let's talk about this.



And on that note, we're gonna take a very quick break to hear from our sponsor, and be right back with Shirelles response. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net forward slash li tz y to sign up for your complimentary marketing audit.



Wow, I've also never discussed this. I mean, if I was just to like speak, honestly,



yes, please.



White people get things because they're white all the time. Like not based on merit, not based on skill based on who they know. Or a back door. You know what I mean? And I as



a person who has benefited in that way, I can absolutely agree. It's Yes, yes. It's true. It's legit happened to me. I like I'm grateful. That's amazing. But like, also, that's so true.



And, and we're like we said this, the schools are not always even, we don't always have, you know, these connections. But a lot of times when you give us a chance, we go above and beyond, because we're like, hey, my ancestors didn't die for this. So I mean, like, and we deserve the chance, I just think we deserve the chance. The playing field is not going to even and this is our opportunity to try and be able to own probably, I think it kind of goes deeper than just Oh, black you let Black people in. But for so long. We couldn't get education. You know, we were enslaved. We built this. We literally built the US, you know, we couldn't own property. So now it's like, Hey, we're trying to get in these professions, so that we can make something of ourselves we can start building generational wealth. Like for me right now. I am like the person. I am the person right now and 2021 that is trying to start building generational wealth for my family, but why people have had this opportunity to do this and save and know about mutual fund all these different things and I'm just now learning and having the opportunity to get to you've been able To do that,



oh, for a very long time, and for anybody who says, Oh, the history that you're mentioning, I'm just acknowledging this history that you're mentioning from a bit ago that how black people came into, it's still not 100% there for basic rights for black people, they don't have access to the education that I got, you know, in this, I grew up in California, in a small town, California, if you don't know, if you buy a shed of your own, it can be worth a million cost a million dollars. It's ridiculous. It's a running joke. California is not it's just a well off area to be living, and which is unfortunate. And from that, we are lacking diversity in our areas, and they are people are not getting getting that access. I also feel like that there's an assumption when people are saying, Oh, now black people are getting in just because they're being black. What if? Let's say this black person, maybe it's just one? Oh, you know, come on, like, you know that Gatson is extremely intelligent and more intelligent than you and has had to put a lot more work in to get into prove themselves just to get in? And you actually don't belong? What if? What about what that? What about that? What about that consideration that there could actually be a lot of people of color, who are more intelligent than a lot of people who've been regularly led into school.



Everything that you just said? That was awesome. Like,



I love that we're sitting on this for a bit, because getting people into PT school is like the base, you know, how do we reach them? How do we access them and everything. And if then we have people saying it's because they're black. They're people who are black are already dealing with so much this is from what I've learned not experienced, obviously, like you're already dealing with so much discrimination on a regular basis. So to So to finally get that opportunity to come in and then be discriminated against, you've worked your tail off more than the average white person is just preposterous, and we need to call ourselves out on it, in order to be the change. Sure, I was just gonna read this smile. She's



emotional mom, because you know, it's like, these are the conversations and these are the things that are said within our circles. But then when you have the ally, say, and you see it, and it's like, oh, it's just so nice to be seen and heard. Oh, and then somebody gets it.



Oh, my God, I do. I do make mistakes. As I go. I've made I've made plenty. And I will continue to do stupid things. But I keep learning and making the changes as I go. But I so grateful that you're on to talk about this. What have you seen, that you think schools are doing that is working to bring in dei and that in schools versus we're taught we've talked a lot about what's not working? What are the schools doing that is working? And what could we do more of pull it out of your buttons fine. Just like brainstorm like, what are the things?



I mean, like I did say the video. I'm having professors,



oh my god, I had a black professor. That was the most amazing thing I had ever had one. I remember



it was so funny. She came in and I was like, Are you a grad student? And she was like, no, actually, I'm a new professor. I remember Mike, one of my classmates, she walked out. We were like in the computer lab. And she was like, now that I see this woman as my, I know, I can do anything. That's what she said. Yeah, so having more black African American ever, professors. If if there can be some type of outreach, I know with my class, so my class isn't good class because I graduated in the middle of a pandemic. So our plan was like, we had many plans and COVID killed the plans. But one of the conversations that I had with a good friend, classmate of mine, she wasn't black, she was a Puerto Rican. And she was like, Oh, I would love to go out to high schools. Let's get a group together and go do it. And then COVID happen and killed everything and we couldn't go anywhere. But I do think in the future. And I know you know, PT school as hard as it is and stressful, but doing some type of outreach in in PT schools and just saying, Hey, this is what you know, get to make it like



a career day kind of thing. When people come and visit and say, Hey, this is a career you can I do think yeah, definitely. Especially in neighborhoods where my dad's a dentist, okay. I have a family of dentists do Wish total stereotype halacha just brush your teeth, Jenna. So what's my upbringing? Look, I oh my god,



I missed you.



The the, but because I had, I grew up with that with people living these amazing careers, I didn't need somebody to come visit because I was surrounded by their neighbors doing a chiropractor friend, one of my best friends her dad was a chiropractor. This was just commonplace. Just in my world. People don't have that. So, uh, yeah, I can even see more. Having people in the profession, someone like my dad even coming and saying, Hey, this is something you could do is great. I think that's, I think that's a really great idea, just literally coming to the schools coming to them. And people don't like if you sit there and just do a social media post and be like, here come to us. Like, it doesn't work that way. Nobody, including any listener, or Sherelle, or myself, we'd like people to just come to us, as we're living our lives.



This is something I just thought about. I don't even know if it could actually happen. Ooh. Like, can we have like a work study? or some type of like, even be volunteer like work study. And like a student? A student runs an Instagram and it's specific for that school. And it's specifically for, like, adding teens or, you know, people of color and and making content that's relatable. Yeah. So that it's, you know, a track. It's attractive, so people learn more you know about it. I think social media is just such, it's just a force right now.



It really is it really,



I don't know what that really looks like. But, you know, yeah. But in talking about, you know, I don't know it just in a creative way.



No, I get what you're saying. I just, I just recently had a big screening with a ballet company. And I contact a local school and had PT students come volunteer and take measurements and everything was awesome for them to get to experience that would have killed for something like that as a student, but things like that, that other businesses are doing schools are doing, they can have events of some kind to bring that in that that could be I don't know what but because we're like in the like, no mode. But I love that. I love that. Let's let this lay as like the EU, we just let this kind of drop as a potential idea. I have only a few more minutes left with you. I would love to two more things. What have you personally been doing to help bring more dei into the profession?



I don't know that I necessarily have because I was so engulfed in school by having this conversation. Literally while you were saying that I was like, Oh, I have some ideas. Like I want to start doing this. But I definitely you know, I speak within my family on my social media. You know, I I talk about, hey, let's be more active, I do a lot around how we can move instead of having to go to the MD The MD is going to tell me to take a pill and then sit you don't have bed rest. But I definitely can do more. I can call myself out about that. You know, when I'm back up, you know, hey, I'm going to be very intentful about a purposeful about doing this. I'm excited actually, unfortunately, I passed my boards. I I kind of had this injury and then I wasn't able to do everything that I wanted. So when I'm back up and I'm full, I'm like, Ah, let's go. Let's add this to the list. I'm happy that you asked me that question, which made me get you know, the juices going and Right,



right. Uh, yeah, I love it. I love it. I give complete credit to Lisa van who's for that question. She said ask this question. I said okay, okay. Where can people we are now coming down to an end. Where can people find you? Sherelle on social media. They can follow you connect. Where can they find you?



You can find me on Instagram at Lego fitness. I believe Oh, well. I do search my name on Facebook, which is Sherwin Williams. Those are the two places that I live right now. At my website is you know is what is it like up If you want to see a little bit more about me there.



And then if anybody might want to email you some people do prefer the email



Oh yes, my email is right now is just Sherelle



I love it. Wonderful. Thank you so much for coming on. You are a force. I frickin love you.



Thank you for having me. This is so amazing.



A big thank you to Jenna and Ciara for a great interview on D AI initiatives in the world of physical therapy and of course a big thanks to Net Health. So again when it comes to boosting your online visibility, reputation and referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition they know you want your clinic to get found, get chosen and get those five star reviews. They have a fun new offer if you sign up and complete a marketing audit, so they can help your clinic when they'll buy lunch for your office. Head over to net forward slash li T zy to sign up for your complimentary marketing audit today.



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


Feb 14, 2022

In this episode, Founder of FitBUX, Joseph Reinke, talks about financial planning.

Today, Joseph talks about financial planning technology, the three buckets of financial planning, and the importance of focus. How can FitBUX help people with financial planning?

Hear about thinking about percentages, self-employed financial planning, and get Joseph’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Money is always relative.”
  • “The big takeaway is percentages.”
  • “If I focus on one, maybe two things, I’m going to accomplish things much faster.”
  • “The more you concentrate on something, the sooner you’ll realize it.”
  • “This should be complementing your life, not dictating it.”
  • “Focus.”


More about Joseph Reinke

Joseph Reinke is a Chartered Financial Analyst (CFA) Charterholder and is the founder of FitBUX. FitBUX has helped more than 11,000 PTs manage $1.6 billion in debt and assets. In addition, FitBUX recently partnered with the APTA to provide APTA members with awesome discounts on their technology.

Joseph has appeared on numerous industry podcast, been an author for various industry publications, and has done over 200 student loan workshops at university graduate programs, SIGs, Conclaves, and annual conferences throughout the country.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Finance, Financial Planning, Income, Expenses, Debt, Money, Technology, Retirement,



FitBUX Investment Round:


To learn more, follow Joseph at:






Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:      

Read the Full Transcript Here: 


Hey, Joe, welcome back to the podcast. I'm happy to have you on again.



Yeah, I'm glad to be here. It's been a long time. It's the very first time. I think there's like a third time, maybe the fourth time. But yeah, it's been quite a journey. So glad to be back.



I'm happy to have you back. Especially because today we're going to be talking about financial planning. Now, I know a lot of people might be like, oh, gosh, this is so boring. But regardless of whether you own your own business, you're working for someone else, you have to have a good financial planning, because you want to be able to get through the rest of your life and have the security of knowing you're financially sound. Right.



Exactly, exactly. So we'll make it we'll make it exciting. We'll give you some, some tidbits that you don't hear anywhere else. So



yes, excellent. Well, let's let's start out with what are a couple of tips for the audience, that you counsel people on when it comes to financial planning?



Yeah, so a lot of us to help is all about the technology, and we're there to guide them through it. And it's really geared around a lot of stuff that I learned when I was in wealth management. You know, everybody always talks about, oh, the problem in financial planning and financial education, and this and that. And basically, what I look at used to look at is everybody in the financial industry, they just double down on using the same stupid stuff. And then when the technology comes out, they just put some cute interface to it, and it just doesn't work. Okay. And there's, there's two areas that I could, you know, illustrate on that. One is like, on these apps, so like these budgeting apps, I won't name any names, I won't pick on anybody, but there's a lot of big popular apps out there. Or maybe you just use Excel. And a lot of times what they do is they just throw a bunch of stuff in basically an Excel sheet, and they put a user interface around that. And it's like, okay, well, where does all my money go? Like, this doesn't make any sense. So that's the first issue that we've seen in the second one, I used to joke around about this, this is where financial technology that I used to have, like, you know, a 60 year old client would come in with like, a stack of paperwork with like, an inch or two thick and say, Okay, what am I supposed to do? And to me, all FinTech did was take that makes file and put it on the internet. And just make a pretty little graph around it. It's like, okay, this doesn't tell me anything. Like, what if I want to buy a house versus rent? What if I want to pay off my loans versus well forget? How am I supposed to look at these things? Like, am I supposed to decide this? And so those are the two big areas that is like, how do you do this. And so the first big tidbit on financial planning to satisfy that first problem, just one big thrill plus, you got to think of things in almost buckets when you start stretching out your plan. So you have things like your income and your expenses. And I'm not talking about like your debt expenses. I'm literally talking about your day to day expenses, like food and rent and utilities. So that's like, step one is your income and your day to day expenses that is happening today. The second step is to say, Okay, how much is going towards investments and how much is going towards debt? And that's the step two is over the long term. And then step three is, well, what am I doing to protect my financial plan? Those are things like insurances. So life insurance, long term care, insurance, disability insurance, home insurance. And so the way you can think about it is, this is day to day, this is long term. And and this is risk management, because protection. And when you start thinking about it that way, it makes life a lot easier to do it. And then you know, we'll pause there, and then go into also, you know, what happens like, Well, what about projecting? What about managing this over time? What's an easy way to set this up from there, but that's the primary the main component of in terms of just setting up the plan itself, of those three buckets when you start thinking about this stuff?



Yeah. And so you suggest people kind of sit down and look at all of those things and kind of write them out. So they have they know their income, they know what their expenses are. They know what they have asset wise, debt wise. So when you're talking debt, can you be a little more specific? Are we talking long term debt like loans or short term debt like credit cards, or bony



any real debt, I mean, credit card. So with credit cards, if you're paying them off monthly, we don't even consider it that we just consider that day to day stuff. But we're talking about where like you have a monthly payment, so car loans, student loans, mortgages, if you do have credit card debt, and you refinance it, for example, into a personal loan, and you're paying that off over time, if you have business debt, whatever it may be, that's the debt that we're that we're talking about in that step two.



Yeah. Thank you. Thanks for the clarification on that. And then of course, All the insurances and things like that, that we all need, that we all should have moving forward, I would say especially if you're a physical therapist, and especially if you're in private practice, boy, do you need those insurances to be on point?



Yeah, exactly the biggest, like the most overlooked one is disability insurance. Because it's like, what do you do if you go to say, well, I can't do my profession anymore. It's like your financial plan completely just ruined if you don't have that. And that's the way you can think about insurance is okay, well, I did my step one, I did my step two. Step two happens over time. What happens if I don't have time because of whatever it is. So like, what happens if I become disabled? My financial plan crumbles. What if I'm married, and I pass away or my spouse passes away? Like we have children like our plan crumbles? What happens if I have a car and I don't have the proper car insurance and I get in a car accident? I don't, I can't buy another car. Now my plan crumbles because I gotta get all this auto debt for another car. So that's what you can think about insurance is protecting just in case time doesn't happen?



Yeah, fair. Okay, so great. Tip number one, just to recap is to break up into three areas, income expenses, assets, debt, and the third protection, or, and that's where all your insurances come in. Okay, what other what other tip do you have when it comes to financial planning?



This one is one of the most important and this, this makes life so much easier, both when you're setting up a plan. And also when you're actually like monitoring your plan. Oftentimes, somebody will come to me and say something like, you know, I'm paying $1,500 a month on my student loans. Is that a lot of money? And it's like, I don't know, like, Well, what do you mean, you don't know you're an expert? Don't you know if that's a lot? It's like, well, no, what I mean by that is, do you make $300,000? Or do you make $30,000? Because it's all relative to your income. And money is always relative. Another example of that, like investments, somebody can't come to me and says, I made $10,000 on my investment. And it's like, okay, is that good? It's like, I don't know, like, Did you invest? 20,000? I'm like, Yeah, I'll just do that. But if you invested a million and only made 10,000, like, that's horrible. Like, don't quit your day job, like, what are you doing? Right? So it really just depends on percentages. And you can take that knowledge and apply it to your financial plan. So when you're actually setting these things up, especially on step two, where you're saying, where's What am I investments? Or what am I debt, when you look at percentages of where your money is going and allows you to say, hey, like, I want to focus on, you know, paying off my mortgage? Well, if that's not your biggest percentage of where your money is going, and you're not focusing on that, okay, and this is like, it's funny, because people like, how did you come up with that percentage thing? And I'm like, well, one of the ways I did was when I first started working, I put all the percentages there. And I realized how much money was going to taxes. It was like, Holy crap, like, what can I do to reduce that? So I'm the financial dork that I am, I went and read the IRS tax code. But it's like, those percentages that I assume realized, from a financial planning aspect, it makes life easy, not just setting up your plan, but actually following it. Because if you say, Look, I have 20% going towards my student loans, I have 5%, going towards savings for a down payment for a house, I have 4% going towards my 401k. Over time, your income should be going up. So it makes it very easy. You don't have to think about how much of my money should be going where you just keep the percentages the same and increase how much you're doing in those categories. Or if you get a bonus or a tax return, say great, I take the percentage, I put it to those categories. If I want to do more, I'm fine. But I don't need to I can go out and actually enjoy this money if I want to and not feel guilty about it. Cuz I know I'm following my plan. And then once you're following that plan, let's just say you have a good life event happened. Like let's just say you paid off debt, you paid off a student loan, you paid off an auto loan, well, then great, you just look at the percentage and say, Okay, where do I move this now to meet my next goal? Very quick and easy. Or maybe you have a negative life event, like you get a car accident, You wrecked your car, and you need to buy a new one, where it's like, okay, well, I have I was focusing on this. But if I've moved this percentage and this percentage here, I'm good to go. And that's it. And then you can actually go out and simulate that and I'll talk about simulating that in a minute. But that's the key thing. One of the biggest takeaway that you can take from this podcast as percentages, what percentage of my money is going where and then from there, instead of tracking your dollars and cents, every single place that goes track the percentages are my percentage is going to where I said they're going to especially going towards your investments and your debt. Some people really like looking at those percentages on their day to day expenses too. That's fine if you want to go that into it for me, as long as you're following the assets and debt sureselect don't enjoy. That's the way I look at it. Because that second floor of the building assets and debt, that's the financial plan. So that's the key thing. There's that percentages, percentages, percentages. And, you know, I wish I could talk to everybody that's like 40 and 50 and 60 that have been doing like the dollar amount their entire life. And it's like, I just switched to this. It's easier, like, do that. Yeah. So that's the big takeaway is percentages.



Yeah, I switched over to percentages a couple of years ago, and it's like a no brainer. You know, so like, when, like you said, for example, a tax return comes in. So I had a tax return. I know it was last year, the year before. And I knew exactly where all of that money was going. Because it was in my percentages. Yep. So it just makes life so much easier. And you'll see you'll accumulate wealth in the places that you need to, because that's your plan.



Yep. And you'll realize, while if I focus on one, maybe two things, I'm going to accomplish things a lot faster. And so that's where the the behavioral side of finance comes in to. And it's a proven fact that more you concentrate on something that the sooner you're able to realize it. And so one of the big mistakes that we see people make, especially on that step two, they're like, Alright, I'm going to save in a Roth, I'm going to save in a 401k, I'm going to save for my child's 529 plan, I also need to save for a house and I want to save or pay off my student loans. And it's like, you're going to do none of those. Like, if you're trying to do all that good luck. Like seeing the percentages and how thin they are, and how long it's gonna take you to accomplish those is a red light to a lot of people, it's like holy cow, like, will instead I just focus on like, paying off my loans, for example. And your my retirement for the time being, you're gonna be able to accomplish a lot more sooner. And then you can get to those other things down the road. So that's another big takeaway is focus, focus, focus, focus.



Yeah. And it's okay to move those percentages around as your life changes. And as things change in life. It's good. Yeah. Okay, cool. Yep. So now, yeah. What I mean, this all sounds great. And I'm sure a lot of people are wondering like, oh, okay, how am I supposed to keep track of all this? How am I supposed to do all this? This sounds complicated. I don't work in Excel. QuickBooks makes me nauseous. What can I do? Like, so explain to us how fit books, can I help people with some of this financial planning stuff?



Yeah, this is where I'm so personally excited. Because this is where we always wanted to take the company even like, it was one of like, five years ago, I first came on the show on your podcast, we specifically we knew this technology was gonna take a long time to build. And so we specifically started the first piece of the technology around student loans to help students, new grads, and then we've been building it, especially during COVID, we've been building out more and more, as long as we don't lose engineers that COVID Every other week. But we've been building out more and more, and we launched the first version out of beta last November. And it literally does all that for you. So when you go to build your plan, like step one is income expenses that two is is your asset contributions, your debt contributions, that three goes into risk management. And then we took it a step further, actually, on step four, you can add in goals and life events. So everything from like getting married or buying a house, or whatever it is that you're going to do. And what that allows you to do is it allows you to say, Hey, this is the plan that I want to follow. And you can actually build out the entire thing and see in the long run what it does, or you can run simulation. So if you're trying to say Hey, should I pay off my loans versus loan forgiveness, or should I rent versus buy, or I'm married, and we just had a child should myself or my spouse stay at home instead of working so we don't have to pay for daycare, you can simulate all those to decide what you want to do. Okay. And then with the technology, once you say this is what I want to do, we take all these complex components, so like your income and your expenses and your assets and your debt. And we bought them all into one data point we called the fitbug score. So you can really easily compare everything and what the fitness score is in the short run, it looks like your risk and your profile and everything else. And then by the time you hit retirement is basically the probability of you hitting retirement and not running out of money. Okay. And so once you say this is the plan that I want to follow, you can then link your financial accounts into the hitbox profile, track yourself right on your profile, and it literally tells you step by step each month, are you doing this right or not. And then if you have one of those life events where you have to change your percentages around you just go back in and have your plan with the percentages around hit save and go back on with your life. So that's why I'm so excited because we've been building that literally for like two and a half years that that bigger technology and it's finally out. So I can actually smile and have a few more gray hairs because of it but it's out So that's where we're at right now.



Yeah, it sounds it sounds like definitely makes life a little bit easier. And now does this connect to your bank accounts or to your QuickBooks and all that kind of stuff so that it's constantly updating? How does that



work? Yeah. So it doesn't connect to QuickBooks, it connects to bank accounts, credit cards, some debt. So it connects almost everything not, you know, there's some credit union stuff that it doesn't link into. Some accounts are more thorough. So like the bank accounts, or the savings accounts are all in there. Some debts, like some companies, like first of all, some companies are there, some aren't. Even if they're not, you can still manually put them in. And I just tell people updated like once a month with your transactions. So it can up to date tell you, the big thing is, is making sure that your gross income is in the technology? Because that's how we base everything, are you following your your plan, based on these percentages, and the only way we know that percentage is if your gross incomes, they're not your net, your gross income. Because we want to see, we want you to see where your taxes are going and everything else in your entire paycheck. And so yeah, you can link your accounts, we do it through a company called plaid, which is, you know, the other major banks use them and everything. So that is who we use to link the accounts.



And can you quickly just for people who don't know, define gross versus net income?



Yeah, so gross income is what you get from your employer on quote, unquote, that top line, so it's what you're actually paid. And then from there, they deduct out things like your taxes, your Social Security taxes, your unemployment taxes, your Medicare taxes, any contributions to your 401k that you're making, anything that you're paying in terms of like medical care, dental care, whatever it is. And then after that is your net pay. So when you get a deposit into your bank account, that's what we see as net pay. And so you have to reconcile that the gross income. And so what we try to do on the technology to make it easy is is once you put in one of your gross incomes, so like if you get a net pay of like two grand, and then you reconcile it to say 3000. Next time we see $2,000, we automatically reconcile it for you. So you don't have to keep doing it. But yeah, we need that done a few times. So that way the technology updates and can start learning what that is and make those adjustments for you. But yeah, that's the difference between gross and net income.



Perfect. And let's say you're self employed, and maybe you're so you're not getting a steady paycheck, but maybe your pay can fluctuate slightly from month to month. So how does the technology work with that? Is it like, on our end, when it comes to a little



bit more, yeah, a little bit more, because you don't know what that income cash flow looks like. But what I tell everybody, like when you're setting up your plan, and you have variable income, so you might not even be self employed, you know, just be based on commission or commission. And what we tell people on that is be very conservative. So like, if you typically make like 80 grand a year and commission or self employed income, do your financial plan based on 60 grand, and do those percentages. And then every month, when you get those waves of money coming in, just take the percentages, and that's what you do. And so again, it makes life very easy. Like if you're putting money to the SEP IRA, or whatever it is, you just know what those percentages are. And that's what you put in. Instead, try where I see a lot of commission based or business owners where they make mistake is actually on twofold. They try to do everything monthly. And then they ended up in a month. It's like, oh shit, I don't have any money. Like, oh, or they go the opposite. They say, I'm gonna do this every six months, I'm gonna see where I'm at, I want to put money into these things. And then six months go by and they're so busy, they just forget. No, they don't do anything. And then all of a sudden, they have 50 or 100 grand sitting in cash, just not doing anything for them. And they don't even realize that it's sitting there. It's like, fantastic. And so, yeah, that's another place where those percentages come in into play big time.



And do you suggest people looking at, look at all of these percentages every month.



If they're following the percentages every month, the only real time you need to change them is when one of two things happen. The first one would be is if you have a major life event happen. So things like you get married, you have a child, there's a debt, you're inheriting money, whatever it is, those are major life events, that's when you go in and change it. Or you hit a major goal. So you pay off one of your debts or something like that, and you have a lot of money now that you need to move around. So those really are the two times and that's one of the big reasons why I'm so excited about the technologies because when I was in wealth management to me, it's like this whole model is messed up like you pay 1000 to $3,000 to a person to come up with a plan and then you walk out and it's completely obsolete. And in some of these guys charge $100 a month, but they don't track anything. They don't have any technology to actually even track anything. So what the hell are they doing for $100 a month? So we were like, Okay, well, we give out the financial planning technology, it's free to build your financial plan, you can even talk to a coach, and it's free to build it. And then when you track it, we could charge a monthly subscription fee, that's, you know, 20, or $30, whatever we charge on that. And it's there, you don't have to worry about spending $3,000 a year, any of that garbage. It's like, oh, it frustrates me so much when I talk about it, because the whole model is just like, completely upside down. And actually, the stuff we're coming out with Next, we just started working on it. As far as investment recommendations for allocations and how you had your investments allocated. And I had heart, I'm an investor, I mean, that's what I've been doing since I was like 12. And so I'm just starting to get my tea sharpened on that one, I'm hoping to have it out by March or April this year, where you can literally build your profile. And then it will tell you how your allocation should be on your investments, how much risk you shouldn't be taking. And the big part that's different, we didn't touch on this. We factor in this thing called human capital into our analytics. We ask everything from like, what's your profession to things? Like do you run marathons? Because that all goes to speak about behaviors. And just like healthcare 80% of outcomes and behaviors, it's the same thing in finance. And so there's no point in our technology saying, Hey, you should do this complex plan, when the behavior is not necessarily there yet. And so we factor all that into our algorithm. And that's part of what we're going to be coding next with the investment allocation. Which that's a whole minefield that to me, is that all traditional advice, like, Hey, you're young, like you can afford, you know, to put everything in the stock market. It's like, No, you can't like you know, what happens if you have $5,000 in emergency fund, and you have $5,000 in a 401k and COVID hits and your 401k goes down 50%. And you also just got laid off that $2,500 that just went out the door might be pretty valuable. So why were you aggressively invested at that point in time? Like, it makes no sense? Yeah, so I, yeah, I can go off for hours on that investment allocation stuff. But that might be a far whole nother podcast.



And that's okay. We'll have you back on. That's not a problem. Well, it sounds like a lot of exciting stuff and a lot of stuff that's really user friendly, and really good for people who aren't financial planners, right? Who like they didn't go to school for this. And they need a little bit of guidance, a little bit of coaching. And this certainly sounds like it makes it very easy for people to do that. Now, what are I know that you said this before? But I'll have you repeat it. If people take away anything from this, what is a big, big thing that you want people to take away from this talk?



Yeah, keep it easy in terms of how you set it up. So again, today, what's your expenses? What's your income today? What are you doing over time with your investments and your debt? And then the third piece is what am I doing to protect my financial plan, that's insurance. The second big takeaway is following your percentages of your income, it will make your life extremely, extremely easy. And then to your key point, caring. This stuff should be complementing your life not dictating it. And it should be easy. And again, that's one of the hours that retirement of it for a PT when I decided, yes, I'm going to launch the company. And the main reason was because I was like, I always wanted to invent something in terms of technology to help people like, but I'm not. I can't like I'm not Elon Musk, I'm not gonna build neuro link or some of these other companies, right? It's not gonna happen. But I know finances. And it's like, okay, well, if we can develop a technology that reduces the amount of time you need to think or stress about money, that means you can do what you're supposed to be doing when you're going to school, like being a PT. Or if you're an engineer, and you're the next Elon Musk, you don't have to think about money because that part of your life is actually taken care of. So it's my small contribution, if you will, to the technology world. Just funny because everyone's like, you're a founder of a technology company. I'm like, I'm a finance guy. I know algorithms. I know math, and I know money. And I'd like I give it to coders and engineers, right? They do it. Right, right, right.



Hey, listen, that's why it's we always work better as a team, right? It's hard to do everything on your own, if not impossible. And now where can people find more about all of this info and how to sign up and how to start using this?



Yeah, so Bostock comm just go on build, your profile is free to go on and you can build like all the tools are accessible to you to build your plan. You can schedule a call with a coach which we highly recommend because this version of the technology We built specifically for people to actually call us and have them help us walk you through the technology to make sure you're using it correctly. And then as we grow, we're building out more and more automation. So that way, it's easier. And then once you want to sign up and say, This is the plan I want to do, that's where you start the subscription and go from there.



Perfect. All right, so that's fit bucks fit bu Yep, you're right. All right. So before we end, before we wrap things up. Last question, I asked everyone, and that's knowing where you are now in life and career, what advice would you give to your younger self? I know you've answered this question before answer it again, come up with a new piece of content, you get to say more advice to your younger self instead of just one piece.



Yeah, this one, I touched on it earlier, and I can't stress it enough as focus. You know, I'm the type of person that like I was at CSM last week. And I pretty sure that I wrote down like seven or eight business ideas. And I'm the type of person that just wants to start working on everything. Like, I used to joke around with my wife. I was like, you know, this was back when I was doing my investment trading. I was like, if I come up with something, I will literally be up for 72 straight hours researching this and figuring out if it works or not. And sure enough, the very first time like, I came up with something, I stayed up, I was on our 71 I thought it was gonna work. And then our 72 is when I found out that it will work. But focus is we're so distracted with things. We're so distracted. You know, that's one of the behavioral things I'll share is like, when you start saying, This is what my focus is, and you have a fundamental reason of why you're doing it. And it's not because you're, you think you're gonna make a lot of money or you think you're gonna do this, but you have a real fundamental, real reason why you're doing it. Focus actually becomes very easy. Like you no longer care about watching TV, like I'm a big sports person. I haven't watched sports in about eight years. Just because there's like, I won't play I was watching a football game. I'm like, Well, this sucks. I'm wasting four hours. And the game's only an hour and a half and watching commercials. So let me TiVo it. And I started TiVoing. And I'm like, wow, they're still wasting an hour watching this thing. Like, I'd rather be doing something else, which I stopped watching sports. And so it's like, if I could go back, I just think about it. Like if I had that same mentality when I was like, 20, instead of getting that mentality when I was 28 or 29. I'm like, my life would be looking a lot different right now. So focus, focus, focus, focus.



Great advice. Joe, thank you so much for coming back on the podcast, giving us great tips for financial planning. I'm sure everyone will take a lot away from this podcast. So thanks so much for coming on. Yeah, thank you for having me. Anytime and everyone. Thanks so much for tuning in and listening and have a great couple of days and stay healthy, wealthy and smart.

Feb 7, 2022
In this episode, Pain Scientist, Clinician, and Distinguished Professor at the University of South Australia, Lorimer Moseley, talks about pain and research.

Today, Lorimer talks about his many streams of research, assessing cognitive flexibility, and his MasterSessions. What is cognitive flexibility and how does it affect pain?

Hear about the social determinants of pain, COVID’s impact on Pain Revolution, the complexity of chronic pain, and the responsibility that comes with doing pain research, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “One of the biggest determinants of your health in the US is your zip code.”
  • “[Cognitive flexibility is] the ability of your system to change its behaviour when the task requirements or conditions change.”
  • “If you’re going to label something, it should be what it says it’s doing.”
  • “[chronic pain] is one of the most burdensome health conditions in the world.”
  • “There’s genuine, realistic, scientifically-based reason to hope things will keep improving for people with chronic pain.”
  • “Love and be love.”


More about Lorimer Moseley

Lorimer is Bradley Distinguished Professor at the University of South Australia. He is a pain scientist, clinician and educator. He has made seminal contributions to how we understand pain and why it sometimes persists and has developed treatments that are now considered front line interventions in clinical guidelines internationally.

He has authored 370 research articles and seven books. His contributions have been recognised by government or professional societies in 13 countries.

In 2020, he was made an Officer of the Order of Australia for distinguished contributions to humanity at large in the fields of pain science and pain medicine, science communication, pain education and physiotherapy.

He lives and works on Kaurna Country in Adelaide, Australia.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Pain, Research, Cognitive Flexibility, Chronic Pain, Perception, Responsibility, Recovery,


Notable Mentions

Caitlin Howlett.

Dan Harvie.

Pain and Perception, by Dan Harvie and Lorimer Moseley.

Epiphaknee, by Lorimer Moseley, David Butler, and Tasha Stanton.

Participate in research (it takes just 20 minutes).



To learn more, follow Lorimer at:





Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     

Read The Full Transcript Here: 


Hi, Lorimer, welcome back to the podcast. I'm so excited to have you back on.



Good. Thanks for having me.



And so today we've got a lot to cover, because we are going to be talking about some of your current projects, new developments that maybe happened since 2021, where you had well over 30 publications. So you had a very, very busy year, I would say. But as we go, as we kind of go through and talk about some of the things that you're working on, I just want you to let me know if there's anything that you're like, Whoa, hey, I can't talk about that. Or if there is reason to be a little vague, because things might be ongoing trials and things like that. So we'll definitely keep that in mind. Now, let's say you've had a lot of publications over the last year, what are some current projects, or discoveries or developments that really stuck out for you in your most recent research?



Ah, nice question. Um, one of the things about being a scientist in a clinical field is that here, it's not often that you get a revolutionary discovery, it's quite unusual. So what I think the things that I'm most excited about are not, not so so much particular papers, although there, there are some really tiny phones, there's one that's not published yet, but will will be out in the next couple of months that I'm particularly excited about. And I can allude to that. But I think sort of like these, these streams of research in which I'm involved that are turning me on a bit, the moment and one of those is a continuation of the whole explain pain thing. But over the last sort of four or five years, we have discovered, we've looked really closely at but at the the outcomes of clinical practice in where people are delivering great educative interactions and, and I've had a fair degree of, of influence over them. So I feel really confident that I did, they're supposedly doing well. And those data from a big cohort of people suggests that, in about half of the people with chronic pain, they see they have this shift in understanding of the problem, but a real flip. And it's in a predictable way, you know, shifting towards really deep in your belly can conceptualizing pain as a protective feeling that's being produced for a reason. And we need to work out what that reason is, and it will almost well, it will certainly not be a single reason, there'll be all these little contributors. So real flipping, understanding. And, and I guess, understanding that as pain persists, the system becomes over protective, and, and really embracing that as a reality. And that's a really hard thing to do. But those those half of the people who do it has great outcomes a year later. That's a for me, that's a really exciting discovery. The half of the people who don't don't have great apples. So for me, again, it's a really exciting discovery. The problem is that we're only winning in half the people. You know, we're only nailing it in half the people and the interventions good across seems to be good across everyone. So clearly, our markers are what's good intervention, they're not accurate. So my gut feeling about that was not accurate. So we've been looking deeply at how, how can we expand that group from half to bigger and, and unexpectedly for me, doubling down on the on the criticality of learning. So I've been learning a lot about learning. And that's been infiltrating our research and infiltrating the whole way we go about helping people with chronic pain or at risk of chronic pain. And so I'm really excited about that. And we're seeing its scientists talk about seeing a signal amongst the noise. And in chronic pain, there's just so much noise, right? Because chronic pain is this truly, in my view, truly bio psycho biggest and it's more or less social thing. And if we can intervene and see a signal in that group, that's a really exciting development. And



I, I'm more excited than I was maybe seven or eight years ago about the potential power of of new and better ways to get people to give people understand. And I started banging on about this in conferences and stuff maybe three or four years ago. And I have this slide that that is intentionally slightly provocative, particularly to the physical therapy world. And that sort of pain science education world, I think in in the US the brand name as popular as paid in neuroscience, education, p and E. These are all brand names, right? PMA expired pain is a brand name. So I like to avoid the brand name. So I call it sort of pain science education or modern pain education. So this slide is meant to be slightly provocative, in say, has education become the objective, instead of learning being the objective, and I think for me, education became the objective. And that was a mistake that, that I made. And I think my research made that mistake, and my clinical practice probably made that mistake. And my own outcomes over the last 10 years, and I get I keep really tight audit data, I can see the benefit of my own development as a, as a clinician, educator, and probably as a human on outcomes. So I'm excited about that, for sure. And I can give a little, a little teaser to the paper that we expect to come out the next couple of months in a big journal near you, which looks at a clinical trial of chronic back pain, where we have done two things that I think are really unusual for our field. One is we've tested, I think, a new complex intervention. And it's made up of less new interventions, but they're all sort of put together into a package if you like. And the other thing that was different that we did that, that are Yeah, I think I'm really proud of the team led by James McCauley is the senior author on it. And Ben once and I were important in sort of formulating the treatment, but Ben's been really critical. But we were all very keen to make the control group the best placebo intervention, we could. So we put a lot of effort into credible brain targeted treatments, matching the educative component. And testing whether people had different expectations or perceived credibility or beliefs about whether they are in treatment or not. So from my perspective, it's a very tight trial. And James and I were fully expecting that we would not see a signal in this. But we would be interested in secondary analyses which tell us mediating effects like what, even though there wasn't an overall effect, where what worked, what what might have been helpful. So that's what we were expecting, but in fact, we saw a clinically important signal. And that's very unusual in back pain trials. It's if you have a control group where you've got a waiting list or usual care, or you've gotten there's been a couple of trials published slightly, or you've got open labeled saline injections, you know, these treatments that will have some sort of effect, but they're no match. Right? So you're not really asking, are the particulars throughout this treatment? Important? All of those treatments will show a signal they all they always do they show exactly the same signal. I've done those randomized control trials. So that's one thing, you can design a trial in a way that you'll show signal. But it's a bit meaningless to us as real world clinicians. Or you can design a trial that we would call an explanatory trial that says, Okay, we've kept all of these things the same in the two groups and the things that we kept the same were as much of that nonspecific therapeutic alliance engagement, credibility expectation, which, which I think is a big part of the whole pain science education thing. So I do think we have to monitor that. You might hear my dog the other



room. Right. All right. We're pet friendly around here. What's exciting



about that is that it means there's some sort of delivery bandwidth to be won, I think it might be this new piano that I discovered even better. Yeah. So anyway, so that will be coming out. I can't say anything more about that, but, but it's a really exciting development. And we've got we've got a few trials that are testing versions of these sorts of things for for different conditionals. But uh, going at the moment and the way we're constructing the education component and integrating it with the movement and loading and anti inflammatory component. So that is three pronged approach. Really exciting for me, as I, you know, I've been doing this for quite a while that feels like, I still feel like a kid. But, you know, I have been researching for a while. And this is a really exciting time, I reckon, in the chronic pain world, because I think we're starting to chug forward again, I feel like the field was stalled a bit. But jumping forward. That's one thing. And then then on the other other side research streams, one of our team called Dr. Emma Karen is doing really difficult and really important, work really well investigating the influence of social determinants of health on chronic pain outcomes. First focusing on low back pain. She's published a couple of systematic reviews, and mixed method study on that, that is pretty intimidating. For those of us trying to move the the outcomes in a positive direction, because as we were talking about before, caring that the social determinants of health are very powerful, and they're powerful in back in back pain and pain outcomes. They're really hard to shift, you know, they're very hard to do much about so. At our field, the pain, field musculoskeletal, the the sort of arthritis field has or has engaged with, it's way better than then the non Arthritis, Musculoskeletal pain, pelvic pain, Fibro fields, we, you know, it's remarkable how little attention, it gets the biggest social and when we talk about the biopsychosocial model, we nearly always conceptualize that as a smallest session and the people around you social, which is important. But we haven't really integrated the biggest social Yeah, the world in which you live in your access to health care, illiteracy. Poverty.



Yeah, that sort of stuff. Absolutely. And I think you kind of hit the nail on the head as clinicians, oftentimes when we talk about the bio psychosocial, we think of the socials, what's your support system at home? You know, do you have, you know, can you get to, can you get to therapy? Do you have access to therapy? But what we're not asking is, do you have access to other medical care? If you need it? Do you have access to fresh foods and vegetables, which we know can play a part in, let's say inflammatory responses in the body? Do you have access to a pharmacy? Do you have access? I mean, all of these things make a huge difference, you know, or do you? Is your social part of that bio, psychosocial? Are you working three jobs and raising children and not having time to fit some of this stuff in? Right? So social part becomes a really big S for a lot of people. Certainly in the United States, like I said before, one of the biggest determinants of health of your health in the United States is your zip code.



Yeah, it's remarkable.



So social determinants of health is is high priority. And I think maybe people shy away from it, because it's can be so overwhelming. So I don't know what you guys are finding research wise, if there are way and how you can address that?



Oh, it's it's overwhelming, for sure. And I totally understand why there is a reluctance to go there. And there are also I think there's very complex ethical considerations about going there. We've we've been planning a study in the northern suburbs of Adelaide where I live, which is an area that's really different to the say, the inner suburbs of Adelaide with respect to all that sort of predictable social determinants. But one question that we've had to look in the mirror about is if if we develop this so we're working on developing a screening tool. If we start to identify people that have significant unmet social needs, and we can't do anything about it, is that is that a ethically defensible position? Yeah, we were able to say to people, okay, we know what the problem is, you know, this, you can't have because we got no mechanism Have of meeting that need. So it's quite a challenging area to move into. Because if you if you imagine that the understanding and overcoming persisting pain is a very slow step by step journey. And now we really have to imagine that instead of going in a straight line, we're almost going in a circle, and we're making slow step by steps of the entire circumference of the circle, you know, and you move a little bit, then you have to stop and move a little bit more somewhere else. Otherwise, you're going to break. And the people who suffer when you break will be the same people, you know, the, the more vulnerable people. So it's a really challenging field. And yeah, I can't, I'm excited to be getting dragged along by Mr. and her colleagues on on this. But I'm also so impressed with how, how robust the approaches to it. So yeah, there's a couple of her papers out already and more, more coming. And I think there'll be really influential in the field. Because no one there are people there. There are people who are engaging in this, but very few people are thinking to themselves, I'll take on that challenge. Yeah,



yeah. Very, very difficult.



