Healthy Wealthy & Smart

Healthy Wealthy & Smart: Where Healthcare Meets Business. The Healthy Wealthy & Smart podcast, hosted by world-renowned physical therapist Dr. Karen Litzy, offers a wealth of knowledge and expertise to help healthcare and fitness professionals take their careers to the next level. With its perfect blend of clinical skills and business acumen, this podcast is a one-stop-shop for anyone looking to gain a competitive edge in today's rapidly evolving healthcare landscape. Dr. Litzy's dynamic approach to hosting combines practical clinical insights with expert business advice, making the Healthy Wealthy & Smart podcast the go-to resource for ambitious professionals seeking to excel in their fields. Each episode features a thought-provoking conversation with a leading industry expert, offering listeners unique insights and actionable strategies to optimize their practices and boost their bottom line. Whether you're a seasoned healthcare professional looking to expand your skill set, or an up-and-coming fitness expert seeking to establish your brand, the Healthy Wealthy & Smart podcast has something for everyone. From expert advice on marketing and branding to in-depth discussions on the latest clinical research and techniques, this podcast is your essential guide to achieving success in today's competitive healthcare landscape. So if you're ready to take your career to the next level, tune in to the Healthy Wealthy & Smart podcast with Dr. Karen Litzy and discover the insights, strategies, and inspiration you need to thrive in today's fast-paced world of healthcare and fitness.
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Now displaying: December, 2021
Dec 30, 2021

In this episode physical therapist and podcast cohost, Dr. Jenna Kantor talks about the highs, the lows, and everything in-between from the past year. 

We talk about: 

  • The effects of Covid-19 on life and the practice of physical therapy 
  • Online bullying in the physical therapy world 
  • Realizing the importance of friendship 
  • The mental shifts we experienced over the past year 
  • What we are looking forward to in 2022
  • And much more! 


More about Dr. Jenna Kantor: 

Headshot Dr. Jenna Kantor Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, Regional Dance America Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre. 

Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia.

During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media.

​Jenna Kantor currently holds the position of the NYPTA Social Media Committee, APTA PPS Key Contact, and NYPTA Legislative Task Force. She provides complimentary, regularly online content that advocates for the physical therapy profession. Jenna runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online course for performing artists called Powerful Performer that will launch late 2019.

To learn more, follow Jenna at: 





Fairytale Physical Therapy


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Read the Full Transcript Here


Hey. Hey, Jenna, welcome back to the podcast for our annual year and Roundup, if you will. And I want to thank you for being a great addition to the podcast and for pumping out really amazing podcast episodes, you're great hosts, the energy is fantastic. And the podcast episodes are always great. So I want to thank you for that.



Oh, my God, you're so sweet. I like I was definitely not as much of a podcaster this year, I acknowledge that. But hey, listen, we've all been adjusting this year to pandemic and now pandemics still happening, but also recovery. And I'm just grateful to still be a part of this podcast in any manner to be in this interview right now. Because I really, you and I are very much on the same page regarding remaining evidence based and speaking to people that we respect in this industry, and also people that we want to see just rise and have great success. So I'm just grateful to be honestly, I am humbled to still be in the room here with you.



Thank you. That's so nice. So kind. Now, let's talk about this past year. So 2021, obviously dominated by the ups and downs of COVID, which is still going on as we speak. We're we're both in the northeast, so we're experiencing an incredibly high surge at the moment. So COVID is obviously a big story. And I think part of the COVID journey that isn't being talked about as much. But I think general public, certainly the mainstream media, are people now living with long COVID. It is just something that seems to be skimmed over. And we know that at least at least the bare minimum is 10% of people diagnosed with COVID will go on to have symptoms of long COVID. And instead of some of the studies that I have read recently, those percentages are much, much higher. So what I guess, what is your take on all of that? And what do you think we as physical therapists can do to keep this in the in the forefront of people's minds.



We discussed this before, but I think there's going to be bias within this. So I want to acknowledge that we all have our biases. That being said, I think we need to first acknowledge there was a phase where there was a part of the world that did not think COVID was real. So based on the research that is out there, and personal experience of a lot of people getting it, as well as personal friends very close personal friends working in hospitals in New York, specifically COVID is real. So I want to say that first. I'm not going to differ from that I really wish there I'm I think we're past that in the world. I think there was never a clear cut of like, Oh, I got it, I see that it's real. I was wrong. I would have liked that moment, because that hurt people in the process. But I just want to say that first. So COVID is real. Okay. Now, let's not belittle it. And I think in regards to the patient care. I think this, the reality of long COVID needs to be just as respected. Just like when you have a patient that comes in the door and says they're in pain, and you don't believe them. We need to stop that. So we need to believe them and their symptoms, and what they have and what it's from and treat it accordingly. Because if we go in the door to help out these individuals who are struggling with this, they're not going to get better. What are your thoughts?



