In this episode, CEO of Julie Wiebe Physical Therapy, Inc., Dr. Julie Wiebe, PT, DPT, talks about running and pregnancy.
Today, Julie talks about running/exercise and pregnancy, creating baselines, the research around female running form, and she busts some pregnancy myths. When can you return to running after pregnancy?
What is Julie’s definition of ‘postpartum women’? She tells us about structuring exercises around their daily exercises and goals, pelvic health education, and she gives some advice to clinicians working with postpartum runners, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
More about Julie Wiebe
Julie Wiebe, PT, DPT has over twenty-four years of clinical experience in Sports Medicine and Pelvic Health, specializing in pelvic/abdominal, pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness and sport after injury and pregnancy, and equip pros to do the same. She has pioneered an integrative approach to promote women’s health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations (ortho/sports medicine, pelvic health, neurology, and pediatrics). A published author, Julie is a sought after speaker to provide continuing education and lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes through telehealth and her clinical practice in Los Angeles, California.
Physiotherapy, Pregnancy, Research, PT, Health, Therapy, Healthcare, Education, Training, Postpartum, Running, Exercise, Pelvic Health, Conversation,
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Running Rehab Roundtable Live Broadcast
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Read the full transcript:
Speaker 1 (00:07):
Welcome to the healthy, wealthy, and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information. You need to live your best life. Healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, Dr. Karen Litzy. Hey everybody. Welcome back to the podcast. I am your,
Speaker 2 (00:39):
The host, Karen Litzy and today's episode. I'm really excited to round out our month all about running injuries and running rehab with Dr. Julie Wiebe. She has over 24 years of clinical experience in sports medicine and pelvic health specializing in pelvic abdominal pregnancy and postpartum health for fit and athletic females. Her passion is to return women to fitness in sport, after injury in pregnancy and equip pros to do the same. She has pioneered an integrative approach to promote women's health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations, or at those sports medicine, pelvic health neurology, pediatrics, a published author. Julie is a sought after speaker to provide continuing education lectures internationally at clinics, academic institutions, conferences, and professional organizations. She provides direct care to female athletes to through tele-health and her clinical practice in Los Angeles, California.
Speaker 2 (01:48):
So Julie's amazing. And in this episode, we talk about some myths about running while pregnant and in the postpartum. And of course, the question that everyone always asks Julie is how can we return to run after pregnancy? So Julie answers that question and cause a lot of really helpful hints for practitioners to look for when evaluating postpartum women and those postpartum women, those runners can be anywhere from six weeks to six years, 16 years, 20 years after having a child. And she also encourages clinicians to think critically, to look deeper, to have a framework for evaluation, to try and, and, and get a baseline to ask your patients to film themselves while they're running or exercising so that you can understand what they look like when they're doing what they do. There's a lot of variables to post to running post-pregnancy and Julie really runs through all of them.
Speaker 2 (03:01):
So I want to give a big, huge thanks to Julie for coming on the podcast today and sharing all of this knowledge. And she also has a discount on the course. So she has a course on running a postpartum running. So she has a course for the listeners. So all you have to do is enter the promo code Litzy that's L I T Z Y my last name for 20% off treating and training the female runner. And just to be clear, this is for professionals, not for individuals. So this is for clinicians. So a huge thanks to Julie for that. We'll have all of the information, including links to everything in the podcast at podcast dot healthy, wealthy, smart.com. And tomorrow you can catch Julie live along with Dr. Ellie summers, Dr. Chris Johnson and Tom goom for our live round table discussion. That's tomorrow, March 30th at 2:00 PM Eastern standard time.
Speaker 2 (04:10):
If you can't make it still sign up because you'll still have a chance to get your question answered by the panel, and you will still get to watch the replay any time you want. And listen, this is a deal. It is $25 for four of, in my opinion, some of the best minds when it comes to running injury and rehab. So sign up today. If you're listening to this today, sign up today because you have until probably, I don't know, it starts maybe until like quarter to two tomorrow, which is March 30th to sign up for our live round table discussion. Again, that's with all four guests from this month, Ellie summers, Chris Johnson, Tom goon, and Julie Wiebe. So sign up to day. Hey, Julie, welcome back to the podcast. I think this is like your third visit to help you well, yes, thank you for sharing your platform with me again.
Speaker 2 (05:11):
I appreciate it. Of course. And, and this month, the month of March, we're talking all about running, running injuries, running rehab, and I know something that you're passionate about is caring for the postpartum woman that returned to running after giving birth. And, and we'll also talk a little bit about running while pregnant. Right. So I think that there are, there's a lot to cover. And so we are just going to, we're going to zoom right through this unintended since we're on zoom. But let's start first with running while pregnant. I feel like there's a lot of myths around running while pregnant. I don't know that it's understood very well by many people, including clinicians as well as the pregnant women. So I'm just going to kind of throw it over to you and let you just kind of talk about the, the running pregnant woman.
Speaker 3 (06:14):
Yeah. You know, and I think I think that regarding running and pregnancy, I mean, that's our focus, but really exercise and pregnancy. We still have, we are limited in our understanding of all things. Related to that I think we are started, we have information about things like cardiovascular response or, you know, some of those pieces of the puzzle. But in terms of the musculoskeletal, the neuromuscular, the response of the female host inter like how is that impacting the mom's body systems. Right. and I think that where we are struggling to have a lot of research there in part, because it's hard to find women that are willing to be participate in research. And then there's also a lot of, I, you know, we have to be protective of them. We have to protect them. And so, so it's this, you know, we want to honor that stage of life, but we also need to research it.
Speaker 3 (07:13):
So so I think we are struggling to, to understand all that, but we're starting to get more and more attention on it, which is awesome. As far as pregnant runners go there's only a few studies that I'm aware of that actually look at the pregnant runner and and of those one is a case study and one is on five women. So we have very limited understanding of what exactly goes on, but there were some themes. So I'll just share some themes. One is that in, in both the studies, they were, they were followed, the women were followed throughout the pregnancy changes were seen in all of the women on how they continue to run through the pregnancy meaning. And particularly the one with the five women, they all did something different, which is the variability is what we're seeing now.
Speaker 3 (08:07):
Everybody's bodies individually adapted differently. But the through line for them was there was a loss of pelvic and trunk rotation. So when we think about that pregnant runner, this is the way I've started describing it. The belly covers a ton of joints. Like it goes from the thorax to the pelvis. It it's basically, it takes all of these reciprocating joints and it turns it into a unit joint. Like it's one big joint, it blocks motion. So it reduces pelvic and trunk rotation. And so it limits, and then it forces them to rotate elsewhere. All of these are adaptions to help them continue to move through space appropriate for pregnancy and running. But when they go into the postpartum, they carry it with them. And that was what happened in both of these studies. They found that at six months for the woman who was the case study, and then at six weeks postpartum for the women, the five women in the other study, they held onto these, these some of these variables into the postpartum period and where that's significant is that women are given that okay by their doctor at six to eight weeks.
Speaker 3 (09:19):
This just like, you can just start doing your thing again. But their understanding is I got to just lose weight and get a flat belly. What our understanding needs to be is we need to understand what's changed for them. Biomechanically neuromuscularly emotionally, you know, fatigue, stress, like all of we have to understand all of those pieces and help them restore their interrelationships. Neuromuscularly biomechanically to be more like their baseline in order to prepare them for return to run. Like it's not just, okay, let's get him stronger. It's how do we help them restore that efficiency in their patterns that they lost, but no one realizes they lost it. So six years later, they show up to an orthopedic office and they have some of these running injuries, but how much of it is related to the compensations that they carried into their postpartum. So that's sort of a, an entry point into our conversation.
Speaker 2 (10:17):
Yeah. And that's, that is so interesting. And it makes sense that they would carry that over because our brain has is plastic and it's going to adapt. And our our sense of where we are appropriate susceptive sense is going to adapt to that. And it just doesn't end because the baby's not inside you anymore.
Speaker 3 (10:40):
Correct. And you're pulling it off, like in your mind, like you're still pulling off running, like you're actually running. So it, the understanding of what has changed is not understood globally. And I think like, I mean this, the running study related to the five runners that I mentioned, and that was from 2019. So this is, you know, relatively hot off the presses in terms of clinical understanding. So our job clinically is to help restore reciprocation that's really, and we understand the reciprocation is so important for all sorts of pieces of the puzzle for running. And one of those things is actually reducing ground reaction forces, getting our center of mass over that lead leg. Reciprocation is a huge piece of that. And so understanding just that, if that is all you walk away with today, understanding that you're a female that has a postpartum is postpartum, meaning they have a pregnancy in their history when you're working with them related to it, running injury.
Speaker 3 (11:39):
If it has a ground reaction force components like a knee or anything, you should be looking North of the border, not just foot strength, not just cadence, not like you have to look North and understand, are they actually reciprocating? Where's that reciprocation coming from? Because when you have a unit joint of the lumbar spine in the lower, the only thing that's left is like TL junction and above. So that's where they're reciprocating is way up high at the chest. And if you watch Fumo runner, that's what they're doing. They're punching the sky, it's all up, up, up, up chest high. And it's, that's the pattern that they partially developed during the pregnancy to continue running and pregnancy. There's nothing wrong with that. It co it's an appropriate compensation, but it does. If you don't restore actual reciprocation between the trunk and the pelvis, that's what you're looking for. And if the woman is in gripping her abs, cause she wants to get flat abs again, that's a UDA joint, it's a uniform engagement of the abdomen is what most women hang on to, or try to do while they're running. And that continues to keep their reciprocation high. So it's like understand what's going on North of the border for these women, versus just looking at things like landing mechanics, landing mechanics are affected by what's happening North so
Speaker 2 (12:59):
Well that's so, yeah, that is so interesting. And now I'm going to be, you know, in central park watching all these women to see, okay, are they just running with their, from like the thoracolumbar junction up? And then just having legs move like a cartoon character or are they actually getting excursion and rotation through the trunk?
Speaker 3 (13:19):
Amen. Yeah. And then we're getting into summer, right? I mean, I'm here in California, so we're gonna be able to see people's abdomens. And the thing that I, my cue for my clinician friends is what's going on with the navel. Like if their navel is staying straight, dead, straight, the whole time they're holding their abdomen. So stiffly through their run, that they aren't reciprocated. Like they can't be like, that's an indication that's a quick and dirty clinical sign that you can see that that means the reciprocation is likely coming up higher. And then it'll sort of clue you in and you'll see it. And they're, they're the ones punching high in the sky. They've got ribs flared up, like it's sort of, and that's a lot of our female runners. And it's a lot of our women that have never had children because they're holding their abdomens.
Speaker 3 (14:03):
Cause that's what they think they're supposed to do. And we also have studies that have shown us that stiff abdomen when they had men jump off a height actually increase their ground reaction forces. So it makes sense it's part and parcel, right? Like, you know, we just got to sort of brought in and I think that's my hope when I talk about stuff like this with my ortho and sports medicine, friends and colleagues because that's really, I'm a sports medicine, PT, I'm not a traditional pelvic health PT, but is to broaden our lens and add these ideas into our differential diagnosis. Like we need to start thinking about how these things are affecting. Some of the things we look for in sports medicine. Like we understand to look at how ground reaction forces what's happening, but we don't often this into our thought process. Like how, why is that a typical running pattern for women? It's not just because we have brought her hips and Q angles and, you know, blah, blah, blah, look North, look North with me. There's more going on for these women. And and we have some strategy pieces that we could add into our thought process to help them
Speaker 2 (15:13):
Yeah, amazing coming in hot, right out of the gate pair with a great tip for everyone. So thank you for that. And one one question that I want to ask, just so the listeners really understand when you talk about postpartum women, can you define what that means?
Speaker 3 (15:32):
I'll give you my definition. Sure. It doesn't necessarily mean that it is the definition. But I consider anyone who's ever had a baby. And, and here's what I'll say about that. I think technically it's the first year that might be kind of more of a technical thought process. And that's mainly because I started learning this backwards when my, on my patients who were 35 and 45 and 55 and 65. And they still look like me. This is million years ago. Now when I was at postpartum early postpartum, like the way that I was using my body and it was creating issues for me, they were using their bodies that same way. And they were like, well, they had grandchildren at that point. And so once we start understanding, yes, it's a normal process that women go through, but our job is to understand what they went through and help them find their way back to efficiency and effective use of their structure and their systems and their like I D I was Chris. I love that Chris Johnson talked about their ecosystems, like, you know, like looking at all of those pieces for them and understanding our job is to help them get back to their baseline, their individual baseline. Cause my torso is this, like this with this link legs. Some people have long legs short, let you know, like to understand that. So my, one of my big pushes I hope to achieve at some point is to get baselines, like, let's start getting baselines. I was women. Yeah, go.
Speaker 2 (17:09):
I was just gonna ask that you, you beat me to the punch. I was just going to say, so if someone is coming to me as a woman who is a runner and she had a child would say a year ago or two years ago, even how do I know what her baseline is?
Speaker 3 (17:27):
Correct? Well, what I do is I have them try to bring me film from prior to the injury. So these are for women that haven't had babies or like what they look like running prior to having a baby. And again, so many women have said to me, well, I leaked even before I had a baby when I ran. So then you might find stuff in their running form that might help explain that like Mabel's that go straight ahead? You know, things like that. But it does give us sort of an understanding of, is the running form that we're seeing right now, is that speaking to why they're having the injury, the, whatever it is, or is this the running form they've always had and they used to run without any difficulty. Like, you know what I mean? Like, so for me, that's how I started to create their baseline.
Speaker 3 (18:15):
Even if I can't see what they look like. And a lot of women will, like, when we talk about diastasis, like, you know, something like along those lines, which I might have to define for the audience, but some women will send me pictures of them in a bikini from like their early twenties. They're like, Oh my gosh, you're right. I actually had a line down the middle, but I never gave it any thought because my belly was flat. But now that my belly is not flat, you know? So it's like, that's where we can start to kind of get some comparisons for baselines. But one of my goals is to reach into the medical community, meaning the obstetricians and the midwives and the nurse practitioners. If any of you are out there is to say, let's start creating baseline. You're the first contact for some women they'll come in for a prenatal visit or something like that. Like, let's get some baselines, encourage them to take video. How will they're lifting how they're running? You know, how are they doing these things that they want to get back to afterwards so that they have a library of their own baseline? Like let's understand what they look like beforehand so that we have a better idea of how to help them find their way back.
Speaker 2 (19:18):
Yeah. Yeah. Great answer. Thank you. And so we've talked a little bit about this return to run after pregnancy. And I know you said that is, that's what people want to know from you. How do I go back to running after I had a baby and you know, everybody wants a protocol. If you could do this, then do this and this then do this. Right? Right. So when someone says to you, when can I start running after I had a baby, what is your answer?
Speaker 3 (19:50):
My answer is, and everyone hates it. It depends, but I tell them what it depends on. And so, and that's what it does get a little tricky in a situation like this, because these are some of the variables that I want to know. So my, whenever I get a question like that, my favorite is when I get it from a practitioner, what should I tell my patient who wants to get back to running? And I'm like, okay, well, my, my response to you is I actually wrote a blog like this. Like, and I always get, Hey, quick question. And I'm like, it's not a quick question. It shouldn't be a quick question. You know, did they have a vaginal delivery? Was it traumatic? Did they have forceps? Did they have a Syrian? Was it, you know, did they have bed rest? Were they on bed rest?
