Healthy Wealthy & Smart

Healthy Wealthy & Smart: Where Healthcare Meets Business. We interview experts and innovators in healthcare, physical therapy, and entrepreneurship to get their expert tips, tools, and strategies to ensure positive outcomes for your patients and your business.
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Mar 23, 2023

In this episode, I am joined by Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD, to discuss diagnosing and rehabilitating gluteal tendinopathy.


Show notes: 

00:01:06 Painful gluteal tendons.

00:06:11 Recognize gluteal tendinopathy.

00:15:50 Load gluteal tendons actively.

00:21:03 Education and exercise first.

00:28:43 Reduce provocative positions.

00:34:44 Improve patient-specific function.

00:35:07 Listen and tailor the program.

00:45:17 Insurance limits treatment options. 00:50:01 Invest in continuing education.


More About Alison:

Dr. Grimaldi is an Australian Sports Physiotherapist and the practice principal of PhysioTec Physiotherapy in Brisbane, Australia, with over 30 years of clinical experience and a special interest in the management of hip, groin and pelvic pain. She has a Bachelor of Physiotherapy, Masters of Sports Physiotherapy and a PhD through the University of Queensland, Australia. Alison was a key investigator on the multicentre LEAP randomized clinical trial comparing the effects of treatment for gluteal tendinopathy. She has had involvement in research for over 20 years and continues her research interests as an Adjunct Senior Research Fellow at the University of Queensland, and in collaborative international research. She has contributed to three leading clinical texts, conducted over 100 clinical workshops worldwide and presented over 50 keynotes, invited or podium conference presentations. Alison also runs a Hip Academy with online learning and live mentoring at


 Resources from this Episode: 

 15% discount on Hip Academy joining fee for Healthy, Wealthy & Smart podcast listeners : Use coupon code: HWS2023


Alison’s Twitter

Alison’s Instagram

Alison’s Facebook

Alison’s LinkedIn

Dr Alison Grimaldi's Hip Academy

May 13-14 New York Hip Workshop Registrations


Key Papers: Wilson R, Abbott JH, Mellor R, Grimaldi A, Bennell K, Vicenzino B. Education plus exercise for persistent gluteal tendinopathy improves quality of life and is cost-effective compared with corticosteroid injection and wait and see: economic evaluation of a randomised trial. J Physiother. 2023 Jan;69(1):35-41. doi: 10.1016/j.jphys.2022.11.007. Epub 2022 Dec 14. PMID: 36526564. Link:


Mellor R, Kasza J, Grimaldi A, Hodges P, Bennell K, Vicenzino B. Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial. J Orthop Sports Phys Ther. 2022 Dec;52(12):826-836. doi: 10.2519/jospt.2022.11261. Epub 2022 Oct 28. PMID: 36306175. Link:


Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018 May 2;361:k1662. doi: 10.1136/bmj.k1662. PMID: 29720374; PMCID: PMC5930290. Link:


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Mar 17, 2023

In this episode, I am joined by Taylor Elyse Morrison, a self-care and personal development expert and founder of Inner Workout. She shared her journey as a workaholic and how she had to build self-care skills to not get burned out. Taylor believes the impetus for her journey came from within but noted that both nature and nurture played a role in her ambition and how society's expectations of her were extra pressures.


Show notes: 

00:02:25 Practice self-care and balance.

00:07:16 Listen and respond lovingly.

00:12:05 Flexible structure for success.

00:17:41 Set clear goals and accountability.

00:23:34 Connect with others for support.

00:29:05 Slow down and enjoy life.


More About Taylor:

headshot of Taylor Elyse MorrisonTaylor Elyse Morrison turned being bad at self-care—and being firmly convinced of every human’s potential—into a career. She’s the founder of media company Inner Workout, and the author of a book by the same name. Recently named one of Fortune’s 10 Innovators Shaping the Future of Health, Taylor is tired of aspirational 'wellness as usual.' Instead, she builds businesses, content, and experiences that make well-being and personal development more accessible. You're just as likely to see Taylor facilitating a workshop at a Fortune 100 as you are to see her talking about TikTok and body image with a high school class. Wherever she goes, Taylor's sure to use her coaching, mindfulness, and movement training to meet people where they're at and offer actionable steps towards creating a world without burnout.


 Resources from this Episode: 


Inner Workout Instagram

Taylor’s Instagram


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Mar 9, 2023

In this episode, I am joined by Dr. Madison Oak, PT, DPT, to discuss vestibular rehabilitation therapy (VRT) - a form of rehabilitation designed to help people with vestibular disorders regain their balance and alleviate dizziness. She explained how the inner ear works, what can go wrong, and the most common diagnoses associated with vestibular disorders.


Show notes: 

00:01:51 Vestibular rehabilitation therapy helps.

00:09:00 Migraine is a neurological disease.

00:11:05 Get medical advice for symptoms.

00:18:41 Ask for detailed descriptions.

00:20:04 Treat dizziness holistically.

00:27:51 Treat vestibular migraine with lifestyle.

00:29:15 Lifestyle changes can help.

00:35:28 Team sport: vestibular rehab.

00:40:30 Work for yourself and have fun.


More About Madison:

headshot of Dr. Madison oakDr. Madison Oak is a physical therapist who specializes in treatment of Vestibular Migraine, Persistent Postural Perceptual Dizziness, and other vestibular disorders. Madison is the founder of Vestibular Group Fit, @thevertigodoctor, and Oak Physical Therapy & Wellness PC. Madison strives to provide excellent, educational, vestibular resources that are thorough, helpful, and actually make sense to people who have vestibular disorders. 

Migraine, headaches, dizziness, and more affect SO many people in the US and the world. When she isn't talking about the vestibular system, you can find Madison out skiing in Jackson Hole, baking chocolate chip banana bread, and hanging out with her dog, Hugo. 


Resources from this Episode: 

Madison’s Website





Dr. Karen Litzy’s Social Media:





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Mar 2, 2023

In this episode, I am joined by Emma Jack, physiotherapist and coach, to discuss her journey from burnout to breakthrough. Emma was overwhelmed and unsatisfied with her career path until a panic attack in 2016 led her to reflect and make a change. Emma decided to take a step back and focus on herself to build a more sustainable, fulfilling career. This is her story and her advice for other healthcare practitioners.


Show notes: 


00:05:17 Check in with yourself.

00:12:17 Fill yourself up first, serve others.

00:17:05 Take time for yourself.

00:26:28 Our worth is not outcomes.

00:30:49 Take care of yourself.

00:40:22 Lean into your true self.

00:40:40 Stay curious and evolve.


More About Emma:


Emma is a sport and orthopedic physiotherapist and owns her own practice Press Play  Physiotherapy and Pilates in London, Ontario, Canada. She holds a Masters of Physiotherapy as well  as a Masters of Clinical Science, has her Sport Physiotherapy Diploma, is a Fellow of the Academy of  Manual and Manipulative Physical Therapy and is a lead therapist with the Canadian National  Women’s Hockey Team. 

Sounds pretty cool, right? While those accomplishments and credentials do bring a sense of pride,  Emma also recognizes that many of those things are ultimately what left her feeling intense anxiety,  chronic stress, overwhelm and burnt out. Her credentials may span two lines on a business card, but  in recent years Emma has totally transformed her practice and life in order to ensure that her  accomplishments no longer define her. Now, much of her time is spent working as a Co-Active  coach helping other clinicians show up fully for their lives and careers in a way that feels authentic,  sustainable and most importantly, fun!


Resources from this Episode: 


Emma’s Resources





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Feb 16, 2023
In this episode, I am joined by Dr. Abby Gordon, PT, DPT, SCS, CSCS, to discuss treating and managing chronic pain in adolescents. We discuss chronic teenage pain and how it’s often not given the attention it deserves. Dr. Gordon, who works at Seattle Children's Hospital, explains the types of symptoms, diagnoses, and treatments typically found in teenagers suffering from chronic pain. She speaks about the interdisciplinary team that examines and plans treatments for each patient and the importance of providing peace of mind to families. Finally, Dr. Gordon shares her advice on communicating with families of teenagers. Show notes: 00:01:06 Treat pain holistically. 00:11:56 Take breaks from activities. 00:12:07 Teach kids to advocate for themselves. 00:20:02 Nutrition is essential for healing. 00:29:36 Mental and physical health connected. 00:30:22 Pain is physical and emotional. 00:39:10 Believe and listen to kids. More about Dr. Gordon: Abby Gordon is a Sports Physical Therapist at Seattle Children’s Hospital and has served as the Team Physical Therapist for the Seattle Storm for the past eight seasons. She owns a mobile PT practice primarily working with women with chronic pain and body dysmorphia, body dysphoria, and/or disordered eating. She is an APTA Washington Delegate and helped develop her first legislative motion, RC 16-22, the APTA’s Position Statement for Inclusion of the LGBTQIA+ community, which the House of Delegates passed last summer. Her blog, “Abby’s World,” is where you can find physical therapy- and women’s basketball-related thoughts. Resources from this Episode: Dr. Gordon's Blog Dr. Gordon's Twitter Dr. Gordon's Instagram Subscribe to Healthy, Wealthy & Smart: Website: Apple Podcasts: Spotify: SoundCloud: Stitcher: iHeart Radio:
Feb 6, 2023

In this episode, I am joined by Dr. Ginger Garner and Dr. Joe Tatta to discuss Integrative & Lifestyle Medicine in Physical Therapy. They are the co-editors of the book of the same name. They explain what integrative and lifestyle medicine encompasses and that physical therapists are uniquely positioned to implement integrative and lifestyle medicine effectively. 

Show notes: 

00:05:30 Practice intentional health promotion.

00:07:05 Integrate lifestyle into care.

00:19:57 Engage in healthy movement.

00:20:11 Empower patients to choose.

00:30:39 Model healthy lifestyle behaviors.

00:38:36 Behavior change is empowering.

00:40:00 Integrative medicine heals holistically.

00:53:15 Trust your instincts and succeed.

00:54:13 Cultivate diverse skills.


More about Dr. Ginger and Dr. Joe: 

Headshot of Dr. Ginger Garner Dr. Ginger Garner PT, DPT, ATC/L is a therapist, author, educator, and advocate for improving
access and equity to pelvic health physical therapy services. She is the founder and CEO
of Living Well Institute, which certifies healthcare providers in Functional; Integrative Lifestyle
Medicine and also offers wellness classes to the public on the same topics. She is also the
creator of the Medical Therapeutic Yoga; Professional Yoga Therapist Certification, the only
certification of its kind worldwide for medical professionals.
Dr. Garner practices at Garner Pelvic Health, which she founded to offer integrative telehealth
and in-person pelvic and orthopaedic care. Ginger is the author of multiple books and book
chapters published in several languages. She has presented internationally at over 20
conferences, teaching on a range of topics about pelvic and orthopaedic health.
Ginger is an active member of APTA, APTA North Carolina, APTA Private Practice, and
Academy of Pelvic Health. She lives in Greensboro, NC with her family.
Visit Ginger at and on Instagram and YouTube.

Headshot of Dr. Joe Tatta Dr. Joe Tatta is a global leader in integrative pain care and an advocate for the safe and effective treatment of chronic pain. He is the Founder of the Integrative Pain Science Institute, a cutting-edge health company reinventing pain care through evidence-based treatment, research, and professional development. For 25 years he has supported people living with pain and helped practitioners deliver more effective pain management. His research and career achievements include scalable practice models centered on lifestyle medicine, health behavior change, and digital therapeutics. He is a Doctor of Physical Therapy, a Board-Certified Nutrition Specialist, and Acceptance and Commitment Therapy trainer. Dr. Tatta is the author of two bestselling books Radical Relief and Heal Your Pain Now and host of The Healing Pain Podcast.


Resources from this Episode: 

Dr. Ginger's website

Dr. Joe's website

Buy Integrative & Lifestyle Medicine in Physical Therapy

Free Therapeutic Yoga Video Library


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Jan 23, 2023

In this episode, Founder of Hearth Healing, Laura Williams, talks about postpartum care after leaving the hospital.

Today, Laura talks about the harms of finding generalized information online, setting postpartum expectations, and optimizing care to the mother and the baby. What is the difference between common and normal occurrences in the postpartum period?

Hear about virtual postpartum healing, the outcomes of Laura’s virtual consulting, and get Laura’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “There isn’t a one-size-fits-all approach to recovery, and we need individualized information.”
  • “The key that unlocks that resilience is knowledge.”
  • “There should be an equal attention to both the baby and to the patient.”
  • “It may not be life-threatening, but it can still threaten your quality of life.”
  • “Giving people knowledge can help them move forward in a meaningful way.”
  • “Imposter syndrome is real but don’t take your knowledge for granted.”
  • “Be brave.”


More about Laura Williams

Laura Williams is a Doctor of Physical Therapy (DPT) and Board-Certified Women’s Health Clinical Specialist. She lives and practices in Salida, CO, with her husband, 3-year-old daughter, and second child on the way.

Laura founded Hearth Healing, a 100% virtual postpartum healing service, in 2022, as a pelvic health consultant. Though not a substitute for in-person healthcare, postpartum healing consultation should be viewed as a vital way to bridge the gap in maternal care. People deserve information about how to improve symptoms that impact their quality of life after childbirth, without having to wait months, or feel limited by lack of childcare or transportation.

At Hearth, Laura provides individualized answers to postpartum healing questions, early healing strategies, self-management advice, and guidance on appropriate resources, products, and providers.


Suggested Keywords

Healthy, Wealthy, Smart, Pelvic Health, Postpartum, Education, Knowledge, Virtual Care,


To learn more, follow Laura at:


Facebook:       Hearth Healing.

Instagram:       @yourhearthhealing.


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Jan 16, 2023

In this episode, Founder of Enhanced Recovery After Delivery, Rebeca Segraves, talks about physical and occupational therapy care after childbirth.

Today, Rebeca talks about why this work is important, the ideal OT-PT-patient ratio, and the major mental health component. What should PTs and OTs be assessing in a person after childbirth in the hospital?

Hear about hospital discharge criteria, preventing readmissions, and get Rebeca’s words of advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “A full evaluation by both disciplines is recommended after any type of delivery.”
  • “A caesarian section is the most commonly performed surgery in the US.”
  • “Among the most developed nations in the world, the US has the highest maternal mortality rate, and it’s climbing.”
  • “The leading cause of death postpartum is now suicide.”
  • “If we offered our services in the hospital after birth, we would see the maternal mortality and morbidity rate go down.”
  • “Change is going to be person-driven.”
  • “Don’t leave the hospital without an OT, without a PT consult.”
  • “Get out and have some fun.”


More about Rebeca Segraves

Rebeca Segraves, PT, DPT is a physical therapist and Board-Certified Women’s Health Clinical Specialist who has served individuals and families within the hospital and at home during pregnancy and immediately postpartum.

She has extensive experience with optimizing function during long-term hospitalizations for high-risk pregnancy and following perinatal loss and pregnancy termination. In the hospital and home health settings, she has worked with maternal care teams to maximize early recovery after delivery, including caesarean section, birth-related injuries, and following obstetric critical care interventions.

She is the founder of Enhanced Recovery After Delivery™, an obstetrics clinical pathway that maximizes mental and physical function during pregnancy and immediately postpartum, with hospital and in-home occupational and physical therapy. Her vision is that every person will have access to an obstetric rehab therapist during pregnancy and within the first 6 weeks after birth, perinatal loss, and pregnancy termination regardless of their location or ability to pay.


Suggested Keywords

Healthy, Wealthy, Smart, Physical Therapy, Occupational Therapy, Childbirth, Surgery, Maternal Care,


To learn more, follow Rebeca at:


Twitter:            @RebecaSegraves.


Instagram:       @enhancedrecoveryandwellness.


LinkedIn:         Dr. Rebeca Segraves.


Transform Recovery After Birth Program.


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Jan 9, 2023
In this episode, Founder of FitBux, Joseph Reinke, talks about financial freedom. Today, talks about understanding financial freedom, developing and implementing a financial plan, and FitBux. How long should you be focusing on one thing? Hear about student loan updates, budgeting vs financial planning, and get Joseph’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “A budget is not a financial plan.” “You’ve got to have intangible financial freedom before you have tangible financial freedom.” “If you focus on one thing, you’re going to achieve it much faster.” “Keep saving.” More about Joseph Reinke Joseph Reinke is a Chartered Financial Analyst (CFA) Charterholder and is the founder of FitBUX. In the past 5 years, FitBUX has helped 15,000 rehab therapist manage over a $2.2 billion in debt and assets using their innovative financial planning technology. Suggested Keywords Healthy, Wealthy, Smart, Financial Freedom, Student Loans, Planning, Finances, Budgeting, Cash Flow, To learn more, follow Joseph at: Website: Instagram: @fitbuxofficial. Facebook: FitBux Official Group. Financial Freedom Webinar: Sign up here using my affiliate link. Subscribe to Healthy, Wealthy & Smart: Website: Apple Podcasts: Spotify: SoundCloud: Stitcher: iHeart Radio:
Dec 12, 2022

In this episode, VP of the APTA Connecticut Chapter, Dr Stephanie Weyrauch, CEO of Inclusive Care, Dr Krystyna Holland, and Obstetrics and Gynecology faculty member at Denver Health, Dr Jennifer Hyer, talk about bottom surgery and gender-affirming care.

Today, we talk about vaginoplasty complications, pelvic floor goals post-vaginoplasty surgeries, and setting post-operative expectations. What are the barriers that trans people face when trying to access gender-affirming healthcare?

Hear about pre-operative education, hysterectomy versus vaginoplasty outcomes, trauma-informed care, and hear their advice to healthcare providers, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “You only have one time in your life to be post-op.”
  • “The only way out of this is through.”
  • “Give yourself grace, because you need to heal.”
  • “Trauma-informed care is a commitment to continuing to try to reduce our own propensity for perpetuating harm.”
  • “Once you start, you’re going to see a lot of folks that need this care.”
  • “Be honest about who you can help and what feels good for you.”
  • “Not everyone currently is a safe person for trans and non-binary people, and that’s okay. We are not all for everybody.”
  • “We are seeing patients who are gender-diverse, and we need to be able to provide good care to people.”
  • “If you don’t change your environment, it’ll change you.”
  • “The hard work is always worth it.”


More about Dr Stephanie Weyrauch

Headshot fo Dr. Stephanie WeyrauchDr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis.

Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA)—most recently, she was elected to the APTA Nominating Committee—and actively lobbies for healthcare policy issues at the local, state, and national levels of government.

She currently serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at institutions including Stanford University and Washington University in St. Louis.

Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.


More about Dr Krystyna Holland

Headshot of Dr. Krustuna HollandKrystyna Holland, DPT (she/her) is the founder and CEO of Inclusive Care, a physical therapy office in Denver, Colorado specializing in the provision of trauma informed pelvic floor care to individuals across the gender identity spectrum. Krystyna’s journey as a provider started as a patient. Traumatic experiences in her own medical treatment inspired her to open Inclusive Care.

In addition to helping folks feel confident in their ability to live without leaking and have intimacy without fear, Krystyna aims to change the fundamental patient-provider relationship from one that centers the provider as a problem solver to one that focuses on collaboration between the patient and the provider.

She is a well-known Instagram educator (@Krystyna.Holland), an instructor of trauma-informed care trainings, and a healthcare consultant.


More about Dr Jennifer Hyer

headshot of Dr. Jennifer HyerJennifer Hyer, MD joined the Obstetrics and Gynecology faculty at Denver Health in 2007. She is an Associate Professor of Clinical Practice in Obstetrics and Gynecology at the University of Colorado School of Medicine. She completed medical school at the University of Tennessee Health Sciences Center and completed her Obstetrics and Gynecology residency at the University of Colorado. She is a Fellow of the American College of Obstetrics and Gynecology and a Diplomate of the American Board of Obstetrics and Gynecology. She is a member of the 2017 class of the Association of Professors in Gynecology and Obstetrics (APGO) Academic Scholars and Leaders Program. In 2022, she joined the Denver Health Medical Staff Executive Committee. 

In 2021, she was honored by her peers with the Denver Health Outstanding Clinician Award. Her clinical activities include full scope practice of Obstetrics and Gynecology at Denver Health Medical Center as an attending physician. She has been providing surgical management for transmasculine patients since 2016. In 2018, she expanded her surgical skill set under the direction of Dr. Marci Bowers and Dr. Chris Carey to include vaginoplasty for transfeminine patients. She continues to provide these surgical services and is the only transfem bottom surgeon at Denver Health. She has presented Denver Health gender affirming surgical data at both national and international conferences. She hopes to expand the Denver Health Gender Affirming Surgical Program and participate in research opportunities to improve care of all LGBTQ+ patients. 

She also has a research interest focused on maternal mental health, and she has presented on this topic at both the national and international level. She has received grant funding from the Denver Health Foundation and Zoma Foundation to support integration of behavioral health into obstetrics clinics. Additionally, she has partnered with colleagues at academic institutions within Denver to collaborate on projects to improve maternal mental health and access to support services. 

Suggested Keywords

Healthy, Wealthy, Smart, Gender, Transgender, Surgery, Gender-affirming care, Education, Advocacy,

To learn more, follow Drs. Weyrauch, Holland, and Hyer at:


                        Dr. Stephanie Weyrauch.


LinkedIn:         Krystyna Holland PT, DPT.

                        Stephanie Weyrauch DPT.

Twitter:            @TheSteph21.

Instagram:       @thesteph21.



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Dec 5, 2022

In this episode, Founder of Andro Brands, Corey Hiben, talks about marketing and websites.

Today, Corey talks about the website do’s and don’t’s, optimal website design, and creating an offer. What should you look for when having a website built?

Hear about the value ladder, building relationships, and get Corey’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Be 90% clear and 10% clever.”
  • “What do you do, what problem do you solve, and what action do you want them to take next?”
  • “Confused customers don’t buy.”
  • “As long as your intentions are pure of trying to help people, you should never have resistance around marketing yourself, building a site, or any of the things you’re trying to do.”
  • “You have the option to choose yourself and to do what you want to do, regardless of what other people tell you.”


More about Corey Hiben

Corey Hiben is the host of The Health Hustle Podcast. He is also the founder of Andro Brands, which is a marketing agency for health & fitness professionals.

Corey used to work as both a personal trainer and a healthcare professional and so he understands the challenges of providing incredible service to your current customers while also trying to attract new customers.

Through many years of trial and error he realised that he is best suited to put all of his time and attention in helping other health & fitness professionals grow and market their businesses.

His mission is to help as many of his fellow health & fitness entrepreneurs to build a business that fits their lifestyle.


Suggested Keywords

Healthy, Wealthy, Smart, Marketing, Website, Offers, Value, Niche, Entrepreneurship, Business,



FREE GIFT: From Followers To Clients in 7 Easy Steps.


To learn more, follow Corey at:


LinkedIn:         Corey Hiben.

Instagram:       @coreyhiben.

Facebook:       Corey Hiben.

Podcast:          The Health Hustle.


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Read the Full Transcript Here: 


Hey, Cory, welcome to the podcast. I'm happy to have you on today to talk all things marketing and website, which is something that is not intuitive for a lot of healthcare and fitness professionals because we didn't really go to school for that. So thanks for coming on and talking us through it. Yeah, that's exactly how I got into it is I solved a problem I had myself and now I help other people with it. So yeah, yep, that's always the way. So we're going to talk about website design, and we'll kind of see where it goes. But can you give the listeners, maybe some must haves and maybe must have nots? I don't even think that's a word on when it comes to website design. So let's talk about things that one should have, or maybe what a site what a good site should have, that will want people to come to see you. Because that's the point of the website. Well, for starters, something very funny and quirky to begin with. No, I'm just kidding. But uh, but just to give people some context, like, Yeah, I'm an occupational therapist, by trade, I really got into this marketing, website design and development thing purely through just a place of pain is somebody who understands the challenges and the struggles of really trying to get new clients and leads and customers and how challenging that can be to both see patients, do your documentation, keep up with emails, do everything you have to do from a practitioners standpoint, or even a fitness practitioner standpoint, and then also trying to figure out how do I also Garner leads and get get attention. And I think so many of us have felt the pain and struggle of like, I don't feel like I have time to do this. And so that's really where I fell back on to okay, how do I create the systems and the marketing and all those pieces in place have to get leads and to get new customers and to keep people coming in the door and in the clinic, and still have time to treat patients at a really high level. And that's really where I landed on this, this pocket of website design development and why it became something that was so interesting, and become so passionate for me is because like, I always tell people that your website is really, it's your mothership, it's your home base, it's your backbone, it's the thing that like, if you can get a lot of traffic and a lot of attention to that place, specifically, assuming it's designed correctly, which we'll talk about in a second, then you can essentially take all these people that are paying attention to you into somewhere down the road, hopefully clients and customers or even referral sources, because like all the other platforms out there, whether you use tick tock or Facebook or Instagram, or whatever your thing is, is you don't own any of them. The only ones that you own, or the ones that are on your email list are the ones that you have phone numbers to, or even maybe an address to if you want to write them a letter if people still do that today. But to answer your question of like, what are the must haves and shouldn't do is have a website? I would say first and foremost is



you have to have a compelling reason for somebody to want to reach out to you is the biggest mistake that I see is that so often people think if they just build a website and throw a contact form on there, that there's somehow going to get somebody to reach out to them. And I can tell you very unlikely, if not, will they ever reach out to you or ever fill out your contact form if you don't give them a compelling reason to do so. And that's why like the topics of like freebies and offers are something that you can offer a value to somebody is so so important, because the the pushback that I always get from people is that will I'm just asking for their email address, it doesn't cost them anything to give me their email address wrong, it costs them a lot to give somebody an email address. And what I mean by that it costs them their trust, it costs them their attention, it cost them the risk of maybe you spamming them. So if you're not giving them something of value in return for that email address, there's no way they're gonna give it to you unless it's your mom or your sister, or somebody that already knows and trust you. But if it's some random person perusing the internet, it's very unlikely. Or if you built up a lot of trust on your social media platform, and have some sort of ask them there that drives them back to it, that might be a way to get it. But I'd say that'd be the number one biggest thing is having a compelling reason for somebody to reach out to you. And unfortunately, I can't just tell you what that is that comes down to really tapping into a really deep layer of empathy of understanding the people that you're working with and how you're ultimately trying to help them. Because like, if you can really speak their language and understand who you're talking to you and have something that's very specific to their needs, then that offer becomes very obvious to you. And that's really what I tell people is like you want it to be a no brainer. It should be they're gonna look at it, they're gonna see this as an offer, and they're gonna go, Oh, my God, that's free. How is that free? Why would I not do this? Right? It's a no brainer offer. That's the biggest one. The one I would say the thing that people get wrong the most is that are the don'ts of a website is they try to do too much. They try to put all their photos and all the copy and they have the world's longest backstory about themselves, not even the person going to the website. And they have all these pages that are redundant and irrelevant and they have way too many colors and way too many buttons and it just becomes ugly and sloppy. And whether you like it or not, people have a judgment on you based on your website, no matter what. And if see



If you've a see a sloppy website or website that has really just way too much wording or something that just doesn't resonate with them, they're gonna assume that you're also sloppy or wordy or don't have a lot of structure into this. And so they will judge you on your website no matter what. And so like if you can have something that shows your authentic self, and I'm not saying it should be professional, I'm just saying, it should show up authentically as you and the people that you want to work with. And on top of that, it shouldn't even really be about you, it should be about them. That's the other mistake that I say, I see as well is that we, when we build sites, we really use what's called the story brand model, which I'm sure you're familiar with. So essentially, it's understanding that the client is the hero of the journey. That's the whole point of a website, right? It's for them to come to that to that site and go, Oh, they get me they understand me. Now there's a compelling offer that I can reach on connect with them. Kind of a long winded answer to your question, but those are some of the biggest things. Yeah, no, that wasn't long winded at all. That was great. When someone is looking to design a website, right? What advice do you have for people? If they're looking, let's say they're looking to hire someone to do their website for them? Are there questions I shouldn't? Let's say I'm the therapist, and I'm looking to have someone design my website. Are there things that I should be looking out for? From the designer before I hire them? Great question. I would say like most things in life, you get what you pay for. And so I think you if you wanted to go, the more simple or an easy route, obviously, there's always the Upwork or the the fibers where you can go on there and hire somebody. But I think what's really important for people to get from your question is that it's one thing to have a website, it is something completely different to have a website that actually attracts and converts customers, right. And that's where we get into the whole game of like SEO ranking on Google, having a compelling offer. Walking a person through a story, like these are all very intricate things that people don't fully recognize and understand. And so like, I would say, the first thing I would do is I'd be asking for referrals and references is like, there's obviously going to be people in your network that you know, that have had good experiences with it. Like, for example, I have a really good friend of mine here in town, I live in Austin, Texas. And she her whole thing, she's a PT, but she does purely pelvic floor in Austin, Texas. And basically, we're able to get her to rank very high specifically in Austin, Texas for the practice on that keyword search term, because we understand who her target market is, and how we're going to actually help her Garner and get leads from that specific population versus if you go to Fiverr and Upwork, which are totally fine, it's very unlikely that they're going to take that level of understanding of like how to actually build a site that actually gives you value to your business. Because like, just so people know, like a really, really good converting website, which people don't realize, is actually roughly maybe 5%. At most, right. And so like most people who have websites, I would argue if they either did it themselves, or they just kind of went the cheap route, which is fine, just so they have a presence on the Internet, are probably converting less than 1%. And if you understand just like basic statistics of how big of a difference that can make, do, how much more leads, you can get into your business from 1% to 5%. If you're getting, on average 1000 views a month, or whatever it is. That's a massive difference, right? And so like when you're researching people I, I've always told people to is like, if you if you don't have a reference to somebody that has shown proven results through data, which is very easy to prove the data, like you can look up Google Analytics, you can look up how well the website is converting, like if they can't show you that they're actually getting people results. That's probably a red flag.



Yeah, that's, that's great. So because I think it's important that the listeners know like, What do I look for? Do I just pick someone and ran at random? Or what questions you have. So that was really great. Okay, let's get back to the website design itself. So everybody wants to have a good user experience, right? Like you said, you don't want to have a million buttons where you don't know what's going on. Let's talk about when people first get onto your website, right? They're going to see live there. Let's say you're on a computer, and they're going to see kind of what's above the fold. Right? So above the fold is what you see before you start scrolling down. So what needs to be above the fold? Because some people might go on and what be on your website? For what three seconds? Yep. And be like, Nope, it's that quick. Right? So what do we need? When people first get onto that website? It should answer three questions, and it should answer them very clear. I always tell people be 90% clear and 10% Clever. And so like people always try to do like the quirky thing like me, as a web designer in the world. People are always like, I'm a website wizard. And it's like, cool, that's clever. But what the hell does that mean? That doesn't really give any context what you actually do.



So to answer your question is three things specifically, it's what do you do? What problem do you solve? And what action do you want them to take next? Those are by far the most important things you could do. And so for you, for example, it could be



physical therapy in Where do you live, New York City, New York City. So physical therapy in New York City, we help females with pelvic floor issues, click here to schedule a consultation, right? Very straight to the point, you could get a little bit more clever, quirky with it. And you can sit down a little bit, but it's pretty straight to the point. Like if you don't answer those questions right away, people are already going to leave. And I see that my own searching behaviors, if I land into a website of somebody that like refers me to their site. And if I can't figure out what it is they even do, there's no way I'm sticking around to continue to check out their content. I will say the other thing, too, that isn't often talked about is how important the, the image slash or maybe video at the top of the website is, is like this goes back to my original point is that people are going to judge you based on your website, whether you like it or not. And so like, if you have, let's say, some background video of people working out at what looks like a CrossFit gym, what does that tell people about? It's gonna it and that may turn off a lot of people 100% Right, just fine, right? If you only want CrossFit people, that's great. But that's a slim amount of people, even in a city as big as New York City. Exactly. It's not a lot of people. Exactly. Which could be a good thing, right? Because like, you equally want to turn people on as you do want to turn them off. Right? Is because like, not only are you trying to attract leads and get customers, you're also filtering the people that aren't a good fit for you. Right? Like if you right, you don't want to work with, for example, the 60 year old grandma, which I'm sure is a wonderful human, then probably having a CrossFit type workout in the background is a good thing, you're gonna filter out that human because she's gonna go there, and she's gonna go, oh, no, this isn't for me, right? So it always comes back to back to just like, really deeply garnering empathy, which PTS OTS trainers are all really great at in that realm. And so like, the more you can understand them, and the more you can build this, this home shipper, this backbone to talk to them and to understand them as a human, the more likely you'll be to convert somebody into a lead or a customer. Right? Yeah. And can you I want you one more time to repeat those three things that everybody must have above the fold. I really want to drill this in. What do you do? What problem do you solve? And what action do you want them to take? Next? Right, exactly. And that action is normally in the form of a button. Right? So it's either schedule here, call here, something like that. But it should be really clear. And it shouldn't be a teeny, tiny little thing off to the side. You want you want people to notice it.



Yeah, you definitely want people to notice it. So if you can answer those three questions, when you look on your website, kudos to you, if you cannot figure it out,



Figure Figure out how you can answer those three questions. Because I know when I redid my website a couple of years ago, it was like a total, like I had a website that I kind of did myself on Squarespace, which is fine. You know, in the beginning, I understand like, everyone's got a budget, and certain things need to be budgeted in a certain way.



But then when I hired people to do it, it what it also did for me is it forced me to look at my business and do a deep dive into that, and dive even deeper into the people that I want to work with. So that things became a lot clearer for me as well. So I think it's important for whether you're a therapist or healthcare or a fitness professional, when you're doing your website, it's your turn, it's your chance to really do a deep dive into who you are as a business owner, who you want to be the people you want to attract and how you want to present yourself to the world. Yeah, I think it's important to just be as authentic as possible to is like, that's the very first thing we do with every project with every client that we work with is that we really get to your point, we understand exactly who we're talking to. We go through all the exercises to dive really deep into who they are as a business who we're trying to attract. And how can we differentiate so ourselves in the market because there's of course, there's millions, if not, I don't even know billions of websites, maybe at this point. And if you're not finding your uniqueness, whether it's funny or quirky or weird or you like doing workouts with cats, in cat sweaters, whatever whatever your thing is, is like as long as you can be authentic to who you are and who you want to attract. That's the most important thing and so like really understanding like, who you jive with and how you help them is so important. Right right and and a website doing a deep dive into website is a great way to figure all that out. And and then what will happen is like



You said, You'll filter out people. And all of a sudden the people that you really like to work with will be coming to you. And it'll just make your life so much better.



Yeah, it's always fun when you get a contact message or somebody signs up in a newsletter, and you recognize that they're like, they're your people. And they're like somebody that you get, and they get you. And it's like, oh, okay, this is fun. Like, that's where things honestly get. So fun is like, when you start building that community via through your website, and contact forms, or however else you want to build it. It's like, that's where things get really fun. It's like when you realize you're connecting with the right people, because again, even to that original point of like, you could garner a lot of tension from people that you're not a great fit for. And that's not fun, right? Is that like, then you got to refer them to other people, which is great for other people. But at the end of the day, like, if you're a PT, or training or whatever, like you're really trying to build a community, honestly, right, and the throw everything at the wall and steel, see what sticks marketing technique is not a good one is that what I'm hearing you say? I literally just today actually finished a whole article about that entire topic, I had somebody have a podcast show as well. And I had somebody on that show recently, that just reminded me of, I think that there's a stage in most people's journeys, where that's kind of the initial part of where you have to throw some stuff at the wall. But really, the whole spray and pray approach is not a useful method to getting people. Like I always, I always compare it between, like, the difference between being a hunter and a farmer, is that as a hunter, you're just like, you're going out and you're shooting everything and you're attacking everything, and you're trying to get them and you're going over here and you're throwing spears this direction, versus a farmer just waters their seeds in their area of the people that they're trying to nurture and connect with and have relationships with. And I feel like the farmer approach is way more fun and way more fruitful. And way more. Just no pun intended. Yeah.



Exactly. Just way more helpful for everybody involved in that entire situation of like, so I always give people grace of like, yeah, there's a stage of prayer, spray and pray. But like, if you came to me, and you talked to me, and I was consulting you, I'd probably be like, not probably not right approach to this. But Right, right. Not, not the best. Not that not the best, not the best way to go. So is there anything else about websites? Let's talk about like maybe what you see, that drives you insane, that you're like, oh, my gosh, I want to jump through the computer or my phone. And I need to change this. And actually, for me, it's non responsive websites. So websites that are that when you look on your phone, you're like, Come on, man, like make this this this should be better. Right? So when I say like non responsive, it means they didn't like optimize it for a phone or an iPad. It's only on the computer. That is like one of my biggest pet peeves. What are yours? Yeah, considering the fact that I think it's now 70% of people that browse the internet, use it on a mobile phone. And so like we we design every website now with mobile first knowing that the majority of traffic is going to come from there. So for anybody listening, keep that in mind and to your earlier point of like, if you are somebody listening, and you're in that situation, where doing it yourself is kind of the avenue you want to go. I think to your point about Squarespace is a good option, because they have a lot of great templates that make that very simple for people to just write on their own. So anybody in that situation, that's usually where I refer them if they're not ready to invest in something like that.



But other than exactly what we're talking about, of not knowing who you're talking to. That is my number one pet peeve. But other than that one, because obviously I feel like we beat that one. Yeah, I would say that the other one is, is



they tried, like I was saying before is they try to do too much is that they have multiple buttons, multiple offers multiple links to things is like, just understanding just to help people from context of basic human psychology is confused, customers don't buy. And so if you go to your website, and if it's confusing at all, if it's confusing to a seven year old, if a seven year old goes to your website, and they don't know what to do, that's a problem. They should then we need to talk about what is the one no brainer offer that you can present to this audience that will get them to actually make a connection and to make a decision. They've done so many studies on it, we don't have to beat it down. But basically less choices is better. It's the same reason why we get like, what is it called? Analysis paralysis. It's like, you go to the shopping aisle in the grocery store, and there's 8000 cereals. And so you choose the one that you've always chosen because you don't want to have to make a decision on a new one. Right? This is true for the websites and the internet as well. Right? It's like if there's too many options, you don't make a decision. And that's not what you want on your website. And so don't make the mistake of having too many offers have one very straight and simple offer.



And then even just repeat it is like I think people feel like this, I see this in marketing all the time is people feel like they're saying the same things over and over again, and they're being redundant. And it's like, you gotta understand the first 10 times you said it, they probably didn't even notice it, it's very unlikely that they even noticed it. And so like, if you feel like you're being redundant, you probably need to say more, honestly. And so like, if you can repeat that offer, again, multiple times throughout the course of the website, that'll one increase the odds that they'll even see it in the first place. And two, it'll make it very clear to them. This is what I want you to do. This is how we can continue to move forward. This is the next step in the process of how we can even start a conversation, whether it is signing up for a contact, whether it is a newsletter, a freebie or whatever it is, but like, make it very clear on what your one offer is. And be a little redundant about it, honestly. And yeah. Thanks for elaborating a little bit more on what the offer is. Because that's because when people hear offer, they're like, What do you mean? Would I have to like, does it? Is it a video? Is it can it just be like book with me? Can it be? So when you say an offer? Can you be a little more specific on maybe some different options that people can use as that offer on their website? Yeah, great. I'm glad you brought that up. Because like that is a whole discussion and of itself is like understanding even how to create an offer. I think so often, that's the thing. The problem that I see in marketing just in general as well is that



people often think that they have a marketing attention problem when really they have an offer problem. And so really an offer at its core level is it's whatever is going to compel them to click to say Yes, right. And so that could be that could be a freebie, like we talked about, it could be an ebook, it could be a free course, it could be an email chain, it could be an email chain, it could be, it could be actually buying the product, depending upon what it is, if you're some sort of product based service, it could be you see it in SAS companies all the time, it could be like, try this free trial for 14 days, I actually have a trainer, a good friend of mine here in town who's doing two weeks for free. And then at the end of the two weeks, you can decide if you want to work them with him or not. And it's actually for any other trainers out there. It's worked out great for him. Because then they get to experience what it's like to work with them for a few weeks, and they often choose to buy but that's his offer right now. Right? says two weeks free, no charge to you. To me, that's a no brainer if you're somebody that concerning our trainer, right? And so like the best piece of advice I can give to anybody who's considering what sort of offer I should do, and I'm stealing this quote from the guy that everyone seems to know about these days is Alex from Mozi. But basically,



it should be so good. People would say dumb to say no to it.



Right? Like, yeah, two weeks for you with a trainer. If I'm looking for a trainer? Hell yeah. Why would I not do that? Right? Like something that something?



Yeah, that's definitely a no brainer. Now when it comes to, let's say, healthcare professionals, where maybe we can't kind of, we can't really give away our services, because as you know, we're a little more regulated than the personal training business.



So what have you found that works best to convert? People, let's say convert emails for wanting to get people on our email list? What have you seen in your experience that works really well is like a lead magnet or an offer? Yeah. And so I want to frame this so that this can be helpful for everybody listening to the show. And I think what's important to first understand is the basics of what a value ladder is. And so a value ladder is essentially like the lowest possible hanging fruit is the thing that you want to offer first, and then you work your way up the ladder. So for example, it could be something of free. And then your next offer is like a $20. Offer, your next dollar is like your $200 offer. And then your next offer is like I buy three months for $2,000. Right, is that you work them up the ladder, you never it's very rare that it works to start at the top and go the other direction. That is That is a thing. It's called an ascending model. But we don't talk about that. But like it's really about understanding, okay, what is my premium offer, and everybody should have a premium offer. If you are listening to the show, and you don't at this point in your business have a premium offer you need to start thinking about that right now today, you need to know is like what is the ultimate crazy priced thing that you could offer somebody that if somebody was willing to buy it, you'd be like, hell yeah, that would be an awesome thing for me to sell to this person, whether it's like a six month package, if you're a trainer or whatever it is like some sort of very high premium style offer. And now what you do is you basically take that and you work backwards from there to get to what is that smallest piece within that giant premium offer that if if your ideal client came to you, and they were like, Oh, I just want this one little tiny problem solved. That's what you love.



Looking for like, for me, for example, I'll just use myself as an example, is that somebody who does marketing, website design development, that's essentially what I do for business, is that my premium offer is like the whole package, right? It's the funnel. It's the website. It's the newsletters. It's the marketing campaign. It's the content. It's everything, right? That's a very big premium package. Right? Well, within that, when I distill it all the way down to its very base level is one little tiny thing in there that people often get wrong, is how to define your niche.



Right. And so my little tiny, very just stepping stone offer for people, which we can talk about at the end of this episode, is like, it's how do you define your niche, right. And so I created this tiny little thing, it's totally free, I can give it to your audience for free. It's called the niche test, there's three pieces that go into it that really talks into, it's not as simple as just picking your niche because everyone in their mom just says, just like pick a niche, and then they'll throw money at you. And unfortunately, it's not that easy. There's actually a lot that goes into it. And but I basically broke down how to do that. But that's my tiny little offer just to get people into my community and very transparent. That's purely the reason that I built it was that just to get them onto my newsletter so that I can obviously continue to offer and garner value to their inbox and continue to talk about marketing things specifically for the health and fitness professional. And through that, we work up the funnel, right. And so for anybody listening to the show, is understand just to break it down really quickly, when we're last time is like understand your premium offer, break that all the way down to the micro thing within that that you can offer your ideal clients. And then that's your freebie. That's your offer. That's you're getting them into the door just to start a conversation, essentially. I love it. Thank you for that. And now, as we kind of start to wrap things up here, what would you what are the main points you want the listeners to take away from this discussion around websites and marketing and how to make them work for you.



I think it's really easy to complicate a lot of it. And I think that the biggest thing I really want people to take away from it, though is that like, if,



in the years that I've been doing marketing, what I've realized time and time again, is that all it is, is another way of saying building relationships. That's really literally all it is, at the end of the day, if you look at all good marketing, for that matter, not your spammy, annoying, slamming at your door, I literally just had to deal with this the other day, it was like some auto deal. It's always auto dealers. But like that type of marketing does not build or Garner relationships. And that's not fun for me. And that's not fun for them. And it's very unlikely that I would buy from them. Right? He's world, it's all built on the back of like, how can we build relationships, and that's really all marketing is, is it's how can I put things out into the world, that's a value to my audience, or that your audience or whoever's listening to the show, that's helpful for them, that will help us build a relationship to support and help each other. That's all it is. And we can complexify it all we want. But like, as long as your intentions are pure, of trying to help people, you should never have resistance around marketing yourself or building a site or any of the things that you're trying to do as long as your intentions are pure of like, I'm just trying to help people and build relationships. That's really all it is. Yeah, it takes out the creepy marketing the slight, you know, because people are like, Oh, I don't want to feel like just slime ball being like marketing to people. But like, if you're not a slime ball in real life, you're probably not going to be slimy with your marketing either. You know, like, if your intentions are pure, you're okay. I always tell that to people. So thanks. I love that now. Last question. It's when I ask everyone and that's knowing where you are now in your life. And in your career? What advice would you give to that young guy ran out of OT school, I would have chose myself sooner. And what I mean by that, just to give people context is I like I said, I used to be an occupational therapist. And there was a point in my career in my journey, where I was very burnt out on patient care, I was struggling with this whole marketing thing, the website thing, all this stuff, I had no idea what I was doing. It didn't know where I wanted to go. And there was a really a point in my career where I was actually trying to get into the tech industry and into the marketing industry and actually get out of being an OT, because I was just so burnt out on insurance model health care, which anyone listening to show can obviously understand. And it's it took the I was in a spot where the pain outweighed the fear of the unknown. And I read a book at that time was called choose yourself by James all teacher. And the title basically says it all is that I was like I was looking for permission. I was asking tech companies would you hire me or I was like reaching out to other facilities or other entrepreneurs or whatever it was that people have like hire me or take me out or metro me or whatever. And I realized after reading that book is like, I can just choose myself and decide to start putting myself out there and start doing what I ultimately want to be doing, regardless of what anybody tells me and it's the greatest thing about modern day society in the world that we live in today is that anybody now can step up and grab the microphone, no pun



intended and choose themselves right and start putting value out in the world, the very first person I ever started building website for I did it for completely free. I helped her for $0 because I just wanted the relationship and I just wanted to show her that I could help her. And so talking to my younger self, or anyone fresh out of school, or whatever it is early stages is like you have the option to choose yourself and to do what you want to do regardless of what other people tell you. Right. Great advice things first time I heard that one. And I've been I've been doing this for a long time. So I thank you so much. That was great. Now where can people find you? And where can they get the free offer you alluded to earlier? Sure. So it's on my website. It's Cory is where the offer would be. You can find me and Cory had calm I'm most active on LinkedIn and Instagram. I also have a podcast show called The Health hustle. I talked to a similar audience that you do is other health and fitness entrepreneurs, specifically little people in Austin, Texas. So if anybody's listening to show in Austin, Texas and you want to grab a coffee, by all means, let me know I love connecting with people in your in town. It's my favorite place in the world. But yeah, that's my plug. Excellent. Well, thank you so much, Cory, for coming on and giving us your time and your information. I really appreciate it. Thank you so much. Appreciate it. Thanks for having me. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

Nov 29, 2022

In this episode, CEO of Practice Freedom U, Jamey Schrier, talks about pricing your services appropriately.