No, I agree. I agree. And I've heard from people living with long COVID that people don't believe them even their own family members, people in who work in medicine, they don't believe them. So I think that's a huge takeaway that if as clinicians we can do one thing sit down Listen, believe because the symptoms that they're having are real. We did a couple of episodes on long COVID thing was back in August and spoke with three amazing therapists and they're all involved with long COVID physios so if anyone out there wants more information on living with long COVID I would definitely steer you to long COVID physio on Twitter and and their website as well. Because they're a wealth of knowledge. These are people living with long COVID their allies, they are researchers and I think they're putting out some amazing information that can help not just you as the clinician, but if you know someone that maybe you're not doing directly treating maybe it's a family member living with long COVID I think the more information you have, the more power you can kind of take back to yourself.



I love that. I love that. It's the biopsychosocial model. I mean to that I from working because I work specifically more with performers, the psychosocial component, my my patients, my people I call my people, my people would not be getting the results they're getting if I didn't have to deal with that, with them standing by their side, holding their hands helping them through and out of their pain. There's symptoms every day and this that goes for anything.



Yeah. And and we now know, speaking of performers that a lot of Broadway shows are being sort of cancelled, and then restarted and canceled and restarted because of COVID outbreaks within the cast. So this may be something people might think, Oh, I work with performers. I don't have to worry about long COVID Well, maybe you do.



Yeah. Yeah. And for them, it's the, from the performance that I'm in contact with on Broadway that, you know, it's I'm, I'm, I'm very connected. I've been in the musical theater industry for a very long time. So for the people who are on Broadway, the individuals I spoken to, they're doing okay, which I'm really, really grateful for. It is a requirement for the performers to be triple vaccinated, and now they're getting triple vaccinated. I know one performer on Broadway, who was about to get her booster shot, and then ended up getting COVID, which was quite unfortunate. She's doing okay, though. Grateful, no signs of long COVID Right now, but for the performers, you're talking about dance, there's endurance and breathing that is necessary. If the singers even if they're, they're not dancing, they still dance, they're still asked to do things, they still have out of breath, emotional moments, were breathing is challenged. So I'm just bringing up one component with long COVID. But that's, that's a big standout for performers specifically, that need, it needs to be kept out for them. I remember one time during, oh, goodness, during 2020. And it was the latter portion of the year. And I was doing virtual readings with performers. That's how I was staying connected with my my friends and people in the industry. And it was our way of being creative. In the meantime, while we're waiting for things to open back up. And one individual is she what I just cast her to read as the lead in the show, and she was so good. It was my first time hearing her perform first time meeting her. She was Outstanding, outstanding. And at the end of it, we were going around checking in with each other how we were doing and she started to cry and opened up about losses and her family due to COVID. And that she didn't think she would be able to sing like that again, because she had been dealing with her breathing problems for so long. And so then we all get emotional with her. I'm getting emotional just thinking about it. So yeah, it's it's a it's a real thing. We didn't have the vaccination then. So I'm interested to see statistically where we are at with long COVID with having the antibodies in our systems. Obviously, everybody is different, but I'm hoping that there's less of it because of the vaccine.



Yeah, time will tell right? Yeah, we have we need those data points. So aside from obviously COVID being, I think the biggest story of the year, certainly within healthcare and even within our field of physical therapy. What else have you seen over 2021? Or maybe it was in an interview you did or a paper you read that really stuck out for you as as a big part of the year you know, it made it's made it it made its mark for you.



Oh, I'm going to focus just on the PT community. And I want to emphasize with community I see our community at really, we've always butted heads there's always things that we butted heads on. But I'll just give the instance that really made me go whoa, I was in a room with a bunch of intelligent wonderful human beings and discussing something I said a term that I thought was really common especially because in the musical theatre industry. We are fighting for dei diversity, equity inclusion all the time. Like if this is a topic of conversation all the time. It is a huge thing in regards to casting what is visually out there the most at like the highest level and, and bipoc the phrase bipoc was unrecognized by a good portion of physical therapists in this room and I was disappointed Did I was it said so much it doesn't. It's not saying that a person is evil for not knowing no. And that is not my point. But it is a problem that it's not being discussed to the level where these common extremely common thing phrases are not just known. That just says a lot to me, because it's in regards to people getting in the door access and being reached, in lesser, lesser affluent areas, that to me, it shows that it's not being discussed, it's not being addressed. If it was, then bipoc would be, and this is just one instance. But I thought that was very eye opening. Because it's just like saying, I'm going to eat today, someone saying, I'm not going what you're not eating, I don't know. And that was a bad example. But just something that is or you wake up you breathe, that is how known the phrase bipoc. Same thing with LGBTQIA. Plus, in my community, like, for me to go into another room and for things to need to be defined. I know we all have different worlds. But I think as physical therapists, there, there's a disconnect, unfortunately, depending on wherever we are from, and we need to fix that. Because I can't live everywhere. I can't treat everyone in the world, I can't treat all the performers in the world, I don't want to I like having my niche practice and treating select individuals, and boom, my people do very well. And if it gets to a point that it starts to grow, I'm going to be passing them along because I don't want I don't want that I don't want it to be huge like that. And with that in mind, I need more people who know and therefore are our allies. To me, it's a lack of ally ship, of just not knowing the basic language. And I and I apologize to anyone who's listening on my intention is not to sound like a white savior at all. It's not. But with my limited knowledge at this point, I'm already seeing something that is really, really lacking amongst each other and we need to fix it. I don't know if it's books or I don't know, I don't I don't know the answer to that. But I'm just addressing that was that was the biggest standout thing for me this year.