Speaker 3 (20:29):
If you're on bed rest, no, you're not gonna start running right out of the gate. You're like, you know, like there's so many variables there was it a complicated pregnancy? Was there, you know, what's been happening to them during the recovery process, have they, you know, are they having postpartum depression? You know, what's the you know, what are all these variables that they're experiencing? Where are they having postpartum depression? Or are they depressed or having baby blues, partly because they've lost their exercise program. Like what, what are all of these variables that we're looking for and what was their athletic capacity before? What is it now? Or what are their goals? Cause I like to make goal specific recommendations. So those are some of like, those are just that's scratching the surface, but I don't want to make it sound like this is an inaccessible population to work with because you don't know what all those things are.
Speaker 3 (21:19):
But what I usually talk to my patients about is I understand their goals and then I break them down and we start preparing for them. So my program for you needs to prepare you for what you want to do. And I need to understand the demands that you're up against. If you want to run, I need to prepare you for impact. I need to prepare you for endurance. I need to prepare you for power and possibly change of direction, depending on what you want to do. Trail runs and jump over rocks and things like that. Like I need to prepare you for what it is you're going to be up against. And part of that preparation is looking at your form, giving you great form twos, helping you build in new form, creating an interval program, getting you impact ready. Like there's, it's not just, I need you to do some curls and tell me stuff and some cables, and now you can run.
Speaker 3 (22:10):
And I think that that's, but that's a typical postpartum recovery program, but it isn't a prep for return to run. I need to teach you to reciprocate. I need you to strengthen into those reciprocal movement patterns. I need you to do single leg work. I need you to do single leg loaded work. I need you to do single leg impact work. You know, I gotta get you practicing some of those pieces. Then I know you're prepared. And if you're leaking or having pain or having an I give you these things we're looking for while we're doing the prep work, we're just not quite ready. We need to modify those things. Keep giving you opportunities to build capacity and strategies for the kind of work you want to do. I'm going to build that back into your system so that you're ready. And if you're, again, if you're symptomatic during all the prep work, we're just not quite ready for the actual events, but let's figure out what still needs to be tweaked and what needs work. You know what I mean? And then like, let's start with elliptical, let's start with hiking. Let's start with things that don't have impact. If we're not, if we're having symptoms with impact, like sort of really parse, what's still creating the problems so that we can troubleshoot that. And then, and then get you back into interval prep, walk, run. You know what I mean? Like it's yeah. So it's yeah. So that's running, that's more running specific.
Speaker 2 (23:27):
Yeah. So if you're not, it's not like, okay, the doctor gave you the all clear at six to eight weeks depending. So I'm just going to give you a walk run program. And that's what you will do. There is a lot more building because like you said you to monitor, you want to give people their program, you want to monitor their, their reaction to it, their symptoms, and then make the necessary adaptations that you need to make and use your clinical judgment. Because we know that there's not a whole lot of research around even returned to run after pregnancy. There's not a lot of research to that, correct?
Speaker 3 (24:05):
Yeah. We're getting, we're starting, we'll give credit where you know, we're trying, but we, yeah, we have a lot of work to do. We need to figure out there's a lot. We need to understand just basics. But, but like some of the things that I, I I'm trying to create like little things, people can remember, like prepare, then participate, monitor, and modify. Like just keep get like put those pieces together for yourself. Cause some people don't have access. That's the other thing, like if anyone out there doesn't have access for whatever reason to the practitioner, like you are, you have a lot of power by knowing what to monitor for knowing it's not normal to have pelvic pressure or leaking or pain while you're running. It's not normal. Like we want you to feel good while you're running and you know, just cause you had a baby, does it mean that you should be in pain and leak for the rest of your life?
Speaker 3 (25:01):
Like that's an incorrect, like I think we did. We say we're going to bust myths. Like that's a myth D please don't buy into it. So yeah, and I think I lost your question in there somehow. Did I? No, no, no, no. Boston my own head. No, not at all, but it is. It's like these, like what else? You know, and then follow the other thing I try to tell people is follow your success. If it seems to be that you're having more symptoms on the flats, but you're okay if you are going uphill, which is not unusual because it sort of helps you have a better running form automatically. Then let's walk the flats, run up the Hill. You don't like listen to what's happening, but learn how to interpret it. I think that's what I'm hoping clinicians can be, is really great interpreters of what's happening with the patient standing in front of them so that they can they can be better guides.
Speaker 3 (25:54):
I mean, that's really ultimately what we're doing. We're guiding people through their process because everyone's process is going to be a little bit different. It should be. And I would love for, I would w I went a hundred percent with lots of over the protocol, charge everybody 10 books now, but it doesn't exist because everyone is different everyone's path through pregnancy is different. That one study we have was so fascinating. All those women did something different to get through the pregnancy running. So, so we, we were just learning, right. We're learning about, about everybody's path through, through all this stuff. So how can we guide them? And I think monitoring modifying, progressing not gradually in a scared way, but in a smart way, like, Oh, we tried that. That was too far. All right. So backing off a little bit. Let's try this. Let's modify, modify, keep adapting. So I don't know. Now I'm going down a whole nother rabbit.
Speaker 2 (26:48):
No, no, no, that's it. This is all, this is all amazing. And I, and I really think the listeners will, we'll definitely come away with, you know, the, the monitor and make it adaptations and watch and listen. And also, like you said you sort of referenced Chris Johnson, sort of talking about the whole ecosystem. So again, I think it's important to when you are sitting down with this patient for the first time, you know, you have all these questions, but then your other questions are, well, how old, how old is your child? Do you have more than one? What are your responsibilities at home? Do you have a nanny? Are you a single mom? Are you working? What are your time constraints? Like, because all of that feeds into what kind of program you can give this person, because they may say, Hey, listen, I have 10 minutes a day to do some exercises. And, and what happens a lot is people think I only have 10 minutes a day. It's never going to work. Right. So how do you get around those with your clients?
Speaker 3 (27:51):
I usually use their exercise program is their fitness program, whatever it is, like rather than ask them to stop. I, and so, I mean, we're talking early postpartum versus someone who's maybe coming back two years later. Right? So you know, I try to integrate, my goals have always been, or my path has always been about building brain strategies, neuromuscular. So then I'm teaching them how to re-establish. Some of the, the, the, so let's talk early postpartum things get kind of funky in terms of how components of the central stability Central's control system operates. I'm working on helping them reconnect and implement it into their function. They have to take care of their kids. If you're lifting your kid, we're going to do it in a way that sort of pulls in the brain's going to use all these components to help them start, to learn, to be reintegrated into your movements, just movement going up the steps.
Speaker 3 (28:50):
Guess what steps is just like running. We're going to actually, if your goal is running, I'm going to make going up and down the steps with your laundry hamper or your baby as your prep for return to run. But we're going to do it super low impact. We're going to think it through. We're going to have to, like, we're going to rebuild that reciprocation through walking up and down the steps. We're going to, you know, match it to your function right now. But if you're two years out and you're, it's a different ball game, I'm going to use your running as your program. I'm going to adapt your running and keep you below your symptom threshold or make it look a whole heck of a lot like running so that you're motivated to do your, if your 10 minutes is spent running and that's your goal, you'll do it.
Speaker 3 (29:32):
Do you know what I mean? But if I say you got to lay down on the ground and do these rehab exercises that make no connection for you, you human, emotional, or your brain to your goal. You're not going to be motivated to do that. So I have always broken down their exercise programs, if they are CrossFitters or going to gym or whatever it is, show me three exercises that you like to do. Yoga, Pilates, whatever it is, what are three things let's implement these ideas and strategies under something that you enjoy, because I know you'll be compliant. And then they know you're listening. That therapeutic Alliance is there, like out of the gate, you want to help them get to their goals,
Speaker 2 (30:11):
Right? So it's, it's like, you can take things they're already doing and modify, adapt it, allow them, give them the tools they need to implement. What will help them in that exercise. And ultimately perhaps help them get back to their running or whatever it might be. Okay.
Speaker 3 (30:31):
Break it down, break it down and then build it back up. That's got it. That's a pretty straightforward way to do it with any athlete. It doesn't have to be running. But you got to know what they're up against. So I, if I am not familiar with something, I just say, show me, I don't know, show me what that is. And I don't know the words, I'm the first one to admit it, but I can't remember what that, can you just show me that and they'll sh and then you can break it down. Like, I think that's, to a lot of people's barriers to working with athletes is they don't feel comfortable with the sport. And then of course we have, you know, members of our community that say things like, well, do you lift, do you even run? I know. And it's like, like, it's really I don't, I don't surf and I will never, my first surfer when I moved to California, you know what I did, I looked at YouTube and I looked at, I watched, I watched videos.
Speaker 3 (31:30):
I looked, I tried to understand what are the physical demands of surfing, but that didn't mean I couldn't help him. You know what I mean? Like, don't get me started. So anyways, so I think that it intimidates because also like, that would mean that men couldn't work with female athletes too. Like, cause you don't have a vagina. Like that's, it's a, it's an illogical argument and it makes me mad. So anyway, surfing is I that's one of the examples that I use because I don't surf and I never will because I'm afraid of sharks. So we w w your job, our specialty physical therapist should be movement analysis. That to me is a pretty basic part of our definition. And I know that you can at least pick out efficiency. Do you know what I mean? Like, you can pick out efficiency and I use video, like crazy.
Speaker 3 (32:19):
Have them bring you videos of them. Weightlifting have them bring you videos of running, and then you can slow it down. Look at it, really carefully. Look at it at home before you stand in front of them, start to break it down, look online. What is a clean and jerk, and then ask them to send you a video of a clean and jerk compared them and start to pick out where it's different. There you go. You know what I mean? Like, I think that we create this barrier for clinicians to be able to participate in this kind of care if we make it unattainable because they don't actually participate in it anyway. Yeah.
Speaker 2 (32:56):
Listen, I could not agree more. I think that's the dumbest dumbest argument against a qualified physical therapist, seeing the person in front of them, because what if you're the only physical therapist for 50 mile radius? What are you supposed to like, sorry, pal. I'm not an Olympic lifter can help you.
Speaker 3 (33:17):
Yeah, it's so stupid. It's so stupid. Well, and it's really the other thing too then is it's also important to sort of highlight and carefully and kindly and respectfully say that's also how pelvic health is understood by so many. Well, it's not, that's not my department, but it's physically inside the woman standing in front of you. It's part of her department. So like, you may be the only practitioner for miles and you are the only person that understands the human body, the way you do as a physical therapist. It behooves you to start understanding some of these processes. When we start to talk about our differential diagnoses for runners is to understand what is happening, what, how might this have affected what I'm seeing clinically? And then it's not, it's not pelvic health, like in this movie way, it's pelvic health as a, it's a, it's a friend to helping you understand what's going on with these patients.
Speaker 3 (34:16):
So, so again, like in the same way that, you know, folks get scooted away from participating with female athletes or athleticism, we don't want to scoot them away from pelvic health because it's scary or UV, or it's not their department. Like we need to open those doors broadly and say, let's, let's skill everybody up. Let's equip everybody, the pelvic health community to understand fitness better, and the fitness community to understand pelvic health better. Like let's everybody come to the middle and not create barriers inside the community to those things. Like, let's appreciate the perspective that we each bring so that we can optimize the care for our patients who don't have resources to go down, you know, and with telemedicine creates new opportunities until unless we can't do it nationally. Right. Can we have a talk about that?
Speaker 2 (35:08):
Yeah. I would love to have a talk about that. Like maybe every, every licensing board across the country, again, it's so stupid because we take a national exam, but we're only licensed in anyway. Yeah. We could have, we could have a round table on that one. But you know, what you said is really important about so for the physical therapist or even other health professionals listening pelvic health, it does not mean that you have to be clinically prepared to do internal work, right? No, not necessary. And it just means that you're treating the musculoskeletal health of someone who happens to have a pelvis, which last I checked is everyone. And so, and so you should, you should be able to do that. You may not ha you don't have to be certified as a women's health specialist, but you can take get information, read books, watch videos, take courses so that you are competent in, let's say for the sake of this month, I'm runners treating a woman postpartum that wants to get back to running.
Speaker 3 (36:25):
Right. And there, and that's, and I think that that's partially, I mean, to just be fair, I think we all learn pelvic health in a very isolated way in PT schools. You know what I mean? So I think that there's been a huge change in the conversation in the pelvic health community over the years. And it's just starting to get out there in, in other ways. So it also behooves those of us. And again, like I find myself always serve in the middle of these worlds. Those of us who communicate it in a way that's relevant to like, let's be communicating in a way that is enticing to learn more. Like, I want those to gain those skills and and understand it in a way that is relevant. And I, and so, yeah, so we have a lot of work to do to the physical therapy educational programming to start to build it into models a little bit differently, so that it's under some of the other side a little differently too. Right. So it's just, we're all we're evolving, but it is true that it has classically been defined that way. Right. Like, right. And so I think so anyway, yeah. So I, I agree with you, there's a lot we can do there. And it's also like, can you at least talk about like, and to have some ability to do that is important, you know, so,
Speaker 2 (37:45):
Yeah. And, and hopefully people like yourself and maybe podcasts like this and other podcasts that are out there will really help clinicians. And non-clinicians, you know, your, your, your gal that, that just had a baby. Who's like, I, I don't know what to do. How, what do I do? Yeah. You know, I just had someone contact me today who is eight months pregnant and she's starting to have a little low back pain. And she said, you know, should I just go to the doctor or should I just go to any PT or what should I do? And and I was like, Oh, I'm so happy that she's reaching out for a physical therapist, you know? But a lot of people just don't even know that that's an option. Right. So,
Speaker 3 (38:32):
Yeah. Cause the messages, while you're pregnant, low back pain, you're pregnant, you know? And, and so it's really, there's a lot of education that needs to happen, but I do think you know, so much of it is around I'm trying to think of a good way to say this, centering the woman as like that, those concerns just because they're common. I hate the common. Not more, it's not, I hate that. I get it, but it's also like, it just always has been, but that doesn't mean that's how it should be, or it has to be moving forward. Like I think we're starting to get more female researchers, myself trying to do that too, to help, you know, we're trying to have females asking questions for females and to the credit of this one particular, he will never know. I should write him a note, but like I had a conversation once with a running researcher.
Speaker 3 (39:28):
And I was like, did you think about the fact that that lady was probably in continent? Like he had just done something at CSM and he goes, that would never have crossed my mind. And I, and he wasn't like a poopoo that couldn't possibly be a variable. He was like, it looks like you need to start doing some research. And it was, it was literally like the last nail in the coffin of me, like meeting that, like I knew I wanted to go that direction, but it was one of those, you know, those really landmarking conversations that just sort of are like, w wait, wait, wait, wait, wait, I'm point. Knowing what I'm doing, like cooking you in the right direction. Yeah. It's to say, you know, this is you, you understand it. And I think that's, you know, again, you know, we talked a little bit about clinical utility and research, like trying to ask the questions that women need to ask, you know, so we need for your eight month pregnant lady, we got to get better information to her and to people that can care for her in her local community.
Speaker 2 (40:25):
Yeah. And, and again, you know, we talked a little bit about this before we went on, but, you know, asking the right questions, asking questions, asking simple questions. Because as, as we've spoken about the research for even simple, for simple questions is not there. So before we went on, Julie was saying, you know, we don't know what the pelvic does when we go to sit to stand, what is it doing when we're walking? We don't, we don't know what's happening in the pelvis and the pelvic floor and, and, and articulations above and below. So how are we supposed to know with certainty what's happened when you're running or when you have impact or jumping? So I think these, like you said, these smaller questions need to be looked at and researched, and then hopefully that body of work can build up to something much more clinically.