Today, Jamey talks about the guilt surrounding pricing, accessibility and luxury, and the 3X model. How should we express the outcomes of our services?

Hear about job security, pricing according to the market, and get Jamey’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “You don’t strengthen the weak by weakening the strong.”
  • “We need to charge appropriately for not what we do but benefits that we provide.”
  • “Always get paid for R&D.”
  • “People will pay for your results.”
  • “I would’ve gotten help from an outside source sooner.”


More about Jamey Schrier

Jamey Schrier, P.T., is a best-selling author, business coach, speaker, and CEO of Practice Freedom U, a business training and coaching company. Jamey has helped hundreds of private practice owners Treat Less, Earn More, and live a life of prosperity and fun.


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Healthy, Wealthy, Smart, Pricing, Money, Quality, Experience, Value, Business,



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Read the Full Transcript here: 

Unknown Speaker  0:02  
Hey, Jamie, welcome back to the podcast, one of my most frequent guests, and I love you for coming on. It's so great. I love seeing you. If only your wife would were here, that would make it so much better.

Unknown Speaker  0:14  
Well, thank you so much, Karen. And she couldn't be here. But I think she's having fun with her friends, because it's around the holidays. And that's what she does.

Unknown Speaker  0:23  
Oh, wow. Next time she's coming on. So let's see, last time we saw each other was that PPS in Colorado? And you had you did a pre con there, right? What was that pre con about just kind of tell the audience in case you do it again, we can get some you know,

Unknown Speaker  0:44  
it's it's one of my it's one of my best pre cons. It's one of my best workshops, it's five steps to additional five figures. And what I do is just grab, like, a few key areas in every business needs these. So for this one, we did a lot of foundational stuff around vision and values. We then went into messaging like, actually, how do you communicate what you do we always complain, no one understands what we do. Chad went into a whole thing on you know, how to develop your message and how to put this message everywhere. So people actually understand what you do. And let's see, we did delegation. Who not you. So to get that stuff off your plate that we all hate doing. You and I are talking about behind the scenes, video editing, it's, we all have things that we hate doing, you hire someone else. And we did some other things around development of systems. So it was four hours, and it was awesome. And it went like just like that.

Unknown Speaker  1:52  
I'm sure it did. Well, it sounds great. And if you do it again, hopefully at PPS people you'll get I know you had like a sellout crowd, right?

Unknown Speaker  2:02  
Well, yeah, I mean, we had it sold out in like a few days. And I thought that we're going to expand it, because we had plenty of room but there was some mix up or whatever. So I'm hoping I can get back there next year and literally do the same talk. I think we could probably get 150 people in there without without a problem. Because it was it was great. I got people still reaching out to me saying, oh my god, I did what you said I, I tweaked my my ad and all of a sudden people reached out to me, they want to work for me. Amazing. There's no secrets, but there's definitely some certain principles that can can always help us. Right, right.

Unknown Speaker  2:38  
Absolutely. And so today we're gonna talk about pricing our services. So this is a question I get a lot, I'm sure it's something you get a lot. And I have a feeling it's what a lot of people struggle with is how do I price my services appropriately? So what is your best advice? Let's just start with that. So how do we how do we properly price our services? And before we even start, I'll also say, I think a lot of physical therapists, maybe you may disagree, are uncomfortable around this conversation of pricing. Because

Unknown Speaker  3:19  
therapists are uncomfortable around the conversation of money. Right?

Unknown Speaker  3:23  
Right. So let's start. Let's start. Let's start with that. So what do you say to those people who are like, Oh, I don't know, I feel bad. I feel bad charging people for what I do. How many times have you heard that?

Unknown Speaker  3:37  
A lot. I heard today, I had three conversations. One too, with clients, current clients and one with someone that was interested in our program. And they all brought up the same word guilt. Guilt is a word I hear so often. And it's the guilt of whatever making money, the guilt of what I should be charging the guilt of, you know, I feel like it should be in with my team and working all the time with them. Or, you know, it's just this idea of this guilt is a motion that isn't a rational emotion. Right. It's an irrational emotion. And that kind of leads us to making some decisions that aren't beneficial for anyone. So, you know, when people say, you know, I, I feel bad about charging and, you know, my, my response back is, you know, what, specifically do you feel bad about? And that's when they kind of stop and it's more of, well, why don't really know, like, they don't know why they feel bad. It's almost like a default mechanism. Right? It's just, it's if you say you feel bad, it's, I kind of refer to it almost like I feel bad. So I'm a good person. Like if I feel bad about charging people, I'm a good person. Now you and I would do a reframe on that. If I don't to charge you, then you don't get to experience my services in a way that you get to pay and feel the value of what I deliver, like that reframe all of a sudden changes the whole relationship. But we don't look at it from that way, a lot of times, I mean, obviously, if we really wanted to become multimillionaires, we probably wouldn't have gone into physical therapy. So we would be, you know, right down the street from in Wall Street. So, you know, many of us do have this idea that helping people and doing good in the world somehow means we shouldn't make money or can't make money. I mean, there's some deep money blocks that that are going on there. And I think that's what interferes, when we try to determine how much do we charge for our services?

Unknown Speaker  5:50  
Mm hmm. Yeah. 100%. And, you know, I think early on in my career, I had those feelings of like, wow, I don't know, I don't feel right about this. And then, and then you realize you have that mind shift of like, well, wait a second. If I am not charging appropriately, to keep my doors open, then I'm doing a disservice to my community, because I can't reach the people I need to reach.

Unknown Speaker  6:20  
Yeah, I mean, I say this all the time. It's, you don't, you don't strengthen the weak by weakening the strong, we are the strong, the business owner is the strong, we're the one that's taking this risk. We're the ones that is, you know, trying to create this vision is something that we want to do and help other people. And yet, we're the ones that work more hours than anybody in our business. Typically, if you add up the hours, you work by what you pay yourself, you're making less than your therapists that you're that you're paying. And you're stressed out, it affects your relationships at home, it's like you give your best to the people that you work with. And you give whatever energy is leftover to the people that you love and that are at home. Right, the whole model screwed up. And it has a lot to do with kind of kind of going back to either our childhoods or what schools kind of teaching us or whatever our influences are, that is screwing us up when we go into this business of physical therapy.

Unknown Speaker  7:24  
Right, right. Because, for me, what was the biggest aha moment or a change in mindset, if you will, is going from being a physical therapist who happens to own a business, to being a business owner, who happens to be a physical therapist. So once you're in that business owner mindset, you need to keep your doors open, you need to know what you need to make to turn a profit to gosh, I mean, at least pay your bills, right. But you should want to pay your bills and turn a profit. So you know, when it so let's talk about when it comes to pricing. Is there a formula? Is there something that people can look at or can plug and play? That gives them a better idea on what they can charge?

Unknown Speaker  8:18  
Yes. So I like to share a little story with you. Um, New York has some beautiful hotels, right? What's What's the nicest hotel you know, of in New York? What's the peninsula?

Unknown Speaker  8:33  
Peninsula, you're like, I don't know. flippin insula.

Unknown Speaker  8:36  
I don't know. Okay, the peninsula. Pretty

Unknown Speaker  8:38  
nice place, right? Right charges. Who knows how much per night but it's not. It's not like 150 bucks. And then there's the opposite end of the peninsula, there's probably, you know, maybe a red roof or something floating around there, maybe a small little Fairfield inn or whatever the case is. Right now, the peninsula probably does pretty well. And I know the Red Roof Inn, they do pretty well as it also. So these are two hotels. These hotels have to make a decision about what is your avatar? What are you about? What do you stand for? And if the peninsula thinks that they're trying to be a red roof in and do some of the things that the Red Roof Inn does, then you as someone that loves peninsula will be turned off. And of course, if the Red Roof Inn starts charging $20 for water in the room, which I imagined the peninsula will do minimum, then you're going to turn off that ideal client. So it is not about what you charge, you first have to answer the question, Who is the audience you're trying to track? And even before you answer that, you have to go in too, what are you about? Where do you put yourself from the peninsula, the high end, Four Seasons Hotel even higher, and the Red Roof Inn, because it isn't bad and isn't good. They're just very different in how they identify their avatar, and how they deliver deliver services and how they market and how they deliver the experience of the Avatar, they both have an avatar, and they both do financially very well. That's where we have to begin, we have to begin with identifying well are we going to be more of a place that might be, hey, we're a little bit more of a volume business, we accept insurance, we're only getting paid 50 bucks a pop, we got to see three people an hour, we do pretty good service, the beds are clean, the pillows work, you know, we keep the place clean, we keep the lights nice, but it is it's like you're going to stay the night and it does the job. Versus Are you going to be a high end boutique, high touch kind of place, you're going to do things that most places don't, you're gonna get that call, the person is going to have your cell number they're going to reach out to it's just a different experience. Each of those places has to charge a different amount they have to write this is really an exercise on clarity. This is an exercise on you looking in the mirror and saying what is this place about? And you have to be honest, because if you're like, well, we deliver the greatest care in New York and where the best work, okay, then that means you have to align your business to demonstrate that don't say you're the greatest, and you got a leak in the ceiling. Your carpet hasn't been changed in 20 years. Right? You know, you got some water fountains sitting outside. One of my one of my clients, he's in Brooklyn, he, you know, we did this exercise years ago, and I said, Lou, what are you about, and he goes on Equinox, I go, um, hi. And he does PT he does ot he does, you know, a little bit of rehab stuff. And by golly, you walk into his place, it is high. And that is his whole way of doing things from the towels he gives in the bottle of water in the art, everything is for that person that appreciates that. And yes, many of his non insurance prices reflect that. So that's, that's where you have to start, you have to determine where you are on that spectrum, let's say make it easy. Let's just say it's one to five. All right, the wine is solid, nice. Probably a little more volume ish, lower price, the high end Peninsula, that's where you have to start.

Unknown Speaker  13:06  
Yeah. And that's when I sort of started my business, I sort of coined the phrase like a concierge practice, because I patterned my business after a high end concierge is like at the peninsula, or at the Four Seasons, or at the, I don't know, the Andaz or something like that, right, these very high end, hotel chains that go above and beyond, you know, they go the extra mile. And so that's how I created my practice and what my practice is, you know, we're all about excellence in every sense of the word.

Unknown Speaker  13:47  
And if you said that to me, and I'm like, Oh, my God, that's great. I love that because I'm status, right? Yeah. When someone tells me the peninsula, it's not because the beds are really that much better. They probably are. But it's not because of that. Let's face it, Seth Godin talks about this all the time, it's connecting with status on a certain status. Now, if you said, I'm the greatest, and you told me you charge $75 a visit, I wouldn't go to you, right? Because that's not enough. I need to be connected with the best, right? Let's face it, the best usually has the biggest price tag. That's why Mercedes, that's why BMW are a different level than some of the other car companies, right. That's what people expect, even if they pay a lower amount, because they started bringing their prices down to fit a different type of it still has that element of oh, I drive a Mercedes.

Unknown Speaker  14:43  
Right. And I think it also comes down to you know, you're looking at that word luxury. Right. So I and I often wonder, I do I think physical therapy is a luxury item. I don't I mean it Well, it could be, but I do think physical therapy should be accessible to everyone. But why can't you be accessible and be luxury at the same time?

Unknown Speaker  15:11  
Well, that's interesting. So you're going to start now moving towards a little bit of the heartstrings that you and I have talked about many, many times. This is where people get into trouble, right? I'm working with a client right now. And he's coming out of a really bad situation for the last couple of years, because he made a decision and impulsive financial decision to accept Medicaid, his businesses, typical outpatient, ortho, you know, one of those types of places, whenever be a half hour type of thing. And he did this because he said, Oh, my God, there's nobody doing Medicaid. The money's not too bad. And we don't even have to mark it, we can get a million people. Well, what he failed to really go through is realize that this population didn't align with everything else that he's doing. It was a completely separate population. It doesn't mean he couldn't have them in, but it was just mixing everything up. almost cost him his business. So he realized, oh, yeah, it was it was seven figures, it was costing him. So he realized, Oh, my God, this is a disaster. Now, he said, like you said, I wanted to try to help and serve more people. So I can help them serve more people. It was easy to generate a referrals. And we can see the population. But the population that came in the type of services that were delivered, the type of culture, not bad or good, it was just very different. What they had, so it caused a lot of internal strife. And of course, the amount of work it took to actually get paid from the government.

Unknown Speaker  16:56  
Right, right. Yeah.

Unknown Speaker  16:59  
So when you start doing things out of alignment, just like our spine, when your spine is out of alignment, it starts to create a problem, it starts to break down. So this this a question about what should I charge? The question is, what are you about? What do you believe in? And then you start to do research, not comparing yourself what someone else is charging. You do research around? I'm similar to Karen. I feel like I'm that place. What is Karen charge? She charges 250 a visit? What is someone else? HR 300. This purchase this person charges? Two. So now, you know, anywhere from two to 300 is in that world?

Unknown Speaker  17:42  
Yeah, you're in the right ballpark,

Unknown Speaker  17:44  
you're in the right ballpark. Now that number can be I don't know, I mean, people that say, Well, I charge 125 of this, like, Okay, the first question is, is that number going to get you what you want? And that's a hard question to ask, right? Why would you want to make? Well, I want to make 200,000 I go, Well, 125 an hour is not gonna get you there. I don't care where you live. Right. Right, right. These are really difficult questions that we have to answer. But the idea is, value is not about. It's not about the techniques. It's not about all that stuff. You're learning all that stuff that our profession sells us, you got to learn more about this stuff, you got to have the fancy technique. It's not about that values, really about the big result. You help people plus the benefits that you add the result or the outcome, and the ancillary benefits. That's ultimately what we're selling, all of us are selling. And if you do this exercise, right, you really start looking at Karen, well, what is the big result that we're giving people? Yes, we're getting them out of pain. But what are they getting back to? They're getting back to running, they're getting back to work. They're getting back to living their life in full. You tell me what that's worth. Because if you dig down deep enough, guess what it's worth? It's priceless. Right? If you truly think about what we do, it's priceless. Because of our health because we only have one body. And you know, if you don't feel good, it's just a miserable, miserable way. So if the value that we provide is really priceless. Then we're just using the the hotel model to figure out where we want to be. And then we align our business and we align everything else we're doing in that way. Right the alignment that's the biggest issue. Because we all say we want to be the boutique, especially the cash base programs, we want to be boutique but our heartstrings, in the way we run our business is the red roof in one's not bad ones not good. It just doesn't aligned. And that creates stress.

Unknown Speaker  20:10  
Right, right. Yeah. So I think if, as when you're thinking about pricing, and correct me if I'm wrong here, but I think you want to look at quality, like, what is the quality of the product you're delivering? What kind of experience and reward are you creating for your patients? Is it through like a controlled sort of channel? Or is it chaos? That makes a big difference? Nobody wants chaos. And then finally, is it a personalized service? Or is it cookie cutter? And I think you have to think about all of those things before, as you're thinking about your pricing. Don't you think?

Unknown Speaker  20:56  
I'll push back a little bit on that? Yeah. I've never met anyone that told me they had a cookie cutter practice, ever. We everyone knows people. But when you look at yourself, right, says they have a cookie cutter practice. Right. Right. So you know, you said you said something about experience. I'll push back on that. I don't really care how much you know, I know. I

Unknown Speaker  21:22  
don't I don't mean, my experience. I mean, greens for the patient. Oh, their experience? Yeah. Have creating a good experience for your customer? I've heard that before. Yeah, that's my experience. No, no, no,

Unknown Speaker  21:36  
I got 10 years and 20 years. I'm like, No, it's the value you provide?

Unknown Speaker  21:41  
Yeah, no, I mean, the, like the patient experience, I should have been more specific the experience that you provide for for them?

Unknown Speaker  21:50  
Exactly. I mean, you know, look, if you're providing if you feel you're providing a higher service, and part of that higher service is creating an experience that really meets people where they are and meets their physical needs, their emotional needs, and all these other needs that they have, then you need to price it appropriately. So you need to look at other places that do something similar, and get an idea of where you should be. Right. I can tell you right now, nobody does that. What they do is they just pick a number out of the hat based on their internal guilt system. Am I feel okay with this number, or if I feel too guilty with it, it's a completely irrational system. And that's how they do because I've seen people people come in our program, and I go, how much you charge? And I like 121 30. I'm like, is that what you're worth? They're like, No, I'm worth 180. I go in charge 180. They're like, really? I can do that. I'm like, Sure can. And then you start getting into, well, what if they say no, what? Every single time very few people ever lead, they just gave himself a massive raise. And now they feel better about the services are providing, right? Let's face it, I guarantee when you were a little younger, as a therapist, you charge less, there's a slight little resentment, I care and just a slight, just a little resentment, like, I'm so freaking good at what I'm doing. And I'm only charging this amount. I know with me there was because I spent a fortune on my education, continuing it hours upon hours learning to get paid the worst paying insurance that I accept it. Right. I mean, it's it's a tough thing. But you need to really look at, you know, a great exercise I like to do is what are the benefits your service or program provides? Like, if you're trying to figure out what are the benefits? What is what is the model? Like, what is the treatment model? We refer to it as the business model. You know, this is the revenue you make for the program or for the service. And then what does the market charge for a similar thing? Now I know people listening will be like, well, no one does it quite like me. No one will ever do it quite like you. But let's face it, there's other people that do something similar to the outside public. It may not be similar to you, but if you're looking outside, it's similar. That will give you an idea of where where you can play, whether you get the high end, the middle end or the low end, not service or anything, just the lower end of what you're going to build for the services. And typically, like you said before, the lower end you charge, you're going to have to do more volume. I just did a masterclass and financial unit We're talking about this yoga program around financials and financial statements and how to look at what's a profitable model. And I like to use the three times model, meaning whatever you charge, per, whatever you charge, whatever you make per hour, has to be three times of what you're paying the person to deliver it. So if you're paying someone $50 an hour, that person has to generate at least $150 an hour. If not, there's not enough money for profit, and for overhead, and salaries and labor costs and all that. So that three times model was always a good model, you can use that really easily in the cash base model, right? Because typically, in a cash base model, you're literally just paying because a lot of cash base is an hour. But hey, if you're paying the person $50 an hour, you can charge less than 150. That makes it really easy to figure out. But I know your model, you're like, I'm not doing three times my models five times, even better. And as long as people are willing to pay it, and you feel good, and they feel good. This is more of a mind a mindset. What do you value, your own services. And the challenge we all have Karen is, once we learn all this stuff, once we go through all the heartache, once we go through all that stuff, all the money and everything, we typically forget about how much we put into doing this. And we only look forward, we only look at other people that we think are better than us. And they know more, and who am I to charge more, they don't even charge that much. When we get into that whole world. And that's tough. We need to to charge appropriately for not what we do, the benefits that we provide. Right? Right. That's what we're billing out. We build out outcomes benefits results.

Unknown Speaker  27:02  
100%? And how do you? What do you advise people to? Or how do you advise people sorry, to? To express that, to whether that be on their website? Or when they're talking to a patient on a sales call? How do they express what they do for them? So what those outcomes would be? Because in the end, everyone's always like, How much is it? Which is normal? Like if people are coming for your services, they should know how much it is right? So how do you so now we're getting

Unknown Speaker  27:41  
into the sales conversation? Well, you know, my favorite topics. Yeah.

Unknown Speaker  27:48  
It's up to you how deep of a dive you want to go on this.

Unknown Speaker  27:51  
But I love I love the sales conversation because it can be really, really simple. Right? I don't have a complicated sales process. I had three calls today. They're the most genuine, authentic just conversation, here's the thing. Step one, identify where the person is, what trouble what pain, what difficulty, are there have it step one be? What are those? What are the problems that they're having? How are they affecting their lives? So in our world, in the marketing world, it's called pain points. What are their pain points. This is not just physical pain points. These are emotional pain points. It could be spiritual pain points, it could be financial pain points, think about financial pain points for a second. So you're working with someone, and you're helping them potentially to avoid a $35,000 back surgery. So there's huge benefits to this, right, you're also potentially avoiding them because they don't want to take medication. So they're now not going to be hooked on oxy. So what's the benefits of that? What's the results of that? So you always start with where people are, have the problem that they're having. So we call them you start in the pain. And then you transition to their desires, their aspirations, their wants, what do they want? And I've had people say to me, well, Jamie, of course, they want to be out of pain. I go, No, they want more than that. Getting out of pain is one part of it. But to do what, like I've had chronic back pain for 30 years. Now when my back pain flares up. First of all, I'll write a check. I don't care how big 100% Right Second of all, what I want is not to get out of pain, necessarily. I want to go back and play basketball. Now of course, it's a hell of a lot easier to play if I'm not in severe pain. Now the question was, or the question is, so what is it about basketball? Well, it's social. It's physical. I stay in shape. I stay connected with my friends. What happens if you can't play basketball? Well, frankly, I'll get a little depressed. I'll just be a slob. I you know, a walk around the neighborhood but that's I'd like to talk smack with my buddies. So you get people into this emotional place of where you are now. And where they want to be where they want to be. The only thing that you need to provide, besides a sense of trust, which is, what's the biggest thing you provide, is you're providing a bridge from what I like to refer to as the House of Pain. Because I like to house the pain. Sure, jump around to play. Yeah,

Unknown Speaker  30:30  
of course, that was that was House of Pain, right? jump around,

Unknown Speaker  30:33  
I know you you got the House of Pain, to Pleasure Island, are going from pain to pleasure. The thing that gets us there, the bridge that gets us from pain to pleasure. That's what you provide. Now, if they want to know the specifics of what you do, then you can share the specifics you could share Well, step one, we do an intake evaluation, and we go through ABC, step two, we determine what's going on step three, we turn the player of the plan, step four, we get you better. So 1234, that's our plan. So because when I trust you caring, if I trust you, I don't need to know every little thing that you're going to do. I really don't care. All I care about is can you help me get what I want? And get me out of this place that I'm at right now. This is the, quote, sales conversation. I have. I mean, I tell people what the sales conversation because people think this is like some bait and switch, some coercive, the best sales conversation in the world are the ones that are most authentic, most genuine, and you actually care and you want to understand where they are. And you want to understand where they want to go. And you have confidence in what you do. If you don't have confidence. You show up weak weaknesses in something people trust, and you show up. I don't know if you're gonna be they really helped me. So if I asked you well, how much do you charge? Well, I don't I mean, kind of I mean, is 100 too much? I mean, I mean, I'll see you a couple of visits, like, you start almost apologizing, right? I've done it.

Unknown Speaker  32:21  
I've done it. I've done it a million times. 100. Yeah, absolutely.

Unknown Speaker  32:26  
But I've gotten over my emotion towards money, because that was my issues. And now it's just very clear. Well, here's what the program is, here's what we do, here's how much it costs. Hey, whatever, you know, credit card, check, whatever worried. And, yeah, I mean, this, this is where, you know, when we do an exercise around sales, you come out of this, not thinking twice about it. But we have to appreciate the fact that we went into physical therapy, we do have some money issues, we do have some guilt issues. But we can address those, because those aren't helping us get create the life that we want. And that's not going to serve the people we want to serve. And that's not going to attract the people that want to work for us either. Right? Because your staff, as much as we like to say, well, the generation, whatever generation we're on Z, Y, whatever, they don't want to work, they don't want to do anything they don't want to nobody wants to work for a boss who's broke. Because you know, why selfishly speaking? Karen, if you're broke, that means my job's unstable. My security is unstable, right? I want you to do well. So it's not that I don't want you to do well. But let's face it, it's it's it's expensive out there. And I want to make sure that I'm secure. So most of the people that bitch and complain about the people out there, they volunteer about his money. Well, the problem is, why can't you afford to pay them? And it's because you're not running an efficient business. Because of some of the things we talked about. Your services aren't priced correctly, you don't know actually how to position and sell your services. But those are skills. Those are skills you can learn there's nothing magic about it.

Unknown Speaker  34:15  
Right. And you can practice those skills. Absolutely. You have

Unknown Speaker  34:19  
to practice Yeah, well, how many when I worked with my, one of my first coaches in this business and in the coaching and training business on my nine years ago, he had me do this extra because he I had so much damn money stuff in my head. He goes, what what's the most you've ever sold in a program is like $500 Like, okay, so you're gonna charge $5,000 for your upcoming 90 Day Program. This This was the first thing I sold. I didn't sell a $97 program or $7 The first thing I was selling despite that I was sweating. And I go what do I say because you say exactly this. You ask them about this, you ask smell that. And then you say, here's what the price is, and you shut up. And I was scared I was sweating up for people said, Yes, I made more money in that thing. And they ended up being clients for a long time. Right? So what he had me do here was the exercise. He goes, I want you to practice doing the sales on your phone. And then I want you to send it to me. I'll give you some feedback. You do it again. So I practice 10 times. give me feedback. I practice 10 more, I knew the sales close. Right? Hey, so what are your thing? All right. So this, what do you that? So I kind of practice that, that thing. And by the end, I'm not saying I still didn't have some issues and butterflies when I said it, but it was a lot less emotional for me. And, of course, the people came on and they they loved it, they did well. So this is what we get to do we get to increase our skill levels and capabilities by practicing for sure.

Unknown Speaker  36:06  
Right, right. And and it's okay to not be perfect right out of the gate.

Unknown Speaker  36:12  
You're not going to be perfect, you're gonna screw this up, of course, you're gonna mess it up. And you know what, they're still going to pay you.

Unknown Speaker  36:20  
That's right. That's right.

Unknown Speaker  36:22  
Another mentor of mine told me always get paid for r&d. And everything's r&d. In other words, everything we're doing, we're just practicing, right, we're gonna practice this, you might as well practice it on people that can write new checks and come in as, as a patient. So, lean into the fear, lean into the worry, practice the the conversation and all that figure out where your price point is, and be confident people, people will pay for the results. Now, that's not your population. If your population is $125 a visit, that's fine, that's fine. People will pay for the results. That's right, you get to choose where your thing is, the only advice I would give you is just make sure you're at that three times multiple, do not charge and we're not talking about you because nobody pays themselves. We're talking about if you are someone if you're just a solopreneur. If you are someone to deliver services, just make sure what you're charging is three times what you pay them. If not, you're gonna you're gonna buck up on some on some issues there.

Unknown Speaker  37:38  
Right, right. And I think that's really good advice, and kind of a one. One have a really good solid takeaway from our conversation. Are there any other takeaways that you want the audience to remember?

Unknown Speaker  37:54  
Decide whether you're the peninsula or the red roof. Look for the people in that level of your market. Look at where they are and what their services are, and charge and price accordingly. Absolutely,

Unknown Speaker  38:11  
yeah. Yeah. I couldn't agree more great advice. Did we miss anything in our conversation? I feel like we hit a lot of really solid points. Was there anything that you were like I really wanted to get this point in? And we didn't hit it?

Unknown Speaker  38:26  
No, I don't think so. I mean, you know, you and I have lots of conversations around this. wish this was more complicated. It's not. It's not complicated. We make

Unknown Speaker  38:38  
it complicated.

Unknown Speaker  38:39  
I don't want to make it more complicated. Because I'm really good at doing that. I don't want to make this complicated. By giving all this other stuff. Here's the biggest problem we have with this. It's not that we're great at delivering what we do. The problem is we have our own internal issues around money around pricing around guilt. That's the part we have to address. No amount of fancy strategy, this subnet is going to change that. So the thing I gave you with the hotels with the this and that, it gives you an idea where you feel comfortable, make sure it's three times what you would have to pay someone to do it and try it. See they'll thank you. They'll thank you for doing that because your issues your own stuff is all in your head. So the only way you can address it is by addressing it so you don't need any more fancy stuff. It's just figure out where you are who you are. Charge it and go get

Unknown Speaker  39:43  
it right kiss keep keep it simple, stupid, right?

Unknown Speaker  39:47  
Keep it simple.

Unknown Speaker  39:48  
Keep it simple. absolute love it now. I know you know this question. So what advice would you give to your younger self? You've given plenty of advice here to your younger self, and I feel like it's a never end Doing well, sources. So give us another one.

Unknown Speaker  40:03  
What advice would I give to my younger self? Um, I probably I would have, I would have gotten help from an outside source sooner.

Unknown Speaker  40:19  
I love it. I just said that the other day, I think that's great advice.

Unknown Speaker  40:23  
You and I, you and I have a value system very similar when it comes to learning. You and I are lifetime learners. Mm hmm. And I wasn't always like this, I learned in my profession. But when it came to the business of physical therapy, I did not invest one 100 of what I invest in my, you know, manual skills and stuff, I, I wouldn't, I wouldn't, I would buy a book. And my younger self, I would have invested much more in my business acumen, I would have hired a coach, I would have went through the uncomfortableness of writing a check to my coach, which I eventually did. But then on the other side of that, you know, you get so much back of that, because you have to go through the fire, all of us have to go to the fire, even the overnight successes, which there's no such thing goes through the fire. So I would have gone through the fire sooner so I could get on the other side instead of through the torment that I did for for pretty much nine years.

Unknown Speaker  41:27  
Right? Right. I couldn't agree more. And now where can people find you? And what is your free gift for the listeners? Because I know there is one here. So they can you can follow me quiz. Ah, your PT practice quiz.

Unknown Speaker  41:46  
Yeah, I mean, look, the first thing you want to do is really understand kind of where you are in your business, you might think you understand where you are. But this this, this pte practice quiz and I have asked you questions that you're not asking yourself. So there's it only takes about five minutes to do it gives you a score kind of rates you where you are in your business, and then I provide resources to help you overcome those challenges that you're having. Because business really comes for most of us, you're really in three different areas of your business, you're in a Stage One Business stage two, stage three. And really what that means is where your income is your your total revenue, whether it's zero to 400,000 400,000 to a million or million to 3 million, that's where 90% of all of us are. So this quiz kind of will ask you some questions and really kind of teach you a lot about your business. So that's definitely something that I would highly recommend taking you want to reach me you know, best way to do is just follow me on LinkedIn. You know at Jamie Schreier. You can reach out for my you know, shoot me an email if you want to shoot me an email Jamie at practice freedom you. I'm all over the place. I'm like you, Karen. I'm all over social media. I tried to get myself out there and try to deliver good, good resources for people to try to help them.

Unknown Speaker  43:07  
Cool and I'll just remind people of the website it's practice freedom you the letter

Unknown Speaker  43:14  
Yeah, practice And then yeah, there's there's a quiz right there or you can leave the link to the quiz.

Unknown Speaker  43:20  
Yes, everything will all of Jamie's information will be at the podcast, website at podcast at healthy wealthy In the show notes under this episode, one click will take you to anywhere you want to go. Jamie Schreier related. So I think that's pretty good, right. That's great. Great. So Jamie, thank you so much for coming on. Again, as always a great conversation. I really appreciate you. So thank you so much. Thank you, Karen. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

Nov 22, 2022

In this episode, Award-Winning Entrepreneur and Speaker, Julie Bee, talks about leveraging burnout.

Today, Julie talks about her experience with extreme burnout, how burnout affects business owners, and how to document your burnout. What is the good side of burnout?

Hear about how to explore burnout leverage points, accepting the fact of burnout, preventing burnout, and get Julie’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Burnout forces you to really evaluate what is most important to you.”
  • “You’ve got to go through it. There’s no going around it.”
  • “The big things come from big work.”
  • “When you get to the other side of something really hard, you realize how resilient you are and how powerful you are.”
  • “If you’re not taking care of yourself, who’s going to take care of everybody else when you’re not there?”
  • “Embrace burnout. Accept that it’s probably going to happen to you at some point, if it hasn’t happened already.”
  • “Schedule time to read and time to think, at least once a week.”


More about Julie Bee

Julie Bee is an award-winning entrepreneur, compassionate and empathetic leader, and engaging storyteller. Julie has spoken for 14+ years on topics including leadership, management, employee engagement and morale, workplace culture, small business ownership, and entrepreneurship. Julie’s leadership insights have been featured on FastCompany, Forbes, Thrive Global, and many more.

Her forthcoming book with Matt Holt Books, The Business Owner’s Guide to Burnout, is scheduled to hit bookshelves in early 2024. Matt Holt Books is an imprint of BenBella Books, publishers ofTraction.


Suggested Keywords

Healthy, Wealthy, Smart, Burnout, Priorities, Leverage, Resilience, Entrepreneurship,



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Read: Addressing the Risks of Manager Burnout.

Read: A Founder’s Journey Requires Prioritizing Sleep and Defining What Success Looks Like, with Julie Bee.

Read: 10 Crisis Communications Do’s and Don’ts During Covid-19.

Read: How To Ask For More Support As You Return To The Office.

Read: The Ultimate Guide To Succeeding in the New Workplace.

Read: Why Successful Entrepreneurs Need To Be Calculated Risk Takers.

Read: Should Companies Take A Stand On Social Issues?


To learn more, follow Julie at:


Podcast:          They Don’t Teach This in Business School.

YouTube:        Julie Bee.

LinkedIn:         Julie Bee.

Instagram:       @thejuliebee_.

Facebook:       @Thejuliebee.

Twitter:            @thejuliebee.


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Nov 14, 2022

In this episode, Co-Founder of the Money App, Maia Monell, talks about entrepreneurship and navigating finances.

Today, Maia talks about the shortfalls in financial education, planning business KPI’s, and the results of financial inequity. How does the App address these concerns?

Hear about financial planning in the world of instant gratification, success milestones, how to keep financial stress low, and get Maia’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Healthcare doesn’t understand finances, and finances doesn’t understand healthcare.”
  • “Money is dollars and cents. Anybody can figure it out.”
  • “The biggest quality of an entrepreneur is adaptability.”
  • “You still have to work to be lucky.”
  • “The results of financial inequity are far-reaching and persistent.”
  • “Patience and adaptability are key.”
  • “Do not act on a TikTok influencer.”


More about Maia Monell

Maia is the Co-founder and Chief Growth Officer of the Money App. is the fitness app for finances, providing personalized financial coaching to build good habits and live financially well.

When she's not pitching, selling, and creating for, Maia is working with her family's two foundations. She's devoted to closing wealth gaps perpetuated by a system not built for the majority of America, and believes that financial wellbeing is an integral part of creating a healthier and more equitable society.

She’s an avid tennis player, skate skier, and runner, with an obsession for physical, nutritional, and financial health.


Suggested Keywords

Healthy, Wealthy, Smart, Entrepreneurship, Finances, Inequity, Patience, Adaptability,


Download the App on iOS and Android.


To learn more, follow Maia at:


LinkedIn:         Maia Monell.

Instagram:       @letsnavit.



Subscribe to Healthy, Wealthy & Smart:


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Oct 31, 2022

In this episode, Founder of Say It With Gratitude, Scott Colby, talks about creating a happier workplace through gratitude.

Today, Scott talks about the 5 languages of appreciation in the workplace, staying connected with handwritten notes, and how gratitude affects the bottom line. How can you infuse gratitude in the workplace?

Hear about gratitude journaling, the gratitude toolkit, and get Scott’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “It starts with you first.”
  • “Find out how each teammate likes to be appreciated at work, and then appreciate them in that language on a consistent basis.”
  • “Write down one thing that you’re grateful for each day.”
  • “Almost 50% of workers choose Words of Affirmation as their first way that they like to receive appreciation at work.”
  • “61% of all US employees are lonely.”
  • “Start now. Do something. Compliment somebody. Flash somebody a smile. Do something different.”
  • “Do some of this unplugged.”
  • “Don’t take things personally.”


More about Scott Colby

After an eye-opening experience in Guatemala, during which Scott witnessed firsthand the power of gratitude, even in poor living conditions, he launched Say It With Gratitude, which helps companies create happy workplaces by having gratitude as a core value.

In addition to delivering his message of gratitude around the world, Scott promotes the power of thank you notes, leads gratitude adventures in the wilderness, authored a book called The Grateful Entrepreneur, and developed The Grateful Deck, a card game consisting of questions that spark meaningful conversations.


Suggested Keywords

Healthy, Wealthy, Smart, Gratitude, Appreciation, Connections, Affirmation, Quality Time, Service, Gifts, Touch,


Recommended Reading:

The 5 Languages of Appreciation in the Workplace.


FREE Gift: Gratitude Toolkit.


To learn more, follow Scott at:



Facebook:       Scott Colby.

Instagram:       @scottcolby.



Subscribe to Healthy, Wealthy & Smart:


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Read the Full Transcript Here: 


Welcome to the healthy, wealthy and smart podcast where healthcare meets business with your host me, Dr. Karen Litzy. And just as a reminder, the information in this podcast is for entertainment purposes only, and is not to be used as personalized medical advice. Enjoy the show. Hey, everybody, welcome back to the podcast. I am your host, Karen Litzy. And today's episode is all about gratitude. So often we talk about gratitude in the context of our personal life, which is great, there's nothing wrong with that. But today, in this episode, we challenge you to start practicing gratitude in the workplace. So to talk us through is Scott Colby. After an eye opening experience in Guatemala, during which Scott witnessed firsthand the power of gratitude even in poor living conditions. He launched say it with gratitude, which helps companies create happy workplaces by having gratitude as a core value. In addition to delivering his message of gratitude around the world. Scott promotes the power of thank you notes, leads gratitude adventures in the wilderness, authored a book called The Grateful entrepreneur and develop the grateful deck a card game consisting of questions that spark meaningful conversations. So into the in today's episode, we talk about the five languages of appreciation in the workplace. So if you are a manager, or a CEO, or you own your own practice, you're gonna want to know what those five languages are. Because that's how you're going to want to speak to your employees, how to stay connected with handwritten notes, and how gratitude gratitude affects the bottom line. So I want to give a big thank you to Scott for coming on and talking about gratitude in the workplace. And so I'm very grateful for him. Everyone enjoyed today's episode. Hey, Scott, welcome to the podcast. I'm happy to have you on today.



Hey, Karen, thank you for having me. Looking forward to a great conversation.



Yeah, it's my pleasure. And today we're going to be talking about happiness and how to create a happier workplace through gratitude. So before we get into the meat and potatoes of our conversation, can you let the listeners know a little bit more about why you came across this topic? Why this is like your expertise. So go ahead and give the listeners a little bit more backstory, if



you will? Yeah, certainly. So back in 2014, I took a trip to Guatemala, I was there to build schools with an nonprofit called hug it forward. And we were building schools out of plastic bottles. And one of my first memories of that volunteer experience, it was about a week long experience was I was riding a bus with 25 other volunteers. And we pulled up to the site. In a community called Chinook stay in Guatemala, we pulled up to the site where we were going to be volunteering, and I didn't know really what to expect. And I looked out the window of the bus. And it looked like the entire community had come out to greet us. And there was people of all ages, kids and parents and grandparents. And as I stepped off the bus with the other volunteers, the community had formed two lines. And we walked in between the two lines of people. And we felt like rock stars, or at least I did, walking down the red carpet, there were people waving the American flag, there was music blaring over the loudspeaker, just they were hugging us and just had smiles all over their faces. And I really learned that they were just being grateful for the volunteers that we had taken time out of our schedule to take that trek to Guatemala. And the other thing that I learned over my week long experience there in genetics day, was that the community had very little, very little clean water. They don't have the smartphones and the internet that we take for granted very little food, cramped living conditions. But they had community they had each other. And again, they had gratitude and appreciation for just other human beings. And as I thought to myself, when I got back, I was living in Denver at the time, when I thought to myself, after I return home, like cash, like how am I living my life, I'm living a life filled with complaining, thinking about all the things that I don't have. And in stark contrast to just what I experienced, and also looking at my life and other people around me, are always on our phones and we're always have our head buried in screens, and we're anxious and we're overwhelmed and we're not making deep connect actions anymore. It seemed like so that was kind of the first start that I had in my head, that, hey, I wanted to do something different in my life to make, to really live in gratitude, and to live with an attitude that I learned from the community and nginx de Guatemala. And then also, I think, and we'll probably get to this a little bit later in the conversation, just my experience in the corporate world of, yeah, you know, I've had jobs where I don't feel appreciated in the workplace and how much of an impact that made to my to my happiness, we spend a lot of time at work. And if you're not happy with your job, and a lot of that is not feeling valued or not feeling listened to that can really impact your your mood and your attitude. And really, whether you want to stay with a company or not. So kind of putting all that together that led me to start a brand called, say with gratitude. And it started with thank you cards, and now it's morphed into where I speak on the topic of workplace gratitude.



And you alluded to this, but I want to dive right in. So how does this translate into the workplace? How does that action of gratitude, that feeling of being appreciated? How do you translate that into a corporate setting, or, in my case, I'm a physical therapist, so maybe into a healthcare setting where people right now are really stressed out and burnt out. And, you know, and carrying a lot of student debt, and empathetic loads, and everything else? So how do you infuse gratitude? What are your recommendations? Yeah, and



that's a lot. And I, I'm glad you brought that up, I actually just came back from Wisconsin, where I was speaking at a healthcare conference on this very topic. I'm a big believer that it starts with you first. So start with the person before we can maybe bring it into the workplace, because we need that. We need to have that right attitude. It's hard to it's hard to spread gratitude around the workplace, if you're feeling, let's say, depressed and overwhelmed and stressed. So what can you do to start your own personal gratitude practice? I also have a health and fitness background. So I love that you're in, in physical therapy. And yeah, so I, I always talked about the analogy of, you know, when you're on an airplane, and they're given the safety instructions, if the oxygen mask comes down, please put it on yourself first, before helping others. And I talked about that, because if you're passed out, how are you going to help other people, but we can maybe not literally get passed out. But we can have the feeling of like, Hey, I just can't do it anymore. So I think we have to take care of ourselves first with self care. And there's a lot of different ways you could practice self care, but for this conversation, what how can you practice gratitude, and help you feel better gratitudes got that kind of magical powers that it can help you be more optimistic, feel less stress, more energy and things like that. So where do we begin here? There's various ways to practice gratitude. Probably the one that people maybe, you know, they think of when they think of the term gratitude, just keeping a gratitude journal and writing down what you're grateful for. I've got a tip there, though. I know a lot of people that do do that just kind of go through the motions. And then you don't really feel that difference. Like if you're just saying like, Hey, I'm grateful for my cat Oliver, which we now know as parents cat's name. I'm grateful for all of her my health and my job. And then you turn the page and you fill out the gratitude the next day. What does that actually mean? It probably is not going to get you into a frame of mind where you're living in gratitude. So we're, I suggest people take it further is if you're writing down, you're grateful for somebody or some something in your life. Follow that up. By writing down why you're grateful for those things, or that person, what is it about that person that you appreciate that you love? And then I take it even deeper and I teach people think about what your life would look like without that person? Or that that thing without that job without your teammate? What would life look like then? And then when you do that, you say what, why and what would your life look like without then it creates a more emotional response. So I'll have people do this in my breakout sessions. And that's usually the hears, people have tears because they start to think, oh my gosh, my life without this person, I couldn't even imagine it. So I think that is one way to start a personal gratitude practice. So you're actually like, Okay, you're, you're reminding yourself of the good in your life. And then what does that mean for work and work, we could talk about two different things. One is like, leading with gratitude, which, in a sense, I take that to mean creating a culture of gratitude and kindness. So in healthcare, trading, treating your patients, like real people, and that have a heart and not just transactional. So I like to, you know, give examples, so people can really think about what this might look like in the real world. So I my favorite coffee shop in Denver, when I lived, there was a coffee shop called fluid. They, they got to know me by asking questions. I went there on a regular basis. So it wasn't just like, hey, here's your coffee, give us money. It was people that took the time to get to know me a perfect example. There was one day when one of my other cats we had talked about cats before we hit record. My other cat, Nomar who who's not with us anymore. He was having two teeth pulled. And so I was a little bit anxious and the barista the manager there, she asked me like, hey, you know what's wrong? I told her, her cat was having a tooth pulled that day as well, just coincidentally, and she just said here, your coffee is on the house today. And it was just just a little thing. But something like that can go a long way. Chewy. Speaking of animals, they're a company that sells pet food and pet accessories to pet owners. I know a lot of pet owners will get their food from chewy on an auto order subscription basis, they automatically send the food every month, and they take money out of your credit card. So there's a lot of stories, but it goes like this. A lot of times when a pet owners, dog dies, let's say or a cat dies, and they'll call you and say hey, please stop my shipment, my dog has passed away. Chewy, of course will express sympathy. And then they'll say, okay, all those unopened bags that you may still have, we will refund your money for all of that. Don't send the food back, we will, we would love for you to donate that food to a local shelter. And then a lot of times in a few days, sympathy flowers and a sympathy card will show up on the doorstep in just as a as an expression of condolences. So chewy is a company that leads with gratitude. So they're not saying like, we need your money back or we need the food back or we can't send these flowers because it costs too much. They're treating their customers like human beings that have a heart.