And it for those of you who maybe are not familiar with the American Physical Therapy Association, they have what's called House of Delegates. So they had a meeting in September of this year during the APTA centennial celebration. And in that they did pass a resolution that the APTA would be an anti racist organization. Now, were you in the room when that passed? Jenna?



No, I was not in the room, I was actually there at the House of Delegates a bit discouraged this year, I know. i The fact that they were able to figure out any manner to put it on is is a feat to be had after 2020 20. However, the in person when you go and if you are not a delegate, which I was not this year, you can usually sit in the room, and just be in the back and listen, because the because of the space that they got in the way it was set up, there were chairs in the back of the room, but there weren't that many and it filled up. So they already preemptively set up another room where you could watch what was happening on a TV, which did not sit well with me. Because I could have stayed home instead of flying in for that. So I was definitely not in the room. I definitely was less present this year. Because of that I was I was bitter, I was bitter. I was bitter. I felt like I I already know you it's through elected and know who you know, to become a delegate, but I really felt disrespected and unimportant. Being in a separate room, watching from a TV rather than actually getting to be in the room because there are ways that they hold the meeting where you can stand up to say a point of order to speak on some points from the from the back of the room. And I just wasn't even going to wait to see how they figured that out. I just felt like not a not an important voice. So I wasn't present for that. But I do know about that. I think it's wonderful to get that on the docket. But the same thing when we voted in dei unanimously. How?



What comes next? You mean? Yeah, well, yeah.



What is the game plan? Because for me, I can say a sentence like that. But then what are the actual actions and that's where it's like, is that going to happen? Two years down the road three years. What are we at what are we actually doing? What are the measuring points and take action? and not meetings on it, not being hesitant on making mistakes. Let's make mistakes. Let's just go for it. That's the only way we're gonna learn. There's no such thing as a graceful change, no matter how hard you try,



right? Yeah, yeah, I agree. I think like you said, what comes next is? Well, I guess we'll have to wait and see what are the action steps they're going to take in order to create that and, and live up to the, the words of being an anti racist organization? Because it was passed overwhelmingly.



Right? And then I'm sure they applauded for it, you know, like, this is great. But to me, I think it's, I it's just like, okay, you know, like, what, but now what? Because from DJI and the I heard that they're trying in the battle in this behind the scenes, trying to move forward, but I have not seen action there. And maybe I'm missing something, you know, feel free to call me out Call me whatever. Like, I'm, I would love to be wrong.



Yeah, these big organizations are slow ships to steer. That's not any excuse whatsoever. But I understand there's a lot of layers that one has to go through to make things happen. As you know, you've been volunteering for the APTA for a long time. So you understand that, but I think a lot of people who don't don't, so that's why I just wanted to kind of bring that up and saying, like, yeah, it takes it takes a long effing time to get stuff done, you know?



Yeah. And I mean, you can hear it, I'm frustrated by I'm not, I'm not happy about it. And but it's, it's because of my friends, the conversations I have, and I, I'm, I'm lucky, I'm a sis white, stereotypical female. So like, the way the world has been made, and the way it caters to humans. It fits me, but it doesn't fit everyone and I'd like I can't imagine what it would be like to just be left out of a lot of things in everyday life. I think that's horrible.



Yeah, agreed. What else? What else do you think was a big something that you saw within the profession? Or even trends in health and fitness that might have really changed over this past year? For better or for worse? I can think of one I think and this is just my opinion that the the communication via social media has gotten a little too aggressive. Is that a nice way of saying it? Like I don't understand it, I don't get it. I took like a little break because I was Oh, can't say I was bullied because I feel like bullying. It's that sort of like you know someone is having like a sustained go at you. So I don't know



it's bullying is bullying. Yeah, bullying is bullying. That's the thing is that we have a lot of bullying that happens but then they gaslight you about their bullying. It's like Whoa, it's next. It's almost like a strategy. Like they're playing a game of Monopoly, and they have down how to win. Like, yeah, people barely there is a lot of bullying.



Yeah, a lot of bullying. A lot of threatening, like, I get like threatening DMS or people threatening me, you know, on their Instagram stories or whatever. For I can't imagine I look back at that interactions. And I'm like, I don't get it.



Yeah, I don't get it. Yeah.



So I and my first reaction was to like, when people will do this and be so aggressive as to send like a Taylor Swift GIF. Of her song, you need to calm down. And then I have to take a step back and be like, that's not gonna help the situation any. Right, right. Right. Don't do it. I just sort of back off. But I think because of that, bullying or threatening behavior, I've



really like I'll say it bullying continue. I've,



I've just like, for the past couple of months, I've really taken a backseat to any kind of social media just to like, give myself like a mental health break, you know, like meeting I don't comment on things. I might post some things here and there, but I don't really make any comments, unless it's to. And that's mainly and I'm going to say this because from what I can tell it's true, is it happens to be men in the profession who are a little more aggressive than the women, like women can seem to have a bit of a nicer conversation around whether it's a question or, you know, something, but when a lot of the men it's just become so like ego driven, that there's no resolution, and it's just mean. Mm hmm. And so I was like I need to take a break. So I saw a lot more of that this year. I don't know if it's because of lockdowns and because of a heightened sense of what's the word? Stress to begin with? And then yeah, or something else on top of it? I don't know. But I, I saw that this year, definitely for the worse, because I just think, gosh, if people outside the profession are looking in and watching these exchanges, what are they thinking?