Speaker 3 (41:15):
Yeah. We need to sort of, we need to build in the basics and, and, and, and we're working like there are teams working on that, like we have, and we're using computer modeling as a way that this is starting to get there because we can't the issue. And also, I really want to make something super clear before we get moving. This direction is one of the things that I'm trying to be really careful about is not just talking about the pelvic floor, but to talk about pelvic health, because the pelvic floor is not the only gatekeeper that creates pelvic health. And it is a component of multiple body systems. And we need to understand that those systems affect the way the pelvic floor acts and behaves and the pelvic floor itself, you know, needs to be, have attention directed at it. But B because when we talk about just pelvic floor, I think it isolated away from relevance to other areas of care.
Speaker 3 (42:05):
So I just want to be clear on that. So but we don't know what its behavior is. Cause we can't see it. We can't put a, you know, it's just, we are, but we're starting to get new ways to be able to understand it better through a technology advances. So we're getting there, right? Like, so that's been a barrier to understand this better in in the dynamic, in dynamic activity. And we are seeing computer modeling as an option to help us start to understand this a little bit better, but that modeling is usually done on like an N of one. One of my favorite studies is a computer modeling study, but it's with something, I can't remember the title now off the top of my head, but it was something like, you know computer modeling of pelvic, the pelvic floor during an impact activity and an athletic female or something like that, or for female athletes.
Speaker 3 (42:52):
But then it literally says in the methods section that the woman they chose wasn't athletic and I'm like, well, crap. Okay. But I mean, it gives us, it gives us new insight. We'll take it. But I would really like to see it on someone who is an athlete, because, you know, we want to understand all of those variables anyways. So, you know, we're just trying to get there, but we haven't always, we can't visualize the pelvic floor in when we're watching a runner, but we can watch it's relationships. We know it's related to the glutes. We know it's related to the pelvis and the low back and the abdomen and diaphragm, we can watch all those other relationships. And we're really good at that in ortho, in sports medicine. So there's all of these interrelationships that we can watch and understand that a little bit better and differently, but you know, there's elements of what's going on there today. I am grateful to our pelvic health community for their capacity to treat directly.
Speaker 2 (43:49):
Yeah, yeah, absolutely. And now, before we start to wrap things up what I'd like to ask you is for, let's say the clinicians that are listening to us right now what, what is your best advice to those clinicians who are working with, let's say female runners who are postpartum at any point postpartum, whether it be six weeks, six months, six years, what have you,
Speaker 3 (44:22):
Oh let's see. That's kind of a loaded question, but I think it would be to learn to ask questions like that would be my best advice, like, and ask questions that make you a little uncomfortable. You will get more comfortable with it. And understand that what you're trying to do is open a door of communication. Like create a conversation around this with your athletes. Here's what we know, which is not much, but my understanding is after you've had a baby or two, it affects your running form and you can hang on to those changes six weeks, six months, six years, whatever, wherever they are, unless we actually look at them. So I'm wondering how that as part of your medical history is affecting what you're doing, but along with that often comes problems with how you're activating your abdomen. Or you might have a public health consideration like leaking when you're running or painful sex constipation.
Speaker 3 (45:24):
Like there's other problems that women have that are under the public health realm. You know, and so so I'm going to ask you, so have them in your intake form, have them, you know, are you comfortable having a conversation with me about that part of your life and your experience? Cause I'm wondering how it might be affecting what we're seeing here. We understand that there's an interrelationship with learning. The research is limited, but, and if you're not comfortable talking to me, understand that, you know, it is something that I think might be a variable. And so I'm going to actually at least try to incorporate your pelvic floor and your diaphragm and some of those interrelationships into our programming. But I also have someone down the street that you can talk to a few, be more comfortable. I just want to open that door, like open the door to a conversation.
Speaker 3 (46:07):
Like if that, if nothing else, if they aren't comfortable, you also should be skilling up to understand these components. How do you, what should, what do you see in a typical postpartum runner start looking for navels, start looking, going to central park, whatever it is, start to pay attention to these other variables and serve to give fit, give it new. Meaning like I, cause I read a lot of running research and athletics like sports medicine research and the meaning that it's attributed that is attributed to it is often based on what we've understood in men or like a strength based model. Like, well, they're just there post your chain. Isn't strong enough. Well, my question is why, why would every freaking females post your chain the off? Let's put that. Let's start thinking about that. That's the kind of questions I want to ask. Like the why we're seeing that as our common, it's not just structure, it can't just be structured because women aren't all structured the same P S all women do not run it into your tilt.
Speaker 3 (47:08):
Like they don't, what do you mean? Come on. Nobody does the same thing. All of us. Like it can't be. So it's like with what we've put this meaning on it and if you're postpartum or you're pregnant, you're you have an anterior tilt. Well, we have to have research has shown us. That's not true. So it's like, and then I don't know how you can overstride and inter tilt at the same time. Like, we need to really think about that because, but we've always, that's sort of the lens. And so everything gets filtered through it to the point that we exclude, like other, like, instead of thinking, Oh, well, this can't be the explanation. Let's ask other questions. It's this becomes the definition. Does that make, am I making sense? A hundred percent. Yeah. So it's like, how do we start say, okay, that's we didn't get to the bottom of it.
Speaker 3 (47:57):
What other questions can we be asking? And and, and to start to look at women, not just women, men too. So it's, it's like, how can we start to ask our questions a little bit differently? How can we start to and really it's to look for the, why's not, what is, why, why in the world are we finding this with all of our female athletes? Could it be the way that we've trained them to suck their stomachs in all the time, since they were 12 and 10, you know, like how could that possibly affect an entire generation of, of participants, right. Let's start looking at this, you know, so yeah. So I love her. Yeah. I mean, we brought up Eric Miura prior, so we'll throw him a little shout out here, but I wanna, I, I heard him speak at a conference.
Speaker 3 (48:45):
I don't even know time has no meaning now, but and one of the things he said was I, which I love was talking about with research. When you read the conclusion and research, is, is there any other explanation that could have come to that same conclusion based on what you're seeing in the light? And I thought that's so smart because sometimes I'm like, Oh, yay. My biases, my biases, whatever affirmed. And, but I, but so he was referring to that related to the research, but I think one of the things that I keep trying to think through for myself, and I think would be a really wise way for all of us as clinicians to think about it is what are other reasons why they responded to my treatment? What are other reasons that they could be experiencing this problem that has nothing to do with what I've always understood?
Speaker 3 (49:28):
You know what I mean? And I am sharing my bias. Like when I look at a female runner, I'm not like, Oh, that calf looks weak. I'm like, Oh, wow. Look at their central control system. Cause that's, you know, that's my lens. So I, you know, so I want to be open to understanding all of that other stuff, but I already, I already learned all that stuff. And this piece is something that isn't being considered by a lot of permissions. And so, yeah, so again, we need to start just broadening our lens and I think we're broadening it. I hope to look at females as not just little men and the problem we have wider pelvises, estrogen, and Q angles. Like there's other things happening for us that, that are not explained by those things. You know what I mean?
Speaker 2 (50:13):
Absolutely. Yeah. Thank you. This was awesome. Now, where can people find more information about you, more information about your, you have a running a female running course, where can, yes. Where can, where can we find all of that?
Speaker 3 (50:32):
I am at Julie PT and I have discovered that you can misspell my name and still find me. So it's J U L I E w I E B E P t.com. And I have, I do have an online course that was recorded from alive lives online opportunity. So it does have that flair that feel, but it also has the questions, which I love. And, but I also have lots of free resources in terms of blogs, videos. I do a lot of podcasts and have a newsletter to let you know about when opportunities are coming up. Like this one and what's coming up for us this next week to be a part of the round table. But but yeah, and I'm on all the socials
Speaker 2 (51:19):
You're everywhere. Thank you so much. You're all over the place in a good way. Not in a bad way, in a good way. So thanks so much before we sign off, I'll ask you the same question I ask everyone, and I probably asked you at twice or three times already, but we'll ask again, you can keep giving the same answer I want growing and learning. So that's true, but that's true. Yeah. So what advice would you give to your younger self? You know, what I'm going to share?
Speaker 3 (51:49):
It's funny. I was just thinking about this before we got on, but, and this is something that I've learned during the pandemic and and it's from Aaron Nyquist just, but he was referring to the spiritual, but I'm going to relate it to our walkthrough. Learning is instead of thinking of learning as this linear thing that I learned this, and now I know this, so that's stupid. I learned I'm making it on my hand. No one can see me. I forgot it was on a podcast, but instead of it being linear, which is so much of what ends up happening in our rural this dichotomy, Oh, well, biomechanics is stupid pain. Science is everything like, instead of it becoming linear in our thoughts is to think include and transcend. And instead of it being a linear line that it'd be concentric circles. And I was like, Oh my gosh, if I could be a learner like that, always if I had started my thought processes that way, like, wow, that would have been important for me as a person growing, but as a clinician growing to like that, instead of it becoming these battles that we get between these dichotomous, like VMO and like Karen, you remember BIMA, well, remember BMO, but instead of these like dichotomous thought processes, let's see, what can we continue to include?
Speaker 3 (53:05):
And then how do we transcend it doesn't mean that what we used to think was horrible and versus stupid. It's like, how do we keep building on that in concentric circles versus this linear thought process? So, yeah, so that was, that was just on my mind today.
Speaker 2 (53:19):
What wonderful advice it's like, it's like a reverse, it's like a reverse funnel. Yeah. Yeah. It just keeps getting brought. Our perspectives should broaden our questions should really never be answered. Like we should never get to the end of that. Do you know what I mean? And I just, I, anyway, it was a really just as so much has changed and, and it's been a really challenging year for all of us. I thought it was a, and we're headed back to a new transcendent, normal that I hope will bring a lot of changes for all of us. You know, I just, it was, I, I think it's a really important perspective as clinicians to, so I thank you so much for sharing that and thank you for spending the time today and tomorrow. I know, and tomorrow is our round table with you and Ellie and Chris and, and Tom.
Speaker 2 (54:08):
And I was saying like, gosh, to have the four of you on like one stage is like, Holy crap. I can't even believe it. So thank you for that. And so everyone you can find out how to join us all by going to podcast dot healthy, wealthy, smart.com. I mentioned it in the beginning, in the intro as well. So Julie, thank you so much. I appreciate you and appreciate your, your knowledge and your insight. Well, thanks so much for having me again, Karen. I appreciate it. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and stuff.
Speaker 1 (54:38):
Mark, thank you for listening. And please subscribe to the podcast at podcast dot healthy, wealthy, smart.com. And don't forget to follow us on social media.
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Chris Johnson to discuss empowering runners through rehab. He is a Seattle-based physical therapist, performance coach, speaker, and multiple-time Kona Qualifier.
In this episode, we discuss:
More About Dr. Johnson:
Chris Johnson completed his undergraduate studies at the University of Delaware, where he earned a bachelor of science with distinction while completing a senior thesis in the physical therapy department under Dr. Lynn Snyder-Mackler. Chris was a member of the varsity men’s tennis team, scholar athlete, captain in 2000, and recipient of the Lee J Hyncik award for excellence in athletics and academics. He remained at the University of Delaware to earn a degree in physical therapy while completing an orthopedic/sports graduate fellowship under Dr. Michael J. Axe of First State Orthopedics. Following graduation, he relocated to New York City to work at the Nicholas Institute of Sports Medicine and Athletic Trauma of Lenox Hill Hospital as a physical therapist and researcher. He remained there for the ensuing eight years until 2010 when he opened his own physical therapy and performance facility, Chris Johnson PT, in the Flatiron District of Manhattan. In May 2013, Chris and his wife relocated from New York City to Seattle to pursue a more active, outdoor lifestyle. In addition to being a physical therapist, Chris is a certified triathlon coach (ITCA), three-time All American triathlete, two time Kona Qualifier, and is currently ranked 16th (AG) in the country for long course racing. Chris is also extensively published in the medical literature and has a monthly column on Ironman and an elaborate youtube channel.
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Read the full transcript here:
Speaker 1 (00:00):
Hey, Chris, welcome back to the podcast. I'm so happy to have you on in our month. All about running and running injury and running rehab. So thank you for carving out the time.
Speaker 2 (00:11):
It's fun to be back it's it's always a pleasure to connect with you. And it just snaps me back to New York city and I still don't know how we never crossed paths when when we were both there, but here we are, and I'm glad we connected and also happy women's history month. You're someone who's sort of spearheading a lot of great stuff in this space. And I think a lot of people, especially women look up to you and that you're a role model. So things that you've accomplished and continue to work on.
Speaker 1 (00:47):
That's very kind. Thank you. And now today we're going to do a basic Q and a with Chris Johnson. So Chris gets tons of flooded with questions and comments and things like that from emails to social media. And so I thought, well, let's see if we can make life a little bit easier, reach a wide audience and get some of these questions and concepts under control for you and out to the public. So let's start with a common question that you get is all is kind of around resistance, training and running. Do you need it? Do you not need it? I know that's a really broad question. So I'll throw it over to you around the the, the concept of resistance training and
Speaker 2 (01:40):
Yeah, and it's a, it's such a great question. I think that everyone's default answer is, you know, basically resistance training is a Holy grail for runners. And I do think it, it has its place, but I think that there are a lot of gaps in the research. And is it something that I prioritize myself as well as in working with the athletes I coach? Absolutely. But I think that anytime you're working with the runner, the primary goal is to get them into a rhythm with their training and to establish consistency of training. And then you can consider to start layering things in this is assuming someone's training and they're healthy. They have no remarkable past medical history. I, I think that, you know, the answer to that question differs especially if we start to get into master level runners who typically have a remarkable past medical history because most of these injuries and conditions go under rehab.
Speaker 2 (02:41):
You and I both know that as clinicians. So I think that a lot of the resistance training may just be cleaning up sloppy rehab that perhaps they didn't get around to addressing things at the tail end of the rehab. So there's a quote that I love, which is, you know, resistance training is really coordination, training under load. So, so yeah, I do think it has its place but it should be there to support our running, into build our capacity to run, but I've seen a lot of people get it wrong and they end up whether it's, if they're racing, they go into races where they're a little bit sluggish or they're carrying some residual fatigue. I've seen people get injured in the weight room if they're not perhaps if they're, you know, younger and more green. So yeah, I, I do think it has its place, but like everything you have to approach that, that runner athlete on an individualized basis and just understand where they're coming from.
Speaker 1 (03:40):
And in your experience, working with runners, what are the biggest barriers to resistance training for runners? Because not everyone has, you know, access to the same equipment and time and everything else. So what, what have you found to be the biggest barriers to resistance training?
Speaker 2 (04:00):
I think a lot of runners are intimidated by it unless they come from perhaps a multi-sport background where they've spent time in a weight room. I think right now with the pandemic, obviously resources and equipment or gyms are not as accessible or gyms opened in New York city right now are on a limited basis.
Speaker 1 (04:22):
They're open on a limited basis. I think you have to make an appointment a certain times and things like that.
Speaker 2 (04:29):
Yeah. And then I think that when people do get to the gym, they may not know what to do, and they may resort to something that they see on social media, some of the time, which might be fine. But I think that with running running has predictable performance demands. So it shouldn't be a mystery in terms of what we're trying to do. We're trying to challenge the calves, quads, lateral hip. And we're also we're not layering this in a ton. We're layering it in maybe twice a week on average. So but yeah, I think a lot of runners lack direction, and that's something that, you know, I try to put out a ton of content online. So people start to see how I'm approaching it. And I'm trying to essentially synthesize the literature and translate it to to just the everyday runner.