It's relevant to it's really relevant, or I guess my interest in it was sparked by our work with pain revolution, which is an outreach project program for rural areas. And it sounds like it's similar in the US. But there's there's areas in Australia not far from big cities, what we would call a big city of Adelaide a million people. There's areas two hour's drive from Adelaide that cannot get a GP or a physio, or a psychologist or an occupational therapist, to worth it. And they've got, you know, wanting four of them have a persisting pain problem that affects their lives. There's no, what do we do? What do we do about that. And so pain revolution is, is really trying to ultimately build workforce capacity. In giving people health professionals have some description, when I care what description, in fact, we were, were looking for money to try our non healthcare professional, being coached and becoming a rural coach. But the idea of that is that if people we know I think from other areas of the pain field that if if a healthcare professional of any persuasion, understands deeply contemporary pain, Science and Management, and takes a defendable, scientific, and now evidence based approach, then outcomes can be better for sure. And outcomes will be promoted by engaging in in care locally, the moment the only model we've got is a fly in fly out model, which is where, you know, the health professionals go from the city and spend a day in the country and come back a month later, in my view, of very limited benefit. Or we've got a full five model where the patients, that consumers come down to the city. And in many cases, that's a 810 12 hour drive. Get an assessment? Yeah, there's no there's no way of training those people or providing effective care for these people. So yeah, yeah.



And I, you know, yeah, no, no, you know, it this, this conversation about this kind of rural outreach and, and maybe training someone who's not in the medical field, reminded me of a documentary that I saw, Oh, gosh, I can't remember the name of it, if I can ever And i'll put it in the show notes. I can't remember it right now. But it was on it was more psychology based around loss and trauma. And there was a woman in Africa, who was not, not a psychologist, she was not trained. But she, she, I think she was trained in some basic coaching skills, but she lived in the community. And people there were more likely to go to her because she understood the community. She was part of the community and they had really good outcomes. So I'm wondering even if training someone who is not a medical professional, but if it's possible to train them even in you know, you don't have to be there in person, but would that person because they're part of this rural community, maybe have better results and someone just flying in for the month and flying out where you have someone who knows the community understands the struggles, and maybe has known some of these people their whole lives. You know, we talked about therapeutic alliances and trust and beliefs. So with people they're more likely believe someone who's part of their community than someone who's doing a fly in fly out. I don't know, it just reminded me of that documentary.



Yeah, I totally get that. And I guess we were really embracing that in, in one aspect with pain revolution, because we're training rurally based healthcare. And that was the impetus you know, they're connected to their communities and their communities are really well connected more so than certainly in Australia, in the cities. You know, you're the physio, if there is a physio will be on the sideline at the Netball day or the football game, way with the consumer, you know, these, these people's normal lives and accessibility and those things that I think reduce the power differentials that that contaminate a lot of healthcare interactions. Was it a part of our drive to drive pain revolution rurally, to tap into this already, and you know, the vision that we state, the pain revolution is that all Australians and I think we're going to change that to all people will have the skills, the knowledge and access to local resources to prevent and overcome persistent pain. And that's the real emphasis that we embed the knowledge and skills locally. And, you know, that's, you know, I've been talking to 1010 years about recovered consumers being coaches, not the healthcare person, but recovered consumers, because they have all this knowledge and expertise that no one else can have. Right.



They're very deep understanding of pain.



Absolutely, yeah. And pain, and not not only the lived experience of pain, but the lived experience of recovery. And I think that's a untapped massive resource. But there are significant regulatory medico legal barriers to us just pushing forward on that, that we're still negotiating. So that's yeah, that's been at least a decade. My perspective. But paint ray of is is so exciting. It's, it's really cool. Like, we are doing it on a shoestring. And I think we now at the end of this year, we will have, I think we'll have about 35 Local pain collective. So these are networks of healthcare professionals around geographical regions that get together, learn more about how pain works, and the best ways of treating it collectively problem solve pain, rave feeds them. curricula, but really, it's a collective problem solving facilitated group. And yeah, I think the panorama was responsible for delivering around about around about 400 community outreach sessions, amazing Australia, in the middle of COVID.



I was gonna I was gonna ask, How has COVID affected? What pain revolution has been able to do, let's say last year, as opposed to previous years?



Yeah, it's, well, it's had its impacts, for sure. And depends where you live in Australia. So two of our states have had a longer period of of living in a COVID world I guess. And in those places, there's there's been no face to face. stuff. They are 2021 outreach tour that we do. So we run this circus that gets a lot of attention raises a fair bit of money on our level of what a fair bit of money is, it's got in the commercial sector be like someone's bonus for the week. But in our sector, it keeps us alive. And we go from town to town, and we run these public outreach and health professional outreach events. We're all dressed up in library, we ride our bikes, and it's all this cool thing. And that's part of a wider program with two other projects that dovetail into that dedicated to the region. And we didn't run that in 2021. And we won't run that in 2022. And that's a big hit for us because it's our main fundraising Avenue. So that's that's a real challenge. Some states in Australia have had basically no COVID And one state still basically there's no COVID Western Australia they They pay us closed to the rest of Australia in the world. And I think they're aiming to reopen in February. Tasmania has recently reopened and they're starting to get cases. But now we're where I live. We are, we're at the beginning of our wall of Omicron. And we really don't know what this year looks like. So we don't have the experience that a lot of places do. And we're very grateful for that. But we also clearly like deer in the headlights at the moment. Federal governments are going everything. Rules are changing all the time, we and you know, we're not as prepared as you would expect us to be having had a month's notice. So that will impact pain revolution for sure. The we're a really small outfit we have I think we have 1.5 full time equivalent staff delivering hundreds of programs, or events, and we're very resilient. And yeah, well, yeah,



we'll you'll get this done. And And if people want more information, they can go to pain., correct. Correct? Yes. All right. So pain, if you want more information about what pain revolution is doing, and maybe how you can help or contribute, if you so if you see if it if it aligns with what you believe in, then I suggest go for it because it is a very worthy cause for sure. And now, it's kind of switching gears a little bit something that we were speaking about sort of before we hit the record button here. And it's a concept that I had to kind of look up a little bit before our talking here. And it's that concept of cognitive flexibility. I think it's interesting. I think it's worth talking about. So I will hand the mic over to you to sort of talk a little bit more about what that is, and how does cognitive flexibility fit in with people living with pain and maybe with practitioners treating those living with pain?



Yeah, well, thanks. And again, yeah, I feel like I don't actually actually do much of the good work, it feels a little bit like because this work is has been done by Caitlin halat, who's a PhD student about to finish and has a background in psychology. We embarked on a new direction probably three years ago, with with a really sensible prediction, I think that possible contributed to not recovering after an acute episode of pain based on if people familiar with Bayesian or other predictive processing models, based on the idea that the outputs that we generate predictions and the system is influencing itself according to predictions, then we need to update the internal models of the models in order to resolve so if I was to cover that really quickly, if we, if we said, when you bend over and you don't have pain, that what what could be happening there is that your brain predicts that this will be safe, your brain produces a feeling that's consistent with that mn let's say you tweak the annulus of a intervertebral disc or something, you get no sensitive data that are that are within the sensory load. And I like to say within the Tampa symphony of Dallas, extraordinarily complex, beautifully evolved system of of information about what's happening in the tissues, we get data that says this is not what I predicted. The evaluator for this is not what I predicted. So we update the internal model to say the back is vulnerable in some way, let's say. And then the new prediction is, well, let's make pain. And let's influence the system differently. And then if we go in the other direction, and every time we've been able to get this nociceptive data within the symphony, and then one day you don't I know you've been over and and you don't get that. And now the theory is the system detects that error says Hang on. That's not what I predicted. So it updates the internal model to say the back is less vulnerable. And now your brain doesn't produce as much pain or produces no pay, and then you've recovered fantastic. So one potential barrier to recovery according to that theory is failure to update yourself. Title model. And and that should happen. If, excuse me, that shouldn't happen if you if you don't detect the error. So if for some reason you don't, your system doesn't detect that the predicted data, the predicted data, which was not receptive, in part hasn't been hasn't eventuated. And therefore you don't update your internal models. So on the basis of that, we became quite interested in this broad field of flexibility, cognitive flexibility, which has been defined in many ways. But I guess the way that we were thinking about it was the ability of your system to change its behavior are when the task requirements or conditions change. So in the language of have that sort of Bayesian idea, and to your ability to update your internal model of things. So we started digging around in this field, or Kaitlyn really started digging around in this field. And often in a PhD, you'll start with a systematic review of the literature on a question that's most most aligned with what our hypothesis will be driving. So. So Caitlin took on what we thought would be a reasonably straightforward job to review the literature in cognitive, mental and psychological flexibility. So the barrel phrases that are used, often interchangeably, particularly cognitive and mental flexibility. And with the question that would help us determine which is the best way to assess it's what's the best way to assess flexibility. And there's two broad approaches to assessment. One is self report, questionnaires. And they have they were developed out of a line of research, starting with personality tests in the 1960s. And that's this sort of this long line of stuff. And someone I can't remember who but in the, I think in the 60s or 70s.



proposed that I think it was empirically based but propose that good communicators perform the answer these sub questions in a certain way. And that research would describe them as positive and flexible people and are good communicators. And then that infiltrated the field. And we eventually got to this situation, we've got cognitive, cognitive flexibility scales, things like that. The CFS or, and there's a few of those, completely independently from that was the development of behavioral tests. The most famous and most common is a thing called the Wisconsin card sorting test. In that, in that test, you you sort cars according to one of three criteria, shape, shape, or number, I think, sorry, shape, color, or number. And the rules for sorting change, and you only realize that change when you make an error. Yeah, that so you put a card in a certain pile, and the tester or the machine goes about anything, what should work, and you have to work out what the next set of rules. And the people doing these studies somewhere in the 80s. Or maybe it was a bit later than that, call this cognitive flexibility. So we've got two independent lines, joining a company flexibility, and then that's then all the whole field just went nuts cross contaminating and all that. So Caitlin has now published and once just been accepted last week, to systematic reviews that are massive. And she had to contact authors for nearly every single one of these studies to get data, asking the question How well do those two approaches to testing 100 Flexibility correlate? Because if the system the same thing that should correlate quite well, one of those systematic reviews is in Healthy People. And one is in people with a diagnosis clinical groups. And in both of those studies, there is absolutely no relationship between those two approaches.



So you have two different tracks on how to assess cognitive flexibility, and there is no correlation between them.



Not at all. And actually a lot of the tests, there's no reliability data for them. Now, there are some cognitive psychologists who won't be surprised at that finding. And they're the informed one Who, who have been working in this field? I guess. But for people like Caitlin and I and the rest of the team on this project, where clinically, it's such an attractive hypothesis, right? Like if if people can't change their, that if people don't easily change their beliefs, explicit beliefs, their implicit beliefs about the vulnerability of their body, what pain means that the targets of pain, science education, then we know those people who don't, don't change some of those targets of pain science education, don't do as well, when we know that. So it's such an attractive hypothesis that they might be less cognitively flexible. But the barrier with hit is so how do we find out? Because we don't actually know what any of these tests are actually.



What are they actually test



measuring? Yeah, yeah. So so the direction for that, and I've asked for money haven't got it yet to do that is to devise a a new way of assessing the ability to change your decisions when there is some sort of risk evaluation involved, because I think for, for pain, I think we talked about the meaning of things being important for painting. And I think one way to distill the meaning is about just a risk profile, that every nanosecond, our system is evaluating risk, and its risk, that determines our feelings. And I would categorize pain as a feeling bad. So my anxiety, fear, fatigue, lead to the toilet, lead to a thirst, all these things, in my view, feelings generated on the appraisal of risk. And, and if we don't have any risk, in an evaluation of our ability to change your behavior, under changing circumstances, and I'm even, I'm nervous to use the phrase cognitive flexibility now, because I know that whoever he is that there are three or four main ways that you understand that. And some of those would be totally different from otherwise. So I would prefer to say, if we keep assessing the ability to change your behavior, according to changed demand or environment. without risk, then I think we might not capture what we need to capture for understanding a potential contribution to the development of chronic pain or recovering from initial pain. So so that, you know, that was one of those, one of those PhDs where it's such an important discovery, actually, and and Caitlin's contribution to the field is very important. But it won't get the citation impacts and the Roth IRA. Because what the country contribution says is, hang on everyone. Why, you know, there are a whole journals dedicated to this. But what is it? What is it, we almost have to go back and start again and say, Okay, let's get really clear on what we're talking about. Let's use these phrases. Anyway, so but that's relevant to the very first question, what are you most excited about? I guess I'm, you're tired to be excited about, clearly, deflationary discoveries like that, but they're so important. They're really important, and they're harder to publish. But they shouldn't publish, in my view, they should publish top journal. In your face. Journal. Yeah. Well,



it's, it's like, yes, it's sort of this deflated response, if you will, to, to the systematic review, but it is important because it's important to use the right words, and to if you're going to label something should be what it says it's doing. Otherwise, why are you doing these tests? And why are you you know, labeling someone as very highly flex cognitive flexibility or low cognitive flexibility when you don't really know. And then exactly, so how do you then so then your treatment, I look at it from a clinician standpoint, how do you formulate a treatment plan around something that's, that's not accurate or unknown? So I think it makes it really difficult but it's it just underlines the importance of this kind of research.



And oh, go ahead. No, I was just gonna say I think that um, it Kayla's research doesn't doesn't tell us that these tests are uninformative. But what it does tell us is that we don't We don't know exactly what they what they mean. So that speaks to your point exactly Karen, that that. So what do we do about it? That's a difficult thing, because we don't actually understand them well enough, I think. But can I put in a plug for? Yes, a research project of Caitlin. So final project for a PhD that we desperately need participants form? Yeah. Because it's an online study. Okay. And it's, it's to do with this kind of flexibility. And we need people without pain, as well as people with pain. Well, that's a lot of types of it. But basically, everyone, anyone who has 20 minutes spare. It would be great if they just went and did Caitlin's experiment online. And maybe I could send you the link.



Yes. Yeah, you send me the link, I'll put it in the show notes. And also put it out on social media. So that girl can can take this online study. So if it's people with or without pain that takes in quite a lot of people, like you said, like, one? Yeah, so I'm assuming she wants a robust number.



We need lots. Yeah. Because we think the signal will be small amongst the noise. Yeah, but yeah, if we did it, and then ask one of their family members or mate, yeah, that'd be fantastic.



Yeah, I'd be happy to send you the way about that. Yeah, definitely do. And as I was, you know, as you were talking about this cognitive flexibility, or the ability of to adapt your behavior, and let's say cognitive strategies in response to a changing task, or to a threat or something like that, it, it always reminds me of this experience that I had. So most people who listen to this note that I had a very long history of chronic pain, I think you're well aware of that as well, about 10 years or so of neck pain, chronic neck pain. And it was this was a couple of years after I could say I was recovered, you know, of course, those times when you have flare ups and things like that, but largely recovered. And I was I was at Disneyland with Sandy Hilton and Sarah Hague. And we had waited in this long line, like an hour to go on what I thought was like a jungle cruise. You know, this very, like, get on a boat and cruise around the water kind of thing. Yeah. And we get up there. And all everywhere. Once we get inside, plastered everywhere was date, big danger signs, you know, the yellow dangerous sign, the red X, if you have neck or back pain, you know, this guy. And I was like, you know, so talk about a threat, right? So my normal behavior, and like, my hands were sweating, my heart rate was up, my eyes were dilated. My normal response, I guess, would maybe show my inflexibility would have been to find the nearest exit and leave. Yeah, yeah, get out as fast as possible. Right. And so I think, Sarah, and luckily, I was with two very incredible women who are very well versed in pain science, and I think I am as well, but when it's you, you're you're like, a big, you know, mashed potato, you know. And Sandy and Sarah just looked at each other and looked at me, and I was like, almost shaking. And Sandy's like, Okay, listen, it only tilts about 12 degrees, and it stops and goes, you're in taxi cabs, they stop and go, you're fine. It's this much of a tilt, you'll be fine. And then Sarah's like, yeah, and the person in front of us like six, you know, there's nothing over your shoulders. It's not that dangerous. And they kept playing down the danger. And so I did end up getting on it very, very nervous. And then I got off and I was fine. They were right. Then it allowed me to be flexible enough to then go on another ride after that. Whereas if I went with my original strategy, which would have been to leave, then I wouldn't have done anything else for the rest of the day. Yeah, so that threat, if left to my own devices would have gotten the, I don't want to say gotten the better of me, but I would have reverted back to the behaviors I had during the that sort of 10 years of living with pain.



Yeah. And, you know, I respect I respect both of those approaches where it makes sense for an organism when you see credible evidence that this is a dangerous situation to take a variety of action. Yeah, makes total sense. And I guess the, I think about the flexibility thing was evident, as Sandy and Sarah are problem solving with you gathering more data. And, and then your choice changed. That's the stuff that seems consistent with in quotation marks flexibility, you know that right? In the face of new data. So the new data, it could work both both ways. And I think there are some people with persisting pain problems where they behave the same way, even in the presence of significant danger cues. And that works against them because they the danger, for example, right, right. Yeah, can work both ways. Yeah, I think I think there's a rich there's there's a rich stream of, of understanding in there somewhere for us to, to uncover. But it does feel a little bit like that's going to require the the archaeologist among us to get out. This is a metaphor, obviously, to get out our brushes and blowers and slowly reveal what that stream of gold is, as distinct from the earth blasters obviously just want to revolutionize in a in a rapid way. And I fit more into the second category. You know, I lose steam on the very slow, the finite, made tool discovery thing. I'm very pleased to be around researchers who are excellent at that. Yeah, it's not so much.



And I always always think about that. What did I think David Butler said they were what did he call them? Oh, I don't know why I'm blanking. I have the book right here. Super. Ah, I'll think of it. It'll come up. It'll come up later. It's from explain pain supercharged, you know, the graph and everything leads. So if you have more, yeah. Dangerous safety Sims. He called them Super Dungeon Sims. Yeah. Jensen says, so he was like, Oh, I think Sara and Sandy were your super Sims at that moment, which is maybe what you needed? Maybe? I don't know. But like you said, it would have been just as valid as if I was like, I can't do this. It's too stressful. You know? Yeah, it's too dangerous. Too dangerous. Yeah. Because those



were the cues that you were, you're getting? Yeah, yeah. And just take it off. I always say it's important in a situation like this to take a moment to reflect on the contrast between the resources available to you in that moment. Right. Which, okay, Sandy and Sarah? Unique, exceptional, exceptional resources. Like, yeah, scrub exceptional. Yeah. But even without them, take your own resources. You know, you're informed, you're, you're resourced with intellectual and other capacities and understand how things work and biomechanics, you've got incredible resources, and then just take a moment to reflect on the contrast when you and most people? Yeah. And is it? Is it any? Is it any wonder at all that people face those situations? And yeah, there'd be a lot of people with chronic neck pain, even if they're on a recovery journey, who would get into that situation and their neck pain would flare up, they wouldn't even do the rod, that's right, leave and they kind of flare up and, and the rest.



And everything that comes after that, go back



to the doctor, get a new script, you know, and we do we attempt to, or they I think there's a tendency in our field to, to look, look down on that approach in some way. But, you know, as they are, that's substantive people. But it's totally predictable. And an excellent, excellent biological organism doing that. And we have to overcome, we just always have to remember the resource differential.



Yeah. Oh, that's, I never even thought about that. But that is so true. And, you know, it just goes to show you why people living with chronic pain, why the burden of disease is the high one of the highest in burden. It's the most one of the most burdensome health conditions and diseases in the world. In most countries. I mean, just low back pain alone, the burden of disease in the United States, I think is third, that's just low back pain. We're not talking about oh, a and other knee or neck pain, other chronic conditions. It's third Well, I mean, things might be different now with COVID. I don't know. But um,



you know, it's usually with disability. And they usually for disability metric for iPads way out in front. Yeah. Yeah. Yeah. I mean, on other metrics to use last year's lost, which includes mortality, then it drops down, right, just a bit.



Right, right. But you know, it just goes to show all of the things that you that you've been working on in 2021 and that you're excited about coming up, let's say in 2022 and all the incredible researchers and PhD candidates that you get to work with it just shows how complex and complicated chronic pain is. And that one or two sessions of pain science education in clinic cut it for most. No, absolutely. And it just shows the complexity of it and how difficult it is from a research standpoint, a clinician standpoint it is a tackle these problems on an individual basis and society as a whole. So I mean, keep keep doing that. Keep fighting the good fight, as they say.



That's scary. Because yeah, gobsmacked, nice weeks that I get to do this for a job and I get paid for it.



Yeah, speaking. And speaking of helping people around the world, you've got master sessions coming up. So you did this in 2021. So now you're doing it again in 2022. It's going to be May 13. To the 16th. Depends on where you live in the in the world. But you want to talk a little bit more about the master sessions, who's involved and what it's all about.



Well, yeah, that I mean, that was that was really cool. We sewing in 2021. No one's traveling, obviously. And noi group UK put, to me this idea of doing something a bit different. And it was really different like I was so that it it, we had two broadcasts, and they were timed friend friendly time zones for Europe or for the Americas. And then Australia and Asia sort of could go to one or the other with not quite as friendly. So for one broadcast, I was starting, I think at 6am. For another broadcast, I was finishing at about 11pm, something like that my time, but it was really well planned really well resource like they are, I'm in a studio basically, I was in that it was in the NOI group offices in Adelaide, but set up like a studio with a producer and sound people and a couple of cameras and Tim Cox working as emcee does a beautiful job on that. And we had a team of people downstairs ferreting around for the papers I was mentioning and all that sort of stuff. And it we were we didn't know how it would go because it was it's not like it's not like a zoom conference. Or, or cause it's really quite different from that there's a fair bit of interaction and it went, it went really well was really good fun, really well received. And the feedback has been overwhelmingly positive. I, I was joined by two people for 2021. social pressure Tasha Stanton came to speak. And she so she did a about a 30 minute talk. And then she and I chatted for about 45 minutes and and then we open it up to q&a and and that conversation between Tasha and I and then the other person who contributed that our two people were Mark Hutchinson, who's professor of everything. Adelaide University, one of the one of the exceptional communicators on neuro immunology, related to pain and defense, personal defense. And so same sort of format with him. And then with David Butler, who everyone knows, if you don't know, David, you, you're missing a key part of life you should have. So it was amazing. It was yeah, it was a really well, it's lots of comments like, I never thought online education could be like this and that sort of stuff. So that was really positive. So in 2022 in, and I think the dates you mentioned are probably the Americas day, so that we're doing to broadcast again, where we got feedback that we're responding to, so the schedule is changing slightly. Mark Hutchinson and Tasha are both coming back to do longer stints. And then we're also having in people with really interesting research and great clinical engagement. So for example, Dr. Jane charmers who's done some excellent work in pelvic pain. So she'll come and she'll do a talk and then we'll, I sort of interview them. So it's the massive sessions are a massive amount of work for me because I need to have my head around everyone else's stuff as well. So I can ask meaningful questions, but the, the feedback is is about how useful those conversations are as well. So yeah, so this Jen channels there's Haley leak, Haley leak has has started working with investigate what people who are recovering from paying value in learning about to publish one paper on that in pain, a beautiful paper, I think that I think should shift research direction of a few groups. Haley also has the probably unique among pain scientists brag point of winning the Australian survivor 2021. So she, she survived. And part of the reason for her survival, I think was her deep understanding of how pain works. And there was some great episodes where she there was one where she I think she was standing on like Pogi point things, Poles, they were all doing this with a with another thing coming slider down lower and lower for six hours.



And lead athletes x s as people have already fallen out and and so she's she's actually done an incredible job in disseminating modern understanding of pain to the wider community because they've all said, How did you do that. And she's able to talk about her understanding of pain. And pain does not mean damage pain is because it was a thing. So no wonder the host is making these comments like that they're trying to rev up my payment system. So incredible impact and she's got a high profile among the people who watch on Survivor on telly. So she's able to integrate that experience with her research. And she's very interesting person. So she's she's coming Sarah wall works doing really interesting work with younger kids. Looking at how how we can engage with young kids on everyday paints in a way that will help them be resilient later. So really fascinating work that she's doing. And then I'm on there as well. So I think I'll cover about half of the time. And it's great fun. Yeah. And you know, people go look at the reviews and all that sort of stuff. But yeah. Love people to to get involved in that. That's in that's in May. Yeah.



And is there? You may not know this, but is there like a cutoff date for signups? Or can you sign up like the day before? If you wanted to?



I think there's a right shift. Okay. I think there's an early bird, right. I think I actually don't know much about that sort of stuff. But they they do have to. I mean, the earlier they get a feel for numbers that they they're able to judge sure how to do it, because it takes a lot of bandwidth and all that sort of stuff.



Right? Yeah. All that behind all the behind the scenes production stuff. You're the On Air talent, you don't have to worry



Exactly. Worry about any of that. But But noi group, if they get annoyed by it, they'll learn everything



about it. Yeah, yeah. And again, I'll put the links in the show notes here. And we'll put it out on social media as well. So that if people are interested, then I highly suggest signing up because it what a great, what a great lineup. And it's not until May. So you have plenty of time to shift your schedule and try and figure out, you know, kind of block the time off so you can be part of it. And one other thing, I believe this is true, you can correct me if I'm wrong. But if you if you're in the Americas, and you you paid for it, you live in New York City, let's say I pay for I live in New York City, I can also watch the other, also get the recordings of the other broadcast.



That's correct. So you get both and you you don't have to be there live watching it in bed. But if you're not you, you're not engaging in the q&a and all that sort of stuff. Yeah, but you get access to both broadcast and you get access to the thing called the Padlet, which is it was an amazing resource from the first time because this is all of the stuff that the team downstairs is getting while the master sessions around. So let's say Professor Mark Hudson mentions this are really exciting new study from so and so which show this then someone downstairs will get that study put the paper on the Padlet. So it's some incredible resource as well. And they have access to that. I don't know for how long afterwards



Yeah, yeah, but you but you have it Well, it sounds amazing. And I think it's so great that this is probably something if not for COVID Maybe you would not have done and it's made a big impact, right so



and and when COVID no longer what it is I'd prefer to do it this way.



Yeah, yeah, amazing. Amazing. And now, I don't want to monopolize any more of your time. But is there anything that we didn't cover that you were like, Oh, I really want the listeners to know this or, or is there a big takeaway?



Ah, I think the takeaway is, it's really consistent over years, actually. Whenever I have an opportunity like this to chat, with such an informed and, and clever interviewer, like you, I'm always struck by how, how important people like you are for our community, because I see my role sort of knowledge generation and, and dissemination in sort of conventional ways, you know, books and articles and things like that. But we need people like you, to spread it, to play the critical role and getting it out to the, to the world in a way that's accurate and engaging and, and it's people like you who put in so much so much effort for your community. And whenever I think about takeaway, I just am reminded of of the potential benefit we can still bring to humanity by doing this chronic pain thing better. And we have made progress, know that we made progress. But it feels to me like were climbing up a really, really tall mountain. And now when we look back, we can see we've actually come quite a long way. But when you look ahead, there's still still a bloody big mountain. So all of these things would have hope. I think there's genuine, realistic, scientifically based reason to hope things will keep improving for people with chronic pain, that will people will have better outcomes. So that's my take home. But can I give a plug to a book that I'm an author on? Yeah, it's a self plug. But I'm not the main author. So Dan Harvey, a truly innovative scientist. And I don't say that lightly. There's not many innovators out there. But Dan Harvey is an innovator. And he's the first author on a book called pain and perception. And the Americans can get that through IPTp. Elsewhere, you can get through no group. And it's a I think it's a beautiful book. It's all about understanding through illusions, and sensorial experiences, more about how pain works, sort of like a coffee table, book waiting area book. The feedback has been fantastic. So yeah, I'm really excited to be involved with that with Dan. And I'll just mention another book that's available in in North America, but not in Australia. And it's called Epiphany. And test Stanton has joined Dave Butler and I to, to write a consumer focused book around the osteoarthritis.



And I will say, I, when I first saw this epiphany, it's not how you would normally spell epiphany. It's, it's, it's an what do they call it? It's an acronym an acronym? Yes. So it's explaining pain to increase physical activity in knee osteoarthritis.



Correct. It's spelled AP IPH a knee,



right? Yeah, very clever. Cuz I was like, epiphany. What did I say? Episode? I don't even know. What's epiphanies? And you're like epiphany. I'm like, oh, yeah, that definitely makes more sense. That definitely makes more sense. But yes. And we'll have we'll have links to all of this stuff, again, in the show notes. And, you know, one last question and talking about, you know, all of the work that you do that isn't in very important work, and it can impact not one or two people but millions of people living with chronic pain. So do you as a researcher, how do you deal with maybe feelings of overwhelm with the responsibility that that place is on your shoulders? Or do you think about that at all? Or am I just projecting what I would feel if I were in your position?



I think you're projecting. I don't, I don't feel overwhelmed in the slightest. I don't feel any sense of responsibility to humanity. That's, that's changed because of what I do. I feel I feel that I have a responsibility. I don't know if I feel I have responsibility. I want to use my resources and my knowledge and my skills, and my connections and my relationships to, to be the best Lorimar I can be if that makes any sense and, and the values by which I judge that are not at all on chronic pain outcomes. I'm a very sort of process driven person, I want to make sure that today I did the best thing I could do. And I don't have any illusion that I, I could use outcomes as a marker of, of how well I've lived my life. Because I just think there's too much noise for, for me to have a measurable signal in the world. So I want to make sure that in this moment, I'm being authentic and true and real. And today, I'm doing my very best, I do my very best. But I do that, because I like myself more when I'm doing my very best. But I feel any burden to humanity. That's different from the burden that I think anyone who grew up in my in my world and life with my skill set, and my influences would have.



Yeah. And I think that's great, universal advice for for anyone. And, you know, normally when we finish the show, I always ask people, What advice would you give to your younger self? So I don't know if any piece of what you said would be maybe part of that advice. But is there anything else that maybe you would give to a young a young Larmour? fresh out of university for first time University, not? Subsequent?



Yeah. I think that I would, I think there would be advice, I don't think it would be remotely relevant to my work, I think it would be love a beloved, look for that, and express and, and value that with the entire depth and breadth of your being. And for me, that includes being a neuroscientist and paying dude with a extraordinary fortune of being able to do the things I enjoy doing for work and resonate with my values and all that sort of stuff. And ultimately, I think we're such a sophisticated organism that, that we may want to one one day discover that it's all just to love and be loved. And I don't know, great advice.



Great advice. Thank you. I'm sorry, not a sage. But no, no, it's amazing advice. I appreciate it. Thank you so much for taking the time out to come on and talk about all the stuff you have going on. And is there a place where people can find you? If I don't know they have questions, websites, something like that.



Yeah, so finding and I've got a homepage at the University of South Australia they can find out about personal pain revolution is doing some good stuff on Annabelle, what we're doing that I I get a lot of emails and I just can't possibly respond to them.



We're not here to give out your your emails, or your personal phone number or anything but I think pain revolution, Oregon and the University of South Australia are great ways for people to find out a little bit more about you because as we said, before we get on the air you are not on social media. So there is no Twitter handles or Instagram or tic TOCs none of that stuff. None of that. So people can find you again, pain or University of South Australia's website or you can just do a Google go to ResearchGate read all your papers. There's plenty of ways to find out more about your research and and what you have coming up. So plenty of ways to do that. So again, thank you so much for coming on. I appreciate it.



Oh, thanks so much for having me. You're a legend. Keep it up.



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

Jan 31, 2022

More About Osman Ahmed:

Dr Osman Ahmed is a Physiotherapist at University Hospitals Dorset NHS Foundation Trust (Poole, United Kingdom) and a Visiting Senior Lecturer at the University of Portsmouth (United Kingdom). He trained as a Physiotherapist at the University of Nottingham in the United Kingdom, before undertaking his Postgraduate Diploma in Sports Physiotherapy and subsequently his PhD at the University of Otago, New Zealand. He is employed by the Football Association (FA) in England to work as a Physiotherapist with their elite disability squads and has been a member of the Team GB medical staff at both the 2008 Beijing and 2016 Paralympic Games. He teaches on the FA’s Advanced Trauma Medical Management course and has recently been appointed the Para Football Classification Lead at the FA.

His PhD was focused on sports concussion and Facebook, and since then he has both published and presented widely (primarily on concussion in sport and technology in healthcare). He holds several governance roles within Para Sports federations including Medical & Sports Science Director at the International Federation of Cerebral Palsy Football, Medical Unit Co-Lead at the Para Football Foundation, and Medical Committee member of the International Blind Sport Association. He is a Co-Chair of the Concussion in Para Sport Group, and a Board Member of the Concussion in Sport Group.

Osman holds Associate Editor positions at the British Journal of Sports Medicine and at BMJ Open Sport & Exercise Medicine and sits on the Institutional Ethics committee of World Rugby as an external member. He is also a Scientific Committee board member of the Isokinetic Football Medicine Conference.

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Read the Full Transcript Here:


Hey, Jasmine, welcome back to the podcast. I'm so happy to have you on and so happy to see you again.



Hi, Karen. Thanks for having me. Really good to be back.



Yes. And so Osman and I both at the International look, Olympic Committee conference in Monaco, a couple of weeks ago, we actually did a talk together. So for the first part of this interview, we'll talk a little bit about we spoke about what we spoke about, and and then get into some of your big takeaways from the conference. And then of course, some of your upcoming projects, papers and all that kind of fun stuff. So why don't I give the microphone back to you, and tell the audience what our talk was, and kind of what we spoke about it IOC? So go ahead.



Thanks so much, Karen, I probably first thing to say is that we've Omicron raging around the world in the week before Christmas, it feels a bit surreal to think back to what was less than a month ago when we're actually out in Monaco presenting together. So the world has changed very quickly. Hopefully, it changes just as quickly back to the nice, stable world that we were getting towards before then. So I have to see what happens in the coming weeks. But yeah, it was great to present together it was something I think that we've both been speaking about for a while in our respective areas about how clinicians can engage with the mainstream media and social media for injury prevention, and athlete welfare, and just generally for spreading positive public health messages to our patients and clients. And so how we did it, for those of you that weren't in the room, we started off by looking at some different examples of how the mainstream media discusses different injuries and issues. And we took the lens of sport concussion, because that's an area that I'm fairly familiar with. And I've got a bit of an interest in from a research perspective. So I talk through some of the different examples of how concussion had been discussed in the mainstream media starting way, way back with Charlie Chaplin, hitting people over the head, progressing through to the movie concussion, more recently with Will Smith, and also touching upon some South Park episodes, the office and new girl. So other examples of concussion being in the mainstream media. And we had a bit of a brainstorming session, really, it was a nice interactive workshop that we did to everybody. That wasn't a room there. Thank you for contributing so much. He made it a lot of fun and asked a lot of questions and stimulated a lot of discussion between the group. And yeah, I mean, it was quite a nice flowing dialogue between everybody there. And there was some really good examples that people in the crowd shared in terms of their experiences with either engaging in the mainstream media or seeing some negative examples, and some less than perfect discussions and injury representations and illness and medical representations, either in TV shows or in news reports and things like that. So yeah, I mean, session was pretty good. I thought I'm obviously I was one of the CO presenters. But yeah, that was a fun session to be part of. And then obviously, from your angle, Karen, it was really good to hear your thoughts in terms of how clinicians can engage with the media, coming up with some really practical tips for people that would be interested in doing that in terms of how to pitch to journalists, sort of things that you should do when you're reaching out to journalists, and some good examples of how clinicians have worked and engage with journalists in order to get positive, evidence based, accurate, scientifically valid information out to places like the Washington Post and New York Times and kind of upmarket newspapers in that regard. So yeah, it was a fun session to be part of and had some nice feedback afterwards, which was made it worthwhile. And yeah, it was a pleasure to be part of it.



Yeah, I really enjoyed the discussion within the workshop from with the participants, because a lot of the workshops and we know, we go to all these conferences, and it's usually the person up on stage speaking, and there's not a lot of interaction during the talk, except for maybe someone gets up and asks a question, they sit back down. But what I really loved is that, like you said, people were sharing their experience with maybe being in the media, or really asking the question of like, hey, is this movie concussion? Was this positive or negative? And it was interesting that people had a lot of different views on what they believed as was as positive was this negative? You know, I think we can all agree on some of the things like Charlie Chaplin hitting someone on the head or, or a head injury being the butt of the joke. We can all agree that's not great. You know, that would be a maybe a not so great representation of that. But with the movie concussion, I think they it brought a lot more conversation to the group. I don't know what do you think? Yeah,



absolutely. I think the noise thing about the topic that we discussed as it's something that everybody's got an opinion on. I mean, arguably, you don't even need to be a clinician to have an opinion on how injuries represented in the mainstream media. But certainly, I've seen lots of workshops and conferences and sessions where I'm not particularly ofay, or knowledgeable about the area that's been speaking about. And I probably wouldn't feel that comfortable in terms of sticking my hand up and joining into discussion in front of lots of other people. But because it was a mainstream topic about the mainstream media, there was lots of people that felt comfortable to do that. So yeah, it was great from that regard.



Yeah. And I think it gave people some tools moving forward, to maybe reach out to a journalist or to maybe even reach out to say, hey, this article wasn't the best. And do you think you can? Like, I'd be happy to contribute to give you a little bit more evidence to that. And I think that's something that instead of going on social media and complaining about an article or a video, instead, why don't we empower therapists and researchers with the tools, they need to reach out to the journalists to say, Hey, I appreciate you, including physio, therapist, researcher XYZ. But what they shared is probably the not not the most accurate or evidence based. And I'd be happy to give you some resources or speak to you or write a and an article follow up article.



Plenty, absolutely. And I think we're completely on the same page here. I mean, it's so easy to read something that you disagree with, get angry about it. So you may it's about a coffee time, and then maybe sharing a whatsapp link to your friends and laugh at it, it's a little bit more challenging, but a lot more productive to actually reach out to those people. And like you say, do something constructive, take control of the narrative, as we kept saying, so who is controlling the narrative, we can control the narrative. And that's a good way of controlling that narrative is by reaching out to those people, and suggested some of the things that you said there. So putting some evidence based links in talking about proper scientific evidence, correcting in a nice, gentle way, some of the inaccurate information that may have been shared in the article, there are really, really good things to do. I think so. Hopefully, if people in the audience doing that, and anybody listening, that's picking up between the lines of what we're saying here can do that as well. That'd be great.



Yeah, and it's easy. It doesn't cost any money. It just costs a little bit of your time. And I mean, like, a tiny bit of your time.



Yeah, absolutely. I mean, time is money to a lot of people work, especially if you work in private practice. I don't, but I'm sure a lot of people listening here well, but yeah, well, it doesn't really take that long, just drop a quick email or a note to a journalist, to tee up some potentially better ways of reporting on what they've reported on, maybe serve as a link for any future articles. I think it was one thing that we both touched on that, I think is a really nice way of sort of crossing that divide. And bridging that gap is by getting in contact with a journalist or newspaper and saying, Look, I'm a clinician, I work locally, if you've got any pieces that you're putting out about a health related issue or a medical condition, or if you want to check anything with me for accuracy, drop me a quick email, send me a quick text message or WhatsApp. And I'll get back to you about that. And then you're then in a position not to create content for the newspaper, you're not writing their article is not a freelancer for them. But what you are doing is kind of member checking and fact checking and steering the journalists towards more medically accurate correct reporting. So yeah, I think that was a key take home for for me and hopefully, for anybody listening today as well.



Yeah. And I think that's, that's a great take home from our talk. So from and also a nice transition into what were your other big takeaways and take homes, from some of the other sessions you went to? So if you want to maybe describe the session, and then what your biggest take this session, the speakers and your biggest takeaways?



Yep, so the one that definitely made a big impact on me was the session on hashtag metoo. So it's about abuse in sports, intentional abuse in sport, and I came up the topic from different angles. So my mount Joy talks about the Larina SAR case that I'm sure everybody listening will be familiar with, which is horrific. And I suppose, because it's maybe slipped out the media attention for a few months now, I wasn't completely familiar with a lot of the graphic and horrific details relating to it. So that was a real eye opener again, for me in terms of how endemic that was and how that could have been nipped in the bud at several stages earlier from the information that we were given there. And I think the other speakers in this session, we're fantastic as well. So Shree Becca, I'm a big fan of sharees work. I went to most of our sessions IOC in Monaco, and, again, she helped deliver a fantastic session around The similar areas as well. And yet, sir to a lackey, who is based at Yale in the US did a really good session about Ghanaian Paralympians, and the perceptions and abuse that they suffer as well back in the home country, with regards to being disabled, essentially, and being an athlete and the barriers that they face and the challenges they overcome. And I thought one thing that was really nice from yesterday's talk specifically was the fact that she sampled the video interviews, and she wove those into her presentation. So you can actually hear and see the Paralympians talking about those things. So unfortunately, like, you can't transport lots and lots of people to the conference to speak as part of your panel. But yes, I did the next best thing, I think in terms of getting the athlete voices literally embedded into a presentation. And that really did magnify and sort of hammer home the points in a really strong way. So for me, that's something that I've since gone back to some of the sporting federations I work with. So I'm involved with the if CPF, which is the International Federation of cerebral palsy, football, and power Football Foundation. And I've spoken to both of those organizations about this and the resources that were provided in that thought were really helpful, just to make sure that we're on top of all safeguarding issues in our sport, I think, for a lot of people listening, I mean, it might sound like quite a boring thing, and quite a basic thing. But ultimately, it's the most important thing I think we can do is to protect our athletes when they're in our sport, and make sure that we've got the right policies, the right procedures, and the right steps in place to look after them. Because as the Larina SRK, showed, I mean that the impacts of getting those sort of basic steps wrong or underestimating those sort of areas of sport are huge and can have profound and very long lasting effects to the athletes involved today. Yeah, for me, that was that was probably the session that had the biggest impact on me. Again, I'm qualitative in my research background, so I was really pleased to be a part of the session with Eva bahagian, Caroline barley, and Christina farga. I thought all three did a really good job of talking about qualitative research. And I think, looking at other talks as well, during the whole conference series, there's a lot more awareness. Now, I think that with athletes and with patients, generally, we don't just need numbers, we don't just need hard cold quantitative analysis, which undoubtedly, is very, very valuable in terms of what we're doing with our athletes and patients, we also need some context to that. And I do feel quite strongly that a lot of that context does come from qualitative research and listening to our players listening to athletes, getting that extra depth to their experiences to either layer on top of the quantitative data or to stand alone and just be independent data that we look at and say this data has got numbers, it's got words, but these are the patient's words. And these are what the patients and players think. And we're going to look at that data, we're going to analyze it, and we're going to respect that data, we're going to act on that data. So Alan McCall, I was in Alan session as well. And he's at Arsenal Football Club, and they do a lot of work there with readiness and return to play. And they collect a lot of data as part of that. But it's really pleasing for me to see some of those high profile as Alan, talking there about the importance of quantitative data and listening to play as the qualitative sorry. Data are listening to players and getting that information as well. So yeah, I mean, I wouldn't call it a revolution in terms of qualitative research. In sports medicine, I think it's a gradual evolution. I think, as we evolve and move through the 2020s as we are, I think there's going to be a greater appreciation, really of the power that qualitative research can bring. And we're going to see a lot more of it, hopefully.