Yeah, yeah, I've definitely seen it in sis males specifically.



Yeah, yeah.



I'm not it honestly. doesn't it's not a specific color of skin. But specifically sis males.



Yeah, I would I would agree with that. Yeah.



I have. I have experienced a little not not to the level, but I've definitely experienced that. And it's for 2021. And it's not okay. No, it's not okay. However, I ever look at it as a blessing. And this is where I get I love looking at it like this. Yes, please, please, thank you. Thank you for identifying that you have no space in my room, my shelf my space at all. I will not take advice from you in the future. And I will not heed any, any value to what you have to say, because of your willingness to chop me down. Thank you for identifying yourself. I'm now in the debate of blocking you from my mental health. And that's it. And that includes in person. That's it. That's it. And I really don't look as blocking as like, wow, for me, I'm going like, No, I don't want to know you. I don't want to know you. And my life is so much better because of it when I was at the PPS conference, because of just going No to the to the people I don't want to know and just saying like, just straight up like I like I don't need you, I don't need you. I want to be a service to people who need physical therapy period. So people are going to just, you know, find ways of you know, and spend their time writing some angry thing. Have that that's on them that's on them. Like I'm like, like, and if it and honestly I will likely block you.



I love that I love like you're you're it's not just that you're blocking the person. You're blocking the energy blocking the energy they're bringing into you and draining you down. So then you're not at your best well, or with your friends or loved ones patients, even with yourself. Yeah, you know, if you have to ruminate on these people. I love that. Yeah, it's not it's not just blocking you from social media, it's blocking the energy that you the the bad vibes, if you will, that you're Brown. And that affects you that affects your mental health that affects you emotionally. And it can carry through to a lot of other parts of your life and who needs that? Yeah,



and, and for anybody who's trying to saying like, I can a bully did it or like it. Okay, let's, let's look at it this way, when you're messaging an individual something, first of all, we all know this. When you write in text, everybody's going to interpret it with different tone. So as soon as you write in text, we all know this, and we're taking advantage of that fact. So that way, you can later go, oh, I said it in a nice tone, Bs when you're typing it, it can be in whatever freakin tone and you know what you're doing. Also, when you're not talking to a person, the only time you show up is to say something negative. Yeah, that's you're not your voice is not important. And you know, your voice isn't important.



It's so true. What I've actually seen is a lot of these, these kinds of people, they're not getting the attention they used to get. Mm hmm. Do you know cuz I think more people are of the mindset of like, I don't need this anymore. Like this was maybe this was funny. Maybe this was cute a couple years ago. Ah, not anymore.



And also I love I don't like having down moments, but we all have our down moments in our career and in our life. But I what I do love about the down moments in the career in life, the people who are around at that time, those are your friends, those are the people you want to know. So I love my moments in the PT world. When I'm in a down moment because the people who want to talk to me then those are the people I want to know. Whereas when I'm you know, can candidate for the private practice section, you know, which is awesome. And then people want to actually talk to me then. Oh, wait, I'm gonna wait and see when you know, I'm not that. Am I still someone you want to speak to? That is those are the people I want to invest time in. Those are the people I want to invest time in. I want to see you you do well and vice versa. I want to be able to get to know you as a human more and more and more. I just want the children Relationships, it doesn't mean I'm going to have time or you know, we're gonna have time to talk every day. But I want those true relationships. So for me, those downtimes, when I might not look the most graceful, I might be messing up or maybe not messing up. Maybe I'm actually making a change here speaking on something or getting people to think differently ever thought of that, you know? Awesome. Like, are you gonna be here to chop me down? Or just be here to have a conversation and having a conversation? Set up a phone call? If you really care? Like if you really could you don't? People don't care that Oh, reaching out, they don't care about you cannot be when they're reaching out to give feedback. Let's have a comfort. No, they just want to get into an attack mode. No, we No, no, don't try to decorate it. We know that's what's happening. And yeah, that were to town. There's enough going on.



Yeah, there's enough going on. And you know, this conversation really made me reflect on the past year, and I think what's been a good thing has been the deepening of good relationships. So like, nobody has time for that other, like bad stuff anymore. Like there's enough bad stuff happening. I don't have time for that. But what you do have time for is the relationships that are two sided, you know, a nice bilateral relationship that you're willing to invest in, and allow that relationship to come deeper and grow. And I feel like, you know, and like, you don't have to be friends with 1000 people, you know, you can be friends with a handful you can be friends with one person. And if that person, it's it's real and deep and meaningful, then isn't that wonderful? And I think years ago, I used to think, oh, the more



people you know, the better. Me too. Me too.