Speaker 2 (05:18):
And I think that there's also this element of rhythm and timing with running and that doesn't always get addressed through resistance training. I think perhaps a little bit more since some of Ebony Rio's research, but again, that's really in the rehab sector space talking about tendons, but I think that a lot of the TNT work or the tendon neuroplastic training work just has such salience to resistance training programs as well. So anytime, you know, people work with me, they're, they're going to get accustomed to using a metronome. It's just one more factor variable that I think that we can control for when we're prescribing. I
Speaker 1 (05:58):
Love the metronome. I love it. Love
Speaker 2 (06:01):
It easy. After a while though, I
Speaker 1 (06:03):
Give to everyone, even with my, even with my younger athletes, they get it, you know, and actually with those younger athletes, I'm talking teens, it's using the metronome, although they're like, Oh my God, I have to listen to this again. But it is actually good to give them a little bit of discipline around the, around the movement, around the exercise. But I love, I love the metronome. I have my patients like download the metronome, get used to it when you're exercising. I know it can be a little monotonous, but I think like you, like you said that with the research of Ebony Rio and others, I think it gives people, I don't know, like a, a little bit more discipline around their training.
Speaker 2 (06:49):
Yeah. I use it a lot when, if I'm giving someone calf raises something like a rear foot elevated split squat. If we're basically doing like a three zero three where it's like down on three seconds, up on three seconds without pausing yeah. It helps to maintain this rhythm. And a lot of the times I'll stop the exercise when they break that rhythm. Because it's telling me that, you know, maybe we're starting to reach the upper end of their abilities for that given exercise.
Speaker 1 (07:18):
Right. And we all know that three seconds to one person is very different to another.
Speaker 2 (07:22):
Yeah. Well, and this is what, you know, when Scott Morrison talks about anchoring and I just did that Instagram post on, you know, stop being awake or start to anchor. I'm starting to realize I'm becoming a dissenter. But you know, that's where the metronome comes in. And I've played with this so much. I mean, my, my neighbors probably think I'm crazy because I'm like out front with a metronome going, and I'm doing all these weird exercises. Well, weird to them.
Speaker 1 (07:49):
What sort of things do you implement to get over the barriers? Well, you just answered that. Anything else that you may implement to get over barriers to resistance training for runners? Like, like you said, in that runner who is very intimidated, maybe never used resistance training before.
Speaker 2 (08:06):
Yeah. I mean, I, a lot of the times when patients show up to my house, I mean, I'm working out of my garage. We have a space on our property, you know, when they arrive a lot of times I'm deliberately training. So they see what I'm doing and they see that this is a normal part of my routine. And then they get a lens into my racing background, yada yada. And so I want them to realize that this is something that is normal. And I think in a lot of running circles, and I think this is starting to change that it's not prioritized to the extent that it is. And maybe I'm just getting older because, you know, as a master athlete, it's amazing having dealt with some patellar tendon issues, like my body craves resistance training, where if I don't do it, I start to sort of get reminded. My knee feels so much better after I load it and load it relatively heavy. Now you have to be cognizant for reasons I mentioned before, in terms of like, you're not going to want to do a bunch of heavy squats. If you have a race coming up you can keep your body under load, but you need to be a little bit more calculated with your exercise selection as well as your dosage.
Speaker 1 (09:12):
Yeah. And, and that's where I think working with a coach or therapist or someone who understands understands one resistance training and two race training and how you can kind of blend those together is really important. And now sticking with training, let's talk about training errors. Can we just blame everything on training errors? Is that, is that an okay thing to do now? Or am I, is that not good? And I say, I say that with a wink for those people who are listening.
Speaker 2 (09:40):
Yeah. I mean, I think it's a convenient thing to do, but I think that I'm going to get myself in trouble here. I think it's a little bit lazy too. In, in, I think that having lived in New York city that you realize the life load factor, right. You know, there's different stressors in New York, between loud noises, you know, smelly things, you know, financial stressors in crowded spaces, you know, maybe your sleep has fallen by the wayside. So you may have a training program that's very sensible. And, and then all of a sudden you have something come up. I think to one of my, I'm an athlete who I'm working with right now, and this guy's just been just so tough and durable. And recently things have started to take a turn in a bad way. You know, he, he lost his mom.
Speaker 2 (10:38):
He's been having to contend with that. He's had some other job-related issues and and then he he's come down with the patellar tendinopathy and his training didn't change that much. And we actually dialed it back a little bit and it just shows it sometimes all of these other factors, you know, play such an important role in the overall being or totality of that athlete. So, you know, I, I, I think that we'd be much better off calling them ecosystem EHRs where perhaps there's a disconnect, but I think that we have to be careful, always blaming it on training. And I, I get the point, I think that, you know, from a, from a research standpoint, maybe the reviewers are requiring the authors to, to present it in that manner. But I just think there's a lot more moving parts. And I find myself having worked with a ton of athletes over the course of my career, being an athlete that you have to really be in touch with your ecosystem.
Speaker 2 (11:39):
And I don't know who first came up with that word. I know Greg uses it quite a bit, but I think it's something that, that is great to consider. And anytime I start working with an athlete, I have a conversation and it doesn't end during that initial consultation or phone call, but I'm saying, tell me about your life. What was it like growing up? You know, what, what was your relationship with food? You know, what kind of sports did you play? You know, were you in public school? Did you go to private school? What was college like if you went to college, you know, what's your current situation? Are you single? Are you married? Do you have kids? Are you a single parent? You know, I need to capture all this information and that's just scratching the tip of the iceberg in that conversation's never ending. So I feel like the more I know where people are in life, the easier it becomes to start putting down sensible workouts on paper and make sure when you put them down on paper, they go and pencil nodding.
Speaker 1 (12:34):
Yeah. I love that. Getting deeper into those questions and, you know, we had a conversation a couple of weeks ago with the surrounding a female athlete on clubhouse and Tracy Blake, who is just fabulous. I don't know if you're familiar with Tracy. She's a physical therapist in Canada. She's worked with a lot of professional athletes there, including their Olympic volleyball team. And she was talking about questions to ask. And I think oftentimes this is sort of floated over kind of skimmed over by a lot of PTs because we asked, tell me about, tell me what happened, what happened with your injury? Tell me what happened here, not the questions you just said. Tell me about your life. Are you married? Like Tracy said, you know, a question she always asks is, do you have children? Do you have pets? What, cause that gives you an idea. What are your responsibilities throughout the day? Yeah,
Speaker 2 (13:29):
I always say, you know, look, give me a lens into your situation and let the conversation unfold from there. And I think, you know, whether you're a physical therapist or coach, I think all physical therapists or coaches, whether they realize it or not, you know, you're, you're trying to basically capture that ecosystem. And to, to just have, you know, talk to people about, you know, I just have a candid chat with folks and from there, then we can start pulling levers.
Speaker 1 (13:59):
Right? Cause then you're getting a, really, a more holistic view of this person. And then you can say, okay, they have two small children they're working from home. Their kids are being at school, school, they're at home. They don't have the time to spend two hours a day between training and running and everything else. And how can you make things work for them? Is that about right? Yeah.
Speaker 2 (14:25):
And I think that any, any time a patient or athlete consults us, they're looking at us as an agent of change and the true agent of change is themselves. And it's trying to help them plot out their own course. And maybe you, you know, you're shining a light on the path here and there, or making sure that they don't step into a pothole along the way. But that's something that, you know, I find myself more and more. I have any expectations to, I don't do things to people. I sit there and troubleshoot with them. And, and I think that that's what we, as physical therapists are phenomenal with. And not only do we have the skillset, but a lot of times it most of us have positioned us to have the time to do that. And you can't rush that process. So but yeah, we're, we're not in a system that incentivizes that, you know, you don't get paid to talk to people, you get paid to do things to people. And that's the fundamental problem with, for the reimbursement structure, for people who are in network. I mean, you and I are a little bit spoiled in the sense that when we're providing care, it's just ourselves and the patient, but that's, I think that needs to be the standard or approximate the standard. Yeah.
Speaker 1 (15:41):
And isn't it like amazing when that aha moment comes as you're sort of talking through things like you said, troubleshooting, and the patient goes, Oh, wait a second. I can do blah, blah, blah, blah, blah. Or, Hey, maybe that I didn't even think about that. Maybe that is contributing to XYZ.
Speaker 2 (15:57):
Yeah. And I, that's a lot of motivational interviewing and sometimes, you know, I was talking with a couple of people yesterday. Sometimes people who've already arrived, you know, if we're, if we're discussing surgery, you know, I think our goal is to always try to help people avoid surgery, but sometimes people are just dead set and you say, look, you know, I get the sense that you've really just you've arrived at the fact that you're going to have this surgery. Am I correct in saying that, and you know, if that's what you've elected to move forward with, this is your decision. What questions do you have about the surgery? You know, and, and then you may start getting into a conversation and say, Hey, can I, can I share my experience? You know, this happened to me with my clavicle. I was in Hawaii, we'll be traveling to Argentina to speak.
Speaker 2 (16:44):
My wife was pregnant. We had a little one, I was going to have to do a lot of physical tasks. And I'm like, I just need the surgery. I didn't have it on my right shoulder when I, my clavicle fracture. And I was just dead set. I'm like, I'm in Hawaii, there's a competent doc. This is not a super involved procedure, like a soft tissue procedure of the shoulder hip. And I had this and I could have been kicked myself for doing it in hindsight, but no one would have talked me out of that at the time. So sometimes people have to learn through their mistakes and sometimes that can be a tough pill to swallow, but that, that patient ultimately controls that decision. So sort of bobbing and weaving, but,
Speaker 1 (17:25):
And, you know, you just led perfectly into the next topic I wanted to cover. And another question that you get asked often and that's, and that is surrounding pain and pain and decision-making, so we, you, I feel like you led perfectly right into that. So let's talk about how we as clinicians and practitioners, where our role is when it comes to pain and decision-making for that client or that athlete.
Speaker 2 (17:53):
Yeah. It's it's one of the first things, if not the first thing that I discussed with people I did a book chapter for this it's called clinical care of the runner. Dr. Harris. Who's a physician at university of Washington was the editor. And he asked if I would read a chapter on training principles. And I essentially said, the first thing that we needed to discuss is someone's relationship with pain and what their understanding of it is and how they approach decision-making in around pain. Because if you're running, you're going to be dealing with pain at some point, you know? And and I think people have an inaccurate understanding a lot of the times. So, and I think sometimes we, you know, I'll use an analogy that Mike Stewart or you used which I think is brilliant. You know, sometimes when we're out training and we're driving through a school zone, right?
Speaker 2 (18:48):
School's in session, the lights are blinking, slow down. All right. Sometimes you may be driving through that crosswalk. School's in session lights are blinking and you have a crossing guard. Who's standing in the middle of the stop sign. Maybe that's a case of someone's dealing with the bone stress injury. So you need to really hate that. Other times you may be driving through that school zone. It's a weekend, no blinking lights proceed as is usual. And I think that's a good way to think about training, but you know, you and I both know that if someone has a lower limb tendinopathy, you know, we want to monitor their pain and understand how it's responding as a function of a particular training session, whether that's a run, whether it's a plyometric training session or a heavy, slow resistance, but we don't want to shut that person down in it.
Speaker 2 (19:37):
As much as we in our profession may be, high-fiving each other thinking that we're doing a good job of this. Most of the people that consult me, even people perhaps worked with me in the past for short periods of time. They still, when they experience pain, they assume damage and inflammation. And what do they do? A lot of times they, they they'll resort to taking anti-inflammatories and here we go. I mean, this is a, this is where things go South. So I think it's just important to say, Hey, what sense do you make of this? You know, what do you, what are your reservations? Are you okay working through some pain? And I think from there then the stage is set to proceed. But with a lot of, I've worked with a lot of master athletes and they're, they've had a history of lower limb tendinopathy.
Speaker 2 (20:23):
I know that with my left knee, that, you know, I, I worked through almost a year of pain, but I never stopped training. And I was just sensible in how I was staggering, my workouts to afford appropriate recovery time. And and also just knowing how college and synthesis behaves. So yeah, I think that people have a, a skewed understanding and it's also something very personal, but yeah, if you're working with athletes, it's a critical conversation to have. And I do think that this is where I know Ellie was on talking about bone stress injuries, that if you are remotely concerned about a bone stress injury, and it involves a high risk site, like zero out of 10 pain is the goal. Most other instances, I'm a little bit more cavalier, but if I know, if I see some of the signs that I would associate with the bone stress injury, especially if we haven't had imaging, I'm going to be conservative as hell. Yeah.
Speaker 1 (21:19):
And I think it's important to, to note that understanding the runner and that's where understanding the ecosystem comes in and understanding, especially for bone stress injuries, where those high likelihood of those injuries occurring. So it also like you have to know your stuff as well is what I'm getting at when it comes to runners and, and having that conversation around pain can be uncomfortable for that runner or for that person. Cause you may have to dismantle a lot of long-held beliefs. So how do you go about that with your, your athletes?
Speaker 2 (21:57):
I just asked everyone who who connects with me. I say, can you give me w what, what's your understanding of your situation? You know, and I think runners, a lot of times may not come clean if they're dealing with pain, because if they go to see a healthcare professional, they're going to be concerned that they're going to get shut down work. Perhaps they interpret it as a sign of weakness. If they're out on a group run, they don't want, want to be the one complaining. So I just say, Hey, you know, what's your understanding of your situation? And no one's ever asked him that. And that's when the conversation unfolds. So, and I think the way people respond is going to be different pending the person, the situation. But I think it's remissive anyone who's working with a runner or an athlete if they don't ask that question. I feel like I started to answer your question, but I don't know if I do.
Speaker 1 (22:48):
No, you did. That's exactly what I wanted. That's exactly what I wanted to hear. Cause I want the listeners to get as much of this like great little tidbits of information from you as they can. And you know, all of the questions, the questions to ask the patient that you've given so far, I think are great jumping off points for any therapist, regardless of whether you're working for, with a runner or an athlete. But that question of give me the, let me know, what is your understanding of what's going on? And that opens up a whole lot of doors for you. And then, you know, as the therapist, you have to be well versed in the science behind pain and, and how to talk to people. And, and of course it's a whole other conversation, but you know, I think what you're highlighting here is that you can't wing it.
Speaker 2 (23:36):
No. And I think sometimes, you know, I had a question from a third year DPT student who watched a presentation. I gave at some and they're like, Hey, I feel like I'm starting to ask the right question, but then I don't know how to respond and follow up. And and I think that, you know, you can't rush this process if you're in, if you're a young clinician that you're going to get better at this through reps, through life experience and just through sort of being in the trenches with people. But you know, the other thing I tell folks is I say, look, you're a smart person, you know? And I, you know, when I first acknowledge the fact, I think it's good that you're being proactive and addressing the situation, but left to your own devices. What do you feel like you, you need to do to get on the other side of this and they start to formulate a plan and I do, I don't need to do anything.
Speaker 2 (24:27):
I just need to pose these questions and say like, I think that's pretty sensible, you know? Are you okay if we nudge a little bit and you start to basically prepare them for the fact that this plan has got to be progressive, if we're talking about getting them back to running, because they have to get back to a low-level plyometric activity. And I just love these conversations. And, you know, people ask me, they're like, where you learn motivational interviewing. And I'm like, I lived in New York city for decade. I'm like, I just talk to people and I have no agenda. I'm just curious, you know, it drives my wife crazy. Cause if we're ever out in public this happened yesterday. I went to, I had to get a new watch because my watch crapped out and this guy was checking out some watches and we just got to talk to me. And my wife was looking over at me, like, where are we go?
Speaker 1 (25:12):
Your wife is looking at her watch, like, come on, Chris, get it together
Speaker 2 (25:18):
And things off the shelves.
Speaker 1 (25:21):
But it's true. I think that, you know, asking good questions, motivational interviewing a lot. Yes. There's a lot of books. You can pick any book on motivational interviewing and read it and it will definitely give you some insight, but it's the more you do. It's the more people you talk to and not just your patients, anybody, the more you talk to anybody, it will help you be a better motivational interviewer. And the more that you listen and like really listen and start to formulate it's practice. I guess you start to formulate your follow-up questions in your head as you're listening. And again, it's just practice, practice, practice.