Yeah. And in comparing IOC 2017 to this one, I don't know that there was much talk of qualitative data in any in any of the talks in 2017.



I can't remember why for dinner last week.



I don't. I don't I don't believe there was. And so I think there is this definite shift in thinking that, hey, if we want to keep our players safe and healthy, and reduce injuries, then we have to listen to them. And we have to incorporate this qualitative data into how we as clinicians, because you and I are clinicians, how we work with our patients, you know, it's a little more than, Oh, you just have to listen to them. Because I think you have to listen, and you also have to understand what their words mean.



Oh, yeah. Listening processing, as well. So you're not just a set of ears, you've got something between your ears as well. And that's the thing that you have to use to process it and then also, act on it. I mean, it's not just a case of listening and processing you need to be Some actions off the back of that change that results from that. So, yeah, completely agree.



Yeah. Because like you said, from the me to talk with Margo and Sheree, and policies and procedures, yes, of course we need to have those in place. But if you're not listening to your players, you can have all the policies and procedures you want. If the Larry Nasser case says anything, right, they had a lot of policies and procedures in place and USA Gymnastics. Yeah. But they weren't listening to the countless girls and women who are abused by this man over many, many years. Because they did speak some of them did tell people, nobody listened.



Again, it's the acting management if you're listening, maybe process maybe haven't. But is the acting that needs Yeah, as well. And that's a key part of it.



Yeah. And I think placing that that athlete in the center. In that case, in particular, it wasn't about the athlete, it was about all the money and all of the prestige that comes with those athletes in your program. So you don't want to blow up the program, they apparent from looking from from an outsider perspective, it's like they didn't want to blow up the program to help save the girls.



Nine. I mean, in an ideal world, nobody should go to an international sports medicine conference and listen to a talk about that scale of abuse. But I mean, if if there is a positive about sitting in a session like that, so that you can spread the word about it. Take action to make sure that never happens again, in any sport ever. Exactly. Absolutely. abomination that happened.



Exactly. Exactly. And, you know, one of my biggest takeaways from the whole event is that context is, is everything. If you're not taking, whether it's quantitative data, qualitative data, exercises, application to the, into the clinic, if you're not looking at the context, around the person in front of you, then I feel like it's all for naught. And the other thing, my other big takeaway is like, I don't really know anything. So those are my two big takeaways.



I think that's always a good thing. If you go to a conference and come away realizing how little you know, I think you've been to a good conference. Generally, I think there's always so many clever people that you listen to and learn from. I went through a cardiology session as well as on absolutely not expert at all. But you go into sessions like that, and you learn a little bit and hopefully take stuff back. And you can apply some of it to your practice. And yeah, it's good that you felt that way. So I did as well.



wasn't just me, then. Yeah, I left. Oh, I'm the worst.



How do I not know anything? What am I doing in this job? It really spiraled down on the plane ride home.



Yeah, so any Junior clinicians or researchers listening, trust us. We're old in the tooth, myself and Karen. So if we feel like this, our stage of our career, then don't ever worry that if you're a new grad, and you don't know everything about everything, but there's something wrong with you, because it really is not, because you get to the end of your career, and there's still a lot of things you don't know, more things you don't know, at the end of your career than you did at the start of the career. So yeah, yes, definitely. Definitely a message I want to share.



Yeah. Excellent. Anything else from the conference that was for you? You know, a big takeaway from any part of it. Or do you think we covered it all?



For me, it was just how lovely and nice it was to actually see people face to face again, it just been such a rubbish. 1819 months leading up to that conference had been postponed two times. It was just lovely to actually get to a place. See people do want to give a lot of thanks to the people that hosted the conference. But the organization was next level in terms of how well run it was. Our safe, everybody felt everybody had masks on. I think we were talking about how good it was in terms of the COVID checks going into the venue, everything like that. So although there were, I think, seven 800 people there, there's a lot of people there. It never felt unsafe. And everybody there was glad to be there. And I think everybody seems to have a good time.



Yeah. And that's what Sheree and I spoke a cup of Sri Becker knights a couple days ago. And we said, you know, the thing that was so great was that everyone there, it felt like, people were there to support each other, and to support sessions and support individuals and, and maybe it's because there hasn't been like, a larger conference like this in quite some time. But it did feel like very inclusive and supportive, and that's kind of the vibe I got and Sheree said the same thing. It sounds like you might have felt the same. So maybe that an NF three is it's it's, it's true then.



Well, I'm a qualitative researcher, so I'll take those quotes and agree with those quotes. Yeah, I think it was just it was a nice nice yeah. place to be I think for a lot of people that first time they've left their country since COVID. It certainly was for me. And me too. Yeah, I think it'd be nice if that's the that's the vibe going forwards if we do go to a concert and can support each other's research, and there's not academic snobbery, or thankfully, I've not really been to any conferences that have been like that. But I'm aware that every now and again, there can be that element of needle two speeches and feedback and those sort of things. So hopefully, it will stays nice and constructive and supportive and positive objectives.



Agreed. Now, what do you have coming up? What do you have going on any new projects in the pipeline papers? If you can give us a preview? Obviously, can't give it all the way. But if you can give us a preview as to what you're working on, for 2022 and beyond?



Oh, okay. Well aware, a few different hats. So one of the hats that I wear is at the BDSM, the British Journal sports medicine. So I think it was announced on social media a little while ago that we're having the first BDSM Live, which is a in person, conference day that's being held in Brighton in the UK in May 2022. So we're quite excited about that. I'm hosting that with Fiona Wilson from Ireland. So it'd be really great to co chair the day with her. And that's certainly something I'm looking forward to. I am also off to the IPF spt. So the International Federation Sports Physical Therapy conference in Denmark in August, where I'm presenting a session with yourself again, Karen, so great to see you there. And again, that's following up on some of the BDSM work that I've done in terms of patient voices and athlete engagement. So I'm really looking forward to that one as well. A lot of 2021 was involved with the concussion and parasport group that I'm a member of so working with international colleagues are involved in Paris sports main concussion. So we released our position statement last year. And hopefully off the back of that there's going to be a lot more studies that take place in 2022. So one of the co authors, in fact, the lead author, Dr. Richard Wheeler, who's very passionate about the area, he's currently doing study looking at the perceptions of blind footballers towards concussion. And so he's done a lot of data collection from that. So I'll be working with him and the other co authors on that paper in the new year, which is exciting. And I'm also looking forward to working with Dr. Mark Murali in Australia, who's a digital health physiotherapist might be one of the best ways to describe him. He's very involved in the tech side of what we do is a professional physiotherapy and physical therapy. And he's got a grant that's been accepted on physio, digital health capabilities, and a model related to that. So I'm going to be working with him looking at that and looking at the digital side of physiotherapy as well. So got plenty of things to keep you busy. And I'm looking forward to hopefully a better year than last year.



Yes, well, you certainly have a lot to to keep you busy as well. And I should also say that you also work to your clinician.



Yeah, so my full time day job is at University Hospital, still on the south coast of England, and I'm a full time clinician, I also work part time for the Football Association as a clinician with their elite power football squad. So that's disability football. And in the new year, I'm also going to be starting a part time role there is the power classification lead for the elite disability football program. So looking after the classifications across all the athletes, power football, sports, I'm looking forward to that role as well.



Nice. And obviously, you'll eat and sleep at some point in between.



If you ask my wife, there's a lot of eating, and we missed out on those too.



Good and a little bit of relaxing and a little bit of fun, right?



Definitely. Always got time for fun. Excellent. Well,



before we wrap things up, where can people find you if they want to join some of the things you're doing? They want to have more information, they just want to say hi, where can they find you?



Yep, so probably the easiest way to get ahold of me is on Twitter and my handles, Osman H. Ahmed. And I think you'll probably share the link in the podcast. So that's probably the best way to find me and I'm pretty responsive on there if people do want to get in touch. Certainly if you're interested in concussion in disability sports, or want to talk more about our work that we've done with the mainstream media and how we can engage with them, then I'd love to hear from you.



Excellent. And yes, that will I will have that link at podcast at healthy wealthy, smart calm in the show notes in this under this episode. And finally, I think I've asked you this question before, but I'll ask it again because maybe you have new advice, but what advice would you give to your younger self knowing where you are now in your life and in your career?



For a couple of things really, don't take yourself too seriously. I think that's probably a key thing for any young clinicians that certainly when I was working in university, there was a lot of people that were really stressed and anxious to make a mark in the profession. And obviously, that is good. And that's commendable when you want to keep that about you. But also, I think, being relaxed in terms of the way that you do that, and doing it in a collegiate way, I think is probably a really good way to progress your career. I like to think I did that. So that that's less advice to me and more advice to other people. forced myself when I was younger. I'm not really sure to be honest, I'm, I'm pretty happy with the decisions I've made through my life so far. So yeah, probably. I don't know. Pass. Sorry, Karen,



know that the piece of advice that you gave, don't take yourself too seriously, is perfect. It's perfect. And I think that a lot of people will enter into we're both physio therapists into physiotherapy or healthcare. And kind of like you said, they really want to move their career forward. And so I think it's important to remember Yes, you want to move your career forward, but your underlying Why should be to improve the health of everyone to improve the health of your community, your population that you see, versus getting best of XYZ, or award for this and award for that. I did this look at how great I am. But instead, how are you really impacting your community through your work?



Absolutely. So keeping everything patient centered. I think that's basically what you're saying there. I think probably the other thing as well is your career is a marathon. It's not a sprint. So you don't have to achieve all of your career goals by the age of 30. spacings out and don't be afraid to reinvent yourself if you find you're in a career or a job that you're not massively enjoying. It's a big profession out there. You're not wedded to one job for your career or your life. There's other places that your career can take you with a degree in the skills that you've got.



Perfect. That is great advice. Well, thank you so much for coming on to the podcast again.



I really appreciate it and look forward to seeing you again in person in August. So thank you so much for coming on. Thank you, Karen. And everyone. Thanks so much for listening today. Have a great couple of days and stay healthy, wealthy and smart.

Jan 24, 2022

In this episode, Founder of Taylor Insurance and Financial Services, Eszylfie Taylor, talks about balancing and prioritizing the mind, body, and money.

Today, Eszylfie talks about wearing many hats, how yoga has changed his life, and his work on Mind Body Money. How is short-term gratification hindering our progress?

Hear about how Eszylfie fits so much into his life, how he picks himself up after a failure, and get his valuable advice for 2022, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “You miss 100% of the shots you don’t take.”
  • “Only something good comes from being bold. Either you’re going to get something you didn’t have, or you’re going to continue not having what you didn’t have anyway.”
  • “Pay yourself first.”
  • “If you aim at nothing, you’ll hit it with amazing accuracy.”
  • “You have to give up smaller short-term instant gratification things for the long-term greater thing.”
  • “Ease is a greater threat to progress than hardship.”
  • “Those who think they can do something and those who think they cannot do something are both right.”
  • “The most successful people in life are those who can endure the most pain.”
  • “No one is on their deathbed wishing they had more money.”
  • “Never give up. You never know how close you are to your dreams.”
  • “The road to walk a mile begins with a single step.”


More about Eszylfie Taylor

Eszylfie Taylor is the president and founder of Taylor Insurance and Financial Services, and serves as financial advisor to individuals, business owners, and high net worth families. Over the past decade, he has been widely recognized as one of the most accomplished producers in the industry, receiving the National Association of Insurance and Financial Advisors (NAIFA) award, “Agent of the Year: Los Angeles" in 2010-2012. Additionally, Mr. Taylor is a 15-time "Million Dollar Round Table" qualifier, the last four of which he has been a "Top of the Table” producer, ranking him in the top 1% of all producers worldwide, and was the recipient of the 2015 Top Four Under Forty Award by Advisor Today Magazine.

Mr. Taylor began his career at age 22 with New York Life Insurance Company, where he soon ascended to the Chairman's Council, reaching the ranking of #1 Broker in Los Angeles (2006-2013), and #1 Agent for the Company's African-American market (2006-2013). In 2007, he began building his own firm, Taylor Insurance and Financial Services.

Mr. Taylor currently sits on the board of three non-profit organizations dedicated to business empowerment, children's health, and social services.

He is the founder of the non-profit, Futures Stars Camp, which provides basketball training and life coaching skills ( for kids. In addition to his passion for business, Eszylfie loves being a hands-on dad.

Eszylfie holds a Bachelor’s Degree (magna cum laude) in Business Management from Concordia University. He has also earned the Series 6, 63, 65, and 7 licenses, and a Life and Health Insurance license.


Suggested Keywords

Healthy, Wealthy, Smart, Finance, Financial Freedom, Success, Perseverance, Yoga, Mind Body Money, Long-Term Goals, Consistency, Resilience,


To learn more, follow Eszylfie at:




Instagram:       @EszylfieTaylor

LinkedIn:         Eszylfie Taylor


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


Hi, Eszylfie welcome to the podcast. I'm happy to have you on.



Thank you for having me.



And I'm excited to talk about you and your journey and all the different hats that you wear in your, in your professional and in your personal life. So let's break all of this down. So you are a financial advisor. You're a yoga instructor, you're an entrepreneur, and you're a girl, dad, and I have a soft spot for I'm one of three girls, you've got three girls, I totally I get it. So if we can, let's first talk about how does all that happen in one life? How do you put that all together?



Yeah, I think, for me, when I was graduating college, I made a promise to myself that I would never look back at my life and say, what if what if I did this? Or what if I try this? And what if I went here? I just say I just say yes. Right? And as as as a result of that I'm a huge failure, probably arguably, the biggest failure you've ever met in your life. And that's also why I succeed, right? So I would rather try something and fail miserably might fall flat on my face and say, Okay, that wasn't for me and check the box, then just wish or assume. Right? And because, you know, again, I think I didn't want to be a grizzled old man sitting on my porch one day thinking of all the things that I could have done with my life that I should have done with my life and then look back with regret, no, no, no regrets?



And how do you pick yourself up after each one of those failures? Because, I mean, maybe my skin's a little bit thinner. But I would just I don't know that I would have the fortitude to continue to pick myself up and move forward again. So how do you do that?



I think for me, you know, sports sports played a big role in helping me create grit. You know, I have a nonprofit that I founded called future stars. And then I teach kids and I'm actually doing a camp right now for kids. And, and I told the kids today, I said, you miss 100% of the shots, you don't take this 100% of the shots you don't take. So my contention is, is I just tell myself, I tell others to be bold, right? Because only something good comes from being bold. Either you're going to get something you've never had, or continue, which you didn't have what you didn't have anyway, right? You're going to get something you didn't have or continue not to have what you didn't have anyway. So what do you lose? To your point? It's really just ego. Right? That's, that's right. Right. And so I'd rather hear or know, or face rejection and say, Okay, well, I didn't have it anyway. So what have I lost? That, you know, nothing, right? Yeah, I look at it, you know, it's, it's only it's only greed, right? It's only only upside.



And so you've so you say you've had all these failures, okay, I believe that, but you're also incredibly successful in multiple areas of your life, one of those being a financial advisor. So talk about how you got into the financial advising game, and then we'll maybe get since we're in the beginning of a new year is 2020, to maybe get a couple piece of pieces of advice from you, on how to set yourself up for success from a financial standpoint. But first, let's talk about how you became a financial advisor. And we'll take it from there.



Yeah, I started my career fresh out of college, I'm in the business which is unique, right, so the average financial advisors probably a 55, six year old white male, right, so I'm anything but that I had one simple, you know, modest dream coming out of college that was to become a millionaire by the time I was 25. Right. So 22 I figured what three years is that's that sample time, right? It's reasonable, you know, by three years, that's, you know, that's, that's that should happen. Um, and, you know, I was at a job fair at my university and you know, I'm going from from booth to booth and all the companies are kind of telling me the same thing. I'm gonna make somewhere between 4050 grand a year, and I'm scratching my head and I'm like, okay, like, I'm not the smartest guy in the world. But that doesn't add up, right? Like I get to a million bucks that way and so you know, by by chance, uh, you know, I found my way into this world of financial services and what drew me to the industry was that it was an industry as a field where I was paid for my work I work ethic and aptitude not my age or tenure. Right and so at the end of the day, I was gonna eat what I kill right I was gonna I was gonna I was gonna make as much money I was going to have as big an impact in the community in the world as I worked tap right and so you know, it's funny against the against the better advice of my father who told me no, you know, get go work for someone else get a job right? Go get a paycheck on the first and the 15th and I just like i Dad, I think, I don't know I like You know, I can't even tell you how I'm gonna do it. But I just believe doing it this way me being in control of my fate is just a better way to go. And 20 years later, you know, here I am.



And I, I can totally relate with the just get a job and get the paycheck. And because I remember leaving college, I thought I would get a job and a hospital or a clinic and I would work there until I retired. Right, because sometimes those worlds aren't open for you right away, and you have to kind of really forge your path. Now you were very successful, as are are very successful as a financial advisor. And then you moved into becoming an entrepreneur, starting your own brokerage. So we'll get to that in a second. But before we do, let's give people a little bit of advice for their financial success in 2022. What's your best advice for us?



Yeah, I mean, one of the guiding principles of creating financial security is the idea of paying yourself first, right? And, you know, tell people you if you work for a company, right, and and and they didn't pay you, would you continue to go to work? Virtually everyone says, Well, no, rather not go to work, have a good day. But my contention is, you get your paycheck, and you pay rent, and you pay your car lease, and you pay your credit card, and you pay your cell phone bill, right, and you don't put any money away, right? No money in savings investments for you, you just work for free, because none of that money went to create wealth for you. Right. So the the one thing that I would tell people is to pay yourself first. And this really comes first and foremost with creating a budget. Right? You have to have a plan, right? I would say if you aim at nothing, you'll hit it with amazing accuracy. Right? So you have a certain amount of money coming in. Okay, so if I make five grand a month, okay, well, what are your bills? My bills are three grand a month. Okay. That that gap between your income and your expenses? That's called your discretionary income? That's do I make dinner at home tonight? Or do I go to that steak house? That's do I, you know, do I go on vacation? Right, you know, to to Hawaii? Or do I just go camping, you know, down down down the road, right. And so those are your choices, right? Those are your choices. But I always tell people pay yourself first. And the reason and I wanted to drive home the importance of this, you want to get to the point where you can live off of interest, you want to get to the point where you've saved, you've accumulated so much money, that the yield the earnings from your money covers all of your expenses. That to me is retirement. It's not about being 65 or 67, or 70. It's the point at which you remove the half twos from the equation, you do things because you want to do them not because you have to do them. And the more money you put away, right, the longer it's working, the greater rate of return you're earning than the faster you get to that point, right. And so I don't care where it is, it could be a savings account to start. It can be a brokerage account, stocks, bonds, mutual funds, insurances, whatever, right? But something you must pay yourself first. Right? And that's, that's the first guiding, no first guiding principle.



And I love that I started doing that a couple of years ago has changed my life. Yeah. And it's like, it's so I feel like I have like less worry and less burden on my shoulders. Does that make sense?



Well, it does make perfect sense. And the challenge is, is people go oh, well, you know, I, my lifestyle will be, you know, be interrupted. And no, it won't, right. And if you think about this, and I love breaking down, and this is maybe a challenge that the listeners can can join in on, take the amount of money you're looking to save on a monthly basis, and break it down to the day makes it even more palatable. So you think about it. If I go, Hey, I want to save, you know, I want to save $1,000 a month. That's my target. Right? So what's that roughly about $33? A day. Right? So you get a lunch every day, Karen, you had to take me to lunch, right? Would that change your life? Would your life suffer? We just ended a living change? Probably not right? You're ready to retire? If I said you have $2 million in your retirement account. Would that help you with that? Would that change your life? I probably wouldn't hurt.



Yeah, it would be good. I'd be I be okay with that.



Right. And that is what you're giving up. So it's like we have to give up smaller short term instant gratification things for the long term greater good.



Yeah. And I think that's that mental shift is so important because we live in a world now where instant gratification is everything right? And so how do you counsel your clients who are used to an instant gratification world to be like, Hey, listen, this is going to come to you but you have to wait. Well,



I think the principle of saving and investing or paying yourself first doesn't mean you can't have fun. It doesn't mean you can't enjoy the fruits of your labor and I think people tend to, you know, live in these extremes, right? Like either save everything you must, you know, not spend don't have any fun like your life is over right? Or, or like, we only live once I'm gonna spend it all right and, and the reality of is there's a balance, you know in the middle, right? And so what I'm saying pay yourself first in that example if I make five grand a month and I have $3,000 a month of expenses, and I decide I'm gonna put away $500 Well, there's still 1500 bucks to go to the movies to go to dinner to go buy that, you know that handbag to go buy those shoes. You want it right, like, but you made yourself first.



Yeah, yeah, I love it. Like I said, that mentality has just changed and shifted everything for me. So hopefully, the listeners will take that and hold on to it through 2020. Now, like I said, you wear a lot of different hats. So financial advisors, one new or very successful financial advisor working for someone else. Right? And then you kind of made a shift, you kind of reached the point where, oh, I feel like I've got all this stuff. But I'm not sure that I'm happy in the place where I'm at. Is that right? Yeah, I



think, you know, for me, I realized I draw the analogy, I felt like I was a shark in a fish tank. Right. Like I had, I had outgrown, you know, the system that I was in. And in order to continue to to flourish, I needed to swim in larger waters, right? I believe in life, you know, you're green and you're Brown, you're growing and you're dying, you're getting better, you're getting worse, there's no staying the same, right? And so for me, I'm always looking to grow, I'm always looking to get better. I'm always looking to be pushed, and challenging. So you know, what better thing than, you know, leaving a 13 year career, you know, and multi multimillion dollar practice than to go out break out on your own and try to build something bigger. So that's exactly what I did.



And again, not easy. Now, was this around the same time that you started getting into yoga and becoming a yoga practitioner? And how did that change? What you do as a financial advisor and even as a dad and as a person? Kind of connecting that mind and body?



Yeah, I think it was somewhat around the same time I've been been practicing yoga for about 14 1415 years and and I've been independent now my own brokerage about 910 years and I think what yoga taught me not only what it did for me physically, but it I was very idealistic visit undermanned, right, this will happen, this lab, this will happen, right? I was very rigid, right? This, this, this. And what yoga taught me is it taught me to detach myself from outcomes. It taught me to detach myself from outcomes and to just focus on process. Right. And so there's a little Mater that I that I shared in the listeners can can take part in this as well. And you got a challenge in your life. Right? You got an issue in your life, you ask yourself questions, three questions. Do you have a problem? No. Okay. Don't worry about it. Right? No problem doesn't worry about. Do you have a problem? Yes. Can you do something about it? Yes. Okay. Don't worry about it. Do you ever problem? Yes. Can you do something about it? No. Oh, great. Don't worry about it. Which basically means all paths lead to not worrying about it. Right? So I believe that everything happens for a reason. And it's exact, perfect timing, even the crappy stuff. Right? Even the stuff you're like, This isn't fun. This hurts. Right? And, and, and, and one of the things that yoga has taught me is this just changes my mantras. I mean, even teaching it right, I have all these intentions and things that I that I that I share with with my students and that I have to also live by I can't say it not believe it or not live with it, right. And even this past week, my watch for classes that ease is a greater threat to progress than hardship. Right? And so through adversity through challenges, that is where we that is where we grow, that's where we get product progress, that is where grit is developed. And so for me, Yoga has softened me in so many ways. And let me accept things right, except that sometimes I will get exactly what I want. And sometimes the door will be slammed in my face and it's okay because if a door gets slammed in my face it was supposed to get now now the challenge is in the big so do you need me Sophie, every time you get rejected, you just accept it like know what I mean by trusting the processes. If I have done what is required of me, if I have done everything that I can do, then I can detach myself from the outcome. I don't mean that I'm sitting at home flipping TV. going like, I'm going to make a million dollars this year. Are you working today? Like no, but it's coming to me I'm manifesting. There's two keys to success in life. Number one, you have to believe that's the first part, those that think they can do something and those that didn't, they could not do something about usually right, then the second piece, then you have to do the work. Right. So what I always had was a tremendous work ethic that I always had. But what was flawed, flawed, or what was underdeveloped, if you will, was that mindset that, that that that positivity, that manifestation? That that, okay, this, this is what will happen, okay? This is what I want to happen, okay, and then go out and do the work.



Yeah. And boy, that second parts, the tricky bit, right, having to do the work. That's the hard part. And I know, and then, what I see a lot, and you probably see this on social media is people will say, Oh, I put it on my vision board, and it just happened. Or I manifested it, and it just happened. And then you're sitting there like, what, like, if that work is



because people people typically aren't posting their losses, right, people are posting their wins, you know, and the reality of it is, is that, you know, you take any anyone in any any arena sports, entertainment business, right there, they're all failures, all of them. They just were too stubborn to stay down. Right. And that's, that's the difference. I've come to believe that the most successful people in life are simply those who can endure the most pain, who can endure the most rejection who can in you know, indoor, and I think that's how I became successful in my business. I think, I think that I coined the phrase at the time when I was new advisor, I put in the phrase, tactical persistence, right? I'm going to be persistent tactfully. I think, in the first couple years of my career, people ultimately just did business with me, because I like, if I don't buy something from this guy, I think he's ever going away. Like, I don't think he is ever. Right. And so, you know, I was just there, they're there. And they're like, fine, right? I mean, you've developed a relationship and people know, right, then he's not going anywhere. He's gonna be here. Right. And, and, and, and I think I think that's, that's, that's important. I mean, anyone, uh, any one of the listeners, you know, of this program can tell you what is the easiest way to put off a salesperson or a telemarketer the easiest way to um, one simple phrase, call me later. And 99.9% of the time, they will not and you're off the hook. You don't even have to reject it. You did. So call me later because they didn't follow through. Right? Right. They didn't follow up. So you didn't have to actually, you know, say no, even right. And so, that's the thing for me, like, No, I'm gonna follow up and I'm gonna follow through and I'm gonna do everything that is required of me. Right. And if you ultimately type he's not right or my services are right then. Okay. Right. But I will not fail because I didn't do what was required. That will happen.



Yeah, yeah. That makes perfect sense. And, you know, speaking of tactful persistence, the other hat that you were is a dad to three girls, so I can only imagine tactful persistence comes in handy. So how has all of this your experience in business, your experience in yoga, your experience in life? How does that come together when it comes to raising three, three gals?



Yeah, um, you know, I, when I was a younger man, I used to pray to God that he'd sent girls to hang all over me. And he took me literally and it's like, here you go, here's three of them. Right? So be careful what you ask for my kid. I've got these three girls. And this is a prime example of you don't always get what you want, but you get exactly what you need. Right? me growing up as an athlete, I was a force for Letterman. In high school, I went on to play college basketball. You know, I recently got inducted into the Hall of Fame in my high school for sports. Right? So of course, I want Boys, boys continue to legacy and go on. And then I get three tall girls, two beautiful girls like oh, man, like God, why? But you know, just, I'm a different man. I'm a different father because I have these three girls. And I think, you know, my, my role and the one thing that I say is like as as a as a man, right of girl, Dad, if you will, I'm the first man they fall in love with. So it's my responsibility to show them, you know, respect and true love and chivalry, because that's where they're going to carry on in their relationships as they get older. And so I think, you know, I feel very blessed. Although, they are sisters and they're they're all flesh of my flesh and blood of my blood. There are three completely different people that represent three completely different sets of challenges and, and, and things to deal with. But I've been blessed because they're good girls, right? And I wish I could say it was because I'm such a great dad. But, um, you know, I think that they're they're just inherently they've got good sweet spirits, which is, which is a blessing to have. And then I'm just doing the best I can to guide them. I think we all can attest to this being as we get older, we become adults, we look back at our parents, and we realize every one of us has said this at some point, like, wait a minute, our parents didn't know what the heck they were doing. Right. Like, and some of us even called our parents out, right? Like, you were just winging it. They're like, Yeah, you know, and so I feel like, you know, I feel like, we're just all doing the best we can, you know, and that's, I'm doing the best we can as much as I feel like, you know, I'm doing all the things from I can from my, my daughters, I'm sure they'll tell you. Yeah, but he didn't do this, or this or this, but, but what they will definitely say is that, you know, I'm president and that I'm, I'm, I'm, I'm consistent, I'm a consistent, you know, consistent force in their life. Right. And that's, you know, that's the most important thing to me. I don't need them to always like me, I don't I don't need them to always agree with me, but I do need them to, to respect and honor Me and then with the love that we have, you know that that's something that you know, is so special, and then I feel blessed to be there for their father. Yeah.



Amazing. And you're putting all of this together, your financial advisor role your entrepreneur role, your community mindedness, your girl, Dad, your yoga, into mind, body money. So what is it? And what can we expect?



Yeah, Mind Body money is a docu series that I created. I have actually filmed all of season one, I'm in the process of talking to a variety of networks now to get it placed on on national television COMM And q1 Next year, so stay tuned. I've also created an app that's on the App Store mind dot body dot money that's on the app store as well. But the idea is that how do we become the best versions of ourselves? And we become the best versions of ourselves balancing those three areas in that order. Mind. Body, money, right? Mindset first manifestation, manifestation. Every day when people ask me how I'm doing I Thomas, the best day of my life, I say that every single day. Now, does that mean that everything is going well in my life at all times? Nope. But that's what I say. I'm manifesting positivity. Right. But health alone is so important. We're getting one body, right? Never no one's ever on their deathbed wishing they had more money. Right? So you got to take care of yourself. And then money, good stewardship of your money, right? Money can't buy you happiness, but it can pay your bills. So I can do a lot of stuff by hand. And so typically, what I find is people are unequally yoked right you might have the money hungry driven person and And admittedly, I was that person coming out of school, I want to be a million dollars. I want to, you know, you know, have a nice house nice car and buy stuff, right? But lacks substance lacked connectivity. Oh, right. And, and, and when I got all this stuff, what I realized, like, oh, an empty because it's not about the stuff. It's not about money. Right? It's about connections about love. Okay, and then you got the other people that understand spirituality? No, it's about mindset and in spirituality, and, and peace. And that's great that you feel like that you want to go on this yoga retreat. But I got a question for you. How do you pay your bills? Right. And so it's that it's the balance between those three areas. And that's what the show features different athletes, celebrities, entertainers, all the way down to your common men and women, and how the journey in life, right, you know, is navigating those three areas. And the one thing that I'll tell you, between all of the people, there is always a story of failure. There's always a story of doubt, or uncertainty that they all press through. And that's the one thing that I say common thread, like the most successful people, right that I've met in my life all can tell you a story where they were down and out or they didn't know what's gonna happen next, but they persevered, right? There's a, there's a, there's a little meme that I that I share when I'm doing my my talks and it has it's a photo of a goldmine that you can envision this in a person with a with a with a pitchfork, and they're digging in, they're digging, and they've dug like a 10 foot ditch and they get frustrated, and they turn around like, like I'm finished right? And they were only one foot away from actually hitting goal but they're like I've done so much And then the mantra here is don't don't ever give up. You never know how close you are, to, to your, to your goals to your dream. So So you swing away, you swing away until you get it. Right. And maybe maybe you'll get there in a week, they will take a year, they will take 10 years, right? Maybe Maybe it's not meant for you. Right. But But again, right, don't leave this earth wondering what if?



And out of all of the episodes that you've done and the people that you've met through mind body money? Is there a particular story that sticks out for you that you can share with the audience?



Yeah, there's two stories that come to mind. Actually, I'll share first one guest we had was on the show was Jordan sparks. She was the youngest American, I



love her. She's great.



She's awesome. Just as lovely. Off off screen as she is on screen. She shared with me so she goes on American Idol. She comes here to actually to Pasadena where I live, she cheats. She auditions at the Rose Bowl and gets cut. She didn't even make it to go see Simon and all those guys, right? She gets cut, right? And she says she remembers walking out, you know, through the parking lot with all these girls. And at the time, she was young. I think she was like 17 or so. But at the time, she said she remember seeing all these older girls and older by but I mean like 2526 year olds, I thought, Oh, my life is over. This is my only chance to make it big. And I'm done. And she thought to herself like, no, like, I'll come back don't get another way for me. So she goes back, she lives in Arizona. So she goes to a regional regional competition in in in Phoenix and wins, right and wins. And the prize for winning was a chance to go to the next city, which was in Seattle, and try again, audition again. And on that second audition, she gets picked up and then ultimately wins



the show. Amazing.



And so that story is when we're like wow, you know, like, wow, you know that what level of perseverance and just believe that like not this, isn't it? And how many of us would have faced that rejection or or stumbled in the live live? Yes, it wasn't in the cards for me. Right? But again, as long as you have breath in your body, keep pushing. Right. The other story I'll share is I had David Hasselhoff he was on my radio show my Ask the Experts radio show. And we're interviewing him. And David Hasselhoff was one of the principals of one of the first billion dollar TV franchises Baywatch, right? Um, I personally think that Knight Rider was cooler but for the for you. Gen Xers with me. But anyway, but but the US, you know, first building our franchise Baywatch, right, and we're talking about that. And again, what a lot of people don't know is that they watched initially was cancelled. It was cancelled after the first three episodes. Because yeah, they killed like five people in the first few episodes and and the viewers didn't like it. So the show got canceled. So in an attempt to revitalize the show, because like I need financing, so in little known, but David Hasselhoff in Germany is like he's huge, right? Like he's like, he's like, yeah, he's like, the biggest thing he's Yeah, yeah. Right. So he goes to Germany's like, they'll give you money, right? It goes in Germany. He raises some money. He gets like 1,000,005 to bring back the show, and comes back and does the show, right? Well, what happens is, they run out of money. They run out of money, they can't finish the episode. So like, man, we got 22 minutes of content, we need 25 And we don't have any more money. What can we do? How can we make the episodes longer slomo that is where slomo comes in. Slo Mo was to stretch out the scene so that they can get their minutes so funny that the most iconic part of the show was really a mistake was really because they didn't have money right? So story after story after story like that, that I've heard in my 22 year career most certainly in filming this Docu series is follow doc that like wow, like so many times people put a lay down so many times people could have you know, given a peck Jeff basals worked at McDonald's guys. You have like, like, like so so when somebody next to you when you're when you're working in Starbucks and the barista next to us like I'm going to be a billionaire and all scoff right you never know.



It can happen you never know. I love these like insider stories. I think it's so cool. So as we start to wrap things up, where can people find more about you about mind body money? Maybe see some little clips things like that. Where can where can people go?



Yeah, I'm pretty easy to find. My name is so unique. There's not a lot of me out there. He Sophie Taylor, Mama variety of social media platforms Instagram, Facebook, LinkedIn, that's at a selfie Taylor s ZYLF ie Taylor at the Sophie Taylor. For the show, we actually have a website, in addition to the social media platform. So we have a website Mind, Body So mind body money calm, you can also get information on the app store as well. You can download the app, the app store at mine dot body dot money, as well. And so yeah, we're out here we're continuing to push out new content, and, and keep everyone posted on the release of everything. But I'm super excited for what 2022 is going to bring and look forward to sharing. I feel like the bottom line for me is like when do you watch television? And and learn something? When do you watch television and feel better? And that's what I'm going to bring? That's what I'm going to bring to the world?



Well, the world certainly needs it at this point in time. So it sounds perfect to me. And now before we end, I asked everyone this same question. And it's knowing where you are now in your life and your career. What advice would you give to your younger self?



I would remind my younger self, that the road to walk a mile begins with a single step. No shortcuts. No matter how talented you are, no matter how smart you are, no matter how ambitious you are, right hard work is undefeated, you must do the work, right foot in front of the left one step at a time you'll get there. I think one of the biggest reasons that I'm successful today, it's all the slow, boring stuff. All the get rich quick, I'm gonna make a million dollars in a month and change the world all that stuff crashed and burned.



Right? So you mean all the stuff you see on social media?



Yeah, all that stuff crash and burn. It was it's the slow and steady. You know that? That is why you know, is why I'm here. Right. And so that's why I remind my younger self and it's hard, right? It's hard to listen, my long term plan at 22 was 25. Right? That was my long term plan. Right? I love that. Right? I mean, I was like, man, three years, that's 25 years old. Right? And so, you know, I can still couldn't even see past 30 like, well, what is what is that? You know, and, and then you you you blink? Right? You blink and you're like, well, 10 years has gone by 15 years gone by 20 years has gone by, you know and so that's what I would remind myself is just stay the course. Don't get you on the highs don't get too long. The lows the road to walk a mile begins with a single step. Just go.



I love it. Great advice. And Sophie, thank you so much for coming onto the podcast one more time. Where can people find out more about you?



Social media at ie Sophie Taylor, Facebook, Instagram, LinkedIn, at Mind Body money, Instagram as well. And at the mind body site as well as a mind body about money on the App Store.



Perfect. Thank you so much for coming on. I appreciate it. I appreciate you. And I wish you all the best in 2022, including your show.



Awesome. Thank you. Thank you. I'll take all the well wishes and blessings I could get. Thank you very much.



You're welcome. And everyone. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

Jan 17, 2022

In this episode, Social Justice and Sports Medicine Research Specialist, Sheree Bekker, talks about social justice in sports, medicine, and research.

Today, Sheree talks about the conversations around physiology and injuries, and the different environments that affect the ACL injury cycle. How do clinicians implement the findings in the research?

Hear about Sheree’s qualitative research methods, the importance of recognising the social determinants of injuries, tackling systemic experiences, and get Sheree’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “We have to recognise the human at the centre of those experiences.”
  • “Gendered language that seems like everyday language in sport can be really harmful to both men and women.”
  • “[Be] cognisant of, and [be] able to have those conversations with athletes, patients, people that you work with all the time about their social conditions of their lives.”
  • “The social conditions of our lives play into our injuries and our rehabilitation.”
  • “It is about not simply seeing rehab as a biomedical issue alone to solve, but thinking about it as socially, politically, and materially oriented is a practice that you might incorporate in your way of thinking.”
  • “Injury prevention, and a contemporary vision for injury prevention, needs to be athlete-centred and human-focused.”
  • “We need to have those uncomfortable conversations about our complex, messy realities.”
  • “Context is everything.”
  • “Sport isn’t neutral. It isn’t apolitical.”
  • “We can start to ask these questions, start to have these conversations. The answers aren’t going to come tomorrow.”
  • “These ripples will take some time.”
  • “Connection is greater than competition.”
  • “Hold on to the power of connecting with people who are at the same career stage and doing work with people who are at the same career stage as you.”


More about Sheree Bekker

headshot Dr. Sheree BekkerDr Sheree Bekker (she/her) was born in South Africa, grew up in Botswana, completed her PhD in Australia, and now calls Bath (UK) home.

She is an expert in ‘complexity’ and research that links social justice and (sports) injury prevention. She has a special interest in sex/gender and uses qualitative methods. This underpins her work as an Assistant Professor in Injury Prevention and Safety Promotion in the Department for Health at the University of Bath. At Bath, she is Co-Director of the Centre for Qualitative Research, and a member of the Centre for Health and Injury and Illness Prevention in Sport (CHI2PS), and the Gender and Sexuality Research Group.

Internationally, Sheree is an Early Career Representative for the International Society for Qualitative Research in Sport and Exercise, and a founding member of the Qualitative Research in Sports Medicine (QRSMed) special interest group.

In 2020 she was appointed as an Associate Editor of the British Journal of Sports Medicine, and in 2021 she was appointed Qualitative Research Editor of BMJ Open Sport and Exercise Medicine.

She completed a Prize Research Fellowship in Injury Prevention at the University of Bath from 2018-2020, and received the 2019 British Journal of Sports Medicine Editor’s Choice Academy Award for her PhD research.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Social Justice, Injury, Prevention, Gender, Sexuality, Physiology, Sociology, Environment, Research, Change,



Anterior cruciate ligament injury: towards a gendered environmental approach


To learn more, follow Sheree at:


Twitter:            @shereebekker

Instagram:       @sheree_bekker


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




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Read the Full Transcript Here: 


Hi, Sheree, welcome to the podcast. I'm so excited to have you on. I've been looking forward to this for a long time. So thank you so much for joining.



Thank you for having me. Karen. I am delighted to be talking to you today.



And today we're going to talk about some of now you had a couple of different presentations at the International Olympic Committee meeting in Monaco a few weeks ago, and we're going to talk about a couple of them. But first, I would love for you to tell the audience a little bit more about you, and about the direction of your research and kind of the why behind it. Because I think that's important.



Mm hmm. Yeah, I've actually I have been thinking about this a lot recently, over the course of the pandemic, and thinking about where my research and my work is going and why I'm so interested in in kind of social justice issues in sports injury research in Sport and Exercise medicine. And I guess for me, there are two reasons for that both of them related to my background. First of all, I was born in South Africa. And I grew up in Botswana. And I think, you know, growing up into countries that have interesting pasts, you know, South Africa having post of apartheid and Botswana having been a colonized country, I think I grew up in places where we were used to having difficult conversations about social justice issues on a national level. And I think, you know, that is something that has influenced me definitely in the way that I see the world. The second part for me is I studied human movement science at university. And my program was in a Faculty of Humanities and Social Sciences. And I didn't realize at the time that most people get their sport and exercise medicine, sports science, human movement, science training, in medical faculties, or in health faculties, whereas mine was very much social sciences and humanities. And I only realized this later that my training in this regard was quite different in terms of the way that I see the work that we do. And so now, I've landed here at the University of Bath, and I'm in a department for health. But once again, I'm back in a Faculty of Humanities and Social Sciences. So it's been a really, really nice connection for me to come back to these bigger social justice questions, I guess, that I'm interested, you know, in our field. So for me, that's really the why I think of why I do this work.



And, and kind of carrying along those themes of social justice and really taking a quat. Know, a quantitative, qualitative, sorry, qualitative eye, on athletes and on injury, let's talk about your first talk that you gave it at IOC, which is about the athletes voice. So take us through it. And then we'll ask some questions. So I'll, I'll shoot it over to you.