And then we've got appreciation in the workplace in the sense of all right, we need to appreciate our teammates, right? There's an interesting statistic. This is kind of a old statistic, Karen, but it's still relevant and maybe worse today. 79% of people in a research study a few years ago said that they left their job, in part because they didn't feel appreciated at work. So it wasn't like, hey, we need more money. Or we need to be you know, get promoted. It was really just not feeling valued, not feeling heard or listened to and not feeling like they mattered. So that's why I like to talk about Okay, starting with yourself first and then spreading it to other people like your customers or patients but also your team. And a great book is the five languages of appreciation at work. It's kind of a follow up book to the five love languages, which is was a popular book that talked about relationships, personal relationships, and we all have a preferred way that we like to receive love. We also have a preferred way that we like to receive appreciation at work. And the languages are the same five languages as the original five love languages book. So think of things like words of affirmation, quality, time, acts of service, tangible gifts and physical touch. We all have a way that we like to be shown appreciation at work usually follows one of those five. And so basically the idea here is find out how your each teammate likes to be appreciated at work, and then appreciate them in that language on a consistent basis. So somebody likes words of affirmation. So you want to appreciate that person, by affirming them with words that can be written, it can be verbal, the idea is to do it consistently. Be very specific. Don't always make it tied to performance. Maybe make it you know, give them a shout out on why you like them, kind of like we talked about earlier, when we write down like, Why do you like somebody's work? Somebody that is loves words of affirmation will love hearing good things about them? So yeah, so that's just kind of a basic rundown. I know, that was a long answer. But I think it's important to, to get all three of those in personal gratitude, leading with gratitude, and then spreading appreciation to your team. Yeah,



that's three, kind of an easy framework for people to follow. And circling back to that gratitude list or gratitude journal. I used to keep one and then I did it. And then I did and now you know, it kind of goes in cycles. Do you have any advice for people on how to be consistent. And as a follow up, I think it's important for people to know that it doesn't always have to be really big things. I remember when I started, the coach that I was working with was saying, Well, you know, it doesn't always have to be big, grand things. It could be like, I'm grateful that I have an umbrella because it was raining today, or I'm grateful I have a warm jacket, because it's 30 degrees today. So it doesn't have to always be a person or an animal or a relationship.



Yeah, yeah. Great point. You want to keep it simple, right. So don't get overwhelmed. So I love your point there. So my first thought to your question was, you know, you've mentioned that you weren't super consistent with your gratitude journaling. I know, I'm not I'm actually not either. You know, I'm seen as gratitude guy. But gratitude journaling never has been something that I've been consistent at. So what I do want to I'll give a tip on how to be consistent. But before I do that, I do want to encourage the listeners to find something gratitude related that you do enjoy doing. So maybe your thing isn't keeping a gratitude journal, but maybe like complimenting somebody. So that is a sign of gratitude. Or a way to show somebody gratitude. Gratitude could be just sending a quick video to somebody. So maybe like, I'm not really much with written but I'll send them a video or an audio. And that could be your thing, or writing handwritten notes, could be your thing. But in terms of if you did want to start with gratitude journaling, and trying to figure out a way to be consistent with that right off the bat, you could do some things that can help you form a new habit, much like forming a new habit to exercise or something like that. setting yourself up for success. So breaking down the habit into the smallest thing possible. So maybe you just write down one word each day instead of trying to form an entire sentence. So that could be a way to break it down in a small, small miniscule habit. But also think about something that you're already doing, and stacking this habit on that and creating a trigger point. So suppose you make coffee every single day. And that's kind of a routine you're already in. So maybe you leave your gratitude journal by your coffee pot or your coffee maker, and just have that next to it as a reminder that oh, yeah, because a lot of times not keeping a habit is just we forget about doing it. So create a way that you will remember to do the habit by having something that you already do be that trigger that reminder, right.



So your habit, habit stacking.



Exactly, yeah, habit stacking. Yep. So you've heard of that. If you're doing something like if you're doing something like writing a handwritten note, I've tried to do like, writing handwritten notes every day, which I've been successful at for a while. That is a little bit more involved. But what I could do is think about the night before who I want to write the note to find the address, get the envelope out, get the card out, get the pen out, get the stamp out and put it all out. So I'm actually see it and everything's not like hidden away in a drawer. So make things visible. So I think yeah, those are my best advice to find something that you like doing so it might not be a gratitude journal. Once you find it breaking down in the smallest component possible. So it's one word versus a list of 10 things and then finally have it stack you know, do Do it while you're doing something that you already do every single day anyway.



Got it? Yeah, much easier makes it much more digestible than like, well, I don't know if I can write the journal and then write the why. And gosh, take me 30 minutes. And do I have time for this? And yeah, so that makes a lot of sense. And I can also, I should also say, like, you can do it on your phone, too, like the notes section of your phone? Yeah. Yeah. You know. So that's, that's a possibility as well. So if you have like, a commute after work, where you're not driving, you can, you can like make that a habit at the end of your day to just throw something into your phone or something like that.



Yeah, I got one more. Yeah, it's similar to a gratitude journal to gratitude jar, which is huge. It's just take any jar. And you can just cut out slips of paper and just write down one thing that you're grateful for. Each day in the paper, maybe you have a family, and you get the whole family involved. And I like this idea. Because the jar can be visible. And it's fun. It's almost fun to watch the stacks of the slips of paper grow in the jar tilde, Giorgio stuffed, filled with gratitude, then you could pick a day, Thanksgiving Day, New Year's Day, maybe go and bring your family together, you sit in a room, on the sofa in the living room, and you go through like hay who said they were grateful for you know, chocolate, and then somebody raises their hand. That was me. And then you said, then you can go into more of the Hey, why did you pick chocolate? What is it about it? And then you can have these amazing conversations as a family. Or you could even do something like this at work as well.



Yeah, I was just thinking that if you have, you know, maybe a smaller to medium size, like a small company, or I know a lot of physical therapy offices. They don't have hundreds and hundreds of people in the same office. So this is something that's actually like, doable. You know, because I think if you had like, if you're in an office with like, 300, people, like it might be a little overwhelming. But most, I think healthcare offices, you know, if you have 20 people, I think that would be like quite a bit. So if you're in a smaller office, it's a great way to stay connected with your co workers. And another way of staying connected is and you'd mentioned this here, and there are handwritten notes. So how do you incorporate handwritten notes in the workplace? And are you only doing this if you're the boss?



Yes, I so handwritten notes I love it's how I started my company, say with gratitude, I, I had kids draw pictures. And I turned them into thank you cards that I sold to individuals and companies. But I love handwritten notes because it provides a connection point between you and the recipient of the note. So it's a way to not only appreciate somebody but actually connect to them on a deeper level. So whereas you know, writing in a gratitude journal, you might be the only one that sees that a handwritten note to people can see it or maybe even more in the workplace. You can use it a couple of different ways. One could be if you start to learn, who in your company likes words of affirmation, right, we talked about the five languages of appreciation. If you find out who likes words of affirmation, then you can make it a point to write a handwritten note to those people and know it doesn't need to only be the boss. I think if you're creating a culture of gratitude, I think everybody should be involved. If you're trying to figure out like, hey, I want to start this gratitude at work thing, not sure where to start, handwritten notes, I think can be a great place to start before you kind of fine tune your your appreciation, tools that you want to use. The kind of latest research shows from the authors of the five languages of appreciation and workplace that almost 50% of workers choose words of affirmation as their first way that they like to receive appreciation at work. So it's a great place to start. Of course also, you can easily write handwritten notes to your, your your patients to appreciate them. We talked about appreciating your customers patients, more is more than just a transaction, like make them feel good. And there's a company that I interviewed the HR had a few years ago, I love what they do every week, like once a week, they would, as a team, they would get together at lunchtime for about an hour. And they would write handwritten notes to their customers. And I liked it two reasons. One, they were expressing gratitude to their team, or excuse me, to their customers, but to they were bonding over the act of writing gratitude notes as a company. So just imagine there's a few people in a room, they're grabbing lunch, they're writing notes, they were being creative, they were putting stickers on the notes. And they were able to kind of chat with their the co workers on a level that they don't normally do, because they're normally just focused on work. So they got to know their team, on a deeper level, just having these conversations as they were writing note to their customers. So it could be a great way to, to bring your team together to just bonding over the act of writing handwritten notes.



And here's the question that I think a lot of business owners are going to want to know. And you may, you may have an idea of what I'm going to ask here. But what does this do for the bottom line of a company? So you're spending this time you're bringing in people from your company? How does does this improve the bottom line? Will this help the company make more money?



Yep. So that one statistic that I mentioned that 79% of people left a job because they didn't feel appreciated at work? Turnover finding new workers as a high cost of business for a company. So anyway, the Yeah, the the research is showing that. Doing things like infusing gratitude at work, appreciating your team, connecting with them on a more deeper level. So a lot of people feel disconnected at work, because they've got a lot of emotional stuff, you know, in their lives are overwhelmed or stressed. But when they get to work, they don't chat about any of that. So there's a lot of research now that shows workplace loneliness is high. Six, up to 61% of all US employees are lonely. So lonely workers and workers that don't feel appreciated, they're disengaged, they're not as productive. They're calling in sick, they're stress. They're thinking about leaving their job, or they're actually leaving their job. And connecting with a team and showing appreciation to your team can change all of I don't know that there's actually hard numbers that are out there yet, but just know that there are studies have shown there's productivity increases, turnover decreases, sick days decreased. So all of this leads to companies that can actually save more money.



Yeah, no, I understand that. Yeah, that makes sense. But I had to ask that question, you know, because people are going to be like, Well, this sounds great. But what's it gonna do? Yeah, it's



the biggest probably, you know, obstacle in doing something like this, because a lot of businesses are like, well, you know, I know if I spend, you know, $100 on Facebook ads, I'm gonna get this exactly. Yeah. Right, and $1 for dollar return. And for something that's more of a soft skill like this, you might not exactly have that data, but just know that there's a lot of money being lost due to low productivity and high turnover. Yeah. And with appreciation and connecting can really solve a lot of this. Yeah,



no, that makes perfect sense. And now, before we wrap things up, I want you to one more time. Yes. Do you mind repeating the five languages of appreciation in the workplace?



Yeah, the five languages of appreciation are words of affirmation. Quality time. So that's the second, the one that second most popular quality time. So two people basically, spending time together like you and I are acts of service. So that could be like helping somebody with a time sensitive project. Tangible gifts. So that could be somebody that actually likes to receive a gift. And that's how they like to be appreciated. The thing is, they're the best you can make the gift. It doesn't have to be expensive, but the more personal, you can make it the better. So a gift of a pair of socks with my cat's face on them is better than handing me a Starbucks gift card because somebody that knows I'd like my cats has done their homework and that would be a really meaningful gift to me. And then physical touches the last one That's not seen very much in the workplace that's like, you know, high five pat on the shoulder for obvious reasons. Yeah, yep. Yeah, that one is usually not somebody's primary way they like to receive appreciation. So the first four are the ones that most things, you need to focus on those four languages. Right,



right. And speaking of gifts, you actually have a free gift for our listeners. So it's gratitude. Can you talk a little bit more about that?



Yeah, that's really a toolkit with a bunch of goodies. So what'd you get there? I wrote a book called The Grateful entrepreneur, which I know you mentioned in the intro, that you get a digital copy of that book, that's all about creating meaningful relationships at work. I've got something else that I created called the grateful deck, which is 120 questions to start meaningful conversations, great to use to start meetings at work to just get to know your team a little bit better. And then I've also got 47 ways to practice personal gratitude, and 29 ways to use gratitude to grow your business. So that's all in this all digital downloads in the gratitude toolkit.



Perfect. And that's awesome. So if you want to go a little bit deeper into what we've spoken about today, then you're going to want to check out that gratitude toolkit. And again, it's www dot gratitude toolkit. All one All right. So is there anything that we didn't touch upon that you want to hit on? Or is there something that you want the listeners to their big takeaway here?



Yeah, big takeaway, I think, is just to start now, do something, compliment somebody flash somebody a smile, do something different. If you want to go a little bit deeper than that, write a handwritten note. And do those three, do the three things that I talked about in the journal, do it for your note? Who do you appreciate? Why do you appreciate them? What would your life look like if they weren't in your life and read that note to them, it's even more powerful than just handed it to them is to read it to them, the connection will be amazing. And the one thing one thing that we didn't hit on, that's kind of near and dear to my heart. Do some of this unplugged. So don't you know if somebody is talking to you Don't be on your phones, pay attention to them. That's a form of gratitude, a form of connecting is just listening. So I if you want to start a gratitude practice, think about doing this, like write your note without like, put your phone in a different room, you'll be more engaged. And you're going to think more clearly. So yeah, that's a I think a good good takeaway for that for the audience. Yeah,



that's great. I love it. And now, I have one more question. It's a question I asked everyone. Okay. That's knowing where you are now in your life. And in your career? What advice would you give to your younger self?



Oh, that's a great question. Lots of advice. I could give my younger self. So I was thinking about this, I would say, and this is I was trying to think of what am I still working on? Because and there's a lot but I was I'm gonna go with don't take things personally. So good. Something I still work out. I don't think I'll ever be like completely perfect with that. But yeah, if I could give my younger self that advice. Because I do take things personally, I'm sensitive. If somebody you know, I could have 100 compliments, and one naysayer, and I'm focused on that naysayer, I think it's human nature. And I take it personally, but but I think like, we don't know, like, at least for me, personally, I know I'm doing good in the world. And I'm changing lives. And I need to not be sensitive and not read social media sometimes and take that own advice of unplugged right and just hanging out with the people that I love. And I know that love me and, and, and really, I think just continue to connect with other human beings in a meaningful way. Get rid of the technology. Don't let negative comments bring you down. Because then it can affect your day, your week thing that affects your performance at work that affects how you relate to your loved ones. And so yeah, so don't take things personally. Advice that I would give my younger self but I would also continue to take that in my older self.



Yeah, I love it. That's so good. And now where can people find you? Where can they connect with you,



too? your main website is saved with you can always email me Scott at Scott And then even on Facebook, my most probably active social media platform at Scott Colby.



Perfect. And we'll have links to all of this over at the podcast at podcast at healthy, wealthy So you can always hit up the podcast website, and one click will take you to all of Scott's info. So Scott, thank you so much for coming on the podcast and sharing with us how to have gratitude and how to infuse that into our workplace in our jobs. So thanks so much. Thank you, Karen. My pleasure. Anytime and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart. Thanks for listening. And don't forget to leave us your questions and comments at podcast dot healthy, wealthy

Oct 24, 2022

In this episode, Nutritionist, and Emotional Eating and Self-Sabotage Coach, Matty Lansdown, talks about dieting.

Today, Matty talks about emotional eating versus hunger, creating healthy and sustainable lifestyles, and the “Why x5”. What alternatives are there to reproduce the “dopamine hit”?

Hear about how to create healthier emotional escapes, intermittent fasting, and get Matty’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Emotional eating is eating for any other reason than nutritional requirement.”
  • “How you do anything is how you do everything.”
  • “We can’t undo the work of the past unless we know what created it.”
  • “[intermittent fasting] can be different for everyone.”
  • “That journey takes a little bit of time, and you’ll fall off the bandwagon - that’s also okay.”
  • “Do you own research, learn, be open-minded, and move forward with absolute curiosity.”


More about Matty Lansdown

Matty Lansdown is a scientist, nutritionist, and an Emotional Eating and Self Sabotage coach
that specializes in weight loss and self confidence for women and busy mothers.

Starting out in the field of nutritional epigenetics, and spending several years working in hospitals as part of a disease research team, Matty believes that most disease and illness is not due to bad luck but as a result of poor nutrition and lifestyle choices.

Matty’s extensive experience allowed him to uncover the deeper challenge people have with
health which isn’t about calories or kale, but in fact mindset and behavior change.

Having been on his own personal development journey, Matty is now super-passionate about showing people how to level up their health so that healthy habits and the best food choices are easy and natural. Likewise, Matty’s weekly podcast “How to NOT Get Sick and Die”, provides his followers and clients with a deep dive into nutrition and how to develop healthy habits that last.


Suggested Keywords

Healthy, Wealthy, Smart, Diets, Fitness, Nutrition, Emotional Eating, Food Addiction, Sustainability, Food,


Recommended Reading:

Atomic Habits, by James Clear.

FREE Gift: How to Turn Food into Self-Confidence.


To learn more, follow Matty at:


Facebook:       Busy Mothers FB Group.

                        Matty Lansdown.

Mailing List:     Join the Mailing List.

Podcast:          How to Not Get Sick and Die.


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript here: 


Hey Maddie, welcome to the podcast. I am happy to have you on today to talk about the D word. And we'll get into that in a second. But welcome to the podcast.



Hey, Karen, thanks so much for having me on.



Yeah. So like I said, we're going to be talking about the D word. dieting. Right? Yeah. Why does everyone go on a diet? Why do we think we always have to be on a diet? And of course, ultimately,



why a lot of them just don't work? Right? Yeah. It's such a good question.



Yeah. And I'm sure a lot of it, it has to do and we'll get into this, the psychology behind it, and why we eat and why we do the things that we do. And I know one of the things that you're really passionate about is working with people to understand their emotional eating. So can you talk about kind of what is emotional eating? And why do we do it?



Yeah, that's like the understanding that is really the the answer to possibly all health questions, I think, I think emotional eating to sort of classify it in like a textbook fashion, would be eating for any other reason than nutritional requirement. And then we get into the weeds instantly with what is nutritional requirement. Because we're in this world, unfortunately, that has, you know, anything in a bag, a box, or a can, is food that is somehow manipulated and changed and altered in a way that doesn't resemble the type of food that our genetics and our body is expecting to receive or familiar with receiving. And so that's why, you know, people are always looking for diets, because we've been consuming this food and living these very westernized lifestyles, which have led to bodies that are sadly, really unhealthy and really unwell. Whether that be through the lens of I've got access body fat, or whether that be through the lens of diabetes, or just any type of dysfunction in the body. It there's the diet is going to be a part of that in some way. And so we've created this Yeah, unfortunate reality where everybody wants to be on a diet, because they're marketed and sold to us as being the answer to basically getting your bikini body back, or pretending that a woman that's 55 can now be 21. Again, you know, and that marketing it, like, it appeals to everybody. Because of course we want, we all want our youth back. We all wish we could, you know, go back in time and be there where we thought we were fat then. But actually now in retrospect, we're like, oh, I wasn't bad at all. I wish I had that body. Or it might be in the case of like physical wellness and disease, which is like, yeah, I've eaten myself into some really significant health problems. And it's not just food, it's important to acknowledge stress, sleep, relationships in your life, the house that you live in toxins that they're all a part of the equation. But yeah, I think it's really important for people to I guess first understand, yeah, what is emotional eating, eating for reasons that are not nutritional requirement? And then second, why would I be eating foods, not for nutritional requirement? And then that's where we get into emotions?



And how, so how can people understand if they're eating is emotional eating? Does that make sense?



Makes perfect sense. Every single one of my clients asked the same question in the beginning. So the way that we sort of get to realizing that is, like, has have the diets you've tried in the past? Did they work for a short period of time? And then you went back to how you were eating before? Or did you you know, you couldn't wait, use lots of willpower for maybe 612 weeks, and you just couldn't wait for week 13 When he got the wine back, the chocolate back the pizza back. And if any of that stuff is a feature of the way that you've gone about food nutrition in the past, then it's highly likely that those foods that you were looking forward to putting back into the diet were consumed from an emotional standpoint, if you're thinking about the food that you're consuming six months or three weeks, that's not your hunger right now. That's definitely emotional. You are looking forward to having an experience that will bring you pleasure. So the way to sort of ascertain it in your day to day life is to sort of do an internal check in when you go to the pantry or to the fridge. If it's not mealtime, approximate mealtime. And that looks different for a lot of people. And you're not actually like, yeah, I've got genuine hunger in my stomach. And it's been a while since I've eaten it kind of makes sense that that now's the time. And you get there and you realize, I actually kind of don't feel that hungry, but I really want the thing. Want the chocolate want the nuts, want the muesli want the yogurt, whatever it is, but I'm not really hungry. There's definitely an emotion driving that behavior. So it's basically Yes, you got to check in with yourself and you've got to take a really conscience conscious 10 to 20 seconds to really check in with your body. And you might even do a little bit of breath work in that time just to calm your nervous system down to be like, am I actually hungry? And probably if you're listening to this, it's likely you're in a very privileged, wealthy country. It's probably very likely that you're going towards that Food for emotion rather than hunger?



And how can what can we do in those moments? So I need to like take a minute breathe. But if it is this emotional eating, how do we get to the sort of root cause of these emotions that are causing us to eat more?



Yeah, well, and that's a that can be a really confronting and heavy answer for some people. And like everybody that jumps into the work that I do a, I don't sugarcoat it in any way, I say this might make you cry. You know, we've been using these tools often to hide from, or cover up feelings that we're uncomfortable with, or situations, that might be a situation with our partner, that instead of having the difficult conversation that's been there for 15 years, we just get wine and chips every night. And I use that example, because I've had clients in that situation that when we removed that, some problems from a long time ago, we're able to be dealt with. And so the, I guess, the way that you want to navigate that is you don't want because we were essentially in that moment, we're using food as an escape, right? We're escaping an uncomfortable emotion or trying to move towards a pleasurable emotion. So if we ascertain the motivation, like, which is that first question, am I trying to escape? Or am I trying to move towards? Once we've answered that question, we can figure out, okay, we need a list of other alternative escape options, other than food, because sometimes we have to escape, because expressing your inner child's worst moment from when you were, you know, hurt, as you know, 1520 30 years ago, in the middle of a board meeting on Wednesday, is a really bad idea. Right? So it's not that we shouldn't always escape, sometimes we need to escape those feelings, because they're not practical to be dealt with in the current moment. So we need a healthy, what I call them routine swap outs. So it's like the eating the food is this ingrained routine or pattern that's automated. And through through this process, we bring it out of automation and into your sort of manual awareness. And then from there, we figure it out right? Now I know what I'm getting for this, from this escaping the pain or moving towards pleasure, what is a list of things that I can put together to change this routine, to be able to then create a more favorable outcome where I'm not punishing myself with food in the process. And then there's, of course, there's the, that's the escape, but then we also need to put a list of things together about how we might actually process because processing is really important. Otherwise, we're on this roundabout forever, hence, the yo yo diet cycle that many people have been on. And some recent research says that most women have been on 17 years of dieting and spent $40,000, only to be left with a problem that they never solved, basically. And so, so yeah, we've got to we've got to actually process so distinguishing the motivating factors, why it's there. And I call it the why times five. And it's kind of like just why am I hungry? It's like the surface level thing might be because I want food. That's like, Okay, let's go a little deeper. Why do you want food? Because I'm bored, bored of my work. I got up from my desk, and I moved to the kitchen. Why are you bored from the from your work? And it might be like, Well, I hate spreadsheets. Why do you hate spreadsheets, I don't feel super confident actually doing them. Like, I kind of feel a bit lost. And, and it's like, you know, I kind of just fumble through the task. And then the why that inevitably is at the bottom of that is I don't feel good enough, right? I don't feel capable enough, right. And it's and it might be one of those things. And that's, that's the little routine that we get people to go through every time they find themselves in a situation where they would be snacking, or even in the middle of a snack, or a binge or an Uber Eats order that you know isn't for hunger. And we dig down that little rabbit hole and you can see how very rapidly it can become very deep and confronting. But once we're there now we've finally confronted or met with the cause of the reason that these yo yo diets have cycled around for years and years and years, because most of those diets never deal with that piece.



Right? They just deal with, you know, eat, eat less food, eat this food, not that food, write everything down, keep a journal, all that kind of stuff, which works in the short term for many people. Yeah. And it comes back again, because I guess you're not really addressing some deeper things. Is that



accurate? Totally. Yeah, totally well, and the other thing is to like, where we're driven by dopamine humans are driven by the hormone dopamine, which is the happy hormone, the pleasure hormone, and it's the reason the species exists that drives us to procreate and have sex. It drives us to hunt food. But the catch is, because in the last 100 250 years, social evolution moved so rapidly along with technology is that we're now in this modern day world where we have access to dopamine. Keep in mind getting dopamine used to be risking your life hunting a buffalo, you know, or a wildebeest and there was a huge cost risk, like In order to get that dopamine, or it was like impressing a woman in much more traditional setting, in order to have sex for both parties, to engage in sex, the man would have to improve, you know, impress the woman, and vice versa. And again, it was a long Costas significant allocation of time before you got your dopamine. Now, we can wake up at 2am and pull our phone out and get a dopamine hit from our Facebook update, Instagram, Tik Tok, or even in most cities in the world, now you can get sugar, which massively like hits the dopamine button in a massive way, from a 711, around the corner that's open 24/7, or a service station or gas station. And so we have to put no effort in to get this hormone that we're driven to seek. So understanding sort of the science and the psychology behind dopamine drive, because many people actually go on this why times five exercise and they're like, I can't really find a belief for a trauma in my past that's driving this. And it can simply be biological addiction to the sugar, which then addicted to the dopamine, the happy hormones, because every single day of our life, we're trying to create situations where dopamine is available to us because it makes every human on the planet feel good.



And so what can we do? When we're in the thick of it to feel good without having that hit of sugar or snack or muffin? You know, you're at your desk and you're not feeling great? And because you know, offices, there's always a muffin or a donut or some sort of sugary something laying around. So when we're in those moments, what can we do to get that, that dopamine hit? I use that in quotation marks? Versus having the sugar and feeding that addiction, if you will, because it is an addiction.



Yeah, no, I totally agree. It's, it's funny often get asked as an emotional eating coach, what's the difference between emotional eating and sugar addiction. And it's one of those things that if you ask an emotional eating coach, they will say it's, you know, they're both the same. If you ask a sugar addiction coach, the, I'll say they're both the same. So it's very much is in that realm. But this list of things that we need to do alternatively, to produce that experience is going to be different for every single individual. And it's, the other thing is to that we've got to have like a really practical list and a little bit later in the week list. Because if you're a mom, or if you've got, you know, super busy job, you can't just necessarily respond to it in that moment, it's like, you know, you might need a list of options that can be done under two minutes. And that might include a little bit of breath, work, a walk around the block 10 Push ups, you know, something that moves your body and we know produces dopamine, it can be simply hugging somebody, like, you know, a lot of people go towards food for love and connection and security and safety and predictability. So and we can get all of those things from hugging somebody that we love. And these might sound overly simplistic because I often tell my clients, we want to find something of equal or greater value. And they're like, Maddie ain't nothing more valuable than a glass of wine. And so then we do this thing, which James clear in atomic habits talks about, which is habit stacking, essentially, which is like, we might need to do two or three of our little swap outs that we've come up with, in order to feel appropriately satisfied, that we can, you know, now put ourselves in a position of power to say actually, now I'm not really not really wanting the chocolate anymore, or the the muffin or the wine or whatever it is. And it's it might even to be just to elapse the time. And they do that a lot in sugar addiction space as well. When you get to the meal or you get to the pantry, you say, if I want it, I'll have it at the next meal. And you do that for every single meal. So you take the stigma away of you definitely want to get away from the don'ts. No, avoid can't have because that triggers our inner rebel to be like, watch me, I'll do that. But But yeah, so we want to take the stigma away from it. But But yeah, that little list of things is gonna be different for everybody. And yeah, we want to explore what's available to us. I literally have a little indoor trampoline. That's one of my own little routine stop outs. And it's purposely on the way to the kitchen because I run my own show from home. And I jump on that for literally about three jumps. And I've totally forgotten about food altogether. So yeah, there's a lot of different ways we can go about it.



So it sounds to me like achieving weight loss goals, or even just being healthier and fit, right because we don't want to have to tie everything to weight loss because that's not necessarily the goal for everyone. I think like you said before, being being healthy being fit, avoiding chronic disease, which happens a lot in people who are overweight. So it sounds like it's not so much about food, but it's about the psychology behind what we attached to that food?



Yeah, you're totally right. And I think it's one of those things I believe in the idea of how you do anything is how you do everything. And the thing that underpins the way you do food, the way you manage the relationships in your life, the way you walk up to your job, and how you execute, it's all from your own mind. So if we can work on that, then there's going to be a positive flow through all areas of your life, but equally food and if you are trying to lose weight, weight loss as well.



Right, and you know, people, people love plans, right? So out of this conversation, you know, it we're talking about changing habits and psychology and dopamine, and a lot of people might be thinking, Okay, what's, what's the plan? Give me a plan here, you know, like, what, what do I need to do to get healthier to be fit and perhaps to lose weight? How can I do that and sustain it? So what is your answer to that question? What's the plan?



Yeah, so the first step of the plan has to be looking backwards, you cannot understand how the present came to exist if you don't understand the past. And I think that's one of the problems with fad diet culture, and yo yo diets is that on Monday, change everything about your life. Why? Because apparently, that's better. And we instead, we can't undo the work of the past unless we know what created it. So we have to reflect on our past, whether there'll be a big trauma there that we can find, or whether we just understand on a deeper level that we've been convinced by 45 years of marketing and advertising the sugar industry, which spends literally billions of dollars, purposely to to addict you and convince you. So we have to understand how did I came to be now? Because if we don't know the answer that question, then no diet is going to work? If we understand that question, then we can start moving forward with okay, how can I navigate that space in a different way, because currently, the way I'm navigating, it has meant that over the last 25 years, I've gained weight every year, or has led to a situation where I've got a cancer diagnosis or a diabetic diagnosis or whatever it might be. Because if we don't understand the driver behind our behavior, where it's very unlikely, we're going to change it because we're not dead. And that's literally how the core reptilian part of your brain operates. It says, if we're not dead, everything we've been doing up until this moment has been relatively okay, because it hasn't killed us. So we won't change unless we can find some kind of understanding as to how we got here, and then also be inspired to be like, oh, and I can do it differently. Which is, you know, a lot of people get their inspiration from social media, but you really need to find that inspiration within yourself. Because there's only so long that we can want to be like, the person on Instagram or Tiktok, that we get inspired by every now and then we need to want to be better for ourselves or our children every single day.



Right? And I love that, you know, you're presented with a situation. And you kind of have to make that conscious decision, like you said, of how can I look at this situation and react to it in a different way than I normally would? So I think first it's, it's confronting the situation and having that sort of internal drive to say, Okay, this is what happens, I can't control the situation. But you know, people say this all the time, you can control how you react to it. And so my question is, you know, if we're working off of psychology, we're working off of patterns within the brain, the more you respond to the similar situations by maybe not having that handful of candy, or the muffin or whatever it may be, will that change that patterning in our brain eventually, so that when we get into that situation, again, the brain is going to be like, Oh, we don't not not necessarily know how to handle this in a different way?



Yeah, absolutely. It won't change it permanently, because the body and the brain. And evolutionarily speaking, we've identified that these fast sugar sources, you know, survival techniques, basically to eat these foods, even though we often live in very privileged, abundant worlds. The brain still is knows that like, oh, there's fast energy, so we're never going to get rid of it forever. And if you ever talk to a drug addict, or a sugar addict, really, that's in recovery, they, they they're under no illusion that it feels good at the time. And that's, you know, whether it be heroin, cocaine, alcohol, they're like, yeah, when I'm in the middle of it, it feels amazing. The same when you put the chocolate in your mouth or the lollies or the candy in your mouth. Like in that moment, it feels great. But the catch is that, you know, triggers a cascade so you'll always have this knowing and this knowledge in your mind that that's the experience. And if you've done it for decades, that will definitely be you know, those new runs in your brain will be really thick. However, we can start building up an alternative set of neurons, which by default will take the sort of physical thickness out of the other ones, it's because the brain works on it, you don't, if you don't use it, you lose it. So we want to start building up the neurons in a different pathway. And we want to do it slowly, too, we don't want to, it's not day one, throw everything out by 400 kilograms of kale and live your healthiest life, I have this little mantra that I that I always use, which is one tweak a week, we want to make one change. And that might be just focusing on breakfast this week, you know, and this is once we've already done the reflective work. But we've just just breakfast forget about every other meal, every other snack, just work on, you know, working on breakfast and making it great, and whatever great looks like for you. And then once that feels kind of normal to your nervous system, your identity, your personality, your routine, then we move on to the next one.



I like that. So you're not kind of bombarding your system with this huge change. Because like you said, like, I'm gonna start this program Monday morning, and, and everything's gonna be great, and it's gonna be no problem. And that's why people start programs and don't finish them. Or maybe they finish them. And then a couple months later, they're kind of right back to where they started. Because they didn't make the slow changes over time. Instead, it was just like, yeah, a shock to the system. And so from what I'm hearing is that it takes time, and that's okay. And I think you also have to give yourself some grace, to know that it takes time. And it's not something that's going to happen. Like, if, if your plan is to lose, I don't know, 20 pounds, it's not gonna happen in two weeks. And if it does, I'd say that's pretty unhealthy.



Yeah, and, like, yeah, we get caught all get caught up in marketing and advertising. And, you know, the, the amazing thing that's just around the corner, but most of the people I work with are sort of in their 40s 50s 60s. And they've done so much of that, that they're like, I finally got enough evidence after doing this for 30 years, that it doesn't work that way. And so if you think about it, I get people to think about it like a mountain. It's like, if you've been walking up the mountain for 25 years, and you're on the top of the mountain, the idea that you can change 25 years worth of behavior in like a 28 day challenge at the gym, or you know, an eight week program is like, even just in basic logic, it doesn't make much sense. So the reality is 25 years up the mountain, we might need to walk down and my mom is a perfect example. She's in the process of walking down it, she's lost 30 kilograms, which is like 70 odd pounds. thing. Yeah. And that's taken up for years. And she's still got plenty to go. But she's been in the situation. She's been with her health for 35 years. So we have to, unfortunately, it's unsexy. And it's not good for headlines, or clickbait or anything like that. We have to, you know, accept that this is going to be a 1234 year journey. But the good thing is every day of that journey, you'll feel better, you're moving in the right direction, rather than going from one extreme to the other.



Absolutely. And I have a couple more questions here. Before we kind of start to wrap things up. But another thing that I see a lot in the headlines is intermittent fasting. So can you talk a little bit about that what it is, and why would we want to do that?



Yeah, sure. So intermittent fasting is just spacing out the times that you do and don't eat, basically, because I think, well, there's a research study that came out of the US last year 2021. And they found that currently in 2021, Americans were eating on average, six to 11 times per day. And I would say if you're eating 11 times per day, it's really just once it's just once that never ends,



when really long meal,



just a grazing day. But that but the point of intermittent fasting is to start winding back the frequency. And a lot of people understand that it's like oh, fasting, so just don't eat. That makes sense. I'll lose body fat. And I'm really sort of anti that message. Because especially for women, because women's hormones really need to be nurtured and looked after, especially if they've been on so many different diets, which smash their hormones around all over the place. And so it's not any defined period of time, it's gonna look different for everybody. But it's basically just making sure that when you're not eating, you're really not eating. There's no snacking, there's nothing in between. And that allows the gut to go into a repair mode. Because we eat so frequently in the Western world, you can live a full 5070 years without your gut ever really having a day off. And we want the gut to actually repair itself because that's where a lot of the immune system lives. That's where the food you know, interacts with our actual body. So it's not necessarily about having a whole day away from food, but it's just about it might be returning to breakfast, lunch and dinner only. But no Next, it could be 7am, midday 7pm That might be intermittent fasting for you. Some people, it might look like breakfast moves till 11am, and dinners at 7pm. So we've got that's kind of like the typical 16 hours fasting, eight hours eating. But it's definitely not about going hardcore deprivation on hunger, you don't want to be experiencing overwhelming hunger. There's some things missing, and you're maybe not doing it correctly. But you'll find a lot of people on YouTube and Instagram and Tiktok that talk about just the the longer the fast, the better. I strongly disagree with that, especially for women.



Thank you, and thanks for clearing that up. Because that is something that we see a lot on social media. And so you think, oh, okay, so I'll just like not eat for a day and then eat again and then take two days off from meeting and just drink water tea. And then it's like, so unrealistic. And it just isn't the



same thing as all the other fad diets, which is throw you all over the place.



Yeah, it just doesn't it doesn't make any sense at all. So every time I see them, I'm like, I don't get it. But like you said, marketing works. Right. And this is dieting is a billion dollar industry. And we've been bombarded by these claims for decades it for, for a lot of us our whole entire life.



Yeah. Well, and if you're not a nutrition or biology expert in any way, it makes total sense if because if you think of the body through a single dimension system of calories in calories out, or energy and energy out, it's like, so I don't put energy in. Of course, I lose weight. That's the whole thinking process for most people. And that's why I totally understand it makes sense. But unfortunately, that's not the reality the body is so intensely complex. Oh, absolutely.



I mean, we're more than one system and more than one dimension. So yeah, so thank you for clearing that up. And and hopefully the listeners have a better understanding of what intermittent fasting is, and that it can be different for everyone. And that you should probably work with a health coach or a nutritionist. If you're thinking about moving into certainly intermittent fasting, I think, or working with folks like you to help get people to their, their why their five, the y times five, to kind of get down and so that they can really understand, okay, this is why I'm doing this. And I need to to face some hard truths in order to get beyond what I'm doing, because it's not helping me and it's not healthy.



Yeah, totally. And yeah, that journey takes a little bit of time. And that's okay. And guess what, you'll fall off the bandwagon. And that's also okay.



Absolutely. And now, I have a couple more questions. I have a question that I asked everyone, but we'll save that for a second. But what would you like the listeners to walk away with if they could kind of encapsulate what we spoke about and what you want them to remember? What would that be?



So I have spoken in, I've been fortunate enough to speak in many countries, on many podcasts, different things, and I've never met somebody that didn't know what to eat. Like a lot of people say information, information information. Information is not like nutrition education. And science is not the transformational variable, it's highly likely that you need to spend about 10 seconds thinking about what you should be putting on your plate you already know. So you already have all of the tools in your mind. But if things are not working, then it might be your psychology, your emotions, your mindset. So it's highly likely you've got the tools for the nutrition. You know what to do there. We need to go a little bit deeper is the take home message I would want everybody to leave with.



Yeah, I never thought about that before. But you're totally right. I mean, I know what to put on my plate and still on like, I don't know, I think I'd rather that gummy bear. That's probably better.



That's yeah. That's not like chocolate good for breakfast. Nobody's ever asked me that. Like,



I think I think that would be a better dinner. Of course, it's not a better dinner. Like we know this. We total it up. Okay, so now where can people find you? If they have questions? Social Media website, all that fun stuff?



Yeah, sure. So, my website, Matty So you can just check out stuff there. We got some articles and few different things there. We've got a Facebook group specifically for mothers. So it's called the Healthy mums collective. And that's for people that are wanting to end their emotional eating and feel good in their own skin again, and Facebook website podcast, how to not get sick and die is the name of my podcast. So yeah, we're just about to hit 200 episodes, which is amazing. So come and hang out there.



Awesome. Congratulations. That's a big milestone. And we'll have we'll have direct links to everything at this podcast web. site which is podcast at healthy, wealthy in the show notes for this episode, so one click will take you to everything that Maddie has going on. And you can learn more about him on his website. And if you want to work with him, you can also learn how to do that on his website. Okay, so Maddie, last question, and it's one I asked everyone is knowing where you are now in your life and career? What advice would you give to your younger self?



Oh, that's a good question. I know that my younger self would not believe I was this older self. He'd be like, you're like a drunk, hippie. But probably to be more open minded. When I started out in western medicine, where I worked in a cancer hospital, I worked in many laboratories. I just thought everything outside of that field was woowoo nonsense, and, and I was so solid in my convictions that science and medicine was the greatest thing ever. Because if it wasn't, then why would it exist? And that was before I really understood capitalism. So yeah, I would just say to people that there's you know, there's a little bit of truth in absolutely everything. And there's a do your own research, learn, be open minded, and just move forward with absolute curiosity. I was not curious enough as a younger scientist, and it led me to well just be delayed in the way that I executed my life and my success, I guess, but, but yeah, be open minded is what I would ask my younger self to be.



I think that's great advice. I love it. The listeners, I'm sure appreciate and love it as well. So Maddy, thank you so much for coming on and sharing all of this. And again, everyone, check out his website. And if you want to work with him, you can get all the information on his site. So Maddie, thanks so much.



Thanks, Karen. I appreciate you hanging out with me.



Absolutely. And



everyone. Thanks so much for listening and have a great couple of days and stay healthy, wealthy and smart.

Oct 17, 2022

In this episode, Functional Medicine Practitioner, Dr. Meg Mill, PharmD, talks about headaches and migraines.

Today, Meg talks about headaches and migraines, what causes them, and how to get to the root of your headache to treat it. What are the major contributing factors to chronic headaches?

Hear about treating headaches as a functional medical practitioner, controlling stressors, and get Meg’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • Environmental triggers:
    • Heavy metals, mold, allergens.
    • Solution: Putting an air filter in your bedroom, doing mold testing.
  • Food triggers:
    • High-histamine foods.
    • Solution: Avoiding aged cheeses, fermented foods, shellfish, avocado, foods with tyramine, citrus, MSG, aspartame, and caffeine.
  • Hormonal triggers:
    • Estrogen-dominance, rapidly changing hormones, and hormone-enhanced products.
    • Solution: Visit to rate your products.
  • “There is hope to make a change in your life.”
  • “Be open. You never know what road it’s going to take.”


More about Dr. Meg Mill

Dr. Meg Mill is a Functional Medicine Practitioner, bestselling author, podcast host, and speaker. In her virtual Functional Medicine practice, she works with patients worldwide to heal the root cause of their health struggles through advanced diagnostic testing and personalized support.

She has been seen on Fox News Channel, ABC, NBC, CBS, CNN and in Reader's Digest, Health Magazine, and has appeared on many podcasts. She is particularly passionate about helping people end headaches and migraines, increase energy and restore mental clarity without drugs or overwhelming protocols with her proven E.A.T. Method.


Suggested Keywords

Healthy, Wealthy, Smart, Headaches, Migraines, Stress, Environment, Hormones, Triggers, Allergens,


The Strictly Business Roadmap: Create the Foundation of a 6-Figure PT Business Working 25 Hours a Week



FREE Gift: 8 Step Guide to Say Goodbye to Headaches Naturally.

Live Group Program Head Strong.


To learn more, follow Meg at:


Podcast:          A Little Bit Healthier.

Instagram:       @drmegmill.

Facebook:       Headache Healing Club.


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


Welcome to the healthy, wealthy and smart podcast where healthcare meets business with your host me, Dr. Karen Litzy. And just as a reminder, the information in this podcast is for entertainment purposes only, and is not to be used as personalized medical advice. Enjoy the show.