Speaker 2 (25:57):
Yeah. And it's, it's fine. I think that it takes on a slightly different flavor as a function of, you know, what generation the person's coming from too, you know? So but yeah, it's just fun to help troubleshoot with people and to really get them to trust in themselves. Because most of the, the folks that consult me, I mean, they're endurance athletes, namely runners and triathletes these days, and they're going to manage their situation conservatively. Sometimes I feel like they need to be talked off the ledge. If they're going to opt for a more invasive procedure, if that's not really appropriate or perhaps an injectable of some sort. So, but yeah, getting people to trust in their body and and not drag them in for therapy all the time, you know, and I, I have to prepare people for that to say, you know, how do you anticipate this is going to go?
Speaker 2 (26:49):
And they're like, well, maybe I'll see you two to three times a week for six to eight weeks. I'm like, who's footing that bill. No, no, one's good. Yeah. So I say, you know, but this, this requires a lot of work on us on the back end because when I write an email, I mean, email, I wrote to this person yesterday, it was basically like, you know, two pages and cause it, kids dealing with the bone stress injury, the parents don't really understand the implications of it. He's going to be running competitively in college. And, and I think that he was under the notion that he was going to be back to running in four weeks. And I'm like let's talk about more like four months. And I lay this out and I'm like, you know, I know this is probably a little bit, you know, overwhelming, or you weren't expecting to hear this. What are your thoughts on this? You know, to engage him, to just know where he is after I've presented this information and he got the memo. But that's, that's a tricky thing about bone stress injuries is people fall under the, you know, the idea that they're just gonna take a couple of weeks off and plugged back in.
Speaker 1 (27:49):
Yeah. Yeah. And again, that's where you, as a, as a therapist and a coach comes in and helps the decision-making you're ultimately, you're not that runner, you're not that athlete. So you're not the ultimate decision maker, but your job is to give as much information and, and your professional opinion as to their situation as you can.
Speaker 2 (28:14):
Yeah. And I, I think that it traces back to that question is like, what are your expectations or questions around this surgery? I mean, this is a very involved procedure. They're putting you under anesthesia and they're cutting your body open. Never we'll frame it like that, you know, when I'm working with people. But you know, I, I rehabbed all of these people after these very involved, soft tissue procedures of the shoulder when I was in New York, coming from Dr. Nicholas in his staff. And yeah, I'm like, this is going to be six months to a year before you feel like your, your shoulder is like firing on all cylinders.
Speaker 1 (28:47):
Yeah. Yeah. I had, I had a complex soft tissue shoulder repair and it was a year anyway, we can go on and on when it comes to a patient mindset, fear, trepidation, everything else. I think that's for another podcast. But I think you definitely got across the decision-making process on behalf of us as a therapist or coach and how we can influence that process for the patient.
Speaker 2 (29:12):
Yeah. And I think that if patients aren't on board, I mean, if they are around muddy water where there's a sinister situation and they start sort of dilly-dallying, I think that we need to really put our foot down his therapist too and say, look, you know, you've consulted me and here are my recommendations or here's my professional advice. And if you're not going to take it, let's just, let's just part here. And sometimes we don't need to do that a lot, but I think sometimes we drag our feet as clinicians and we need to, we need to put our foot down if we have to protect that person from themselves, because we can't get tangled up in that mess. I can't think of the last time that's happened, but it has happened over the course of my career.
Speaker 1 (29:57):
So those, I mean, those are sticky conversations to have, but for the safety, I mean, our job is to protect that, protect our, our athlete, our patients. So if that is our job, then you have to have those sticky conversations. Yeah. And that's it. All right. So I think that was thank you for that conversation on decision-making and hopefully it sparks plant some seeds in our listeners here. And now we'll go on to two more questions that you usually, that you get the easy ones. You will we'll breeze through these too. These are easy. How do you become a runner running injury expert To how many times do you get that question? How can I do what you do?
Speaker 2 (30:41):
Yeah, I it's, I, I love getting it it's flattering. You know, and, and it's something that it was sort of, I looked back and all, I, there, there were a couple of defining moments in my life. And one was when I was told that I'd never be able to run again. You will never run again. Right. I heard that a couple of times from very world-renowned orthopedists. And I think that's what ultimately put me on a trajectory to do this. And I never ran competitively when I was younger. I probably should have been channeled into a little bit more of a, a running program, but I was always playing sport, different sports, you know, from skateboarding to soccer, to tennis, to baseball, to basketball, to lacrosse, to, you know, rollerblading snowboard, like you name it. I played it. And except football, just because my high school didn't have a football team.
Speaker 2 (31:39):
So I always relied on running to help me in sport. But I feel very fortunate in hindsight that I never started really formal distance running until I moved to New York city around like maybe 24, 25. But I, I think that when I started getting into triathlon is when I started working with a lot more runners. And I think when I started distance running, that was around the same time and it's just a fun bunch to work with. And I think that initially I was overconfident and it got to be frustrating when I'm like, geez, this is a healthy person. Like I would send them out. I'm like, Hey, I think you're doing good. And they would come hobbling home. Or they would call him and be like, Oh, I blew up on that run. And I'm like, why are these people blowing up on these runs?
Speaker 2 (32:25):
Like I thought they were doing a good job. And then it just really forced me to stare at myself in the face and say like, what do I need to be doing to really help these people? And, you know, I started reading a lot of the research. I started spending time around runners. I started speaking a lot with this fellow Bruce Wilke, who was sort of like a savant with running who unfortunately has since passed. But I started to really get a handle on running and not only on running, but just the mindset of runners, how they approach training how they've sort of just been dismissed by the medical community. Because you're like, Oh, here's a runner here comes another crazy runner. And then you start to realize that runner, when someone tells you they're a runner, you don't have other athletes.
Speaker 2 (33:09):
When you meet someone, you know, you could meet someone, you could meet a world-class athlete and they may not come claim that the fact that they play a competitive sport professionally, or they play a professional sport until you talk to them, runners like I'm here, I'm a runner, you know? And so they really stuff, they go through an identity crisis. So you have to look at this from so many different lenses. You have to understand the performance demands of the sport. You have to understand, you know, just running communities. You need to understand that these people's identity revolves around their running. So they become fragile when they're not running. So I just loved the challenge of, you know, addressing all these different factors and and it helps that I, that I'm still training and racing competitively because I sort of go through, I think a lot of the same struggles and challenges that they face so I can speak to them.
Speaker 2 (34:01):
But I think that if people want to go, go in on running as a young clinician, coach running is having a moment go all in, right. We saw an uptick and running with the, you know, with the pandemic. And I think that if you're going to work with runners, you don't want to say like, Oh, I do general outpatient orthopedic, orthopedic rehab. It's like, no, my whole practice revolves around running. You know, people are like, they come to me because they know that, you know unfortunately I've had a pretty rich experience in terms of my, my didactic training. And, you know, when I was getting reps under my belt in New York city. So I feel like now I can look at things through a very global lens when a runner presents and we can troubleshoot most of the time, I'm seeing people for one, maybe two sessions. But I think that that running rehab is challenging in a lot of different ways, but if people have a, an interest go all in,
Speaker 1 (35:02):
I think that's great advice. And I also really liked that. You just mentioned, Hey, I'm not seeing runners three times a week for six to eight weeks. You know, I'm not, this is not how I'm, I'm, I'm building my practice. And I think that's important to let people know, because I think a lot of newer graduates or students might be thinking, Oh, this is going to be great. I'm going to be working with people several times a week for six weeks. And then they're all better. Not so much the case when it comes to running injuries.
Speaker 2 (35:31):
Yeah. And their runners just seem to perpetually get these niggles and aches and pains. But, you know, I, I, I think it's doing a disservice because if you bring someone in, if you say, Hey, look, I need to see a couple of times a week for the next six to eight weeks. You know, someone told me that I'm like, man, I must have something serious going on. So I just say, Hey, look I'm not concerned. Anything sinister is present. I want you to be sensible. You're around muddy water, but carry on. All right. In calling me if you need me. And I think that they're like, wow, I've had people reach out and are, you know, this person told me they were running five to six days a week and their quads were a little bit sore. I'm like, Oh, you're good, man.
Speaker 2 (36:10):
You don't need to see me. You know, I said, and I asked him some, some more involved questions, but I'm like, you don't need to see me. That's a really empowering message, you know, because the person's like, Hey, I'm here ready to pay you. And you're telling me that you don't want to see me. I, one of a guy who's become a good friend of mine. He was dealing with some hip pain. He was in a bicycle accident and he had some films in between x-rays MRR because of a woman who who's pulling out of a parking lot, had collide with him for whatever reason. And you know, and I got a lens, you know, I saw his power profile on his bike. I saw the lifts that he was doing because we were training at the same facility. And he's like, I, I need to come and see you for physical therapy.
Speaker 2 (36:52):
I'm like, no, you don't. I'm like, I'm watching you lift, man. You don't need to come and see for, you know, let's, let's just chat. If we cross paths here and he's become a very good friend, he, he always jokes. He's like, you're the only PT you've told me not to come and see you. He's like all these other people are like trying to get me in and get me on these programs and tell me, I need hip surgery and PRP and yada, yada. So, but you need to know that nothing sinister is going on the flip side of the coin.
Speaker 1 (37:19):
Right. And that's where experience comes in and confidence as a clinician comes in as well. And that takes time. So you're not going to be, so what I'm getting is if you want to be a running injury expert, go all in, read the research, do the things, take the classes and take time. It takes time and leave your ego at the door.
Speaker 2 (37:39):
Yeah. And I think the patterns will become, they'll become pretty straight away in terms of where runners are getting into trouble. You know, where are these injuries are manifesting? And, you know, I, I think that most of it is being disconnected or out of touch with your ecosystem and not laying down programs that sort of reflect your ecosystem and realize that target is always moving. Right?
Speaker 1 (38:03):
Yeah. Yeah. Excellent. Okay. Final question of our interview here. And again, it's, it's an easy one. So, so we talked about this ahead of time. This is an easy one. So, well, how do I even phrase this in looking at the profession of physical therapy, what can we do better to define what we do and kind of stake our claim on what we do as a profession?
Speaker 2 (38:37):
Yeah. I still am organizing my thoughts around this. I went into physical therapy because I thought it put me in the best possible position to help troubleshoot with people through a conservative approach. And I think that the challenge we have is physical therapy is a very tricky thing to define. And I think that where we're ultimately, and this is a quote from Jen Shelton, who was you know, in born to run, she was a young gifted ultra runner at the time. I don't know what she's up to these days, but she's she's a trip in all great ways, but she said physical therapists are your best friends in healthcare. And I think that we're well positioned to be the first line of defense because we're trained across such a broad through such a broad range. So, you know, you may see us working in cardiopulmonary capacity.
Speaker 2 (39:40):
You may see us working in wound care. You may see us working in a neurologic geriatric with geriatric population. You may see us basically with working with pro sports teams you know, pelvic floor. I mean, it's tricky when you have all these moving parts, but I, I don't think that we've defined who we are as a profession, to the extent that we need to. And and I think that's why a lot of other people end up defining us sometimes in good ways sometimes in bad ways. But I think that it's sort of like, you know, I'm in Seattle, I'm going to use a microbrew example. You know, you have run of the mill rehab. And I think some people lump physical therapy ended up, but physical therapy to me is sort of like a microbrew, right. We need to tell people what to think about it.
Speaker 2 (40:34):
We can't let them conjure up their own ideas. We need to really define who we are as a profession. And and I, I don't think we've done that yet. I think that we're, we're getting there, but I don't, I don't think we've done a really good job defining physical therapy. Cause if you ask people, you know, people are like, yeah, I've tried physical therapy and we know the same, the response, it's a heat ultrasound TheraBand. And it's always funny when people connect with me, they're like, this is so different from like what I expect to physical therapy to be. And I'm like, well, what did you expect it to be? And it was generally the response is what I just mentioned. And they're like, you just helped me troubleshoot and in sort of the seamless way. And, and that's what I think we do.
Speaker 2 (41:21):
We triage and troubleshoot. But we look at things through the people who I really respect in life. They're able to look at challenging situations through multiple lenses. And I think that that's how we're trained as physical therapists. And I think that that's why we're in such an incredible position to troubleshoot with people. So I don't know why you've got my gears grinding even more. And I, I, I think about this morning, noon and night is, you know, how do we better define our profession? So we don't let people conjure up their own ideas of what it is, because I think a lot of times if they've had a bad experience, that it becomes very skewed in physical just saying physical therapy doesn't capture it.
Speaker 1 (42:09):
Yeah. I agree with that. And so what can we do as a profession to change that? I agree it needs to be changed. And I agree we need to be the ones out in front talking about what we do and how we do it and why we do it. So when, when you think about that, what sort of ways can we be out in front and take control of the narrative?
Speaker 2 (42:33):
I mean, I think it needs to be orchestrated. And I think that that's, that's a major challenge right now. Because I think that is a profession we're a little bit more fragmented than, than one might think. So I think that we have to have a lot of people come together from different sectors of the field and have have a long, hard staring in the mirror and talk with each other to try and arrive in a definition for what we do. And I think it's a really challenging thing, but I think it's something that is very important, but I think also individuals like yourself where you start to represent the profession. You know, I try to do the same thing. I think that holds a lot of weight too. So I, I think it, you sort of have to take a multi-pronged approach.
Speaker 1 (43:23):
Yeah, yeah. So you have to take that 30,000 foot approach by having a lot of people from different areas come together and give that wide umbrella. But then from a micro position, individuals can also be out there and trying to, to change, to make a change.
Speaker 2 (43:40):
Yeah. And and I, I'm confident that we're going to do that. I don't know. I feel like I'm in my early forties now and I'm starting to become more reflective in life. Right. And and really think about, you know, a lot of things, one of which is a profession and, you know, I just feel like a pig in poop having landed in this profession because I'm such a diehard PT, but I also, like, I feel like the perception of physical therapy needs to change too.
Speaker 1 (44:09):
And, you know, I will say that I do see it changing slowly. I mean, this is a big ship to turn and I'm talking from a societal standpoint. And I say that because I see more and more in mainstream media, whether it be on television, print, blogs, podcasts, et cetera, that journalists are now reaching out to physical therapists. Whereas they would have reached out to a trainer, a chiropractor, a yoga instructor, or something like that when it comes to their articles on everything from training to, I just did an interview yesterday about pillows, you know? So it seems like, well, what, why would they reach out to a PT about pillows? You know, but it's nice that they are reaching out to PTs about things like that. And things about training and things about COVID rehab and, and long haul COVID patients, you know, physical therapists are now being part of that conversation. I'm seeing that more and more from main street, main stream journalists. So I feel like that's a good sign.
Speaker 2 (45:12):
Yeah, for sure.
Speaker 1 (45:14):
A good sign, for sure. And, and also showing that journalists are open to hearing from different groups. So I always say to physical therapists like contact your local newspaper, if you live. And, you know, I'm from a small town in Pennsylvania contact that local newspaper asked to write an article, ask to, you know, be a contributor, get onto your local news stations find, cause that's, that's the way the general public finds out, you know, on social media, there are some people like yourself and others that have great social media followings and are putting out great content designed for the consumer. But a lot of physical therapists on social media, probably myself included do social media posts for other therapists. So it's a little different, right.
Speaker 2 (46:01):
Yeah. And I think that's okay. And I think it's
Speaker 1 (46:03):
Okay. Yeah. But I think we, it could be broader.