And now I think because of the upheaval of the last couple of years now, I'm really finding like, you know, I need like couple of good people that I can count on to have my back to, like you said, lift you up when you need to, and maybe to like, give you the honest truth when you need it as well. Right? Exactly. So I've been really, really happy that over the past year, I've made some really nice deeper connections with people than the physical therapy World Sports Medicine world. And I'm really, really happy about that. So I think that's been a real positive for me,



I totally agree with you, I mean, that our relationship is naturally growing over time, which I appreciate and, and I really do I completely on the same page completely on the same page. And and for me, when I go to conferences, like I'm really isolating more and more, who are the two are the people that like I must spend time with? And and then if other people want to join sure, you know, absolutely. But I I'm not overwhelming myself, oh, I need to be friends with that. No, I don't need to. And you know what, like, that became very apparent when I seen people speak, even at PPS, where the goodness, they were showing slideshows with their friends, and it was like, literally all people who are elected in the higher positions are all best friends with each other. It is it's true, you can't deny it. If you're up there. If you're one of those people. It's true. And you know what, I look at it like this, my friends may go up there to that, mate. That's not why I'm friends with you, though, you know, in friendship through because I like you as a person. So I'm gonna let that lay and not even explain and go into more depth and let people interpret that how they want and the right people will stay in



my life. Exactly. So what are they? What are they? Let's, let's sort of wrap this up on a positive note. What are their positive things came to you this year, whether it be professionally, personally,



oh, I think being more comfortable in my skin at conferences. So I had the I mean, absolute honor. Like I was really overwhelmed with happiness at the private practice conference this year. It was just so cool to be nominated. And I felt so much more comfortable in my own skin going up there. I you know, there there are a couple naysayers not realizing there'll be naysayers that, you know that I had to deal with but going up and it was a small moment. But we had you have this rehearsal. I don't know if it's done the same way. For the nominees where they go, you practice when your name is called going behind the podium and then walking down the stairs so you know what to do when you're asked to go out there and give your speech. And I went out there and I did a great vine to my spot. And I mean, I was so happy I did that because I was feeling it and that's what I would do. I did a great fine. And I know that silly, nobody else paid attention to me honestly probably knew that I was doing it. And some were probably like, Oh, but I didn't care. I was like I am on this freakin stage right now, this is the coolest thing. And to be at that place of like more self acceptance, because I know I don't have the stereotypical personality and energy, you know, that that is normally accepted amongst the vast community. So to be more me in that moment, I felt very proud. I felt very proud of myself. And that was really cool. I'm really, really happy about that. And then I like Dan, you know, sat down and ate some more bacon, it was great.



Well, and you know, being comfortable in your own skin that then comes across to the people who are in front of you. So when the speech actually came about, I'm sure people picked up on that picked up on the fact that you're now more comfortable in your skin that you're more comfortable, perhaps as a physical therapist, and because you found you're not that you've, you've already had this niche, but you sort of found your niche. You know, what, you what you're in the physical therapy world to do. Does that make sense? Yeah, yeah. Yeah.



Absolutely. Absolutely. And I got a little bit picked on for being too perfect with my speech and everything. And I was like, I you know, in reflection on that, I was like, they just haven't fully accepted my energy. That's okay. Don't get there. Okay. That's it. Don't get there. I'm like, I'm a performer. So it's gonna happen. You know, do you want to join a British company dialect? That's,



that's a weird comment. That's a weird criticism. Yeah, but yeah, you know,



but I felt I felt I felt like I had to reflect to go No, I actually felt really good, because I've definitely put it on before. No, I practiced it to be to deliver it. Me as me. And now it's so fun. So fun. Oh, my God. Yeah, I was just that that was a big, positive. Awesome, awesome feeling. I work with so many people who are in the PT industry, who want to be dance physical therapist or physical therapist assistants and imposter syndrome is super real. And so I like that I'm practicing what I preach and self love. And and it's awesome. How are you doing all that this year?



I'm better. I mean, imposter syndrome, I think, for me is always there, like always kind of underlying the surface, if you will. But I think that's pretty normal. You know, the more and more I listen, or I read about, like, these famous people who are up on stages and in movies, and you know, people who think oh, they have no, they must be like, amazing. And no, they it's the same thing. So I think for me, accepting that it's normal has actually helped decrease it a little bit. Instead of feeling like, oh, boy, everyone else here is like, amazing. And I'm like the loser trying to keep up. And then I think, no, that's pretty normal, because I think everyone else feels that way as well. Yes. And then once once I was able to accept that it makes going up on stage, like, I don't get as nervous as I used to, and it's been. It's been much, much better for me even speaking. Like I was joking, I could say I now I shared the stage with FLOTUS, because at the future physical therapy summit, I spoke for literally a minute and 45 seconds as a spokesperson for the brand Waterpik. So Waterpik has these wonderful showerheads. And they sponsored the future physical therapy Summit in Washington, DC back in September. And so the sponsors got to go up and say a little something. So you have literally less than two minutes, and I had to get all their talking points in. But I also like, decided to make it funny. So I was just saying things off the cuff. And afterwards, everyone's like, that was a great bit. I love that bit about your parents. I'm like, I didn't think of it as a bit. But okay. But then the good news was afterwards, people came up to the table, the Waterpik table, you know, in the, in the hall area, and like the one guy was like, I wasn't gonna come up, but then after that talk, I had to come up and see what you guys are all about. I needed to find out what you were doing and hey, can you do this? And so, for me, I felt as nervous as I was to go up and speak be mainly because it wasn't about me, it was about Waterpik. So I wanted to do them proud, you know, and afterwards, they got so much great feedback and possible partnerships selling through clinics with 700 locations? And can we do a study with Waterpik? On wound care? Can we do a study with Waterpik on people living with CRPS and using these, like, and that's exactly what they were looking for. So that made me feel like much better and gave me a little bit more confidence. And it was also fun to be able to do such things kind of off the cuff. You know,



that's so cool. Yeah, I love that. You should definitely be proud. That's so cool.