Yeah, so um, my first talk, the first symposium that I was involved in at IOC this year, we had titled The athlete's voice, and those of us who were involved with it, we're really proud to be able to get this topic, this kind of conversation onto the agenda in Monaco. I had so many people comment to me afterwards, that this was the first time that we've been able to have this kind of discussion at this specific conference. And, you know, previous editions, I think, have been very much focused on that biomedical that I was just talking about, given that it's Sport and Exercise medicine. And it was the first time that we've been able to bring athlete voice into this space. And so this symposium in my talk in particular, was really focused on qualitative research. Even though when we pitched the symposium, we kind of decided that we couldn't call it qualitative research, because it wouldn't have been accepted at the time. And, and now, it's amazing to me how far we've come that we can actually talk about qualitative research in these spaces. So what I spoke about, and what I was interested in is, you know, what are the kinds of different knowledges and who are the people that we might listen to in Sport and Exercise medicine and sports injury more broadly, that traditionally we maybe haven't scented and haven't listened to? And I was interested in those kinds of social meanings of injury and of injury prevention and how we might do things differently. So you know, for me, it was that Recognizing the value of alternative perspectives, and working across disciplines and advancing our research and practice in this way. And so that's really what I spoke about was, you know how we might do these things differently by actually listening to the people at the center of our work and listening to athletes themselves. And that was really the focus of that symposium.



And in looking through some of the slides from the symposium, some of the quotes that I'm assuming we're taking from the qualitative work are, gosh, they're kind of heartbreaking. So what do you do with that information once you have it, right? So you're conditioned not to quit, you turn off your emotions, you become a robot as soon as you step onto the field or the pitch or the court. So how do you take that qualitative research? And what do you do with that once you have it?



Yeah, so you know, my talk, the way I kind of structured my talk was to talk about how we generally do injury prevention. And what we generally do is we, you know, figure out what the issue is what the injury problem is, we develop an intervention, and then we implement that in intervention and hope that it works. And, and some, you know, that's the kind of general cycle that we use. And what I decided to do in my talk, which was only a 10 minute talk was to dedicate two of those minutes to a video that I showed, that was just set to music that flashed up all of these quotes from athletes. And there were quotes that I'd collected from a number of different sports, a number of different athletes and spaces over the years, that really speak about their experience in sports and these toxic environments, which is something that I think we tend to kind of put to the side, maybe sometimes and ignore, sometimes in sport, when we put sport up on a pedestal and only think about the good things that happen in sports. And those quotes are also, I guess, a throwback or connection to one of the other talks that I had at IOC, which is not something that I think we'll speak about today, but about safeguarding and recognizing safeguarding as an injury prevention issue. And so we had these, like two minutes of these quotes from athletes. And I think that video really signaled a palpable shift in the room in recognizing what athletes are actually saying, and what their experiences are in sport about needing to, I guess, you know, put their their kind of robot hat on and be this strong person within sport where they can't break down where they can't have injuries or anything like that. Otherwise, they're going to be the team. And just for us to come back and to recognize that humanity in that experience, within sport, I think is really, really important, especially when we're at a conference where we're talking about injury prevention and interventions, we have to recognize the human at the center of those experiences. And so for me, coming back to your question about what do we do with that information? I think that's really powerful information, in terms of how we think about what injury prevention is, and does. And I guess we always focus on bodies, and you know, body parts, the ankle, the knee, the hip, the growing. You know, that's, that's kind of been a big focus of injury prevention. And I think we often forget that injury prevention is and can be so much more than that. And that there are these social factors, or social determinants, that to play into injury and its prevention. So the social aspects of our lives in terms of, you know, abuse that might happen in these spaces, or just being exposed to toxic spaces, you know, how that does actually render us more susceptible to injury, and how that can thwart our injury prevention efforts in these spaces. So for me, it's about integrating both of those two things I think together, and that's what I'm kind of getting at with qualitative research.



And, and that leads me into something else I wanted to talk about, and that is a review from the British Journal of Sports Medicine that you co authored with Joanne Parsons and Stephanie Cohen, anterior cruciate ligament injury towards a gendered environmental approach. And what you just said, triggered in me something in in reading through that article was that there's intrinsic factors and extrinsic factors that can lead to injury and injury prevention programs, if done well, should incorporate both of those. Right but they often concentrate on the biomedical part of the The, whether it be strength training, or landing, or, you know, whatever it may be when we look at a lot of these injury prevention programs, but there are so many contextual issues and extrinsic issues that can impact any of those programs. So I'll kind of let you sort of talk through that a little bit and talk through some of the main points that you found in that paper. But gosh, it really gets you thinking like, Well, wait a second, it could be, like you said, if you are, depending on the environment in which you live, can have a huge impact. And it's, it's more than just, especially when it comes to girls and women, it's more than just oh, it's because you have your period. And that's why this happened. Or if your hips are wider, that's why you got injured, right? So go ahead, I'll throw it over to you. And you can kind of talk through that paper a little bit, and then we'll see what comes up.



Mm hmm. You know, I'm so happy to hear you say that, because I'm so I'm not a clinician, but it has been amazing to me to hear how this paper has resonated with clinicians and people working in this space in terms of your own experiences and what you see and what you hear from the people that you're working with. So yeah, you're absolutely right. I mean, this paper was born out of conversations that Steph and Joanne and I had in terms of how we were frustrated by I guess, the discourse around sports injury, particularly for girls and women, often being blamed on our physiology on our bodies, right. And to us, that seems like a bit of a cop out. And just to say, oh, you know, girls are more susceptible to ACL injury, because they have wider hips, so there's nothing that we can do about it, you know, so that's really pitched us that intrinsic risk factor that girls and women are just inherently weaker, or supposedly more fragile than boys and men, and there's nothing that we can do about it. So we're just going to have to kind of live with those injury breeds. Right. And, and we found that this kind of thinking had really underpins so much of the injury prevention work that we'd seen over the last 10 or 20 years. And we wanted to problematize this a little bit and to think through what those kind of other social and I would say structural determinants of sports injuries are. So I'm starting to talk about this idea of the social determinants of injury. So not just what are those intrinsic things, but actually, what are the what are the other other social modes, I guess, that we might carry that might lead to injury. So in this paper, we speak about how we, as human beings, literally incorporate I think, biologically, the world in which we live. So our societal or ecological circumstances, we incorporate that into our bodies. And so we can start to see how injury might be a biological manifestation of exposure to that kind of social load. So for girls and women, how our gendered experience of the world might render us more susceptible to injury, rather than just positioning ourselves as being more weak, or more fragile. So we were interested in how society makes us and skills in women more weaker, and more fragile. And so in this way, we speak about how you know, from the time that we're babies, girls are not expected to do as much physically we are brought up differently to young boy babies might be when we go through school and play sport in school, we play different kinds of sports, and again, you know, on average, or in general, and girls, goes out, you know, not encouraged to be as active and to do as much with our bodies as boys. And we then go in right to have this kind of that cumulative effect of less exposure to activities and doing things with our bodies. Actually, that is what leads to us being more susceptible to things like ACL injury over time. And this is carried on in the kind of elite sports space as well. So we see how girls and women's sports are devalued in so many ways and how we're not expected to do as much or to perform as well. Or to train as hard I guess, as boys and men So an example of this that actually happened a couple of weeks after we published the paper was the NCAA March Madness. I don't know if you remember, there were those pictures that were tweeted all over social media, about the women's division, only being supplied with one set of teeny, tiny Dunda. Whereas the men's division was given, you know, massive weight room with everything that they needed to be able to train to be able to warm up and do everything that they needed to do in that state. And the first that was just an excellent example of what we're talking about in terms of girls and women being expected to and actually being made, I guess, weaker than boys and men are in exactly the same sports spaces. And so that's kind of a rundown, I guess, of what we wrote about in the paper.



Yeah, and I look back on my career as I was a high school athlete, college athlete, and not once was it, hey, we should go into the gym and train with specific training programs, because it will help to make you stronger, maybe faster, better, less prone to injury, but the boys were always had a training program. You know, they always had a workout program. So I can concur. That is like a lived experience for me as to what training was like, comparing the boys versus girls college straight through or high school straight through to college. And yes, that March Madness thing was maddening. Pun intended. I couldn't you could not believe couldn't believe what we were seeing there. That was that was completely out of bounds. But what I'd like to dive in a little bit deeper to the article, not not having you go through everything line by line. But let's talk about the different environments that you bring up within the article, because I think they're important. And a little more explanation would be great. So throughout this kind of ACL injury paradigm, you come up with four different environments, the pre sport environment, the training environment, the competition environment, and the treatment environment. So would you like to touch on each of those a little bit? Just to explain to the listeners, how that fits into your, into this paper and into the structure of injury prevention?



Yeah, sure. So um, yeah, what we did with this paper was we take we take the the traditional ACL injury cycle, and that a lot of us working in sports injury prevention are aware of, and we overlay what we called gendered environmental factors on top of that, so we wanted to take this this site, call and think through how our gendered experiences and girls and women, again render us more susceptible, and over the course of a lifetime, or a Korean. And so starting with the pre sport environment, you know, that goes back to what I was just saying about girls and boys being girls being socialized differently to boys, when we're growing up. So that kind of life course effect, gender affects over the life course, in terms of what we're expected to do with our bodies. That really starts in that pre sport environment when we're babies and young boys and young girls. And then we track how that works throughout the ACL injury cycle. So moving into the next step, coming back to this NCAA example, you know, what the training environment looks like, and how it might be gendered in ways that we might not even pick up on. So another example here, and this is a practical example that we've given to some sports organizations, since then, is, you know, the kind of gendered language that seems like everyday language and sport that can actually be really harmful to both men and women. So for example, you know, talking about girl push ups, you know, that really does set a precedent for what we think about girls and women in sports spaces. When you say, Oh, you go over there and do some girl push ups, it really does render girls and women as being more weak, you know, weaker and more fragile than boys and men. So those kinds of gendered experience in sports spaces, and you're an example there is really key. But then we also talk about kind of during injury and post injury as well. And this comes more into the kind of rehabilitation space and so on how, again, expectations of girls and women's bodies might play into what we expect when we go through rehabilitation as well and, and how that plays into that ACL injury cycle of recovery, as well. So that's really for So it was overlaying gender, across all of those spaces. And I think that gives us a really powerful way of looking at ACL injury differently and to, to conceptualize what we might do both in injury prevention, but also once injury has happened to help girls and women differently.



And in reading through this paper, and and also going through the slides that you graciously provided on Twitter, of of all of your talks at IOC, as a clinician, it for me, gives me so much more to think about, and really sparked some thoughts in my head as to conversations to have with the patient. So what advice would you give to clinicians, when it comes to synthesizing a lot of this work? And taking it into the clinic, talking with their patient in front of them and then implementing it? Because some people may say, oh, my gosh, I have so much to do. Now, I have to read all of this. Now I have to incorporate this, do you know what I mean? So it can some be somewhat overwhelming. So what advice do you have for clinicians? Yes,



so I really do think and as I said earlier, I think a lot of what we're seeing here is what clinicians are doing all the time anyway, I think, especially people who are already connected to this kind of idea of this social determinants of health. And so I guess, for me, it is really just being cognizant of, and being able to have those conversations with athletes, with patients with people that you work with all the time, about their social conditions of their lives. So not again, not just reducing people down to bodies, but recognizing that people have you know, that the social conditions of our lives play into our injuries and our rehabilitation, and holding space for that, you know, when I'm teaching, that's what I say to my students all the time, but I know that that you know, this, and clinicians know this better than I do. You, you know, it's not just about saying to someone, go away and do these exercises, and come back to me when you know, that person might have a full time job with three kids to look after. And, you know, a lot of other things on their plate as well that that one exercise or exercise program isn't necessarily going to be the silver bullet or the answer to, you know, the way that they need to be dealing with that injury. So I think for me, it's again, that re humanizing and being able to have those those conversations and recognizing those social determinants of injury or recovery, and so on. And so I think for clinicians, it is about not simply seeing rehab as a biomedical issue alone to solve, but thinking about it as socially and politically and materially oriented as a practice that you might incorporate in your way of thinking. That's really it. It doesn't need to be any more than that. We don't need to complicate it. Any more than that.



Yeah. Perfect. Thank you for that. And as we start to wrap things up, is there a, are there any kind of key points that you want to leave the listeners with? Or is there anything that we didn't touch on that you were like, oh, I need I need people to know this. This is really important. Hmm.



Yeah, I think, you know, if we kind of connect the conversations that we've kind of had today with the different points that we've connected to, I think, you know, what I saw in IRC at the IOC conference in Monaco is I really felt especially on day one at that athlete centered symposium that we had, I really felt like a palpable shift in that room. And in the conversations that I've had afterwards, with people I've had so many people come up to me to say that, you know, that it was really inspiring, and it's helped them to be able to go away and have different kinds of conversations, incredibly have different kinds of conversations about the work that we're doing in injury prevention and in Sport and Exercise medicine more broadly. And so I really think that we need to focus on that idea that injury prevention and a contemporary vision for injury prevention needs to be athlete centered and human focused. And I think if we truly committed to this, I think the ways in which we develop our interventions, and the ways in which we might go about our work, more generally in Sport and Exercise medicine, in physiotherapy and so on, it needs to reflect the socio cultural, so meaning those social determinants of injury in cluding the ways in which things like sexism, and misogyny, and racism, and classism, and ableism, and homophobia and transphobia, how that all can and does actually lead to injury. I think those are larger conversations that we need to be having enough field that we've started to have very slowly, but they are difficult conversations to have. And we often cut them out when we only think about injury as a biomedical thing, again, only thinking about bodies. And so for me, I think those are the those are the thing that we now need to get uncomfortable, you know, about, we need to have those uncomfortable conversations about our complex, messy realities, and that we're dealing with that athletes are human beings, that these are our experiences of the world, that sport and exercise medicine needs to reflect that as well. In terms of our composition, we need to reflect the communities that we serve as well. And Tracy Blake talks about that often. And you know, those are the conversations that I'd like to see our field having going forward. And I do think there was a shift in being able to say those things at Monaco this year.



Yeah. And so what I'm hearing is, was the big takeaway for me from Monaco is context is everything. And we can't, we can no longer take that out. And focus, like you said, just on the biomedical aspect of this person in front of us as if they don't have past experiences and emotions and thoughts and fears and concerns. And context is everything. And for clinicians, it sounds like a challenge to start having these conversations at more conferences. I know it's this little kind of bubble of clinicians, but if it can start there, perhaps it can make a ripple out into the wider public and into having these conversations with your athletes and patients and not be afraid to have these difficult conversations, or to ask the probing questions to the person in front of you. Because they're more than just their ACL injury, they're more than just their back pain. So I think challenging clinicians to have these conversations, whether it be one on one like this, or within large groups at conferences, and then take that back to your, to your practice and really start living it and understanding that this can is as important, maybe, in some cases more important than the biomedical injury in front of you.



Oh, I could not agree more with that statement. I mean, something that I've spoken about a lot before is that, you know, sport isn't neutral. It's not a political. And it's the same for the work that we do. It's, you know, for far too long, it's been positioned as a neutral science thing that we do. And I think we're now starting to recognize the context around that, that our values and our principles and people's lives and experiences, you know, as you say, play as much as if not more of a role in their experience of sport, and injury, and rehab, and all of that. So I would agree with you completely, we need to be having more of these conversations, we need to recognize this within our research, we need to recognize this within our practice. And we can't keep going on as if you know, none of so if we can remove all of that from the practice of working with human beings and being human beings as well. You know, all of this is connected for me. And as you know, as we're seeing now, it's for all of us who work in this space, once we start to have these conversations, we can start to ask different questions, we can start to think about things differently. And I think that that's really powerful for the future of our work in this space.



Yeah. And I think it's also important to remember that we can start to ask these questions start to have these conversations that the answers aren't going to come tomorrow. So that instant gratification that has become the world that we are now living in that if it doesn't happen within the next couple of days, that means it's not going to happen, but that these ripples will take some time. Yeah, absolutely.



And, you know, so a lot of my work is in complexity theory. And what I say about that is, you know, there probably are not going to be hard and fast answers here. But it will bring up new considerations and it will bring up I think, I'd like us to move away from this idea that we can solve things, but actually move closer towards the idea that this is an ongoing practice. And that that's always going to be I think, more powerful for me when we see things like injury prevention as a process or a practice. That's not necessarily going to solve things. But that is you know, really To the context in which we live in our lives is an ongoing thing. And I think that's what we brought into the ACL injury cycle. Papers. Well,



yeah, I think it takes away from the clinician as being the MS or Mr. Fix it to, okay, we are layering ourselves into people's lives. And we need to be able to do that in a way that fits the person in front of us as best we can.



Yeah, exactly. Beautifully said exactly. We can't necessarily solve those things for them. But these provide considerations, things that we can do. And yeah, we can move with that.



Yeah, absolutely. Well, Cherie, thank you so much. I mean, we can go on and talk for days on end about this stuff. And perhaps when one of these days we will we'll have a bigger, wider, broader conversation and and make it go on for a couple of hours, because I'm sure it will bring up a lot of questions, maybe some answers, and perhaps some changing of minds when it comes to injury prevention and what our role is as clinicians. So thank you so much, where can people find you?



Thank you, Karen. And I love that I think broader conversations are so helpful in this space. So people can find me on Twitter at Shree Becker, that's probably the best place to find me. I'm always over there and happy to have broader conversations with everybody. So please come and find me on Twitter.



Perfect. And we'll have links to everything, including the paper that we're talking about. From BDSM. We'll have links to everything at the show notes at podcast dot healthy, wealthy, smart, calm. So one question left that I asked 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?



Oh, so that's a really good question. And it's I think it's my Elan series, again, connected to what we saw in Monaco. And something that I've said for many years now is connection is greater than competition. And something that I live in that I feel like I wish I had done earlier is to hold on to the power of connecting with people who are at the same career stage and doing work with people who are at the same career stages as you especially someone who has and is an emerging researcher, or researcher clinician in this space, because I think the exciting new conversations that we're seeing in this space are coming from people who are you know, recently merging, I guess, in these researchers faces and so it's okay to collaborate rather than being in competition with people who are doing great work in your area. So that would be my advice.



I love it. I love it and couldn't agree more. So Sheree, thank you so much for coming on. Thank you again. I appreciate it.



Thank you so much, Karen. And everyone. Thanks



so much for tuning in and listening and have a great couple of days and stay healthy, wealthy and smart.

Jan 10, 2022

In this episode, Founder of the Rizing Tide Foundation, Heidi Jannenga, returns to the podcast to talk about fostering diversity in the physical therapy industry.

Today, Heidi talks about the incredible work being done by the Rizing Tide Foundation, the process of awarding scholarships, and future Rizing Tide developments. Which changes still need to be made in the industry?

Hear about the growing student debt problem, how you can get involved with Rizing Tide, and get Heidi’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Almost every single one of them [students] were working full-time jobs at the same time as going to PT school. Some of them, more than one job.”
  • “There’s a huge segment of the folks that answered that survey that have more than $150,000 of debt post-graduation.”
  • “It takes a lot to try to balance the price of education to what we actually are getting paid as clinicians.”
  • “A rising tide raises all boats.”
  • “Be open-minded to a path that you may not have thought that you might go down.”
  • “If something aligns with your vision and values, then go for it.”


More about Heidi Jannenga

Dr. Heidi Jannenga, PT, DPT, ATC, is the founder of the Rizing Tide Foundation, which seeks to inspire more diversity and inclusiveness in the physical therapy industry. Each year, Rizing Tide presents scholarships to five promising BIPOC (Black, Indigenous, and people of color) students who are on the path to earning their Doctorate of Physical Therapy (DPT) or furthering their PT education by pursuing a residency program.

In addition, Heidi is a physical therapist and the co-founder and Chief Clinical Officer of WebPT, a nine-time Inc. 5000 honoree and the leading software solution for physical, occupational, and speech therapists.  As a member of the board and senior management team, Heidi advises on WebPT’s product vision, company culture, branding efforts and internal operations, while advocating for rehab therapists, women leaders, and entrepreneurs on a national and international scale. Since the company launched in 2008, Heidi has guided WebPT through exponential growth. Today, it’s the fastest-growing physical therapy software in the country, employing over 600 people and serving more than 90,000 therapy professionals - equating to an industry-leading 40% market-share.

In 2017, Heidi was honored by Health Data Management as one of the most powerful women in IT, and she was a finalist for EY’s Entrepreneur of the Year. In 2018, she was named the Ed Denison Business Leader of the Year at the Arizona Technology Council’s Governor’s Celebration of Innovation. In addition to serving on numerous non-profit leadership boards, Heidi is a proud member of the YPO Scottsdale Chapter and Charter 100 as well as an investor with Golden Seeds, which focuses on women-founded or led organizations.

Heidi is a mother to her 10-year-old daughter Ava and enjoys traveling, hiking, mountain biking and practicing yoga in her spare time.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Representation, Scholarships, Diversity, Inclusivity, BIPOC, Student Debt, Education, Opportunity,



Higher Education? By Andrew Hacker and Claudia Dreifus.

Apply for a Rizing Tide Scholarship.


To learn more, follow Heidi at:


Twitter:            @HeidiJannenga

LinkedIn:         Heidi Jannenga


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the full Transcript Here: 


rising tide, scholarship, pt, students, people, heidi, industry, physical therapist, foundation, profession, podcast, scholarship program, year, works, residency programs, physical therapy, pts, residency, crest, education



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'm wishing you all a very happy New Year and welcome to the first episode of 2022. We've got a great one in store. But first, a big thank you to Net Health for sponsoring today's podcast episode. So when it comes to boosting your clinics, online visibility, reputation and referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and get five star reviews. So they have a new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using NET Health's private practice EMR, be sure to ask about his new integration, head over to net forward slash li T zy to sign up for your complimentary marketing audit. Okay, on today's episode I'm really excited to have back on the podcast Dr. Heidi J. Nanga. She is the founder of the rising tide Foundation which seeks to inspire more diversity and inclusiveness in the physical therapy industry. Each year rising tide presents scholarships to five promising bipoc students who are on the path to earning their doctorate of physical therapy, or furthering their PT education by pursuing a residency program. In addition, Heidi is a physical therapist and the Co Founder and Chief Clinical Officer of web PT, a nine Time Inc 5000 honoree and the leading software solution for physical occupational speech therapist. As a member of the board and senior management team Heidi advises on web PTS, product vision company culture branding, efforts, and internal operations while advocating for rehab therapist women leaders and entrepreneurs on a national international scale. Since the company launched in 2008, Heidi has guided web PT through exponential growth. Today, it's the fastest growing physical therapy software in the country employing over 700 people serving more than 90,000 therapy professionals, equating to an industry leading 40% market share. In 2017, Heidi was honored by health data management as one of the most powerful women in it. She was a finalist for he wise Entrepreneur of the Year in 2018. She was named Ed Dennison, Business Leader of the Year at the Arizona Technology Council's governor's celebration of innovation. In addition to serving on numerous nonprofit leadership boards, Heidi's a proud member of the YPO Scottsdale chapter and charter 100 as well as an investor with golden seats which focuses on women founded or led organizations. She is also the mother's 10 year old daughter Ava enjoys traveling hiking, mountain biking and practicing yoga in her spare time when that spare time is I don't know. So today we are talking about the rising tide Foundation. And if you are a physical therapist and you are hoping to go into residency or you're in your residency, you must listen to this episode because you can win a scholarship from the rising tide foundation. If you're listening to this today, Monday, you have until Friday in order to to submit an application to the rising tide foundation to get a scholarship for your residency. So get on it people a big thank you to Heidi and everyone enjoyed today's episode. Hey, Heidi, welcome back to the podcast. Happy to have you back on.



Hey, Karen, so great to be here. Thanks so much for having me.



And so today we're going to be talking about a foundation called the rising tide foundation. So what is it and why did you decide to start this foundation?



Well, thanks so much for having me on. And to be able to talk about this because it really is a has been a labor of love. And a true way for me to give back to a profession that has given so much to me. The Rising Tide foundation really started after a few years of us doing the real estate of rehab therapy industry report which you and I have talked about on this podcast, and every year. There doesn't seem to be a change into two major things that we ask the serve the people that we survey, one was what you mentioned student debt, and actually, not that it hasn't changed, it's actually increasing. And that's a big burden, as you can imagine, to an industry. And then second was actually the biggest emphasis, which is the the, the lack of diversity within our profession. And being a person who identifies as a person of color. The fact that we have this lack of diversity has been a real, real issue, that hasn't made much change, despite, you know, the APTA and others sort of bringing attention to the issue. But the percentages as far as what the makeup of our profession looks like, has not changed has not really changed at all, in the last five years that we've been doing that survey. And so that was really the two major impetus behind me starting this foundation, I've been lucky enough to have financial success with web pt. And so had started the rising tide Foundation, not knowing what I wanted to do with the foundation back at the end of 2019. And then with everything that happened through 2020, it just sort of hit me over the head that this is something that I can personally make a difference in, within our profession. And



what exactly does the rising tide foundation do?



It is a scholarship program. So we have two tracks of scholars. We have the crest Scholarship, which is actually geared towards new and new students coming into the profession. And so we provide $14,000 scholarships to three participants, or three scholars, three scholarship winners, that is renewable for the three years PT school, and then we have to serve scholarships, which actually is for physical therapists who are going on to residency programs. And those are $10,000 each, for the one your usual one year program of residency. How, how



are these winners chosen? What give us a peek sort of behind the curtains, if you will, as to how the process works, so that if people listening to this, whether you are a physical therapy student, or you are one of those people like Gosh, I really want to do a residency, but I don't know how I can make it work financially. So how can these folks apply to the program and and like I said, gives a little peek behind the curtain on how it all works?



Sure, well, first and foremost, you have to qualify and so if you go to rising dash, you will find all of the specific sort of qualifications that are required. So for example, for the crest scholarship, you are either an undergraduate who is applying or an undergraduate who is applying to PT school. So you have will have graduated from an undergraduate with an undergraduate degree going on to DPT program, or you're a PTA that's entering into a PTA Bridge Program, which is there's only a couple of schools that do that. But we are also providing scholarships for any PTA who they want to go on to get their DPT so there is a actual physical, like documentation style application, which you have to fill out as well as writing three short essay that include questions like What inspired you to become a physical therapist? And, you know, what does it mean to be a community member? And then also, you know, we really wanted to dive into the essence of who the scholars are. Because we feel like we want to invest in professionals who who are really going to want to make a difference in the profession. So the last question is talking about sort of a failure that you've experienced in your life and what you've really learned from that training. Did you know dive into a little vulnerability and understanding of who they are at the core of the person. And so you also need some letters of recommendation, and transcripts in the normal sort of thing that you might think about in going through a scholarship. So once you you send all of that information. We have a selection committee, which I'm really, really proud of. I was honored to gather quite a few thought leaders from the industry including a fossa, Joe Badea, Maria Gonzalez seen Sharon Wang is actually not from the industry. We wanted to bring together our selection committee, which I call our Beachcombers, hopefully see that sort of nautical theme here. Wendy HARO, who is a software engineer actually works with me with PT, Moyer Tillery, who is also a PT, and then Jean shamrock rod. And those folks make up our our base comers who were to which our selection committee, so we scour all of the applications that come in for each one of the scholarship programs. And we narrow it down to around 10 finalists, and each of the finalists and have to go through an actual live video interview with the selection committee. And from there, we then get the really tedious and hard, difficult decision to narrow it down to the three winners. We just went through the crash scholarship selection process, and it was absolutely amazing. And, and we we were able to narrow it down. But having been our first process, it was just an incredible experience. And we had so many great applicants that we actually ended up awarding five scholarship winners, three of the full scholar, scholarship cross winners, and then we actually started two new sub winners, which are the what we're calling our rising stars, which actually got $5,000 scholarship towards their tuition and, and fees, they might be paying towards PT school.



That's amazing. And how many people applied for the crest scholarship?



Yeah, you know, Karen, you know, all about startups right in that first, first year, you kind of are working out the kinks, you're trying to figure out the right processes to have in place. And we had a fairly short window of about 60 days, 45 to 60 days that we opened up the application process this year, for our first cohort of crest winners. And our goal was to get 20 applicants. And after a social media polish and the PR, including, you know, me talking on a few podcast, we actually got 40 applicants which I was so so thrilled about. So we doubled the number that we wanted, then, obviously through that process, it's was so great that we couldn't actually just narrow down to three. So we actually awarded five scholarships and I I just wanted to give a shout out to the amazing scholars that did winner that are part of this first first cohort we had three winners from Northwestern University, Ruth Morales Flores is actually a second year students. Ricky Loki, who is a first year in Jackie Hua, who was a first year as well, just phenomenal, phenomenal students. And Alicia lead from Washington, St. Louis University and Tyrrel McGee, from Regis University. So a really broad spectrum of really interesting and thoughtful students who I know are going to make huge impact on the industry moving forward.



And you know, you had mentioned that part of the application process was interviews. So a lot you had the members of the committee interviewing 10 Different students and you're reading through 40 different essays. So what did you learn about the PT education system through hearing from all of these applicants and the eventual winners of the scholarship program?



Well, for First and foremost, as I mentioned, one of the goals and the mission of rising tide is all about improving the diversity of the workforce within our industry. And so, obviously, you know, the number of students that have been accepted to PT school in order to really receive this scholarship and qualify for the scholarship has to be people of color. And so the fact that we were able to get the number of scholarships applications that we did, in such a short period of time, was amazing to me. And, and I attribute a lot of that to the physical therapy, schools really putting diversity as a high priority in terms of their recruiting process of really also trying to change the face of who we are, and to become less homogenous, and more reflective of the society in which we live in. And so that was a real, I want to say, eye opener, but but pleasant surprise, that, you know, despite the fact that we haven't seen the numbers change, that it is something that is a huge priority, and is now after a few years of changing processes, and changing how the recruiting, where they're recruiting from and how they're actually going through the actual student selection process. For example, there are many schools now that are either eliminating, or D prioritizing SAP scores as an entry component, or GRE scores as it goes into graduate school, as a as a component of the process, and putting a higher priority on interview and essays and other things and more more, I guess, tangible areas of interest as they go through the, the selection process for their incoming classes. And so that was a that was really positive for me to really hear that. But it more than that, it was the passion that the students had for the industry. You know, I don't think much has changed in terms of why people get interested in the PT field, most of them had had experiences, whether it was personal or with family members, that really sparked that inspiration to to go into the PT field. Some of the other things that were just amazing about these students is almost every single one of them were working full time jobs, at the same time as going through PT school, some of them more than one job. We heard stories of, you know, students who basically had to decide whether they were going to pay for food, or pay for a book. And so the determination and just the sheer passion around why the and what they're able to do in order to accomplish their goals, was just astounding. And I don't know that, you know, most people understand the sort of path that, you know, underserved populations sometimes have to take in order to accomplish those goals.



Yeah, that's amazing. What a great group that you you got to meet. Now, after talking with these students, aside from the fact that hey, schools are kind of changing the weight of inclusion criteria, what further changes do you think need to be made within the industry? And on that, we'll take a quick break to hear from our sponsor, and be right back with Heidi's answer. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic win. They will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration. Head over to net forward slash li tz y to sign up for your complimentary marketing Audit?



Well, we know as, as we you, you started talking about in the beginning of the show is the student debt ratio that pte students are coming out with post graduation. We've seen that time and time again, in our state of rehab therapy industry report, as we surveyed, you know, 1000s, of therapist to understand their biggest woes, as they are navigating through this profession. And, you know, I, there's a huge segment of of the folks that answered that survey that have more than $150,000 of debt post graduation. And that was a 5% increase over what we found those numbers to be in 2018. So just in a few years, that number has grown significantly. And so that's to me, it's just not sustainable. When you compare what the compensation is, for an average, you know, new grad, being somewhere between depending on the type of PT services that you're delivering anywhere from 60 to 90 grand. That's just not commensurate to be able to be able to live and then pay off that debt, which you know, $150,000 in PT school usually means on top of another 100 grand at minimum that you you've accumulated through undergrad. So we're talking a huge, tremendous amount of debt. And so what I know is also happening is looking at shortening the timeframe in which it takes to get a doctorate degree, there are universities and colleges like South College, that are changing the way we think they're trying to change the way we think about PT school, where it doesn't have to be 100% in person that, you know, a large portion of the time spent can be done online. So that cuts down significant amount of debt in terms of having to pay for housing and other things. And it just becomes more accessible to more people, and decreases the cost of the overall educational process. So I really think that the cost of education, rethinking how we do the curriculum, of what truly is necessary to be in person are things that that really need to be looked



  1. Yeah, and when we talk about that sheer amount of, of debt, when I speak about that to other people, I always preface like, you know, like you said, Pts are coming out of school 50 to $90,000. It's not like we work at Goldman Sachs, where in two years you get like $500,000 Bonus, do you know what I mean? And and why law paid off? Right? So it's a little bit different PTS are not usually getting a $500,000 bonus. May I don't want to, I don't want to get yelled at by people on the internet. But I'm pretty sure that doesn't happen often.



No, I don't think that happens very often. As a matter of fact, I think, you know, especially in the times that we're in right now, you know, the the 5%. Five to maybe 10% increase year over year is probably what's on average. So, you know, it's gonna take you a while, especially if you're you're starting out as a new grad in that maybe 60 to 70 range to even get to the, you know, the six digit. Right. And so, yeah, it takes a lot to try to balance the price of education to what we actually are getting paid as, as clinicians.



Yeah. And and if there's a really great book, Heidi, I don't know if you've ever heard of heard of this book, but it's called Higher Education question mark. And it's by Andrew hacker and Claudia Dreyfus. And they talk about the cost of higher education. And what are some of the extraneous things happening on college campuses that aren't going directly to the education of the students, but yet is being reflected in the price of admission. So if people want to learn more about that, I would highly suggest reading that book.



Yeah, absolutely. There's a lot of debate happening right now around higher education and the need for it. You know, I know even within our own profession, there's a lot of question marks around the DPT on whether it was worth it or not. But at the end of the day, we are here we are At level professionals, but we do need to figure out if we are going to continue to grow and have an attract the top talent that we want to continue to have our profession, you know, be recognized as adding, you know, tremendous value to the overall healthcare system. We definitely want to, you know, remain viable and relook and relook at how perhaps we're doing some of the things because I just don't think that the way the path that we're on today is truly sustainable.



Yeah, I agree with that. And now, let's say you're a student out there, or you're going into residency, how can they get more information to apply for upcoming scholarships? And is there are there any scholarship applications that are due soon?



Yes, I mentioned we have the crest scholars, but we also have the search Scholarship Program, which is for residency programs. And that current application process is open right now. And so it will be closing on January 14. So if you are a current resident residency program participant, and would like to apply for the surge scholarship, and you are a person of color, you can apply at res rising dash If you go to search scholarship on there and just hit the Apply button, it will take you right to the page in which you can fill out all of the information, upload any documentation that we're requiring. And then we will definitely take a look at the application and put you into the process.



Yeah, so that means if you're listening to that, listening to this podcast today, on the 10th, you have until the end of this week, so get on it if you want money to help you get through your residency, so you've got like you've got five days, so get on it.



And this is an annual annual renewal process. So we will launch a new cohort every year. So if you miss out this year, but you're going through your residency programs, this year, you will get another chance at the end of this year to apply for the scholarship. And definitely any students out there who might be listening or interested in the field of PT, and you are going to be a new grad in this upcoming year of 2022. Or I'm sorry, a new student to PT school this year. And please, please, please think about offsetting some of that student debt through a scholarship program like rising tide.



Excellent. And now what's new with the foundation? What do you have coming up aside from these amazing scholarship opportunities,



while being part of rising tide means you're part of our community. And so one of the really awesome things that we are going to we are doing with our cohort is getting them together annually for sort of rising tide retreat in which we're going to have thought leaders from the industry come together to help be mentors to these students. Each cohort will be building on itself. So as we have this first group of 2021 Slash 2022 go through this year, they will then come back and be be mentors to our next cohort of students that will be coming through so part of the sort of surge and crafts together where you've got, you know, physical therapists going through residency programs will help to be mentors to these up and coming students. And so creating this community of connection, and education is really what we're planning through 2022.



I see what you did there. I like it, I like it. And now let's say you're a physical therapist like me, and you're like, wow, I am loving this rising tide. How can I can I donate to this? Can I be a part of this? What can I do?



Yeah, that's a great question. Karen and I, since launching this this past year in 2021, I just been so honored by the amount of outpouring of support that people have wanted to give to this program, including financial. I mentioned that it was self funded. And you know, We've had many, many years of scholarships that are going to be awarded. But with this outpouring of support of people who wanted to donate financially, I, I went ahead and change the 501 C three status to allow me to have donations. And so in March of 2022, we will be opening up the rising tide foundation to people who want to donate. And my hope is to actually double the number of scholarships that we're going to be able to award in 2022, that we we were able to do in 2021. And so if we can continue to do that every year, so that would mean we would award 10 scholarships in 2022, rather than five for at least the cross scholarship and then four of the search scholars, I think that would be absolutely amazing. And as you can imagine, if we did that year over year, we would be funding almost every PT student in let's say, 20 years.



Exactly. Hey, that's that big blue sky dream, right? The be hag? Yes, yes, the big big dream. And and, and it's a great dream to help future physical therapists not be saddled with the amount of student debt that a lot of students over the past couple of years have, unfortunately, had to deal with. So I think it's a wonderful foundation. And I applaud you for taking the initiative to putting this out into the world. And again, where can people find Oh, you said it a couple times, and we will have a link to it in the show notes. But where can people find more about the scholarship and about rising tide?



Yep, it's www dot rising with a Z r i v i n g dash And I'm sure many of you have heard the saying rising, a rising tide raises all boats. And that's really where it came from. It's something that has that thing has really meant a lot to me, in how I perform as a leader, and what I sort of prescribed to as sort of my own personal culture of wanting to help people. And so that's where sort of the name sort of stems from. But yeah, go to rising And you can learn all about our foundation and scholarship program, you can sign up for our blog subscription, we have a monthly vlogs, coming out about all kinds of things that has to do with how students can improve sort of how they think about becoming a physical therapist, too, just thought provoking ideas as we go about wanting to sort of change the face of the PC profession.



Perfect. And I'll also add that you're also on Instagram, and on Twitter. So if you go to the website, you can go down to the bottom and click on the little icons, and you can follow rising tide on Instagram and Twitter and LinkedIn as well. That's right. Yeah, perfect. All right. Well, Heidi, as we start to wrap things up, I know, I asked you this before, so you're gonna have to think of something new. What's another piece of advice you would give to your younger self?



Well, I would just say be open minded to a path that you may not have thought that you might go down, go down. I will just say that, you know, starting a nonprofit, and a scholarship program was really not on on my radar. And as things have unfolded, just like starting in that entrepreneurial mindset, like it works in your professional life, as I'm sorry, it works in your personal life, as well as your professional life in terms of finding problems that need to be solved and figuring out a way to do that. And so stay staying really open minded to things that come your way that may not be necessarily what you think, or had planned to do. To find ways to just try to try new things and be open minded to those options and they can take you down path of trim adding tremendous value and to others but also just in, in in to yourself as well.



Yeah, excellent advice. keep your mind open. And if something aligns with with your vision and values, then go for it. Great advice. Heidi, thank you so much for coming on to the podcast today talking about rising tide. And again, if you're going to mention this one more time, if you're going into your residency program, check out rising tide, check out the website. We mentioned it several times, also in the show notes at podcast at healthy, wealthy, smart, calm and apply, because you've got a couple of days if you're listening to this on the 10th of January 2022. You've got until the 14th to apply for the surge scholarship. Is that That's right, right.



That's right. Okay. Well, you got until the 14th until the midnight of the 14th and mentioned that you heard it on rising tide or on the healthy wealthy podcast. And we'll just move you to the top of the stack.



Yes. So So do it. People get on it be a part of the rising tide. Heidi, thank you so much for coming on.



Karen, it's always a pleasure. Thank you so much. Yeah,



of course. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Dr. Heidi Jenga for coming on the podcast to discuss the rising tide foundation and of course, thank you to Net Health. So again, they have a new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net forward slash li te zy to sign up for your complimentary marketing audit to get your clinics online visibility, reputation and referrals increasing in 2022



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


Dec 30, 2021

In this episode physical therapist and podcast cohost, Dr. Jenna Kantor talks about the highs, the lows, and everything in-between from the past year. 

We talk about: 

  • The effects of Covid-19 on life and the practice of physical therapy 
  • Online bullying in the physical therapy world 
  • Realizing the importance of friendship 
  • The mental shifts we experienced over the past year 
  • What we are looking forward to in 2022
  • And much more! 


More about Dr. Jenna Kantor: 

Headshot Dr. Jenna Kantor Jenna 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.

​Jenna Kantor currently holds the position of the NYPTA Social Media Committee, APTA PPS Key Contact, and NYPTA Legislative Task Force. She provides complimentary, regularly online content that advocates for the physical therapy profession. Jenna runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online course for performing artists called Powerful Performer that will launch late 2019.

To learn more, follow Jenna at: 





Fairytale Physical Therapy


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Read the Full Transcript Here


Hey. Hey, Jenna, welcome back to the podcast for our annual year and Roundup, if you will. And I want to thank you for being a great addition to the podcast and for pumping out really amazing podcast episodes, you're great hosts, the energy is fantastic. And the podcast episodes are always great. So I want to thank you for that.



Oh, my God, you're so sweet. I like I was definitely not as much of a podcaster this year, I acknowledge that. But hey, listen, we've all been adjusting this year to pandemic and now pandemics still happening, but also recovery. And I'm just grateful to still be a part of this podcast in any manner to be in this interview right now. Because I really, you and I are very much on the same page regarding remaining evidence based and speaking to people that we respect in this industry, and also people that we want to see just rise and have great success. So I'm just grateful to be honestly, I am humbled to still be in the room here with you.



Thank you. That's so nice. So kind. Now, let's talk about this past year. So 2021, obviously dominated by the ups and downs of COVID, which is still going on as we speak. We're we're both in the northeast, so we're experiencing an incredibly high surge at the moment. So COVID is obviously a big story. And I think part of the COVID journey that isn't being talked about as much. But I think general public, certainly the mainstream media, are people now living with long COVID. It is just something that seems to be skimmed over. And we know that at least at least the bare minimum is 10% of people diagnosed with COVID will go on to have symptoms of long COVID. And instead of some of the studies that I have read recently, those percentages are much, much higher. So what I guess, what is your take on all of that? And what do you think we as physical therapists can do to keep this in the in the forefront of people's minds.