Speaker 2 (46:07):
Yeah. I just, I think that when I work with folks and I, I'm not alone here, but when people start getting a lens into my thoughts on a particular situation, if they're like, Hey, I have some calf pain, they call me on the phone. They're like, they may be an athlete. And they're like, Hey, I have some calf pain, but a great example. This guy reached out to me the other day. And he was dealing with what he was told was an Achilles tendinopathy. And he was under the care of a physician and other rehab professional outside of the profession and I'll leave it at that. And when he came to see me, his primary complaint was he was starting to lose coordination in his left, lower extremity on the run. And he started to feel more disjointed on the bike. This isn't an Achilles tendinopathy.
Speaker 2 (46:54):
He may have symptoms that, you know, that are consistent, but that's not what's driving. So, you know, you start to think of, okay, well what could this be? You know, is there something going on maybe like from a differential diagnosis, you're starting to run through like, Hey, is he's telling you this, like okay, is this unilateral? Is that bilateral? You know, is there any loss of sensation, strength, power you know, is this, like if we just start asking a different set of questions, you know, could this be a runner's dystonia? Could it be something like multiple sclerosis, it could be ALS. So you have to, when someone says, Hey, I have this complaint, we're asking in terms of what's running through our mind and the questions we ask, they're very different. So I'm going to start challenging him from different coordination tasks.
Speaker 2 (47:44):
I'm going to take them through lower quarter screen. I'm going to get a lens into his running. You know, I'm going to understand how an Achilles tendinopathy would present if he's not having issues doing calf raises. And he's able to sit there and jump in place. I'm like, you're killing is, is pretty, pretty good, man. You know? So for whatever reason, there's this timing issue in his Achilles is probably seeing a different or an unaccustomed rate of loading that, that he's not withstanding from a timing perspective. So, you know, he's someone that probably ultimately needs to consult a neurologist, right? So why is no one told him that for a year? And they're telling him that he needs to do a more aggressive form of scraping and he's a candidate for a PRP, excuse my language, but that. Right. So this is where our role is just so critical because we sit, we spend an hour with people or at least, you know, a lot, and we, we can sit there and troubleshoot with people and really get them into the right hand. Why is no one ever he's like your assessment makes so much sense to me. And so many examples. Yeah,
Speaker 1 (48:51):
Many, many examples. Well, Chris, this was great. What a good conversation. I think there's a little bit of got a little bit of everything in here, and hopefully we answered a lot of w V a lot of the questions that you get on, on a daily, weekly, monthly basis. So thank you so much now, where can people find you?
Speaker 2 (49:11):
I can't tell you no,
Speaker 1 (49:13):
I'm going off social media now.
Speaker 2 (49:17):
Instagram is good. I'm just at Chris Johnson, the PT, and I'm in the process of revamping my website and that should hopefully be done at some point in the next couple of weeks. And and that's gonna really just, I think, make it easy to understand what some of my offerings are and how to sync up with me. And yeah, for folks, if, if you want to sign up for a crazy newsletter please join my newsletter. It's a little bit of reverence. So I'm preparing it now in, in good ways. So,
Speaker 1 (49:49):
And how can they sign up for your newsletter? That'll be on the website and Chris Johnson, pt.com or Zara and PT.
Speaker 2 (49:56):
Chris Johnson, pc.com. Yeah. Going back to my roots,
Speaker 1 (50:01):
Go keeping it simple. Right? Well, this was wonderful. Last question, knowing where you are now in your life and career, what advice would you give to your younger self now that you're, you're pondering, you're pondering life in your early forties.
Speaker 2 (50:18):
Oh, stop taking yourself so seriously be present with people, equally people, power, power, your phone off, and and be present with people. And for folks who are who are coming to see you understand that a lot of what brings about changes in what helps people are these non-specific effects, you know, during a clinical interactions. So don't feel like you need to have this gnarly didactic knowledge. That's going to come in time by continuing to read the research, spending time around other mentors or clinicians. You respect taking courses from them. But if you can just be present and engage with someone, take a genuine curiosity in their situation, that's going to do wonders and and yeah, take the pressure off yourself.
Speaker 1 (51:07):
Excellent advice. Excellent. And I thank you so much again, Chris, for taking the time out. And we will see you in a couple of days next in a week or so for a round table discussion, which I also think will be phenomenal. So thank you so much.
Speaker 2 (51:22):
Yeah. Thanks again for having me on Karen and keep up the great work. It's fun to, to just sort of follow your, your journey and calling me if I can do anything to support you.
Speaker 1 (51:31):
Thank you so much. And everyone, thanks so much for listening. Have a great week and stay healthy, wealthy and smart.
In this episode, we have Tom Goom with us again to join us with our running injuries and running rehab talk this March. Today we will be talking about acknowledging types of persistent pain in our athletes or runners.
He talks about the bigger picture on persistent pain and its other connections, differentiate this persistent pain versus series of acute flare ups, where we should focus the treatment, and navigating injured athletes return to their sport and many more.
Pain, athletes, running, persistent, bigger picture, acute injury, symptoms.
More about Tom Goom
Tom is physiotherapist and international speaker with a passion for running injury management. He has gained a worldwide audience with his website running-physio.com and has become known as The Running Physio as a result! Tom remains an active clinician committed to providing high quality, evidence-based care.
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Read the Full Transcript Here:
Speaker 1 (00:01):
Hey, Tom, welcome back to the podcast. I'm excited to have you on today.
Speaker 2 (00:06):
Thanks for having me back. I really enjoyed it. Last time we took proximal hamstring. Didn't we last time it was a good chat
Speaker 1 (00:13):
We did. And now this time you are part of the month of March and this month we're talking all about running injuries and running rehab. So what we're going to talk about today is persistent pain in these athletes. And I know this is something that you're seeing more and more of. So let's dive in what let's talk about as physical therapists or physiotherapists. Do you feel that we're acknowledging these types of persistent pain in our athletes or in our runners? Or are we just thinking, Oh, well, you know, they have this tendinopathy or this strain and it's just keeps recurring. It's just like a, it gets better and then becomes an acute injury again or this back pain. Oh, same thing. It, it kind of goes away and comes back. So what, what is your opinion on that? Are we acknowledging persistent pain in these athletic populations?
Speaker 2 (01:20):
Yeah, that's a good question. I think maybe we D we do look at it a bit more, like you're saying, we just kind of see it as a sort of repeated acute injury may be large rather than seeing it as a persistent pain problem. And I think that's because in part, when we see people with persistent pain, part of our, of our advice and our management is for them to be active. So if you've got someone to come see seeing you, that is actually already sporty, they're already active that, you know, you kind of think, well, what else needs to be offered here? And I think sometimes we don't really think about the sort of psychosocial practice in sporty or active people, because they're not obviously fear avoidance, especially if they're keeping their sport going. So we, we tend to go down the route. That's perhaps a bit more biomedical isn't now we looked at biomechanics, we look at strength and conditioning and these all can be valuable, but we mustn't lose sight of the bigger picture. I don't actually think sometimes we do need to acknowledge that it is more of a persistent pain state and a, not necessarily a series of flare ups of acute injury.
Speaker 1 (02:24):
How do we differentiate this is persistent pain versus a series of acute flare ups.
Speaker 2 (02:30):
Yeah, I think there's going to be an overlap between those things. We know that people with persistent pain that isn't necessarily stable with change can change quite a lot. People go through periods of quite severe flare ups as well. I think it's about sort of looking at the bigger picture and looking at the connection between things like pain and load. So in, in an acute injury situation with something like tendinopathy, quite often, there is quite a clear load pain relationship. It hurts when I load it. It doesn't hurt when I don't, I'm in a more persistent pain state. We might actually see that that relationship becomes a lot more blurry that the pain may well flare up when load hasn't changed or the pain may remain present. When there isn't a great deal of loading going on. So we start to see a bit of a breakdown of that connection between load and pain. And perhaps you start to see other aspects influencing symptoms, you know, lack of sleep, stress, fear, et cetera. We see other sort of types of behavior creeping in there as well around maybe avoidance coming in. So now they are backing away from their sport. So I think that's something we need to have a lookout for particularly that lack of relationship between load and pain and then exaggerated pain response as well.
Speaker 1 (03:48):
And when we're looking at these more sporty athletic people are runners how do they differentiate from say maybe our non sporty or non-running population?
Speaker 2 (04:01):
I think that there will be some definitely some, you know, some crossover between different people in different groups. And I really would, you know, w I use the term athlete, but I, I have a really broad definition of that. Someone, someone who wants to be regularly sporty and active fits that category for me. So I'm not necessarily necessarily when I say athlete referring to an elite athlete, competing at a high level, this, this can be people that want to be running three or four times a week, that really comes in that category too. But I think they can have, you know, similar concerns to someone that's not sporty around pain and damage, for example. So they might have similar concerns there. They might both have quite high life load which is a term I quite like this, somebody mentioned in one of my courses recently.
Speaker 2 (04:49):
So, you know, this is where you've got lots of stress going on with, with work and family life this kind of Highlife load that plays upon your pain. And they may also both groups have poor recovery. So, you know, athletes may not be brilliant sleepers non-athletes may not be brilliant. Sleep is too, they might not get much downtime much emotional recovery. So there can be quite a lot of of overlap. I think perhaps where they differ is they may have quite different goals. So I think it's, I see Mike might have wanted to go back to running half marathons, marathons, ultra marathons, and beyond potentially. So that might be quite a different goal to non-athletes that want to be more functional with day to day activities or lower level activities, perhaps like walking distances and perhaps something that we do see in athletes.
Speaker 2 (05:38):
That can be different though. Again, we see this in non-athletes too, is they may be a bit more inclined to push through pain. Most of us that have done sports at any level will know that pain is quite often a normal part of sport. And to some degree we do have to work with it. If, if we stopped every time, something we we'd never really, really do sport for very long, but this isn't necessarily always the right approach, gritting your teeth and pushing on through. Isn't always the right answer. And it's not always obvious that that's the case, but sometimes actually we do need to know when we need to back off a little bit. I'm an athletes particularly really highly driven athletes may not be quite so good at recognizing when they need to back off.
Speaker 1 (06:21):
Yeah, that's for sure. Especially if, like you said, they've got this goal of, I want to run a half marathon and marathon or an ultra to be able to, to have to abandon that goal due to pain, persistent pain or injury is, can be very devastating. Right. So how do you, how do you navigate that with your athletes and with your runners, especially with a more persistent pain, how do you navigate that? Very, I would say very sensitive goal or topic with these, with these runners or athletes.
Speaker 2 (06:58):
Yeah. It's not, it's certainly not easy. I think it's it can be challenging. I think wherever possible, we want to try and invite them to review their expectations and goals. So that it's not necessarily us being prescriptive and saying, this isn't realistic, or you're not going to achieve this, but if we can help them have slightly more fluid expectations of themselves and slightly more realistic goals, the ideal world then is that they then come around to the idea that perhaps this marathon they've got on the horizon, if it's not realistic for them, that they can set a different goal with it. And th this is one of the things, again, sometimes with, with higher level athletes, certain personality types is that being, being able to persist is a good skill, a good good thing to have, you know, and you need it when you get to sort of modulating 19 in the marathon and your legs are heavy.
Speaker 2 (07:50):
And, you know, you've got to keep going to hit your target. Tom, you need that in the time. You've got to have that level of persistence. And, and for that to be at least a little bit rigid because you you've got to, if you're going to achieve that goal, you've got to keep going, but to keep going at a certain time. So at times that rigid persistence is useful, but if you apply that all the time when circumstances are changing and your expectations are rigid, it doesn't really work very well. So for example, with the situation's changed, you're now in quite a lot of pain, you're struggling with day-to-day activity. This marathon is, is a lot closer now than, than we would, would like it to be. Ideally we have to try and encourage them to be a bit more fluid there and say, okay, well perhaps what we need to do is change that goal a little bit.
Speaker 2 (08:37):
Let's push it a little bit further down the line, give ourselves a bit more time and helping them see the positives of that decision can help. So you all often say to them, well, you know, if we can, if we can move this, you know, a few months down the line or let's go for a half marathon or a 10 K, it's going to take the pressure off you. You're not going to feel like you're constantly chasing your tail because you're trying to catch up with the training. You're not able to do. You're going to be able to focus on the rehab side of things. You're not going to feel so much pressure, and we can really focus on getting you well and ready to race rather than rushing you to get through a particular event when you've got a whole life of running ahead of you.
Speaker 1 (09:15):
Fair, very fair. And, and I think that's great for clinicians to hear, because I think that wording is very sensitive to the, to your patient and also gives them the goal gives them that aspirational goal that they can eventually get to. So I think that wording was great. Thank you for that. Now here's a tough question. And, and I don't know all the answers to this one, but in your opinion, and in your experience, what do you feel may be driving persistent pain in these runners or athletes?
Speaker 2 (09:53):
Well, we had us, that's a good question. Isn't it? A million dollar question and I would acknowledge I don't, I certainly don't have all the answers with this, and I don't think the research does yet either because it's an area, you know persistent pain in athletes isn't brilliantly well researched. So I think there's a lot that we can, we can learn about this, but there's a few things that would, I think, would spring to mind here. So I think beliefs are important. So and this is, can be beliefs around what the pain means. And then they, you know, what the pain means is if it's, if it's a sign of damage if they think it means they need to stop their exercise altogether, how they feel their body's gonna respond to exercise when they have pain that continuing to run, for example, will that be more harmful for them?
Speaker 2 (10:38):
It can be around beliefs around training too. A lot of people will feel that unless they're pushing themselves a hundred percent in every session it's not worth doing. So that can be quite difficult then for them to pace themselves and modify their training because it kind of all or nothing really. I think one of the things that I'm realizing more and more over the years working with with people and athletes is if they are quite heavily reliant on the sport for their mental wellbeing, then that can have a bigger impact too, because they might be using that, that sport to help them with their mood or anxiety or depression. So if they can't do their sport, it increases the impact of the injury. And I think it increases the fear associated with that because they're losing this coping strategy, they're losing physical fitness, they start to worry about the future.
Speaker 2 (11:27):
And I think maybe that links in with pain science, because it increases the threat that this injury has, and that has the potential then to have a knock on effect in terms of the pain and increasing pain severity and things. And a lot of these things are interlinked. I think training behaviors go hand in hand with that, you know, tending to push yourself hard all the time, boom, or bust, things like that. I think there's also a lot of stuff that we might not necessarily, we see like negative messages from others. So other other athletes, sometimes coaches, health professionals, unfortunately I'm so pumped. Sometimes we can be responsible for that life. I've treated lots of runners. Who've been told that they should never run again, for example, by various different health professionals. So we need to be aware of that. I think Google might have a lot to answer for I don't, I'd love to know. I think you've been Dr. Google doc to goo exactly. I don't, I don't know many situations where someone's been worried about something and put it into Google and felt better.
Speaker 2 (12:31):
What you find is the worst case scenario from it, which does amplify, you know, it does amplify people's worries. And that's actually something as a clinician, I would check in with your patients about what what'd you do when you worried about this? Did you go and Google it? What'd you find when you Google it? How does it make you feel? Because quite often they'll find the worst case scenario and I feel a lot more worried. So we want to discourage them from doing that, come to us. If you've got questions about your care, that's what we're there for really. So there's a lot of things that also impact of the injury, perhaps not being fully addressed. So you know, looking beyond the kind of physical impact of the injury, but the loss of the social side of the sport, the loss of their identity around sport the effects, as we said, it might have on mental health.
Speaker 2 (13:18):
There's lots of other things that go alongside the injury that often don't get talked about. And if they're not addressed, I think they can amplify it as well. And then the final thought I would add to this is perhaps if not had really particularly appropriate rehab it may be, it's been very focused on pain and not really focused on function in maybe that it's not been progressive and it's not really looked to address their rehab needs, lots of stretching and foam rolling and, you know, ice and, but no real kind of planning and progression in that.