So that was really fun. And then the next speaker, it was it. The next speaker a two speakers after me was the First Lady of the United States Dr. Joe Biden. So yeah, there you go. No big deal. No big deal. Yeah. FLOTUS. So that was really fun. And was that yeah, for me, I think that was a big highlight of of the year for me, I guess professionally, which was really cool. is cool. That is so cool. It was it was cool. Anything else that for you? Did we miss anything that you wanted to get in?



Yes. For the Yes, yes. Yes. Okay. I now live in Pittsburgh and and was visiting New York had a great time. I got to see Karen at one of my favorite salad places, although I didn't get my normal favorite salad, which now I'm in regret until I go back again, to get my favorite salad from Sweet greens. It's the kale salad. It's so good. Caesar kale salad. I highly recommend it if you're going and you want to save some money because I love to be cheap in New York. Okay. said that. Now I'm not sponsored by sweet green. I just love sweet green. Okay,



I know we're dropping. We're dropping a lot of like,



I know. Like suede. And also get Levine's cookies. Okay, yeah. When you go, I never have gone to the tourist areas. I avoid it. But I spent a lot of time in Times Square because I was going to see Broadway shows. And it's also one of the few Disney Stores that still is open. So I had to go in there. I got a wreath I didn't need but I needed you know, and Okay. Rockefeller Center. So I go there to meet Stephanie. Why rock as you and I didn't have enough time with your Stephanie. But while we were waiting, there's a whole show of lights. A GG know that you knew this that like it's with music and everything like Disney. I had no idea. What's the store that darkness said yes Avenue, Saks Fifth Avenue. And it's like castle and lighting. It was I was just joking. If you don't know, I love Disney. I love Disney so much. And this was a Disney experience. And I just we weren't waiting in the cold. I'm like, all bitter. You know, I just I'm not happy in the cold. So I'm like, and then the light show on Japan?



Yeah, it's spectacular. It was



so great. I had no idea and it goes up like every few minutes. It's quite regular. So if you like oh, we miss it. You're fine. Just wait a few minutes. It'll start again. i Oh, go see it. Go see it. Don't stand in Time Square for New Year's. But go see that that was such a wonderful, positive, beautiful moment. And, and just great. It was great. Also, there are a lot of great photographers in New York. So if you're visiting New York, and you want to get stuff for social media, that is the spot to get it. There are so many talented photographers you can get reasonable prices and and build your social media real fast. All right, that's it.



Perfect. Well, before we wrap up the year, where can people find you if they want more information about you in any of your programs? And also let us know what you have coming up in 2022?



Okay, well, most immediately, you're going to find me at Disney Land in February this year in 2022. Because I'm going to be there my birthday. If you go there on the 16th of February. Just let me know. And we'll like meet up with you. But no, I'm going to be eating junk food all day. So if you're expecting me to be held a healthy influence, I will not be alright. For me, I'm going to be continuing with my private practice, working with performers and continuing with helping people live their lives as dance PTS helping you on the business and treatment side with my dance PT program. But most importantly, because I'm always like I'm a performer and physical therapist. I'm doing all this work right now. I am getting back into performing which I'm really happy about so I'll be submitting a lot more which I'm just super stoked. I feel like all my work stuff is is being is much more easier to handle now I've got it down. And the systems are in place if you will get to audition more than I'll be a movie star just like that because it's so easy. It'll be great, but I'm really excited about that. What about you Karen?



Oh, that's exciting. Gosh, I'm not gonna be a movie star. Anything So what do I have coming up? Let's see, um, this past year I finished the Goldman Sachs 10,000 small business program, highly recommend anyone to apply to because it's really amazing. How many more plugs can we drop in this episode? And so I'm going to this year, I'm looking to hire another PT for my practice, right? Mm hmm. Which is very fun. Exactly, it grows, but



you're like, I'm not going to take all the patients. It's gross,



but time to bring on someone else. Right. And then continuing to work with just a couple of people. With business coaching, I like take four people at a time for me that I get it handle, it's good enough for me, I'm happy to do it. So that will open back up again. Maybe end of January of 2022. Because like you said, when you know what you can handle and you know that you can help the people who want to be helped, then it becomes so much easier. So now I feel like I've got this under control. I know how to split up my time and manage my time. And so I'm really looking forward to that in 2022 and we'll see what happens.



I love that. That's awesome. Yeah. Yeah, are so cool. I love what you do.



Where can people find you? Oh,



yeah, so I have the dance physical therapists Facebook group. So that's one specifically for PT so you will find me in their active conversations once talking about performing arts research all that stuff. You can find me at CSM Oh yeah, social media, dance physical therapists on Instagram. I am also musical theater doc on there. But I really associate people more regarding musical theater, not other pts. So dance physical therapist, is that and then on Facebook, Jenna cantor. And yeah, pretty much Jenna Cantor from Twitter and Jenna cantor. Yeah, your website. Jenna cancer, PT, calm.