Hello, everyone. Welcome back to the podcast. I am your host, Karen Litzy. Thanks so much for joining me, I really appreciate your ears on the podcast. Now before we get started in today's episode, I have a couple of announcements number one announcement. If you are listening to this podcast on October 17 18th, or 19th, for that matter, I have a big announcement I will be running a workshop. That's right, not a webinar, but a workshop. So be prepared to do some work, called the strictly business roadmap create the foundation of a six figure PT business working 25 hours a week. In this workshop, we will cover the human resources needed for a successful business, the organizational resources needed to keep your business running smoothly the surprising amount of technology resources you will need. And finally the financial resources and knowledge that are imperative to pay yourself and your business. So the details it will be Wednesday the 19th at 8pm Eastern Standard Time on Zoom. Of course, there will be a link in the show notes for this podcast. So if you head over to podcast at healthy, wealthy You can sign up for that workshop. Just do it by Wednesday. All right now the other announcement is we are placing the podcast interviews up on YouTube. So if you want to see the podcast interviews, watch us interact with each other head over to YouTube to my YouTube channel, just Karen Litzy. And you will be able to see us talking back and forth and I'm sure one of these times you will also see a big orange cat hop up on to the screen on my screen. Alright, so today's episode is all about headaches and migraines and the treatment of them. And to help guide us through that today is Dr. Meg mills. She is a functional medicine practitioner best selling author, podcast host and speaker. In her virtual functional medicine practice. She works with patients worldwide to heal the root cause of their health struggles through advanced diagnostic testing and personalized support. She has been seen on Fox News, ABC, NBC, CBS, CNN, in Reader's Digest health magazines, and many many more. She is particularly passionate about helping people and headaches and migraines increase energy and restore mental clarity without drugs or overwhelming protocols with her proven eat method. That's e period, a period T method. And for all the listeners of the healthy, wealthy and smart podcast, she has a free gift eight step guide to say goodbye to headaches naturally. Again, go to podcast at healthy, wealthy And you can click on that and get her free guide. So a huge thanks to Dr. Meg mill. And if you are suffering from headaches or migraines or know someone who is please listen to this or refer them to this podcast episode. Thanks. Hi, Meg. Welcome to the podcast. I'm happy to have you on today to talk about headaches. So welcome. Thank you so much for having me. So headaches is something that affects millions of people every day. Sometimes it can be a little headache, or then you have people with more chronic headaches and migraines. So where did your interest start for treating people suffering from headaches. So I'm a functional medicine practitioner. And whenever I start working with people, they fill out a really detailed intake questionnaire and symptom questionnaire before we start working, just then we really review their whole health history. And what I started noticing as a pattern was that either people were coming to me suffering with these chronic headaches and migraines, or they were coming to me for other reasons. And when I'm going through their health history, and they're really going through these forms, I'm like, Oh, they're suffering from regular headaches. Oh, they're taking Advil once a week. Oh, that, you know, and, and normalizing and they didn't even even really realize like, Okay, I'm coming to you because I'm having this problem. It's just that that's been such a part of my life. I didn't even really think about it as a problem. And so I saw this happening, particularly with women, really in both directions, and then we would start working together and they would say, oh my god,



As my headaches are gone, I never believed this was possible, I didn't even think I couldn't, wouldn't have them. And I just kept seeing this over and over again. And I wanted to get the word out. You don't have to suffer with headaches and migraines, you actually it's actually your body giving you a message. And when we put all the connections together, we see this dramatic decrease in both incidence and severity. And, in your experience, what have you found as major contributing factors to people living with chronic headaches, so we want to look at, you know, there's there's two aspects of that. So we want to really put the connect the dots. So that's what I always say, we're trying to connect the dots, your head pain is giving you a signal. And so we're looking at connecting all those dots and you and really like digging, sort of down through the layers because it could be the top layer and we could fix it right away, we could just get you some supplements that give you the right nutrients, and it might go away, but like you may be layers down to all the connections that are going on. So you know, we want to make sure we have the right nutrients, we want to make sure that we're not eating foods that can be triggered. We want to make sure our hormones are balanced that our stress hormone, you know that our stress is managing our stress hormones, we want to look at our environment, even sometimes, like underlying gut issues are different things that are happening that are that can be causing like this inflammation and immune response to that can trigger headaches. Okay, so let's drill into a couple of those a little bit further. So you mentioned stress. Everybody has stress. Not everyone has headaches, thankfully. But how does stress contribute? And what advice do you have for people that maybe they can do right away? To help control their stress as it relates to their headaches? Because I hear it all the time. Oh, I've had it just when I'm really stressed. Yeah. So what happens what I call it the chain of pain, actually, because, you know, when we think of stress, we think of like, Oh, our to do list or you know, we're busy, we're in this fight or flight because we have so much going on. And stress can actually be physiological can be biological, there can be a lot of reasons that our body's responding to stress, and one of which is pain. So it's like this cycle, when you have pain, you can your cortisol can increase your stress hormone, which can actually increase another hormone called prostaglandins are called prolactin, excuse me. And then once prolactin is released, that can actually increase pain sensitivity. And so you can get stuck in this like pain causing stress causing pain. And we see this, the cycle happen a lot with people. And so we just need to do things, like you said, to get out of the chain of pain to really get your body to relax. So one of the things I think you could start doing right now is really just practicing breathing, because our breath can bring us back to the parasympathetic nervous system, we often breathe through our chest, we're breathing like high up in our body. But if you can take a couple minutes every day, it doesn't have to be anything drastic. But just like set a timer, you know, a lot of our watches even more, say, take a deep breath, you know, sit and take a minute or two out of your day and really practice that deep breathing, because we know that those deep breaths can bring us back into that parasympathetic nervous system. So that's just like a simple place to start. Yeah, so I think a lot of people, when they think of stress reduction, they think of mindfulness techniques and meditation. And they think, well, in order for that to be helpful, I have to do it for 20 minutes. And then I don't know, 20 minutes, and then they're stressed out because they don't have the 20 minutes in order to do that. And it keeps going and going. So I like the recommendation of hey, let's just take a couple of breaths. Keep it simple in the beginning. Exactly. I agree with you, because a lot of that feels like another stressor. So if I say to you, like we have to meditate, then you have to you know, and then it's like, Why can't meditate, my thoughts won't slow down. I don't have 40 minutes, I don't want to do so. So just if you can say like, Hey, I'm gonna do it, like we do anything else, put little chunks in your day, you can start to build and then if you practice that breath, when you are stressed, you can bring it in. It's very hard, when you don't aren't practiced that it to use it when you need it. And so that's I think, like building that muscle of being able to do it, get the practice and then being able to bring it back when you need it. Yeah, just like anything else. If you can practice something and build up like muscle memory, I use that in quotations



so that you can tap into that when you need it. I think is so important, rather than just maybe doing some breath work once a week, or once a month. Kind of when you think not even when you think about it, but maybe if someone mentions it to you then you're like oh yeah, I thought I was supposed to do that versus making something a habit right? Because habit building is something that human beings can do. We can do this. Yes, yeah. And you just put it in you just get it as a part of your habit and then you'll and then you'll really see the advantage when you're a



But when it is a habit, you're able to use lies it when you're in that stressful situation, because you can really actually feel your body calming down. If you're stressed and you think, like something happens, and you can get to that breath and really use it, it's actually just, you can physically feel the relaxation, we know physiologically that it does, you know that your breath really can bring you back into the parasympathetic nervous system, it's just a matter of being able to actually do it. Right. Okay, great. Now, another thing that you mentioned in all these contributing factors to headaches is your surroundings. So can you explain that a little bit more? Because I think a lot of people if I'm playing devil's advocate advocate, would say, Well, how can I change my surroundings like I live? Where I live? I do what I do, what are you talking about? So go ahead. Yeah, so we there's a, there's a couple of things whenever we talk about our surroundings, so we want to say like, actually, heavy metals can be a trigger for so if you have heavy metals in your body, sometimes even things like, like a lead could be in your bones from when you were younger, and sometimes as well, more women and we age, our bone density changes and actually can release toxins later in life that you may have absorbed when you were young. So it's just in some of those loads, or maybe not even what you're around right now. But we know some of the heavy metals, then we you know, mold can be another factor. So if you do live in a moldy house, we could look into that and see if you're surrounded, that's like also something if you see like, oh, I moved and my headaches started, after I moved or you know, at a certain location, some of those kinds of things, but then just also environmental. So when we look at our environment, sometimes people that have migraines, can have a genetic variant and this enzyme called Dao enzyme, and that's an enzyme that helps us break down histamine. So we want to think of that when we're eating foods that have histamine. But if you also have, you're also exposed to environmental allergens, you know, you're you're getting this allergic response, you know, this immune response. And so just actually also cleaning up your environment can make a big difference. We I one thing I would say is even if you're going to pick like something in your environment, you can't change where you live, obviously, you can, you know, clean up, but putting an air filter in your bedroom can be helpful. And you don't even have to go to the top of the line, you know, you can start out with something that you you know, find anywhere.



And just put it in your bedroom, because it's hard to get them in every room in the house. But we spend a lot of time sleep is so rejuvenating. And just if that's like one thing you can do, I think that is a help often for people just to add that. Yeah, and air I actually bought an air filter last year with the all concerns of like air quality and COVID and things like that. And so I have one and it wasn't very expensive. It's not like you said you don't have to go top of the line or anything you can get they have some really good basic ones that can fit the square footage of a bedroom really well. And I'm glad you say you know, even if you have an ingest your bedroom, that's good, because a lot of people might think well, what am I supposed to put one in every room in my house? It's gonna get really expensive. How am I going to do that? But now you're saying listen, at least have it in your bedroom where maybe you're sleeping and spending eight to maybe nine hours a day in that room? Yes, yeah. Cuz it is, it's hard to say like, Okay, I'm gonna put it everywhere. But you're, you know, you're gonna be there a ton of time, and it will be good while you're sleeping. It was funny, because when I was going to buy, like the first air filter that we bought in our house, my husband's like, we have a filter on our furnace. We don't need this. And I was like, you know, I just want to have it I you know, I think it's important. And then the first time we change that filter, he was like, Oh, it was shocking, because you think your air is being cleaned by your furnace. But when you really see those filters, and when you get their filter, there is a lot that's coming out. So yeah, yeah. And I I live in New York City. So if I just opened my window for half a day you're getting God only knows what blowing into the apartment. So yes, air filters very easy to do. What about you had mentioned mold? So there are obviously ways to clean mold. But let's say you're going to look at a house or an apartment or something like that. Can you ask about mold in the structure? Yes, they do. You can do mold testing. So that is something that you might want to look at because there can be black mold under things and so if you are looking for a new you know, a new home that is something related to take we you know, we check radon, we check different things, but are we actually checking mold and the you know, the people aren't I had a plumber come in one time that was like, I had a leak in my sink and I was saying like, is there mold is it and he was like, Oh, it's fine. That's not a problem. And I'm thinking yes, it is a problem. I actually know that it is. So I my point there is that you could have people just brushing it off that are saying like, Oh, that's not a big deal. Oh, we don't even need to look for that. But you know, that's always something that you can ask for it.



Yeah and you had mentioned that foods can also have an anti histamine effect is that right? What can you give some examples of foods one can eat like what would be considered a low histamine diet? So you want to be you want to avoid things like aged cheese's fermented foods sometimes shellfish even like avocado is a high histamine foods so you want to avoid foods that but I think if you try to you know stick the big classes would be like aged cheese's fermented you know, fermented foods have a lot of prebiotics in them so we're really hearing a lot about things like sauerkraut, kombucha things right are feeding our microbiome in a positive way and so you can hear that and you hear things about like avocados or healthy fats and all these things so that's what kind of gets tricky with with headache foods or migraine foods because they're often foods that maybe you're hearing are healthy for you but they're just not like they may be healthy in certain ways, but they can be potentially triggering your your headaches or migraines and you're not even knowing it. So we want to look at foods that are getting high in histamine. This is the one I mentioned. You also want to so some of the other categories of foods that we know are foods that have tyramine so think of like cured foods, aged foods, they're the foods that have nitrates. So you think of like hot dogs and foods like that. You also salicylates and that that can be like citrus foods. So things like lemons, sometimes oranges, those are, are ones that you wouldn't necessarily suspect. So then we have like MSG, aspartame, MSG would be like in canned foods, box foods, aspartame, diet, foods, and then even caffeine. So that's an interesting one, because caffeine can be helpful sometimes for people with headaches, but you can get rebound headaches, if you you know, are withdrawing from the caffeine to so so that so I'm gonna give you like their buckets. So like that those are foods we know actually have data, we know that those are they can cause the headaches and migraines. Now, it's not the same for each person. And there can be a threshold. So you may eat that food at one point. And like let's say you have a glass of wine and it has tyramine in it, and you're like, I hear this, like people say, well, sometimes wine, I'll get a migraine after but other times I can drink it. So it must not be the wine. Well, it might be the wine with some of that aged cheese that you had, or something else, that the combination of those two foods together was enough to like put you over that threshold to have the headache. So that's where it kind of gets confusing, I think because you you're it's harder to pinpoint your exact foods sometimes when you're trying to think about it, because you're not always getting the headache with that food. Right. And so that flows very well into my next question. And that's how do you know what, if any of this stuff is causing your headache, whether it be the food, you're eating your environment, your hormones? How do you know? Because that's a lot of buckets. Yes, right. Well, that's why when I work with people, I have like roadmaps. So no one you find a practitioner that you can that you trust that can give you a roadmap, but one of the things that because Because yeah, you get the guide to know like this, and this and this means this and that's very helpful. But one of the things you can start doing right now is printing out, I have people start by printing out a blank calendar, and write foods down like if you get a headache, or if you get a migraine. Wait, what you ate that day and the day before, and then just start to look for connections. So you know, start to look for like, okay, you know what, every time I get a headache, it's three days before I get my period, or every you know, like my migraine or every or it's mid month, maybe you're ovulating, you know, or I didn't sleep last night, but uh, you know what, I don't sleep. If I don't sleep, well, I get it, or I'm dehydrated or the ate these foods. So once you start to like, just you don't have to do it every day. But if you just do it when you're getting the headaches, it can start to show you patterns. Oh, that's a great idea. And then you can address them accordingly. Yes, right. Right. Right. Got it. Now, you had mentioned days before period ovulating. So obviously, advice for women who suffer from hormonal migraines. What do you got? Yeah. And that's one more thing I didn't have to worry about. Right? Yes. Yeah. So the two most common reasons that we get migraines associated with hormones are estrogen dominance, and rapidly changing hormones. And that's why with estrogen dominance, you often get it right before your period because estrogen and progesterone are both dropping, but sometimes then progesterone is lower than estrogen. We were having the dominance now. We really do. Test testing can be really helpful for this because if you have estrogen dominance, why, like do you have low progesterone or do you have I have estrogen or I see a lot of people that have normal estrogen, but maybe some of the metabolites that estrogen is going into are higher and they're not there. You want to look, we want to say use it or lose



that when we talk about estrogen, you want that to really be in your body, but you want it to be able to be metabolized and excreted. And if it's not being done that way, then you're getting the these higher levels of metabolites that actually have a little bit more proliferative effects sometimes, and we're getting these symptoms. So, you know, really one, if you can get the testing the right testing done, then, and you have to be careful, because if you just see the extra dial, like if you just get a blood draw, that's not really the whole picture. Because you're not seeing all like I said, all these metabolites in the way, you know, that might be okay, but the way they're processed, but you so if you're looking for something you insert, right now, you can look out, there's a lot of products in our life that have what we call Xeno estrogens. And so those are estrogens that are outside of our body, and things like BPA, so think of all the plastic containers in your kitchen, have BPA in them. And what we do is we eat out of those, but we also often we'll put those in the dishwasher, sometimes we'll microwave them. And when that happens, they're also like decomposing, you know, they're breaking down their structure and they can leach into the food. So then you're eating that food that sitting in that plastic that so we're getting some of these estrogen components outside of the body. So you know, just really taking a look at that. We look at that in you know, your skin is a giant mouth and skin products, hair products, all the things that we're using, so that's just a good place to start. And yeah, I actually have I can say I switched to glass for all of my food storage needs, or I'll just put it in like a regular bowl and just cover it with which is probably not good. But I cover it with



with aluminum foil. Okay, I don't think that's good. Well, that's not touching. Yeah, you don't want to high levels of aluminum either. But yeah, you know, might not be touching the food. No, no, no, no. Yeah. No, usually it's like in the bowl like, yeah, yes, for the most part, I decided last year, I'm like, I feel like I should switch to glass. You know, storage instead of using like the Tupperware or Tupperware like storage. So I guess that's good.



And when you're looking at things like what you're putting in your hair on your face, are there things that are you're like, do not buy this product, if it has this ingredient in it, or is that a little too broad. So what I would suggest that you do is actually go to Skin Deep website, so they rate all products. And so you can actually tell you just tight, it's really easy. Just type in what you have. And you'll see a rating. So you'll say like, Okay, if it's a one or two, you're you're feeling comfortable. If your products and eight or nine, then you know, replace that product, it would be a good idea to really try to, you know, try something else. And I tell people to like, for cost purposes, if you just replace one product at a time, it really doesn't, you know, it add up so much. So yes, if we're going to say I need to go get all new makeup, that's going to be expensive. But if you're like, Oh, my foundation ran out, let me think of what you know, let me really think about that. Be mindful of what foundation I buy, or, you know, the next time your shampoo runs out, you do the same thing, you're spreading that cost out. And then you're just replacing one thing at a time. And it's just lowering your overall toxic burden. It's lowering those, you know estrogens that are coming in. Another thing I guess with that is also like looking at beef and dairy because we're you know, the animals are often given hormones. And then when we eat them, we're also getting that, so really paying attention to those those foods to to make sure you're not getting any extra hormones. Got it? And can you say that website one more time? Well, yes, sure. It's Ew, And then in that that's Environmental Working Group. And within that there is a section that specifically for products and it's called skin deep. And they have a whole bunch of products. They have sunscreens and makeups, and you know, shampoos and all sorts of different things. So it's just a nice resource, because I think it's just nice to be able to, you know, you look at the back of the shampoo bottle, and you're like, what does all of this mean? So it's sometimes hard to figure out on your own, but it's just nice to be able to put that product in and you know, put it in and then find a ratings like gives you like a little bit of a clear guide. Yeah, no, this is great. I mean, all your tips are amazing. So hopefully people if you are someone that suffers from headaches or know someone who suffers from headaches, then definitely get them over to this podcast so they can listen to all these great tips on how to not suffer as much because I know headaches can be just absolutely debilitating. I have several friends who've had you know, a history of a long history of migraines. And I'm lucky to be a person that doesn't really get that many headaches.



But now when I do I'm going to kind of be thinking about you you're going to be in the back



Could my head I'm going to be thinking about all these tips and seeing what I can do to help mitigate the headache when and if I get them. So thank you so much. And now, how, you know, you had mentioned that you're a functional medicine practitioner. So how does a functional medicine practitioner differ from



a medical doctor when it comes to the treatment of headaches? Like what do you guys do differently? Yeah, so I'd like to actually take use an analogy for this, because it kind of points out the way we're treating headaches in the conventional space. So if you took your, if you took your car to a mechanic, and you said, it's making noise, and the mechanic walked away in it, they walked away with your keys, and they came back and handed you a pair of ear muffs and your keys back and said it's fixed. Would you be comfortable driving your car? And we wouldn't, we'd say like, No way, it's so broken. And that's kind of what's happening a lot of times in the way that headaches and migraines are being treated. Conventionally we're giving, we're given medicine to cover the pain. So you're treating your pain, but your headaches are still coming back. And we see that happen all the time. You know, people are saying, Okay, well, I take this for my pain, but that they're never going away. They're just being covered up. So what we do in functional medicine is we flip it around, I say, like we do it actually the opposite. And we're really putting all the connections together, outside, sometimes even of your head, and putting everything else that's going on in your body together and really kind of diving into why you're getting a headache. So it's not as much about the pain treatment, which we do still want, you know, we still want to treat the pain, obviously, because we don't want you to experience that. But we want that my goal is for you to get the incidence and severity down because I want you to not have them so that you're not having to take the medication. Right, that makes sense. And



I think I like how you said you want the incidence and severity to go down because sometimes it may not be complete elimination for the rest of your life, like people may have flare ups, I work with a lot of people with chronic pain. And oftentimes, you know, they may have chronic low back pain, we've gotten them to the point where that back pain is no longer burden burdensome, but you know, every once in a while they may have little flare up. Right? So how do you explain that when you're speaking with your patients that like, hey, sometimes you may have a flare up, it doesn't mean that you know, all is lost. You need to give up what kind of what does that conversation look like for you? Yeah, so generally the people that finally get to me have had chronic you know, or severe headaches so they're just thrilled to not wake up like I you know, I get one of my favorite quotes is one of the people I work with when I patient said I just love the fact that I don't wake up wondering if it's going to be a headache day like she you know, she everyday was living her life like, is it going to you know, wait, I get you have that fear waking up like is today going to be a headache day, if I plan something? Am I going to be knocked out with a migraine? And so yes, I can't promise you that you'll never have another headache because I can get a headache. You know, because of you know, maybe I'm dehydrated. And I've slept weird on my neck and you know all these things. But I can't promise that but that's when we see this dramatic decrease in both incidence and severity that they're not really affecting your life that you're not taking medication, they no longer have to, you know, sometimes we were on prescription medication, Botox injections, all these you know, there's, there's a wide variety of things that peak cocktails that people were taking, and they're still coming. And so it's it's really saying you don't have and I think like deeper than that all these medications have side effects like we're getting they're not without consequence. They can, you know, have good purposes, but there's always the consequence. So you're still getting the headaches, you have the consequences. So we want to pull get you in a place where, okay, you're not relying on that. And you're you're not suffering from any side effects of having to take regular medications. Yeah, I think that's great. And the the biggest part there is like they feel like they're not suffering anymore. So you know, when people come in and you ask, Oh, what are your headaches or your pain on a scale of zero to 10? And people are saying it's a 20? It's because it's so they're suffering and it's affecting their life in so many different ways. And so if you can bring that down for them, I mean, that's a real blessing, I would think and they must be like, super excited about it. Now. Yeah, it's life changing. Yes. Yeah. Yeah, it's life changing. So now, what, what would you like the listeners to kind of step away with from this conversation? If you can distill it down into your main points? What would it be? Yeah, I just like them to know that one. You know that if you are someone who has, I think people feel that they've had these headaches for you know, a lot of times people had them since childhood even. And so you feel like well, I've always had this. This is something that I'm not going to change. I'm managing it. It's



You know, but it's, it's just who I am, I see those people be able to make that change and not have them, you know, so I think or if there's something that you're dealing with all the time. So I just think knowing that there is hope that you don't have to live this way that if you just maybe take a new perspective, I think we can get stuck in that same pattern of like, oh, this is just what I do, oh, this is how I treat it. But I, I think if you can be open to a different perspective, then you there is hope to really make a change in your life. And then I also would say, you're just really maybe dialing in and listening to your body and listening, you know, if you can be more in touch with, like, what food you're eating, if you're dehydrated, if you're not sleeping, if you're you know all those things that we talked about, and like really just kind of put a mirror up and see like, where are you on some of those spectrums? Excellent advice. Now, where can people find you? If they have questions they want to consult, they're having headaches, they they need you? Where can they find you? Yes. So my website is Meg So that's just my name M eg mi LL. And then I have a podcast called a little bit healthier. So I'm talking about headaches and migraines, but all different ways you can add be a little bit healthier in your life. And then I'm over on Instagram, and Facebook at Dr. Meg mill, just Dr. Meg mill. Perfect, perfect. And now, last question. It's one I ask everyone. And that's knowing where you are now in your life in your career, what advice would you give to your younger self?



Oh, that's a good one.



I just think that, you know, so I started out on the conventional side of medicine. So I guess I felt like, Okay, this is the this is the way to go, although I always was into more prevention than treatment. And so I, I think my path is different, it's veered a lot. So I think maybe in some of those times that I was really frustrated with the system and the way things were going even though I knew all the protocols, I knew why it was happening, that that I was that I wouldn't be able to find another way. So I would have to say that's probably the advice that just be open, you never know what road it's gonna take. And I did think of one more thing, I have a freak, I forgot to tell tell, say this, when you asked me Yes, I do have a free guide that you can go to just called help my So if you're looking for some steps to get started, you can look at that guide to I should have mentioned that earlier. No, that's perfect. And we'll have links to everything. We'll have links to your website, your social media, and help my so people can go on and get this free resource to help their headaches, which would be wonderful, because man, I



I always, I feel I have so much empathy for people who suffer from headaches, because I think I had like maybe two or three in my life. And I was like, Oh my gosh, this is how do people live this way. So I have a lot of empathy. And I have a lot of gratitude for people like you who have chosen to really work with this population, because it's vast, and they need the help. So well done on you.



Yeah, and again, what's the name of your podcast again, it's called a little bit healthier. So it's just about taking tips too, that you can do every day in your life to be a little bit healthier. Love it. Excellent. Well, thank you so much, Meg, for coming on and sharing all of this great info so many good tips. I was like looking down and taking notes and I'm definitely going to that website and I'm going to put in all of my skincare and



hair products to see what I have going on and and then I'll take some deep breaths so then I won't get stressed out about it. But thank you so much for coming on the podcast. This was great. Thank you for having me. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.



Thanks for listening. And don't forget to leave us your questions and comments at podcast dot healthy, wealthy


Oct 10, 2022

In this episode, Founder of MasterTalk, Brenden Kumarasamy, talks about public speaking.

Today, Brenden talks about becoming an exceptional communicator, online versus in-person presentations, group presentations, and presenting as an introvert. How do we get better at communicating?

Hear about Brenden’s random word exercise, answering questions proactively, and building the jigsaw puzzle of a presentation, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “If you can make sense out of nonsense, you can make sense out of anything.”
  • “The best way to get rid of fear is to have direction.”
  • “You’re only as strong as your weakest link in group presentations.”
  • “When you are not speaking, you are still speaking.”
  • “Someone out there needs your message, and you’ve just got to go out there and share it and leverage your strengths in the process.”
  • “The goal is not to live forever but rather create something that will.”
  • “When we realize that communication is about leading a more fulfilling life, we’ll start to take it more seriously.”
  • “Ask yourself one hard question about life every single day, and you’ll never be the same ever again.”


More about Brenden Kumarasamy

Brenden is the founder of MasterTalk, a coaching business he started to help ambitious executives & business owners become TOP 1% communicators in their industries so that they can accelerate their success in the workplace & companies.

He also hosts a successful YouTube channel by the same name with over 25,000 subscribers.

Brenden has coached many executives from companies like Salesforce, Amazon, IBM, Morgan Stanley, Blue Cross, J. Walter Thompson, Deloitte, Verizon, and many more.


Suggested Keywords

Healthy, Wealthy, Smart, Communication, Public Speaking, Presentations, Fear, MasterTalk,


Recommended Reading:

Thirst, by Scott Harrison.


To learn more, follow Brenden at:


YouTube:        MasterTalks.

LinkedIn:         Brenden Kumarasamy.


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


Welcome to the healthy, wealthy and smart podcast where healthcare meets business with your host me, Dr. Karen Litzy. And just as a reminder, the information in this podcast is for entertainment purposes only, and is not to be used as personalized medical advice. Enjoy the show.



Hello, welcome back to the podcast. I am your host, Dr. Karen Litzy. And in today's podcast, we're talking all about how vital it is to be a good communicator to be a good public speaker, especially for healthcare professionals. So I have a great guest to walk us through all of that and he is Brendon kumara Asami Brendon is the founder of master talk a coaching business, he started to help ambitious executives and business owners become top 1% communicators in their industries so that they can accelerate their success in the workplace in companies. He also hosts a successful YouTube channel by the same name master talk. With over 25,000 subscribers. Brendan has coached many executives from companies like Salesforce, Amazon, IBM, Morgan, Stanley, Blue Cross, J, Walter Thompson, Deloitte, Verizon, and many more. So like I said, today we're talking about public speaking, how becoming how to become an exceptional communicator, how to give great presentations, whether they're online or group and presenting as an introvert. So it's all about getting better at communicating. Brendon has some great tips and tricks, some homework for us all to do so that we can become better communicators, presenters and public speakers. So big thanks to Brendan, and everyone enjoyed today's episode. Hey, Brendan, welcome to the podcast. I'm excited to have you on it to talk about public speaking. So thank you so much for joining me, Karen. The pleasures absolutely mind. Thanks for having me. All right. So public speaking. As you know, sometimes it can be people's number one fear in life getting in front of a group of people in the I'm a physical therapist in the physical therapy world.



Public speaking is something that can really help move the needle on your career. Yet, so many people are afraid to do it afraid to apply afraid to get up there, that sometimes they just never do it. So before we get into a lot of things in this interview, because I have so many things that I want to ask you, from what you've seen, and in your experience, what are the biggest challenges people have with public speaking? You know, a lot of people, Karen, they think it's fear. But there's actually a challenge, even greater that fear, surprisingly. And the challenge is motivation. Because if we aren't motivated to actually work on our communication, if we don't have an intrinsic reason, we'll never push through the fear. Because the fear will always exist in some way, shape, or form. Even for me, even for the person on the podcast. Why? Because of me, and you are having lunch and Elon Musk calls me and he says, Hey, man, I really liked your YouTube channel. Can you come and coach and I'll pay you a million bucks? Would I be scared? Yeah, it's Elon Musk. But with motivation. The reason this is so powerful is from this question that I'm sure a lot of physicians a lot of healthcare pros don't really think about, which is how would your life change? If you became an exceptional communicator, we dream about becoming a doctor, we dream about finishing finishing med school, we dream about expensive vacations, things we want to buy experiences we want to go on. When was the last time we dreamed about a life in which we're a better communicator in it? And if we don't want to make it about us, I'll throw another one out to you. How would the lives of your patients change? If you became an exceptional communicator? We know in health care patient experience is so important how we make them feel. So if we're not going to do it for us, we might as well start by doing it for them. Yeah, I think that's a great way to to kind of turn that narrative around to take it off of ourselves and say, Well, wait a second, if I were better at communication, because it's communication in front of 100 or communication front of one, it's still being able to communicate effectively, right?



Absolutely. Yeah. So how do we get better? Right? So there's a couple of things on Oh, go ahead, John, jump in. Oh, you're good. So so a couple of things that are current communication. The reason why a lot of us don't work on it is because we don't know the strategy behind that example. Communication is like juggling 18 balls at the same time. One of those balls is body language. Another one is storytelling. Another one's eye contact, facial expression, smiling and the list goes on. So if we try and juggle all 18, all of them will naturally fall to the floor. So instead, what are the three easiest balls that we can juggle in the air to get started with this practice?



What I call my easy threes. So start number one, I'll pause after each one. So I don't monologue for 15 minutes. So the first one is the random word exercise, pick a random word like tea like trophy, like Master, like paper towels, and create random presentations out of thin air. Why is this exercise effective, because it helps us quickly think in our feet, I always tell people that if you can make sense out of nonsense, you could make sense out of anything. And it's also really easy to do. Because all of us listening to this podcast, I hope showers every day. So you got 10 minutes in the shower to do this exercise. Or if you have kids, you could do it when you're picking them up from school. So by random word exercise, you mean like, if I were to say a microphone, and I'm doing a presentation on a microphone, I'm trying to sell a microphone. What does that mean? Does that work? Absolutely. So to your point, let's demonstrate this throw any word at me. But don't use microphone because it's too easy, because I have time to think about it. Right? Right. How about polar bear? Awesome. So Karen did not give me the word polar bear proaches. Conversely, I just need to invent something that it didn't want to do. Right now. When I think of the polar bear, I think of many things. The first one is the cold temperature in the North Pole.



But minus just how aggressively killer these polar bears can be. There's also a bright side, kind of like how polar bears are the main attraction to the Coca Cola brand, or I'll pull up yours kind of reminds us of Christmas and of Santa Claus and of the holiday season. But the reason I bring up the polar bear is that the polar bear has both an aggression. That's a bit crazy, but also a soft nature to them when you look at them from afar anyways. And I think life in many ways is that way too, especially when it comes to our dreams. A lot of us from the outside, it's the opposite. We think it's really, really scary. But then when we get closer towards it, that's actually not that bad. Kind of like a polar bear from 10 or a long feet away. So what's the advice or the advice here is



follow your dreams. Because all it takes is a little polar bear. All it takes is a little bit of ambition for you to say, You know what, even if that polar bear might be scary. Let's just see what happens. And that's just the random word. It's just just something random. That's it. That's crazy. Yeah, well done. You well done and people like I literally did not give him that word ahead of time. So that was just speaking off the top you have kind of like improv improvisation. Yeah, which I took improv classes a couple of years ago to help with the podcast. But what I found is it really helped with my patient interaction. So tying back to what you said before I became a better communicator with my patients as well. Okay, so number one random word exercise, improving sort of riffing on things. What's number two? Absolutely. So number two is questioned drills. We get asked questions all the time in our life care,



on podcasts, on shows, at school at work and med school, we're always getting asked questions, and most of us are reactive to them, especially for patients. We wait for the question to come. And then we go oh, let me answer that one.



In the same way, but a few years ago, when I started guesting on podcast, I sucked. I remember one question somebody asked, he said, Where does the fear of communication come from? And I looked at the guy and I said, I don't know man of San Diego, London, it's you tell me like I didn't know how to answer it. So I was being very reactive, instead of proactive. So what did I do differently? Every single day, Karen, for just five minutes. That's all answer one question that you think the world will ask you. But if you do this for five minutes a day, let's say we take a list of your commonly asked questions by patients. If you just do that once a day, let's say day one is where does your communication come from? Day two is when will I hear back? You know, day three is Will everything be okay? You know, just just make a list. And if you do this once a day for a year, Karen, you'll have answered 365 questions about your industry, you'll be absolutely bulletproof.



I like that. I like that a lot.



That's so interesting. I never really thought about doing that. And as you were speaking, I was like, what are the common questions that physical therapists get asked? So now I'm gonna have to do a think on it, and maybe write down seven. So you got a week's worth. And then, as you're kind of answering those questions, I'm sure other ones will start to pop up. So I don't want people to think



Oh, you have to write out 365 questions right off the bat, right? Correct. I'm glad you jumped into the news. Let me even help help the audience even a bit more, because I'm glad you went there. Don't do this alone. I just said that because I want people to take action. So what's the easiest version, but there's others. But then people will make excuses. But I'm happy to give it for your audience here. Because you're all medical professionals, sure, you'll take action. So what does this mean? You know, there's other people, you got friends who are in physio. So what I would do the smart way of doing this exercise, whether you're the CEO of let's say, the Office of the clinic, or you got friends in that field, I would book a call with like, seven other people. And I've seven other people bring seven questions. So then you have 49 questions. And you're what's great about this process, is we're not competing against each other. If I don't know the answer to the question, I'll just ask you, Hey, Karen, I don't know what to do. How would you answer this question? And then you tell me and I go, Oh, let me just copy that with my patients.



Because the questions are the same. But the point is just to do the exercise, there's different ways of doing this. The easy one is just a load in your basement. And if no friends, you know, write it out every day. But to your point, yes, I'm sure you have colleagues in the medical profession that you could just do this with. Yeah, that makes it a lot easier takes us takes the pressure off, because I'm sure you've heard this before. Like, if you're under 65 questions, forget it. It's too much. I'm not gonna do it. Right. Absolutely. So to kind of have have some pals help you out will make a big difference. Alright, random word exercise question drills. What's number three? Absolutely. So number three is so simple. That nobody does it. Make a list of the five people you love the most in your life could be your mom, your sister, your brother, family members could even be patients. And ask yourself a simple question. When was the last time you sent them? Not a 20 minute, but a 22nd video message, just to tell them how much you appreciate having them in your life, the people who helped you through medical school, the people who really believed in you, the teachers, the mentors, the people supported you. video messages, make people's days, Karen, but more importantly, video messages teach us a very important lesson that the education system does not teach us. The education system teaches us, Karen, that communication is a chore. Oh my god, I have to get better at this thing. Because I have to do well. And then it's so much stress and anxiety. Versus when you start sending video messages and you wake up the next morning, you're shocked at the responses you get. A lot of people look at you look at the text and you say whoa, everyone's saying it made their day it made their their week feel really special enough. Some people never got a video message in their life. And it helps us relearn what communication is for, which is to create an impact to share an idea with the world. Going back to the fears we alluded to earlier. Right? I don't want to share my message I don't want but what happens if you don't?



Well, if you don't, you won't be able to serve as a role model for the people who are going through medical school right now, and are looking up to you. Don't worry about the millions of people in the world. Just worry about the people behind you, or rather, before you I think is the right way of putting it. Yeah, yeah. All right. So three really great sort of drills or strategy that we can use at home either on our own or with some pals to help us find that motivation for public speaking. Right. So let's say we've, we're motivated, now we want to do it. We're we've got a conference coming up. And what happens next, right? We know our stuff, we're good, but you're still it's still in there. You get up to the mic, and you're like



so what do we do that? Sir, sir? So so a couple of things before that moment arrives, hopefully people get to this episode of time, which I hope I would say the next piece. So now you're doing these drills, you're really building up your momentum, your skill set. What's what's my go to strategy for keynote prep? I call this the jigsaw puzzle method. Communication is like jigsaw puzzle security, you know, those pieces, you know, little things used to do as kids those toys, right? So whenever we're doing this jigsaw puzzle, we always want to start with the corner pieces. And the reason is because they're easier to find at the box. So if you open a jigsaw puzzle, you get these corner pieces, you put them all together, and then you're working into the middle. Now you're probably wondering, Brendan, why are you talking about jigsaw puzzles? And the reason is super simple care. The reason I talk about jigsaw puzzles is because in communication, most of us do the opposite. We start with the middle first, we shove a bunch of content or presentations. We get to the podium, and we ramble throughout the whole thing. And then the last slide sounds something like this.



Thanks, not the right approach. So what should we do instead?



To prepare presentations like a jigsaw puzzle, start with the edges first, practice just your introduction here. 50 times 50 Seems like a big number, but it really is it because your introduction is 60 to 90 seconds. So we're talking like an hour's worth of work. Same thing with the conclusion, what's a great movie with a terrible ending, terrible movie last time I checked. So same thing with the close, do it 50 times, once again, it'll take you another hour, then focus on the middle. If you do that, especially in this industry that we're talking to right now, most people don't bother prime, I've coached a lot of the the people in this industry, most people don't even spend a lot of time and effort doing the communication. So if you just spend those puzzles, and you just practice in that way, you'll blow everyone's minds.



That makes a lot of sense. I was just



a way at a at a physical therapy conference. And I did have to do an opening of the conference with another physiotherapist. And what we really did do a lot is we practiced that first slide that opening to make sure that we're grabbing people's attention. And then like you said, we actually did sort of finish with, again, another slide that grabbed people's attention and left people feeling really good about it. And we didn't do it intentionally. Mind you, we just kind of it just sort of happened, you know. But now I like that working on the edges. It's like when you're doing your you write the outline, and then you just start filling it in.



But I really like the beginning in the end, because it's true, you always remember sort of that last image, that last slide, whether it's a presentation, or even, you know, a TED talk or Keynote, you kind of always remember the end and kind of how that made you feel. So I think that's really great advice. I really liked that. What else? Is there anything else we need to? I mean, I'm sure there's a million things that we need to think about, although the podcast is not 10 hours long. But what are some other kind of big things that we should remember when it comes to the presentation itself? While we're in those prep stages? Absolutely, Karen. So I would say for the for the prep. What's nice about doing the beginning the end is because it builds momentum really quickly, especially in the industry. Right now we're in healthcare, where a lot of us, you know, we're dealing with a ton of patients, we're working long hours, we don't have as many hours as other industries to actually invest in our communication. So I'll give you an example. So people understand the comparison. Let's say you have three hours to practice a presentation, that's 30 minutes, what most people in any field will do is they'll practice a 30 or 30 minute talk three times in a row, they'll get tired, and then they'll eat lunch. That's generally what happens. But the problem is, is in those three practices, they don't really see that much growth. Because it's a big presentation, it's hard to keep improving upon. Versus if you take that seemed three hours, and you just spend the same the first two, the first hour doing just the intro and the second hour just doing the conclusion, you're going to go to lunch really happy, you say, Wow, I just delivered the best introduction of my life, the best conclusion of my life. Now I'm just going to spend the next hour to your point filling out the dots connecting the rest. So that's the reason strategically, why that works more sense, it's a better investment of time, in terms of the other points. Now we're going into the bonus round. So the bonus round is this. Every great presentation, Karen generally has one key idea, what do you want them to remember, I'll give you an example from one of my clients. What she is trying to do is the draw the relationship between empathy and patient care experience. That's what our presentations, but if she tries to talk about 10 Other things for a TED talk, it's not going to work, because she only has 15 minutes to talk. So every story, every analogy, every tool, every statistic is really revolving around the idea that we need to bring more empathy into not just the patient care experience, but towards other functions within the hospital, whether it's the support teams, the it the ops, so that the patient care experience is 360 Not just one ad, right. That's our whole key idea. But notice how clear that is. But if we try and do 10 different things, we go nowhere. So what's the advice, the advice is to bullet down 10 different key ideas on a list, and then look at that list with your friends if you have any ideally, and then look at that list and saying hmm, out of these 10 ideas, which one energetically excites me the most. Which one energetically gets me wow, like this is the one that I really want to land and the frame number two



Getting a little bit more advanced. But the frame around this is just asking ourselves this question. What is the one key idea out of this long list that I just wrote that I feel no one else is talking about the conference? No one else is emphasizing. No one else is really drawing a point around in the same way. We talked about Ajay, right, where she focused on the other areas of the hospital, not just doctors. That's her key idea. What's yours? So that's the other piece. And then the last piece to presentation prep, is the willingness to experiment like a painter, like an artist, like a mad scientist. What does that mean? That means try a bunch of tools, try a personal story. Try an anecdote, try statistic. And the only question you ask yourself, is this one, and I'll throw it back to you? Does this defend my key idea? Does this personal story does the statistic does this anecdote, defend my key idea? Yes or No? Try a bunch of things. And then you'll figure out the ones that make the most sense. That's what goes into the final deck. Yeah, that's great. I love that advice. I'm taking copious notes here. Because I like the way you're kind of laying it out for people. And I think that it's simple, it's easy to follow. Most people love a template, they love kind of instructions, right? I'm sure you get that all the time. Like, just give me instructions on how to do X, Y, and Z. And then I'll do it. And then when you feel at least, I'm going to say this personally, when I feel better prepared going into a talk, it's a better talk, I'm a little more relaxed, I can kind of go with the flow. If there's a complication or a tech issue, it doesn't completely throw you off your game. So I think, to your point by being prepared and prepping adequately, I think that can help take away some of the fear.



I completely agree. You know, what I always say is that the best way to get rid of fear is to have direction. If you're focused on direction of where you're going, and you're not thinking about the future thinking, Oh, I should probably do the branch board exercise tomorrow. I should probably do some question drills, I probably should get some buddies together. On and so on, so forth. Yeah. Now, switching gears slightly, but



we're still you know, in these COVID times, everybody's on Zoom. There's many, many, many zoom conferences. So does your advice change when it comes to an online presentation versus an in person presentation? And can you compare and contrast those for us? Absolutely happy to Karen. So the advice does stay the same. But there are three ads that are that I'll jump on that I'll let her on top for online. So the first one is eye contact. So when you're in an in person setting, Karen, do you want to move your head based on who's in the crowd to maintain eye contact with them? What's nice about online is whether you're speaking to one or 10,000 people, you only have to look in one area, which is the camera lens. That's it, you just gotta look in one direction, which is nice. So that's one. The second one and this is the most important, I would argue is energy. Look at the end of the day, Karen, it's easier to shove with energy when you're in person, because the accountability is higher, you'll take a shower, you'll wake up earlier, because you actually have to talk to people, you have to shake their hand, you have to hug them, depending on what your preference is. When you're online, you go like well, I mean, I guess they put my PJs on, no one's gonna know. So it's, it's that it's just that piece. It's impossible, in my opinion, to have that same level of standard as we do online than offline. So what's the advice, the advice is bring more energy in person, get really good in person and bring as much of that as possible, online. That's the advice. And then finally, number three, is accessibility a lot easier to get feedback from your audience when you're in person, because there's no friction, you just go up to them say what's up, you want to get lunch. And that's it. Simple, online. Not as easy, not as easy to build relationships with event planners and things like that organizers. So in that situation, you got to force those relationships, caring that means you got to get on calls with people you get on feedback calls with the organizers who brought you there to make sure you keep that relationship alive. You're getting the feedback you need, but you're also closing more speaking gigs through those relationships.



You're muted, by the way



I was gonna say it's all about the follow up.



And when your online follow up, can seem a little bit harder.



So follow up people email, text, voice message, DM however, whatever you need to do, but follow up. That's something that I admit I was not great at up until a couple of years ago was that follow up?



and it makes a huge difference. And it's it takes, I don't know, two seconds of your time to send an email to follow up, right? It's not that invasive to your time. No, yeah. So follow up, follow up, follow up. Okay.