We discussed this before, but I think there's going to be bias within this. So I want to acknowledge that we all have our biases. That being said, I think we need to first acknowledge there was a phase where there was a part of the world that did not think COVID was real. So based on the research that is out there, and personal experience of a lot of people getting it, as well as personal friends very close personal friends working in hospitals in New York, specifically COVID is real. So I want to say that first. I'm not going to differ from that I really wish there I'm I think we're past that in the world. I think there was never a clear cut of like, Oh, I got it, I see that it's real. I was wrong. I would have liked that moment, because that hurt people in the process. But I just want to say that first. So COVID is real. Okay. Now, let's not belittle it. And I think in regards to the patient care. I think this, the reality of long COVID needs to be just as respected. Just like when you have a patient that comes in the door and says they're in pain, and you don't believe them. We need to stop that. So we need to believe them and their symptoms, and what they have and what it's from and treat it accordingly. Because if we go in the door to help out these individuals who are struggling with this, they're not going to get better. What are your thoughts?



No, I agree. I agree. And I've heard from people living with long COVID that people don't believe them even their own family members, people in who work in medicine, they don't believe them. So I think that's a huge takeaway that if as clinicians we can do one thing sit down Listen, believe because the symptoms that they're having are real. We did a couple of episodes on long COVID thing was back in August and spoke with three amazing therapists and they're all involved with long COVID physios so if anyone out there wants more information on living with long COVID I would definitely steer you to long COVID physio on Twitter and and their website as well. Because they're a wealth of knowledge. These are people living with long COVID their allies, they are researchers and I think they're putting out some amazing information that can help not just you as the clinician, but if you know someone that maybe you're not doing directly treating maybe it's a family member living with long COVID I think the more information you have, the more power you can kind of take back to yourself.



I love that. I love that. It's the biopsychosocial model. I mean to that I from working because I work specifically more with performers, the psychosocial component, my my patients, my people I call my people, my people would not be getting the results they're getting if I didn't have to deal with that, with them standing by their side, holding their hands helping them through and out of their pain. There's symptoms every day and this that goes for anything.



Yeah. And and we now know, speaking of performers that a lot of Broadway shows are being sort of cancelled, and then restarted and canceled and restarted because of COVID outbreaks within the cast. So this may be something people might think, Oh, I work with performers. I don't have to worry about long COVID Well, maybe you do.



Yeah. Yeah. And for them, it's the, from the performance that I'm in contact with on Broadway that, you know, it's I'm, I'm, I'm very connected. I've been in the musical theater industry for a very long time. So for the people who are on Broadway, the individuals I spoken to, they're doing okay, which I'm really, really grateful for. It is a requirement for the performers to be triple vaccinated, and now they're getting triple vaccinated. I know one performer on Broadway, who was about to get her booster shot, and then ended up getting COVID, which was quite unfortunate. She's doing okay, though. Grateful, no signs of long COVID Right now, but for the performers, you're talking about dance, there's endurance and breathing that is necessary. If the singers even if they're, they're not dancing, they still dance, they're still asked to do things, they still have out of breath, emotional moments, were breathing is challenged. So I'm just bringing up one component with long COVID. But that's, that's a big standout for performers specifically, that need, it needs to be kept out for them. I remember one time during, oh, goodness, during 2020. And it was the latter portion of the year. And I was doing virtual readings with performers. That's how I was staying connected with my my friends and people in the industry. And it was our way of being creative. In the meantime, while we're waiting for things to open back up. And one individual is she what I just cast her to read as the lead in the show, and she was so good. It was my first time hearing her perform first time meeting her. She was Outstanding, outstanding. And at the end of it, we were going around checking in with each other how we were doing and she started to cry and opened up about losses and her family due to COVID. And that she didn't think she would be able to sing like that again, because she had been dealing with her breathing problems for so long. And so then we all get emotional with her. I'm getting emotional just thinking about it. So yeah, it's it's a it's a real thing. We didn't have the vaccination then. So I'm interested to see statistically where we are at with long COVID with having the antibodies in our systems. Obviously, everybody is different, but I'm hoping that there's less of it because of the vaccine.



Yeah, time will tell right? Yeah, we have we need those data points. So aside from obviously COVID being, I think the biggest story of the year, certainly within healthcare and even within our field of physical therapy. What else have you seen over 2021? Or maybe it was in an interview you did or a paper you read that really stuck out for you as as a big part of the year you know, it made it's made it it made its mark for you.



Oh, I'm going to focus just on the PT community. And I want to emphasize with community I see our community at really, we've always butted heads there's always things that we butted heads on. But I'll just give the instance that really made me go whoa, I was in a room with a bunch of intelligent wonderful human beings and discussing something I said a term that I thought was really common especially because in the musical theatre industry. We are fighting for dei diversity, equity inclusion all the time. Like if this is a topic of conversation all the time. It is a huge thing in regards to casting what is visually out there the most at like the highest level and, and bipoc the phrase bipoc was unrecognized by a good portion of physical therapists in this room and I was disappointed Did I was it said so much it doesn't. It's not saying that a person is evil for not knowing no. And that is not my point. But it is a problem that it's not being discussed to the level where these common extremely common thing phrases are not just known. That just says a lot to me, because it's in regards to people getting in the door access and being reached, in lesser, lesser affluent areas, that to me, it shows that it's not being discussed, it's not being addressed. If it was, then bipoc would be, and this is just one instance. But I thought that was very eye opening. Because it's just like saying, I'm going to eat today, someone saying, I'm not going what you're not eating, I don't know. And that was a bad example. But just something that is or you wake up you breathe, that is how known the phrase bipoc. Same thing with LGBTQIA. Plus, in my community, like, for me to go into another room and for things to need to be defined. I know we all have different worlds. But I think as physical therapists, there, there's a disconnect, unfortunately, depending on wherever we are from, and we need to fix that. Because I can't live everywhere. I can't treat everyone in the world, I can't treat all the performers in the world, I don't want to I like having my niche practice and treating select individuals, and boom, my people do very well. And if it gets to a point that it starts to grow, I'm going to be passing them along because I don't want I don't want that I don't want it to be huge like that. And with that in mind, I need more people who know and therefore are our allies. To me, it's a lack of ally ship, of just not knowing the basic language. And I and I apologize to anyone who's listening on my intention is not to sound like a white savior at all. It's not. But with my limited knowledge at this point, I'm already seeing something that is really, really lacking amongst each other and we need to fix it. I don't know if it's books or I don't know, I don't I don't know the answer to that. But I'm just addressing that was that was the biggest standout thing for me this year.



And it for those of you who maybe are not familiar with the American Physical Therapy Association, they have what's called House of Delegates. So they had a meeting in September of this year during the APTA centennial celebration. And in that they did pass a resolution that the APTA would be an anti racist organization. Now, were you in the room when that passed? Jenna?



No, I was not in the room, I was actually there at the House of Delegates a bit discouraged this year, I know. i The fact that they were able to figure out any manner to put it on is is a feat to be had after 2020 20. However, the in person when you go and if you are not a delegate, which I was not this year, you can usually sit in the room, and just be in the back and listen, because the because of the space that they got in the way it was set up, there were chairs in the back of the room, but there weren't that many and it filled up. So they already preemptively set up another room where you could watch what was happening on a TV, which did not sit well with me. Because I could have stayed home instead of flying in for that. So I was definitely not in the room. I definitely was less present this year. Because of that I was I was bitter, I was bitter. I was bitter. I felt like I I already know you it's through elected and know who you know, to become a delegate, but I really felt disrespected and unimportant. Being in a separate room, watching from a TV rather than actually getting to be in the room because there are ways that they hold the meeting where you can stand up to say a point of order to speak on some points from the from the back of the room. And I just wasn't even going to wait to see how they figured that out. I just felt like not a not an important voice. So I wasn't present for that. But I do know about that. I think it's wonderful to get that on the docket. But the same thing when we voted in dei unanimously. How?



What comes next? You mean? Yeah, well, yeah.



What is the game plan? Because for me, I can say a sentence like that. But then what are the actual actions and that's where it's like, is that going to happen? Two years down the road three years. What are we at what are we actually doing? What are the measuring points and take action? and not meetings on it, not being hesitant on making mistakes. Let's make mistakes. Let's just go for it. That's the only way we're gonna learn. There's no such thing as a graceful change, no matter how hard you try,



right? Yeah, yeah, I agree. I think like you said, what comes next is? Well, I guess we'll have to wait and see what are the action steps they're going to take in order to create that and, and live up to the, the words of being an anti racist organization? Because it was passed overwhelmingly.



Right? And then I'm sure they applauded for it, you know, like, this is great. But to me, I think it's, I it's just like, okay, you know, like, what, but now what? Because from DJI and the I heard that they're trying in the battle in this behind the scenes, trying to move forward, but I have not seen action there. And maybe I'm missing something, you know, feel free to call me out Call me whatever. Like, I'm, I would love to be wrong.



Yeah, these big organizations are slow ships to steer. That's not any excuse whatsoever. But I understand there's a lot of layers that one has to go through to make things happen. As you know, you've been volunteering for the APTA for a long time. So you understand that, but I think a lot of people who don't don't, so that's why I just wanted to kind of bring that up and saying, like, yeah, it takes it takes a long effing time to get stuff done, you know?



Yeah. And I mean, you can hear it, I'm frustrated by I'm not, I'm not happy about it. And but it's, it's because of my friends, the conversations I have, and I, I'm, I'm lucky, I'm a sis white, stereotypical female. So like, the way the world has been made, and the way it caters to humans. It fits me, but it doesn't fit everyone and I'd like I can't imagine what it would be like to just be left out of a lot of things in everyday life. I think that's horrible.



Yeah, agreed. What else? What else do you think was a big something that you saw within the profession? Or even trends in health and fitness that might have really changed over this past year? For better or for worse? I can think of one I think and this is just my opinion that the the communication via social media has gotten a little too aggressive. Is that a nice way of saying it? Like I don't understand it, I don't get it. I took like a little break because I was Oh, can't say I was bullied because I feel like bullying. It's that sort of like you know someone is having like a sustained go at you. So I don't know



it's bullying is bullying. Yeah, bullying is bullying. That's the thing is that we have a lot of bullying that happens but then they gaslight you about their bullying. It's like Whoa, it's next. It's almost like a strategy. Like they're playing a game of Monopoly, and they have down how to win. Like, yeah, people barely there is a lot of bullying.



Yeah, a lot of bullying. A lot of threatening, like, I get like threatening DMS or people threatening me, you know, on their Instagram stories or whatever. For I can't imagine I look back at that interactions. And I'm like, I don't get it.



Yeah, I don't get it. Yeah.



So I and my first reaction was to like, when people will do this and be so aggressive as to send like a Taylor Swift GIF. Of her song, you need to calm down. And then I have to take a step back and be like, that's not gonna help the situation any. Right, right. Right. Don't do it. I just sort of back off. But I think because of that, bullying or threatening behavior, I've



really like I'll say it bullying continue. I've,



I've just like, for the past couple of months, I've really taken a backseat to any kind of social media just to like, give myself like a mental health break, you know, like meeting I don't comment on things. I might post some things here and there, but I don't really make any comments, unless it's to. And that's mainly and I'm going to say this because from what I can tell it's true, is it happens to be men in the profession who are a little more aggressive than the women, like women can seem to have a bit of a nicer conversation around whether it's a question or, you know, something, but when a lot of the men it's just become so like ego driven, that there's no resolution, and it's just mean. Mm hmm. And so I was like I need to take a break. So I saw a lot more of that this year. I don't know if it's because of lockdowns and because of a heightened sense of what's the word? Stress to begin with? And then yeah, or something else on top of it? I don't know. But I, I saw that this year, definitely for the worse, because I just think, gosh, if people outside the profession are looking in and watching these exchanges, what are they thinking?



Yeah, yeah, I've definitely seen it in sis males specifically.



Yeah, yeah.



I'm not it honestly. doesn't it's not a specific color of skin. But specifically sis males.



Yeah, I would I would agree with that. Yeah.



I have. I have experienced a little not not to the level, but I've definitely experienced that. And it's for 2021. And it's not okay. No, it's not okay. However, I ever look at it as a blessing. And this is where I get I love looking at it like this. Yes, please, please, thank you. Thank you for identifying that you have no space in my room, my shelf my space at all. I will not take advice from you in the future. And I will not heed any, any value to what you have to say, because of your willingness to chop me down. Thank you for identifying yourself. I'm now in the debate of blocking you from my mental health. And that's it. And that includes in person. That's it. That's it. And I really don't look as blocking as like, wow, for me, I'm going like, No, I don't want to know you. I don't want to know you. And my life is so much better because of it when I was at the PPS conference, because of just going No to the to the people I don't want to know and just saying like, just straight up like I like I don't need you, I don't need you. I want to be a service to people who need physical therapy period. So people are going to just, you know, find ways of you know, and spend their time writing some angry thing. Have that that's on them that's on them. Like I'm like, like, and if it and honestly I will likely block you.



I love that I love like you're you're it's not just that you're blocking the person. You're blocking the energy blocking the energy they're bringing into you and draining you down. So then you're not at your best well, or with your friends or loved ones patients, even with yourself. Yeah, you know, if you have to ruminate on these people. I love that. Yeah, it's not it's not just blocking you from social media, it's blocking the energy that you the the bad vibes, if you will, that you're Brown. And that affects you that affects your mental health that affects you emotionally. And it can carry through to a lot of other parts of your life and who needs that? Yeah,



and, and for anybody who's trying to saying like, I can a bully did it or like it. Okay, let's, let's look at it this way, when you're messaging an individual something, first of all, we all know this. When you write in text, everybody's going to interpret it with different tone. So as soon as you write in text, we all know this, and we're taking advantage of that fact. So that way, you can later go, oh, I said it in a nice tone, Bs when you're typing it, it can be in whatever freakin tone and you know what you're doing. Also, when you're not talking to a person, the only time you show up is to say something negative. Yeah, that's you're not your voice is not important. And you know, your voice isn't important.



It's so true. What I've actually seen is a lot of these, these kinds of people, they're not getting the attention they used to get. Mm hmm. Do you know cuz I think more people are of the mindset of like, I don't need this anymore. Like this was maybe this was funny. Maybe this was cute a couple years ago. Ah, not anymore.



And also I love I don't like having down moments, but we all have our down moments in our career and in our life. But I what I do love about the down moments in the career in life, the people who are around at that time, those are your friends, those are the people you want to know. So I love my moments in the PT world. When I'm in a down moment because the people who want to talk to me then those are the people I want to know. Whereas when I'm you know, can candidate for the private practice section, you know, which is awesome. And then people want to actually talk to me then. Oh, wait, I'm gonna wait and see when you know, I'm not that. Am I still someone you want to speak to? That is those are the people I want to invest time in. Those are the people I want to invest time in. I want to see you you do well and vice versa. I want to be able to get to know you as a human more and more and more. I just want the children Relationships, it doesn't mean I'm going to have time or you know, we're gonna have time to talk every day. But I want those true relationships. So for me, those downtimes, when I might not look the most graceful, I might be messing up or maybe not messing up. Maybe I'm actually making a change here speaking on something or getting people to think differently ever thought of that, you know? Awesome. Like, are you gonna be here to chop me down? Or just be here to have a conversation and having a conversation? Set up a phone call? If you really care? Like if you really could you don't? People don't care that Oh, reaching out, they don't care about you cannot be when they're reaching out to give feedback. Let's have a comfort. No, they just want to get into an attack mode. No, we No, no, don't try to decorate it. We know that's what's happening. And yeah, that were to town. There's enough going on.



Yeah, there's enough going on. And you know, this conversation really made me reflect on the past year, and I think what's been a good thing has been the deepening of good relationships. So like, nobody has time for that other, like bad stuff anymore. Like there's enough bad stuff happening. I don't have time for that. But what you do have time for is the relationships that are two sided, you know, a nice bilateral relationship that you're willing to invest in, and allow that relationship to come deeper and grow. And I feel like, you know, and like, you don't have to be friends with 1000 people, you know, you can be friends with a handful you can be friends with one person. And if that person, it's it's real and deep and meaningful, then isn't that wonderful? And I think years ago, I used to think, oh, the more



people you know, the better. Me too. Me too.



And now I think because of the upheaval of the last couple of years now, I'm really finding like, you know, I need like couple of good people that I can count on to have my back to, like you said, lift you up when you need to, and maybe to like, give you the honest truth when you need it as well. Right? Exactly. So I've been really, really happy that over the past year, I've made some really nice deeper connections with people than the physical therapy World Sports Medicine world. And I'm really, really happy about that. So I think that's been a real positive for me,



I totally agree with you, I mean, that our relationship is naturally growing over time, which I appreciate and, and I really do I completely on the same page completely on the same page. And and for me, when I go to conferences, like I'm really isolating more and more, who are the two are the people that like I must spend time with? And and then if other people want to join sure, you know, absolutely. But I I'm not overwhelming myself, oh, I need to be friends with that. No, I don't need to. And you know what, like, that became very apparent when I seen people speak, even at PPS, where the goodness, they were showing slideshows with their friends, and it was like, literally all people who are elected in the higher positions are all best friends with each other. It is it's true, you can't deny it. If you're up there. If you're one of those people. It's true. And you know what, I look at it like this, my friends may go up there to that, mate. That's not why I'm friends with you, though, you know, in friendship through because I like you as a person. So I'm gonna let that lay and not even explain and go into more depth and let people interpret that how they want and the right people will stay in



my life. Exactly. So what are they? What are they? Let's, let's sort of wrap this up on a positive note. What are their positive things came to you this year, whether it be professionally, personally,



oh, I think being more comfortable in my skin at conferences. So I had the I mean, absolute honor. Like I was really overwhelmed with happiness at the private practice conference this year. It was just so cool to be nominated. And I felt so much more comfortable in my own skin going up there. I you know, there there are a couple naysayers not realizing there'll be naysayers that, you know that I had to deal with but going up and it was a small moment. But we had you have this rehearsal. I don't know if it's done the same way. For the nominees where they go, you practice when your name is called going behind the podium and then walking down the stairs so you know what to do when you're asked to go out there and give your speech. And I went out there and I did a great vine to my spot. And I mean, I was so happy I did that because I was feeling it and that's what I would do. I did a great fine. And I know that silly, nobody else paid attention to me honestly probably knew that I was doing it. And some were probably like, Oh, but I didn't care. I was like I am on this freakin stage right now, this is the coolest thing. And to be at that place of like more self acceptance, because I know I don't have the stereotypical personality and energy, you know, that that is normally accepted amongst the vast community. So to be more me in that moment, I felt very proud. I felt very proud of myself. And that was really cool. I'm really, really happy about that. And then I like Dan, you know, sat down and ate some more bacon, it was great.



Well, and you know, being comfortable in your own skin that then comes across to the people who are in front of you. So when the speech actually came about, I'm sure people picked up on that picked up on the fact that you're now more comfortable in your skin that you're more comfortable, perhaps as a physical therapist, and because you found you're not that you've, you've already had this niche, but you sort of found your niche. You know, what, you what you're in the physical therapy world to do. Does that make sense? Yeah, yeah. Yeah.



Absolutely. Absolutely. And I got a little bit picked on for being too perfect with my speech and everything. And I was like, I you know, in reflection on that, I was like, they just haven't fully accepted my energy. That's okay. Don't get there. Okay. That's it. Don't get there. I'm like, I'm a performer. So it's gonna happen. You know, do you want to join a British company dialect? That's,



that's a weird comment. That's a weird criticism. Yeah, but yeah, you know,



but I felt I felt I felt like I had to reflect to go No, I actually felt really good, because I've definitely put it on before. No, I practiced it to be to deliver it. Me as me. And now it's so fun. So fun. Oh, my God. Yeah, I was just that that was a big, positive. Awesome, awesome feeling. I work with so many people who are in the PT industry, who want to be dance physical therapist or physical therapist assistants and imposter syndrome is super real. And so I like that I'm practicing what I preach and self love. And and it's awesome. How are you doing all that this year?



I'm better. I mean, imposter syndrome, I think, for me is always there, like always kind of underlying the surface, if you will. But I think that's pretty normal. You know, the more and more I listen, or I read about, like, these famous people who are up on stages and in movies, and you know, people who think oh, they have no, they must be like, amazing. And no, they it's the same thing. So I think for me, accepting that it's normal has actually helped decrease it a little bit. Instead of feeling like, oh, boy, everyone else here is like, amazing. And I'm like the loser trying to keep up. And then I think, no, that's pretty normal, because I think everyone else feels that way as well. Yes. And then once once I was able to accept that it makes going up on stage, like, I don't get as nervous as I used to, and it's been. It's been much, much better for me even speaking. Like I was joking, I could say I now I shared the stage with FLOTUS, because at the future physical therapy summit, I spoke for literally a minute and 45 seconds as a spokesperson for the brand Waterpik. So Waterpik has these wonderful showerheads. And they sponsored the future physical therapy Summit in Washington, DC back in September. And so the sponsors got to go up and say a little something. So you have literally less than two minutes, and I had to get all their talking points in. But I also like, decided to make it funny. So I was just saying things off the cuff. And afterwards, everyone's like, that was a great bit. I love that bit about your parents. I'm like, I didn't think of it as a bit. But okay. But then the good news was afterwards, people came up to the table, the Waterpik table, you know, in the, in the hall area, and like the one guy was like, I wasn't gonna come up, but then after that talk, I had to come up and see what you guys are all about. I needed to find out what you were doing and hey, can you do this? And so, for me, I felt as nervous as I was to go up and speak be mainly because it wasn't about me, it was about Waterpik. So I wanted to do them proud, you know, and afterwards, they got so much great feedback and possible partnerships selling through clinics with 700 locations? And can we do a study with Waterpik? On wound care? Can we do a study with Waterpik on people living with CRPS and using these, like, and that's exactly what they were looking for. So that made me feel like much better and gave me a little bit more confidence. And it was also fun to be able to do such things kind of off the cuff. You know,



that's so cool. Yeah, I love that. You should definitely be proud. That's so cool.



So that was really fun. And then the next speaker, it was it. The next speaker a two speakers after me was the First Lady of the United States Dr. Joe Biden. So yeah, there you go. No big deal. No big deal. Yeah. FLOTUS. So that was really fun. And was that yeah, for me, I think that was a big highlight of of the year for me, I guess professionally, which was really cool. is cool. That is so cool. It was it was cool. Anything else that for you? Did we miss anything that you wanted to get in?



Yes. For the Yes, yes. Yes. Okay. I now live in Pittsburgh and and was visiting New York had a great time. I got to see Karen at one of my favorite salad places, although I didn't get my normal favorite salad, which now I'm in regret until I go back again, to get my favorite salad from Sweet greens. It's the kale salad. It's so good. Caesar kale salad. I highly recommend it if you're going and you want to save some money because I love to be cheap in New York. Okay. said that. Now I'm not sponsored by sweet green. I just love sweet green. Okay,



I know we're dropping. We're dropping a lot of like,



I know. Like suede. And also get Levine's cookies. Okay, yeah. When you go, I never have gone to the tourist areas. I avoid it. But I spent a lot of time in Times Square because I was going to see Broadway shows. And it's also one of the few Disney Stores that still is open. So I had to go in there. I got a wreath I didn't need but I needed you know, and Okay. Rockefeller Center. So I go there to meet Stephanie. Why rock as you and I didn't have enough time with your Stephanie. But while we were waiting, there's a whole show of lights. A GG know that you knew this that like it's with music and everything like Disney. I had no idea. What's the store that darkness said yes Avenue, Saks Fifth Avenue. And it's like castle and lighting. It was I was just joking. If you don't know, I love Disney. I love Disney so much. And this was a Disney experience. And I just we weren't waiting in the cold. I'm like, all bitter. You know, I just I'm not happy in the cold. So I'm like, and then the light show on Japan?



Yeah, it's spectacular. It was



so great. I had no idea and it goes up like every few minutes. It's quite regular. So if you like oh, we miss it. You're fine. Just wait a few minutes. It'll start again. i Oh, go see it. Go see it. Don't stand in Time Square for New Year's. But go see that that was such a wonderful, positive, beautiful moment. And, and just great. It was great. Also, there are a lot of great photographers in New York. So if you're visiting New York, and you want to get stuff for social media, that is the spot to get it. There are so many talented photographers you can get reasonable prices and and build your social media real fast. All right, that's it.



Perfect. Well, before we wrap up the year, where can people find you if they want more information about you in any of your programs? And also let us know what you have coming up in 2022?



Okay, well, most immediately, you're going to find me at Disney Land in February this year in 2022. Because I'm going to be there my birthday. If you go there on the 16th of February. Just let me know. And we'll like meet up with you. But no, I'm going to be eating junk food all day. So if you're expecting me to be held a healthy influence, I will not be alright. For me, I'm going to be continuing with my private practice, working with performers and continuing with helping people live their lives as dance PTS helping you on the business and treatment side with my dance PT program. But most importantly, because I'm always like I'm a performer and physical therapist. I'm doing all this work right now. I am getting back into performing which I'm really happy about so I'll be submitting a lot more which I'm just super stoked. I feel like all my work stuff is is being is much more easier to handle now I've got it down. And the systems are in place if you will get to audition more than I'll be a movie star just like that because it's so easy. It'll be great, but I'm really excited about that. What about you Karen?



Oh, that's exciting. Gosh, I'm not gonna be a movie star. Anything So what do I have coming up? Let's see, um, this past year I finished the Goldman Sachs 10,000 small business program, highly recommend anyone to apply to because it's really amazing. How many more plugs can we drop in this episode? And so I'm going to this year, I'm looking to hire another PT for my practice, right? Mm hmm. Which is very fun. Exactly, it grows, but



you're like, I'm not going to take all the patients. It's gross,



but time to bring on someone else. Right. And then continuing to work with just a couple of people. With business coaching, I like take four people at a time for me that I get it handle, it's good enough for me, I'm happy to do it. So that will open back up again. Maybe end of January of 2022. Because like you said, when you know what you can handle and you know that you can help the people who want to be helped, then it becomes so much easier. So now I feel like I've got this under control. I know how to split up my time and manage my time. And so I'm really looking forward to that in 2022 and we'll see what happens.



I love that. That's awesome. Yeah. Yeah, are so cool. I love what you do.



Where can people find you? Oh,



yeah, so I have the dance physical therapists Facebook group. So that's one specifically for PT so you will find me in their active conversations once talking about performing arts research all that stuff. You can find me at CSM Oh yeah, social media, dance physical therapists on Instagram. I am also musical theater doc on there. But I really associate people more regarding musical theater, not other pts. So dance physical therapist, is that and then on Facebook, Jenna cantor. And yeah, pretty much Jenna Cantor from Twitter and Jenna cantor. Yeah, your website. Jenna cancer, PT, calm.



Perfect. Perfect. Excellent. Well, Jenna, thank you so much for coming on and wrapping up 2022. And for all of your help and friendship throughout the year. I really appreciate it. And appreciate so



much. I have to just say that joke that keeps coming to my head every time you keep saying wrapping up. I feel like I should be wrapping a present. I just it's a stupid joke. But I just need to put that in there. Thank you. I said it.



Tis the season when in Rome, right? Yes. All right. Well, thank you again, so much. And everyone. Thank you so much. On behalf of myself and Jenna, for listening to the podcast all year and for supporting it. And you know if anyone has any suggestions on anyone they'd like either one of us to interview please let us know. You can find us on social media. I'm on Twitter at Karen Litzy. NYC and Instagram at Karen Litzy. You can email me Karen at Karen Litzy. Calm it couldn't be any easier. Or you can find me at Karen Litzy calm. We're super easy over here. So let us let us know if there's any topics or people that you're like man, I really want to hear from this person. We'll be more than happy to see if we can get it done. So thanks again. Everyone have a very, very happy new year and a healthy 2022 And of course stay healthy, wealthy and smart.

Dec 21, 2021

In this episode, Specialist Sports Physiotherapist, Morten Hoegh, talks about pain and injury management and research.

Today, Morten talks about his workshop on pain, the problems in the research around pain and injuries, and embracing the patient as the expert. What is nociplastic pain?

Hear about the injury versus pain narrative, treating the perception of injury during pain, the problem of over-treating pain, and get Morten’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “There is a difference between having an injury and being in pain.”
  • “You will have injury and pain on one end, but you will have pain without injury on the other end.”
  • “Just because we know something doesn’t mean we know everything.”
  • “Pain prevention is well-intentioned, sometimes unrealistic, and possibly unhelpful.”
  • “All pain is real. It’s always experienced as pain.”
  • “People who live their life with pain, they are experts.”
  • “We have different aspects and different competences, and we should bring them together.”
  • “We should definitely try and cure pain from the planet, but maybe not by opioids.”
  • “Things take time to cope with.”
  • “Make sure you stick to good ideas if you think they’re good, but also leave them if they’re not.”


More about Morten Hoegh

After qualifying as a clinical physiotherapist (1999) and completing several clinical exams, Morten was granted the title of specialist physiotherapist in musculoskeletal physiotherapy (2005) and sports physiotherapy (2006). It was not until 2010-12 he made an entry to academia when he joined the multidisciplinary Master-of-Science in Pain: Science & Society at King's College London (UK). From 2015-19 Morten did his PhD in Medicine/pain at Center for Neuroplasticity and Pain (CNAP), Aalborg University. He is now an assistant professor.

Having spent more than a decade as clinician, teacher, and business developer, he decided to focus on improving national and international pain education based on the International Association for the Study of Pain (IASP).

Morten was vice-chair of the European Pain Federation’s Educational Committee from 2018-20 and has been involved in the development of the Diploma in Pain Physiotherapy and underlying curriculum, as well as the curricula in nursing and psychology. At a national level, Morten has been appointed to several chairs and committees, including the Danish Medicine and Health Authorities and the Danish Council of Ethics.

He has co-authored a textbook on pain, and written several book chapters, clinical commentaries, and peer-reviewed basic science articles on pain and pain modulation. Morten’s first book on pain in layman’s terms will be published in January 2021.

Morten is regarded as a skilled and inspiring speaker, and he has been invited to present in Europe and on the American continent. He is also a prolific debater and advocate of evidence-based and patient-centred approaches to treatment in general. Morten is motivated by his desire to improve management of chronic pain, reduce stigmatisation of people with ‘invisible diseases’, and to bridge the gap between clinical practice and neuroscience research in relation to pain.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Neuroscience, Pain, Injury, Rehabilitation, Research, Experience, Treatment, Management,



#IOCprev2021 on Twitter.


To learn more, follow Morten at:



Twitter:            @MH_DK

Instagram:       @mhdk_drmortenhoegh

LinkedIn:         Morten Hoegh


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:      


Read the Full Transcript Here: 


Hi, Morten, welcome to the podcast. I'm very excited to have you on. So thanks so much. Thank you for having me, Karen. It's a pleasure to be here. Yeah. And today, we're going to talk about your really wonderful, wonderful workshop at the IOC conference in Monaco. That was just a couple of weeks ago. And you did a great workshop on pain, which is one of my passions.



But I would, I think



the best thing for us to do here is to just throw it over to you. And let you give a little background on the talk. And then we'll dive into the talk itself. So go ahead.



Thank you. And, you know, I'm really happy that you liked it. It was a great pleasure to present that the IRC was my first time there as well. A lovely place to be and very lovely people. And he really well organized conference as well. Well, back to the background. So the tool was, the workshop, as it were, was actually originally something I planned with Dr. Kieran or Sullivan, who is now in Ireland. Unfortunately, he couldn't come due to turn restrictions and all of that for COVID. So we had to change it slightly. But over the period of the last sort of year or so I've been working with colleagues at all university where I'm affiliated and test Denton and Steven George of Adelaide and, and to university respectively. And together with them, we sort of have written up this idea that there is a difference between having an injury and being in pain. And the reason we came about that was because we wanted to try and look into what is actually the sort of narrative definition of a sports injury. And and some one of my colleagues are actually two of my colleagues Kosta, Luke, and Sabine Avista. We're looking into this and trying to sort of find out what the consensus what they came up with, when they were looking at the last 10 years of of sports related research is that the same articles could use injury and pain for the same thing. So it was being used almost as well, not almost, but as sentiment synonymously throughout the program, or the manuscript, and others will stick to pain and others will stick to injury. But if you then try to go down into the methods and find out what is an injury, really, some would have definitions, but there weren't really anything. And definitely, there wasn't a clear distinction between when is the tissue injured. And when is the athlete suffering from pain that is keeping them from not doing what they want to do.



So we came up with this idea to write an editorial for the BDSM. We couldn't get it accepted as an editorial, we were under the impression that maybe the topic was a bit too narrow. So it really wouldn't have any impact. But we had a we had some some help from from



sorry, you can cut that bit out. I was just losing her name. Let me just get it here.



Oh, that's she was such a great help. I'm really sorry for not being able to I definitely think we should put her name in there.



Oh, here we go.



So we wanted to do the editorial first. But we were under the impression that we couldn't get the editorial through because the topic, you know, is probably a bit too narrow. But fortunately, Madeline Thorpe, who is working with TAs in Adelaide, she helped us create this infographic that sort of conveyed the message of the difference between what we call a sports related injury and a sports related pain. So after a few revisions, the BJs took it in as an infographic with a short text to describe what we mean. And and it's been. It's been, you know, quite well cited afterwards. So we're very happy with the the attention that this idea has got. And then of course, what we really are trying to do here is to create two new semantic entities as we say, Where where it's clear when we do research, but also when we talk to athletes, are you really injured? Is the tissue injury that needs healing and where you might need you know, specific treatment for that injury versus Are you having pain as a consequence of an injury or even without an injury, which is what we call sports related pain. So that's sort of the broader concept and and I hope I've I've done right with my co authors.



because they've Of course, been been a huge part of both the development and the writing of these, these, this infographic.



Yeah. And can we now sort of dive in a little bit deeper? So, injury versus pain? Right. I think a lot of people will think that every time you have an injury, there's pain. So used a really nice example in your talk. So does tendon tissue damage lead to pain? Yeah. But is the pain in the area of the tendon equal to damage to the tendon?



Maybe not. Yeah. Right. Oh, so yeah. So let's, let's have you kind of dive into this injury versus pain narrative. And if you want to go into those pain mechanisms that you spoke about, we can dive into that as well, because I know that that people had some questions on that on social media. So let's first talk injury versus pain. Yeah, again, my my perspective on this with my background, being a physio and, and sort of a neuroscientist is that I come from it, I would say from a pain, scientist pain mechanistic approach. And what I try to do is to understand what goes on in the human that could explain why they feel pain. And in some instances, and for instance, in low back pain, we we think, in about maybe 80 to 95% of the cases, we don't know what's going on. So we're pretty sure that the risks are mechanism, perhaps are quite complicated. One there has multiple factors that are interrelated, but there's probably something. So that's really difficult to study. Again, consider consider, you know, if you were tasked to, to come up with a, you know, a model where you could study this model would be, for instance, an animal model. So not that I would encourage people to go out and, you know, do bad things to other animals. But just, you know, for the sake of the example, let's imagine that you wanted to do an animal model of low back pain, or even a herniated sorry, a groin injury, you could say, in sports.



If you know, the most basic thing to do would be to create an injury. If you don't want to create an injury injury, what you could do is induce inflammation, you know, inject capsaicin, or put something under the skin or down into the tissues, and that makes your immune system go, you know, make inflammation. And that inflammation makes your nervous system respond more powerful. We call it sensitization, I think many people have heard of that word by now.



And that's a really good way to create that sensation of pain in humans as well. So we can inject capsaicin again, and people will usually feel pain.



In that case, that's what happens or that's how we understand what happens in the case of a tissue injury. So when there's a tissue injury, there's inflammation, and we understand that pain. So when the tissue hit healing period, is sort of crossing from what you could say, the inflammatory phase, into the prolific face, pain should go down. And in most cases, that's what happened. But what when the pain persists after the inflammatory phase. You know, from the science perspective, we don't know that. But we still know that this person is in pain. So whether that be an athlete or non athletes, they're still in pain. And in this in sort of the pain research world, we have a definition of pain that doesn't necessitate any type of injury, not even any activation of those, we call them nociceptors. But nociceptive system you could say.



So we acknowledge that people can have pain and not be Do not be damaged, not be injured, not have pathology. And that's sort of the idea that we are trying to bring into sports medicine as well, which has been over the you know, many last decades I've you know, I've been in in sports medicine or as a sports physio, for 20 odd years and sort of dominating belief. And also perhaps, trajectory has always been sort of the orthopedic sports related and to some extent, also pharmacological approach, combined with and that's important, combined with a non pharmacological physio, perhaps approach. So there's been this interrelationship collaboration between doctors and physios and other health professionals, which is quite unique. As I see it in the musculoskeletal system. We don't see that to the same extent, for instance, for low back pain or neck pain, but sports has done that. But maybe there has also kept people within the realms of sort of orthopedic approaches trying to understand what goes on. It's



tissues, and why did they hurt, and then when you couldn't find out why they hurt, we've just looked deeper into the tissues, which is, of course, a good idea from a scientistic or scientists perspective, because there are definitely things in the tissues that we don't know today, which will, you know, make us become more aware of what goes on, you know, as, as late as in the beginning of October, wasn't it where the Nobel Prizes were given out, there was given a Nobel Prize out for the person, I might do violence to his name, but it's part of Putin, I think he's last name it.



I didn't, I suppose a Putin or something like that. I do apologize for not being able to pronounce it. But he got the Nobel Prize was shared the Nobel Prize for his work on a peer to two receptors, which is a quite new phenomenon and sort of the longer perspective, but it might learn us over time, why could movement hurt? Which is something we don't know today? So if there's no sensitization, why does it hurt to be moving? And that's really interesting. But again, coming out in the clinic, we don't know enough. So we will have patients in the clinic where we simply do not know why they hurt.



And you could say that doesn't matter. We can call it anything. But then if you take a clinical look at what goes on what happens again, if you look at the signs, what does it mean, when people are hurting, and they think they're injured? They This is what a percentage again, they seem to be thinking that they're being in pain is the same as being weak. If you're weak, you're not, you know, you're not allowed to be in on the team, you might lose your position. So it has a lot of negative connotations. And I mean, that in itself is wrong. But what if it's based on a misconception that just because you're hurting, you are also injured? And couldn't we help people who are hurting with their pain,



just as well as we could if they are injured with a tissue injury. So what we are saying is that the two are different. They're both real, they should both be addressed. And they're not, they're not opposite ends of a dichotomy, you will have injury and pain in one end, but you will have pain without injury on the other end. So we need to pay attention to both of them separately. Yeah, it's because sometimes a person has a pain problem



may not be a specific tissue problem, but they have a pain problem. And so this pain problem may, like you said, cause certainly a an athlete to catastrophize. And to really play out to the point where maybe now they're fearful to get on the pitch or the court or the field. And so where does that leave us as physio therapists when it comes to their care? How do we help manage someone, or I should say, help someone manage their pain in order to play their sport, knowing that their every time they go out and play, they're not compounding, quote, unquote, tissue damage?



Yeah, and interesting, let's say someone has the perception that their tissues are injured, and every time they move, that's a sign of their tissue injury, or even when they hurt more, the injury is bigger, then that person, I mean, if that's a person like me, I would think that I should do something about that injury so that I don't hurt. But pain is always a symptom of something underlying it. Whereas we know from pain research in for instance, low back pain, that pain can in itself, be the disease, what the ICD 11 is now describing as chronic primary pain. So you can have that in your body, you can have it in your tendons, you can have it all way where your tendons are, you can have it where you know, where the bones are, where the where you feel the muscles are. And it's the pain itself is the problem. So rather than looking specifically at a tissue, which needs strengthening or some sort of treatment, then we can look at the person and say, What is it really that you need? A very, very simple example here, which is unlikely to be, you know, the case for everyone. But let's imagine we have someone with knee pain. And the thing that happens is that when they start running, their knee pain gets worse. But if they've been running for a kilometer, or two kilometer or miles, whatever, you know, whatever metric you use,



then the pain might be the same. So it sort of comes from nothing to let's say, five in the first mile, and then it stays at five, maybe six, and that person wants to run two miles perhaps. But what's the problem in that? I mean, the problem of course, is if pain in this case is a sign of an injury



that we should attend to. So we need to understand that it's not an injury.



Once we've done that, why not help this person, deal with the pain and maybe deal with it when they run, just like we would say to someone, if they have, again, back pain, for instance, and they have pain when they work, but their pain is not necessarily worse when they work, should they not be working? I mean, of course, if, if your pain can go away by two days of rest, and graded exposure, that's fine. But in some cases, and they're not as rare as I think most people believe they are, that we just need to work with that person and help them do what they need or want to do with that pain. And why is that, you know, of course, it's not the optimal it would be much nicer is if we would just kill the pain. Or if they could kill their own pain. But we're not there yet, we are still working to get it. And we're not giving up, there's a lot to do. But currently today, and tomorrow, we need to help people work with their pain, that's the best thing we can do now, and and, you know, giving people that agency to actually manage their pain. So in the case of the runner before, maybe the best thing we can help them do is share with them ideas and make them take agency over their pain by you know, using perhaps a cold pack or heat pack or a rest regime or watching you know, something that takes off their mind of their pain for a minute look at you know, watching dope sick on Disney, whatever they need to do to get their mind off, you know, the pain that they have, so that they can recharge, and they can be as you know, their normal again, before they go out for another run. So all of these things would make absolutely no sense if we didn't acknowledge that pain in itself is the problem, because it's not helping anyone's tissue injury, if there was a such to become better. So again, that's the infographic in its essence is that on one end, you use those inspiration to how to manage pain, what that means and how pain is influenced. And on the other side, you will have tissue injuries, and how to manage that, for instance, loading. In sports medicine loading is a big issue. It's probably the one thing that you know, everyone is doing when you're rehabilitating some someone after an injury or pain. But pain doesn't necessarily necessarily sorry, pain doesn't necessarily respond to loading. So you can have the same pain, whether or not you're loading. But there could be tons of other things such as the way you think about your pain, the way you respond to your pain experiences you've had before the context your work in. So you can run in one context without too many pains or problems. But in a completely different context. For instance, when you do a competition, or if you know, if you need to do something, because that's the bar to get onto the competition you want to do, then pain can be a much, much bigger problem. So we need to understand that context of beliefs and experience really influences pain, whereas loading may not. But it could have caused, but it doesn't have to. So pain is a much larger, much more complex topic of which we still don't know too much. We do know quite a lot. And as long as there's an injury, we understand the pain that goes with it. But when it comes to these pains that are there by themselves, the ICD 11 type chronic primary pain, then that's the type of pain that we you know, we've really, we don't have the sort of blueprints on that. So we can't help everyone. And we can't say this is right for you or wrong for you. We need to do individualized care for all of these people and help them find the best tools to support themselves. Yeah, and I think that was something that people who weren't at the conference and kind of reading through tweets,



that certainly brought up some questions, one of which was the pay mechanism, no sub plastic pain, where we can't fully explain it. And so then there was a question of, we can't fully explain it, why even bring it up? So I'll throw it over? Yeah. It's, again, it's a good question. And especially if you're a clinician, why would you use it, though, they're basically what they are. They're ways that scientists understand the pain. So again, imagine you're standing at one end of the road and you're looking at the other end by the end of that road, a very long road, you have pain. And then the way the place you're standing at is how you explain how to get to that end point. And if you're standing at a place and you know there's a tissue injury, there's inflammation. We understand that as



Part of the normal normal nociceptive system. So we would call it nociceptive pain.