Perfect. Perfect. Excellent. Well, Jenna, thank you so much for coming on and wrapping up 2022. And for all of your help and friendship throughout the year. I really appreciate it. And appreciate so



much. I have to just say that joke that keeps coming to my head every time you keep saying wrapping up. I feel like I should be wrapping a present. I just it's a stupid joke. But I just need to put that in there. Thank you. I said it.



Tis the season when in Rome, right? Yes. All right. Well, thank you again, so much. And everyone. Thank you so much. On behalf of myself and Jenna, for listening to the podcast all year and for supporting it. And you know if anyone has any suggestions on anyone they'd like either one of us to interview please let us know. You can find us on social media. I'm on Twitter at Karen Litzy. NYC and Instagram at Karen Litzy. You can email me Karen at Karen Litzy. Calm it couldn't be any easier. Or you can find me at Karen Litzy calm. We're super easy over here. So let us let us know if there's any topics or people that you're like man, I really want to hear from this person. We'll be more than happy to see if we can get it done. So thanks again. Everyone have a very, very happy new year and a healthy 2022 And of course stay healthy, wealthy and smart.

Dec 21, 2021

In this episode, Specialist Sports Physiotherapist, Morten Hoegh, talks about pain and injury management and research.

Today, Morten talks about his workshop on pain, the problems in the research around pain and injuries, and embracing the patient as the expert. What is nociplastic pain?

Hear about the injury versus pain narrative, treating the perception of injury during pain, the problem of over-treating pain, and get Morten’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “There is a difference between having an injury and being in pain.”
  • “You will have injury and pain on one end, but you will have pain without injury on the other end.”
  • “Just because we know something doesn’t mean we know everything.”
  • “Pain prevention is well-intentioned, sometimes unrealistic, and possibly unhelpful.”
  • “All pain is real. It’s always experienced as pain.”
  • “People who live their life with pain, they are experts.”
  • “We have different aspects and different competences, and we should bring them together.”
  • “We should definitely try and cure pain from the planet, but maybe not by opioids.”
  • “Things take time to cope with.”
  • “Make sure you stick to good ideas if you think they’re good, but also leave them if they’re not.”


More about Morten Hoegh

After qualifying as a clinical physiotherapist (1999) and completing several clinical exams, Morten was granted the title of specialist physiotherapist in musculoskeletal physiotherapy (2005) and sports physiotherapy (2006). It was not until 2010-12 he made an entry to academia when he joined the multidisciplinary Master-of-Science in Pain: Science & Society at King's College London (UK). From 2015-19 Morten did his PhD in Medicine/pain at Center for Neuroplasticity and Pain (CNAP), Aalborg University. He is now an assistant professor.

Having spent more than a decade as clinician, teacher, and business developer, he decided to focus on improving national and international pain education based on the International Association for the Study of Pain (IASP).

Morten was vice-chair of the European Pain Federation’s Educational Committee from 2018-20 and has been involved in the development of the Diploma in Pain Physiotherapy and underlying curriculum, as well as the curricula in nursing and psychology. At a national level, Morten has been appointed to several chairs and committees, including the Danish Medicine and Health Authorities and the Danish Council of Ethics.

He has co-authored a textbook on pain, and written several book chapters, clinical commentaries, and peer-reviewed basic science articles on pain and pain modulation. Morten’s first book on pain in layman’s terms will be published in January 2021.

Morten is regarded as a skilled and inspiring speaker, and he has been invited to present in Europe and on the American continent. He is also a prolific debater and advocate of evidence-based and patient-centred approaches to treatment in general. Morten is motivated by his desire to improve management of chronic pain, reduce stigmatisation of people with ‘invisible diseases’, and to bridge the gap between clinical practice and neuroscience research in relation to pain.


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Neuroscience, Pain, Injury, Rehabilitation, Research, Experience, Treatment, Management,



#IOCprev2021 on Twitter.


To learn more, follow Morten at:



Twitter:            @MH_DK

Instagram:       @mhdk_drmortenhoegh

LinkedIn:         Morten Hoegh


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




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Read the Full Transcript Here: 


Hi, Morten, welcome to the podcast. I'm very excited to have you on. So thanks so much. Thank you for having me, Karen. It's a pleasure to be here. Yeah. And today, we're going to talk about your really wonderful, wonderful workshop at the IOC conference in Monaco. That was just a couple of weeks ago. And you did a great workshop on pain, which is one of my passions.



But I would, I think



the best thing for us to do here is to just throw it over to you. And let you give a little background on the talk. And then we'll dive into the talk itself. So go ahead.