Speaker 1 (13:50):
Okay. So that leads me to the next question as clinicians, where should we be focusing our treatments? Good segue there.
Speaker 2 (13:57):
Yeah. I like the connection. You've done this before, I think. Yeah. Yeah. I think, I think he's got to start in the first session with trying to develop an understanding for that person, if we can help them to, to understand their injury. And it takes time to build on that, but really make that part of that first session and give them the opportunity to share their story in that first session and also to air their concerns. You know, I really think we want to make the focus of these treatment sessions on the patient and their needs, not necessarily a kind of a list of things we need to tick off to do in a session because there is actually research showing that quite often, people whose needs aren't really identified we can be quite dismissive as clinicians. So we want to get in there right in the early, early stages and say, you know, what would you really like to, to from, from your treatment?
Speaker 2 (14:52):
What are your concerns? What are you particularly worried about here? What would you really like us to help with? Because we can start with that. I think that helps us form a good, strong connection. We can really help them understand the injury and build on it from there. I think that alongside shared goal setting, I think big PA plan of I'm a big fan of collaborative working you know, so you're working towards their goals. How can we help them achieve those goals together? And again, get a good idea of those in the first sessions. And it is part of the reason I really love working with rhinos is because many of them have a goal. Even if it's just, they want to get back to running 5k, you know, great, brilliant. It's a measurable goal. We can start the planning towards that pretty much from, from session one.
Speaker 2 (15:37):
And then we do want to have some progressive rehab because they're all gonna be psychosocial factors. In many cases, we've talked about, you know, beliefs to address perhaps poor recovery load management to talk about that quite often, there are physical needs as well. So we need to address those if there's a lack of strength or control or range and address them in a progressive way, as opposed to just loads of stretching and rolling, and then we can start to do a graded return to sport when, when they feel like they're physically and psychologically ready to engage in that.
Speaker 1 (16:10):
And what are some, some examples that maybe you can give of the types of diagnoses or the types of patients that you're seeing coming to you with persistent pain, you don't have, we don't have to go into, you know, the specifics of how you treat XYZ, but what are some things that you might be seeing in your patients coming to you with persistent pain?
Speaker 2 (16:36):
So I, I do specialize to some degree in tendinopathy. So we will see a lot of patients with long-standing tendinopathy lots of patients with proximal hamstring tendinopathy, because that's particularly the area I've researched in. But it will say Achilles tendinopathy issues as well. See people with low back pain and hip pain as well, falling into this category people with persistent patellofemoral pain syndrome persistent bone stress injuries, like medial tibial stress syndrome. So it's do see quite a mix. And, and many of those will have been treated first and foremost in quite a kind of biomedical model. I think,
Speaker 1 (17:16):
Yeah, so I think I just wanted to ask, cause I think it's important that clinicians out there hear like, Oh wait, you can have a persistent tendinopathy problem. You know, you can have like, Oh, I, I wasn't aware. I thought, you know, after let's say proximal hamstring after a year of rehabbing, if that kind of comes back, Oh, it's probably just like a muscle strain. It's probably not that tendinopathy again or, or not again, but it continuation of that. Absolutely. Yeah. And
Speaker 2 (17:50):
To give you a clinical example then, because we talked a little bit about how the connection between load and pain can be blurry about how that may, we may see an exaggerated response. So to give you an example of that proximal, hamstring, tendinopathy patient that I've been working with who will not be able to sit for more than maybe 30 seconds because that will really cause a flare up in their symptoms. Now we can see then that's a, that's a really exaggerated pain response. And the average person sits for somewhere around six to seven hours a day. So not to be able to tolerate even 30 seconds of sitting because there's pressure around that that tendon is, is an exaggerated pain response. And that person's pain will fluctuate not necessarily in line with load. So there'll be days where her symptoms are much worse and she doesn't really know why it's not because she's run a long distance or done anything different.
Speaker 2 (18:53):
The fluctuations in activity levels might be small in the range of a few minutes here and there. And yet the pain response is really exaggerated. And again, I talked about sort of beliefs and things go going into, you know, going into this area. And when we talk to this particular person about her beliefs, you can see she's very concerned that sitting damages the tendon and therefore that adds to the threat value associated with the city. She's very fearful of sitting when you ask her to do it, you can see she's really reluctant, but also we need to acknowledge why it really hurts. It's really hard for a long time. So there should be no judgment and our pie, we should be reckless. Yeah. This is really difficult. This is having a huge impact on this person's life. Can't if you can't sit down and even to have a cup of tea or to watch a move at the end of a long day, what should we eat dinner? Like that's big. So I think we have to recognize that as a persistent pain picture and with aspects of tendinopathy in there that we can manage, but just seeing it, like you say, as, Oh, it's just another flare up of the proximal hamstring tendon. We were missing that bigger picture, I'd say.
Speaker 1 (20:01):
Yeah. And that was a great example. Thanks for that. And now, you know, when we talk about running, we talk about athletes. So one thing they all want to do is they want to return to their sport. So can you talk to us a little bit about how we navigate that, how we prepare these people to return to their sport and what that, what that sport may look like?
Speaker 2 (20:24):
Yeah. I think, I think maybe we start, if we can, by seeing if we can reduce irritability a bit where possible. So if we think back to that lady, I was talking about Verrier to boost symptoms at the moment. So if I go straight into a greater return to running, I think that's probably going to be a little bit too much to start with. So in many situations we may we say, okay, let's see what we can do to reduce the symptoms and irritability helping someone understand their pain and that it's not a sign of damage can help helping them work out a list of things that may help to reduce their pain. Maybe particular exercises that help simple things like, you know, using heat or ice if necessary, but trying to give them strategies and work with them. So they've got a little bit of a list of things that can turn that, that pain volume down a little bit, and we're placing them in a bit more control, reducing that threat value.
Speaker 2 (21:17):
And then we can start to work towards that graded return to sport. And again, if we want to plan together because we really want the person to be in the driving seat and us maybe just helping, you know, being a bit of a satnav along the way to keep them on track. So we've had this recently really lovely runner I've been working with who in the first session said to me you know, what she'd like to do is first of all, build some strength then increase her cardio fitness by bringing in a bit of cycling and swimming. Then she wanted to bring in some, some impact and some plyometric exercises before doing a graded return to running. And I thought immediately, brilliant, this is fantastic. This person has a great plan.
Speaker 1 (21:57):
And they find this woman,
Speaker 2 (22:00):
I met wonderful one, and this, this is someone with a lot of experience in sport. Who's also studied a sport of science, so knows the topic really well, but that's a fantastic plan. Let's go with that plan and just help the person with their plan there. So, and we might follow quite a similar plan to that for, for patients. You know, we try and calm things down where we can, we build some strength to try and address some of their physical needs. We bring in some cardiovascular exercise to build some fitness up. We start to introduce impact because it can build impact tolerance, but it also is often a a way of developing some power. So perhaps some plyometric exercise to restore power, which is often neglected in rehab. And then we start to do a graded return to running and that's then where we got to try and work with them around their goals and also work with them around pain. And that can be a bit of a barrier.
Speaker 1 (22:53):
Yeah. And so how much pain is acceptable? How much is too much? Yeah.
Speaker 2 (22:59):
Like our pain scales you know, sort of scoring pain out of 10. And I, I would say there's actually quite a few studies that have done that quite successfully. So I think there's some value in that. But what we've talked about with these pain groups is that the connection between load and pain, isn't very clear and the pain response is exaggerated. So if we're guided purely by pain, we are going to struggle a little bit, I would say with these patients. So I would tend to say that the patient needs to decide what they feel is acceptable, and we provide some, some guidance. And we need to try, and if we can look at longer term trends, then now patients quite understandably might get very focused on day-to-day pain fluctuations, but it's actually more the long-term in pain over the, over the weeks and months that we're a little bit more interested in.
Speaker 2 (23:49):
And we also perhaps need to recognize that there are almost two slightly separate goals here, improving function and improving pain. If you're seeing improvements in function and pain, hasn't changed, that's still a win because you're doing more. In fact, that's quite good when, because you're doing more and your pain doesn't get worse, but patients often won't see that as a win because understandably they may want that pain to go away, but we can often folks first will say, okay, well, let's start with what you feel is a manageable level of exercise. Let's work with it consistently. First of all, and then gradually build as long as you feel the pain is, is an acceptable level. And sometimes what we tend to see then is over time, they're able to do more and more, and then gradually that pain does subside because they're able to do more.
Speaker 2 (24:39):
They're more confident they're starting to get their life back. The threat value of the pain is starting to go down, but that takes quite a long time. So I think quite often, wherever possible, placed the focus a bit more in function and just save the patient a few phone that feel that it's manageable. It's acceptable. This is fine. If it's too much, if it's not manageable, we'll dial it down a little bit, but we want, if we can to stay consistent with exercise, because otherwise we're going to have a lot of beam, bus tear will build you up and stop they'll drop and stop. We want to just see, can we keep you ticking along, even if it's at quite a low level
Speaker 1 (25:13):
And do you have your patients keep a log or a journal or some way so that they can see, Oh, I was doing this. I started with Tom on March 1st and here it's April 1st. And this is what I was able to do Marsh. Now this is what I can do in April. My pain's around the same, but look at how much more I can do, or maybe my pains a little less. Or do you, how do you keep track of all that? Do you give that to the patient to help them with their own sort of locus of control? And are you using the pain scale? Are you saying well, what is your pain March 1st? Let's compare that to April 1st. Let's compare that to March 1st.
Speaker 2 (26:01):
Yeah. I would try and see if we can monitor that goal activity because it's important to be able to see that they're improving and they're progressing towards their goal. If you've got quite a specific goal, like running a 5k in order to get that, you've give it a C you know, how, how far you're able to run. And that's the simplest question. How far can you run now? But that can be it could be steps for day. If someone's wanting to build up their walking, it could be minutes rather than miles with any activity, really. So I think it's a good idea to try and monitor what people are doing. I do, I do use the pain scale a little bit. It depends on, on how comfortable the person is with it, whether they like using that. I tend to perhaps make it a little bit more simple and just say, is your pain mild, moderate, or severe sort of break it down into those into those three sort of different categories, really.
Speaker 2 (26:58):
But the thing is with pain is there's so many different aspects of it. Are we talking about average pain day to day? We talking about peak pain. What did the pain get up to is it's at its highest, we're talking about pain frequency. So how often you've had that pain during the day, are we talking about pain distress, which I think is almost a separate thing. How distressing are you finding that pain? So if you're especially worried about it, that pain often will be more distressing, even if the severity isn't necessarily higher. Do you see what I mean? So I think, I think where possible we focus on the golf function and we, we try and take that focus off pain a little bit because as well, you know, if patients are monitoring it every day, that drawing that focus on pain every day, and they're asking ourselves, how much does it hurt?
Speaker 2 (27:47):
Even some patients have no one used the term morning MRI. I used to get up in the morning and do it, do a sort of stretching test on his Achilles. That was what he called his morning MRI to test the Achilles out and see how he thought it would be that day. We don't really want to do that. To be honest, we want to focus on what your valued activities let's really try and bring them back in, build those up and keep a kind of a little casual, casual notice of pain, let pain tell us if it's too much, if it's breaking through, into your attention and in telling you it's too much, that's probably when we need to act, if you're looking for it, if you're, if you're kind of really questioning, is it worse today? I'm less concerned about it.
Speaker 1 (28:26):
Got it. Yeah. So you don't want them to, you don't want your patients to be waking up and be like, wait, do I feel, do I feel more pain today? Weight you're you're well aware that you have pain.
Speaker 2 (28:38):
Yes. Yeah, absolutely. I think that calling is focusing on the pain as well. It's quite, it's quite a normal thing to do. I think we've kind of pathologized it a little bit. But I think actually it's understandable for people to do that. There's another layer of context around the pain and what it might mean and what that might mean for your, for your future. So I'll give you an example from myself. So I have I have psoriasis and I have nail bed changes with psoriasis and that increases the likelihood of you developing cirrhotic arthritis. So a couple of weeks ago and surfing on Twitter and someone posts a link to a research paper that says new studies shows link between nail bed changes and severities, psoriatic arthritis. And I start thinking, yeah, my fingers are a bit sore today, you know, and that's one of the areas where you can get psoriasis, arthritis, changes in the joints and the fingers.
Speaker 2 (29:41):
And then I throw it comes back a little bit later that day and for a few more days afterwards, and now I'm sort of noticing like achy thumbs hands are a bit stiff in the morning. And if I allow myself to keep focusing on that and measuring that and worrying about that, it would be understandable that that could become really quite a worry for me, because then you think, well, is it cirrhotic arthritis? That's been, that's known to actually affect the joint and perhaps even damage the joint. And if I've got nail bed changes, that means it can be very severe. And what impact would that have on my life? And these are all just normal things that we have as, as people, as health professionals that know quite a bit about pain. So I think we can acknowledge for someone who's not a health professional.
Speaker 2 (30:25):
There's probably a lot of that going on, particularly the pain's been there a long time and pains is a real nuisance because it can, you can kind of like stop worrying about it. And then, then you have the pain and it kind of reminds you and goes on about you and that can start worrying prices over again. So it is hard. And I think sometimes it's health professionals, we think like, well, I talked to them about their pain and I reassured them that pain doesn't damage tech. But that if you think that that is enough to wipe out that concern, we are. Yeah, but we may need to be consistent with that message several times. And we might need to encounter that worry coming up several times and to try and help someone contextualize their symptoms and to see that not what they're fearing, but what really is going on.
Speaker 2 (31:18):
And to look at a bit the now of how symptoms are. So with my hands, you know, I don't have any of the classic signs of cirrhotic arthritis. I don't have swelling. I don't have a loss of joint range. I've actually been tested for psoriatic arthritis and it was negative. So it was trying to contextualize it and see the reality is I've just turned 40 and I've got slightly stiff fingers. That's the reality. So let's focus on the now and what is real for you now and not what you fear might be coming up in the future.
Speaker 1 (31:47):
Yeah. And that's something that I say to myself every time I wake up and my neck's a little stiffer sore, you know, my upper back feels a little sore instead of my, what I used to do is, Oh, okay. I better not go to work today. I better just relax. Let me get a heating pad. Let me just, I don't want to do anything. I should probably just lay down. And these are all the things I used to do. And so now when I wake up or if I do have a flare up of neck pain or something like that, now I'll just say, okay, I know nothing is seriously damaged. I have the MRIs to prove it multiple. And you know, these are just things that I have to continually say to myself. And I think I'm pretty well versed in, in the science behind pain and, and even working with people with persistent pain. I mean, I do it every, but even for myself, I have to continuously sort of recite these mantras to myself in order for me to get through the day when I have a little bit more discomfort or pain. So the struggle is there, you know, and I think imparting that and telling that to your patients, especially your runners with persistent pain. I think that can be very powerful.
Speaker 2 (33:07):
Yeah, absolutely. And, and recognizing, as I said, the bigger picture of knowing the person and, and the things that make them make up them as a person. And if they are, for example, running to their mental wellbeing, what, what, what is the, the thing that, that they're running to help? And how does that link to their pain? Are they running to help anxiety? In which case are they someone who is perhaps going to struggle with negative thoughts about chain, and they're going to be drawn into ruminating about those negative thoughts about pain, and they're going to be looking for reassurance that those thoughts, you know, jumping on Dr. Google, I'm finding actually it makes it worse because they see all the negative outcomes they're afraid of laid out on a web page. So if they are someone with, with that, then they, they may need more, more help with that. They may need to, you know, you may need to work with a mental health professional to help them work with those thoughts and to find ways perhaps to not get drawn into that ruminating pattern and to look for other coping strategies, we show it to them. The long-term can be useful because they're less reliant and upon the sport, because they actually learn perhaps a slightly different relationship with that, with their thoughts and from that, then can help that their mental wellbeing.