Underneath that there is a range of different changes and modulator modulators of the system that leads to, for instance, peripheral and central sensitization. So they're not unique to anything that is there also in nociceptive pain, but it's induced by, for instance, a tissue injury.



If you have a different tissue injury, the one that hits your nervous system, we call it a neuropathic pain, so you have a nerve damage, along with pain, we call that a neuropathic pain. So again, you're standing on this long road, but in this case, the road itself is sort of gone wrong. But we still know what's going on. Again, if you want to use the study metaphor, you can, you can design a study, you can just take an animal, and you can compress or do something to the neurons, and you can create this similar pain experience, or at least the behavior that it assimilates this pain experience in animals, other than humans. And then finally, we have this new, we call it a mechanistic descriptor knows a plastic pain, which is much much blurrier. And perhaps it's more like a waste bin. As it is now it's, it's where you would say we acknowledge that people have pain.



And a lot of things goes into it. So just like in nociceptive, and neuropathic pain, sensitization is definitely part of it. It could also be part of the note of plastic pain. But unlike the other two, you don't have the inflammatory response that could explain it. And you don't have the neuron damage that could explain it. But the person experiencing the pain could have a similar experience. So what is it really? How do we a scientist tried to understand that pain, and that's what most plastic is at the moment. And there is a little bit of debate that whether or not you can actually use algorithms to diagnose or, you know,






justify at least that you yet the person in front of you are experiencing this type of pain mechanism or pain related to this mechanism, we definitely have a very, very, you know, widely embraced algorithm used for neuropathic pain. And some very, you know, high profile researchers has just recently come up with a paper suggesting that the same can be done for noisy plastic, sorry, for noisy plastic pain. But personally, I don't think we should, because unlike so nociceptive and neuropathic pain, they're both well understood by signs and we can separate them, they are different. So you can have both, but you would have different qualities to it, there'll be a nerve damage in one and there wouldn't in the other, for instance.



But we don't know about most plastic pain. So it could be changes in your nervous system, it could actually be, you know, increased responsiveness of your immune system in interaction with your nervous system. It could all be all of that. So it could be sensitization, but it could be tons of other things as well. So how can we start when we don't know what the mechanism is? How can we start to clinically differentiate? So I don't personally think we're quite there yet. Although I like the idea that maybe we can at some point, what I'm afraid of, if we start to use these clinical descriptors, sorry, these mechanistic descriptors, as clinical guidelines, is that what happens to the people who are now embraced and validated in their pain experience by scientists saying, Well, we know what you have, it's mostly plastic pain. But what if we made up an algorithm? And we used it for people? What about the people who fall out? Do they need, you know, a fourth descriptor? Are they just weird? Do they have unknown pain? Are they back to the psychogenic pain? So we've come quite a lot of way, embracing the clinical aspects of pain into the pain research world. And I think using you know, these three mechanistic describers, as you know, trying to really differentiate them and create perhaps treatments that is directed at either one. At this point, or especially anatomy is specifically directed at most aplastic point pain. Just because we know something doesn't mean we know everything.



So yeah, that's that's the issue. There was a bit of off topic. I'm sorry. But it's such an interesting topic. And I think that the most important thing about no plastic pain is that it is a construct that researchers use. It's embraced by the IRS, the world pain Association, the pay Research Association, and it validates that all pain is real. And there's, you know, it's still real even though we can



not understand it from a science perspective. I think that's important. And I would hate to see that we misuse it. To say that some really has it. And some don't. Because that's just, you know, that'll be I'll be sad. Yeah. And and can't one's pain experience?



Everybody's pain experiences individualized. But one person's nociceptive pain experience may be exactly like someone's neuropathic pain experience or someone's no support plastic pain experience, because it's in so then to categorize the persons Oh, well, my pain is like this. So it means this, so I can't have this. And I think it can get people a little confused. And when you have more long term or chronic pain, it's like, the the pain is there. Pain is pain. Some people need the the label or categorization, but like you said, Is it is it really helpful? And it kind of leads me to the one of the last slides in your presentation, and it was like pain prevention is well intentioned, yay, thumbs up, sometimes unrealistic, and possibly unhelpful? Yeah. So do you want to expand on that a little bit? And what you meant by that slide?



Yeah, that's slide was. That was actually the whole idea when, when I started to talk with Dr. Kieran Sullivan about workshop is that we see a lot of people, athletes. So both of us are still clinicians. And we see and we hear stories of a lot of athletes who have been treated and treated and treated again, or assessed and assessed and assessed again. And again, because they have a pain that we cannot objective eyes. So we can't find anything on scans or blood samples or clinical tests. So rather than acknowledging that pain can be there, so let's say nosey plastic pain, those are, there's something going on in your nervous system that gives you this pain, and we don't know what it is, we can't see it, that will be the, I would say the proper thing to do. So rather than doing that, we tend to keep sending people off. And it ends up with too many scans and too many assessments and too much worry. And in that process, we know the athlete is unlikely to be performing optimal during that period of time. Partly, of course, due to the pain, but also due to the insecurity to you know, if nothing is found on the first scan and a second scan that at some point, they probably start to wonder whether or not they're completely broken, or if it's a really rare disease or even if it's gonna kill them. And these are things that we might feed into by overtreating. So, of course, we should try and prevent pain. Statistics suggest that that's quite tricky. And we, you know, it would be great if we could or even perhaps what we can do is give people tools so they can take agency over their pain when it flares up. But having this idea that when you are in pain, you are damaged is very unhelpful. We think. So we really wanted to highlight the fact that sometimes pain is is that it is pain is still disabling. It's that feeling of pain, and nobody can feel whether or not their pain is due to an injury or not, it feels just like pain. But we identify all pain as if there was an injury, when in fact, it's it's quite unlikely that the majority of cases would have an injury attached to it. And just coming back to one thing you said before that it was quite subtle, but I think it's a really important point you made there, which is that all pain is real, it's always experienced as pain, whether that be of any of the descriptors or for any reason, it always feels like pain, and the quality that we attached to it, it's a muscle pain, or it's whatever is something we do it's our perception is our belief about what the pain is. And maybe that's what we need to also address in sports medicine is that disbelief about what your pain is caused by is a potential target for treatment, we call it psychotherapy or psychoeducation. Or, you know, and that doesn't have to be paying neurobiology education that's unlikely to be better than any other good education and listening and embracing. So there's a range of different interventions that are combining or embracing the fact that you need to talk to your athlete or your patient and help them make sense of their pain in a way that gives them empowerment will give them agency over their pain.



And something that came to my mind as you were saying, oh the pain it's it's in the muscles, the tendons, the bone, it's the joint and can't that all



So be a coping mechanism of the athlete. So they may say, oh, it's, you know, this is just a muscle strain. It's so it's their way of coping of saying it's nothing I can continue to to move forward. Do you know what I mean?



Yeah, absolutely and, and I think as long as it empowers them, if you know if you have the pain that you again, think about Dom's, or delete onset onset muscle soreness. That's an empowering pain, isn't it? I mean, I have Dom's, I was doing exercise yesterday. And if you really want to, you know, be good at something, then perhaps Dom's is your sort of reward even, even though it's painful, it should be awful, it might actually feel like a reward. So in that case, you interpret the pain that you are experiencing, as a reward or something you want it to happen. And I definitely think that some would say that this is just a minor thing, again, think about general health and male, you know, older men, like myself, tend to not go into, you know, the GP for what we consider to be minor things, but in fact, that might be killing us. Because we say, no, no, that's nothing, no, that little spot, that's not cancer. And I would say I don't, I don't think it's a lump, it's probably just something that's here this week. So we should be much better at listening to it, and giving it you know, you know, the quality or the, you know, the meaning that it should have. So it's on both ends of the spectrum, sometimes we neglect that pain is there for a reason, and we should listen to it. And sometimes we should understand that the pain is there without anyone really knowing what it is. But it doesn't mean just because we don't have a universal tool that can treat all pain, which is what we say when we say there's no treatment for chronic pain. In fact, there's quite a, you know, a variety of well established evidence based treatments, that can reduce pain, but they need to be targeted, and individualized so that each one find their, you know, their way through their pain. And of course, one way to do it is to go to everyone you know, who has a, you know, any background in health and ask them what to do, probably the best thing to do is to talk to someone who knows about pain, and then get advice about what seems to be working for you. Embracing that the one in this case, the athlete with pain, they have perhaps one or two years experience with their pain, they know much more about their pain than I do. But I can act as a consultant, I can listen to them, I can help them structure, I know what you know, patterns out there. So I can listen for that. And then together, we can try a few things. But over a period of maybe weeks, they should know as much as I do about pain generally, but with their focus on it. And and that should give them you know, with a bit of practice the ability to find out what works and what doesn't. And rather than thinking of pain management, in the case of a sports related pain, as an on off thing, so either it works and the pain is not there, or it doesn't work, it only reduces the pain a bit, we probably should be realistic and say that most people can have reductions in their pain, perhaps 2030, perhaps more percent. But the majority of people will experience from some sort of management of pain reduction. But it doesn't mean that the pain is going to go away. And it doesn't mean that thought is going to be absolutely pain free. But we need to find a balance between the two so that we understand when pain is actually a sign of either injury or possible injury. But also understand when pain is something that might just be part of life. And the best way we can do the most evidence based approach to that would be to find your way through it, you know, in perhaps, together with a



clinician of some sort? Yeah. And my gosh, I was just gonna say as we wrap things up, would you like to put a bow on it on your talk and at at the IOC conference and to this talk today, and I think you've just done it? I think you'd beat me to the punch. But is there anything else that you'd like to add?



That, that you want the listeners to take away?



I think the most the thing that I always want to stress is that people who meet or live their life with pain, they're experts. And we as clinicians, and researchers should embrace that much more. So the patient as an expert, is something I feel deeply about.



And I think we should be able to understand that as you know, as a scientist, you might know, you know a lot about groups.



As a clinician, you might know a lot about people who come to you with a similar symptoms, but as a person who have pain, you have two or three years



perhaps have experience with your own pain. And I think the best way to you know to get all of these together is by everyone being aware that we have different aspects and different competencies, and we should bring them together. And I think that's the best we can do right now. But still, don't give up hope we should definitely try and cure all pain from the planet, but maybe not by opioids. Yes, I would agree with that. And now more and where can people find you if they want to learn more about what you do? Read your research, where can they find you?



I think the easiest way would probably be to either find me on on Facebook, or go on Twitter. My handle is at MH underscore DK. And I'm also on Instagram. It's at MH DK underscore Dr. Moulton. Whoa.



Excellent. And one last question. It's a question I asked everyone is what advice would you give to your younger self, knowing where you are now in your life and in your career?



Remember, things take time to cope with sometimes you have a good idea. And you can't imagine, however, too, you know, you hear something and everyone else knows it. And you're like the only one who doesn't get it. But give it a bit of time. And, you know, I we have a saying that Rome wasn't built in one day. I think it goes in English as well. So give things time and and make sure you stick to good ideas if you think they're good, but also leave them if they're not.



Excellent advice. So Morton, thank you so much. This was a great conversation. And like I said, your talk at IOC was really wonderful. There's if people want to see his slides, there are tons of tons of tweets with all of his slides and great descriptors. You could go to IOC p r e v 2021. That was the hashtag for the conference. And as you look through, you'll see a lot of tweets from his from Morton's workshops. So thank you so much for coming on and expanding on that for us. I appreciate it.



Amazing. Thank you. It is a huge pleasure and privilege to be here. Thank you, Karen. Thanks so much. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.

Dec 14, 2021

In this episode, Bryan Guzski, Director of the Orthopaedic Residency Program at the University of Rochester Medical Center, and Tim Reynolds, Clinical Assistant Professor of Anatomy & Physiology at Ithaca College, talk about their work on Movers & Mentors.

Today, Bryan and Tim talk about their book, Movers & Mentors, and they get the opportunity to be the interviewers for a portion of the episode. Why is it important to have mentors?

Hear about the motivation behind the book, some surprising interviews they’ve done, the value of having a team, finding your ‘why’, and choosing when you say ‘yes’, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “From an entrepreneurial standpoint, from a business standpoint, your partner is everything.”
  • “Invest in [yourself] and take care of [yourself], physically and mentally, so that you can take care of your patients better.”
  • “Challenge yourself to step beyond your comfort zone, because the benefits of that can be significant if you’re willing to try.”
  • “Find a mentor and don’t fear or stray away from the imposter syndrome. Use that as fuel.”
  • “If you never ask the question, the answer is always no.”
  • “Trying to do it all will keep you small.”
  • “You have to really only say yes to things that align to your values.”
  • “Take a step back, know who you are, know your values, know what your individual mission statement is.”
  • “He who knows others is wise. He who knows himself is enlightened.” - Lao Tzu
  • “If you don’t have the capacity for it, then don’t do it.”
  • “Stay curious.”
  • “Continue to search for the ‘why’. It’s okay not to know.”


More about Bryan Guzski

Bryan GuzskiBryan Guzski PT, DPT, OCS, MBA, CSCS, is an outpatient orthopaedic physical therapist practicing in Rochester, NY working primarily with patients with spine related issues and persistent pain.

Bryan earned his Doctor of Physical Therapy degree from Ithaca College in 2014, completed an orthopaedic residency program through Cayuga Medical Center and received his Orthopaedic Clinical Specialist certification in 2015, and earned a Master of Business Administration degree from Simon Business School at the University of Rochester in 2021.


More about Tim Reynolds

Tim ReynoldsTim Reynolds PT, DPT, OCS, CSCS, is a Clinical Assistant Professor of Anatomy & Physiology at Ithaca College and a part-time physical therapist practicing at Cayuga Medical Center in Ithaca, NY, where he predominately treats patients with spine or lower extremity impairments.

Tim earned his Doctor of Physical Therapy degree from Ithaca College in 2014 and completed both his orthopaedic residency and spine fellowship through Cayuga Medical Center, and currently helps mentor and teach in both of these programs as well. 


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Academia, Movers, Shakers, Mentors, Prioritizing, Self-care, Self-improvement, Values, Motivation,


To learn more, follow Bryan & Tim at:


Twitter:            @moversmentors


Facebook:       Movers and Mentors

Instagram:       @moversandmentors



LinkedIn:         Bryan Guzski

                        Tim Reynolds


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


Hey, Brian and Tim, welcome to the podcast. I'm happy to have you guys on to talk about movers and mentors. So welcome.



Thank you, Karen, thank you for having us today. We're sharing this sit down chat with you.



This is great, Karen, thank you so much.



Well, thank you guys for including me in your book with over 70 Other pretty illustrious folks in the Movement Science physical therapy world. So let's start with the basic question that I'm sure a lot of listeners want to know. What is the why behind the book?



Yeah. So Karen, Tim and I were going through residency orthopedic residency together. Back in 2015. We both graduated from Ithaca College in 2014. And we both entered into a residency program at ethika are in Ethica, in 2015. And as we were going through the coursework there, and kind of taking different classes and really kind of immersed in the PT literature and physical therapy, space and various different content. We started noticing a lot of reoccurring names and reoccurring themes. And so, you know, different names like Tim Flynn, Josh Cleveland, surely sermon, Stuart McGill, you know, all these all these names that, you know, names in our rehab space that I've done a lot of really cool things and have put out a lot of different research that that, you know, we follow to this day. So we started noticing those names. And Tim and I were also reading a book by Timothy Ferriss called Tools of Titans at the time. And we really liked that book. And we enjoyed it. We got a lot out of it. He interviews people like, you know, Arnold Schwarzenegger, and Oprah Winfrey. So various different industries and various different spaces. But we like the model that book and we started to ask ourselves, well, I wonder how, you know, individuals and movers and shakers within our industry would answer questions that we have. So fast forward two years. That was 2017 2018 at that point, and Tim and I started putting together a list of questions and a list of names. And at that point, you know, we kind of we kind of took it from there. And Tim has a little bit more info on how we how we came up with the names.



Yeah, so it's one of those things that we could have written a 5000 page book in regards to the movers and shakers within the physical therapy industry. And I think one of the most important things that Brian I have tried to stress is that this is a living project. This is not a one and done situation where there are movers and shakers that are currently developing and changing the practice. And so I think that's one of those things that, yes, there are people within the pages that I'm that are, we're happy to have there. But at the same time, there's so many other people would want to reach out to, and we look forward to have the opportunity to potentially talk to those individuals in the future, and are excited to see how does the profession change in the next five to 10 years and who are going to come up and literally shake the industry that we have the opportunity to be part of. And so as we started to go about this, like Brian said, we're diving into this literature, I had the opportunity to do spine fellowship after doing my orthopedic residency. And so the amount of Tim Flynn articles that I've read over the past three years was obnoxious. And so we started to make this almost like PT Dream Team, if you would, where we said okay, from, from a literature standpoint, who do we do we invest ourselves into a lot of, and like Brian mentioned, John John Childs, and we have Josh Cleveland. And then we have Tim Flynn, and the surely SARM and Gwendolyn Joel, there's these names that we have read multiple articles from and so kind of selfishly, we put together this list of people that we would really appreciate reaching out to, because we've been so invested in their in their literature over the past several years. And then from there, we kind of spread our net a little wider, because we had to see who's moving the industry from a clinical practice standpoint, right. So not necessarily from an academic or research standpoint, but from clinical practice. And who's moving it in regards to social media influencers? Because as someone who works in academia and works with the up and coming physical therapy generation, those are the people that they're following on Instagram and on Twitter, and so they're moving and shaking the industry in that format. And we looked at who's been guest speakers at recent conferences and who's putting out podcasts and how He was really trying to have the opportunity to get our profession to move in a positive direction. And so from there, we created this sort of master list, we reached out to all of them, and some have the opportunity to participate, which we're super thankful for. Some respectfully declined based on the fact that they had other stuff going on. But I think one of the things to remember, Brian is sort of given us timeframe, this was right pre pandemic, that we started to reach out to all these individuals. And what's been such a blessing is that we've been able to cast a wide net across multiple different countries across multiple different professions. But at the same time, we reach out to people in Australia, and there's Australian wildfires. And so we're trying to really respect individual's personal physical well being while navigating global pandemic while trying to also conduct interviews. And so it took us a little over two and a half years to be able to accumulate everything and be able to put everything out into a book format. But I'm super thankful to have those people within the pages. And like I said, I'm excited to have the opportunity to reach out to more in the future.



And so it takes, you know, a couple of years to get all this together. How did the two of you kind of keep the momentum going? Number one, because that's hard. And then number two, how did you kind of kind of temper your excitement and your expectations? Because I know, I'm the kind of person who's like, let's just get it done. Let's go, go go. But here, you know, you've really taken your time, over two plus years. So can you talk a little bit about that?



Yeah, I think from the outset, Tim and I both thought, I will send out some emails, you know, we'll get a handful of responses. It'll be a cool book, maybe we'll sell to maybe, you know, five, including our siblings, and parents, that sort of thing. And it really from the first batch of emails that we sent out, you know, Tim and I were really, every time we got a response, we would text each other, shoot each other an email immediately, Hey, Peter O'Sullivan responded, or David Butler responded, or Karen Litzy responded, you know, this is awesome. Like, we're actually doing this thing. So I think it you know, you spoke to momentum, Karen. And that's one thing that Tim and I, you know, we've never really hit a point where we were at a lack of that, or hit a dull moment, if you will. Because every time we got we did another interview, or we got another email, or we set up a, you know, maybe a podcast, it was definitely adding fuel to the fire. And, you know, they kept us pretty engaged and pretty excited throughout the whole thing. So, yeah, I mean, to I think if you asked us when we first sent out our emails in 2018, hey, you know, this is you're going to publish this in 2021, we'd say, No, it's going to be next year. And then life happens and pandemics happen and several other things. And, you know, it turned into a two and a half year project. But you know, it's been a lot of fun the whole time. And Tim and I still are still excited about it and excited about about the future, too.



And I think that's one of the things. There's kind of like Christmas every single time we had a response because it was super cool. You send out these, these emails, or you give a phone call to people that you've literally have had as your mentor from afar for years. And it's like, oh, my gosh, I cannot wait to have the opportunity to sit down. Like Peter, I saw that I've watched a lot of Peter softened videos from pain science standpoint, from spine fellowship work. And having the opportunity to sit down with Peter resolve them for an hour and 15 minutes was like, amazing. I was super stoked. And so so all those opportunities to talk to these people definitely continue to keep flame burning. And at the same time you talk about how do we sort of balance that, that excitement and try not to do too much too quickly. Brian and I have known each other for years, this has been such an amazing project to be able to find a partner that you want appreciate and to after two and a half years don't hate. So I think that's like a really good thing. And I think we balance each other out very well, where we're both skilled in a variety different formats. And then at the same time, after reading your draft manuscript, probably like five times through and through, you really do not want to read one more time. And there's points where we're like, I think it's good. I think we just just push it out, call it a day. And then Brian could probably agree that I'd say well, let's just read through it one more time, and then you catch one or two small mistakes. And so I think it's one of those things that just finding the right person that's willing to invest and stay motivated to push you and challenge you From an entrepreneurial standpoint, from a business standpoint, your partner is is everything. And so I think that's been one of the blessings that we've had this for this project.



Yeah, I love it, I think that's great advice is to have that person who complements you. Right and because you don't want to have just like a yes person, but instead you want something that's going to complement you and push you in, in a positive direction. And, and I will second the Peter O'Sullivan, he is just what a nice person and giving and charitable and gosh, I had an interview with him at CSM a number of years ago. And I had to ticket it. Because it was live at CSM. And we actually had to ticket it so that only 25 people could go and I it was only for students. And by the end of the interview, he was laying on the ground, you know, students and stuff. It was just so it was such a great experience, because he's just one of those very kind of electric personalities.



Definitely. very warm, very electric.



Yeah. Were there any interviews that you did that surprised you?



Um, in



a, in any way that doesn't have to be good or bad. Just surprise you because perhaps the persona that this person has, whether it be their research, social media clinical that you thought they had, and then when you interviewed them? It it surprised you?



Yeah, I would say. Obviously, when you when you interview over 75 individuals, you get a variety of different responses, you talk to a variety of different personas, devided different characteristics. And I think going into it, knowing the background of someone's, I use the metaphor of like the front cover of a book, we all have like front cover worthy attributes or accomplishments. And then it's like, well, what's on the inside of those pages. And so we see everybody's bio, and I've been on X, Y, and Z shows or published this many papers and, and so we see all that stuff. But we never really hear some of those people talk or talk personally about some of their successes and some of their failures. And so I think everybody had the opportunity to have some elements of surprise. But I think what was also cool as Brian, I made up this master list, and it was basically just based off of accomplishments and achievements, or their influence on the profession. And so, for instance, I was looking through and like talking to Michael Radcliffe, who is who is a researcher that I've read your research, but I, I never really pictured what you would look like. And I never really perceived that you would have such amazing responses within this book. So I think it was those individuals that I might not have been so invested from like falling on social media, or have watched your YouTube videos, and really getting a chance to know them in an hour, hour and a half. Those were the interviewers that really caught me by surprise, but at the same time, I think I walked away with so much more, because there is so much unknown that they're willing to offer me. Um, and so I think I think that was the most exciting part or the most surprising part for me.



Yeah, I think kind of, because of the types of questions that we asked, we really intimidate joke about this, if we want to know, you know, surely Simon's recommendations for motor control. We can find that online. We can we can Google that. Right? If we want to know, you know how David Butler opens his pain talks, we can probably find that somewhere and explain pain or explain pain Supercharged. But you know, how Heidi genetica who's the CEO of versio Excuse me? Why pte how she structures her day. And what her favourite failure is it those are things that you can't find you can't find that in textbook you can't find that online. So the types of questions that we asked really opened, opened it up to knowing these people from a different perspective, which we thought was pretty cool. I'd say that one of the individuals that really stands out in my mind, Tim actually did this interview, but I transcribe it so I got to listen to everything, literally word for word was Stanley Paris, who's one of the founding fathers of orthopaedic manual physical therapy and then the United States and North America for that matter. And I mean, this guy is is just incredible from sailing around the world to swimming the English Channel to founding St. Augustine to being, you know, a founder and president of various organizations like the guy has done it all to owning a winery or several wineries. I believe he's just, you know, a jack of all trades. And I think listening to that interview, I was like, you know, he's, I think 83 Now, and my jaw was dropped to some of the some of his answers and some of his experiences. So that was, that was really cool. But, I mean, we had so many so many great interviews, Jeff Moore was a terrific interviewer. Peter O'Sullivan, like we talked about Kelly star it gave, you know, exceptional answers. So we were really, really lucky. And, you know, positively surprised, I should say, surprise, in a positive way with with all of our guests.



Yeah. And it it, it does kind of, like an education for you. Right,



definitely. Yeah. 110% Yeah, I mean, it was one of those things. I had the opportunity to speak with Michael shacklock. Um, and such a well spoken. Such a thoughtful, mindful person. And back in residency, Brian Knight did some research with neurodynamics and your mobilizations. As I was like, Oh, my gosh, like, you're the Dude, that was like, given us all this information. And now we have the opportunity to actually speak to the source. So I think back to being like eight or nine years old, and have all these posters of Major League Baseball players up on the walls, and just like, thinking about how cool it was to have their pictures, and to think about what it would be like to play baseball with them. And now to be able to communicate with some of these movers and shakers within the industry, and have them be peers, and be able to carry out a conversation with them learn from us as much as we're learning from them in that conversation is just such a rewarding opportunity.



And do you feel like it has changed your clinical practice at all? How you are with patients? Did any of the answers or just even the interactions with some of these folks change the change the way you practice? Um,



I think yes. I would say I've slowed down, and I'm more intentional. Just based on a few, I guess, specific responses, but one that comes to mind is oh, shoot, pause. This might be a Karen, you might have to take this this out. And then wait,



wait, wait a mess up. Or 25? I



know. We were crushing it. Dude. Millet mark. I don't know. I want to say more. Mark Milligan. So we'll jump back in. Yes, I would say more mindful and intentional. And I've slowed down in my practice, one response, or several responses from Mark Milligan definitely kind of changed the way I think and operate within the clinic. And I've definitely tried to be more intentional and kind of think about my thinking a little bit more in the clinic from a specific, you know, tactical exercise prescription perspective, not so much. Because that wasn't really the focus of our book. But just, you know, Mark's mindset, and kind of his, his recommendation to all young professionals to really kind of invest in themselves and to take care of themselves mentally and physically so that you can take care of your patients better, I thought was really powerful. So yeah, I'd say, a little bit more intentional, focused, and I've slowed down.



Yeah. And I think sort of piggybacking off of what Brian was saying, less so about the actual clinical approach to what sort of treatments are you providing? And I think that was one of the the most exciting things about the book was we were not talking about what's your favorite three exercises for X y&z Because there's so much saturation, I'd say from a social media standpoint, which is great. I think that's one of the things that's challenging the profession, that anybody has the opportunity to put out content, and it's one of the curses of the profession that anybody has the opportunity to put out content. And so I think the opportunity for young graduates and PT students, and individuals interested in the Movement Science field that is sift through a lot of information to be able to find out what is truly valuable for them. And like Brian was saying, These are the answers questions that aren't necessarily within a textbook, but also probably not necessarily on people's social media channels also, right? No one really steps up to the plate and says, you know that one time when it took me three tries again to PT, school, Dad was really a good important point in time, my life, or, yeah, I remember when I failed the boards. Those are things that I think can really influence and the sort of career life changing for these individuals, who, as a current college professor, writing final exams, getting ready to watch by an influx of tears in my office in the next bout 48 hours, who perceive a failure as such a detriment to their potential growth, and well being as a person, I got a B plus on this test, all my friends got A's, I cannot necessarily navigate that situation. That's like conversation that I hear all the time. And so talking about how has things changed in my practice, I'm currently part time in the clinic, more time from an academia standpoint. So I think it's changed my communication opportunities, with the next generation, being able to literally use this book as an encyclopedia. And knowing the responses that people have given flipping to their name, and saying, I need you to read this chapter from Mike Reinhold, where he talks about becoming an expert, because you're not there yet. Because you shouldn't be there yet. Because you haven't gained clinical judgment and clinical experience. And it's going to be okay. But go read this come back in five minutes. And so I think that's how I've been able to sort of benefit from this, from this experience and how I've taken it influenced my own practice.



Excellent. And, and as a side note, Tim, the, my podcast episode coming out tomorrow, my podcast is with Silvia Zubaan. And she's a clinician 50% clinician 50% academia at St. Louis University in Washington, Washington University in St. Louis. Sure. And surely, sermons. Yeah. And it was a really nice conversation on how to navigate. She's been doing it for 15 years now. clinician and academia and academia. So it was a really nice, really wonderful conversation on how to navigate that those two worlds successfully and how to be vulnerable when you need to be and with whom, and because it can't always be great and perfect, like you just said. So if you have a chance, I would come out tomorrow, I would listen, I'm excited. Currently to edit this part out. I don't need to plug my own podcast within a podcast. He was a little self indulgent. But because you, you're kind of in a similar position. She's just been doing it for a lot longer.



That's awesome. I appreciate that. So



check it out tomorrow. It was really, like, such a good conversation. She's super cool. She should be in your next book. There. Yeah, like it. She's super cool. Yes, Silvia it's CZ you PP o n. Yeah. And she does some research and and she's written some papers and things like that, but she's super cool. Okay. So, um, is there anything? Before we sort of flipped this a little bit? Because I know you guys were like, Hey, would you like to expand on some of your answers, which, you know, is fine. So we'll flip this in, in a bit. And I'll have you guys host and I'll be your guest. But before we do that, is there anything else kind of about the process of of compiling and publishing the book, that you would love people to know, because it made such a big difference in your lives?



I think one of the blessings of our profession is the lat orality component to your growth as an entrepreneur, but also as a professional. We graduate with a clinical doctorate, or and this can be transcribed across multiple professions, but you go to school to be able to learn how to learn right and in our profession where you sit for a board certification, which gives us the opportunity to practice as a clinician within that. You can wear multiple different hats and I think what was nice with this is That title allowed for us to speak to a variety of different people and have this mutual commonality, which was physical therapy, or Movement Science or the treatment of individuals with certain pathologies. And I think this would never have happened if we didn't make ourselves vulnerable and uncomfortable. Because who are Brian and I? And why should we have the opportunity to talk to Karen Litzy? Or why should we have the opportunity to talk to David Butler? Or why should in so we had this idea, and it all stemmed from the courage to be able to reach out and ask because you never know, unless you try. And so I think sharing one of these thoughts with your listeners is, I think we all have dreams and aspirations that are slightly beyond our scope of practice. And sometimes we can limit that opportunity for us to navigate those ideas, because we are either potentially afraid of failure, or just don't know what the outcome is going to be. And so since that's an unfamiliar territory, we just assume, and therefore we never attempt. And so I think the one of the best things that I've learned from this is accepting failure for what it is, what's the worst that they're going to say? No, I do not want to be part of this, thank you for the opportunity. And the best thing that we could do is create a relationship, create a mentorship opportunity, and have sort of this professional friendship that stemmed from a cold call email. And so I would, I would recommend, at least my thoughts would be challenged, challenge yourself to step beyond your comfort zone, because the benefits of that can be significant if you're if you're willing to try.



Yeah, Brian, right. Yeah.



Yeah, I think there's some level of kind of normalization of failure and imposter syndrome within this book. And I think when you dive into it, and you dive into the responses, everyone has been there, everyone, I'm speaking to, you know, students, new graduates, young professionals here, but guess the message kind of spans anyone in any part of the PT space or industry with however many years of experience, you know, everyone's felt that level of imposter syndrome, or, or fear of failure, and the kind of ability to, to kind of push through that, overcome that and almost use that and leverage it to, to push further or overcome obstacles is really powerful. So I think of it like if you're ever kind of at the top of a mountain, in terms of, you know, imposter syndrome, if we look at it, like, like a curve or like a mountain, if you're at the top of it, then you know, what's really driving you and what's what's pushing you forward, if you're kind of somewhere along along the line on the slope, then you have some level of uncertainty, some level of fear, or some level level of imposter syndrome, and that's actually going to feel fuel you to learn more and be better be more effective. And again, one of the main themes of this book was finding a mentor and the importance of that and how valuable that can be in any, any track or any, you know, facet of our profession. So kind of find that person that's doing something similar or doing exactly what you want to be doing. And, you know, don't hesitate to reach out to them. Because we're in the, we're in the business of helping people and thankfully, we have a lot of professionals around us that that want to help other people but also want to help you know, students, young professionals, so don't hesitate to reach out. I think you'll be surprised with with, you know, the the feedback or the the return on that. So, definitely, definitely find a mentor and, you know, don't don't fear stray, stray away from the imposter syndrome use that as fuel.



Yes. And I will say I got a piece of advice several years ago from a fellow physical therapist, son. So her name's Cecily de Stefano. She's a physical therapist outside of DC. And we were in Chicago for a one night q&a With Lorimer Moseley. And the next day, we were walking around, she had her five year old six year old somewhere around there, young son with her, and she was sort of walking up ahead and he was walking Next to me, and he said this, Karen, would you like to have a play date? And I said, Well, I don't. I don't have any children. And he was like, no, just you. And I said, Oh, um, okay, well, I think we should probably ask your mom first. And then he gave me a great piece of advice. He said, Yeah, because if you never asked the question, the answer is always no. And I was like, and I said, that's the best piece of advice I've gotten in years, and you're like, five. So just to begin with what you guys said, If you never ask the question, the answer is always no. And I've never forgotten that, since he said that. And so now I just always add, ask the question, because the worst that can happen is it's no and so okay, you move on. But you never know. Unless you try. Okay, so true. So let's, uh, we'll start wrapping things up here. But now I, again, thank you for including me in this book. It's a real honor. So if you want if you guys have any questions to I guess I can expand upon or, you know, anything else that that may be? I don't know, you go ahead. Talk about being out of your comfort zone. Go ahead. And you asked me, I'll hand the mic over to you guys. And I'll see, we'll see what we can do here.



Sure. Karen, thank you, again, for being a part of this. I really liked your response. We were speaking about failure a little bit before. And I really liked your response on failure in the last comment, here you have, I'll read it right from the book, it says, failure has taught me to be more introspective to have an open mind to trust in others more. And to know that in the end, it will all work out the way it is supposed to. I was wondering if you could expand on the to trust in others more? Do you have a specific example that you're thinking of, or examples, or just, you know, have other people come in at really important times to help you out when you're, you know, in a in a, you know, event of a failure?



Well, I can't think of one person or one incident in particular, but what I will say is, I am personality type a driver. So someone who likes to get things done, who likes to be in the driver's seat who I don't need help, I don't need help, I can do it on my own, I can do it on my own. And as a result, I think that yeah, I've had failures, because I tried to do it all by myself. And it just doesn't work. You know. And so there's a great team building exercise called lost at sea. Google it, I won't go into detail as to what exactly it is. But you have to you fill out. They give you a list of things that maybe you need when you're lost at sea, and you fill them out what you think you would need from one to 15 or 16 or something like that. So you do it on your own. And then you you do it as a group? And then you find out, like, did you do better on your own? Or did you do better when you had someone helping you? And better meaning like, did you survive? lost at sea? Or were you eaten by sharks? Right? And time and time again, and the group that I did it with? Everybody did better with the group. Right? And so for me, and I learned that I took the Goldman Sachs 10,000 small business program, and it was part of that program. And the big part of that program is learning how to be part of a team and learning how to have people around you that make you better. And so I think my biggest failures came because I didn't ask for help. Because I always thought no, no, I can do this on my own, or I can handle this and quite frankly, I couldn't. And so it resulted in a failure resulted in a less than optimal outcome. It resulted in stress on me and and perhaps some mental and emotional anguish, when in fact, I could have just had a team around me ask for help. And that task probably would have been done better than if it's just me and so yeah, I always so when I said that line, I didn't have one particular person or event in mind, but rather that like sometimes you have to like suck it up, you know, and admit that you can't do things and it's okay. It's just part of life. Like I had interviewed a woman Her name's Stephanie Nikolaj and she said you know trying to do it all will keep you small and she's right. You know, you can it's hard to grow as a person as an entrepreneur as a clinician, my God if you just did everything I Your Own I mean, you'd be like, I don't know you'd stop growing from the day you graduated from college right from your PT program. So you you need the these people around you need people around you, who can lift you up and and make you a better person, a better clinician, a better entrepreneur, whatever it is. But you'll never be that evolved person if you're on your own, it's just impossible.



Yeah, I think, Karen, like the number of hats that you wear as a business owner, a podcast as a volunteer and advocate, right? You, you kind of need people like that in your ecosystem, and it for so many projects, and especially the bigger the project, it really does take a village, and you need people that specialize in certain aspects to come together as a team. You know, Tim and I have talked about this kind of checking, checking your ego at the door sometimes and just kind of leaving that, as you said, Karen, you know, kind of admit that you can't, you can't accomplish it all by yourself. So I that was a that was a really great answer. And, you know, I think you spoke to some of the points about being more introspective and having having an open mind as well.



Yeah, and being able to trust people, clearly, I have trust issues. But you know, I think finding like, like you guys said, like you found each other, you knew each other for many years, you have this really nice trust and bond. And I don't know, maybe it's like 20 years in New York has made me a cynical New Yorker or something. You know, but really finding those people that you can connect and trust that they have your back and you'll have theirs. I think it's really important.



I think, another question that I would have just to sort of elaborate on, obviously, we have a variety of individuals that are listening, right now clinicians, non clinicians, entrepreneurs, and one of the questions that we asked within the book is, what advice would you give to a smart driven college student or a young professional entering the quote unquote, real world? And I think one of the things that you mentioned, that was really valuable was that it is easy to say yes to everything, when you believe it will further your career, I would advise you to only say yes, the opportunities that align with your values and goals, as the saying goes, saying yes to one thing is saying no to something that might be a better fit. I think that's really powerful. Because I think we're in a society of more is better, or the perception that doing more is better. So knowing knowing who is listening to this and having the microphone if you would, for for a minute baseline question. Can you elaborate on that? Or if you had to give that sort of monumentous speech regarding that topic? I think that can be really valuable for a variety different people this?



Yeah. And I think that saying that saying yes to everything, or only saying yes to things that align with your values? I mean, yes, you have to really only say yes to things that align to your values. But I think that speaks to speak to that 30,000 foot view of society in general, and of social media and what we're seeing everyone else do, right, so you may scroll through your Instagram or Twitter, Facebook, Tik Tok, whatever it is, you're on. And you may say, Well, gosh, this person just, they wrote another article, or Gosh, this person speaking here, and they're doing this and they're starting an app, and they're, they've got a podcast, and how come I'm not doing all that? Should I be doing all of that, so I should be set? Why, you know, I need to be doing XY and Z and, and, you know, you've got that, that FOMO disease, you know, your fear of missing out, and then you bombard yourself with things that you think you should be doing because other people are doing them. But it's not even something you believe in, but you think you should believe in it? Because Because other people in the profession are doing it and look at how many followers they have, or, or look at all the success and I use that in quotation marks because we don't really know someone's true success out on social media, right? Because we only put the good stuff on social media, you're not going to put the shitty stuff on social media, right? And so I think this saying yes to everything. I think a lot of it is based on societal pressures, what you're seeing on social media, maybe what a colleague or someone that graduated with you like, oh my gosh, they already started their own practice. And I didn't do that yet. So I guess I have to do that. And I have to say yes to this, that the other thing and it's, I think you really have to especially now like take a step back. Know who you are, know your values know, know your what your individual mission statement is, right? I know you guys said you have a mission statement for your book, but I would challenge everyone like you have your own mission statement as whether it's a clinician or you're in academia. But really you have to know deep down what your values are, what you're willing to take and what you're not willing to take, and, and really know yourself in a very deep, meaningful way. And I'm not saying I know myself in a deep meaningful way yet, but I'm trying, right? It doesn't mean and again, it doesn't mean you have to know that. So again, that's another thing people think, Oh, I have to do this now. But you know, in researching a talk for CSM that I'm actually doing with how do you Janemba my, the part of my talk is increasing your self awareness as an entrepreneur, and how do you do that, and I came across a really great quote, he who knows others, as wise, He who knows himself as enlightened by louts Lao Tzu, la Otz, you I hope I'm pronouncing that correctly. And I saw that quote, and I thought, Oh, that's so perfect, right. Because as, as clinicians, and as physical therapists, our job is to get to know the patient in front of us or the student in front of us or whoever it is in front of you that oftentimes, I think we give away big parts of ourselves without taking it back and looking inward.



And so you kind of get this like, drain on your empathy, and your energy goes on as the day goes on. And I think that happens a lot. And in these kind of giving professions that we are in, whether you're a professor or a clinician, or even a researcher, right, you're going to give all of your energy to that. And then you see you're always looking outwardly all day. And do you take the time to come back at the end of the day and look at yourself inward? And say, Well, what, what am I doing? Like, why am I doing this? Am I doing it for the likes? Or to get more followers? Or like, what is your goal? Right? And so I think that's kind of where that saying no to things comes in, if you know, your why behind what why you're doing things. It will make it easier for you to say yes, and to say no, because it's going to align with with who you are. But that takes time, you know, so as a new as a student, or a new professional, maybe you do have that all figured out. And if you do awesome, come on the podcast, let's talk about it. How did you do it, but you know, if it takes time, and you have to kind of find your groove and, and really know, where you want your career to be headed. And some people do know that right off the bat, I didn't. But it doesn't mean that other people don't have a very clear path of where they want their career in life to go. You know. And, and there's obviously that changes here and there. But I think that's what I meant by that, quote is looking for those opportunities is to really know yourself, and what your How much are you willing to take? How much capacity do you have for XYZ? And if you don't have the capacity for it, then don't do it? Because it's going to be done like half assed, you know, and nobody wants



nothing. That's great. Yeah, great advice. Yeah, finding, finding your why and staying true to your why and finding things that that sort of line up with that to allow for you to not have that emotional, physiological draining. If you would find things that fill your cup not not dump your cup out.