One more question around the presentation and presentations is, oftentimes I see this a lot at in physical therapy conferences, or sports medicine conferences is, oftentimes you're presenting as part of a group. So there may be, you know, anywhere, maybe two people up to four people in a symposium or within a presentation. So what can you do to prepare for that, and present and stand out within this group presentation? Absolutely. So let me ask a clarification. Question, Karen on this. So when you've been stand out, because usually, and because that's why I want your feedback on this. A lot of the times when I'm coaching people in this industry on group presentations, it's usually like a research study that they all did together. So is that the context you're coming in from as well? Or is there like a different context that I missed? You? Know, I think that's definitely part of it is it'll be a research study that a group of people did on their own, or it may be part of a symposium on knee pain. And they'll be three or four different people speaking on knee pain, perhaps presenting their own individual research, or sometimes it can be researched together. Hmm. Okay, interesting. So I'll go in the context of let's assume they're all on the same team, because the other piece is more like you want to stand up for everyone else, which goes back to the individual tips, right, just just when, then then just do the rest of our exercise and just get the get the recognition. But in terms of the group, there's a couple of nuances be control. So thanks for that, Karen. The first difference is realize that if you're listening to this podcast, you are automatically the leader of the team. And the reason is because you have the most information, unless you're sending this podcast, which I encourage you to do as well, right to your to your fellow teammates in this group. Because you're the person with the most information, I encourage you to take leadership and understand the strengths and weaknesses of everyone on your team. Why? Because you're only as strong as your weakest link in group presentations. That would be my first advice. Take leadership, take all the hardest parts on make your teammates life as easy as possible. That's tip one. Tip number two, realize that when you are not speaking, you're still speaking. What do I mean by this? Let's say me and Karen are on the same team. We're both presenting this amazing research Bravo, she she did all the work, because what do I know about the medical industry? And she's presenting. And as she's presenting, I'm looking in the sky, and I'm thinking, Ah, what's for lunch? Even if I'm not talking? I'm telling my audience something, Karen, what I'm telling them is, by the way, guys, I spent six months researching this with Karen. And I don't care what she says. So you shouldn't either. And that's the message we're sending people. So what's the point? The point is you got to speak even when you're not speaking, which means when Karen's talking bread's looking at her and going, Wow, nodding his head, wow, when she says something great, you nod your head. So do the same thing with your teens be sure you're paying attention to the people that are speaking. That's number two. Number three is have a solid system for q&a, especially in the context of research. Why? Because generally in those presentation, not always it depends on the format. But usually, you will get specific nuanced questions about the research, the thesis, the sample size, what you did, you gotta be strong. Because if you miss those questions, or worse, you contradict each other, your whole presentation sinks. And that's what a lot of people don't get. So I actually have a system on this, but that nobody the medical industry uses that people, you could be the first one who is I call it q&a Master. So q&a Masters is a technique I learned from a team in Sweden, that I thought was really fascinating. So what they did is that the best person who answers questions became the master. And then based on the questions they got from the research teams, or the people in the room, or judges, what that Master would do is he would filter or she would filter all the questions, turn to the research team, and see who has their hands in front of their body. So everyone has their hands in front of their body wants to answer the question. And whoever doesn't want to answer the question has their hands behind their body. It's super nuanced, nobody would actually notice it. And all the Master does is that he looks really quickly or she looks really quickly and picks out the people. So he evenly distributes the question. So there's no stress because he knows who the expert is. And if nobody has their hands up, he just answers the question because he's the best at q&a. That's it q&a Master. I love it. That is such an easy and like you said nuanced way so the audience isn't really picking up on that and it makes your q&a flow so much



To easier, correct? Oh, that is such a good idea. I love that one. All right, if I, the next time I am in a group presentation, I will definitely bring that up. I love it. Okay. So






when we're,



when we're presenting and we're up on stage, people often think, well, of course, they're up on stage because they're such a people person. They're the extrovert of the group there. You know, of course, only extroverts get up on stage, which we know is not true. So what advice do you have for those folks who might be a little more introverted or shy? And to get up there and do their thing? Absolutely. I mean, let me start with this, Karen, I had no business getting up on any stage. You know, I was 22. When I started master talk, my average client is 20 years older than me, I have a bachelor's degree in accounting. I spoke my whole life and a second language, and I have a crooked left arm because of a surgery head when I was younger, who in the world am I to share ideas on communication and public's view of the world? So the better question now becomes, why did I press record? Why did I do it? I had every excuse not. I did it for the 15 year old girl who couldn't afford me. I never did it for my executives. I just said, Hey, wait a second, like people are like 12 years old? Like who are they going to relate to with their communication, not some six year old white guy who's retiring, and what's seven PhDs and comms, she's going to relate to me. And I'm the only person who can share these videos, I have the expertise because I've been doing it for so long, even if I'm 26 have been doing for seven years. Nobody has that kind of resume. So I said it's either I do these videos, or nobody does. So think about that message in the context of what you want to share with the world. So if you're a little bit more shy or introverted, that generally means a few things. And let's focus on the positive three things specifically wonder a better listener. Okay, extroverts like me, are terrible listeners. That's why we make great guests on podcasts. Yep. All the time. Right. When you're an introvert, you listen more because you speak less. So it's easier for you to be empathetic, not just to the patients you serve in your day to day work, but also empathetic to your audience. You know what's going to land because you're asking them powerful questions, you're listening to them. That's one, two, you're better off Pausing. Pausing is the most important tool in communication, because that allows us to draw emphasis with our key ideas. Extroverts suck at pausing, because we hate space for at a party or at a bar, and we're just staring at somebody and there's no conversation. We start to get really anxious, and we've got us caregiver color. As a freak out. Resident introvert never has that problem, Karen, because they're just comfortable silence don't talk about much anyways. So pausing is really easy for them. And then the last piece is accessibility. Introverts are actually a lot more accessible to share their ideas than extroverts are. Example. Gary Vaynerchuk, CEO of VaynerMedia, massive social media following. I'm a big fan personally, but you either like the guy or you don't you either like he's really, really loud approach or you go get this guy away from me. Nobody says that about Brene. Brown, Karen. Nobody says I hate Brene. Brown. So what's the message? The message is someone out there needs your message. And you just got to go out there and share it and leverage your strengths in the process. Oh, great advice for all of those introverts out there. Or even you're sort of somewhere in between that introvert and extrovert, right? I think it what is it an entre entrepreneur, entrepreneur?



Entrepreneur, no one ever heard, and pervert, right? Right, right. No, I was gonna say an entrepreneur. And then I'm like, No, that's not right. Yes. So great advice. Now, you had mentioned master talk a couple of times. So can you talk a little bit more about that? Yeah, for sure. Karen. So master was just a fluke, you know, after university ended for me, I had no plans of being an entrepreneur, like a content creator. Similar to a lot of the questions you would ask around introverts, I was just going to become an executive at IBM. That was my goal. So I went on to work there for a few years. But I realized that everything that I was sharing with the students back then wasn't available for free on the internet. So I started making YouTube videos on communication. And it just turned into something I never could have imagined, which today, of course, a coaching business and a media company for people can't afford a coach.



That's wonderful. I love that. You're, you're supplying people with really good, relevant content. That doesn't cost 10 grand to get it



out at all. Fabulous. Now, as we start to wrap things up here, I have a couple more questions for you. These will be easy. Number one, what are your top three books for public speaking or speaking in general, that you would wreck



have met, I'll recommend one because usually when you recommend three people don't buy all three. So I'll give one an unconventional one. Thirst by Scott Harrison. So that's thirst by Scott Harrison Scott Harrison is the CEO and founder of Charity Water. It's a nonprofit, he started to help people gain access to clean water. The reason I recommend Scott's work, Karen, is because the guy's a world class storyteller. I've never seen anyone like him where he would practically went from a nightclub promoter in New York City in his 20s, to building the largest water charity in America, he raised $100 million, just last year to find clean water projects. And he did it primarily through communication and storytelling. And there's a great quote in the book that I'd love to share. And the quote is simply this. The goal is not to live forever, but rather create something that will and that quote will always stick with me. Excellent, great. So that's thirst by Scott Harrison. And just so people know, we'll have a link to that in the show notes at the podcast website. All right. So what are you? What do you want people to take away from this conversation? I would say for me, Karen, it goes back to the question we alluded to a bit earlier in this conversation. How would your life change? Or rather, how would your patient's experience in life change if you became an exceptional communicator, I fundamentally believe that the biggest piece that's missing in this field is excitement and passion for pursuing communication. Communication is supposed to be fun, like everything we shared today, isn't like, Oh, my God, like you have to sit there and find your key idea. Like it's fun, do this with people around you get excited. Why? Because it matters. Because it's every moment of your life. It's not just about getting on the stage. It's not just about making your patients feel like they're the most important people in the world in that moment with you. It's every conversation you have with your family. It's the way that you talk to your children, your nieces, your nephews, it's the way that you're the foot at restaurant or when you make new friends. And when we realize that communication is about leading a more fulfilling life, we'll start to take it more seriously. Excellent, great takeaway for everyone listening. Thank you so much. Where can people find you? Absolutely can This is a great conversation. Thanks for having me. So two ways of keeping in touch one, the YouTube channel, just go to master talking one word, you'll have access to hundreds of free videos on how to communicate ideas effectively. And number two, I do a free workshop over zoom that's live and interactive. It's not some boring webinar. And I facilitate it. So if you want to jump in on one of those, all you have to do is register for free. At Rockstar, communicate Perfect. So that's Rockstar, communicate tour o Perfect. And again, we'll have links to all of this at the podcast website, podcast at healthy, wealthy One click will get you to Brendan and all of these amazing resources. So last question, knowing where you are now in your life and in your career. What would what advice would you give to your younger self? My advice, Karen would be asked yourself one hard question about life every single day. And you'll never be the same ever again. That's the biggest thing. I'll give you three to not make your audience too crazy here. One, if you had all the money in the world, how would you spend your time? You know, a lot of us are always optimizing for the magical number 65. But if I made you an instant billionaire, what would you do with your time now? That's one, two, if you could only accomplish three things in your life and only three? What would you accomplish and why this helps you focus because time is limited time is the essence that we're all trying to optimize again. So use it effectively. And number three, what's a goal or a dream that you secretly gave up on? And never told anyone about? I'd encourage you to answer that question because it might lead to a dream that you should be pursuing in your life. Wow, great advice. And I think that's a first I've never heard that for a piece of advice and I asked all my all my guests this that's the first time I've gotten that piece of advice. So you are certainly a first on the podcast and I'm really happy that you came on and shared all this great info with myself and with with the listeners of the podcast. So thank you so much. pleasure was mine can't that's for me. Yes and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.



Thanks for listening. And don't forget to leave us your questions and comments at podcast dot healthy, wealthy

Sep 26, 2022

In this episode, Professor and Associate Dean at the University of Wollongong, Evangelos Pappas, talks about ACL injuries and surgeries.

Today, Evangelos talks about having difficult conversations around ACL injuries and surgery, some of the recent research that he has done, and the psychological effects of surgery versus non-surgery. What can physical therapists and associations do better?

Hear about continuing education, embracing digital health, and get Evangelos’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “For things to change, it cannot be done individually.”
  • “We need to tailor the treatment to them after we educate them.”
  • “Be more confident. Question things.”
  • “Don’t worry. Everything will work out in the end.”
  • “Digital health is the future.”


More about Evangelos Pappas

headshot of Dr. Evangelos PappasEvangelos Pappas is an experienced academic leader currently holding the Professor and Associate Dean (intoHealth) position at the University of Wollongong where he works on the development of the Health and Wellbeing Precinct at the Innovation campus. He has previously held academic appointments at Long Island University-Brooklyn campus (2002-2013) and at the University of Sydney (20013-2021) where he has also served as the Head of the Discipline of Physiotherapy (2018-2021).

His research focuses on the aetiology, prevention and treatment of serious athletic knee injuries such as those that involve the anterior cruciate ligament (ACL) as well as the long-term consequences of these injuries. He has published extensively in this area on research projects that utilize biomechanical, epidemiological and clinical approaches and he has been active on educating students, clinicians and patients on the latest evidence on the topic. He has disseminated his research with over 130 publications, primarily on athletic knee injuries but also more broadly on musculoskeletal injuries and disease.

He has been interviewed for his work on knee injuries and yoga injuries for newspaper articles and podcasts (Healthy, Wealthy, and Smart, and Knee Guru). He has taught extensively in the areas of musculoskeletal biomechanics, anatomy, orthopedic rehabilitation, clinical decision making, and digital health.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, ACL Injuries, ACL Surgery, Recovery, Rehabilitation, Research, Digital Health,


To learn more, follow Evangelos at:


Twitter:            @evpappas.


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


Hey Evangelos Welcome back to the podcast. Always happy to have you on.



It's fantastic to be back, Karen on the regular since the days you were on satellite radio.



That's right. That's right. Since I was, I was doing this show out of a studio live every Monday at one o'clock. That's how it all started. And yes, your circle. That's right. And you were you were like one of the first guests and you keep coming back. Which, which only means that you keep doing really good



work. While you keep inviting me so well. And Matt,



and it's a good time, it's a good time to catch up and everything. So people don't know evangelists now used to work together in New York City. At on 57th Street, and actually, you know, we're as we're recording this, we're just a couple of days outside of 911. And I was with you on 911. That's where I was right. That's where we were. So someone asked me the other day, where Where were you on? 911? I could tell you exactly where I was. I was on 57th Street with working with you and and Mike and Amy and and that's exactly where



I was. That's right. Yeah, that's Tuesday. And then we went through all the trauma after that, which people are hearing now live in Australia. And people here asked me about my experience. And my response is that it's the closest I have you ever been to a warzone? So that's, that's the memories I have.



Yeah, yeah, I remember it very, very vividly. And, and now you're in Australia, and just publishing work like a fiend, paper after paper after paper, which is very exciting. And just so people know, we'll have all the links to all of your published works in the podcast in the show notes. But today, we're going to talk about your specialty. We're going to talk about ACL injuries. And we're going to talk about rehabilitation, whether you have surgery or you don't have surgery. So I think the the first question I have is when you're working with a patient, so they they they have an ACL injury, they come to see you maybe a couple days after, and they're kind of debating do I have surgery? Do I not have surgery? And they asked for your opinion, which happens all the time. So what what advice do you have for therapists listening, when people ask them that question, how do we answer that?



Well, just like with a lot of these questions, there's no easy answer. And obviously, you have to tailor the answer to the patient, their goals, their needs, their physical activity that they will use to do the physical activity as opposed to go back. And I have to say, it can be a somewhat heartbreaking interaction, because one area where we have not been doing so well, the physical therapy world, but also the orthopedic surgery world, is to be honest with our patients about what happens after an ACL injury. And I think the media has a responsibility here because you know, frequently they talk about the latest athlete who has come back stronger than before, after an ACL reconstruction, for example. And all that is incongruent with the evidence. So an ACL injury is a very serious injury, that in the majority of the patients can be a life changing injury. And we don't and it's difficult to say that to a 16 year old, it's difficult to add to tell them to educate them that, you know, not only you've missed the season, but that's the least of your worries, because you know, 15 years later, your knee has a very high chance of entering degenerative stage and developing debilitating osteoarthritis. So so we and I think, answering that question, do I need to have surgery should start with education? I guess, throughout this podcast, you know, you mentioned before, the research that we're publishing and you know, it is important to give credit to those who are doing a lot of the work and I'll be mentioning a lot of my PhD students and postdocs who are leading a lot of these work. So we I post supervise Andrew gamble, who is a amazing physiotherapist here in Australia, working on decision aids for patients who had an ACL injury and the younger than 18 year olds. So I think these are the tools that I really hope to see in the next few years that then allow the clinicians and the patients to navigate the different choices that they have. Have educate them, and then then make an informed decision. So if I were confronted with this question, I would ask tactfully, as I can explain that this is an injury that is serious, and that a lot of the treatments will probably be trial and error. So we don't know who does well with non surgical treatment. And who does well, with surgical treatment at this point, we just don't have the prediction models that that allow us to do a few tests. I mean, certainly not at two days, but even at three months after the injury, we just don't know who does well. And we'll be talking later about the three RCTs that have been published that give us some insight on the outcomes after ACL injury and the different treatment options that are available. But yeah, you know, I would educate the patients about the risk of developing new osteoarthritis, and I would also encourage them to consider other sports, because nobody wants to say that, as I said, to a 16 year old, who is playing soccer and wants to get on a scholarship to go to college. But yeah, if you had one ACL injury, you are your risk of suffering subsequent ACL injuries with everything this means for the health of the knee is is much higher. And again, that's the second area where we have failed as a profession to educate our patients. Try to redirect them, of course, it's their choice, if they make an informed decision that I love soccer, and I want to get back to it no matter what, then we'll support them to do that. But we have really failed to educate them about the seriousness of the injury and the advantages of switching to other sports that can keep you active.



And that's a really hard conversation to have. And I've been going through this over the past couple of weeks with a patient and the decision was made, she went back to the sport in which she initially injured which was soccer. After myself, her surgeon, a couple of doctors, they went for second opinions, everybody was of the opinion that it's not a good idea, and that your risk is much higher. And she said, I know the risks.



So it was three theta nonsurgically. And she went back to soccer, she enrolled surgery with surgery.



Okay, yeah. And she said, I know the risks, but it's what I do I want to do this. And she is 16 years old. She's a sophomore in college and high school. And she said, No, I know the risks. And if I tear it again, I that's, you know, that's on me. And I understand and I know what's going to happen, and I know what happens long term, and this is what I want to do. Yeah, and so you can't chain someone to the sideline, you know,



should Yeah, and you shouldn't either, you know, as long as they understand the race, I mean, we take risks every day, you know, people are doing really risky things, frequently, with a lot less reward than than playing the sport that you love. So, so Yeah, as long as it's an informed decision, and they're aware of the risks, then then I would be very happy to help them get back to this goal. When I tore my ACL, I did not have an ACL reconstruction initially, and I went back to play basketball. And you know, I was doing a PhD on ACL injuries, and it ended up being a terrible idea, long term, you know, with a subsequent injuries that I suffered, but yeah, well, you know, it's applied fine for for a few months. So, you know, you feel invincible, you know, when you do that. And, and I think that's the risk here can because I asked you whether this patient had an ACL reconstruction, because, yeah, obviously having an ACL reconstruction, going back to sports, it is a risky thing. But in some ways, it doesn't make sense. Frequently, patients have reconstruction exactly, because they won't go back to sports. But I do think with all this publicity in the last few years around non surgical options for people who have an ACL reconstruction, I believe that the pendulum sometimes is swinging way too far in the direction of that provides the impression that well, the ACL is not needed, you know, they're there. And then they isolate a couple of examples of athletes who play with no ACL. And then everybody believes that that's going to be the next person who's going to be in the news for that. And we do know that that just not the case. So I just, you know, one thing I can very comfortably say is that being ACL deficient and playing this cutting and pivoting sports at a high level isn't Other good combination, it does place your knee at a much higher risk of subluxation episodes, and then subsequent cartilage and meniscal injuries. And it does make a subsequent ACL reconstruction more difficult, I would say. So, yeah, one thing I will say is that if they're determined to go back to these high level sports, then then an ACL reconstruction is probably one thing to consider there.



Yeah. And I think it's also important to consider as you're talking about, you know, the athletes that are in the news, it's important for people to understand that that's their job. That's their job. They have a team, they have a coach, they have a strength and conditioning specialist, a PT, probably nutritionist, you know, it's their job to literally work out and get stronger. So for the majority of clinicians, we're not seeing professional athletes, we're seeing someone who wants to play basketball on the weekend, but has a full time job and maybe can't work out and do the amount necessary on a weekly basis to get back to that level of sport.



Or absolutely, you know, having if we all replaced our job with the time we spend with rehabilitation, obviously, our body would be in different shape. But the thing here to to add to what you said, Karen, is that frequently, we hear about those few exceptions that played with the being ACL deficient. And we don't hear about all those who tried to return to sports, with no ACL and failed, and these are the majority. So yeah, just want to be clear, clear here is that the ACL is a very important ligament and then cutting and pivoting sports and ACL deficiently is not a good idea. Yeah.



100%. And of course, they don't talk about the people who tried and failed, because that's not newsworthy. That's not a news story. Although, I would argue that is the news story. That's yeah, right. Okay, so let's talk about you mentioned some of the research that has recently come out, in and so why don't you walk us through some of those RCTs and what you found and the people who helped you along the way?



Yeah, so it is an exciting time to look into treatment options for ACL injuries, because unlike a few years ago, we have some really good evidence that is coming out in the form of the randomized control trials. So just a couple of weeks ago, in the Lancet, one of the top medical journals, there was another RCT that was published by a group in the UK that looked at non surgical versus surgical treatment randomized so patients signed the form that said, I had you know, that they met the inclusion criteria that they had an ACL injury, minor meniscal injury, some of them but but nothing that required, you know, more expensive treatments and broken bones, and so on and so forth. And when they accept it to be in one of the two groups, either having an ACL reconstruction, or to try non surgical treatment with the option to obviously convert into surgery down the road. Now, the difference of these last trial that was published compared to the previous one is that they had chronic instability. So this is the group that that had the chronic instability, the better candidates in many ways for an ACL reconstruction, right. And it is impressing just like the other two trials. So the Canon trial that is the one that has the longest follow up at this point, and we should start seeing the 10 year results, hopefully soon from this trial, because we have seen the two and the five year results, and then they compare trial out out of the Netherlands, there is some impressive consistency in some of the outcomes. The last trial on the people who had chronic instability is different in that it showed statistically significantly better results in many of the outcomes in favor of the surgical group. But when you look at the difference, and you actually look at the statistics a bit more carefully, the difference it is statistically significant, but not but borderline in terms of its clinical significance. So it does confer an advantage on the average patient but probably not not the it's not a clear winner. We would say the other two studies. Again, you know, some minor differences between them. So the Dutch trial they found in some of the outcomes again, slightly better outcomes in the surgical group, but the cannon trial but in many of the other outcomes difference. And then the Canon trial actually found that there is no difference between the two groups. So when we look at the totality of the evidence out of the studies, there is a few outcomes here, a few back consistent messages. So one is that, if there is an advantage of the ACL for the ACL reconstruction is probably quite marginal. But also, and that ties in with what we're discussing at the first part of this podcast, Karen, when you look at the physical activity levels of the patient, it's very few of them sustain high physical activity level down the road. And again, that Canon trial provides a bit of evidence there, because it is a five year follow up a lot of the patients either by choice or because their knee, not happy with the health of the knee, do not return to their high level of cutting sports. Of course, as you would expect, there are some differences there. And the ACL reconstruction does indeed provide a more stable knee with a slightly better chance of returning to high level sports. But yeah, it is important to educate our patients about that, that you know, you and these are patients who are motivated, they are returning, they are enrolling into an RCT. So that is one key message here. The other key message and again that for us as physiotherapy as PTS, you know, it's important to keep that in mind is that from those who were randomized in the non surgical group, half of them end up having surgery.



So when you look at and when we read this paper, it's it is important to actually keep that in mind, because you look at the outcomes for the non surgical group. But we have to keep in mind that half of these patients in this group had surgery had an ACL reconstruction. So when you look at obviously, if you take those out, which again, that kind of takes away some of the advantages of the RCT, you cannot just remove that group and then just compare the group that's stuck with a treatment with the treatment allocation of the non surgical treatment with the other group. But yeah, you know, it is in the canon trial, I did a little bit of that. So it is important to look at all these different comparisons. But that is another consistent message from both of these trials that you know, a lot of half about half of these patients, they switch treatment, and they end up having the ACL reconstruction. Now, this does not mean that they're happy with the ACL reconstruction, obviously, you cannot undo the ACL reconstruction. But but it does demonstrate that they were not very happy with the outcomes that they got from the non surgical treatment. So that is important to keep in mind as we are looking at this evidence.



And in these trials, are they also taking into account sort of the psychological effects of surgery versus non surgery? And maybe the expectations of what one might have? I you know, I don't know. Because I know I've had people who were kind of on the non surgical route and doing very well and then just said to me, you know, I can't live with the fact that there's something torn in my body, I can't do it. Can't do it. You know, they're like, from a psychological standpoint, I can't do it. I realize I'm doing everything I want to do and can probably continue to do it. But I need to have this corrected. Right. So there is always that kind of psychological component. And, you know, to your point earlier, what you see in the media, I think can sway people.



Oh, absolutely. Yeah. See, to put it simplistically, the patients who tear their ACL, they frequently feel that they want it fixed rate. And they believe that if they go to the most expensive surgery and the one who is treating the professional athletes, and have tons of physiotherapy with somebody, again, who is famous as a physiotherapist, that they will get the best outcome. So so doing more treatment is really going to fix that in many, you know, in many other parts of our lives. They work like that, you know, if you do buy a very expensive car frequently is better than you know, use very cheap car that you can buy from your neighbor. But in healthcare, it frequently doesn't work like that it didn't maybe not the best treatment and, and we spoke about that in a bit more detail in an editorial that we wrote in sports medicine about three years ago, Joe Zadra, who is doing amazing work as a research fellow now within the equivalent of the NIH here in Australia called the NHMRC. And he's looking at this MCs called supervising Andrew gamble that I mentioned earlier, you know, doing a lot of work in this space. but it is about that it's about the expectations that either people have intuitively that, yeah, well, I tore something, I'll go fix it as soon as possible. And that will make it good. Versus the evidence which, you know, the reality is that frequently things break in the human body and cannot be fixed, not to the same in the same way as before. And the ACL is definitely one example here.



Yeah, and I think the hardest part about the rehab process is oftentimes managing those expectations.



But also thinking that, you know, and when we were working, you know, in midtown Manhattan, then you would frequently have patients who would see some of the very famous surgeons and the expectation, either explicitly or implicitly, will be that that, you know, everything will be as good as before. And frequently, the clinicians isolate one fact like one laboratory study that showed that the graft is stronger than the original ACL, and serve that to the patient that that that doesn't help with these expectations. So yeah, it is it is a bit of a challenge the error in creating these expectations in the healthcare system that doesn't help achieve that.



And so where do you think? Or where or what do you think physical therapists can do? Better to help manage this? Because like you said, oftentimes, yeah, you cherry pick some research that follows the narrative that perhaps you're hearing from the patient, but I guess the question is, Is it okay to be truthful? You know what I mean? I know that sounds like, of course, it is, from like a moral standpoint, of course. But if you have a patient who really wants to hear something, it also then becomes, hey, if, let's say, and this goes into a whole other thing that you may not have the answers to. But if you're a physical therapist that owns a practice, you know, Peter O'Sullivan will often say what's good for wellness or what's good for the patient isn't good for business. So if you have a patient who just wants to hear this, and you want to stay in business, you know, I'm not advocating to compromise the patient's health or anything like that, but,



but yeah, definitely, but yet compromise is part of our daily life as clinicians and you know, I am speaking from a position of privilege here as an academic, you know, so I certainly don't don't, I'm not trying to take the higher moral ground. But I do understand, obviously, the challenges, I mean, not only financially, but also the fact that if you are the party pooper, who is telling your 16 year olds that, well, you're not going to you should not get back to soccer. And then they go across the street to somebody else to another big surgeon or a PT, who tells them I've had all of my patients when back to the previous activity level, who are you going to go with? You know, it is intuitive. So, yeah, I certainly understand the challenges. And you're correct, but I don't have the answers. And I think the four things to change, it cannot be done individually. So you know, individual physiotherapist can are not going to change this. There's so much inertia in the system. So I do think that collectively we should. Yeah, well, the the, there are associations that have made statements for specific things that I've seen recently read one, the Hospital for Special Surgery, where they tried to place the evidence around ACL repairs, which are, you know, there are some surgeons who are doing them, and they may have a place. But again, the evidence shows that they do fail at the higher rate and an ACL reconstruction. So maybe it's a question and a place where associations can play a more major role. But certainly people who teach continuing education courses. And that's not different for a lot of the other pathologies that we see. We certainly want to educate our patients and you wouldn't tell your patient who had a total knee replacement that they shouldn't be running marathons, you know, 20 marathons a year, that just wouldn't wouldn't make sense. So why do we do that for our patients who have an ACL reconstruction? It is obviously that they're younger and it is but you know, we don't want to get them goes back to clinicians traditionally being viewed as the Guru's who. Just use marketing techniques to talk about the outcomes that they have. And if you're good at If you're good at selling that to your patients, then you do get Vizier. But you there are ethical issues there, as you pointed out, the reality is that there is a lot of work for everybody. So we don't have to do that. That's my sense. And of course, you don't have to be able to sleep comfortably with our conscience, you know, being comfortable without conscience at the end of the day. But one thing that I've seen, and that's, you know, probably a bit different, but related to this discussion we're having Karen is this turf wars that still exist between professions. I mean, I've seen that in Australia, you know, quite obviously, here in that a lot of the some of the physiotherapist they are trying to throw as much mud on the ACL reconstructions as they can. And they are probably over utilized. We had a debate here a few months ago with an orthopedic surgeon, as part of a debate that the sports medicine in Australia are organized. And the consent, one of the things we agreed on is that ACL reconstructions are probably over utilized, and the outcomes are not as good as we're telling patients that they are. But at the same time, we should not completely disregard ACL reconstruction because it does have a place and it does provide a more stable knee. And we should avoid this turf wars where physiotherapists are trying to convince everybody and utilize the evidence to their advantage, demonstrating that ACL reconstruction don't work. Well, of course, there's two big surgeons, they are cherry picking some of the outcomes showing that it does work, that the truth is in the middle, in that thing, to change things, we should work with the other professions, and make sure that we're all on the same page. Because there is quite a bit of evidence that is emerging. And it actually says a few things that are good for some professions, but a few things that aren't good for the same profession. So



yeah, so doing your best to give all sides to the patient. And then ultimately, like you said, in the beginning of the podcast, it's the patient's decision. It's not our decision. It's not the doctor's decision, it's the patient's decision and what they feel like they're going to do moving forward from movement and activity perspective and what they need.



That's exactly right. We do tailor the treatment to them after we educate them. But But I really hope that again, that goes back to all of us joining together and those of us who do research, that in the next few years, we can develop some algorithms that will tell us who is a better because of everybody's is, has the same chance of success with each one of the treatments. I had patients who have been ACL deficient, some of them bilaterally, and they're skiing hard and dancing and playing sports that you would think that we'll be able to, there are these examples. And of course, there are the examples for those who have an ACL reconstruction, and they forget that their knee ever had an injury. So there's good outcomes in both sides. But we really have to do work to and to do these studies, they're very expensive, you know, they're very, very difficult to do. And you do need very large sample sizes. So it will have to be multicenter and multinational, I will say collaborations that that. But that if we all joined our forces together, and we say that in the next five to seven years, we should develop good algorithms reliable algorithm that then can tell you, when you tore your ACL, what are roughly your chances of being successful with no surgical treatment, then yeah, I think that will be a good outcome for everybody.



I mean, that would be a really good outcome for everybody. And would make I think would allow the patient, the therapist, the doctor to move ahead with this, maybe some more confidence in that they're making the right decision, because we're human beings and everybody. So I mean, I second guess what I'm going to have for lunch. I mean, I can't imagine like, you know, to have a surgery or to not have a surgery, it's a big decision. So there's a lot of like, second guessing. And now earlier, you had mentioned continuing education. So we're gonna pivot to that for a moment because you're speaking Friday and Saturday, the seventh and eighth of October at the Paris lower limbs Summit. So do you want to give the folks a little sneak peek as to what you're gonna do? I mean, you don't have to give away everything you can like tease like, Oh, I'm going to talk about this research that I've never spoken about before. So if you want to tease that a little bit, go ahead.



No, I have nothing to hide in other things you were publishing, as you said, so everything is out there. And again, if any of the listeners want to read the paper, it helps with putting you to sleep, I would say the methodology section, please feel free to email me and I'm happy to share some of the work that we have been doing. So yes, I'm going to Paris in a few weeks for the lower extremity Summit. As yawns are there pay a has been organizing this conference has been postponed a couple of times because of COVID. But it is happening right next to the, to the tower there to the Eiffel Tower. And you know, the these guys are really professional, they, the I was told that the tickets for that conference were sold out in 24 hours. So that just demonstrates the hunger that exists in Europe about high quality, continuing education. So they have invited a lot of really, really smart people. But because they're French, and they're very modest, they also invited average people like myself, to balance out the intelligence level there. But yeah, a lot of great speakers, I'm really excited to listen to everybody else speaking, to be honest, and I will be speaking on the topic of surgical versus non surgical treatment. So if you haven't been paying attention in the last 10 minutes, probably the message is there. So but I will be providing obviously in much more detail on the RCTs that have been published. And also, some of them are cohort studies that have been published again, you know, my message will be that not everybody benefits the same from all the treatments and that there is a wide spectrum of outcomes. But there are a few things that have emerged from these three RCTs that are quite consistent. So yeah, if you if you are in the in Paris, in the beginning of October, I don't think there are any tickets left. But you'll see us partying somewhere in one of the local clubs there in the evening. But I'm really looking forward to this conference, which will be the first one the first time I'm going out of Australia since the COVID pandemic and the first international travel. So that's gonna be interesting.



Yeah, it's a big deal. It's a big deal. It's I've been out of the country twice so far, once to Monaco for the IOC and then to Copenhagen for the Fourth World Congress and sports pt. And they it was both amazing conferences, great information. But the best part was kind of seeing all those colleagues that you haven't seen in a long time. And I'm sure that's one of the things you're looking forward to, as well.



Oh, absolutely. Yeah, the social part of this conference will be very interesting, too. But yeah, the scientific part. So and the good thing about not having been at a face to face conference in three years is that there's so much many more things that you have to learn now, because all this research that has been published over these years. So yeah, please come and say hello, and if you haven't tickets for the lower extremity Summit, love to hear from you.



Perfect. And then where can people find you outside of Paris? Let's say they just want to get some of your research. ask you questions. Where can people find you?



Well, physically, they can find me in Google and Gong, just this beautiful place, an hour and a half south of Sydney. So I am the Associate Dean for a developing health and wellbeing precinct here at the University of Wollongong. That's my day job. My evening job is research and I do have 11 PhD students in a very large network of collaborators that I have been working with. We are growing our team here at the University of Wollongong. So if you are in Australia, and you want to do a PhD and ACL injuries, please talk to us. So we have a lot of very interesting abs and a lot of problems that you can help us solve. And then as a busy father and husband I do how I try to save some time for social media. So I'm on Twitter at EV Pappas tweeting all the great work that my PhD students do and occasional some political commentary there. And yeah, on LinkedIn, evangelist Pappas, so



perfect. So we will share all of this information with people so if they want to get in touch with you with questions and things like that one, click at podcast at healthy, wealthy And you'll be able to find evangelists very quickly. So before we wrap things up, one more question. Given where you are now in your life and career, what advice would you give to your younger self? I know you've answered this before because you've been on the podcast before but give another give another piece of advice. Oh, don't



even remember if I have answered it and what I say Yeah, well how young Um, I mean, it could be age myself, or is it professional advisors, life advisor,



life, it could be anything, you know, it could be right out of PT school, it could be, you know, when you're in New York toiling away and at NYU getting your PhD or, you know, whatever, whatever you



guess, yeah, I would give a different made, I will give different advice to different parts of my personality in different parts of my life. Certainly, when I did move to the United States, I did my undergraduate in physiotherapy in Greece. That was in the late 90s. And that was when I did a master's degree at Quinnipiac University. And and, again, the a lot of the continued education back then was around myofascial release and cranial sacral therapy. And so I do remember myself, struggling with a lot, I mean, trying to get as much knowledge as possible and not questioning a lot of what was presented then. So so that's one piece of advice, question more. But I think I speak for other people when I say that. Obviously, we now we know that a lot of these treatments are not based on on a lot of evidence, and even the mechanism that were proposed to be based on they have been proven, understandably not not very valid. So yeah, quite question a bit bit feel more confident, feel more comfortable question more. I do remember, there was this conference in Las Vegas where I went, and as they commonly do in this continuing education courses, they take somebody from the crowd, and they say, Well, let's look at their pelvis, and if it is aligned, so So the instructors immediately says, As soon as they expose the PSA axis of that participant, you know, say, Oh, wow, obviously, you see that, and then everybody around so home, wow, as everybody would see something really obvious, it was not obvious to me, but then I looked around. And eyes, see that thing, I couldn't see anything, you know, it was not even wearing my glasses, and I was too far. So even if there was something there. So yeah, I think, you know, being a bit more confident to question things, that's what I encourage my students nowadays, and thankfully, these newer generations are a bit more brave, and question skeptical and questioning things, so you can't fool them very easily. And that makes me very optimistic about the future. And when I was doing my PhD, and you know, working with you, Karen, that website, physical therapy, back there, you know, obviously, a lot of fun and learning from each other, but challenging times to, in many ways, you know, trying to balance everything and do a PhD full time at that time. So, so the advice I would give myself back then is that don't worry, everything will work out at the end. So yeah, but the advice I give myself now, and then maybe that's a good idea for you for another podcast is that digital health is the future. So that's obviously a large topic. And we can open this discussion up in different podcasts in in different episodes. But one of the great things from the pandemic is that a lot of the things that then there are quite a few things that are wrong in our profession, they seem to be addressed. And there is companies that are aggressively moving into the space, and democratizing which is the catchy word that we have been hearing the last couple of years physical therapy, and that's not gonna, you know, it cannot turn back the clock. So I do think that 510 years from now, a very big part of physical therapy services will be delivered in a in a digital environment. And I think we should embrace that instead of fighting it as a profession. And we should try to look at the advantages of this approach.



Yeah, I agree. There's, like you said, you can't do you can't want to let out of the bottle the genies out of the bottle, you can't step it back in and the quicker we can embrace it and, and find ways to perhaps make it a little easier for physical therapists across the board around the country and around the world to be able to utilize digital assets I think the better so I agree with you on that one. Well, Evangelos thank you so much for coming onto the podcast again. And I guess now we'll schedule another one for digital health. We could do like a digital health panel you know, have like a couple people have a series Yeah, it's a good idea to I'm up for so you don't you love how guests come on, and then they immediately booked themselves for another work. That's great. It's perfect.



So when is the past Oh, well. Invitation.



Maybe after we'll let you go to Paris first. When you get back from Paris, you let me know. Yeah, yes. All right. Well, yeah, if you're still if you're not too jet lagged. Give me a few days. Yeah, we'll give you a couple of days. But again, thank you so much. So great to catch up with you and to see you and thanks again for coming on.



Oh, thanks for the opportunity, Karen. And Lovely to see you again. And then speaking to, you know, going back to the satellite radio day, so obviously, things have changed rapidly for you and you deserve all this access as you are doing great work, educating the profession.



Thank you. Thank you. I appreciate that. And everyone. Thank you all for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

Sep 19, 2022

In this episode, PT student and Miss North Dakota 2022, Sidni Kast, talks about her journey to becoming a PT and being Miss North Dakota.

Today, Sidni talks about the Miss America Organization, the One Body Movement, and going through Miss America orientation. How does Sidni balance her job as Miss North Dakota while completing her studies?

Hear about Sidni’s devotion to self-care, the value that Miss America can provide to young girls, and get Sidni’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “Whatever your dreams are, and whatever you want to achieve, as long as you set your mind to it, then you can achieve those goals.”
  • “No matter what age, we can accomplish whatever we want to.”
  • “Stop trying to speed through every part of your journey.”


More about Sidni Kast

Sidni Kast is a second year graduate student at the University of North Dakota pursuing her doctorate in physical therapy.

While attaining this goal, she has decided to make an impact on her community as the current Miss North Dakota 2022. Her platform as Miss North Dakota, the One Body Movement, correlates perfectly with the profession of PT and grants Sidni the opportunity to speak to people all over her state, and on a national level when she competes at Miss America in December 2022 in Connecticut.

The focus of the One Body Movement is to preach the importance of overall health, and not just how people look on the outside; mind, body, and soul all play a major role in our quality of life. Sidni plans to speak to people of all ages on this matter, as she sees its importance for every demographic, especially after the isolation our communities underwent during the pandemic.

Although, it can be challenging to balance these two time-demanding endeavors, Sidni finds the enthusiasm she has for both outlets as her motivation to continue her pursuit of success.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Miss America, Scholarship, Success, Opportunity, Impact, Advocacy, Inclusion,


To learn more, follow Sidni at:


Instagram:       @sidnikast


Facebook:       @missnorthdakota2022


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


Hi, everyone. Welcome to another episode of the healthy, wealthy and smart podcast. I'm your guest host today Stephanie y rock, I am joined by Karen Litzy, who is the primary host of this podcast. And today we're interviewing Sydney cast. And Sidney is the current Miss North Dakota 2022. But she's also a doctor physical therapy candidate at the University of North Dakota School of Medicine and Health Sciences. And so she's joining us today. Hi, Sydney. Welcome to the show.



Hello, thank you so much for having me.



So tell us a little bit about yourself. And tell us kind of your connection between being a physical therapy student and being Miss North Dakota and what that all entails.



My name is Sidney Cass, and I'm currently a student at the University of North Dakota, I have loved going to school there. And the best part is that it's still kind of close to home. So I'm originally from Minot, North Dakota, which is about three hours from Grand Forks. And that is where I grew up and really found my passion for what I wanted to do with my life. And that was physical therapy, I applied after, you know, I'm really glad that I waited after COVID Before I started my education, because that's really helped me get a good experience and really gotten that hands on experience. So I'm very happy with that decision. But ya know, so went to U n, d. And then I started my kind of connection with the Miss America organization before I got to u and d. And that was back in 2019. So it's very new to me personally, I didn't grow up, you know, Toddlers and Tiaras or anything like that. But I really found a passion for it, because it allowed me to get scholarship money. And it allowed me to perform once again, because I did choir and theater all throughout growing up. And once I was done with high school, I really didn't have that opportunity anymore. So that's what led me to join the organization. And it has truly been life changing ever since not only becoming Miss North Dakota, but meeting all of the different people and having new experiences has truly shaped how I go about my everyday life. And I'm so thankful that I'm able to combine my doctorate of physical therapy, and also my job as Miss North Dakota into one.



So you know, people have heard of pageants before. And there's lots of different types of Miss North Dakota as a person can be. Tell us about the Miss America organization and how it's different from some of the other pageants or organizations that we're aware of like Miss Universe, tell us a little bit about the organization and why it's unique to you.



So the best thing about any type of these organizations is you make it your own. For instance, what I do is Miss North Dakota is completely different than the previous minutes North Dakota has done and that's okay. That's the best part is it can evolve as we evolve. And what I love about the Miss America organization is it truly honors scholarship. And that is the base of everything they do. Whether it's fundraising, or it's different events, scholarship is the base of what they prioritize. So that kind of is what allows me to that is why I chose that organization over other ones, I probably wouldn't have done another organization because I had that preconceived notion of what a pageant was. And it is so much more than the stereotypes. And it's, it's hard to explain that to a lot of people because they grew up oh, well, Miss America, it's just a beauty competition. And that is the furthest thing from what it really is going to and we'll talk about this later, I just went to my Miss America organized orientation. And that was so uplifting because I wasn't the only one trying to push an issue that I saw was important and was something I saw our nation needed. Every single candidate going for the job of Miss America has something unique, that allows her to show her passions and really provide an insight to what she believes needs to be changed in our country.



Yeah, I've always said, this is kind of a disclaimer to our listeners. I was also involved in Miss America organization, and competed in Miss North Dakota back in my younger days. And one of the unique things that I thought besides of course, the scholarship money which did help pay for my PT school was that you have to have a platform and you dedicate your entire year as Miss North Dakota or if you're a local title holder, to helping people understand that platform and raising awareness. So Sydney one of the things that I think is great about your platform is it is very much related to your future job as a physical therapist. Can you tell us about your platform give us a little bit more detail and what inspired that platform.



My platform is called the one body movement and what inspired that entire thing is, being in physical therapy, there are so many things about the body that connect to one another. And Mind Body Soul is really the root of what I'm after. And what I want to preach to not only the state of North Dakota, but hopefully the entire country that we have to take care of ourselves, and invest in our bodies in entirety, in order to thrive and have a greater quality of life, which, as physical therapists we know is the number one thing we're looking to improve. So having both that connection to my current my future career, and also being able to show that on a state platform is something I'm truly excited about. And I feel when I talk about it, you can sense I'm excited about it. And not all things, when people go into these different outlets, you can see that passion, I feel like I'm able to have that passion for it.



Yeah, and I think that that's something that we talk about a lot on this podcast is that mind body connection and understanding how everything is connected. I know that as a physical therapist, I do that every single day with my patients. And it's unique that you have this statewide platform where you can, as I like to say, preach the gospel of physical therapy, to especially young kids, you know, there's one thing that we want people to do is to grow up and be physically active and to move their bodies, and to practice habits so that they can have health, healthy lives as they get older. What are your plans as Miss North Dakota to kind of spread this message across the state.



So my way of, I think the best way to spread knowledge is through stories. And I can definitely relate to when I was growing up, I thought, Uh, well, in order to be successful, I have to look a certain way I have to come from a certain background. And I want to tell people throughout the state that that's not true. Whatever your dreams are, and whatever you want to achieve, as long as you set your mind to it, and know, this is why I want to do it, then you can achieve those goals. Whether it's your overall fitness, whether it's your mental health, or whether it's, you know, the job you want to attain, anything that you want in life is, is under your control. So being able to speak through my own stories, whether it's different diet cultures that we all experience, or social media, how it really affects different generations is how I would love to connect to others, and portray what I believe we need to move past.



And what types of things do you plan to utilize from your education to kind of help spread some of those messages?



Oh, absolutely. That's, that's the best part about all of this, every day, I'm learning something new, that I can relate to what I want to share. I kind of talked about this, the last time we spoke, but an example of when I talk to a class is I'll have four guests come up. And you know, I like to have a little classroom involvement, whether it's a school presentation, or whatnot. And all four of those guests will represent the parts of a car, four different tires. And those four different parts of the car, or the tires each represent a part of our lives. And it can be different for each person. Because as we all know, we come from different walks of life. For myself, personally, one tire would be my physical health, the next tire my mental health, and then my school and social my school and work life, and then my social life. Because as we know, those are all different parts of our lives that directly affect us what and what I would demonstrate to those people is those tires like on a car, if one goes flat, the car won't move forward. So we have to give energy and input input to each different outlet, if we want that car to move forward. But like, unlike a car, you can replace the tires, you can't replace your body. And that's why I really focus on the one body movement as a whole and really, like trying to inspire others that we have to invest in every little part and not just you know, inflate one tire.



I love that story. I think that that makes that that's something that people can really everybody has seen a car. Yeah, everybody's probably experienced a flat tire. So it's, Oh, I understand. And I think, you know, one of the things that is that I think you can definitely apply to when you become a physical therapist is our patients also respond to metaphors. And speaking in metaphors helps them understand like, why am I in pain, what is going on with my body and makes everything a lot less scary to them, especially if you can give them something that they can see that they understand the story that they understand. So I love that you're doing that. You had said that you just got back from Miss America orientation. then. Yeah. So tell us about that Miss America is happening in December. Correct. So tell us about the orientation process and what the contestants were that you met there.