Speaker 1 (34:22):
Yes. I agree with that. And Nelson, before we kind of wrap things up is there anything that we missed or that maybe we flew by a little too quickly that you want to elaborate on? And if not, what would be your best advice to a clinician that is working with AF that is working with people with or athletes with persistent pain problems?
Speaker 2 (34:54):
I think in terms of things we might have missed, I just would say that there's a, there's a nice paper from Halon as torn in 2017 that's well worth a look, which is, is actually looking at things a little bit more in terms of pain in athletes. And there's, there's quite a nice quote in that that I'll just briefly read now if that's the case. So they say even low level inflammation, for example, linked to sleep deprivation, ongoing stress and load exceeding the tissues capacity can reduce the athlete's mechanical nociceptive threshold sufficiently to make normal mechanical demands of sport painful. So that sort of Lincoln into this bigger picture stuff saying here, actually, if we're not recovering enough, or the load is excessive on the tissues, it's actually going to have an effect potentially on sensitivity know nociceptive threshold.
Speaker 2 (35:49):
So this is where it's quite important for us to see the bigger picture. They also say in that paper that the, the link between tissue change and pain is thought to reduce over time. So if you've got someone with very persistent symptoms, years' worth of pain, you should already perhaps be suspecting that this is probably not just going to be driven by the tissues. I mean, when is there ever a situation where pain is, but, you know, it's probably going to be a bigger picture here that we need to identify. And I think that's probably one of the key messages to take from what we've talked about. Hey, really, you know, you, you start right with the first question is perhaps just to, to try and see if you can recognize when you are looking at a more persistent pain state and to try and really get to know that person and the bigger picture, and what's driving that because then I think you're going to get better results with them and then try and see if we can work gradually towards their goals and just keep them on track with it and give it time.
Speaker 2 (36:45):
It will take time, you know, this, the patients I'm seeing, we're looking at at least six months, probably a year of working together because there's so much to work through. I think we sometimes say, Oh, we reassured them about their pain. Give them some exercises away. They go, it's not really like that. You know, it's going to be lots of ups and downs. We're going to have to stick with them for a while and just keep chipping away, but you can get some really good results with people and you can get them back to the sport that they, that they love. And that can be a really, really big thing for them.
Speaker 1 (37:13):
Yeah. that's a great way to to end our conversation here. One, one question, what was the, who's the author of the paper from 2017?
Speaker 2 (37:26):
I think it's Hamline at all. I believe it was in the but I can find a link to it for you to put in the, in the show notes, if you would.
Speaker 1 (37:36):
Perfect. That would be great. And I will look it up as well. But thank you for that. Now before we finish our conversation, where can people find you? If they have questions?
Speaker 2 (37:48):
Yeah. Come and say hello on on Twitter, I'm at Tom goo or an Instagram ad running dot physic. Also I've got my website, which is running-physio.com. So yeah, come and say hello, ask questions and things. So it's good to chat.
Speaker 1 (38:03):
Perfect. And last question. What advice would you give to your younger self knowing where you are now? And I know we've, you said this before is, and I have to say something different. Now you get a chance to give yourself a second piece of advice.
Speaker 2 (38:16):
Oh, good question. Oh now that I'm thought 14 spending a bit on top, I'd, I'd say really enjoy your hair while it's there. Yeah. now I don't know, in all seriousness, I think I would probably sort of say you know, really make sure that you kind of value value, that things are important in life friends and the family, you know, always, always try and put those things first because ultimately they're, they're the things that are most important for us. And I think a lot of people already know that and I've learned it, especially during COVID, but I think there's a lot to be said about, you know, focusing on family and friends and things first you can still have a very fulfilling career and things, but I think that that's the important, the important stuff. That's what makes, makes life great. Really
Speaker 1 (39:08):
Excellent advice. Well, Tom, thank you so much for coming on to the podcast again and sharing all this great information with us. I really appreciate your time. Thanks for having me back here. And it's been really good pleasure, pleasure, and everyone. Thank you so much for listening. Have a great week and stay healthy, wealthy and smart.
In this episode, Founder and Host of Entrepreneurs on Fire, John Lee Dumas, talks about the 71000-word, 17-step, 273-page success roadmap that is his first traditionally published book.
Today, JLD talks about the launch of his book, The Common Path to Uncommon Success, and we get to hear a few of the 17 foundational steps to success, and we hear about identifying what we want to achieve, all on today’s episode of The Healthy, Wealthy & Smart Podcast.
Uncommon Success, Roadmap, Process, Entrepreneurship, Wealth, Prosperity, Freedom, JLD, Entrepreneurs on Fire,
More about John Lee Dumas
John Lee Dumas is the Founder and Host of Entrepreneurs on Fire, an internationally-acclaimed award-winning podcast with over 1 million monthly listens and 7-figures of annual revenue. To date, he has interviewed over 3000 of the world’s leading entrepreneurs, including Gary Vaynerchuck, Barbara Corcoran, and Tony Robbins.
His first traditionally published book, The Common Path to Uncommon Success, is an amalgamation of the lessons learnt from the over 3000 interviews he’s done.
Get the book: https://uncommonsuccessbook.com
To learn more, follow JLD at:
Facebook: John Lee Dumas
YouTube: John Lee Dumas
Subscribe to Healthy, Wealthy & Smart:
Read the Full Transcript Here:
Speaker 1 (00:01):
Hey, JLD welcome to the podcast. I am so excited to have you on
Speaker 2 (00:06):
Fired up to be here. Thank you for having me and listen. You've got a beautiful cat. I've got a beautiful dog. They might make a Paris's in this interview who knows
Speaker 1 (00:15):
It is possible. And I have to say, this is like a full circle moment for me, because I have always as a podcast or looked up to you for your podcasting, for your show entrepreneur on fire 3000 interviews. I mean, that is, that is amazing. And, and for all the listeners out there that is not easy to do. And now you've got a new book coming out. Your first traditionally published book. How exciting is that?
Speaker 2 (00:47):
Listen, I'm fired up. This is a combination of the 3000 plus interviews I've done over the last decade. I've interviewed some of the world's most successful entrepreneurs over the years, and I've learned from every single one of them. I mean, every one has been my mentor and I've been able to distill their genius down into what has turned out to be 71,000 words of my blood, sweat, and tears. Cause it took me 480 writing hours to write the 71,000 words, the 273 pages that comprise this book. But I couldn't take a single word out. This is a definitive 17 step roadmap to financial freedom and fulfillment. So if that's interesting to you, this book is your guy,
Speaker 1 (01:34):
Which is amazing. So it's the common path to uncommon success, the road to financial freedom and fulfillment. And you know, you, as we know, have been very successful online entrepreneur, but let me ask you a question. Sticking in that online entrepreneur have people been lied to by the quote unquote experts in the online business world.
Speaker 2 (01:59):
Listen, the online experts in this world. There's a lot of fantastic ones that are doing amazing things out there. And there's some not so fantastic individuals out there who will lead you to believe that the path to uncommon success is secrets. It's hidden. Maybe it's complicated. Listen, it's none of those things I've seen over 3000 successful entrepreneurs and I've interviewed over 3006 successful entrepreneurs. And I've seen that all of them have taken what has turned out to be a very common path, a very common path to one comma success. Now, by the way, it's hard work. It is absolutely hard work, but it's a common path. It's not secret. It's not hidden. It's not complicated. It is a very, very clear, very common path. And it's not something that, again, these so-called gurus that will try to, you know, sell you some key for $1,997 and 97 cents. Like, listen, that's the answer. The answer is clear. The content is out there. I've done over 3000 interviews. You have individuals like Karen and others who have done interviews. There's great content out there to be had. And I could tell you right now, just go listen to all 3000 of my episodes, but that's tens of thousands of hours or is distilled down into one book, 17 steps, 273 pages. And it's there for you. That's the common path to uncommon success.
Speaker 1 (03:29):
And when you look at success and we look at financial freedom and fulfillment, what, what do we really want to achieve here? What does that mean?
Speaker 2 (03:38):
So this is what I've really identified. That individuals really desire in life. Freedom. Freedom's one simple word, but it's so hard to attain, but think about it when you're free every single day to wake up and to do these three things, do what you want, where you want with whom you want. What else is there in life? Like when you can literally say, I get to do what I want to do, where I want to do it with whom I want to do it. I have that freedom. That's happiness, that's success. That's what people want. And this is what so many people have been able to achieve. You know, unfortunately, a lot of people don't think that's possible and they will never be able to achieve as a result. But those type of people don't listen to podcasts like this. So I know I'm talking to the right individuals right now. It's there. It's possible. It's, it's, it's a, it's a common path to your version of uncommon success.
Speaker 1 (04:38):
Now, you know, you say in the book, it's a 17 step roadmap. Most people will give you five steps or maybe eight steps, right? So what, what is the 17 step roadmap? If you can give us a couple of little snippets or details.
Speaker 2 (04:54):
So here's the process it's like when I interviewed these 3000 plus now individuals, and I've been able to really boil down and distill down the core foundational elements that all successful, aren't new or share in common. There were 17 of them. Like I wish there were 18 or 16. I like even numbers, but listen, it was 17. I couldn't take one away. I couldn't add one. It was just simply 17 foundational steps. And I was able to put them in a chronological order. And before me, I had the 17 chapters of the book and a step-by-step format, 17 steps to financial freedom and fulfillment. And let's go over a couple right now. Number one, this is where most people get it wrong, by the way, identify your big idea. Keywords, your big idea. So many people, Karen, they are right now living and acting in a week pale imitation of somebody.
Speaker 2 (05:53):
Else's big idea. They're like, Oh, look what Karen did or John. And they're having success doing these things. Let me just do that. And then they wonder why they're not successful most because they're a week pale imitation of those people that are trying to copy. They're copying somebody. Else's big idea. That person, it's their big idea. It's their zone of fire. That's why they're successful because they're living in their zone, a fire. You need to sit down maybe for the first time in your life, by the way, and really give yourself the time, the space, the open bandwidth to really come up with and identify your big idea. And your big idea is out there. Your zone of fires out there and chapter one, listen, it's not just words on a page. There are exercises. I teach you how exactly you get to your big idea.
Speaker 2 (06:42):
And that is a super critical part. That by the way, most people will die. Never even knowing what their big idea is because they never took the time to sit down and identify it. And it doesn't even take much time, which is the sad and scary part. But here's the thing here. If it was just that simple to identify your big idea, it would be one chapter in my book. And there were just be one chapter in my book. There's 17 steps. So there's a lot more to it than I than identifying your big idea. Let's just jump to step two. And then we'll skip a little ways ahead to, to show you any part of the book as well. But once you have your big idea, people are like, Oh my God, I'm so excited. Like I have my big idea. Let me go all in on this.
Speaker 2 (07:22):
That's a huge mistake because guess what? Your big idea is a great idea. And other people have had it too. And there's competition. That's out there crushing your big idea, which is a good thing because that's proof of concepts. That means that your big idea really is proof of concepts, but you can't right now launch against entrenched competition that's out there. So instead you go to step two, which is discover your niche. That means you're going to identify within your big idea, an un-served opportunity, a void that needs to be filled, that you can be the best solution to that real problem within your big idea. That's how you win. Like Karen, when I launched a podcast, that was just this broad idea, but then I was like, well, I'll launch a business podcast. That's a little more niche. Okay. It's still kind of broad.
Speaker 2 (08:14):
There's a lot of people there. Well what about an interview business podcast? Okay. There's like seven or eight other interview business podcasts. What about a daily interview? Podcasts of the world's most successful entrepreneurs, zero other competition. The day I launched entrepreneurs on fire, it was the best daily podcast interviewing entrepreneurs. It was the worst daily podcast interviewing entrepreneurs. It was the only daily podcast interviewing entrepreneurs. Like can't you see, like, that's why I won at such a high level. How can you be the best? Sometimes it means being the only, or it means niching down till you look around your competition is terrible. So you can kill them immediately. You can beat them up. That's how you discover your niche. Then of course, there's step three, four, and I take you all the way through and beyond. Let's skip forward right now to step seven.
Speaker 2 (09:09):
So every chapter in this books, an average of a three to 5,000 words, this chapter I wrote and I wrote and I wrote, and I wrote 13,500 words. By the time I finished this chapter, step seven, chapter seven, creating your content production plan. That is why we've won financially at such a high level because our content production plan is amazing. And I say that because it took us 10 years to get here. It's stunk at first, but now it's amazing. And I poured it all into this chapter and it is phenomenal and it's listen, it's not easy to emulate, but it's all there for you. And you will see after reading this chapter, why we're winning at such a high level and frankly, you know why you might not be because likely your content production plan is nothing in the same realm of what we have just like ours.
Speaker 2 (10:06):
Wasn't in this realm, obviously when we launched back into, you know, almost 10 years ago now, so that's just a glimpse of three of the 17 steps. And we have actually a bonus chapter called the well of knowledge. And it's a really cool chapter is chapter 18, a bonus chapter. And that's just the best pieces of advice, mentorship, inspiration, motivation that I picked up over the years. I just dropped it into this chapter. And this meant for you to really just take your ladle, dip it into the well of knowledge every now and then when you need it, when you need a little bump, a little boost. And man, that chapter is really cool because it's not meant to just read all at once. Like go there, consume it. One passage to passage, get the kind of inspiration you need, then get back to work. That's the process
Speaker 1 (10:56):
Amazing. Well, I mean, I don't know about anyone else listening, but I am so excited to get my copy, which it releases on March 23rd. So tell us, tell all the listeners here a little bit more of the details of the book launch so they know where they can get their copy.
Speaker 2 (11:11):
So listen, all the magic is going to be happening over at uncommon success. Book.Com, uncommon success book.com. You can head over there. You'll see the personal endorsements from Seth Godin, Gary Vaynerchuk, Neil Patel, Erica Mandy, Dorie Clark. You'll see a video of me describing more details about the book. You'll see. The first chapter is there for free just to read, to consume it, to see kind of like, well, how my writing process is plus the five bonuses that come with the pre-orders. So do not wait until March 23rd. You want to pre-order this book because it is amazing what we've done for these five bonuses. Just one of them, by the way, I'm to your door. All three of my journals, the freedom mastery and podcast journal. I'm literally shipping to your door at my expense. Well, drop them all. If you live in the United States of America, outside of the U S I'm going to give you the digital pack of all three immediately they're beautiful fillable versions. They're awesome. And there's four other insane bonuses. You can learn more about those other firstname.lastname@example.org.
Speaker 1 (12:21):
And I, I ha I will say congratulations are in order already. Cause an Amazon I checked today is already a number one bestseller on Amazon and it's not even out yet. And for the listeners, I am going to be giving away five copies of the book and you'll find all the details on my Instagram page. So check that out. Cause I will be giving away to five lucky winners, five copies of this book, because if you just go on to the website and read even the first chapter, you're like, man, I get it. You know, and I, and I also love the fact that you're vulnerable, that you're saying, Hey, this didn't happen overnight. And that's what a lot of people think. And that's what a lot of people sell. And it's so refreshing to see people out there experts like yourself saying it's hard work, it's work, but you can do it. So you're welcome. So I want to thank you so much for coming on the podcast. And one more time, where can people find all the info,
Speaker 2 (13:21):
Uncommon success, book.com, check it out a lot of great stuff there. And once again, much appreciated.
Speaker 1 (13:30):
Thank you so much. And everyone thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.