Yeah, exactly. Exactly. Yeah. It's a nice way to put it.



Um, yeah. So Karen, thank you so much for, you know, kind of expanding and elaborating on some of those. You know, as Tim and I mentioned in the, in the beginning, I think when we were chatting probably before we were recording, Tim, and I want to probably get a podcast started at some point in the future. And, you know, we'd love for you to come on and be one of our guests, so we can talk more about this stuff.



Yeah, I'd be happy to. And now before we wrap things up here, where can people find you guys? Where can they get the book? Let's go. Go ahead. The floor is yours.



So we have a website. The website is movers and mentors calm on there is all of our social media information and links directly to Amazon where you can find both our Kindle version and paperback version. If you have questions, comments, please tag us send us stuff on social media. Tim and I love that we you know, we've been very fortunate we've had really engaged you know, an engaged audience up until this point and so you know, we're looking or looking for more of that and shoot us an email if you want and with with comments or feedback. We love to hear that as well.



Great. And how about where can people find you on social media? Oh, yeah. Yeah,



it's in those that thing tendons got our handles there.



Yeah. So my, you can message me on Instagram. But Tim Reynolds DPP would be my thing. That's my Twitter routes, and would be my Instagram. And we'll send you that Karen. So you can sort of tag along for the podcast. But I like Brian was saying, I think the opportunity to interact with our, with our audience is one of the most exciting things, getting somebody that reading the book from South America and is so excited to receive the book is one of the highlights of our day. And I think having the opportunity to have our our audience also send us Who do they think should be the movers and shakers in our potential upcoming volumes of this would be something that we'd really appreciate. There's so many people within the profession that we do not know of yet. And so obviously, appreciate having their insight and input in that as well.



So I'm at at Bryan, Bryan, Gaskey, and Instagram and then we're at movers and mentors, both on Instagram and Twitter.



Perfect. And all of that will be in the show notes at podcasts at healthy, wealthy, smart, calm. So before we wrap up, what is question I asked everyone, what advice would you give to your younger self? So let's say fresh out of PT school at Ithaca? What advice would you give yourself?



I would tell myself, stay curious. Because I find that when I'm curious and asking questions, that means I'm engaged. And I think engagement. If it aligns with your your purpose and your passion, then you have kind of all three things in alignment. And that, you know, lends itself to a happy, fruitful and hopefully, you know, effective career.



Excellent. Tim, go ahead.



And I would say sort of piggybacking off what we were talking about earlier, Aaron would be continue to search for the why. And it's okay not to know. And I think that's one of those things where finding your why and staying true to the values is one of those things I'll add to life journey, continue to search for that throughout the lifespan. But I think actively checking back to is this lining up with my Why would be one of the things that I would want to do, either from a journal reflecting standpoint, or just from like a quarterly check in. But then also, the acceptance of it's okay, not to know not necessarily not to know what your y is, but not to know certain things in part of your life. Um, and I think being 20 to 2324 and try to navigate your 20s. And I'm thinking that everybody in that sort of FOMO aspect is having the solutions and answers. And it is okay that you do not know yet you are enough, you will be enough, challenge yourself and have the opportunity to allow for that growth and expansion.



You guys, that is great advice. Thank you so much for coming on the podcast and sharing your book. Again. It's movers and mentors, and it's available on Go to their website, go to the social media. Everything again is that podcast out healthy, wealthy, smart, calm. One click, we'll take you to any thing you need for both Brian and Tim. So thank you so much, guys, for coming on.



Thanks for having us, Karen. Yeah, thank you, Karen.



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

Dec 7, 2021

In this episode, Dr. Sylvia Czuppon, Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine, talks about balancing her role as an academic with her role as a clinician.


More about Sylvia Czuppon: 

Dr. Sylvia Czuppon received her Bachelor of Arts in Psychology in 2000, Master of Science in Physical Therapy in 2002, and her clinical Doctorate in Physical Therapy in 2011, all from Washington University. She received her Certification as an Orthopaedic Clinical Specialist from the American Board of Physical Therapy Specialties in 2010. Her work has been published in British Journal of Sports Medicine, PM&R, Physical Therapy, and Journal of Orthopaedic & Sports Physical Therapy. Dr. Czuppon is currently an Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine in St. Louis, Missouri. She divides time between outpatient clinical practice treating musculoskeletal pain patients and teaching orthopaedic content in the professional DPT curriculum at Washington University. She has given local, state, and national presentations on lower extremity injury rehabilitation and return to sport. She volunteers her time educating coaches, parents, athletes, and the community about youth injury prevention strategies.


To learn more, follow Sylvia at:

Twitter: @czuppons


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Read the Full Transcript Here: 


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



Thanks for having me, Karen.



Of course, of course. And, you know, we were talking before we went on the air about, you know, not seeing people in person and going to conferences. And the last time we saw each other was in Vancouver, at the third annual World Congress of sports, physical therapy.



Yes, right. That's right. Yeah,



I think that's correct. Yeah.



I can't believe it's been that long.



I know. I know. 2019. Right. Beginning of 2019.



I think it was. Yeah, it was COVID. Year, but it was before all that stuff. Yeah, yeah,



exactly. And, you know, shameless plug, the fourth annual World Congress on sports. PT is going to be outside of Copenhagen in August of 2022. Absolutely. So I encourage people to try and and your fingers crossed, it'll work. I keep saying 2022. It's gonna be the year. So shameless plug for that. Now, let's move into you. So today, we're going to be talking about life as a clinician and academia. And I love this topic, because I think there's a lot of clinicians out there who are wondering, well, how do I get into academia? How do I how do I do that? So why don't you give the listeners a little bit more about your background and how you did it? Sure. Yeah. So



I've been fortunate to be on faculty at Washington University in St. Louis for 15 years now. I think, approximately, it's been a while. And yeah, I sometimes I'm like pinching myself. I'm like, How is time flown that way? How 15 years? Yeah. 15 years? I graduated in 2002. So yeah, yeah, it is, oh, my gosh, I



can't believe it, I can't believe it.



So. So when I, when I joined the faculty, honestly, it was it was a nice, it was a nice mix of events. When I came out of PT school, I knew I wanted to do a little bit of teaching, but the Washington University at least, recommends that you have about a year of clinical practice under your belt before you join an academic institution. Like lab assisting. So that's how I got my start, I started lab assisting in classes that had orthopedic content. And when a position on the faculty opened up, I, I basically jumped at the opportunity got lucky enough to be hired. And away I went. So when I first started, my split, I think was 90% of my time was in clinical practice. And about 10% of my time was in, it was in teaching and it was all a lab assisting. And over the years, that is at has morphed considerably. I'm about 5050 right now. So I spent 20 hours a week in the clinic and 20 hours a week, teaching or doing teaching related things. And it's been a I don't think I'll ever go below that. But who knows what will happen. But I like that balance that I've struck right now, I can't ever see myself coming completely out of the clinic into teaching, like some of my colleagues have done, you know, you go to PT school to become a clinician, you don't go to become an educator, otherwise I go to, you know, to get my teaching degree. And I think that's probably been one of the biggest challenges is I am a PT, learning how to provide high quality education without an education degree. So there's been a bit of a learning curve associated with that as well.



And what do you feel are the advantages of being a clinician and, and working in academia? So what does your clinician hat bring to your students?



Yeah, you know, I think it's interesting. So, um, as a clinician, what is nice is I can give them I don't want to call it real world application, but it really is. So they students, we teach them in the ideal scenario, like, Okay, your your patient comes in, they have this positive test this positive test this positive test, what must be their diagnosis? Is any patient ever that cookie cutter clean No, 99% of the time, they're not right. So we teach our students in the best case scenario, the easiest ways to understand and so being a clinician, I can still give them a little bit of perspective, but like, here's where the gray areas come in. And this is why we teach you that ideal scenario so that you recognize the ideal, but here's how you can kind of think more with the clinical hat on it's a little bit similar to being like a clinical instructor. I think that's the greatest part about being a clinical instructor and shameless plug for those of you that are out there that are not clinical instructors. We need a lot more of them there. You know, our students are. It's such a rewarding experience. It really is. It's time consuming, don't get me wrong, but it is very, very rewarding, but I'm so be so being a clinician and being able to, to give the clinical the true clinical perspective on some of the things that students is learning, I think can be, can be invaluable. Like I have students all the time. They're like, Sylvia, this this sounds like a load of hooey like this doesn't even make sense, like help me understand when I would ever do this, and to be able to tell them look, you know, this is exactly why you need to know this level of detail, or this is why as a, even though, you are determined to go into sports, physical therapy, or you're determined to go into orthopedics. This is why you need to understand neuro for example, like, this is why they teach you neuro related things. I think I posted on Twitter, you know, like a couple of weeks ago, I've been to patients this year, that I think I'm, you know, not to toot my own horn or anything, but it's unfortunate, these people fell through the cracks, I think, in referring them out, both of them have gotten a diagnosis of ALS that nobody caught before this point. And it was based on what history they had given me, as well as some of the signs and symptoms that I saw with it within them. They referred to me like one had scoliosis, and horrible back pain, and another one that was a total knee replacement. And those are not diagnoses, you would expect to have ALS diagnoses associated with them. But some of the other things they were describing, it was terrifying. And just, again, like these are things to help students understand that they all do go together, you're treating a person that doesn't come in with a strict diagnosis, you're treating a whole person. And they don't always get that in the education setting when we're giving them fabricated cases.



Yeah, I couldn't agree more. And that's, that's amazing, by the way, from a clinical standpoint, that you were able to refer them to the right people to get the right diagnosis. Yeah. And that's, you know, and again, that's where physical therapists come in. And I'm sure that this is part of your teaching to your students that, you know, we can be that kind of primary care provider, you know, and even the second opinion,



sure, sure, yeah. And it is, it is one of those, you know, Missouri is not a direct access state. And so it's interesting, like teaching in a non direct access state, because we do typically get the patients they have the referral, it's generally pretty accurate, but you get some of these that fall through the cracks. And it's why we get the training that we get as physical therapists, you know, for those scenarios. But even again, in a non direct access state, these patients had been screened by other physicians, and it possibly just the complexities of their care, it just things got missed. So



amazing. Well, now, let's talk about what your responsibilities are, as a clinician, educator, so if you want to break it apart clinician educator, separately, or just let because I think it's important if people are interested in in, going in this direction, they need to know what it entails and what their responsibilities. Sure.



So I think it's a little bit different if you're so so my position is a faculty member means that I split my my time, assume a 40 hour work week, you know, nobody who actually works that when they're a faculty member on any any academic program, but, um, so I split my time for many people that come from a physician, whether lab assistant, in addition to holding a full time job, that's usually hours, in addition to whatever your hours are in a week. So when I was working as a lab assistant, before I joined faculty, I was working 40 hours a week plus lab assisting X number of hours a week, so there was a little bit of that, because very few employers will give you that time off and say, Oh, you want to live six, eight hours, we sure only work 32 hours here, like, it's very difficult to get that. And then depending on when the classes are during the day. So we have labs from like one to three, some people couldn't do that it's smack in the middle of prime, you know, treating hours. So that is definitely a consideration that people want to make. If you're working part time, it becomes a whole lot easier. Your schedules are a lot more flexible, as a faculty member, so I have 20 hours a week, again, dedicated to patient care, 20 hours for teaching. So in my patient care responsibilities, I basically have a set schedule that is has to be designed around the times that I'm supposed to be in class. So that has to probably be the worst for the person for my for my clinic boss who has to come up with the clinic schedule. He's working around everybody's class schedules and the times that we can actually physically be in the clinic. And so I treat in our clinic, we have a one on one model, so we don't overlap patients, you know, and so that's, that's really nice. We do have physical therapy assistants that we work with as well. And so I balance my caseload, I feel like any like I would anywhere else, I have autonomy to decide when I want to delegate when the patient needs, needs to come back to CV, frequency, duration, all of those kind of standard, standard types of things. Um, I am fortunate because I've been there long enough that I do get a little bit of flexibility and asking for the patient. Two types that I want to see. So I love the postoperative knees and any knee, really. So I do get a little bit more of those than maybe some others do seniority, it's great. And then my academic hat is complicated. So I'm depending on what semester in the year that we're in. And we're also going through a curriculum renewal right now, which is a whole nother whole nother topic of discussion. But in some semesters, I am a course master for for a class. And so that entails doing everything you would expect from a course to making sure the syllabus is up to date, to organizing exams, practicals, lab assistants, supplies, outside lectures, patient labs, etc. to an other the other semester I am, quote, unquote, just a course assistant, so facilitating the course master with all of those duties. So those hours are kind of wrapped up in our actual academic time. So if I have 20 hours a week, and I'm only in lab for 12 hours, my other eight hours are supposed to be spent doing all these other behind the scenes things which are, which easily kind of add up. So it is a little bit of a mix, and the curriculum renewal that I was talking about. So Wash U is going towards more of competency based education, which I think is the movement in education as a whole. And so we're we're in the beginning stages of that our first year classes going through the start of our new revised curriculum, and I am helping to craft the second year curriculum. So that's a huge task, taking what we currently have reorganizing it, restructuring it into an even better product than what we currently have. So there's a lot going on, that is certainly more than 20 hours a week. So yeah.



And can you explain competency based education versus what's currently happening? I don't know if that's like opening a huge can of worms. But let's go for



Yeah, yeah. It's also challenging my my full understanding of this, because it's all it's all this is like a complete foreign language. It's like going through, as I as I kind of alluded to earlier, I'm going through, I'm becoming like, I feel like I'm going through to get my education degree in the process of learning how to teach the this material better. So with the competencies, it's essentially like saying, Okay, you're competent in gosh, there's domains, there's, there's all sorts of terminology, but basically saying that, like, okay, that you have this one domain of patient and client care, within that you have different competencies, like, I'm able to take a, I'm making stuff up, because I don't know them off the top my head, but like, able to take a complete history for like, able to do communicate with respect and dignity for the patient and care provider, like things like that. So there's different things that this student is now having to pass and show competence in these competencies, a pass individual competencies, versus getting a grade in a class to say, you're good enough for that grade, it could be really strong in one area, but really not great and another, but their overall grade is enough to move them forward. We want to kind of raise the bar a little bit and say, You know what, that was good. But we can do better. And taking it to like each one of these competencies you need to pass in order to continue on curriculum. Got it?



Got it? Well, that makes actually makes a lot of sense.



Does now trying to make every lesson plan, every lecture that you give mapped to every competency that you have is a whole nother topic of discussion. Yeah,



good luck. Yes. Yeah. Good luck with that. And now something that you kind of alluded to before, which I want to dive into is, so your 20 hours practice care, 20 hours teaching, and I put 20 hours in quotation marks, right? So we know as clinicians, it's always more than 20 hours, right? And in teaching Gosh, it's definitely more than maybe what you signed up for. So how do you and here comes the question, how do you balance all of that with the rest of your life? Because you've got kids?



I've got two teenagers. Yes, got a dog.



I've got two dogs, actually two dogs, you've got a home, you have got a life outside of all of this. So what do you do to balance it all?



Yeah, so that was probably the most challenging thing that if I could have gone back in time and talk to my younger self, I would have been like, don't say yes to everything. That was probably the first thing that nobody really ever told me. Because I thought that if I said, No, nobody would ever asked me to do anything again, you know, you feel like this. Oh, this is a fantastic opportunity. I don't know where the time is gonna come out of but I really want to do it. And so I just started I would say at the time yes to pretty much anything that sounded interesting. And even yes to some things that I was like, I'm not sure if this is what I want to do, but I feel like if I don't say yes, I'm going to lose this. They're going to think I'm not interested in it. Think so, naively when I was when I was a younger faculty, um, that's what I did, I said yes to literally everything and almost put myself in a horrible spiral of I had so many issues in terms of that work life balance, I didn't have any it was work, work work. And then life was like a tiny fraction of that. And that was when my kids were little, I've got teenagers that are 17 and 14 now. Um, but what I discovered over the years was that those opportunities are at least and I still believe this, if those opportunities were meant to be, they're going to come around again, if people really want you, they value your expertise and your knowledge and your skill set, they will come asking around again. And you know, just saying no, one time, and just even saying like, No, you know, what, now is not the right time, I'd love to help you out. Can you come back again, like, you know, if you have another project, just ask me. I mean, hopefully I'll have time at that point, you know, there's no, there's good ways to not just firmly shut the door right to leave that still open. Um, so I've found a better balance for myself now, because I've figured out what is super important for me, and what is not, like really important. So I started saying no to different class commitments that I had previously done, because it was it was stuff that was okay. But it was not my passion in teaching. And so I started whittling down to the things that that made me honestly, the maybe the most happy to think about teaching or be involved in. And when I started doing that, I did become happier with with how that balance was shaping up, because some of that work really wasn't work anymore. You were enjoying doing it, versus looking at it and saying, Man, I got three more hours of this that I've got to prepare for, and I'm just not feeling it. You know, there's a reason nobody's ever asked me to be an anatomy lab assistant. And it's, I mean, enjoy anatomy. Don't get me wrong, but the level of detail I just, that would that was not my forte. No, that was not my forte. And it's like, I want to know the applications and things that I'm interested in. But some of the things that they have to learn for PT school, it just wasn't wasn't in my wheelhouse. You know? Yeah. So it's like, things like that, where, where I just prioritize a little bit better.



Yeah. And I was gonna follow up question I was going to ask is, How did you? Like, what methods did you use to decide what was best for you? And what methods did you use to break down? Like, no, like, this is a No, maybe not forever? But uh, no, for now, this might be a no forever. This isn't a solid? Yes. Do you know what I?



Yeah, yeah, it wasn't in certainly not easy. Um, it came again, across several, several years to try to figure that out. So part of it came down to okay, I was lab assisting in multiple classes. And did I really want to stay lab assisting in that context? If the context, if there was a, there was an immediate hesitation in my answer, then I thought, okay, that can't be the number one priority that I really want to stay in that class. So then I started adding up hours, and how many hours a week? Or really, am I spending in that class? What could I replace it with? Um, is there another opportunity right now that I want to replace it with? So it was sort of like, figuring out the timing of things would be one thing? And then some of it was just just deciding, okay, well, I know it's gonna throw me over the, the 20 hours or whatever that I have right now. Am I okay with that for a little while. And for a period I was and then now that I'm older, I'm not, you know, I've got I've got a, I've got a teenager that's going to be leaving the house in two years. And I've decided, you know, what this would, this is the time I actually I want to spend with her, you know, not that I didn't want to spend it with her as a little kid. But now I'm like, feeling that like, empty nest feeling starting to grow. And I'm like, I don't want to miss, you know, all the things that she's doing. And, and so I've just prioritize, you know, what, no, I'm gonna say no to that. Or I'm gonna say, you know, I can't do this this year, or I can only do this for part of the time, like, admissions committee, you know, figuring out who we accepted to our program. Like, well, I can't do it the whole year, but I can do it for part of the year Will that be okay, you know, and try to work out compromises with the people that are there looking for my time.



I love it. And, you know, so often women have such a hard time with this. Yes, you know, yes. Because we think if we say no, like you said, That's it, we're done, or we're gonna be labeled difficult, or, you know, someone that you know, she doesn't, she's not interested. We'll never get back to that. Right. So I think it's, as a woman, we really have to kind of get over that kind of thinking and and realize like, Hey, if you say it's a no for now, but not a no forever and the people are like, Oh, God, she was setting it up, well, then they're probably not your people. Right? And that's okay to let that go as well. Right.



I think what also complicates it a little bit is this whole Superman thing, right, like women that believe they can literally do everything. So you've got to be the best parent, you've got to be the volunteer at all the PTO, whatever school stuff, the sporting team, the in then at school, and then it works the same thing, I got to be able to handle this whole load and show nobody a crack in my facade, you know, so that they can see that I can do it, you know, and if I do you crack, then they're gonna think that I'm weaker, you know, just stereotypes that way. I think that's obviously it's really unfortunate that that still exists. Um, but, uh, I, we're not super human, like we have, you know, we have breaking points too. And we need to know what those are for ourselves for our own sanity, you know, for the sanity of our family members, our friends, all the people around us, you know, the pets, yo, all of that. So,



yeah, and your students as well, like Have, have you ever kind of displayed that vulnerability, whether it be to your employer, obviously, your family, and that's a different story, but maybe to your employer or to the university, to say like, I'm reaching a breaking point. And so how did you do that?



Yeah, definitely. to the employer. Um, yeah. So So there have been times where and unfortunate our program director, gammon Earhart is amazing. And her predecessor, the CCD singer, was was great, too. And they've always been wonderful with this sort of open door policy. So when you hit that point, or you feel like you're coming up to that point, I felt 100% comfortable going to them and saying, Hey, guys, look, I am, I'm over my head right now. And I don't know what to do. Like, I really need some help. And they kind of talk you down a little bit and say, Okay, well, how can we make this better, I have been very fortunate to be supported in that role. Same thing with even my immediate supervisors within the clinic. Same kind of idea. I had some personal struggles earlier this year, unrelated to COVID. And having and knowing that I had that support system, by being in a good place, I think this is true of any job. But being in a in a in a supportive environment, where they were like, take the time that you need to get your your self. Right. You know, it was it was very nice to know that I had that kind of support.



Yeah. And so I think the moral here is, it's okay. Absolutely, to let people know that you're not okay. And it's okay to be vulnerable. And if you're the people you're working with or for don't accept that, then I think it's a clear sign to say, Well, wait, wait a second, what am I doing here?



Right, right. Yeah. And I would love to say like that, I have been fantastic. And always being vulnerable. That is definitely a lie. Nobody, nobody, nobody, nobody is and I, I, you know, grew up in a, in a, in a household where perfection was like, required, it wasn't even, you know, it was it was an expectation, just as you know, my hair is black. And it will say, well, it's gray now, but that it'll say one color like it was the expectation you will be perfect you will be you will not show or have any flaws. So bringing that into a scenario like I am in right now and telling somebody I'm not like I'm vulnerable, I'm hurting, I need help, like even asking for help was was a huge, huge deal for me. But again, I had I had a good support structure, even within my workplace environment to allow me to do that.



Yeah. And it is, it's hard to ask for help, you know, because because you don't want people to think you can't handle it. All. Right. Right. Right. So asking for help is I know, I have a really hard time asking for help. But I'm getting better at it. Yeah. But it is, it's hard to reach out, it's hard to ask for help. Because you're afraid that someone will maybe think of you as less than or incapable or whatever, you know, all those bad things that spin around in your head, right?



Or just that if they're thinking about asking you to help out with something that you really want to do, they're not going to ask you anymore, right? Like, you know, and kind of where I'm at as a as an associate professor trying to rise to the professor level in a couple of years, trying to take a larger leadership role in our curriculum, there was definitely a fear of well, wow, if I tell them that I can't handle what I've got right now. There's no way they're going to ask me to do X, Y, or Z. So do I risk doing that? Or do I just drown? And I wasn't willing to drown? No, no, no job is worth that. My personal happiness was not worth that. And again, fortunately, everybody was very understanding the the fear that I had built up in my head was no near nowhere near what I experienced at all. Like it wasn't there. They were like, You know what, we get it. Take the time that you need, it's fine. We'll figure it out. And we'll help you figure it out. We'll give you whatever resources you need, whatever support you need. So it was wonderful. It's really wonderful.



Yeah. And it's so important to kind of voice that because like you said, you're trying to kind of climb up this academic ladder. So if you never voiced that maybe you would never, you would never reach that Professor level. because you would have burned out left. Absolutely. Yeah. Right. So why not put those fears out there and and find the things that like not to use Marie Kondo here. I don't know if you know Marie Kondo she's so Marie Kondo is like this organizational guru. And her thing is if it doesn't bring you joy, get rid of it. Yeah. And so I wrote that down when you were talking about how, you know, anatomy lab, not for me doesn't bring me joy. This does. So I'm sticking with this. And and what you find is when you do the things that bring you joy, this sort of Marie Kondo method, I mean, she doesn't like, you know, does this shirt bring you joy? And if it doesn't know, this book, this, you know, tchotchke, whatever it is, but you can you can apply those principles, I think, in this scenario, when deciding what to say yes, and what to say no to? And even if you have nothing else on your plate at the moment, you can still say



no, sure. Absolutely. Absolutely. Right.



You can still say no, and that's okay. Absolutely, well, this oh my god, I'm so glad that we talked about this is so good. So let's, let's talk about now, I would love to get from you, maybe two or three pieces of advice that you would give to a clinician who's trying to break into the world of academia. Yeah,



so, um, I think with with clinicians, the first thing is that you've, you've got to know what your, what kind of teaching you want to do, right. So like, if you're, if you're an orthopedic just being happy with, I'll take any orthopedic class, that could take you from going geometry and manual muscle testing, to examination and treatment kind of thing. So knowing sort of what level you want to be involved in helps. Because when you're then approaching the education division director of a program, that's usually who you send your resume or your CV to, when you're interested, they can have a better idea of whether there's a need honestly, in the in the curriculum, for another lab assistant for another lecture, if there are certain topics that you know very well, that you are passionate about, that he would love to lecture on. I'm even offering that up, like, hey, you know, I have a special interest in blood flow restriction training, but I'd love to be able to share that with your students. You know, this is my experience and background with that, let me know if there's there's any any availability for that, I think that's that's another part of it. I do think that it is, um, it is nice if you have a connection to the school, I mean, obviously, like, I got fortunate, I graduated from Washington at school, I'm now in faculty here. So I already had a connection to the program, it made it easier for me to get my foot in the door, because they already knew me as a student. And then as a clinician, because I was in the area. I do believe it is harder when you don't have those connections. But that's where I think networking in general is huge, right? So like you and I, we met through the Twitter verse, and then of course in Vancouver, but like making connections because people that you connect with have connections elsewhere, right. And they might know, just in talking to you. They might say, Oh, wait, I remember Sylvia said that they were looking for X, Y or Z at their at Wash U, maybe you should reach out and talk to her and see if there's anything going on. You know, I think connections are the other part that that people value, but you don't necessarily value maybe as much as you should. As a clinician, I think I take for granted that. And I don't know, if you feel the same way, we travel a lot, we get to go to a lot of conferences, we get to get a lot of all these pre COVID, we went to a lot of conferences. And that's where a lot of the networking happened, right. Clinicians do have to take continuing education in order to keep their their licenses active. But I feel like clinicians are probably taking the cheap local easy place near them to take on it because they don't probably have the benefit, always a funding behind it like I do at an academic institution. And I think that's, you know, you do what you have to do, but finding other ways to network, whether it's through your state organization, like the Missouri Physical Therapy Association here, through the national organization through some of the sections like sports section, ortho section, you know, getting involved that way to make connections, you don't have to attend conferences to do this, but you can get involved. I mean, everything's through zoom right now, you know, and so being involved that way to make connections can get you in the door in other ways. And I think that's probably an underappreciated part of the whole, how do I get my foot in the door?



Yeah, I would agree with that. And I love all the options that you just gave for clinicians and even students who are thinking, hey, one day I want to do both. Sure, right. So let's know what kind of teaching you want to do. Reach out to people in the school if you have a connection if you don't have a connection start making those connections. Absolutely right. And as a student, I think connecting through whether it's a PTA in general, or the components or your state is a great way to do that. And I would also say, stay in touch with the with your professors.



100% 100%. Yeah, I mean, and your clinical instructors as well, I mean, for me, my first job coming out of PT school, was because I went back to talk to one of my clinical instructors, and she's like, Hey, by the way, we have a job opening, would you be interested in applying? And I said, Oh, I'm not sure. And she goes, Well, I already submitted your name. And literally, that's how I landed, my first job was like, Okay, well, I guess I have to like, contact them now. So it was great. Yeah.



Yeah. I love it. I love it. Okay, so now, as we start to kind of wrap things up, is there anything that maybe we didn't hit in the conversation that you came in? Like, ooh, I definitely want to talk about this. Did we miss anything?



The one thing I will say is, is being on faculty, what did help me was naturally meshing and getting myself a mentor on the faculty. So not all academic institutions, like I know why she didn't have it at the time. They didn't really have like sort of a mentoring program for new faculty joining. And I don't know if this is true for all academic institutions. But for anybody that's interested in doing that, or joining an academic institution, as a clinician, academic, or as a researcher academic, is understanding if there is some kind of mentoring program because without the guidance of my mentor, Marcy Harris, Hayes, there is no way I'd be where I was at today, Marcy was like, kind of like my voice of reason, she was the one that was just like, Okay, you your interests are like humongous Sylvia, you need to narrow it down a little bit, you cannot keep saying yes to everything. She was the one that pushed me in certain directions, because she knew that a gentle nudge would help me get to where I wanted to be, even if I didn't want to take that leap for myself. If I was doubting myself, she would be the one that would say, you can you can do this. She was the first person that put me in front of a crowd of 300 people at CSM. So I have a lot to say, and I never would have, I genuinely never would have done that without for encouragement. And her understanding that I was ready for it. As well as it was something that was going to help me in the future. And that I'd appreciate it later on down the line versus my fear, again, of doing it on my own, would have prevented me from getting that far. So so definitely identifying a mentor. And again, this is for clinicians, even to in the clinic, like don't go into a clinic, and just expect to just learn it all just on your own or through Con Ed guy, I would hope that whatever clinic somebody joins into, has some kind of mentoring program as well. So that you can learn you can shadow you can get experience from other people. And it's different than just being able to say to your your pod mate, hey, I had this patient that was a little complicated. What do you think like truly having a mentor, I think is a big, big thing. To help enhance the level of clinician you are as well as again, if you're an academia, how to get up that level ladder and how to navigate it to I think that was the other thing Marcy gave me was some advice on how to how to get a little bit further because she was ranked ahead of me, and she had some great personal experience. Pros and cons, I guess you could say, to navigate that.



I love it. I think that's great advice. And I love how you said not only get up the ladder, but navigate it as well. Right? Because there's a lot of things that are gonna push and pull you along each rung of that ladder. Absolutely. So I think that's amazing advice. Okay, where can people find you if they need a mentor? Or they have questions?



Yeah, so Twitter's the easiest place. So I think you've got my contact information, but I am on Twitter, and an email is perfectly fine as well. So they can find my email address just to the washi website. Or really, if you just Google my name, it's pretty impossible to miss. There's not that many Soviet coupons out in the world. There's none, in fact, so it's pretty easy to find me I come up readily on a Google search.



Excellent. And we will have all the all of those links in the show notes. And now I have a question that I asked everyone at the end, but you already answered it, but I'm gonna ask it again. And that's what advice would you give to your younger self?



Yeah, totally. My younger self would be learn how to say no, and how to prioritize what you really want to do. prioritize what's going to make you happy. What's going to make you the clinician, the person that you wanted to be when you grew up, you know, because if you sacrifice what you want for what everybody else wants, you're not going to be happy. Perfect, I



love it. Thank you so much. I appreciate this conversation so much. I appreciate you for coming on. This was wonderful. So thank you so much.



Yeah, thank you so much for giving me the opportunity to be on I appreciate it



too, of course, and hopefully we will see each other in person soon. That



would be fantastic. Indeed, indeed. All right, and everyone,



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

Nov 23, 2021

In this episode, Physical Therapist at Kelly Hawkins Physical Therapy, Meagan Duncan, talks about creating safe spaces for the LGBTQ+ community.

Today, Meagan talks about trauma-informed care, navigating trauma during the subjective exam, and the importance of consent. How can PTs make clinics safe spaces for the LGBTQ+ community?

Hear about the discrimination faced by the LGBTQ+ community, doing community advocacy work, and get Meagan’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Gay men can undergo sexual violence at twice the rate of straight men. 50% of transgender people will experience some kind of sexual violence in their life. It’s even more if they’re a minority.”
  • “Being trauma-informed is important in any discipline because you don’t know what somebody has been through.”
  • “I think it’s about really small gestures.”
  • “Starting with paperwork, gender has every option you can think of. If it’s a paper form, gender’s a blank space.”
  • “We have small flag stickers for every flag that you can think of with all the colours that represent different parts of the LGBTQ+ community.”
  • “Be more vigilant about asking for consent.”
  • “Asking for consent is something that should be ongoing and all the time.”
  • “Education is a big part of asking for consent, because in order to consent to something, people have to understand what it’s going to entail.”
  • “Providing options Is a really important part of consent.”
  • “It’s not patient-directed care. It’s patient-centred care.”
  • “Don’t just go around touching people without consent.”
  • “Find a niche. If you can find a niche that you are passionate about and that is needed, you are never going to struggle for work or for satisfaction.”


More about Meagan Duncan

Meagan Duncan is a Chicagoland native who earned an associate degree as a Physical Therapist Assistant in 2013 from Kankakee Community College. She then worked for six years in an orthopaedic setting while earning a Bachelor's in Interdisciplinary Studies from Governor State University in Illinois. Later, she moved to Las Vegas to earn her Doctor of Physical Therapy degree from the University of Nevada Las Vegas in 2020.

As a PTA, she developed and ran a pro bono clinic at her first post grad job in her hometown of Joliet, Illinois. She now practices in Las Vegas and specializes in pelvic health after completing a specialty clinical rotation with the VA Hospital in Las Vegas.

Duncan currently works at Kelly Hawkins Physical Therapy, a prominent outpatient physical therapy company in the Las Vegas area. At Kelly Hawkins, she built a successful pelvic health program that she has overseen and grown over the past year and a half.

Duncan also works for NPTE Final Frontier, a premier national physical therapy exam preparation company that works with domestic and foreign trained students to help them pass the board exam. In this role, she tutors PT and PTA exam candidates and assists them with content development. She advocates for students and professionals to balance life outside of physical therapy.

Outside of her profession, Duncan enjoys hiking, biking, paddleboarding and anything she can do outdoors with her husband and dog. She is excited to welcome a new addition to her family soon, as her first child is due in a month.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, LGBTQ+, Inclusion, Trauma, Pain, Discrimination, Sexual Violence, Advocacy, Consent, Pelvic Health,


To learn more, follow Meagan at:



LinkedIn:         Meagan Duncan


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


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



Hey, Karen, awesome to be here. Thank you for having me.



Yes. And like I said in the intro, today, we're going to be talking about creating physical therapy space, a safe spaces for the LGBTQ plus community. So before we talk a little bit more about that, can you let the listeners know where your passion for this community comes from?



For um, so I guess I feel like I'm just kind of a fan of the underdog in any situation. And I can't say that I have personally experienced, like so much in this community, aside from having a lot of relationships with people, and seeing what they go through and what life looks like on that side of our world, because it's a very different experience from what I've had as a heterosexual, white female. So when I was in high school, I just kind of ended up best friends with a gay man. And he kind of brought me into the circle of his friends, which ended up being just a really large, wonderful welcoming circle of people on all spectrums of the LGBTQ plus community. So I got really interested in just kind of gay rights and things like that went to marches and did all of that. Tried to advocate for the community as whatever I need to do as a 16 year old, which was not very much. And now I found myself in this position that I can do something which is awesome. And it's not even necessarily something I thought about when I went into the niche that I'm in. But I am really happy to be able to finally say that there's like some baggage behind this lifelong commitment that I kind of said that I had towards the community, but was never really doing anything about it other than like, your like Facebook posts here and there that talk about, you know, advocacy or supporting a community that's not well supported. So I'm happy to be able to do something about it now.



And let's talk about what you can do, or what we can do as physical therapists to help support this community, because I'm sure a lot of people may be listening to this and say, Well, what does the community need? That's so different from the rest of of other communities? So what is it about this community in particular, that perhaps they're more exposed to certain things? Or do they not get the care that they need? So go ahead, I'll pass the mic over to you.



Yeah, absolutely. So just discrimination in general, it's a problem in so many realms of social issues, being gender and sexual preference, of course, is one of those huge ones. So people feeling like or actually having less access to healthcare, getting denied health care, or getting given less than optimal treatment, or not really getting the best of their provider because of discrimination or because of biases that those providers have. Likewise, they might be afraid to go to facilities or go get treatments for things that are going through because they've experienced poor care before. So my niche actually, is pelvic floor physical therapy. And in this, there is so much that I can do for the community and physical therapists as well. And I was thinking about this podcast and thinking, what actually makes my job so different from the way everybody should be treating everyone. And I think there's a lot to learn, aside from just treating in pelvic floor PT. But in pelvic floor PT, I see a lot of people in the community because they are much more exposed to sexual violence and sexual trauma. And that correlates really significantly with pelvic floor dysfunctions. So we know from studies that gay men can undergo sexual violence at twice the rate of straight men, transgender people will usually experience about 50% of people will experience some kind of sexual violence in their life, which is a huge number 50%. And then it's even more if they're a minority. So that's a huge community of people where like, most of them need our help or need pelvic floor PT, or need more support than they're getting. So I think that we can play a big role in advocating for people and making spaces where they feel like are welcome. Or be that person that they can come to and after bad experience, bad experience or bad experience in healthcare, they can come to you and feel comfortable. And that's a really great feeling from my end. And I hope that other physical therapists out that out there feel better experienced that because it's awesome.



And you know, when you're talking about sexual trauma, or sexual assault within this community, I mean, the thing that sticks out to me is trauma. And so there is more and more research. And I think more and more people are now aware of trauma informed care. So can you share with us some of the principles of trauma informed care and why physical therapists should care?



Yeah, so this is kind of one of those things I was thinking about. trauma informed care and pelvic floor physical therapy is like, every class every time, we're always talking about every continuing ed course, because the nature of the work is so intimate, and very personal. And we're asking questions that make people uncomfortable, and hopefully not too much, but putting people in uncomfortable positions a lot of times, and it takes a lot for somebody to even come into my office to tackle these issues. But I think we should all be kind of treating in that same way. Because we don't really know like, of course, I know, when people come in for pelvic floor PT, they're probably uncomfortable. Like most of the time, people don't really like, want to be there. They're there because they need it. But that goes for a lot of things in physical therapy, right? Like people don't want to have back pain and come in and like, a lot of people don't want to get like touched and massage like, that's not what they intended on doing. But here they are, because they need it. So being trauma informed in any discipline is really important, because you just don't know what somebody has been through. So talking about trauma informed care, I think understanding a little bit more about trauma is probably a good place to start. So I do kind of think everybody should



reflect a little bit on what that means. So I was thinking of a good example. And I think that trauma can be kind of like pain, where we don't have a measurable, like objective measure for like, what pain is or what trauma is. So I know if a patient comes in says they're in six out of 10 pain, I have a patient with that same diagnosis that might say they're in two out of 10 pain. Or maybe I see, let's say I see somebody with a knee replacement. And I know that like a good healthy knee should have zero degrees extension, right. Or before they leave the hospital, we want them to have 90 degrees of flexion. But like I can't say to somebody, like you have a 15 degree trauma contracture. Like that doesn't make sense. There's no reference point that we know of other than what that person's experienced. So it's important to understand that trauma is different for each person. And some people could be really traumatized by an event. And some people could not really be traumatized by the same event. And that could depend on what factors they have in their cultural background in their other life experiences or the lens that they see things through. So somebody could experience their parents getting divorced, and maybe they came out of that fine. And they're like, Well, I came out of that fine. I don't know why it's so hard for everybody else. But you don't know what it was like to experience that with these other issues around you with being a minority or having financial distress or anything else like that. So understanding traumas is the most important part first. And then when we talk about trauma informed care. And this is from a Substance Abuse and Mental Health Services Administration, there's kind of the principles of trauma informed care, what does that mean? So the first part of that is to realize that trauma is a widespread issue. And it is invasive, and pervasive, and it affects people in a lot of different areas of their life. And then also realizing that there are pathways to potential recovery. After that, we should be able to recognize the five signs and symptoms of trauma. So recognize what is trauma look like? Sound like? How does that patient act? How can we pick up on if they're a traumatized individual. So seeing a patient being uncomfortable in your clinic, they might not make eye contact with you, they might not want to face you directly, you might see their body language is a little bit off, their arms are crossed. Things that we've all seen. We all have patients probably every day ranging anything from like that super bubbly, happy patient to the one that comes in and has done PT before and had bad experiences, and they're really unhappy. So recognizing what does that look like, and then responding by implementing that knowledge into practices and policies within just not just yourself, but the the facility as well. So using what you know, to actually change or adopt practices better, going to be more inviting or more informed and make more comfortable spaces for people that are traumatized. And then we have resisting retraumatization. And this, I think, is the most important part for us as clinicians. So thinking about what we can do to make an environment that does not correlate with any kind of trauma, anybody has had to make them have to revisit that. So and that could be anything again, like there's traumatic events that range from, you know, like really terrible sexual violence, and these are maybe things I hear about, but then there's also the trauma of like, having been misdiagnosed or having been told this or that by that provider or getting a hopeless diagnosis or being told that there's nothing that can be done for them. Those are things that we can actively try to resist re traumatizing that patient in. So being on honest and informative, making sure that we're not making false promise promises, but also that we're providing hope. And then thinking about what our space is like. And this is probably relative, maybe a little bit more for like LGBT, t plus LGBT plus community, where I am making sure that my space has signs that say All are welcome here. And things that make people feel invited, because they very possibly have had an experience before where they walk into a facility and like, immediately feel discriminated against or immediately feel like, this is not a place that I want to be here, this is not a place that's going to give me good care, and maybe the Carolinas without a dentist, but at any rate, they've experienced that and probably are very likely more than once. So I want to make sure that whatever I'm doing is not recreating any of that for them.



And when you are, understanding what trauma is, and really trying to understand the trauma of the person sitting in front of you, right, I would assume a lot of that comes through our subjective exam. So do you have any advice for therapists who are navigating these waters, even newer therapists perhaps are navigating or who maybe aren't, are not as well practiced in the art of the interview? Or in that process of, of that subjective exam? So do you have any like, what types of questions do you ask that kind of stuff?