Yeah, orientation for Miss America is both one of the most exciting, but also the most overwhelming things I've ever, like witnessed. And the reason I say that is, I'm a very like, extrovert, and you're going in and meeting 50 other women that are also extroverts and also accent Yeah. So it's a lot. And it's a lot of, you know, high energy. People that really just want to get to know you. And that I mean, the first few days, you're just really having that small talk really like, Oh, hey, like, where are you from? It's you walk up to somewhere like Sydney, North Dakota, nice to meet you. And it's so cool, because you can you can see that everyone's excited to be there and get to know one another. And that's what I really love about the Miss America organization. It's so uplifting and empowering and everyone wants the other to succeed. It's not that you know, Catty, 80s movie, we're Oh, no, we're, you know, we're in a pageant we have to compete. It's it's so much more than that.



Are you talking about drop dead gorgeous, because it's the greatest pageant movie of all time, in my opinion. Maybe Miss Congeniality? Yeah, no,



I was gonna say those two movies, they're at their high competitors. I love watching those movies, because it's so fun to compare it to real life situations. But other stuff that happened at the orientation was the teen competition. So there's a whole Miss America, like women, part of the competition, and then there's the team portion. So I actually got to watch my team. And it's so amazing to see women, the ages between 14 and 18 to 19. Show such poise and grace. And I'm sitting there thinking I was taking speech class, when they went in there on a national stage presenting in front of stars, I mean, me of Franklin, Michael Phelps, his wife, Monica, from cheer, I don't know if you've watched that on Netflix, but just, you know, to be at that age, and to handle that situation just shows the preparation that the Miss America organization gives young women. And then after the team competition was when we really got into orientation. And let me tell you read every contract before you sign it. Because there's no, it was the funniest part, we all showed up. And we had our contracts pre signed, and you know, you know how contracts work, you might skim a few. But there are some important things in there that are about the Miss America organization that you really have to pay attention to. And I don't believe I'm at liberty to discuss that. But there's a lot that there's so many logistics, some things I would never even imagine. But the best part was getting to talk to the current Miss America, and hear how she's handling her year. And you'd be amazed at the life that they live and what they have to endure in order to be this, you know, the face of Miss America. And it's my favorite part was listening to how she coped with the stress and how she really took time for herself in order to succeed at that role, because it is time consuming, and it is overbearing, some days. But you could tell she took the steps to handle her situations. And overall, the experience was wonderful. I'm so happy to have met the women now and not at Miss America in December because I just think that would have been way too much to handle.



Well, you know, you talked about Miss America not being able to handle a lot you are going to PT school and you have u of n you have the full time job of being Miss North Dakota, which, you know, if our listeners aren't, aren't familiar with what it's like to be in the Miss America organization, when you're a state title holder, you are that is literally your job, you are going and doing public speaking engagements nearly every single day during your year. So how are you balancing all of this? We have a lot of physical therapy students that listen to this podcast, we have a lot of people who are working their normal jobs and going home and maybe doing a side hustle or parenting who are probably wondering like, wow, how are you doing it? So tell us how you're handling everything.



Yeah, the two biggest things I would say our communication with both organizations, and also self care, those those things are my like golden rule and no matter what I'm doing because the communication part, whether it's talking with my manager who books me for all the events I go to, or talking to, for instance, Cyndi Flom, who is in charge of all my PT scheduling, being able to communicate with them and tell them when I need to be where I need to be, is utmost most important thing for me and something, I really have to, you know, hone in on because I am in a generation where emails are not prioritized. And I know that I know that's a flaw of mine is answering emails, but it's something I'm working on and able to admit. And the next thing that really has helped me get through not only my first year of PT school, but this summer since becoming Miss North Dakota, alongside of PT school, is taking time for myself when I need it. And I know so many people forget to do that. And when we're constantly baring our souls into one thing, and not taking time to whether it's read a book, or watch a movie, take a walk with your friends, or, you know, just take time for yourself is my number one thing and not only taking time for yourself, but not feeling anxious, while you're taking your time. Well, I could be doing this, I could be doing that. But really taking it in and fully relaxing. And then moving on to whatever to do list you may have.



I totally agree with you. And I remember when I was a student, and I would go out and do something fun, I would think oh my god, I should be studying for that test. I should be doing this. So like, how do you do that? I mean, how do you let go of that anxiety? When in devote that full time to that self care or to the present? What advice do you have for people for that?



Number one, set your phone down? I think our phones control our lives. And that's, you know, that's an ongoing battle we all face because well, what if I want to call someone like maybe that's my free time, do that. But saying you're out with friends, just put your phone aside and relax in that moment. Because when those like dings come up your notifications, that's when you're like, Okay, I should get back to this. But being present in those moments and fully diving into them is my number one advice. I love my, my time to myself is when I go workout. And I just you know, turn the tunes up, listen to a podcast, whatever it may be. And that's I just remind myself, this is my me time. And you know, whatever comes in, I tried to set it aside, but really just relaxing in those moments and reminding yourself it's okay to take this break, because that is what is going to lead to your success and survival. And whatever it is that you're anxious about.



I appreciate that a lot. I feel like I've learned to live in the moment a lot more since I've become a parent. I was definitely not I was definitely not an in the moment kind of person. I had some areas, somebody who was in the moment to help teach me that. And then I had to become a parent to really actually do that. So you're way ahead of me know, oh, I Lycos. I couldn't even



keep a dog alive at this point. So you know, what you do is amazing. And you should recognize that whenever you can possibly.



What are you most excited about for Miss America? And maybe tell us a little bit about I mean, I know you haven't gone to Miss America yet. But you did go to orientation. What's that? What's what's a typical Miss America competition? Like, from what you know? What are you most excited about?



Well, if you asked me before last week, I'd say I'm most excited about meeting all of the candidates because that is where you truly that is the best takeaway from any Miss America experience I think you have is friendships. And I have gotten to meet those girls and have formed those connections. Now I'm most excited probably for the competition part, but specifically the talent portion. And the reason that's sort of on my mind right now is we actually get to turn in our talent request form this in the next few days. And how that works is you just submit whatever song talent, dance you plan to do. And they tell you, Okay, you can do it. Or they say, Oh, another person has that. Well, let's rock paper scissors to see who gets it sort of thing. So I'm so excited to do that. Because my talent is really where I get to express myself in a way other than words can allow. And what I do is I play piano and sing. And I did that at the state level. And I ended up getting the top talent and top vocal award which I'm so, so proud of because growing up I thought I was good at singing. But it's not until you have that stage moment that gives you the confidence and the validation that what you're doing is really what you were meant to do. So being able to do that. And then also, that will be the moment I get to talk about this platform on a national stage. And if given the opportunity to make Top 15 Because that's how it works. You have two nights in prelims. And then one night of finals, and in finals is where they cut you down to 15. And if I were to be able to that top 15 and really get to speak about my passions and speak for the physical therapy community, that would be a life changing no matter what place I ended up in, just being able to share my stories and my passions would be something I just, I can barely find words to form, but I would be so excited for that opportunity.



Oh, we would love to hear you talk about physical therapy on a national stage. Yeah, I think that I think that you'll have you'll definitely have at least 100,000 APTA members rootin, for you for one thing, and then those people who maybe are physical therapists from around the world or maybe not APTA members, hopefully they'll hear this podcast too. And rude for you as well. So you'll have the whole PT community rooting for you while you're on that stage. How do you think this experience is going to help you in your journey becoming to becoming a physical therapist,



I mean, just this right now, this networking, this opportunity to share my story and share my passions is what I've already noticed, has made a change in my future as a physical therapist, because this gives me opportunities to connect with people from all over the world. And not every second year DPT student gets to say that. So having that, you know that networking opportunity is what I'm most grateful for. But also, it's giving me that connection to people that you'll have as a physical therapist, that one on one being able to relate and tell people stories, but also to listen, I think that's one of the main things we do as PTS is listen to people, and what it is that's causing them pain, whether it be their physical or mental, and having the opportunity to really kind of get a dip my toes in the water as Miss North Dakota, will be will help me exponentially as a physical therapist. Well,



Cindy, this is Karen, I'm just for people listening. I'm just gonna hop in with one last question and comment. first comment is I am so blown away and impressed by your poise and your speaking ability. And, you know if this is something that you can take forward with your patients and to be a representative of physical therapy in the future, regardless of what happens in in the competition in December, I think you are well ahead of the game. So kudos to you on that. I'm very, very impressed. It's been a pleasure sitting in and listening to you and Stephanie chat. And my I had one sort of follow up question before we ended the the interview. And that is what do you feel? The Miss America? Or sorry? Yeah, Miss America. Okay, I thought I got that wrong for a second. No, no, no. I'm like, what do you what do you feel the Miss America Pageant can bring two young girls. So not someone who's you know, a second year DPT student, not the not even the teens. But you know, we're really looking for the for the young girls who are watching these pageants and looking up to you all. And just think maybe they're thinking, Oh, look at how pretty, but it goes a lot deeper than that. So what do you want those young girls to know?



So I love that you asked that. Because just recently at the Miss America, teen competition, they have this thing called Empower Academy. And it's for young women, young girls that have been watching the Miss America competition for years. It is for them to have the same experiences. So this weekend, I watch girls from the ages of five to 10 speak on a stage in front of judges in front of the entire Miss America class, speak as if they had been doing this for years. And I can't even imagine having that experience at such a young age. Because it really breaks down these barriers that young people can accomplish things. And just watching them I was amazed. And maybe it was the same kind of for you to me, but me to them, in this case that no matter what age we can accomplish whatever we want to and I got to see that firsthand this last weekend. So the Miss America organization is already accomplishing that kind of task of making young young women believe that they can do what The role models they're looking up to have been doing. Yeah, that's very



sweet. Go ahead stuff.



I appreciate that. Because I think that the first time I ever spoke in front of anybody was when I was like, I don't know, maybe 10 years old, maybe a little younger than that. And it was like through some type of pageant type experience. And I've been public speaking now for oh, my gosh, over 20 years. And I feel like what you just said about gaining confidence speaking in front of a national audience having to answer questions that have substance in them is and being able to express your own opinions to a lot of people that may disagree with you. I mean, that all that all starts at at at a stage like that. And so, you know, I do think that there is something to say about having a platform where young people, not just women, but young people in general can go on a stage in front of an audience and start speaking, because what's the number one fear of people? It's public speaking? Oh, yes, there are so many times that I go to a conference and somebody comes up to me, and they're like, Oh, my God, I'm gonna go speak and I'm so like, nervous, and I don't know what to say. And, you know, I get nervous when I go on stage, but it's more excitement, nervous. It's not like, Oh, my God, I'm afraid I'm gonna mess up, or I'm afraid of what these people are gonna think of me I have, I have that confidence. And I think a lot of that, in addition to some other things that I've done in my life, but a lot of that started on a stage in a situation similar to those young people. So I appreciate you saying that. Yeah. Yeah. It's,



it's been truly wonderful. And I've, I've loved being a part of it.



That's amazing. So I have one last question. Before we wrap things up, and it's a question I asked everyone, and knowing where you are now, in your life, and in your career, your Yeah, career? What advice would you give to your younger self?



There's a lot of things, I would give advice to my younger self. And it's crazy to say that at 24, because I still consider myself quite young. But I would say, to stop trying to speed through every road, every part of your journey, whether it's okay, I'm excited to graduate high school, and then I can go to college. Oh, I'm in college, I can't wait to get into graduate school. Oh, I'm in graduate school, I can't wait to get married, get a house, instead of rushing through those moments to really take time and understand why you're there. Because once you're done with that part of your life, it's gotten, you know, like, and I Yeah, I'd say it started when I was a swimmer in high school. I was like, Oh, I can't wait to be done with swimming. This has been my entire life. But now I look back. I'm like, I miss those days. I, I look at my undergrad, I constantly was stressing about getting into PT school, which a lot of us go through that. It's competitive. That's normal, but not always stressing about what's next. And being in the moment. That would be my number one piece of advice to my younger self and something I'm really taking into this year. Because the job Miss North Dakota is 365 days. I have to enjoy each and every day and not worry well, next month I have a conference or tomorrow I need to get this video done. It's taken in each moment. Like right now I'm sitting in this podcast, talking with you and experience in it to my full ability. And that is what I'm very happy. I've been able to notice that and learn from it.



That's very wise. Very wise advice. Well, thank you so much, Sydney for joining us. We had an awesome talk. Where can people find you if they want to look you up on social media or want to contact you?



So my personal Instagram is my name SSID and I KST and then my Miss North Dakota Instagram is Miss America en de in on Facebook. You can find me at Sydney cast Miss North Dakota, email Sydney All all spelt the same and super easy. And yes, my name is spelt Correct. I don't know what was going through my mom's mind. But we love her for it makes me different.



That's funny. That's great. Well, Sidney thank you so much, Stephanie. Thank you so much. We'll have links to all of your contact info and any other info you want to share at the podcast in the show notes for this episode at podcast at healthy wealthy Stephanie, any closing remarks?



No, just good luck at Miss America, Sydney and we are all rooting for you.



We are we are and everyone Thanks so much for tuning in, be sure to watch the pageant or I should say scholarship program like the end of Miss Congeniality scholarship competition scholarship in December and let's all root for Sydney. So everyone, thanks so much. Have a great couple of days and stay healthy, wealthy and smart.

Aug 29, 2022

In this episode, Physical Therapist and Advocate Dr. Mercedes Aguirre Valenzuela, PT, DPT, talks about advocacy in physical therapy.

Today, Dr Valenzuela talks about the different types of advocacy and the latest updates in advocacy. How is grassroots advocacy different than lobbying?

Hear about APTA advocacy, making a difference as one person, and get Mercedes’ advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • Three types of advocacy:
    • Self-advocacy. Advocating for yourself.
    • Individual advocacy. Advocating for someone else.
    • Systems advocacy. Advocating for changing policies, laws, and rules.
  • “You don’t have to be a member of a certain group in order to send an email or make a phone call.”
  • “Don’t feel like you have to start on your own.”
  • “You can really make a difference, even as one person.”
  • “Get used to making mistakes, not being perfect. It’s all part of learning.”


More about Dr. Mercedes Aguirre Valenzuela

Headshot of Mercedes Aguirre ValenzuelaDr. Aguirre Valenzuela received her Doctorate in Physical Therapy from Rutgers School of Health Professions in 2020.

Her dedication to professional advocacy has led her to leadership roles in the APTA on a National and State level. She was selected to serve as an APTA Board-sponsored Centennial Scholar and worked on the APTA “PT Moves Me” national campaign.

In 2022, she began her term in the public policy and advocacy committee (PPAC) and CSM Steering Group. Within the Academy of Pediatric Physical Therapy, she is an active member and was elected to be in the Nominating Committee.

In the state of New Jersey, she is an APTA Delegate as well as a Key Contact in her district. Clinically, she currently works in the early-intervention and school-based settings.

Outside of the clinic setting, she uses social media to educate PTs/PTAs/students on how to advocate for their profession and encourage them to run for office.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Advocacy, Lobbying, Legislation, APTA, Representatives, Interventions,



Our Experiences Matter When it Comes To Advocacy

APTA Patient Action Center


To learn more, follow Dr. Valenzuela at:

LinkedIn:         Mercedes Aguirre Valenzuela

Instagram:       @theptadvocate


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here:


Hi, Mercedes, welcome to the podcast, I am happy to have you on and to see you again.



Nice to be here. Thank you for having me. Yes. And today we're gonna be talking about advocacy, which, in physical therapy, which I have spoken about with a lot of different people over the years. And I think it's great to get different perspectives on advocacy, especially from younger therapists, because I think it's great that you guys get involved. So my first question to you is, how did you get involved into an advocacy work for the profession? And why is it important to you?



So I graduated in 2020.



I was very even before I started PT, school, I was very into politics, legislation and public policy.



And then once I went into PT, school, I never learned about what the abt does in terms of advocacy, I felt like he kind of mesh, kind of like the two things that are really impassionate about and enjoy. And so I became more involved as a student. And then once I graduated, I wanted to create



content that was related to advocacy and explained in a very simple way. What are like the current updates going on right now? Because I feel like legislation, can we, it can be a bit intimidating for people to understand and to really get into. And I wanted to show people, what are the updates without all these extra details that they don't really want.



And that's what I've been doing thus far. And it's been really a great learning experience. When we talk about advocacy, I think that there are a couple of different types of advocacy. So could you go into a little bit more detail on the different types of advocacy, especially in the PT world?



Yeah, you're correct. So there are several definitions of advocacy.



I can just give you three of them. So number one, is self advocacy. So advocating for yourself, for example, you're advocating for a pay raise or a change in work conditions. There's individual advocacy, so advocating for someone else, for example, sending out a letter to your patient's insurance company in order to get more PT visits. Then there is systems advocacy, which is my personal favorite. And it's about changing policies, laws, rules, and how they can impact multiple people's lives. And that is more targeted at a local state or even national level.



And when you're talking about systems advocacy, is that when you know we as physical therapists, ourselves, and maybe encourage our patients to send a letter to CMS or send a letter to your Senator, advocating for whether it be you know, the stock, the Medicare cap, that was a number of years ago, things like that.



Yes. So what are you are describing right now is a grassroots movements.



So, grassroots movement is similar to how the way grass grows from the bottom up. So we are the grassroots advocates, we are at the bottom we are what legislators call constituents meeting, someone who can vote.



And we advocate for things that affect the top so the top is like policy, law, etc.



And the APTA has grassroots movements. For example, as I mentioned before with CMS, it was the hashtag fight the cut movement, which was one of them. And there are examples of different types of movements in grassroots, such as me to or love wins, black lives matter. So that's kind of how grassroots advocacy works. How is that different than lobbying? So how does that work if you can compare and contrast the two?



Sure. Let me explain what a lobbyists first perfect, though a good start. So a lobbyist is someone whose job is to build relationships and network with legislators and their staff. And that lobbyists represents an Oregon



datian So the APTA hires lobbyists. And their job is to advocate for us, they don't have to be physical therapists themselves. But we can also do the acts of lobbying, such as making phone calls to a legislator, sending emails, even having meetings.



But it's not like our job because you know, we have our own stuff to do.



Right, exactly, exactly. So you can be part of a grassroots advocacy effort, and then kind of take that into the act of lobbying not as a professional lobbyists, like you said, but like, for example, when a PTA and I know the private practice section will do this, will have groups of physical therapists go to meet with their lawmakers from their state on Capitol Hill, and also individual states will have lobby day within the state. Yes, correct.



And you don't have to be a member of a certain group and whatnot, in order to send an email write a phone call is really what you want to see change personally, or even like a small group of people don't ever feel like you have to like be a part of something big. Like, it's about what you are passionate and care about. Right. So if you're not part of the APTA you can still lobby on behalf of patients. Is that correct? Yes, I wouldn't call it necessary lobbying, but like advocating, advocating, like, you can still send a phone call, Hey, I had this patient experience and I want you to know about this and be aware about this. There's going to be a one this change in my practice, ag whatever like your state is advocating for you can still do that without being a member. Right. And how do we know as physical therapists? What is on legislative agendas, let's say for the APTA Is there a tool we can use to find out what's going on? Yes. So the APTA has an advocacy network, and you can join, it sends a newsletter,



every month, every couple of months, you can also visit that abt patient Action Center, which they have pre written emails that you can send out to your legislators, and you don't have to be a member in order to do those things. Great. So the APTA patient Action Center, and there's an app for that, right? Yes, there is a PT,



advocacy app that you can use, and you can also go on your browser as well. Right, right. So I think the big takeaways from there is there, there is an app for that.



Or, or you can go online, and you can find sort of pre written letters and things that you can send off to your senators or your congress people, whether that be at the federal or the state level. And you don't have to be an APTA member in order to have access to that. Yes, perfect, perfect. Okay, what are our current advocacy updates? What's on the table? What's on the line? What do we need to know? So for the last couple of Congresses,



there has been a bill that has been introduced called the Allied workforce diversity Act, which helps in recruiting a more diverse allied health workforce, as well as retaining those students and



just increasing the graduation rate as well, because sometimes you get these students in these programs, but they don't graduate. So that's the goal of that bill. It has not passed in the last couple of Congresses, but it was that bill was merged. Like the right the wording of it was merged into a pandemic bill, which has a high very high probability of passing. So that has been great news. That bill is called the prevent pandemics act.



And it's just to modernize the country's pandemic response, and they felt that workforce diversity was really important in it. So that's



that that's pretty huge since it was, has been a battle



To get this bill to pass for the last couple of Congresses, another one, if you're in pediatrics going to try to diversify these updates.



So there is a bill called the specialized instructional support personal services act.



You can also find it as a gross gross CIPS Act, as well, they call it hr 7219.



So this bill is going to create grant program, a Department of Education to increase partnerships between school districts and colleges to train specialized instruction support personnel. So PTS are included as that type of personnel, as well as PTAs. And they, and this is great, because, um, I was I worked at a school based physical therapist, and there is such a need for more therapists, so I could understand why they wanted to kind of increase, have more of a network between programs and school districts in order to retain the therapists.



Especially I,



you know, I saw, we're going to school way therapists, but like, I just always get emails all the time, like, we need therapists, we need therapists. And, you know, there's some kids that like I can't even see, even in the same school. So



very important for you school, PTs and PTAs. Out there, there is also a pelvic health bill that has been introduced. So moving on to pelvic health, the purpose of this bill is to educate and train health professionals on the benefits of pelvic floor physical therapy.



I think that's such a huge thing for pelvic health therapists is just a lot of people that don't know what it is. And you know, patients that go to their physicians for answers, they don't provide them the enough guidance, because they don't know that that help is out there.



So they'll be great. And the bill will also help to educate postpartum women on the importance of pelvic floor examinations and physical therapy.



And what it is and how to obtain a pelvic physical therapy examination, which would help increase access. And this bill was actually worked by representatives from a BT pelvic health, which is pretty amazing that, you know, Pts helped in creating this bill.



Yeah, and that was introduced into the house already are in committee. It was introduced, like into the house. Yep. Fabulous. Yeah. Anything else on the legislative docket? I can talk about a federal agency. Yeah, go for it. Update from the NIH. Okay. So the ABA is part of the disability rehab research coalition. And they some, which is occupational therapists are part of it, a lot of associations are a part of it. And they submitted a comment to the NIH requesting them to consider designating people with disabilities as a health disparity population, which I didn't think that they weren't. So I was really surprised by that. And this is just so important, because for the purposes of federal research, for this minority group, and it will develop and inform critical policy solutions to reduce and eliminate health disparities for people with disabilities. So I don't know the current update, but it is great that it is being brought up at this time. Perfect. All right, so we've got allied workforce diversity act. We've got the HR hr 7219, which was for school based PTS, and that was a really, really long



name for that bill. Yeah. And then we've got the pelvic health bill. So all those those three bills plus an update from the NIH. And if people go to the advocacy APTA PT Action Center, they should be able to find more information on that on those bills and how to contact their Congress person, correct?



Yes, perfect. So



in turn



terms of like federal agencies, if you're talking about the CDC, NIH, that's not necessarily something you just send an email to.



But for other legislations, yes, you can find pre written emails in regards to that. Excellent. All right. Well, that is a great overview of where we are right now. And current current advocacy updates. Thank you so much. Now, next question. What advice do you have for students and younger physical therapists, new career physical therapists who might want to get into advocacy? But maybe they feel like, Oh, I just don't know enough? Or I'm too new. What do you say to that?



Well, I will say contact me because I love



going to students sake meetings at different states and talking about advocacy, I have been to a few SEC meeting, so contact me and I will gladly, you know, present and help you guys out in any way possible. But also, when I was a student, I was really interested in to advocacy. And there wasn't much going on around in my program student lead wise. So I contacted my trusted professor, which is someone that I looked at as a mentor, and they really helped and guided me. So don't feel like going to have to start on your own, you know, find a professor that you trust and you feel is kind of already involved in advocacy in some level.



And they will help you out as well. Perfect. And who was that professor for you? Let's give them a shout out. It was Dr. Mike Rella. Ah,



yes, yeah. She just retired, right? Yes, he did. Yeah, that's a loss for sure. Yeah. But yeah, she really helped me out a lot. Oh, amazing. Yeah, she's a nice, she's a nice lady, for sure. Well, it's great that you had that professor to help guide you. And I think that's great advice for students and, and new graduates is reach out to those professors, because they, they can really help to guide you through advocacy, and through a whole bunch of other things as well. And they can also follow you on social media. Right. So what is your what is your social media handle? And where can people find you? At the PT advocate? Perfect, and that's on on Instagram? Perfect. That's the gram. Just the gram for now. That is great. And is that the best way for people to reach out to you they can just slide into your DM. Vic about advocacy only please?



Yes, or piece, you know, yeah, yeah, or pediatric care. Perfect. Perfect. All right. So what do you want people to take away from this conversation? If you can kind of distill it down to a couple of points? What would that be? I know, sometimes we can feel that we're just one person, one change can we make? And I know I feel that way. Sometimes too. Even though I have this advocacy, Instagram, sometimes I'm just like, all the stuff that's going on in the world's I walk in Mercedes do what can I even do about this, but you can really make a difference even as one person, that phone call that email that you send, even just reading about it and being aware and talking to colleagues about it or your patients about it, increasing a word that awareness of that can still be great and can still make a change. Don't feel like you are alone. There's a whole Association backing you up in this, and it's all for, you know, to progress our profession. So don't feel alone. And don't feel that like you can't not make a change because you can and your voice is really important. I love it. And last question, it's when I ask everyone, knowing where you are now in your life and your career. What advice would you give to your younger self? I would say get used to making mistakes not being perfect.



Because when I was a student everytime made a mistake, I was like, oh proceeds How could you do that? That's horrible scar for life. And as a new grad, I make a mistake every other day, every day. So just get used to it saltwater learning. Yeah, and I can say as someone who's been out for over 20 years, I make mistakes every day, too. Yeah. So it's never it's never ending we'll have mistakes and that's okay. Because like you said, you'll constantly learn from them. Thank you so much, Mercedes, for coming on and talking about advocacy. I love your passion. And I think it's great to see new graduates out there and making a difference. So thank you for that. And thank you for coming on. Thank you



for having me. My pleasure, everyone. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.



Thanks for listening. And don't forget to leave us your questions and comments at podcast dot healthy, wealthy

Aug 22, 2022
In this episode, The Word Magician and Bestselling Ghostwriter, Crystal Adair-Benning, talks about effective copywriting. Today, Crystal talks about ways to improve your copy, pleasure copy versus trigger copy, and when to hire a copywriter. What is copy? Hear about the eight levels of perspective and belief, using love letter language, and get Crystal’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “The best copy meets our clients where they’re at, so we can take them where they need to go.” “The world is triggering enough. We don’t need to see it in our copy.” “Your clients will tell you exactly what to write.” “Follow your zone of genius.” More about Crystal Adair-Benning Crystal Adair-Benning is the Word Magician, Story Supercharger, Copywriter & Ghostwriter for rebels, misfits and world-changing humans. She is best known for being not known at all. A secret weapon amongst successful entrepreneurs who covet her Quantum Copy Method - combining the science of writing with the spirituality of creativity. A multiple NYTimes Bestselling ghostwriter and former highly sought-after luxury event planner, Crystal finds joy in being an Intuitive Creative, digital nomad - free to explore the globe with her husband, dog and laptop. If you really want to know Crystal, here are some fun facts: - She never leaves home without her passport. - She saves trees with tech (her Remarkable is everything)! - She was truly embarrassed to call herself an empath for years and hid her genius because of it. - She met and married her hubbend (husband/boyfriend) in a month... because she was a smitten kitten. - She believe in LOVE above all else and will happily destroy the bro-marketing patriarchy word by word. Suggested Keywords Healthy, Wealthy, Smart, Copywriting, Beliefs, Perspective, Communication, Conversion, Storytelling, Resources FREE Copy Workshop. To learn more, follow Crystal at: Website: Instagram: @wordmagiccopywriting Facebook: Word Magic Copywriting Twitter: @WordMagicCopy Subscribe to Healthy, Wealthy & Smart: Website: Apple Podcasts: Spotify: SoundCloud: Stitcher: iHeart Radio: Read the Full Transcript Here: 00:05 Welcome to the healthy, wealthy and smart podcast where healthcare meets business with your host me, Dr. Karen Litzy. And just as a reminder, the information in this podcast is for entertainment purposes only, and is not to be used as personalized medical advice. Enjoy the show. 00:28 Hello, everyone, and welcome to the healthy, wealthy and smart Podcast. Today we've got a great podcast, which walks you through how to connect, convert and catalyze conversation through copy. And yes, this means how to get more conversions how to possibly make more money with your copy. So to bring us through today's episode, I'm really happy to have crystal Adair Bening, a word magician story supercharger, copywriter, ghostwriter for rebels, misfits and world changing humans. She is best known for being not known at all a secret weapon among successful entrepreneurs who covered her quantum copy method combining the science of writing with the spirituality of creativity, a multiple New York Times Best Selling ghost writer and formerly highly sought after luxury event planner, Crystal finds joy and being an intuitive creative digital nomad free to explore the globe with her husband, dog and laptop. So I met crystal a couple of months ago at Selena Sue's mastermind, and I am like in love with this woman, she is so good. She will walk you through what copy means how to make it your own and how to talk to your customers. Now, aside from all of this, wonderfulness, and you'll hear throughout the podcast on August, the last week of August, I think on the 31st She is having a free three hour master class word magician copywriting workshop. You guys, it's free. She's going to take you through everything. So you can head over to podcast dot healthy, wealthy Go to the show notes for today's episode and click on for her free three hour workshop. You can also go to word magic And you'll sign up it's like a waitlist, you'll sign up for the waitlist and you guys three free hours with a copywriting expert. I know I am no copywriting expert. So if you want to have better copy for your website, your sales page, your funnels, your social media, check out her free class, that is going to be the last week of August either the 30th or the 31st. Otherwise, enjoy today's episode. Hey, Crystal, welcome to the podcast. I'm excited to have you on today to talk all about copy. So thank you so much for coming on. My pleasure. Thank you for having me. Yeah, I'm excited. This is definitely an area where it is a weakness of mine. And dare I say weakness of a lot of people certainly in my profession of physical therapy, and I'm sure you hear that all the time. Not like that's anything new. But before we go on, I want you to define what copy is. 03:30 Oh, good question. So copy is literally the words that you use to market your business. So it can be your website, your emails, your social media, and ebook you use a book you write. It could be literally like an ad that you run on social media might be copy. So copy is all of those things. We think about the words that come out of our mouth when we're talking to our clients. But when we put it down on paper, it becomes coffee because it's something that somebody can refer to us. Perfect. And how important is that for business? Let's let's get into this. Essential, right. Super important, super important. And here's another question that might seem like a dumb question. But how can copy be used to make a connection with your audience maybe make that sale? What is the purpose? So when we write copy, the best copy that we write is naturally about us. It's for the humans that we're writing for. So I teach a lot of times about the idea of it being a love letter. So if you think about the average client that emails you and maybe they email you and say, Hey, I've got this problem and my back's sore and this and that and I need I'm struggling with this and how do I do it? You might immediately hit reply and you say yeah, but when appointment in my calendar, very good, right? Like that could be an option. What if we instead decided to treat it like coffee? 05:00 and use the love letter principle Love Letter language and say, Hey, I'm really sorry that your back hurts, that's awful. I know how challenging that can be. And we definitely want to take care of you, here's a link to my website, I would recommend we get you in within the next six to seven days, because that's probably when the pain is going to feel worse. And when we have the most opportunity to fix it. By simply adding words to the copy, you're still getting across the exact same message. But there's a level of I've got you that we feel in a love letter, if you think to honor the love letter you've ever received, what's the underlying tone, it's your magic, you're amazing, I love you, and I got you. And so if you can impart that into the language that you're reading, whether it's a website and email, your social media copy a book, your audience literally feels that vibration, and it starts to pull them in, because suddenly they not feel what they feel seen. They feel taken care of supported, they feel comfortable with you, they're willing to say, Hey, I may not know this human yet, but they're inviting me into their space, they're welcoming me. And that feels good. And so they will actually move toward you instead of against you. So that's one of the ways that I would highly recommend you use it. Yeah. And in the physical therapy, I'm a physical therapist. So in physical therapy, and in healthcare, I would say, a lot of people, when they're coming to see us, they're in a point where they're feeling vulnerable, where they may be in pain, they may not be at their best. And so I like how you describe it as a love letter, because we're trying to tell them like it's okay for you to be open with us. Do you have any other examples of how we might be able to convey that to someone who's feeling maybe at their worst? Yes, so absolutely. So what we need to do first and foremost, and this is where the psychology kind of takes over. So my work is a lot of science needs spiritual to kind of combine it all together and create what I call word magic. And this is the science piece of it. So each of your clients already comes in, they have a belief that they currently believe, right, they're living in a system, they have an understanding of the world around them, they have a perspective of their values of the beliefs that they believe in. So on a very basic level, because we've got a short window of time, I'm gonna give you the there's like eight levels. So I'm gonna give you the overview. So number one, we're basically survivors, these are babies. Oftentimes, if we're in a really traumatic situation, if you're a refugee, for example, if you're homeless, you might become this person, your whole goal is to get your basic needs met and actually survive, right? Your belief is just I need to survive period. In Level two, I call this cult cohesion, who ever desire to fit in, we're learning all about rules and how we fit into society, how we fit in with our families, how we fit in with our communities. These are the reasons we call it a cult cohesion is because often, if you've ever joined a call, not all of us have. But if you've been part of a cult, there's a very strong belief system around the rules of that cult and fitting into that cult people often don't leave because they're going to be excommunicated, right. And so that's kind of the second level, it's not real bonded Level. Level three, we go up and these are black sheets. Think teenagers, right? When we're teenagers think of that angst, right? But we're recognizing that we have special gifts, and we're different than those around us. For the black sheep of our family, you'll often hear that we're searching for our gifts and our talents and level three, so teenagers most often, but you'll also see it in a lot of musicians, artists, people that really don't fit the norm. Lady Gaga is a perfect example of a value level three or belief three, believe four, we move into family rules. So we return from I'm so special, I'm unique. I'm a I'm a black sheep and we move we come back to family. You'll often find mom's fit here really well. If you work with a lot of moms, you'll hear about family is the most important thing. And they're very selfless. They're very giving their marbles, right. They believe in process systems and steps if you're a strong family person, if you work in government, military, religion, schools, they all fit into this rule kind of category. Then we move into five, if you're an entrepreneur, like many of the PTS on here, maybe you are an achievement architect is what I call you. You're entrepreneurial, you're driven for money and achievement. You know, we associate words like hustle faster, stronger, easier, better. We're seeking a goal we're very goal oriented in this level. Grant Cardone, Gary Vee are examples that I can think of that are very achievement oriented. Then we go into level six, level six, we go from being very self motivated and as achievements to 10:00 Being very world motivated, we often have achieved a lot in our lives and fives were high achievers, who suddenly recognize that there has to be something else to this. We can't just achieve for the sake of achieving and doing it for ourselves, there has to be more to this. So we often come into spirit at this point. I kind of joke sometimes that this is often the people you'll find in Mexico doing Ayahuasca retreats, or going to Peru, and, you know, trying to find themselves trying to find God or their version of God. They often turn away from financial achievement at this point. So we achieved so much that we're like, I don't have to keep working for money anymore. And now we turn to like, what is spiritual like sound for us? John Lennon, Nelson Mandela are great examples of this. They're people who achieved a lot in their lives. And ultimately, we're like, it's not about the money. It's about how can I give back in my community? How can I impact then we go into sevens, sevens move again, from spiritual tools, it's about everybody. Sevens come back and go, well hold up. I haven't the money that I gave it away, and I found God. But now, why can't I find God and make money? 11:07 Why is that not a possibility. So they really want to make money, certainly with money, they really want to make money. And they want to have impact. They believe that they can do both. Tony Robbins, Oprah Russell Brand great examples of these humans. They're the ones that really have like, we have it all, and we're going to give it away in the celebration, it's affordable. So they're really trying to do better things with their money. And their opportunities and visions, number eights, these are harder to define. So the eights are the cosmic connections, these are Ascended Masters, these are the people that know and understand that we are living in quantum existence on multiple timelines, sometimes all at the same time, and that every single thing we do is affected by somebody else. So I'm in my hands. And this affects somebody else down the road, I write on an email, and like millions of people can be affected by the email I write. That's where the Cosmic Connection is. So what's important here, when we talk about making connection, and how does coffee really convert is, there's two things you need to understand what is the belief bubble that your client currently sits in? What is the belief bubble that you as the owner setting. And then just for bonuses, your business also sits in a belief bubble, your business has a belief system that it abides by, if you know those three things, you can write incredible copy, because we write to the client, and not to ourselves, which means that typically, so if I'm a five, if I'm a high powered entrepreneur, and I'm working predominantly with moms, and dads who are burnt out, they're family focused, but they are given at all for their kids, and there's nothing left for themselves. I need to write to them, I need to speak their language. I need to know how they speak about the problem, that they're experiencing, how they're experiencing it. And I need to reverberate those words back to them in the copy my language and their language may be different. We know this, right? A client may have a presenting problem they walk into your office with, and they use words like, you know, my back's sore, or my back's tender, or I can't lift my kids. And you might know that it's partially about those muscles in those numbers. But there might also be an emotional attachment that you have to deal with, there might be a traumatic injury that you have to deal with, or long term problem that you're trying to support, you know that the presenting problem is not the real problem. It's just what they're noticing. 13:47 We need to speak to the thing they're noticing, not to the thing they actually need help with what when we do that work is when they're actually our client, they trust us, they know that we understand them by speaking their language. And then the real work can be done. It's not lying to your client. It's called meeting them where they're at. So the best coffee meets our clients where they're at so we can take them where they need to go. Yeah, that was great. I took a lot of notes there. And so what I'm hearing the bottom line is know yourself, your business, your the values of your business, so that you're coming from a solid foundation, and then really understand your potential clients and really get deep into who they are, what they need. Maybe what they're fearful of what they like, dislike so that you can write to them from a solid from your own solid base. Exactly. You're using their language, your solid base is where they want to go. 14:53 We typically work with clients that are a belief below us or are just like during the same 15:00 We bubble but they're just, they're just underneath us in our beliefs, we have a belief and then we have a neurology. So what often happens is, for example, I tend to sit as I work with a lot of fives I work with a lot of entrepreneurs are really kind of trying to kill it in their business. But if I look at the five, their neurology is already in sixth, they're already starting to think more spiritual and about there has to be more to this, I'm thinking about impact. So they've got higher level neurology. But the problem is, their client is sitting in a poor potentially wanting to become a five, I have to meet them in the floor in the language where they first meet me. So the language where your client first meet to, in case you haven't figured it out yet, typically, it's your website and your social media, that's where your client first meets you. So it's super, super important that we speak their language, not necessarily our language, when we first meet them, once we get to know them, once they're involved in our processes a little bit more, once they've been part of things, I might offer a book that's more in my believable mind language for them. Because I know that they're going to work with me for a little bit, and we're going to get them there. But to start with, I have to meet them where they're at, they're not going to understand me, coaches are the worst for this, I'll use a great coaching example. Coaches will say things like I do quantum timeline therapy, or I'm somebody who does quantum releases or breakthroughs. Your client has no idea what that I was just gonna say. I don't know what that means at all. Exactly. And every coach who who does those things goes well die know what that means. But your client who has never worked as a coach has no clue what we're talking about. The same thing happens in PT, right? You have things that you know what this specific thing is, but if you said those words to client, a client, we go, excuse me, what? What is that? So we need to go okay, hold on to this, this complicated process that we do? How do we reframe it in a way that our clients can understand it? How, what is it in their life, and if it's as simple as a massage that releases your back pain, and allows you to functionally lift your children again, then that's the way you explain it, instead of a, you know, repetitive injury release tension system, whatever the whatever the phrase would be a BT, clearly, I'm not a PT, but you want to break it down to what are they saying? And how is this gonna relate to them. And the best tool you can do is if we go back to that love letter, languaging, rather than trigger them by being like, you're this problem. And this problem and this problem, if we then speak into the power of what they can create, by doing the work with us, that's better. So if I can say, I'm going to create the ability for you to keep up with your kids, lift them longer, have more energy and stamina to like, go three rounds in the bedroom at night, if you want. Whatever it is, if I use the language of what the outcome of working with you is, versus just the trigger of why they showed up in the first place, they're going to be much more likely to stay on board. The world is triggering enough. We don't need to see it in our coffee, we do need to show them that we understand them we feel their pain. But what we need to express more often than not, is what is the outcome of working with me, if you work with me, I will do X, you will feel x times better, you will have the ability to do X, Y and Zed that you couldn't do before. That is much more compelling than simply saying stop hoarding. 18:43 Right, right. 100%. Yeah, or just try and relax. 18:50 Right? That's another one that we hear a lot. It's like, never in the history of the world. Has someone relaxed by someone just saying we'll help you relax? Yeah, it's like, it's so like, What are you talking about? Is the ultimate oxymoron, right? Like, tell somebody the rocks and they're immediately gonna be like, 19:09 yeah, yeah. 19:13 I catch myself doing it too. Like, my like, word for kind of my mouth. And I'm like, Oh, that's not going to help the situation at all great. Just put in our coffee, we have a chance to be really clear and to really understand the belief system or climate, the understanding are going through. So if you're telling a busy mom to just relax, she's probably not going to be too receptive. However, if you tell her that she's going to be able to appreciate the moments with her family more by doing this work. That's a much more enticing and appealing approach to her. Yeah, no, that's a great example. Thank you for that. What advice do you have for folks who are trying to get there, whether it's their website 20:00 their social media or wherever copy may land. What advice do you have for them? If they're like, I just have no idea what to do here, like I? I am like, because, again, you'll hear again and again, I'm not a writer, I don't know what to say. So what advice do you have for people in that situation? 20:23 I mean, of course, the selfish thing to say here is, right, aside from hiring, right, right. Right from that, though, that the thing that I would say is this. Start with the understanding of the belief bubble that somebody's in, start by really listening to our clients, how do they talk about their presenting problem and mimic it back to them, the easiest thing you can do is your clients will tell you exactly what to write, because they're already telling you in clinical sessions with you, every single time, what is my problem? literally read it verbatim. And keep yourself a list. Oh, how many times did I hear mom say I can't look my kids. That's probably a problem that they're really interested in getting sorted out. How many times did I hear people say, I struggle to bend over and lift boxes? Okay, maybe I need to focus on the ability like functional movement and the ability to lift things. Functional Movement is jargon speak for us. But for client, the ability to lift boxes with ease? Are you kidding me, that's a great tool to start listening to your clients. If you want to write better. The second thing that you're going to do is honestly start following and paying attention to your numbers. How many of our emails get opened, how many things get clicks, how many people visit your website? How many people leave your website? How many people show up? Or how many people get your email and you get snarky responses back? Right? If you're finding yourself in a situation where a lot of your emails are short and snarky, you probably have a problem with writing love letters, you might want to check that out. But if we look at the numbers, the numbers don't lie. The numbers tell us important to the problem among our clients will literally tell us how to fix it. For me, there's two places I would always start, I would start updating your website, making your website in the belief bubble and language of your client. And I would have a look at your emails and see if there's a way that even with two or three sentences, you can make them more loving, kind and allow your client to be seen. And if you do those simple, two things are usually simple. But I obviously no, it's not recorded. But if you seriously take those things, and implement some minor changes to things, watch, your clients start to shift their ability to work with you their ability to show up to start being more vulnerable with you speaking more openly with you and really deeply connecting with you. And from there, they'll tell you exactly what to write. And if all else fails, then you come to somebody like me, and we start talking about the strategy behind it. But the simple solution to start emails and website, start there. I love it. And I love 23:19 that you said when you're listening to your clients, just jot stuff down, like make a list of things you're hearing over and over again, and then just put that on your website, or put that into an email. Yeah, I mean, it seems like a no brainer. But like, Why? Why did I not think of this? 23:41 And most of us don't, right? Like it goes in one way or the other. You might be doing an intake with a client and hearing them and they're talking about struggling to pick up their kids and you're busy reading, you know, they've got a lumbar problem or a back pain issue. You're putting it into your language, if you simply wrote down exactly what they said a few times over and you don't even have to do this for long like I'm talking like, take two or three days, like six or six or eight clients even and you'll start to hear repetitive patterns in your clients. You probably intuitively know then you've just turned them into PT speak. 24:18 So take them out of PT speak and put them back into client speak change site on your website. Make sure that your website itself is written like a love letter that it allows your client to feel seen and valued and heard. Give them the safe space it's not about you it's about them. So if your website has a lot of eyes in it, change it to WE ARE THEY ARE you it is not about you it is about them. So the number one tool after listening to your client is making a buy bomb. If your website currently is all about you and when you do, 24:50 flip the script, make it about them. 24:53 You are going to feel so much better when we work on your ability to 25:00 Let your kids know so much better than I help moms be able to lift their kids. Because that feels so impersonal. 25:09 Right? It was wanting to put that personality back into that love back into it. So if you do those couple of things, you're immediately going to start to see incremental conversion challenges where things are not challenging, but opportunities for you, where you're going to get more conversion. And then the next step is, of course, going in with a deeper strategy around how do we build all of your pieces together so that it's always about the client. It's always spoken from love. It's ethical, crappy, meaning that it's not triggering, it's really about pleasure for the person. So pleasure copy versus triggering copy is a great tool for people to be able to utilize. So pleasure copy is all about calling people in by giving them the real results and the inspiration that they're going to receive by doing the work with you. Because first and foremost, when we're purchasers, we want to know, what can you do for me? Not what's the like physical aspect, not the, like manipulation of my body, not the tools around mindset, we don't care about that stuff. It's not the how we're gonna get there. And so what am I gonna get? How am I going to do that? So that's what somebody actually wants. So I would say if you can go into pleasure, copy and writing pleasure, so don't trigger them, instead, inspire them, talk to them in Love Letter language, and speak in their belief system, not your own keys to converting and actually catalyzing conversation, which is truly the key to converting a man I mean, such great tips. I like I said before, I've been taking so many notes and thinking about Oh, does my website do this is it so now I'm gonna have to go do an an edit of my website. So thanks a lot for adding a little more work on to the plate. No, I'm just joking. It's good work. It's good work. It's good work. This was great. What? What would you like the audience to take away from this conversation concerning copy and how we can connect and how we can convert? And ultimately, because if we have a business, I mean, we do want to make money, right? We're not all in the world motivated, where, where we've made a whole bunch of money, and now we can give it away. But we do want to make money. And we do want to make an impact. So what what are the things that you want the audience to take away from? So I think the first thing is, know your beliefs. Know the beliefs of your client, know the beliefs of your business, right to your clients beliefs. First, knowing your beliefs is helpful, because it will, it will show you what the gap is between your beliefs and your clients beliefs. And that's important to understand because it's often about jargon or lingo, keep that out of your copy, speak to the pleasure, talk about the results you're going to create for their client and inspire them to live a life better than they currently have, by doing this work with you speak into that more than you speak into their pain, right? We're the life like literally triggering enough right now. Stop focusing on pain, instead, start focusing on the pleasure that they're gonna get working with you. And I finally move into love letter language. So love letter language is just taking a couple extra and this is rare for a copywriter to say, but add a couple sentences, show them that they're seen, show them that you hear them, allow them to be vulnerable with you by asking great questions that encourage that vulnerability from them. And you really utilize that and if all else fails after that, Kelly copywriter, that's what we're here for. But you can do this, it is completely possible to do your copy in a way that is fully aligned and a way that is loving to your client and immediately get to conversion. We only opt out by working with copywriters, but start doing it on your own. Everybody should do it on their own first and call us second. And speaking of hiring a copywriter where can people find you if they have questions or they want to hire you as their copywriter? Yes, sir. Absolutely. word magic. is my website. That's the best way to get a hold of me send me a smoke signal or a text message or whatever from Yeah, otherwise find me on Instagram at word magic, copywriting. Pretty simple. I'm always around. I've always got a free class coming up too. So there's usually a waitlist on my website to get into my next free class where I teach. And I talk about specifically how would you combine these things? And how do you how do you put it all together. So if you're interested in learning, you can always take one of my free classes. And then if you just want to hire me we can go that route as well. But I love it when people simply connect. And at the very least, I promise you if you sign up for my email newsletter, I send tips and tricks all the time. So if you 30:00 Want to do it on your own in small bits and pieces? That's a great way to perfect and we'll have links to everything crystal just said at podcast at healthy, wealthy under this episode, so one link, little quick click, and we'll take you to everything. So take her free class, follow her on Instagram and get the newsletter. Okay, Crystal last question. And so when 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? 30:37 Ooh, juicy questions, I would tell my younger self to follow your zone of genius first. And what I mean by that is I actually spent two decades as a live event professional. I was always a writer, I was a writer from the top, I could write, I won awards for it, I always wanted to write. And then I followed the money. And I wanted to advance and I kind of let my copywriting and my writing kind of slide a little bit. I mean, I was reading New York Times, bestsellers, and 16. Like it was brilliant. And I let it slide because the money was better in advance. And I slipped in and eventually became a zone of excellence. And I did it for two decades. But there was always a little piece of me that felt unfulfilled because I wasn't just a writer. And that's what I wanted. 31:29 And when I left the bounce, and just started writing, everything got easy. It was like I hit the easy button on my zone of genius and cerebral doing work, I was super passionate about stuff I loved. I got to you know, work in strategy and marketing, because copy is a lot about strategy and humans. So a lot of the work I did in advance actually magically comes into play and copy. But working in my zone of genius. I think from the get go, I would have changed everything for me, I would have felt so much more fulfilled, so much younger, and so much more let up by this work. 32:05 So yeah, I would have told my younger self to follow your love of writing. Follow your zone of genius first. What great advice crystal, thank you so much for coming on to the podcast and sharing all these tips and tricks to help us write better copy, whether that's on our website or our newsletters or our social media. So thank you so much. You're so welcome. Thank you and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart. 32:38 Thanks for listening. And don't forget to leave us your questions and comments at podcast dot healthy, wealthy
Aug 15, 2022

In this episode, Physical Therapist and Founder of Redefine Health Education, Dr. Katie O’Bright, talks about the role of the physical therapist in primary care.