Yeah, sure. Um, so I asked a lot of questions and pelvic floor PT. But I think the more important concept around that is, um, sometimes instead of asking questions, I, and that's not that we're talking at patients. But I do take a moment to do this. And if I am getting a sense from a patient, that they may have experienced trauma, that they're not going to share that with me. And that is probably more likely than not, especially on the first day, when I'm doing my initial evaluation, they don't know me, they don't trust me, they don't really want to share any of this with me, let alone even be there. So, a lot of times, I'll take the opportunity to talk about how trauma or how other experiences can relate to pain. So I might say to, let's say to my pelvic floor patients, I don't need to know or I don't need you to tell me any details or anything. But I am aware that trauma increases pelvic floor dysfunction increases pain, and it can really affect the way that people recover. So if there's anything that I can do during this treatment to make you more comfortable in any way, let me know if we need to stop anything. We're doing them, you know. So I might just take it as a piece of information, instead of asking a direct question, like making them tell me, maybe they'll do that later on in another session or two. Maybe I might need to know more at some point. But I've really never ran into that situation. A lot of patients will tell me the extent of it right there. They might do it another session or two. But it's not something that I really want to force out to people like day one, because if if I do that, like are they going to come back? Because that re traumatizing them? Have they been forced to talk about it before. I'm not a psychologist, I'm not a psychiatrist. I'm maybe not the person that they want to share all that with. So I want to make sure they have the open door to tell me about it. But I'm not like dragging it out of them.



Yeah, that's, that's wonderful advice. I really love that. And the other thing is, that I heard a couple of times during kind of these principles is creating that safe space, creating that space, where like you said, Everyone is welcome. How do you have any other tips and it could be from the person at the front desk all the way to, to the therapist and every employee in between? So are their conversations with the all the employees who work at the within that space? And and this may seem kind of like a silly question, but I think it's important, but colors on the wall artwork, things like that. I think it makes a difference. Right. So what do you what do you think?



Yeah, so I think that maybe places are a little bit hesitant to, like, fly this giant rainbow flag outside their door, right? Like, I would totally do it if I have my own clinic, but I recognize that I'm like, you know, working we're still working in a world that like from a business model. Maybe we don't want to do that because we want everyone to feel welcome, right? But it doesn't really take much. I think it's about really small gestures. So in our clinic, starting from paperwork, like they fill out paperwork online. And gender, for example, has every option that you can think of. If it is a paper form, gender is a blank space, so that blank space leaves people the option to write how they identify. And I love that option because That's even better than having to choose from like an overwhelming amount of options, or not finding the option that you're looking for. So a blank space for gender is fantastic. And then what we have in our clinic, like I said, small gestures, I think small gestures are really the thing, we have very small little flag stickers, like on the Plexiglas from our front office. Just little flag stickers for like every flag that you can think of, or it has like all the colors that represent different parts of LGBTQ plus community. So that little flag makes such a big difference, because I'll tell you, a lot of our patients are not going to notice it, like your patients that don't identify in any of those ways are not even going to notice it. But those people that do are going to see it, and they're going to love it. And we get compliments on that all the time. They think like, Oh, my God, people are so thankful for this little tiny sticker, we got like four pack on Amazon for like, probably a couple bucks, you know, just doesn't take much. And then another thing that we have in our waiting area is a sign that says All are welcome here. And that's such a simple thing, because that's not offending anybody that's making all people feel welcome. And people that are looking for that in their space, they know exactly what you're talking about when they see that fine. And everybody else is just like, oh, that's a nice thing. And they might not think very much of it. But it's certainly still a good thing to hear like, older people are welcome. Younger people are welcome. Everybody's welcome here. So it's really easy option.



And I love that these are all really easy, inexpensive, and accessible ways to show that you are working hard on creating a safe space for everyone. And like you said, a safe space for the LGBTQ plus community who oftentimes can't find those safe spaces.



Yeah, yeah. Another another small thing that I do personally, because I want my patients before I even go into their room maybe to like understand that I'm an advocate, I just have like a rainbow water bottle. And that's what I drink out of that work. And they see that sitting on my desk, and maybe some other stickers on like my laptop and stuff like that. But something that they might see like, Oh, that's my therapist, and they see like a rainbow water bottle. And it's just like a little thing that makes them feel more comfortable. I love it. I love my water bottle, so everybody's happy.



And do you go out physically into the community for advocacy work or as part of the clinic just so that people know that you're there? You know, like, how, how does that work within your community? Because I'm sure there are people who I mean, I'm in New York City, right? So I talk about like a large amount of people, right? So how do people know how to find? So how do people, especially in these marginalized communities know how to find the people who are creating spaces for them? Yeah,



so most communities, I'm in Las Vegas have support centers or community centers that support or provide or refer to services like my own or other providers that they know, create these safe spaces. So we have a support center here in Vegas, I've spoken to a little bit, I'm not necessarily within everybody's insurance providers. So that makes things a little bit harder. I'm in pelvic floor PT, I get so many patients from all over. And I've had a very long wait time, it's been tough to go out and mark it. And I'm also leaving for maternity leave actually in a couple of weeks. So I have plans for when I come back to reach out a little bit more, but I have been swarmed with what I have. But going out into these community centers, just letting them know who you are dropping off some cards, I have done that. And that is a really good way to at least get started. Get your name or your clinic out there. And maybe you're not what every person is looking for. But if they have your card handy, and they are providing social services to somebody, they might say, it sounds like you could benefit from this I know a great physical therapist that you could go to. And then, of course, we're a little bit bound by insurances. And that's definitely something I see in my future is trying to provide a little bit more preventive care to people that are uninsured or under insured. But that's probably a future problem for me at the moment. Right.



Right. And I think that's great advice. So if you're in a city, reach out to local community groups, community centers, things like that, and I think that's a great way for you to get out and in the community and really make a difference. And now there's one more thing that I want to talk about before we start wrapping things up. And that is the importance of asking patients for consent. So you touched on this a little bit, right? But especially in the pelvic floor world. Where does this explained explain to the to myself and to the listeners, how you go about asking for consent And why this



is yeah, this is definitely like if we can take home anything from if listeners could take home anything, it's to be more vigilant about asking for consent. And I can kind of trace this back to like how I've evolved in asking for consent. And I think about an IC O I think probably hope I'm probably not the only one guilty of this. But when I started, I started as a physical therapist assistant. So way back, when I graduated as a PTA, I went to work at a facility where the, the clinic was pretty manually aggressive, a lot of manual therapy, a lot of kind of aggressive manual therapy, which can be a little jarring for patients that are maybe not prepared for that. But I think about how many patients, I just went into the room and like started palpating, or like, Okay, I'm going to check this and then just like put my hands on them. And I think now about like how strange it would be to just like, grab somebody like psi SS without like telling them where you're going, like grabbing the back of their hips or having them like face a wall and then touching their back. And that can be like a very, that can like reiterate some traumatic events for people being grabbed from behind. That's, it's, I can't believe that I did this being the person that I am now. But I did, I did it every day all the time. And I never really thought about consent, I just figured the patient was there, maybe the provider before me had probably done similar the same things as a PTA, so I assumed PT had done the same. And I just think how crazy that is. Now, to me, it just is like so out there that I would have done that. Um, but asking for consent is something that should be ongoing and all the time. So from the initial evaluation, and education is a big part of asking for consent, I think too, because in order to consent to something, people have to understand what it's going to entail. And for me and pelvic floor, that's certainly relevant because I do do internal pelvic floor exams. So they need to know exactly what I'm going to be doing. And I use a model to demonstrate and to talk about what that's going to entail, and then discuss that they have the option to consent to that or to not consent to that, if they don't, there's other things that I can work on that I can help with. So I don't want them to feel pressured, that they have to consent to anything that I asked for. So consent, those should be informing the patient pretty much every step of the way. So instead of saying, I'm going to check your pelvic alignment, nobody knows what that means, like our patients don't know what that means. So I might ask, Is it okay with you if I touched the front of your hips, and then that's how I started just kind of simple and explaining in layman's terms, what I'm going to do. And a lot of times, I'm asking a patient or giving a patient options. And this is kind of part of trauma informed care is enabling or empowering the patient to make choices or have options. So instead of saying, say I want to do soft tissue work, instead of saying, I will be right back, I'm going to go grab some lotion, and then the patient knows I'm going to do soft tissue, but they didn't get an option to consent to that. I just went to go grab it. And now they feel like they're stuck there. And I'm going to come back with lotion and they're going to get a massage and they don't have a choice. So I might say, I would like to work on this. This is why. So we can do that. If you don't want to do that. We can work on mobility in this other way. So that way they have an option for what they want to do or how they want to do it. So providing options, I think is a really important part of concern. Um, I think yeah, I think that's mostly what I mean with consent.



Perfect. Yeah, I think that's great. And listen, I used to do the same thing. And I can't believe I did that either. Yeah, just like walking into a room and just like touching. Like, I wouldn't want someone to do that to me. I can't believe I did that.



I know. And I wonder is that like, a time? A time thing? Like 10 years ago? Was it just more like then we're just more informed now? Or was I just like totally oblivious? Because that's certainly



possible. I think it's just we're more informed now. I'm gonna I'm gonna go with that, you know, and yeah, and and maybe a little bit of a being oblivious? I don't know. But you're right. Like, I would just come first of all stand up and you just be like, hands on the pelvis. And it's like, what is like, how, what, what was?



And like next to I think, like, we were just yeah, like not grabbing,



grabbing onto people's heads and everything. What's that about? I would never do that. Now. You know, even if I'm just going to touch someone's arm. I was like, I'm just gonna put my hands here if that's okay. And we're gonna. Yeah, it just makes so much more sense. And I love the fact that you tied that in with the patient education component. Because I think like you said, you can't have one without the other. It's just so important.



Right? And I think that we underestimate like how much the patient wants to be educated about things. So and that's a lesson, I think I've learned pelvic floor PT, because so many people did, like they don't even know they have a pelvic floor or what it does. So education's been a huge part of my practice, like the whole first session is really education and training, and bladder and bowel training and things like that. But patients want to know, they want to know all the details, like they love it, tell them so they know what you're doing. So they know if they want that done or not.



Yeah, absolutely. At your right patients want to know, and it doesn't matter the age, they want to know, what's going on with their bodies and and what they can do to be a part of it. So it's also a great way to empower your patient to understand and take control over their, over their bodies. You know, and and give, give the patient some autonomy and some confidence.



Yeah. And to give that the patient the opportunity to, like collaborate with you, instead of be told what's happening. So to have the opportunity for them to feel involved and to have a voice in their decision making and understand even why they're making a decision, like so that they might know. Yes, I do want this internal pelvic floor exam done. Because I want to know more about the tone of my pelvic floor so that I can know why I have pain or why I have difficulty emptying my bladder. I want them to be able to make that connection in their head and be able to consent to it. Knowing why.



Yeah. And it's all part of patient centered care. I mean, that's what we're all supposed to be doing. Right? Yeah, absolutely. It's not patient directed care. It's patient centered care.



Right. And just as relevant as it is for me and pelvic floor. I think it's the same anywhere else across the board.



Yeah, across the board. Absolutely. Well, I, you know, I want to thank you. I think this was a great conversation. I feel like I've definitely learned a little bit more about trauma informed care. So I thank you for that. Now, where can people find you? If let's say they have questions, they, you know, they want to know how they can implement some of the things you're doing in your clinic in their own clinics.



Yeah, sure. So I typically use my work email for anything like that. So that is M Duncan at Kelly And I like I said, I'm not much of a social media person I wish I could say I was that's probably not the best way to contact me.



I know you're not missing anything. Don't worry about it.



Yeah, but I'm always happy to check emails and respond that way. For people trying to figure out where to start. I did want to mention CSM has a lot of great topics on this, I've certainly gotten a lot of information, or directed myself onto what things I'd like to learn more about by going to CSM and going to these discussions. There is some information on trauma informed care at CSM this year, as well as introductions to pelvic floor PT, for those that are interested. And there are always platforms and other lectures on what we can do for the LGBT Q plus community. Excellent.



Thank you so so much. And before we wrap up, I'll ask you the question I asked 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?



That's fine to not just go around touching people.



Yeah. That advice to each other.



I think I'm fortunate that never really panned out to be anything too negative, but I would love to go back and not do that. But what I do tell people and recommend as far as career is to find a niche. So my niche is pelvic floor PT. Within that my niche is being passionate and treating the LGBTQ plus community treating patients that are transgender, that is a great niche to be in, not everybody is doing it, it is so needed. If you can find a niche that you're passionate about, and that is needed, you are never going to struggle for work or for satisfaction. Um, it really is kind of been if you build it, they will come situation. And people told that to me when I began pelvic floor pt. And that's what I did, I built a pelvic floor program, the company that I work for now. And like I said, I am very busy, very satisfied with the way my career has gone in. So find a niche and it's not something that every new student is going to know right away. But get out there and explore like go shadow and go find places that are outside your comfort zone. Like I wasn't I didn't think I was going to go into pelvic floor PT. I don't think a lot of us that end up in it do. It's maybe not something I would have thought to shadow I would have been like, that does not sound good. I don't want to do that. But again, outside your comfort zone, go shadow and find therapists that are doing things that you don't think you would ever do, and see if you can find somewhere that you're going to land and be successful.



I love it. That is great advice. Thank you so much, Megan. I really appreciate your time and your knowledge sharing with myself and the Audience So thank you so much yeah thank you and everyone thanks so much for tuning in and listening have a great couple of days and stay healthy Wealthy and Smart

Nov 16, 2021

In this episode, Associate Professor at the University of the Sciences and Director of BTE Laboratory, David Logerstedt, talks about monitoring and responding to load injuries on the knee.

Today, David talks about the most common loading injuries on the knee, difference between external and internal loads, and how to improve tissue capacity. What is mechanical loading?

Hear about David’s most recent research paper on mechanical loading and the knee, how therapists can monitor and respond to loads, how clinicians can apply the information in the paper, and get David’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “A lot of the stresses that cause the injury also are some of the same stresses that you can use to rehabilitate the injury.”
  • “Most of us have enough tissue capacity to walk, but we might not have the tissue capacity to run a 10k.”
  • “You really are trained to look at how the joint is reacting to the loads that you’re placing on it. Measuring irritability is probably the best way to describe it.”
  • “Even just asking how they feel can give a lot of information.”
  • “If people understand the ‘why’, then maybe they’re more likely to do it and follow through.”
  • “Don’t say no. Always say yes to opportunities. Especially in that early career, if an opportunity comes along, take it.”


More about David Logerstedt

David Logerstedt, PT, MPT, PhD is tenured Associate Professor at University of the Sciences and Director of BTE laboratory. He graduated with a Bachelor of Science degree in health and human performance from the University of Montana and a Master of Arts degree in exercise physiology from the University of North Carolina. He earned a master’s degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and movement science from the University of Delaware.

Dr. Logerstedt has been a practicing rehabilitation specialist for over 25 years and is board certified in sports physical therapy. He has presented his research on knee disorders at national and international conferences and has published in high-impact sports medicine journals on ACL injuries. He has co-authored several clinical practice guidelines on knee disorders.

His goal to improve the implementation of clinical research into practical and accessible for all clinicians.


Suggested Keywords

Healthy, Wealthy, Smart, Knee Injuries, Loading Injuries, Tissue Capacity, Stress, Research, Rehabilitation, Recovery, Physiotherapy



Effects of and Response to Mechanical Loading on the Knee


To learn more, follow David at:

Website:          David Logerstedt's Bibliography

Twitter:            @DaveLogPT

LinkedIn:         David Logerstedt


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Read the Full Transcript Here: 


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 Karen Litzy. And today's episode is brought to you by Net Health so when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about his new integration, head over to net forward slash li tz why to sign up for your complimentary marketing audit. And it's great, I use it and it works. So I highly recommend it. Now onto today's episode. So I'm really really happy to have Dr. David lager stead on the episode today. And we are talking about monitoring and responding to load injuries on the knee. So Dr. Lager stat is a tenured associate professor at the University of sciences and director of the BT EE Laboratory. He graduated with a Bachelor of Science degree in Health and Human Performance from the University of Montana and a Master of Arts degree in exercise physiology. from the University of North Carolina. He earned a master's degree in physical therapy from East Carolina University and a doctorate in the interdisciplinary program of biomechanics and Movement Science from the University of Delaware. He has been a practicing rehabilitation specialist for over 25 years he is board certified in Sports Physical Therapy. He has presented his research on knee disorders at national international conferences and has published in high impact sports medicine journals on ACL injuries. He co authored several clinical practice guidelines on knee disorders. His goal is to improve the implementation of clinical research into practical and accessible, make it practical and accessible for all clinicians. So yeah, so today we're talking about a new paper, that he co authored the effects, the effects of em response to mechanical loading of the knee to great paper, you can go to podcast at healthy, wealthy, smart calm, to find a link to the paper. And a big thanks to Dr. Lager stead for breaking it down for us and everyone enjoyed today's episode. Hey, David, welcome to the podcast. I'm happy to have you on.



Thank you for having me. Yeah, and I'm excited. Today we're going to talk about a new paper that your co author on that came out on to be very precise, October 20, of 2021. And it's the effects of response to mechanical loading on the knee. So of course, my first question, I'm sure this is the first question everyone asked you is, why write this paper? What is the why behind it? You know, as a, as a clinician, as well, as somebody who is now in academia, I've always kind of had this question myself, you know, what kind of loads are on the knee? And I've always had this, you know, concern about dosing and trying to figure out like, how can we can best dose exercise around the knee. And as I, as I really started to think about this more, really started to find that there hasn't been any review, or any kind of clinical commentary kind of brings at least the concept of mechanical loading, kind of in one place. And the knee is always a good model, because it does seem to have a lot of a lot of research around it. And it's an area I'm familiar with, because of my work in ACLs. And so I, we, you know, we just started, started thinking about, okay, how can we best talk about what kind of loads are being placed on the knee and, and some of it kind of kind of came out of some conversations I had with another colleague of mine, where we've really started to talk about the use of inertial measurement units and how those can start to give at least some general indications of what loads are occurring through the lower extremity. And so we decided to just kind of put a team together



who had expertise in in loading? And then expertise in specific structures related to the knee? And so that's kind of how it kind of came together. And when we're talking about loading of the knee, so in this, in this paper, you're talking about mechanical loading. So let's, let's go with some more definitions here. So what is mechanical loading? And why is it important in respect to the knee will stick to the knee? Yeah. So, you know, in the paper, we really describe mechanical loading, this is the physical forces that act on are free to make demand on the body, either at the system's level, or even on structures at a specific organ or tissue level. And so if you think about mechanical loading can kind of subdivided into different variables, such as, like the magnitude of the load, how long the load is being applied, how frequent it might be applied, or even maybe the direction or the nature of that load. So



so when we think about loading, though, all those components kind of interact, can interact with one another, and then create different loading patterns that can impact again, the knee is the organ itself, or specific structures within the knee. And when we're talking about loading, I think most people think of loads as external, so something that we are placing on that knee, but there are external loads in their internal loads. Can you kind of differentiate those for the listeners? And how, and why are both important? Yeah. So when we think about, you know, external loads, to kind of think about is like, really kind of that work that's being performed? So like, how far did I run today? Or how high did I jump? So when we think about like, like that, it's almost, it's almost kind of like that outcome in, in an essence when we think about external load. But when we think about internal load, you can either think about what what's the physiological process that's going on inside the body related, potentially related to the external load, or maybe even the psychological. And again, maybe even that biomechanical response to that external load? So So usually, when we think about internal load, it's like, you know, how what, you know, what is your heart rate doing related to how far you run? Or what is the extra? Or what's the amount of stress that's being placed on the knee after you land from a jump? Yeah, so so both are important, especially when it comes to knee injuries, and loading injuries. So let's talk about what are some of the common loading injuries on the knee?



Yeah, so if you think about some of those different types of loads, you can kind of really subdividing at least at Deneen to kind of three major categories. In essence, whether it's a compressive load, a shear load, or a, you know, a tensile load that occurs, there's some other loads that can occur, such as some hydrostatic pressure loads, but the primary ones are really related to that. And so then if you break that down into specific structures, such as a ligament, you know, like the ACL, which is one of the more common injuries that occurred the knee, you know, that's usually related to some kind of tensile load that's occurring on that ligament, it can occur either from, you know, cyclical loading, where you can continue to put stress on that ligament until that ligament ultimately fails. But usually, it's one usually large load that occurs that relates in, you know, a traumatic tear. That's probably an example of kind of one of the more common ones. But, you know, we, you know, we commonly see other tissues damaged, you know, the meniscus is another common injury. And that's usually again, that's really related more to some compressive with shear load. And then, you know, cartilage also kind of was kind of relies on



a shear load to be damaged. So



all those different loads occur on the knee, it just sometimes it depends on again, all those other variables that we've talked about, you know, the nature of it, or the compressive versus the shear versus the tensile load, but then again, how quickly does it occur? Maybe at what angle your knee is bent that can impact all those types of things? Yeah, I would think angles, speed, fatigue levels, hydration levels, you know,



All of that I can only imagine goes into



a type of injury from one of these loads, right? And you say, you know, and if think about, you know, again, you have that that external load, but then, you know, think about some of the other internal loads, you know, the muscles around the joint contracting, to maybe unload the knee at a specific time, because, you know, we have, you know, you've seen many athletes like they cut and pivot 1000s of times in a career, why is it that one certain time, they do the exact same maneuver, they've done 1000 times before, their ligament tears or their meniscus tears. So there's, there's so many other underlying factors that lead to it.



And so part of this papers, at least trying to describe some of those things, so people have an understanding of what is the underlying loads that can can lead to an injury. But then,



what can we do after that? How can we use those exact same parameters of same loading parameters to rehabilitate them? Because the same, a lot of the same stresses that caused the injury



also are some of the same stresses that you can use to rehabilitate the injury? Right, and I would think have to use to rehabilitate the injury. Right? Right. Yeah. So so they, so they can adapt to that stress and be ready to handle the stress the next time it occurs. Exactly, exactly. And now what one of the figures we were talking before we went on the air within this paper is figure four. So for everyone who is listening to this, we'll leave a link to the paper in the show notes. But when you go through, you'll see there's one figure it's figure four, it's a conceptual model of loading of the knee. And it's like a monster of a figure like it is. It's large, it looks very intimidating, and very complicated. So can you break it down for us? Yeah. So this is how, you know, we started to think about taking a lot of these other models that have been out there that have described, you know, maybe the physical stress model, or many people have commented on the,



on the die model, related to the envelope of function, and also the dynamic recursive model related to injury, probably the, is the best one, best way to describe it. But you got to take into all those factors that can influence or just leave somebody susceptible to an injury,



as well as including this their underlying physiology. And again, that could just be related to those non modifiable factors such as your age and your sex.



And then again, your underlying physiology, you know, your genetic makeup, maybe even just some kind of a little bit of your underlying fitness level. And then what are some things that can predispose that tissue to injury? And again, it could be, you know, do you have a strong tissue or a weaker tissue? Does the, you know, do you have certain types of muscle fibers, you know, that can influence again, things like fatigue? And then what are the external factors that lead into it? So, some of these models have already been kind of described in the ACL related literature, you know, you know, shoot a surface interactions, whether that occurs out there is, is it turf versus grass. So, those types of things can all potentially influence an injury and then,



you know, moving into the next part, then you just think about the mechanical load. So, again, all those factors related to magnitude and duration and frequency. And then we wanted to kind of



try to articulate that, again, if you took, you know, just conceptually took it is looking at each of the different major structures in the knee that could be impacted, and then talked about how those tissues respond to some kind of stress and strain. So, you know, if you put it,



again that load under a specific type of compressive versus shear strain, how does it respond to that, and William Thompson did a really nice review in ptJ a couple of years ago, looking at some of the Meccano therapy and McKinna biology that occurs at specific



tissues that Karim Khan had kind of initially proposed back, God 10 years ago or so. And then if you take all those things account, and the stresses and strains, so then you start to look at how that impacts how the tissue adapts to those stresses and strains. And, you know, using kind of the fitness model, or the fitness fatigue model is, is if you apply the right stresses at the right time. And you do that consistently over time, it basically builds up into tissues adapt to it, and it gets stronger, and fitter. But if you don't do it, or you do it at a delayed time, it may stay at a homeostatic level, or than if you do it too infrequently, or the loads are too much, too frequent, then you can actually fatigue the tissues. And, of course, if you get too much fatigue, and you get the right amount of load placed on it, then that can result in injury. And then you kind of go through, go through again, and go through it again. And again, that's part of the rehab process is taking all those things into account. And so



that's how we tried to really try to conceptualize it and think about, you know, and so we really kind of focused more on the the tissue levels and the response to injury, and how you can use that kind of this conceptual model of kind of stress and strain along those other factors, too. I think it's important to note that we're not only talking about ligaments or meniscus when we're talking about the tissues around the knee, ligaments, meniscus tendon, articular, cartilage bone. It's not just, we're not just talking about ACL 10. Lien, you know what I mean? There's, it's really the all the structures that that make up that knee joint, correct? Correct. Yeah. And, I mean, I think that's even a really important point to like, when we're rehabbing. You know, somebody and you know, you take somebody with a meniscus tear, not only are you impacting the meniscus that you're working on, you're also impacting a lot of the other structures around it. And so you can influence the all that rehab, or that rehab impacts all those tissues, depending on how you're providing the specific load. Right? Absolutely. And, you know, one of the the words that's in that figure is tissue capacity. And so during the rehab process, certainly after injury, but even, let's say, without injury, right, I think one of the goals is to always improve tissue capacity. So can you kind of talk about what exactly that means? What that What does tissue capacity mean and as physical therapists, what where do we stand in the improvement of that capacity. And on that note, we'll take a quick break to hear from our sponsor and be right back.



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Kind of an in a general layman's term, you think about just tissue capacities, it's all related to the under I think sometimes so the underlying tasks that's being performed, right, you can have a certain level of tissue capacity that allows you to, to walk or run the tissue can meet the demands of that load placed on placed on the body by that specific task. Right. But if the task is too high, or the load is too high, relative to what the tissue can handle the tissue than this doesn't have the capacity to handle that load. And again, it may be able to handle that load one or two times. But over a repeated bout, it may fail much quicker. And so I think sometimes tissue capacity is it's also related to the task that's being performed. may know most of us have enough tissue capacity to to walk community levels and things like that. But you know, we might



not have the tissue capacity to run a 10k, even though that we may have the underlying structure that we could build up to that, I think those are the things you have to take into account. And from a rehab perspective, you know, you always have to think about kind of that starting point of what people can handle, and then how, how you can adjust the rehab process to improve that capacity over time. So that that leads into what are some ways we can monitor load and respond to that load? So we're the therapist, we're taking care of our patients, how can we monitor and and, and change that load as necessary? Yeah, so.



So from, you know, a clinician standpoint, you know, most of us probably in the clinic, you know, we don't have high tech equipment, like global GPS units are inertial measurement units to measure



acceleration, and



you know, how far people have gone



a certain amount of distances they walked or jogged or done the whole thing, like you have seen with some of the devices like catapult or, or



I measure use IMU units. But I think from a clinician standpoint, we still have a lot of great tools that I think are that we still under utilize, to some degree. So,



you know, I, I always like to tell my students



that you really are kind of training to look at how the joint is reacting to the, to the loads that you're placing on it? And are you making the tissues more irritable or less, irritable, measuring irritability is probably the best way to describe it. And the knee, you know, you can see things like, you know, increase swelling, you know,



which is a common, probably a common measurement to see for, for increased irritability, but it can also be, you know, is the joint getting sore versus the muscle getting sore, right? And so trying to be very clear,






the person you're working with is, you know, does it hurt inside the knee, or is it just hurt in the muscles around the knee, because we'd expect to see some muscle soreness if you're working those, right, but you don't want the, you know, the irritation to be in the knee. Um, so those are probably the two major major, major ones that I like to use. But



you can also look is, you know, do Did they have a sudden decrease in a range of motion, you know, which can be an impact, or, you know, a factor of them, having some irritability, has their strength gone down, which is probably a little bit harder to assess more consistently, but those are probably the major things I would consider looking at is, if you're starting to see some of those means the tissues become a little bit more irritated. But if you don't see those, then you know, the next, you know, maybe the next session, the next couple sessions, you can start to slowly increase the load a little bit, and see how they respond. And I think that's always the challenging part. Like, I like to challenge my students with is, but that's one of the great things about being a therapist, who is we get to see them again, and see how they respond to our treatments. And we can regress or progress them as needed. Yeah, and and I think that's a really great thing that you said at the end, we can regress or progress as needed. So if someone if you give someone some exercise or some loading, and they come back with like an angry knee, it doesn't mean stop everything and go back to passive range of motion. It means okay, let's just take it down a notch. But continue. Yeah. Yeah. And I think when the the last one I meant should have mentioned is, you know, just even just ask them how they feel. Mm hmm. You know, how are you how do you how does it feel today can give a lot of information then you can use things like you know, a session RPE schedule, you know, scale, say, Okay, your knees a little bit angry. Let's back, let's back your exercise session down two or three today, instead of working at a seven. Mm hmm. So you can still do something still keep the knee moving. Still keep it kind of moving forward, but you've kind of backed off in gave it a little bit time to, to calm down. Yeah. So it's, it's sort of this combination of what you're seeing objectively and then asking them how novel What a novel idea you're doing or you're having



Having trouble? Yeah. The other day you were doing stairs really well. And now you're having trouble doing stairs, you know, some of these functional day to day things? Yeah, exactly. I mean, I think, like you said, those are just really simple tools, I think we, we get so focused on, you know, what we like to call the objective data, instead of just asking people, how do you feel today? Yeah.



Absolutely. And now, how can we and I say myself, we, I'm a clinician, how can how can we clinicians use the information in this paper to start applying load to a REIT to the rehabilitation of an injured knee? Or post surgical knee? Or what however you want to categorize? Yeah, yeah. I think, you know, as we were talking before, there's a, there's a, there's a lot of data in this in this paper, too, that the clinicians can think canoes, and so I don't want them to get overwhelmed with all the numbers in the data, but it's really there to be is it as a resource for clinicians to say, Okay, I have somebody who has a pretty irritable knee, and these are the activities that we're doing before, you know, and we can get a sense of, okay, that that activity, you know, was, you know, three times body weight, I need to find an activity, that's maybe two times body weight.



So we can regress them a little bit. And this is an activity that kind of fits that or this was an activity that put this amount of stress on the ligament, we know that that stress is still within us safe range to, to push it a little bit to the next level.



Because, you know, I think some of the, some of the fear is, is that if we're putting stress on the ligament that we're going to injure it, or even on any tissue, right. But we, as we know that, especially after the initial inflammatory phase, you need to start putting a little bit of stress on the healing tissues, because that's how tissue gets stronger is that it has to respond to stress. But if you're putting, you know, if you're putting state and I'll put an air quotes, safe, safe stresses, or stresses that are below kind of the the below the failure rate, and you're monitoring the knee for those inappropriate responses, then you can use that information to slowly progress them through a rehab safely and adequately the healing structure to then kind of into the next level of repair. The one of the tables, we talked about this, again, before we came on, was table seven, within this paper, where you have some activities where it's like this is like you said, maybe it's 1.4 times body weight, or this is 20 times body weight, or this is eight times body weight. And I think that's a really nice guide for clinicians. But I think it's also a really great educational tool for the patient. So you can show this too, because most patients get it. I think a lot of times we underestimate our patient's ability to understand. Yeah, a lot of these concepts, you know, and and so I think if we can say the patient, hey, listen, this is X amount, your body weight, this activity is less than that. And let's say you're a month out of like some sort of surgical procedure, hey, let's go with the one that's less times body weight than this. And because people say, well, what's the big deal? It seems like it would be fine. But I love that because I think it's a great way for clinicians to use the paper also is a great educational opportunity. Yeah, no, no, I think that's a that's a really valid point, is it? I think if we can educate the patients on, you know, these are the activities that you should be doing right now. And as you strong, get stronger and get better than you can move into these activities the next time, right. And so they're always asking, patients are always asking, like, what can I do now? What can I do now? And so, you know, this table can give them some insight of, okay, this is where you're at. These are the things that you start doing now. And these are the things that probably wait a little bit longer. I think that the patient will really understand the why behind, you're giving them the exercises that you're giving them. Yep. And that's really important, because if people understand the why then maybe they're more likely to do it. Yeah. And follow through. Yep. So I mean, I think it's great. I think this paper is great. Is there anything



thing that we didn't touch upon in the paper, the process of doing this paper that you would like to share before we start to wrap things up, no, you know, I'd really like to, you know, first of all, thank my co authors who were willing to, to sit down and write this, it was, it was no small feat, you know, pulling together, clinicians from around the world to, to do this. And so, you know, definitely want to, you know, think tour MacLeod, Brian higher shyt, J uebert. Tim Gavitt and Brian eckenrode, for, for agreeing to do this, you know, this, like I said, this was a paper that had been mulling around in my head, probably since I was in PT school, you know, for a long time. And, you know, this just felt like the opportune time to pull it together. And fortunately, you know, in the last several years, last 20 years or so, we have, we have the data now to support a lot of the things that we do is physical therapist that I think intuitively, we've always done. But I think now that we can, we can demonstrate a lot of what we do, and some of the value that we bring to, to rehabilitation into to patients and to clients. Yeah, and and I mean, I like this paper from a rehab standpoint, but I think it's also really great from a strength and conditioning standpoint, right? Because as physical therapists, we don't have to just be the people there when the athlete or the person is injured, we can also be the person that helps to keep them strong and kind of improve, especially in I know, in a lot of professional settings. You've got strength and conditioning coaches, and athletic trainers and pts. But for the average physical therapist, like if you're in a small town, maybe you're it. Yeah, you're doing it all. Yeah. So I think this paper is really helpful not only to progress, people after injury, but to kind of look and say, Hey, this is the load that we can place on you that will hopefully help to decrease your chances of getting injured. Yeah. So I appreciate that in this paper. And now, where can people find you? And like I said, we will have a link to the paper in the show notes. But where can people find you if they have questions of you specifically? Yeah, I'm fairly active on Twitter. And so that's primary, my primary social media outlet so you can find me It's Dave, log PT. You know, if there's any questions or anything like that, that's probably the best, best way to reach me is either directly through DMS, or, or through my Twitter feed. Perfect. And now before we wrap things up, I have one more question. And it's a question I asked everyone is knowing where you are, in your life and in your career? What advice would you give to yourself? Let's say as a new grad, right out of PT school, I would probably, I would say, at that early stage advice, actually was given to me before is don't always don't say no. Always say yes to opportunities, especially in that, that early career, that if an opportunity comes along, take it, it may or may not be the perfect opportunity. It may not be what you dreamed of, but it more likely or not, will



be the a value to you. And many times it's a huge stepping stone. I would say you know, an opportunity comes along, say yes. Especially when you're young. Yes, yes. Young and full of energy. I think that's great advice. So listen, David, thank you so much for coming on the podcast breaking down this paper. It's a great paper. So congratulations on that. So thank you for coming on. You. Thank You, anytime and everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Dr. David lager stat for coming on the program and talking all about load parameters around the knee joint and of course, a big thank you to Net Health. So again, their digital digital marketing solutions can help your clinic win by allowing you to get found get chosen and get those five star reviews on Google. They have a new offer if you sign up and complete a marketing on it to learn how digital marketing solutions can up your clinic when they'll buy lunch for your office. Head over to net forward slash li T zy to sign up for your complimentary marketing audit today.



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

Nov 9, 2021

In this episode, Founder of the Concussion Corner Academy®, Jessica Schwartz, talks about the nature of concussion treatment.

Today, Jessica talks about her concussion experience and how it has shaped her work leading up to the Concussion Corner Academy®, the reality of long-term concussion symptoms, and some of the top concussion myths. Is it ever too late to have your concussion symptoms treated?

Hear about treatment barriers, some of the surprising statistics in concussion and TBI research, and the importance of education, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “When you’re young, make sure you have extended disability on yourself.”
  • “There’s no evidence-based, agreed upon international definition of concussion or traumatic brain injury.”
  • “There’s been zero phase 3 trials on TBI and concussion in over 30 years.”
  • “Up to 30% of folks now have persistent symptoms of concussion.”
  • “If we can teach one, we can serve many.”
  • “2012 was the first year the International Consensus Statement discussed the cervical spine in terms of examination treatment.”

“2015 was the first academic year in which there was a formal training for both TBI and concussion if you were a neurology resident.”

“2017 was the first year on the International Consensus Statement that we identified concussion as a rehabilitative injury.”

  • “The injury of concussion is an injury of loss. It’s a loss of your ‘I am.’”
  • “Join Twitter.”


More about Jessica Schwartz

Jessica Schwartz PT, DPT, CSCS is an award-winning Physical Therapist, a national spokeswoman for the American Physical Therapy Association, host of the Concussion Corner Podcast, founder of the Concussion Corner Academy®, and a post-concussion syndrome survivor, advocate, and concussion educator.

After spending a full year in rehabilitation, experiencing the profound dichotomy of being both doctor and patient, Dr. Schwartz identified the gaps in concussion treatment and management in the global healthcare community. Her role has been to identify the cognitive blind spots and facilitate collective competence for healthcare providers, physicians to athletic trainers, focusing on comprehensive targeted physical examinations, rehabilitative teams, and concussion care management.


Suggested Keywords

Healthy, Wealthy, Smart, Concussion, Research, Statistics, Physiotherapy, Neurology, Concussion Corner, Myths, Healthcare, Rehabilitation, Injury, Loss,


To learn more, follow Jessica at:

Website to Join the Program:          The Concussion Corner Academy®

Facebook:       Concussion Corner

Twitter:            @ConcussionCornr

Instagram:       @ConcussionCorner

LinkedIn:         Jessica Schwartz

YouTube:        Concussion Corner



Subscribe to Healthy, Wealthy & Smart:


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Read the full transcript here: 


Hey Jess, welcome to the podcast. Finally, I'm so excited to have you on.



Thank you so much for having me. I can't believe we haven't done this yet.



I know it's like absolutely insane. And just so people know Jessica and I both live in New York City, and we actually see each other quite a bit. And this is the first time I've had you on the podcast. But I'm really excited to have you on today because we're going to be talking about concussion, persistent post concussion symptoms, and you'll talk a little bit more about that name changed in the bulk of the interview. But before we get into some common myths around concussions, I would love for you to let the listeners know a little bit more about why you decided to really specialize in this niche within medicine and rehabilitation.



Awesome. Well, I thank you for the softball pitch care know. For those that don't know, Karen used to play softball on Central Park quite a bit. But yeah, no, I mean, I thank you so much for having me on. First. I've been listening to healthy, wealthy smart forever. So just thank you again. And yeah, I mean, gosh, I think back to I was a we were one of the first six residents actually, we were the first six residents in orthopedics at NYU in 2010. When I finished up grad school and all that jazz, and we I had it, I got the dream job, right, got the dream job. I had to leave New York City for it, which sounds crazy. But I think a lot of folks can connect to that, you know, working in, you know, the old adage, Jay, we used to call mills and things like that are seeing three or four patients plus per hour. And I was like, this isn't why I went into physical therapy. This is not why I wanted to do this. And I found this great clinic out in New Jersey during residency and we saw one to two patients per hour. And we had a support staff and they were emotionally intelligent. They were physical therapy owned, and they let us grow. And keep that like use of excitement, right? I don't know about you. But I'm hopped up on caffeine and too little sleep as we launched a new business this week. But it was great. And it really it fed my soul. It was wonderful colleagues and we ended up I ended up starting kind of in the opposite end of things, a civilian prosthetics program. So I was, you know, volunteering and showing up at the Manhattan VA, which has a wonderful prosthetics program. And then we also launched a breast cancer program and be launched a concussion program. So that was kind of like my first entree into concussion about 1011 years ago. And we were the only really only office in New Jersey with that type of rehabilitative practice at approaching concussion. And so very Dunning Kruger ask, it was like, you know, you don't know what you don't know until you kind of are made self aware of it. I got hit by a car. So I was hit by a car in October 3 of 2013. And right before then, oh, actually, it wasn't even right before then care. I'm sorry about that. But it was two years before it was our last day of residency. We saw that there was a conference at NYU at the hospital. And it was on concussion and it was NY us first concussion conference. Now this was 2011. So my best friend from Italy Beatrice, you know, hi, BIA. She's in Lucca. She's a great physio, if you're out in Italy listening in. And we were like, What do you want to go and it was our first weekend off for residency. I mean, we were exhausted, excited. And we're like, let's do it. So we went to this conference, I fell in love with it. And so we were at least aware of what this program was at NYU. Fast forward two years from there. And I was actually hit by a car here in Manhattan. So that's really where it's my life's work and passion is to become because I actually live with persistent symptoms. So and went through quite a recovery. So that's kind of how it all kind of came together and coalesced.



And when you suffered a concussion, and this was in 2013 It did you did you have kind of the self awareness at that time to think, well, you know, I've been learning a lot about concussions, I think I can I can kind of help myself here and did that then really propel you to learn more and to dive in even more.



So when I was hit, I was hit by an unlicensed driver from behind and my airbags did not go off. I was in my Toyota Prius you may have even been in that car at some point. And I didn't think anything of it but I knew I when I said the story is I I got out of the car. I want to get out of the car. I got hit so hard. I was stoplight at a red light wasn't looking behind me because we were stopped. And it was the traditional traffic right care like we're just inching forward. And I was probably on that block of 12 Street between Fifth and Sixth Avenue for about two or three light cycles because of traffic. So I just got Walt from behind and so the New Yorker in May right so born and raised New Yorker You know, unbuckle the seatbelt and get out of the car to give this guy the business. And I was just so dizzy care. And I held onto the top of the hood of my roof of the car and I was like, I gotta sit down. Fast forward. I thought this was quote unquote, just going to be a concussion. And at that time, we really thought concussions were pretty much resolved spontaneously within seven to 10 days based off of the literature from 2002. From Brolio and McCrea at all from the NCAA study. But we don't have that's false. And we have so much updated information we can chat about if you'd like. So I thought it was just going to be seven to 10 days. I went back to work for for a week, I thought, you know, I would just be sore, kind of like a whiplash or like a Dom's. And now, I just kept D compensating and then from there went from 10 to 14 hours of rehab a week for 14 months.



And how did you continue to work and continue to function during all this time?



I did not. So I went off of I went out of work, mind you, I was just promoted to junior partner the week I got hit. So I remember I was like directing a prosthetics program, we had all these other programs, I just became junior partner, which would have been a profit share with a company and I loved my job, I would still send people back to that clinic, those four clinics in New Jersey in northern New Jersey. So essentially what happened was, it was a conversation that went on for months. So I was on short term disability for six months. And I say this to all physical therapists, physicians, OTs, PTs, whoever's listening to this, when you're young, make sure you have extended disability on yourself, because our bodies are so fragile at the end of the day. And again, I was an athlete, I was a cyclist I was training for, for a century bike ride and life changes in the blink of an eye. And I was underinsured with a $50,000 policy policies for car insurance to go up