Today, Dr O’Bright talks about direct-access in outpatient clinics, patient satisfaction with teams-based approaches, and the sustainability of physical therapy as a profession. What is the primary care physical therapist?

Hear about billing as a direct-pay PT, learning from ED PTs, and Redefine Health, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “The primary care team is a team.”
  • “The more we can get integrated into teams, the better.”
  • “I don’t think that our profession, the way that we’re doing things, is sustainable at all.”
  • “Every health professional has a role in lifestyle intervention.”
  • “Do we really know, for different pathologies, what views and types of modalities and studies are actually required in order to effectively rule out a condition?”
  • “If we can do anything to make our population more healthy, and to make other healthcare professionals see our value, then do it.”
  • “The more I learned about the things that I didn’t know, the better clinician and person I became.”
  • “Always have listening ears.”
  • “Never drink the Kool-Aid. It’s not a good idea.”


More about Dr. Katie O’Bright

Dr. Katie O’Bright, PT, DPT, OCS is a residency-trained physical therapist and educator who has spent much of her career in multidisciplinary primary care settings.

She started her career as an active duty Army PT where she worked in a team-based Soldier Centered Medical Home. Since then, she has worked in multidisciplinary care settings in academic health systems and private practices, including oncology care. She also serves as adjunct faculty in several DPT programs, teaching foundations in primary care, oncology, musculoskeletal and gross anatomy.

In 2020, Dr. O’Bright founded Redefine Health Education, an education & consulting company with the mission of getting more physical therapists competent and prepared for work in first contact, team-based care settings, starting with primary care. She is the lead instructor in Foundations for the Primary Care PT and contributes to musculoskeletal imaging curriculum.

She currently lives in the Chicago metro with her husband & 2 sons, enjoys being outdoors & Buffalo Bills football.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Education, Teams, Sustainability, Primary Care, Redefine Health, Lifestyle Medicine,



Chicago PC Course (Aug 27-28).

MSK Imaging Certification (Starts Sept. 7) - 2-hour modules, 1x/month for 9 months or online self-study.

Use “HWSPodcast2022” for $50 Discount.


To learn more, follow Dr. O’Bright at:


Cell:                 312-772-2322


Facebook:       Redefine Health Ed

Instagram:       @redefinehealthed

Twitter:            @RedefineConEd

TikTok:            @redefinehealthed

LinkedIn:         Redefine Health Education


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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 in today's episode, we are going to be talking about the role of physical therapy as the primary care P T. So what does this mean? This means that if physical therapists being first point of contact for the patient into the medical system, and what do physical therapists need to know in order to be the primary care PT? So to talk us through this topic, I'm really happy to welcome Dr. Katie o bright. She is a residency trained physical therapist and educator who has spent much of her career multidisciplinary primary care settings. She started her career as an active duty Army PT, where she worked in a team based soldier centered medical home. Since then, she has worked in multidisciplinary care settings and academic health systems and private practices, including oncology care. She also serves as adjunct faculty and several DPT programs, teaching foundations in primary care, oncology, musculoskeletal and gross anatomy. In 2020, Dr. Albright founded redefine health education and education and consulting company with the mission of getting more physical therapists competent and prepared for work in the first contact team based care settings starting with primary care. She's the lead instructor and foundations for primary care PT and contributes to musculoskeletal imaging curriculum. She currently lives in the Chicago Metro with her husband and two sons and enjoys being outdoors. And as a Buffalo Bills fan. We'll let it slide because you know, I'm a Philadelphia Eagles fan. But I want to thank Katie for coming on. We've got a lot of resources on podcast at healthy, wealthy And she's actually giving giving healthy, wealthy and smart listeners a $50 discount for courses at redefine health education. So you can use h w s podcast 2022 for the $50 discount. So big thanks for Katie for coming on talking about primary care, physical therapy. Hi, Katie. Welcome to the podcast. I'm happy to have you join us today. Thank you so much. It's really honestly a pleasure and a privilege to be on your show. I've been a longtime listener. So this has been awesome. Oh, that's so nice. Thank you for that. And today, we're going to talk about the role of the physical therapist in primary care, which for those of us like myself, who's been in the profession for quite quite many, many years, I feel like this concept of the primary care PT



is on the newer side, depending on maybe what part of the country or the world you're practicing in. So before we get into the meat of the interview, I would love for you to define what is the primary care physical therapist? Yeah, that's a really good question. And I think that you're going to get a different answer from, you know, you'll get 10 different answers from 10 different people that you ask, but the way that I really like to think about it, and even my definition has evolved a bit over time, but the way that I like to think about it is



a lot of people think that primary care PT just equals you know, direct access or first contact or seeing a patient without a referral. But as I've learned more about what it what it is to be a primary care provider, I think that it has a lot more to do with being a being able to comprehensively assess a patient across all different specialty areas. So it's not just you know, you are an advanced neuro musculoskeletal professional. It's you're able to assess and effectively manage the functional needs of a patient, whether they have primarily orthopedic complaints, or primarily, you know, maybe they're a pediatric patient, or they primarily her, you know, dealing with some other non communicable diseases like diabetes and hypertension. You as the primary care PT are able to understand what it all of those how all of those systems play into their functional needs. And you're able to provide guidance on the management in conjunction and in sync with other health care professions.



Smells like the primary care physician. But you're able to effectively manage a variety of different conditions, not necessarily just their orthopedic or just their neuro or just their pelvic floor.



So that's kind of what my definition of primary care PT has come to evolve into. And I feel like my colleagues at the primary care sing would probably agree with me. Yeah, that seems reasonable. Have you ever heard of people saying, Wait, primary care? pte. Isn't that overstepping our license? Or isn't that going beyond what we should be doing? How do you respond to that? Well, I respond to it this way.



I think that pride, the primary care team is a team. And you can have a primary care physician or PA nurse practitioner. And they're typically in most cases, and especially in the United States, you will have a primary care physician and they'll also have a team of, of nurses, maybe they'll have a clinical pharmacist. And oftentimes that doesn't include an in house co located or, you know, maybe not co located but down the hallway, PT. But I think a lot of health systems are starting to see the advantages of having a variety of healthcare professionals that can be first contact. So for example,



the there there's physicians that can build primary care codes like e&m Primary Care codes, nine, nine series codes, and then there's non physician professionals that can build those codes as well. And that's limit that's not not just limited to pas and nurse practitioners, it also is encompassing behavioral health professionals, midwives, clinical pharmacy to a certain extent, and I think you're gonna start to see more and more primary care teams functioning as a team, which also includes a physical therapist that can contribute to the, you know, the, like managing the patient's functional needs, and everybody contributes to what component they need to contribute to.



Yeah, and that's interesting, you bring up the code. So normally, the physical therapists are billing under the nine sevens, usually. So in this case, if you are working with someone within their insurance system, and you're not a direct pay physical therapist, how do you bill for the services? Or? Yeah,



great question. So I actually just connected with Rick, Glenda last week, and I want to talk to him a lot more about this. So I actually have some, some meetings arranged, or I'm reaching out to plan some meetings with him to consult on that specific topic, because the health systems that I have worked with, or that I've consulted with, they're all doing different things. Some of them are billing nine, seven series code codes within the primary care setting. But a lot of this over the past couple of years, since I've been really into this space, a lot of these clinics have not received the feedback from their billing and finance departments because of, you know, COVID, short, you know, short staffed because of COVID. And, you know, we were shifting our focus to this area, so we can't give you the finance data that you need in PT. So a lot of them don't have reasonable data. So I'll just tell you what I do know, some of them are billing nine, seven series codes, some of them are doing, they have a PT that is co located in primary care, they see a patient for a quick evaluation and may provide them with some treatments, if they do some treatments, the physician or other health care providers also seeing that patient in the same day. And they'll do a warm handoff to pt. So then they do incident to billing under the physician's care because they're so they're kind of like CO treating at the same time, even though the PT is collecting those RV use for that visit. So that's one way that they know it can get reimbursed. Some, some locations are not billing their services at all. They're sort of like eating the cost while they're in the primary care space, but they're seeing downstream, you know, boosts in their revenue because more of their patients that they have touchpoints with in primary care are actually then following up and actually seeing them in physical therapy.



And then they're also keynotes finding, like we were reducing imaging by being co located. So there's other you know, benefits.



Then, I mean, there's, I could go on and on, but there's tons of different ways that people are doing this. But we don't have the hard data or anything like in the research to show Yes, this is Effective here. It's going to be effective for every insurance and this and that. It's such a complicated problem.



So I'm just trying to figure out



But as much as I can about it so that when people approached me and asked me questions about how to bill for it, in a typical insurance type system,



I have a variety of options that they could start with. And then I, you know, I hope to eventually talk with some of my, some of my colleagues that are, you know, more more interested and nerdy about research that could actually help me set up a research trial and study the whole thing and report on it accurately. But right now, I'm just collecting data. Yeah, that makes sense. A lot of times as things that are a little bit newer, you kind of go through some growing pains until you can figure out, hey, where does this fit in. So let's say you're a physical therapist in an outpatient clinic, you're not co located with the doctor, and someone does come to you in that direct access. Way, which for those who don't know, it, direct accesses, that means you can see a physical therapist without a referral from a physician, which I think is getting more and more common across the country to a certain extent. So if, if you're



advertising, your marketing is including like, Hey, we're primary care, physical therapists, what does that look like in the clinic? Can you give some examples or an example? Yeah, I can. So one of the things that I teach in my course. So I, I'm the owner of redefine health education, and the two areas where we, where we teach, in particular, our foundations in primary care, PT, and musculoskeletal imaging, which really go hand in hand. And one of the main feet main things that I focus on in my primary care course is how to effectively perform a systems review in a way that is all encompassing, so that if a patient comes to you with a primary shoulder complaint, not only are you doing a systems review, to rule out red flags related to that shoulder complaint, but you're also identifying problem areas that can affect their health, in you know, in the near term, and in the long term, so that you can learn how to educate them appropriately. So let's say a patient comes in to you, you're not co located with another primary care team or anything like that. But if a patient comes to you with primary shoulder complaint, and you also find that they have have hypertension, and they're pre diabetic, and maybe they have an autoimmune disorder, and you know, oh, by the way, they had COVID really bad and they were hospitalized, and they're having some long COVID symptoms, how to ensure that you're including components in your plan of care that address all of that, whether it's just little bits of education here and there.



And also, you know, of course, you know, I want to the one of the other things I teach in my course, is not only just understanding all of that from an evaluation perspective, but then understanding how much the patient is willing to go down and actually allow you to intervene



in their lifestyle habits or, or other areas. So I think that



that process is something that PTS that are working in a typical outpatient orthopedic clinic, are not doing very well. Because usually, we are seeing patients exclusively for an isolated shoulder condition. And we're not really looking into what the rest of their medical history really spells out for us.



But what I teach is



basically intervening in lifestyle and ensuring that they're, you know, if they need medication management for an autoimmune disease, are they actually following it? How is that playing into are related to their shoulder pain? How is that affecting their nervous system? How is that affecting their cardiovascular system?



So yeah, I think that I think that you certainly could, you certainly could. And then another thing, I've had a, I had one outpatient clinic team, or they were kind of like a local regional chain. But they also had a kind of a, analogous to them was a local, regional primary care group, that they were interested in it both privately owned, really interested in collaborating together. So even though they weren't co located, one of the things they thought about doing and that they're in the process of building is they're actually going to have a PT hanging out in the primary care office, whether it's 1233 days a week, or a hat, you know, an afternoon here or there, just to be able to be there and to be able to address patient's functional needs on the spot if they need it. So there's there's all different ways that you can do it. Even if you're going to privately owned you know, private practice or you own your own cash based practice. I think that the more we can get integrated into teams, the better



and do you have any



Um, data that shows how perhaps a team based approach may may improve outcomes or patient satisfaction? I do. Yeah. So a couple of the a couple, there's there's a number of studies that have looked at this, but one of the one of the main ones that I was looking at recently was, I think it was a Dutch study, I'll have to look, I'll have to look at it. But I'm pretty sure this was conducted in the Netherlands. And it was looking at elderly adults, community dwelling, elderly adults, where they had a team based group. So they they looked at a comparator group work was really just a physician and nurses. And then they looked at basically the same, the same group that had a physician, nurses, social workers, I believe they had clinical pharmacy, they had a recreational therapist. So they had this team that would all work with the patients together. And one of the main things that they found was not only improved patient outcomes and patient satisfaction, but also provider satisfaction. And that's one thing that I have found. So that's just one study with one example. But there are a number of studies that show this and just from my own experience working in team based primary care,



I, if I would not have been in those settings, I do not think I would have as as good of an understanding of,



of the other body systems as I would have as I would otherwise. So I think that they, when you work together more frequently, whether you're co located or whether you're just on the phone, or being able to have like a texting relationship with other providers,



they're going to understand what you do a lot better. And, and then they'll learn and grow from that, and vice versa. So I think that not only is there benefit, not only do patients reap the benefits in their health outcomes, and in their satisfaction, but also providers are, they seem to be much happier and have a lower rate of burnout, when they do work in a team, as opposed to just kind of being around the same old, same old all the time, you know, if you just are surrounded by people that are so much that are like you and think like you and do like you and are trained like you all the time for your entire career.



You're not going to learn and grow as much as you would if you were around other people who don't, who weren't trained to like you, and who have a different perspective. And I think I'm able to treat my patients better because I for the most for most of my career have have not been around pts.



And how do you think this fits into the sustainability of physical therapy as a profession? Yeah, so that's, that's this is my favorite question. Um, I gave a presentation recently for the primary care sake, I think it was in May this year 2022. And one of the things I talked about was how I don't, I don't think that our profession, the way that we're doing things is sustainable at all. In fact, I think that



there are so few patients, you know, it's estimated that seven to 10% of all patients with functional complaints ever end up seeing a PT, which is not a good thing, that is not a good thing at all.



And the model that we're kind of trained under and the model that a lot of PT clinics tend to follow, especially if you're in the insurance market,



is they follow where they were, you're seeing a lot fewer, a significant fewer number of evaluations than you are seeing like treatment sessions per day.



But if if the World Health Organization is saying that, you know, 25% of all complaints 20 to 25% of all complaints give or take, you know, depending on your region, and the timeframe, and yada yada 20 to 25% of any any patient encounter in the primary care space or in the emergency department is going to be neuromusculoskeletal related.



And only 7% of those are ever ending up seeing us. Imagine what it would be like if we could be kind of that first person to consult with them. Just imagine that. And so you know, we might see a higher number of evaluations per day, but we can be there to intervene, where it's really the most important, where we can ensure that they're not receiving excessive amount of, you know, imaging or medications or unnecessary tests and studies. And we really are the professionals that should be determining and assisting in figuring that out. So I think that if we were able to intervene just in that one area, then we could save our healthcare system a whole lot of money, we could improve our population health tremendously and



Then we're also going to be leveraging our skills. Because I started my career in the army, I saw a lot of evaluations, like more evaluations than then treatments most of the time. And what I found was my differential diagnosis skills and my ability to screen got really, really, really good really, really, really fast. So the more evaluations and consults that we see, we've been, we're able to recognize more and more patterns, we're able to intervene quickly.



And other providers around us see our value more significantly. And then insurance companies on the other end CRC or value more significantly, if you if you flip the role, and we don't, let's say we don't do that we just continue down the road that we're currently on, where we have, you know, an evaluation or two a day and you know, all of these treatment sessions in order to keep the lights on, if you're still in an insurance based market, in order to keep the lights on for any private clinic owner, you have to you have to maximize the number of visits, that a patient is being seen. Whether that's necessary. Or if you're maybe just loosely saying that's necessary to make sure that you can keep the lights on



if reimbursement is only getting worse and worse and worse, because insurance companies are like, well, we don't really think that's necessary. And we're saying, oh, yeah, yeah, that's necessary. And maybe in some cases it is. But for the vast majority of musculoskeletal health, musculoskeletal problems, we know that if we intervene early, if we reassure if we educate, if we say stay active, and exercise, the the natural history is that they will probably improve and get better. So if we can intervene there,



then we probably will kind of see it shift where we'll do like more evaluations and consults and less treatments and therefore save the insurance company a whole lot of money, save the patient a whole lot of time and money. And then everybody's everybody's happy. So I think that if the roles flip a little bit, and we learn as as a profession, how to be how to serve in more of a consultant role for population health neuromusculoskeletal conditions, maybe, maybe just maybe, maybe I'm crazy, but maybe just maybe the tides will turn and we can be says more sustainable as a profession in the insurance market.



Does that's a long way of answering that question. No, that was a great answer. And you brought something up kind of



more and more people who are going to emergency rooms, a lot of times for musculoskeletal health, and we are starting to see PTs in the ER. And would you? I mean, that's obviously so certainly a primary care physician, right. So what do you think that your typical outpatient or inpatient



physical therapist can learn from those emergency room PTS, that we can kind of take into different settings? Does that make sense?



Sort of I'll start by addressing the the the IDI PTS, by the way, shout out to Rebecca Griffith who is you know, just launched her IDI DPT because this year and she's doing a great job with that but um so if you need specific questions about how to V any how to be a physical therapist in the IDI I personally don't have any experience in that space. But but she does so reach out to her



and maybe we can put her her name in the show notes



but there's a lot of overlap and I think you know we there since there are more there are more PTs in the IDI you'd be surprised actually I've been finding out more and more about PTs in primary care than I ever thought was actually there and probably maybe the the IDI has just been more there's been more exposure given to PTs in the IDI so, so to answer that question, what can



there's a little bit of a difference though. So PTs in the IDI typically don't see their patients back, you know, they might, they might see them one time and it's truly Well, unless, of course the EDC has a lot of repeat offenders but But if we're talking just like the average patient showing up at the IDI, they see their patient one time and it's truly there to to rule out red flags to ensure that they're receiving the most of if they need imaging, the most appropriate, most necessary type of imaging study and that they're getting the most adequate referrals and consults that they need.



Reducing opioid prescriptions and other types of unnecessary excuse me prescriptions and also giving them something to go home with



whereas if they if they just see, like an IDI physician or or another type of typical IDI care provider, they're not as, and I don't want to speak for them I am. So I'm such a huge proponent of working with physicians and nurse practitioners and PAs. But I know that from my experience, even they have told me that I have, I have the knack for just talking to those patients and being able to do that, do that little bit of motivational interviewing and figure out figuring out what's, what works for them, what's going to empower them what they need. And that little bit of education is is important. So but it typically in the day, they won't see their patients back, it's kind of like you're doing a quick evaluation, determining their needs, and then like discharge planning, or the patient is admitted or whatever, right? In primary care, my my whole theory, and really my vision for PTs in the primary care in primary care teams is that we would be co located and or just affiliated, maybe you're not in the same location, but you are affiliated somehow, or you have a close relationship with a primary care team, where you can have lots of good integrative care planning for the patient, and it becomes almost like a revolving door. So with your, with your patients that you see,



like I have my own primary care physician, I can go to my primary care physician whenever if I have a problem or for my annual visit or whatever.



Within my primary care team, I also have access to if I needed, I also have access to a behavioral health provider who is part of that behavior primary care team. And if at any point, I had, you know, a mental health crisis or something like that, I would go to this person because she's a part of my primary care team, and then they all work together and figure out what to do. And, you know, with with my, with my input, figuring out what is the best situation for me. So with PTS, being a part of those primary care teams, you you get access as a patient, you would get access to a PT on a revolving door basis. And then you have established, you have kind of, um, you know, if I, if I was, if I was



the, how do I jump jumbling up, because I get so excited talking about this. If I were a patient coming to see your primary care, PT, my very first visit would be a well visit. And then I would kind of like go through, maybe figure out identify some risk factors or maybe identify, you know, you're not necessarily having a problem. Now, here's what your body normally does and looks like. And this is what you do for physical activity. Let me give you some pointers, maybe, you know, maybe you want to increase your exercise, here's how to do it safely. And then if and when problems do develop down the road, we can address those and I know what your baseline is like. And it doesn't have to be this this finite linear relationship, where there's an evaluation, treat, treat, treat, treat heart discharge, for this one problem. You know what I mean? So I do like, yeah, so it becomes this, you have a team of care professionals that are on your side, and that know you and that know each other, and, you know, maybe they all they're all trained differently, and they all see things from a different perspective. But they all collaborate as a team to help you be able to help yourself the best. And I think that's that, that is my vision for what the future of pts and team based care looks like. And I am like just dying for it to happen, you know, I will make it happen thrive in this. I think that, you know, the rate of burnout in our profession is substantial. And it kills me like I some of my my students are coming out of school after their first couple of clinical clinical rotations. And they're like, this isn't what I signed up for, like, what are my other options? I don't want to be a PT. That's scary. And I think that PTS would



be able to at least at least delay the onset of burnout. If we were able to shift into these types of care models. It would be so refreshing. Yeah, I mean, it definitely sounds like that patient centered care that we talked about the bio psychosocial system of care model of care that I would say most health care professionals are moving towards hopefully.



But it does sound like it's a good environment for the patient a good environment for the clinician, and like you said, you have the opportunity to learn from different professions and from different folks who might not have the same skill sets as you and vice versa. And it also kind of started to bleed into a little bit of lifestyle medicine and things like that, which is something that we can all use. Absolutely. Yeah. I love it. I love all of it. Now



So you had said, you briefly



talked about redefine health. So do you want to go in and and tell the listeners a little bit more about that if they're interested in learning more on how they can brush up on their skills to be a better primary care? PT? Yeah, for sure. So,



um, I've always wanted to I had always wanted to get into the education space, but never in a million years did I think I would ever be starting my own education company. COVID did this to me. But you know what, thank you COVID For that, you know, if there's one,



there's like these unnecessary, I guess unprecedented things that came out of the pandemic. And for me, it was I lost my cash business after it just started.



And it there was a number of things going on with that. But I decided to just jump right into education. And it was a it was an evolving thing for me, I really didn't know exactly what what direction I wanted to take it at first. So it's taken, you know, almost two, it took almost two years to really find my to find my niche and really find my truth and what what I'm the most passionate about, and well, for me, it has always been primary care.



And it just took a while for me to like figure that out from a business perspective. So



So yeah, I teach foundations for the primary care pt. And my my partner, Dr. Lance Mabry teaches our musculoskeletal imaging certification. So I'll talk just briefly about both the foundations for primary care PT is an 18 hour CTE course, and it's really meant for the the physical therapist that wants to wants to like break free of this, this model where patient comes in for neck pain, and you're just really looking at their neck. And



lifestyle medicine, for me has been something that has been really actually life changing. For me personally, I after having kids had a lot of autoimmune problems that I had no idea what was going on. And I just was like kind of scattering going to different physicians here and there. And everyone was like, almost kind of like mandating all of my problems. And then I finally connected with a lifestyle. She's a board certified family medicine and lifestyle medicine physician. And, um, honestly, she helped me so much by just helping me intervene with my diet, and really looking deeply into you know, those six pillars of lifestyle medicine. So, after really kind of seeing what that did for me personally, and what I was able to do as a trickle effect with my patients, and then just diving into the research and seeing wow,



we really need to intervene in lifestyle, if we're going to affect population health. And everybody, every health professional has a role in lifestyle medicine, and lifestyle intervention. So in my primary care course, the whole first day is all about just taking your everybody learns a little bit of medical screening, or should learn pretty solid medical screening and their DBT education, taking what you learned and your DBT education to the next level, where you know, if somebody circles Yes, on a certain number of, you know, past medical history or symptom profile, if they certainly yes, on those things on their intake form, you know exactly what questions to rule up or rule down different conditions to bring you to your, you know, your final set, or your initial list of differential diagnoses. So that's kind of all day one. Day two is more,



kind of a deep dive into visceral pathophysiology. So, okay, we all learned about anatomy and physiology, the heart and the lungs and the GI system and all that stuff.



But when was the last time you really actually spent time with it. So day two is all review of visceral pathophysiology. And I focus a lot on the cardiovascular system, because let's be honest, everybody has Atheros everybody has some level of atherosclerosis. And for most people, it's just it's just your dislike a day or two away from becoming pre hypertensive. So I focus a lot on that and what PTS can do to intervene in patients in their, you know, in that sweet spot, you know, ages 25 to 45, where we can really have an effect on somebody developing or not developing those those chronic illnesses.



And then I also talk about, you know, you can maybe identify, excuse me, you can maybe identify that somebody has some lifestyle factors that need to be assessed, but how do you assess their readiness and their willingness to change? And how do you make sure that you're respectful of their wishes, maybe they don't want to go there. And maybe that's okay, so



I'm so that and then of course, interdisciplinary collaboration and communication as part of my core series I have, I've interviewed other physicians in different specialties of practice and kind of their thoughts on what what PTS are what PT should do. And I play these videos in my course. Because I think that overall,



I don't want to speak for my whole profession, but from my experience, there's more PTS than not that are afraid to pick up the phone and call a physician and tell them what they think and recommend what they want to or what they what they feel is appropriate and and say, Hey, I, you know, this patient seems like there, they've got a neurologic profile that kind of looks like Ms. And, you know, maybe you want to take a closer look at that. So, so what these other fishes physicians actually think and say about PT.



So that's kind of my primary care course, in a nutshell, and Lance's musculoskeletal imaging course. I mean, a lot of people think that imaging is just kind of like, something that's done, you know, if like, you have a if you suspect a fracture, you know, you got your auto ankle and, you know, you've got your, your,



your auto when he rolls and like all the you're Canadian CCI rules and all that. But do we really know for different pathologies? What views and what types of modalities and studies are actually required? In order to effectively rule out a condition? Do we recognize and understand that radiographs are inherently specific not inherently sensitive? So if you have a high level of a high index of suspicion for something, you need to continue the workup? And what do you continue the workup with? Is it MRI? Is it CT? Is it something totally different? Are you doing this to rule out something that's vascular or something that's soft tissue or something that's bony? And I think that, in general, probably not just PTS, but there's a whole lot of people that don't understand those things. And I think we're doing our patients a disservice by not fully understanding those. Because let them I mean, we have to face the fact that imaging is a part of the diagnostic process, whether we want to recognize it or not. So we have to whether you can place the order yourself or not. You need to understand how you need to understand how and why it's done for what purpose, and then how to clinically respond once a patient has had imaging, and who to communicate with and you know, when to pick up the phone and ask some questions to the radiologist. And so Lance does a tremendous job with a way better job than I would do with all of that. So. So yeah, that's kind of the the courses that we have to offer. And, really, I want to, I am not doing this to make money, trust me, like I would be



my husband just graduated with his MBA, like a little more than a year ago. And he's always like, go get your MBA, like you can use how much potential you can make so much money in this space. And I'm like, I don't know, I was put here to do a certain thing. And PT is the profession that I have just like it's, it's more of a vocation for me than anything else. And I just really feel like our profession needs some dire change, and needs people, certain people in it to make moves and make changes. And I understand that my, the visions that I have in my head right now for what our profession could be seem like pie in the sky, craziness, especially with the way that insurance is right now. But if this is the one area where I can have an impact, and start to make more PTS more confident and competent doing this, than Hey, I will, I will retire a happy woman, if that's the case.



Well, and I think that's a great way to start wrapping things up. And I was just going to ask you, like, hey, what do you want the listeners to take away from this discussion? I think you might have just said it, but is there anything else that you really want the listeners to take away?



I mean, basically just that, like, if you if you can, if you want our profession and see the value in what our profession has to offer, we have got to make moves. And and if we can do anything to make our population more healthy, and to make other healthcare professionals see our value, then do it. You know, don't don't like get stuck in your your ways of you know, one patient after the other and then you're home at the end of the day and you know, try to try to do those things to make a change for yourself and for your community.



Just by setting a positive example of what right looks like from a from an evaluative perspective, and from like a from a health care provider management perspective. And the one thing I will my one little parting, parting gift



for everybody, if they if you are interested in taking either one of our course tracks, I you can use the I have a discount code a $50 off discount code for, for either one of those courses for any of the listeners, if you just put HW s podcast 2022 And we'll just maybe put that in the show notes. That'll give you a $50 off discount and it's always Yeah, always happy to chat with anybody or,



you know, hear any inquiries, my email addresses info at redefine health You can call or text me any time and I'm so open to it at 312-772-2322 and I'm on social media and trying to trying to turn it into something so go and follow me at redefine health Edie on all the social medias except for Twitter because it was one character too long, which is so annoying at right so it's Twitter ad redefined Con Ed. Perfect. Well, thank you so much. I can't believe you gave out your phone number. That's insane.



Hopefully, business number.



Oh my god, I was like, I'm gonna have to edit that one out.



That's, that's, that's the big number. So all right, good, good. Good. Okay. Now, last question. It's when I asked everyone and that's knowing where you are now in your life and in your career? What advice would you give to yourself as your younger self maybe right out of PT school? Yeah, I think as a as a young PT, I really thought I knew a lot. And



I really thought I knew a lot I really thought PT could do everything. And



the more I learned about the things that I didn't know, I think the better clinician and person I became and I think that's just kind of the natural evolution and the natural evolution if you're really paying attention to who you are and what you do is you'll find out you just know less and less about you know, you know a little bit about less than less over time and



and yeah, so like always be open to learning other things in different ways from people that you didn't think were were were experts or



you know, just always have listening ears and never drink the Kool Aid. It's not a good idea. Kool Aid is not good for you anyway.



I love it. And you know, that's that is



definitely something that I've heard again and again, as the advice that people would give to their younger selves. So you are in very good company. So Katie, thank you so much for coming on and really, hopefully lighting a fire under some of the physical therapists who are hearing this to



be open to new ways and be open to the to primary care and lifestyle medicine and incorporating that into physical therapy so that we're more than like you said more than just treating the shoulder and the person goes away. So thanks so much for for all of this info was great. Yeah, absolutely. Thanks so much for having me. It's really a privilege. 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.


Aug 8, 2022
In this episode, Physiotherapy Lecturer and Tendinopathy Researcher, Seth O’Neill, talks about tendinopathy. Today, Seth talks about his interest in tendinopathy, and his presentation at the Fourth World Congress of Sports Physical Therapy. What is the warmup response? Hear about Seth’s diagnosis framework, the appropriate use of imaging, rehabilitation, and get his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “You’re going to have some discomfort with these exercises and that’s okay.” “Get your diagnosis right in the first place.” “Say yes to things when you can. Push yourself and you’ll get there.” More about Seth O’Neill Seth is a Physiotherapy Lecturer at the University of Leicester whilst also maintaining clinical work. He has a PhD on tendinopathy, within this Seth has identified prevalence rates of tendinopathy in UK runners and developed a greater understanding of risk factors surrounding Achilles tendinopathy. His later work has completed a more in-depth analysis of how tendinopathy affects the Plantarflexors. This has focussed on how the strength and endurance is affected and which of the Plantarflexors is most involved. This work has highlighted the involvement of the Soleus muscle in human Achilles tendinopathy. This has led to the further work related to Calf injuries in sports. Whilst Seth’s focus is on the Lower limb he maintains a strong interest in all MSK conditions. Seth feels passionately about supporting Physiotherapists to undertake further research either as standalone projects or MRes’s or PhD’s. Seth is currently examining tendon structure and changes that occur during health and disease along with Biopsychosocial interventions for tendinopathy and LBP and developing an international database of calf injuries. Suggested Keywords Healthy, Wealthy, Smart, Tendinopathy, Physiotherapy, IFSPT, Injuries, Recovery, Rehabilitation, Diagnosis, Exercises, Resources IFSPT Fourth World Congress of Sports Physical Therapy To learn more, follow Seth at: ResearchGate: Seth O’Neill Twitter: @seth0neill Subscribe to Healthy, Wealthy & Smart: Website: Apple Podcasts: Spotify: SoundCloud: Stitcher: iHeart Radio: Read the Full Transcript Here: 00:02 Hey, Seth, welcome to the podcast. I'm so happy to have you on. 00:06 Thanks very much for having me, Karen. It's great to be here. 00:08 Excellent. And today we're going to be talking about tendinopathy, maybe specifically Achilles tendinopathy. But before we get into that, I just want to let the listeners know that you're one of the amazing speakers at the fourth World Congress of sports, physical therapy taking place in Denmark at the end of this month, August 26, and 27th. And you will be talking about tendinopathy. So before we move on, I would love to know why. Why tendinopathy? How did that become sort of your specialty, your interest? 00:46 Yeah, tricky to sometimes answer these type of questions, really. But I've had tendon problems myself. So being active and sporty, I developed an Achilles problem, number of years back when I was a relatively junior physio, and we didn't really understand how we were trying to manage these things. And that took a long time to settle down. So that really sparked it off. And then not long after I developed poutine. And problem as well, my Achilles from wearing sorts of constricted footwear. So wearing wetsuits, boots, for a day, with doing wakeboarding and stuff. So developed the interest because I had the problem myself, which is probably the answer for most people, I think, with how we ended up specializing in one thing and went on to look at Achilles problems and differentiating these out as part of a master's dissertation project that did, and then still had some clinical questions I wanted to answer to help me understand how to manage people better. So I did my PhD in it as well. So yeah, it's one of those sort of sorry, stories of a while me. 01:50 And before this sort of deep dive into the literature, and a master's in a PhD, and maybe even during that journey, are there any cases that you worked on that you were like, Man, I would do it so differently now? Because I'm sure I mean, I know I have that every physio listening to this can probably relate to this. But where have you learned from your mistakes in relation? We'll say, we'll stick to Achilles tendinopathy. Right. So in relation to Achilles, tendinopathy, so that the listeners out there can be like, Oh, I think I just did that. And maybe I'm gonna change my mind. Yeah, 02:28 yeah, we're at a good number of these things, including not too distant past as well. I think like everyone, we're always learning. And we've all just got to admit to mistakes and where we can benefit and do better. So I think my early ones, particularly were around differential diagnosis, getting or missing things that were going on as well. So remember, one relatively young lad with an Achilles problem, sent him off doing Alfredsson Essentrics, this was probably 2001, something like that, came back loads loads worse and had this funny swelling around the back of his money, hola. And I was like, never seen this, this is rare, and didn't know what was going on at all. So sent them off for an MRI scan via our consultant at the time and came back with an accessory soleus, which is where part of the muscle is low lying and actually sort of fills where cake is fat pad is back in money can cause pain and be symptomatic. And the old school approach is to just go in and cut it out. So the surgeon is booked out and ordered and dusted. But I totally missed it. The first time I saw him, I don't know whether the swelling was there at that point, or whether I triggered him off or made him worse with the sort of rehab. So possibly, but also then I've had a couple of people during Alfredsson regimes that have actually ended up with ruptured or partial ruptures, partial tears, as a consequence, and then yeah, you end up sort of feeling terribly bad that what you were doing to try and help someone's actually caused a significant worsening of their function and symptoms, and they even had a patient with this happened last year, who will go and try and write up as a case study because it's really interesting management program afterwards with scans and stuff, but ultimately, they have big problems. 04:15 Yeah, it does. It happens to us all. And how do you from that? You can, you know, we can edit this out if you don't want to answer this. But how do you deal with that from sort of the mental standpoint of oh, shoot, like how do you mentally deal with that? Because I think that when that happens, it can you start to question why am I doing this? Am I the right person for this job? It can lead to burnout, that stress. So how do you manage that from a mental health standpoint, when things like this happen? 04:53 I think the thing is often as a junior therapist, you beat yourself up more because you sort of think I should have known I should sort of understand that, I think as you get more experienced than me, I'm 22 years 23 years qualified. Now you have lots of experiences like this and have to pick yourself up from them. And you just start to accept that that is like that's normal, whatever area of work you specialize in, or work in, whether it's physio, or even being an accountant or something, mishaps in things that you can learn from learning experiences happen all the time. And it's really just then taking what you can from it and developing and getting better. And when you have a bit of a boo boo happen like this, we tend to remember it and you never then miss it in the future. I mean, a couple of examples that I had in the past would be like federal stress fractures wasn't even on my diagnostic radar back when I was a junior therapist. You don't get taught at university and stuff, and then you sort of you miss one. And it's like, right, never missed one again. Now, it's always high up on your index of suspicion. So it's really just not trying to beat yourself up, realize it's a learning experience and identify what you can do. Going forward with it. Part of your CPD of your reflective practice that we're all encouraged to do and often do do but not formally. So yeah. 06:14 Yeah, great advice. Okay, now, let's get into the meat of the podcast here. So what we'll talk about is kind of you mentioned it differential diagnosis. So we'll talk a little bit about that, and then go into some possible treatments and, and outcomes and things like that. So let's say someone comes to you, with posterior ankle heel pain, they haven't been to their GP or to the orthopedic yet, because that happens a lot. Here in the US, I'm sure it happens a lot with you in the UK, as well. So I will hand the mic over to you. And you can maybe walk us through your differential diagnosis framework, what are you looking for when someone comes in with that? 07:03 So the first thing, I think is, as everyone already knows, is not to take whatever the previous diagnostic decision was, if they have seen someone as well, I make sure you do your own workup, because let's face it, we all make mistakes as well. So I'd always look at them with fresh eyes and not go with the the original diagnosis and make my own mind that the three big things that mimic Achilles tendinopathy really then are related to posterior ankle impingement. So in order to try going on, whether it's a bony impingement or not, and they're the ones actually see quite commonly that have been mismanaged that add a cricketer, recently, his professional cricketer, who had been sent from their medical team in one of the counties in the UK, or England, I should say, and unfortunately, that miss that he had a posterior impingement, not an Achilles problem and been trying to manage them and manage him using some invasive procedures, and actually scan and everything else when I scanned in, but absolutely pristine and fine. And that's the one thing I do come across time and time again, it's just people miss the impingement side of it, and normally, the x, so aggravating factors and easing factors that the patient will report to you if you listen carefully, and inquire, will be very, very different. It'll be a totally different set of positions, not about tendon load, it'll be their ankle position. And being in that plantar flexed position that's relatively simple and straightforward. But again, it just, it commonly crops up other common or relatively frequent presentations, then we'll be around several nerve. So one of the branches of your sciatic nerve runs on the lateral aspect of your Achilles, we just want to simply look at something like a straight leg raise with a neural bias for the inverter area. So you do inversion with dorsiflexion. And if movements like that provoked the pain, that's not normal for a tendon, it would normally only hurt when you put larger loads through it. And energy storage demands not simple structures, except in very highly irritable cases. But you can only determine that clinically. So they're the two big things that the third group then is other localized tendinopathies. So to be honest, posterior, or per Nei, which I think you guys call something different in the States. What are the perineal inverters of the foot? We always have problems when we teach anatomy with our students, if they use an American app, it gives it a different name. I forgot this. But anyway, so yeah, so just looking at the differential between those other tendons. So patients may refer and sort of suggest its posterior heel, but actually it's in front of the Achilles. So it's normally relatively localized pain and there's lots of debates on social media about what happens when you get diffuse pain in that area. diffuse pain is really quite rare in this area, and I do see a lot I still work clinically as well as work in that university from a research perspective and I do a lot of consultant work in sports. and wider as well. And we just don't see widespread pain in this region particularly. And the evidence really suggests that tendon off the Achilles particularly will be localized pain. It doesn't sort of spread out. But there will always be some exceptions, I'm sure. 10:15 And it sounds like from what you're saying one of the other really important things is that subjective interview. Yeah, right. So what questions are you honing in on? What are you What do you really want to know? 10:29 So I'm actually take a leaf out of Peter O'Sullivan's approach for back pain and look at the patient's story. How do they describe this originally starting? What's gone on with it from then? And what are their thought processes around that. So we really look at the whole patient, not just that the mechanical bio sorts of components here, but then our teas into the aggravating and easing factors. So where the pain is what makes it worse, what makes it better how long it takes to come on, often expecting a latent response. So the pain is not necessarily happening during this activity, it will be a latent flare up later. Although you'll sometimes get a warm up response during the activity as well. So we're looking for these hallmarks. And what we should pick up in the subjective is progressive tendons stress. So the example would be walking for the Achilles versus running versus hopping or jumping or London being progressive load, the higher you go up that ladder, the more it will flare them up or make them sore. And then what we're trying to do is look at the sin factor, then if you guys use that, as well, so severity, irritability, and the nature, but the irritability is key, the more irritable these are the lower level, we're going to start your rehab. And a lot of this subjective really helps guide our initial intervention program. But of course, on top of all this, we've got to consider the patient and the complexities that we get from our psychosocial component. And we've just had a sort of paper out with Neil Miller, and the group from Glasgow on biopsychosocial approach to tendinopathy. This the icon statement from the international group, that Karen Silverado that you mentioned earlier, and that's really looking at the psychological factors and social factors that are relevant for tendinopathy. Because like any musculoskeletal condition, the person's important, it's not just the the localized tissue that we sometimes can get overly focused on. 12:25 Absolutely, I'm preaching to the choir there. Now you had mentioned something in that, just now the warm up response. So can you explain what that is for the listeners in case they're not quite familiar with that? 12:38 Yeah. So this will be the person that will go for a walk or a run, or whatever their activity tennis, squash, whatever it happens to be, and they'll find it sore initially, and then it will get better, it feels better during the activity. And we tend to see this happens when they've sat for any length of time, if they're an inactive person, they'll get the same response then so the first five minutes of getting up having sat for an hour or two will feel sore, and then it gets better. And this is particularly common in the morning, where patients get up. And they say I was sore for 10 minutes until I've walked downstairs, made myself a coffee or had a shower. And then I feel better ready for the day. And that's typically what we see. So this sorts of pain that is focused around starting an activity when you've been inactive for a period. So that's 13:27 excellent. Thank you so much. So going back to our fictional patients here, they come in, they've got sort of posterior ankle pain, you've ruled out posterior ankle impingement, sural, nerve, local tendinopathies. And now you're really thinking well, given their subjective exam, given the little bit of objective exam that I've done, I think that we're dealing with an Achilles tendinopathy. Right, so you've kind of made that diagnosis. Now, what happens? 14:03 So once we've determined that we think it's an Achilles problem, we just want to make sure that's the case. And the best, most accurate, sensitive clinical test at this moment, whilst it gets a bad press is actually the site of pain. So asking the patient's point to it, or you look at then gripping it and looking at how Patri pain, they should put them to touch that tendon. If it doesn't, then we perhaps not dealing with an Achilles problems that would set up some alarm bells. The next thing then is to work out what sort of tendinopathy they have. And within that, what I mean is there's this sub entities, so there's different groups that will cause Achilles pain. So you could have a parent teen and disorder, like I mentioned, with myself earlier, which is essentially inflammation of the sheath around the tendon a bit like you get with the equivalence, Tina synovitis in the wrist or thumb is that same process, and that probably needs to be managed very differently because that's about friction of the sheath against the tendon. And so we've managed differently, we'd also then consider insertional, tendinopathy versus midportion, the risk factors, and some of the subtle management may differ. And as part of that, often we'll talk about trying to reduce compression of the tendon, which is what happens when you're in a dorsiflex position where the tendon will swash against the superior aspects of the calcaneus. That is had probably inappropriate interpretation from lots of clinicians, where they've heard about it and then say, we should avoid dorsiflexion. And patients then get told to avoid it. But that is forever. And of course, dorsiflexion is normal. So we've got to make sure we have encourages it. But in a highly irritable case behind center factor, we'd avoid that in the initial phases, or reduce it. So might use a heel wedge, so midportion and insertion burn, then with the mid portion, we're trying to look at whether it's really related to the Para tienen there's a potential of a partial tear. Or you can get these other disorders, which we have academic disagreements about, called splits, where actually, if the fibers run sort of longitudinally, you can get a pull in a part of the fibers. And they're called longitudinal splits, or occasionally get a flat tear where the back of the tendon or deep section and tendon pulls off. 16:18 Clinically, for me, they are much harder to manage. And they're the ones that I have, certainly in the last 510 years, made much worse, both symptomatically, functionally and also structurally. And they're the ones I think we need to be cautious about how we look at differentiating those out clinically is on subjective, again of how did it start? Was this a onset that you develop during a sporting activity or a activity a functional activity, like crossing the road and stepping up a curb? Or going down stairs or making a bed or something? Or did it involve whatever else or did it just come on gradually, you were sore the next day, after you did a long walk or a long run, that's more akin to normal typical tendinopathy being a generalized process of degeneration with some inflammatory elements that we sort of know and love as tendinopathy. But these sub entities seem to be very different, I think for management, the problem with all the research, nobody splits them out. So all the research doesn't differentiate out these sub entities, they stick them all together. And part of this is why I think a lot of regimes have washed out, they they look like people get a generally good response, some get worse, some don't respond. But generally about 70% of people get better. I personally think if we can look at these different entities, we will probably improve our rehabilitation. And Karen silver novels work I've forgotten now is going to go ahead and first author a bit. So I apologize. Currently the senior author, they've looked at actually identifying clinical groups, so psychological. So the profile group, a structural group, and more of a biomechanical sort of weakness group. And that's, I think, got some legs to go forward with how we might look at our patients in the clinic. And remember, if there's one more group, there is one more sort of sub entity which is plant Taris, induced tendinopathy. So typical presentation will be middle section pain, a little bit higher than typical midportion. And they may find that actually been in plantar flexed or dorsiflex positions when contracting the muscle, and therefore loading the tendon actually hurts. And that's because the RENNtech muskies work that he's done has shown that you get some compression of the plantaris tendon against the Achilles tendon, it seems to then set up a tendinopathy based on compression. So we can identify that clinically with palpating, the medial side. But ultimately imaging is probably then the better way to identify it. But it doesn't mean they need surgery, either. That's the other important message for you to take away from it, they've always had that plantaris. It's always been there for that person's life, they've developed the symptoms for whatever the reason, and they will probably respond to normal management, but maybe with some modification to load in in dorsi, flex or plantar flex positions. So we work in the middle a bit more initially until we're starting to settle and improve. Certainly in my clinical work, they will settle just as well as any other area does. But of course, with a lot of the research people are seeing tertiary sort of work failed, we have failed rehab with multiple people. And then of course, they're more likely to go on to surgery. So we've always got to interpret the literature a little bit with caution based on the populations that the research groups or whoever is writing the paper actually see and deal with clinically. 19:45 Yeah, that was a great overview. Thank you so much. Now that you mentioned imaging, so can you explain how you explain to the patient Do you need imaging? Do you not need imaging? When it comes back? Let's say an MRI comes back. And they're all out of sorts, because Oh, the doctor said, I have damage to my tendon, how am I going to fix this? Right? So how do you deal with that? Because if that is what happens, and then people say, well, when we're done, should I get another MRI? So that I can see the tendons back to normal? So how do you respond to that? 20:29 So that last one I'll deal with first, that is that actually, you're probably going to see some residual changes in the tendon that will take a long time to settle down. And this may be akin to scarring. So when you put your hand you end up with the scar afterwards. And that actually, what we're seeing on the imagery at a later date may be similar to that scoring process. And also reminding them that attendance is very slow to remodel and recover. So really, we're talking about imaging a year plus, if we want to look at it. And it doesn't matter what the tendon looks like, it matters, whether their symptoms and their function and good early on, I would have a different conversation in an elite sporting population, though, where actually, we know that attending that has structural changes is seven times more likely to develop symptoms the next season. And actually, I would probably then want to be changing the tendons structure. But again, that will be a discussion I have with the medical team, perhaps not the athletes so much, because we don't want to, we have to be very careful about the psychological impact of our words with our patients. And this is why imaging has had bad press over a number of years. Because it's often given to patients and they get told, Well, you've got tendinopathy, you've got big tearing there, there's loads of fluid and inflammation and the patient's like, well, I need to then rest until it settles, I need to sort of get this better, and how the hell is it loading exercise is going to help me get better when that's actually what's triggered it. So they're the clinical challenges that we have to explain in terms of the first phase, when we do the imaging, I simply try and D threaten them with it. So say, Look, this is typical of what we'd observe for somebody with tendinopathy. So that is tendon pain that you've presented with. This is not out of the ordinary, this isn't something that's particularly severe, assuming that that's the case based on the imaging. And I've also with MRI identify that it's actually a poor technique to look at collagen. So all we're going to see is high signal, really, it's very, very hard, you need to be have an excellent scan and an excellent radiology radiologist to really examine collagen fibers with it. So it will tell us how big the tendon is. And it will tell us how much fluid there is in there. But we know that that doesn't have a strong relationship with pain. And this is again, part of the reason why we wouldn't want to do it down the line say much. Having said that, again, Karen southern handles group, it's got some lovely papers that have come out that showing structural change does occur with functional resolution and improvement in symptoms. So we've got 42 different research groups in the world at the minute the Australians have often said we shouldn't be looking at imaging, whereas actually Karen's group and I think where we're taking it in the UK is that we should it has a use. But we've got to be very careful with that interpretation. And we certainly see changes in tendon structure as we have patients, we don't need to see it in order to get resolution. But that's because structure doesn't correspond to what's likely to be the key chemical factors in the tendon that are actually what's triggering pain. And we know there's lots of different chemicals involved in tendinopathy. So it's sort of trying to tie it all together. My reason for imaging, I use imaging in practice most of the time is to help we lay patients fears because often they're concerned about the risk of rupture. And this has come out in Shama core lifts qualitative work on Achilles patients. So by imaging, I can actually say, Look, your tendon has plenty of healthy tissue here. This, as best we can say, at this moment in time, is a very low risk for rupture is no higher than a normal person, because there's the same amount of tissue as a normal person would have. 24:06 Where we then have to be careful is where we find that's not the case. And we've just been doing a big longitudinal study in premiership rugby in the UK. Looking at this to see about how that changes. And Matt, who's doing a PhD with me, is going to be analyzing and looking at that data. So Matt Lee is head of medicine at Northampton saints. So Matt's got a big bit of work to determine whether really it ties in and whether we can predict who gets more symptoms, how that ties and, and they don't leave those, but we need to test that and so we're going into it to see probably, but yeah, good use, I think for imaging but not longitudinally imaging for most of your patient group. And it's not necessary and most of you patients you've got coming through your front door for a normal practice. But where there was a sudden onset of pain during activity, and they don't respond Do a six week sort of period of intervention or 12 week period, that's when I would want to image to see what I'm dealing with. Or where there's overt metabolic changes in the person. So adiposity, so high lipid levels, high adipose levels, so the waist circumference, and diabetes, then we want to just make sure they've not got some underlying problems, like, sort of gout that's going on or pseudo arthritic complaints. So yeah, that's where we're going, we might just step up a little bit and maybe consider blood tests as well. 25:33 Great, thank you. Now, let's move on to some treatment options. Right? So we've we've done the differential diagnosis, maybe we got imaging, maybe we didn't, we've, we've ruled everything out, we're pretty confident we've got an Achilles tendinopathy, I will leave it up to you, if you want to say well split it from like, you know, lower to sort of an upper you can, I'll let, I'll leave that in your hands, and how the rehab may be different. 26:05 There's no magic. So that's the first thing. There's no exercise, it's better than the other. It's about understanding the basic principles of rehabilitation here. And this is really what we do, I think, for all of our patients we ever see during a normal clinical role is going well, what do they want to do? Where are they now? How do we bridge that gap? And that's essentially what you're trying to do with your patient is, what's their functional ability at this moment in time? What do they want to do going forwards and coming up with a strategy to try and progress through that? Making sure that that allows for appropriate timescales. So tissue recovery, after exercise, if we're trying to adapt muscles, and muscle strength, which is often one of our big aims, we need to allow appropriate timescales. So 12 weeks plus, rather than expecting rapid changes quickly. So what that looks like in practice is going well, initially, we're going to start off with some form of loading for the Achilles tendon. Now, I would use a very, very isolated exercise, because you can compensate by offloading us in other muscles if we do more complex tests often. So an isolated simple exercise will be a heel race, you can't cheat, you can't use your quads and glutes to compensate, you have to use your calf and it puts stress through your tendon. And there's a nice work with Steph Leser, there's just to out on a systematic review, we're just sort of tweeting about earlier today on tendon material properties and how loading modifies the tendon, and part of what we want to do is improve the stiffness of the tendon, because with the Achilles tendinopathy, it will be less stiff. And that's generally pretty accepted. So we want to make it stiffer. And loading does that the loading needs to be progressive in nature. So we use the symptoms to determine that current simple novel, initially pioneered the pain monitoring model. So looking at how sources during the activity and afterwards, getting an appropriate level of discomfort that the patient can tolerate, doesn't impact their function and making it harder. So something like bilateral heel raises if somebody's really Niggli and saw progressed to a unilateral heel raise, that's about four times body weight through the Achilles tendon. For a bilateral erase, again, depending on the modeling method that's used Josh Baxter in the state system, some nice work on this in his lab, and he's got a lovely paper with Karen as well showing exercises that increase tendons stress. And that's a really good paper for your listeners to have a little read off to look at how to progress or to give ideas of exercises and how they would progress through that. Running, for example, be about five to six times body weight for the Achilles per step. So what we're trying to do is go well walk ins for running six, how do we cross that boundary and use other exercises, or just add external load on to heel race, which is probably easiest way. And that then allows very isolated, monitored exercises. At the same time, I would always use walking or running the same period of time, we wouldn't withdraw them unless we're very, very slow and very struggling. So we'd always use that. And in most patients, if we're not talking athletic, we don't need to use plyometric training jumping up in and stuff we can use walking and running, if necessary to do that. But the more elite athletes, I would always be looking at plyometrics. So hopping jump in London, whatever it happens to be accelerations decelerations off tangent runs, they all increase the stress through different fascicles of the tendon. And that's I guess one of the aspects we can consider that's not been researched yet, and it's where we're going with our work is how we might bend the knee or straighten the knee or rotate the foot to isolate the stress through different sections of the Achilles that correspond to where on imaging we see the degradation. So if we ever want to remodel the tendon, we also need to Reese stress To the tendon at an appropriate threshold, that needs to be 85 to 90 or more percent of your maximum voluntary contraction. And let's face it, we have never done that because most rehab doesn't quantify strength. So I'd always measure spend 30 on a lot of you guys, I think in the states have access to isokinetic devices within your clinics or in local clinics, or other force measurement devices. And I, Scott Morrison's, got quite a lot of sort of workout suggesting how you might be able to do this with a handheld dynamometer, then there's methods we can do with that, or even a set of bathroom scales, to actually utilize a measure strength to give a patient a marker. So our normal data in rugby and football on large cohorts is twice body weight is normal. And we've got similar in endurance runners, our patients are typically one and a half times the weight. But that means doing a heel raise with just their bodyweight will not strengthen them significantly. And that's where we lack we have been our rehab has to be a lot heavier than we've often done in the past. So yeah, so in a nutshell, bilateral raises unilateral progressing through I don't use isometrics early as a method for pain relief, because the evidence substantiates it's not actually that good for pain relief, unless patients find it when the fork which case use it, the heel raises. good warm up response anyway. 31:24 Perfect. Yeah. And in the states do a lot of places have isokinetic testing? I don't know. Sorry. I don't I don't know about that. Even here in New York, I don't think you know, outside of like the larger systems. I don't know that a lot of individual physical therapy offices have that i i do have a handheld dynamometer. And I'm lucky enough to be friends with Scott Morrison. So he was able to kind of take me through and and how to use it. And but it's sometimes this setups can be a little complicated, especially if you don't have an office, if you go to people's homes, how do you stabilize one end and use the other end, and I've come up with some interesting options? Yeah, it's work. I use a seatbelts, I have chains, I have like this, the green, you know, the green stretch strap. Yeah, that with all that I started using that, because it doesn't give, you know, it's pretty, it's pretty good. So kind of it kind of along the line of a seatbelt, you know. So I started using that instead of using even some chain link, I found it to be a little bit easier, a little more gentle for people on their phones, 32:49 strap ratchet strap that you might use on a roof bar. So roof rack, you might actually use that strap and those type of straps can be very good, especially if the wider if the narrower than it hurts the person's knee when you strap it on top. But ultimately, I like it because we can showcase that they need to do strength work because they are weak, more data to give them when you haven't got that opportunity, it's really just sort of giving them this sort of step sort of wise approach to go while you're here need to be there, we need to progress through this and you then just target an exercise that is tolerable, but is sort of getting a little bit of reaction afterwards for a short period. So I've said bilaterally raises unilateral, unilateral with weight, or progressive forwards. And if you're a physio or PT that likes lots of different exercises, give them a dozen, that's fine. But if you're like me, I'm very simple, I just give them one or two things to do really well to do very regularly. And what we avoid in that way is they don't do the things that feel comfortable and easy, because that's what patients generally do. And they're avoid the ones that hurt them because they think it's making them worse. But if we educate them that this is critical, we've got to poke it a little bit to stimulate the cells and improve muscle strength to help the muscle shock absorber for the tendon, which is our current understanding of what we're trying to do with rehab. Then we've got to actually sort of work very well in a bit of discomfort. 34:21 And you beat me to the punch that was going to be my next question is how do you talk to the patient about like, this is not going to be pain free, necessarily, you know, you're gonna have some discomfort. So you kind of beat me to the punch on that. But I think it's important that patients know that you're gonna have some discomfort with these exercises and that's okay. Because a lot of people have been told, I certainly I see it, I'm sure you see it their whole life if it hurts, don't do it. 34:47 Yeah. says and what you've got to explain to them and I often use examples of relatives that you might have had that have had a hip or knee replacement done in the hospital and how afterwards they have to bend it have to walk And actually, yes, it hurts when he gets better or if you've broken your arm and you're in a plaster how gently stretching out when you come out of plaster help to get better. And that's then normally enough to help people go. Yeah, I understand that I can see how that would help and I also then often just explain that as you do this and you get the symptoms afterwards that's the cells in the tendon excreting some chemicals that whilst it makes it a bit sore, they also actually be modelled the tissue. And what we're trying to do is wait the cells up to repair the tissue, wait, repair the tendon, but also improve your muscle as well at the same time. And we've got to stimulate it. It's no different from delayed onset muscle soreness if you go to the gym so that's the other one that are commonly used as the example then we'll turn them penis Dom's is this chap called William Gibson in Australia has done a whole PhD on delayed onset soreness, because it's tendons that you've looked at and connective tissue, not muscle fibers sarcomere itself. And his work I think is really pivotable pivotal with our understanding of it. So yeah, flip it around as Dom's most patients have had Dom's at some point in their life. Yeah. 36:11 Oh, that's great. Yeah, I love that. Well, I have to say, I'm gonna have to re listen to this a couple of times, even though I'm here, I feel like I'm missing things. Like you're speaking I'm like, wait, what? Wait, did I miss this? And we have to listen to this over and over again, because everything is so good. And I think thank you for making it so applicable to the practicing therapist. Because I think that there are nothing against researchers. But there are a lot of practicing therapists out there probably more so than researchers who depend on you guys to be able to to some disseminate this information in a way that is practical and makes sense. So thank you for that. Now, as we start to wrap things up, what do you want the audience to take away from our conversation today? What are some key points, 36:56 I guess the most important parts of monitoring and treating people with tendinopathy is just get your diagnosis right in the first place. Differential diagnosis gets a lot of bad press at the moment, I think on social media, and it's been wanting to sort of dumb down and go with just we've got posterior heel pain, but how I treat an impingement versus tendinopathy will be very, very different, you need to differentiate. And then you need to look at isolated tendon and muscle exercises that is progressive in nature. And I think the key message to physical therapists and physios is that we need to load a lot heavier than often we've done in the past. And by getting normative values for certain sports like we're doing at the moment will help guide what we should be targeting. And they have performance relevance as well when you're dealing with athletes. But for a normal patient, this is a difference between crossing the road quickly in front of the car that's coming in, versus actually ended up with the car getting a bit too close to you. 37:55 Got it? Yeah. And and I love that load heavier and looking at the normative values, because like you said, if running is five to six times body weight, and you're working with someone doing a single leg heel raise, just with their own body weight, that's just not going to be enough. Yeah, right, we've got to we've got to push them a little bit more to load a little heavier. So thank you for that. Now, Seth, where can people find you if they have questions they want to ask you or they, you know, they want to find your research, where can they contact you. 38:27 I'm not a huge one for pushing the sort of research out other than via Twitter. So I have a Twitter handle that we sort of use regularly. And we'll put papers on there and things. But I don't have technically got a website that's on my Twitter profile, but I don't update it. So I'm terribly slack and too busy to bother updating it and need to sort it out. But hopefully this next year, I have a bit more time. So Twitter's The best one is just Sefo Neil, but yo is zero, because there's already another stuff anyone in the world someone and then my other handle is Achilles tendons on there. And just so you all know, it wasn't ego thing. We set it as Achilles tendons, because we went on Twitter originally to recruit patients for our research because some cancer specialist at the University had suggested it was a really good way is terrible, because you need loads of followers to be able to recruit patients and actually get your message out there. It was great for networking. And that's I think the big thing with it. So I network predominantly and occasionally advertise research projects that we're doing now. I've got enough followers to actually get some patients through the door that way. But yeah, not ego because it just so we're clear, 39:33 of course, and we'll have links to those Twitter accounts in the show notes at podcast at healthy, wealthy And like I said at the top of the our conversation, you are speaking a few times at the fourth World Congress is Sports Physical Therapy in Denmark at the end of this month, August 26 to 27th. So do you want to give a little sneak peek about what you're going to be talking about? At And what are you excited about for the conference? 40:03 So, myself and Karen Silva novel are going to be running a joint session for the British Journal Sports Med breakout on treating people with tendinopathy. So we're gonna do two sort of sessions of that. So replicate it. So hopefully, if you're interested in coming in, you can come in and send that and hopefully, it'll be nice and interactive, and flesh out some of the aspects we've discussed now, Karen, and then I'm chairing the session, which will be the session that I'm most looking forward to with Karen's there, who else have we got, I gotta get it right now. Michael Caja, and also Ben, Steph, Dakin, as well. So really looking forward to that. We're really nice to hear these guys talk because they are literally at the top of that sort of pinnacle of researchers and clinicians really worldwide. And then Denmark's nice. I mean, every conference, all I've ever managed to see is a little bit of Copenhagen. Because it's been sports Congress. And I normally dash in and bash out at conferences. So it's a little bit the same this time around. But I'm actually looking forward to seeing a bit of seen a bit of Nyborg. And also put two hours in the middle of the day for activity. And they've suggested paddleboarding. And whilst I dislocated my shoulder a week ago, or two weeks ago, it's my second time and I'm actually I was paddleboarding at the end of the week. So I'm hoping that there'll be a bit better by then and actually get out and have a decent paddle board and some exercise rather than just sat at the conference. So that's one of the things I'm looking forward to, and of course, enjoying a small beer with yourself. 41:40 That's yeah, it's a small beer. I look forward to it. And I'm looking forward to going in the summer, because I've only been to Copenhagen in February, and it is cold, and snowy and rainy, and all that stuff. So I'm looking forward to going in the summer. And just looking forward to seeing a lot of people that I haven't seen in a while. So that'll be really fun. And now last question, it's a one I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self? 42:13 Oh, gosh. Yeah, it's a really hard question. For me. I always fancied doing research, but I was always put off because there was no ability to do it when I first qualified to do a PhD in the UK was rare in physio, and you might have been able to get a stipend which is 15,000, a year, UK, which actually quite peaker often they further physios as well. Whereas now I'd actually say if that opportunity comes up, even if it's a bit of paper, I take it if you can, because it does open a lot of doors as you progress forwards. And I would unlike other people, sometimes I'd actually say yes to everything. Generally speaking, when it comes to work, not anything else in life, to look at options that we can just opens doors, you get so many things that you don't realize where it will lead and you agree to do something and actually, certainly in these uncertain other things that are fantastic and change your career. So say yes to things when you can push yourself. And yeah, you'll get that. So read the next Roscoe put that. 43:21 Perfect. Thank you so much. This was a great interview you gave us so much to think about as myself as a practicing clinician. So this was great. Thank you so much. 43:31 Pleasure, absolute pleasure. And thank you very much for having me, Karen. Yeah. And 43:35 everyone. Thanks so much for tuning in. Have a great, great couple of days, stay healthy, wealthy and smart. And also if you hope to see you in Denmark, so there's still time we've still got a couple of weeks before the end of August. So if you haven't already, sign up because it's going to be great. So thanks, Seth, and thanks everyone for listening and stay healthy, wealthy and smart.
Aug 1, 2022

In this episode, Founder of the Elevate to Thrive Academy, Relinde Moors, talks about self-limiting beliefs and entrepreneurship.

Today, Relinde talks about how our inner work can determine our business success, and how to identify limiting beliefs before they take hold. What are 5 limiting beliefs that keep us stuck?

Hear about ways to change limiting beliefs, how our thoughts impact our beliefs, and get Relinde’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “You can shift a belief in a moment what has taken a lifetime to build.”
  • “If you are feeling a desire to change that story in some way, you actually can.”
  • “The thought creates a feeling or emotion, and that emotion creates an action.”
  • “The thoughts, in the end, creates the result, not the circumstance.”
  • “If you have the vision or the idea or the feeling or the impulse, that is the thing to follow.”


More about Relinde Moors

Relinde Moors is the founder of the Elevate to Thrive Academy. Elevate to Thrive helps vision-driven coaches and experts make more impact and money, by elevating their energy, story, and sales.

Her clients have turned their freelance work into a multiple 6-figure thriving business, changed to 3-day workweeks while doubling their revenue, and moved to their dream country with their now 100% location independent online empire.

Her signature approach comes down to creating a clear and simplified business strategy and elevating your subconscious beliefs to support you goals.

Relinde lived and worked worldwide and recently found her way back home to a beautiful little ‘castle’ in a Dutch forest.


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Healthy, Wealthy, Smart, Entrepreneurship, Limiting Beliefs, Vision, Strategy, Myths,



5 Myths About Limiting Beliefs that Keep Entrepreneurs Stuck.

How to Assemble a Mental Superhero Team to Realize Your Dreams.


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Read the Full Transcript Here: 


Hi, are you there? Got it. Okay, great. Yeah, yeah. Hi, Melinda. Welcome to the podcast. I am so happy to have you on as a guest. We've been trying to do this for a while. So I'm really excited. Thanks for coming on.



Yes, thank you for having me. I'm really happy to be here. Finally.



Yes. And our connection is we did Selena Sue's impact accelerator in 2020. I believe it was, because it was right during the beginning of the pandemic. And so we spent nine months together, I think, right? Was it nine months, six months, nine months was a long time. So it was really a wonderful group of women led by Selena and her team. And Linda was one of those wonderful women. And I'm really excited to have you here now. And we are going to talk about some limiting beliefs that we may have as entrepreneurs that keep us stuck that don't allow us to move forward. But before we get to those nuggets, let's talk about how you came to realize that business success was highly dependent on the inner work we're willing to do. So I'll kick it over to you.



Yeah, great. Okay, so a little bit of my background, I studied dance and theater. So I actually worked as a choreographer as a dancer for like, 17 years, and I have my own dance company. And, and I thought that that was going to be what I would be doing my whole life, until things just changed. And I ended up going for a holiday to Bali. And in that holiday, a lot changed. And a lot happened. Long story short, I decided to quit my dance company. And I decided that I wanted to start more of a business of my own and an online business. And I ended up staying in Bali. So I got a little job there in a local yoga school teaching yoga and teaching contemporary dance, making very little money, because that was in rupee, us. And you need a lot of rupees to go around. So I could just maintain my living there, I was living on my savings, and I was making there. And in the meantime, I was learning more about business. Because even though when I look back, I wasn't an entrepreneur before that. I really didn't know that in a way that was just artistic. That was my focus. So it was learning about entrepreneurship, about online business, I found out how to do things I learned all the techniques started to create online courses, that all the things but it didn't really take off. And in that time on Bali, I took a course on limiting beliefs, it was specifically on that topic. And in that course, I at one point said to the teacher, listen, I need to really take a break because I'm working with a business coach, and I need to write my about page and I need to write all these things. And I have been working on it for days and days and days. And I don't seem to get it and I need to spend time and she said, that's okay, you can take the afternoon off. But why don't we look at the beliefs that are in the way of you just writing them. And she tested beliefs. And I remember there were beliefs like, I am a leader, I'm an expert. I I know who I am, I know what I want to do things like that. And some of those beliefs and I say tested actually have to explain that. We tested that with muscle testing with a Kinesiology technique. And she did that. And they were like testing as a no. So we worked on the beliefs and right after I said, Okay, I'm gonna sit down and write is about page and I just wrote it. I got it out. And that felt really good showed it to my business coach. And about like, two weeks later, I started to make so much more money. I literally made $15,000 In two weeks, which was totally surreal for me. And from then on, just something clicked in my head, I was okay, I needed to shift certain beliefs to have a breakthrough in a way to put myself out there and actually run a business and make money in a healthy and empowering way.



And what were the beliefs that were holding you back? What did you have to step over?



Yeah. I mean, fairly, honestly, a big belief that I found that I didn't know wasn't in because these beliefs live in your subconscious. So they often feel very big and dramatic, I would say. But there was a belief that I found that was I'm a failure, which was also related to me as because in the Netherlands, I was having a good career as a choreographer, my dance company against all odds was touring in the Netherlands and, and even abroad. And I was quitting that, but I felt I'm a failure, I'm like a failure, if I do that, because I didn't become this artist, or I'm gonna always feel at this business thing, I can never make so much money. So that were the kind of beliefs that I was mainly battling. And, and that and that felt deep, that felt really painful. It was very confronting to look at that. And to, to see that and so we did all the work around it. We'll get to that a little bit. Maybe later on, but there's just events in life that create those beliefs. So all of that came up. And I had to work through pretty emotional things to really let them go and have the change happen, because those beliefs changed.



Yeah. And now let's talk about those limiting beliefs. So there are a lot of myths kind of swirling around about some limiting beliefs that might keep us stuck. So why don't we dive in? I think there's five I'm sure there's 50. If there's five, right. But we'll take maybe some common ones. So let's, let's talk about number one.



So one is that a belief is just a thought that you keep thinking? And I don't I don't agree with that it does. It's not for that song on repeat. Because very often, we don't even know what are those beliefs, we think now I think I'm good enough, I think I'm good enough the way I am, right? And then when you look at the subconscious mind, it might not actually deep down believe that. Or I've worked with people, even really successful business people that make millions, and, and they have built so much success in their life. And I've worked through that. And they have, you know, the cars and the house, and they have the success. And we worked and we found beliefs around confidence. Like again, like the kind of I'm not good enough beliefs, or I'm not confidence, I actually don't know. This only can cut. And, and what so what seemed is that you can have this external reality of really success and being confident and being all the things. But then the belief doesn't have to support that. And then it even seems that this belief of I'm not successful, or I'm not confident, so I'm not good enough, actually became a motivator. A drive to always work harder to always do better. So it becomes it's another reason for the for the subconscious mind to not let go of that belief is like, hey, we get a lot out of that. Mm



hmm. Yeah. Especially if it becomes a driving force, you think, well, this is a good thing that I think or believe this, because it's driving me to where I am now. And then so then the question is, Is it harmful to get rid of that belief? Or what would happen if if that belief were to change if that's your motivating factor?



Yeah, when I work with my people, like in the method that I use, really, literally tell the brain? I mean, we will look for like, what are those benefit benefiting factors that came from that limiting belief? What are the good things and often Yes, motivation, or I'm connected, you know, other people like me, if I don't have I'm not so successful, I play a little small, and really liked and loved. And, and those are good things. And it's good to be connected to other people and to be humble even if you want that. But you don't need the limiting belief for that. And we will literally tell the brain, you can be successful and still be liked and loved and still be a really good person. And you know, you can have all those good things. I'm thinking of a woman I worked with, and it's a really clear example. She had this limit of she had her own business, and she was making about $5,000 a month. And she really felt like a limit there. Like, really like every time I go above that I get really uncomfortable. I do something to have a be relaxed the next month, she would even sometimes get physically sick. And I said, Okay, let's look at the belief. And what turned out is that in her life, in many different ways, she had learned that it's really, that you become a bad person if you make a lot of money. And she had worked before that for oil and gas companies and had stopped that because she felt my values just don't align with that. But it was over Ever in her life, it was reinforced that you can only make if you make a lot of money, you're a bad person. And when we could switch that I remember so well that she switched it. And she said, Oh, I want what I really want to believe is that money can be a force for good. And that if I make lots of money, I can make a beautiful positive impact in the world. And she literally, we did that session. And literally the next month, she started making three times more or four times more, just because she could not do that in a way that will stand in line with with her values. Really?



Yeah. And that's a deep, that's a deep one. To get over. I was



really deep. And then you also see it already, the parents have, you know, always taught her things like that. And then you just see how to hold family. And of course, the whole society would would teach things around them. Yeah, yeah. Oh, wow.



Okay, so that's a big, that's a big myth. What's Myth number two.



So Myth number two is that you can just replace the belief with a simple thought. So you just decide, I don't feel good enough or rich people are evil, like rich can be literally you believe or if I'm rich, I'm, I'm, I'm bad, or anything like that. And then you see it, and you just change it. Sometimes that might be the way and that is great. But it really isn't always. And that is because there's different reasons, as we just talked about this idea of like, hey, it's actually served me that the subconscious holds on to it. I speak about four reasons which one reason is the gifts as we just said, like the good things that came out of the limiting beliefs is the fear of the positive belief, I have so much money, that no, I will lose all my friends, because we will get to bigger difference, for example. And then there is people in places, which is people that told you that. So for example, my father told me that and I'm part of the family, as we just said, because he believes that so I want to believe the same. And then as emotions, which has to do with forgiveness, letting go of anger and letting go of resentments or regret.



Right, so you just can't say a positive thing every day. And poof, the belief is expunged?



No, yeah, as I said, it's really great. Because sometimes, yes, sometimes that works. But if something is a bit deeper, it's really good to do some deeper work around it. And that is, yeah, what I hate if people feel bad because of that, they're like, Oh, I just did all my affirmations. And I noticed and still I don't do this, and they almost get angry with themselves. And I'm like, let's get really kind with ourselves, because it's nothing but your subconscious mind actually wanting to protect you and thinking, hey, this believe we've had this for a long time. We want to keep it Yeah, right.



Right. Okay, that makes a lot of sense. Okay, what's Myth number three.



Myth number three, that would be another side of the coin is that you can't change them. So some people think this is just the way you are, people don't change in the core as they are, this is how it is or, and that is not true. either. You can definitely change them, you can change them on a deep, subconscious level. And then it will be you will almost forget it. Like I get clients and I have forgotten that I felt that behavior. Normally I would get really nervous if I would get on stage and speak in front of people. And this time, I just didn't even feel anything because we shifted to believe that was causing that nervousness, for example.



Yeah, and I'm sure a lot of people even as they get older, so you know, I've, I've been around for 50 years, you're not going to change my beliefs. That's part of who I am. Right. So that must be challenging to work with someone like that. So how do you approach a person that may come to you and say, Well, this is me. Can't change it? Yeah,



absolutely. I mean, first of all, I would talk about the fact that a lot of the beliefs that we have appear to be the truth, and that this might be one of them. So I would challenge that and I would see if I could get an opening in and what if we could we could change in right now. And and and then it might take time to really embody it and to really integrate it in your life. But what if that wouldn't be possible?



Yeah. And then it gets people thinking, Well, I mean, well, what if it did happen, then what would the outcome of that be what would my life look like? If I was able to, to change some of these beliefs that I think are impossible to change.



Yeah, exactly. I would also explain that. And this makes it quite concrete, I think that we have, you know, you have all the outer circumstances in life, the things that we experience. And then sometimes we feel powerless over those circumstances. Yet, the moment that you become empowered is when you think, Okay, this is the circumstance, I don't know, what would be a good example something that we're not happy with.



Let's say your what's your it'd be a good example. You. I mean, we can you can't find people to join your or to to be a part of your online course you you're launching an online course you've launched it, it's been a couple of months, and it's crickets no one's coming. So must mean oh, well, I just as I thought it's not good enough. No one's coming.



Exactly. Okay. Great example. So we have that circumstance, not selling anything, you did a whole launch did all the work, and it didn't work. So now, if your foot is exactly that must mean, it's not good enough, this is not gonna work, then you can ask yourself, Okay, I have that thought about the circumstance. I have that thought, what kind of what emotion does that create? So if I think you see is not good enough, I'm gonna feel a little sad and tired, I think and not so motivated to start over again. Then if I have that emotion, what kind of actions do I take? Maybe I quit it once. I, you know, I won't do it again. It's just like, I tried that this didn't work. And then I will have that results, it will never come. So this is how we and that is also how it works is like all the time does belief gets confirmed in life. That's how it works. So now when you change the thoughts, and you think, Hmm, interesting with curiosity, it didn't work this time. I am totally convinced that it can work. What can I change? Now you will have a different emotionally motivated, you're curious, maybe you'll ask a mentor or your hire a coach, I don't know what you'll do to figure that out. You take different actions, you launch it again, this time it sells out, yay. And then you have a different result. And then the belief will really be shifted. So this makes it I think, pretty concrete, and how those beliefs shape our reality, and how we actually have so much more power over our circumstances, no matter what happens, because we have power over what we think about him.



Yeah, I love that. And it, it's like, instead of looking at it as a complete failure, perhaps it's an opportunity to go a little deeper to do a little investigating. And to put it out again. Yes,



exactly. Yeah. And you know, if we go even a little deeper into that, for example, when I had my belief, I'm a failure, and some fat and I had actually a course that I sold it only to one person, and this person had in two weeks time asked for refunds. So imagine having that belief was horrible. It was so shit ashamed. You see, I'm a failure. So triggering that but having the understanding and then shifting, that belief was so powerful, not only for the business side, but in so many other areas of my life. So I now always say, Never waste a good trigger. If something like that happens. Yeah, that's amazing. We can find a belief we can shift it and that actually good news.



Wow, thanks for sharing that. What about myth number four?



Myth number four. Is that if you have that, yeah, we talked a little bit about that, but that it takes a lifetime to change them that if you've I've heard this often well, if you had something for 30 years, you will take 30 years to get rid of it. If you do and I really believe in going into that deep subconscious work. Because the conscious mind of course, it does a lot that the subconscious drives a lot of the behavior and results in the end, then you can actually change it in in a single session or in a in a moment. And then of course, as I said, it takes time to integrate it but they are Yeah, you can shift to believe in in a moment What has taken a lifetime to build? Yeah,



right. And I think that's important because a lot of people may think, Well, I don't have time to do this kind of work, because it's going to take months and months and months, years and years or a lifetime. I don't have the time.



Yeah, that that would be. It depends on how. So as I'll think about it right now is that it really saves me a lot of time, because instead of trying to change the outer reality, I'm going to get to the core shift the belief, and then the other reality on so many areas will change. So I think that that would be also my answer to that. And yes, indeed, it doesn't have to take you don't have to be in talk about it in therapy for a long, long time, you can actually find it another modality that works with this is EMDR. It has a similar approach. And yeah, I think it's very, very effective in a short amount of time.



Yeah. Because, you know, people these days, I mean, we can't even sit through, you know, an entire movie, sometimes going onto your phone or being distracted by a million things. And now you want to just short, tic TOCs, or short reels are all like, it seems our brain is primed to, to have the attention span for Do you know what I mean? So it's like, if it's gonna take a week, a month, years, whatever, people will throw up their hands and say, Oh, forget it. Yeah,



yes. And in a way, I think in a way, that is a way for the brain to avoid the possible, confronting things that this might bring up. So there is this feeling of I know, this might bring up things from my childhood or things that I find really painful. And I believe that that thought of like, I don't have time for that is actually a resistance to that might not because part of the work is in the moment maybe uncomfortable. Yeah,



yeah. So it's your brain saving you that discomfort and and protecting you essentially, that's what the I mean, our brains protect us, right? And so if, if the brain feels like, Oh, this is going to, no, I don't want to do this, it's going to be too uncomfortable. I'm going to protect you, we're not going to do it at all. If we compare it to like, the physical body. Like if, if you you were on a ledge, and it was a 10 foot drop, your brain would be like, Nope, because you're gonna probably hurt yourself, if you go down and jump off this 10 foot drop instead, why don't we take the long way around and use the stairs? To save to save ourselves? Right? So it's kind of the same thing. It's like the brain is just protecting you from what could be something that's uncomfortable that is going to make you do something you don't want to do.



Yeah, yeah, absolutely. Yeah, absolutely. Yeah,



that makes a lot of sense. Okay, what is myth? Number five? I feel like this is a big one.



Myth number five, is that the ones from your family that you can't change it? So this is a big one. And there are studies on that believes genetically or trauma genetically gets passed on, right? So there is and the experience is I just I've grown, this is who I am, we, my, my whole family lives this way. It's important for me to protect that. And I understand. And really, you know, sometimes when you change a certain belief or attitudes towards something, it might be that people are confused for a moment, or that it changes your dynamics with your parents or with your family or with your loved ones. And that fear, again, is underneath that as well. It is the most beautiful and empowering thing, I think to to realize that you can write your own story. That's how I think about it, that the family line comes with a certain story. But if you are feeling a desire to change that sort of story in some way that you actually can, and very often it actually changes the dynamic also for the better, very often it releases or unleashes things in the family that are actually really healing not only for you, but also for the people around you. Yeah,



yeah. So again, things can change. beliefs can change. So I'm going to recap myths one through five you'll let me know if I Don't get them. Right. So myth one is their thoughts just stuck on repeat. Myth number two, you just replace them with more positive thoughts. Myth number three can't change them hardwired? Sorry, I'm too old to change can't What is it? You can't teach an old dog new tricks, right? Exactly that myth number four, they take a lifetime to change. And myth number five, the ones from your family can't change. So all those are myths. So I think we've busted all of them. Now, a lot of people may think, oh, boy, subconscious mind, the brain. This all sounds a little too out there for me. So what would you say to folks who are resistant to go there? Because they think it's a little too out there?



Yeah. I would actually ask, like, imagine that you would see that as a belief, first of all, so that you would say, okay, I can, for a moment just play an experiment and the things that I see as true to my life. Let me see you this. Okay. That's the that's really the rooted belief that I have right now. And then play around with what if you would say, Yes, I'm going to completely subscribe to that idea. I'm going to think that limiting beliefs can be changed in a subconscious in one session, just like Melinda just said, like, what could possibly be bad about that? How could that be a bad thing? And that would actually be fierce around that whole idea. Now, maybe when you've determined that, why not give it a try? Like why you don't have to completely believe that it works that way. But why not give yourself the benefits of you know, give this whole idea to benefit of the doubt and just say like, you know what, I can experiment with it, I can just give it a go. And when a belief comes up, or when something comes up in your life that doesn't go the way that you wanted, or you have something that really triggers you in some way. Why not write down what you think the thoughts and the beliefs are that underneath that, remember that idea of we have the circumstance, the outer reality, and then we have the thoughts that creates a feeling the feeling creates an action and the action creates a result? So what if you would slightly change your foot around it? And just give yourself that that play of okay, well, good, what would that actually do to me?



Yeah, well, I love that. Can you say that again? So you start with the external, and then it goes to your thoughts. Go ahead. You complete it, because I thought that was really great.



Yeah, yeah. So yeah, so the external is a circumstance, the reality is the bank account that doesn't have enough money, the arm that hurts the I don't know. I don't know, boyfriend who is not calling like, I don't care, like whatever that is the business, as we said, the course that isn't failing. And then the thinking, okay, that's the circumstance. Now, what is my thought about him. And this is such a great first thing to do to become aware of the thought about it, you know, that these thoughts goes so fast, because you've practiced that a lot. So these wires in that house that is wired in a brain that is just happening so fast, that you might perceive them as the truth, but slow down, and just write down this is the thought, the foot creates a feeling or an emotion. And that emotion creates an action. So as we just said, If I feel a little disappointed and powerless, I might not take action, or I'll stop my business at all my online course thing at all. And that action creates results. So here's where you can see that the belief the forts, in the hands created the river, so not the circumstance.



I love it. I think that's great. And what a fantastic takeaway I was going to ask, okay, what do you really want the listeners to take away and I have to tell you, I think you beat me to the punch, because that's great. And it also shows, like we say, in the physical therapy world, I work with a lot of people with chronic pain, that the brain has plasticity, the brain can change. Yes. And it's not just in the physical. So what you're saying is you have these circumstances, here's your initial thought about it, if we can change that thought, perhaps the emotion connected to that which we sort of comes out of that amygdala area of the brain, that can be changed, that can be altered because the brain is plastic, and it can change. And I think that's such a great way to button up this conversation. I love it. I'm gonna think about that. Now. Every time something happens in and I have a thought and be like, Okay, wait a second. So Slow it down. What if I thought about it differently, I may have a different feeling. But then most importantly, your action will be different. So instead of saying my corset and tell I'm going to curl up in a ball on my bed and never leave, instead, it's my Corsten cell. Okay? Let me that could be an opportunity for me to go in and look at it, maybe jigger things up and see if I can, I can change things to make it a little bit more appealing. So then your action would be way different. So instead of curling up in a ball, it's let's edit this course, which are two very different things.



Exactly, exactly. Yeah, that's it. I love that.



Yeah, I love it. I think that's awesome. Now, where can people find you if they want to learn more about you, they want to work with you. Go ahead.



Great. Okay, so you can find me on all the socials, you can find my website, which is where Linda If you're listening, maybe not so easy. to spell that one, I do have a little mini course on how to shift any limiting belief. And I made a tiny URL, it's just to make things easy. And that would be Any limiting belief altogether. So little sentence, that one, I think is a great one to have. It has a couple of videos and some PDFs, where all of the things that we just talked about gets explained a little bit more in depth and just give you a simple process to do it or try it out for yourself.



Awesome. And we'll have all the links at podcast at healthy, wealthy So that you can go on and click and take a take this limiting shift any limiting belief course. So we will have all of the and links to all of your social media and everything else as well. Now, before we go the last question, which is when 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?



Yes. So I would really tell my long younger self to be more trusting of the things that I felt that I want to I've been always doing things I would say kind of against the status quo. I've even had a teacher one who said you always have to make the impossible possible. And now it would be like okay, trust yourself, and then it's gonna turn out okay. And even if somebody else doesn't believe it, or doesn't see it, if you have the vision or the idea or the feeling or the impulse, that is the thing to follow. So that is what I would say. I think



that is wonderful advice for your younger self and for all of our listeners listening today. So Linda, thank you so much for coming on sharing all this info. And again, everyone will have all of her Linda's information at podcast at healthy wealthy So Linda, thank you so much for coming on the podcast.



Thank you, Karen. Really lovely to be here.



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


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