Thank you. And, you know, I'm really happy that you liked it. It was a great pleasure to present that the IRC was my first time there as well. A lovely place to be and very lovely people. And he really well organized conference as well. Well, back to the background. So the tool was, the workshop, as it were, was actually originally something I planned with Dr. Kieran or Sullivan, who is now in Ireland. Unfortunately, he couldn't come due to turn restrictions and all of that for COVID. So we had to change it slightly. But over the period of the last sort of year or so I've been working with colleagues at all university where I'm affiliated and test Denton and Steven George of Adelaide and, and to university respectively. And together with them, we sort of have written up this idea that there is a difference between having an injury and being in pain. And the reason we came about that was because we wanted to try and look into what is actually the sort of narrative definition of a sports injury. And and some one of my colleagues are actually two of my colleagues Kosta, Luke, and Sabine Avista. We're looking into this and trying to sort of find out what the consensus what they came up with, when they were looking at the last 10 years of of sports related research is that the same articles could use injury and pain for the same thing. So it was being used almost as well, not almost, but as sentiment synonymously throughout the program, or the manuscript, and others will stick to pain and others will stick to injury. But if you then try to go down into the methods and find out what is an injury, really, some would have definitions, but there weren't really anything. And definitely, there wasn't a clear distinction between when is the tissue injured. And when is the athlete suffering from pain that is keeping them from not doing what they want to do.



So we came up with this idea to write an editorial for the BDSM. We couldn't get it accepted as an editorial, we were under the impression that maybe the topic was a bit too narrow. So it really wouldn't have any impact. But we had a we had some some help from from



sorry, you can cut that bit out. I was just losing her name. Let me just get it here.



Oh, that's she was such a great help. I'm really sorry for not being able to I definitely think we should put her name in there.



Oh, here we go.



So we wanted to do the editorial first. But we were under the impression that we couldn't get the editorial through because the topic, you know, is probably a bit too narrow. But fortunately, Madeline Thorpe, who is working with TAs in Adelaide, she helped us create this infographic that sort of conveyed the message of the difference between what we call a sports related injury and a sports related pain. So after a few revisions, the BJs took it in as an infographic with a short text to describe what we mean. And and it's been. It's been, you know, quite well cited afterwards. So we're very happy with the the attention that this idea has got. And then of course, what we really are trying to do here is to create two new semantic entities as we say, Where where it's clear when we do research, but also when we talk to athletes, are you really injured? Is the tissue injury that needs healing and where you might need you know, specific treatment for that injury versus Are you having pain as a consequence of an injury or even without an injury, which is what we call sports related pain. So that's sort of the broader concept and and I hope I've I've done right with my co authors.



because they've Of course, been been a huge part of both the development and the writing of these, these, this infographic.



Yeah. And can we now sort of dive in a little bit deeper? So, injury versus pain? Right. I think a lot of people will think that every time you have an injury, there's pain. So used a really nice example in your talk. So does tendon tissue damage lead to pain? Yeah. But is the pain in the area of the tendon equal to damage to the tendon?



Maybe not. Yeah. Right. Oh, so yeah. So let's, let's have you kind of dive into this injury versus pain narrative. And if you want to go into those pain mechanisms that you spoke about, we can dive into that as well, because I know that that people had some questions on that on social media. So let's first talk injury versus pain. Yeah, again, my my perspective on this with my background, being a physio and, and sort of a neuroscientist is that I come from it, I would say from a pain, scientist pain mechanistic approach. And what I try to do is to understand what goes on in the human that could explain why they feel pain. And in some instances, and for instance, in low back pain, we we think, in about maybe 80 to 95% of the cases, we don't know what's going on. So we're pretty sure that the risks are mechanism, perhaps are quite complicated. One there has multiple factors that are interrelated, but there's probably something. So that's really difficult to study. Again, consider consider, you know, if you were tasked to, to come up with a, you know, a model where you could study this model would be, for instance, an animal model. So not that I would encourage people to go out and, you know, do bad things to other animals. But just, you know, for the sake of the example, let's imagine that you wanted to do an animal model of low back pain, or even a herniated sorry, a groin injury, you could say, in sports.



If you know, the most basic thing to do would be to create an injury. If you don't want to create an injury injury, what you could do is induce inflammation, you know, inject capsaicin, or put something under the skin or down into the tissues, and that makes your immune system go, you know, make inflammation. And that inflammation makes your nervous system respond more powerful. We call it sensitization, I think many people have heard of that word by now.



And that's a really good way to create that sensation of pain in humans as well. So we can inject capsaicin again, and people will usually feel pain.



In that case, that's what happens or that's how we understand what happens in the case of a tissue injury. So when there's a tissue injury, there's inflammation, and we understand that pain. So when the tissue hit healing period, is sort of crossing from what you could say, the inflammatory phase, into the prolific face, pain should go down. And in most cases, that's what happened. But what when the pain persists after the inflammatory phase. You know, from the science perspective, we don't know that. But we still know that this person is in pain. So whether that be an athlete or non athletes, they're still in pain. And in this in sort of the pain research world, we have a definition of pain that doesn't necessitate any type of injury, not even any activation of those, we call them nociceptors. But nociceptive system you could say.



So we acknowledge that people can have pain and not be Do not be damaged, not be injured, not have pathology. And that's sort of the idea that we are trying to bring into sports medicine as well, which has been over the you know, many last decades I've you know, I've been in in sports medicine or as a sports physio, for 20 odd years and sort of dominating belief. And also perhaps, trajectory has always been sort of the orthopedic sports related and to some extent, also pharmacological approach, combined with and that's important, combined with a non pharmacological physio, perhaps approach. So there's been this interrelationship collaboration between doctors and physios and other health professionals, which is quite unique. As I see it in the musculoskeletal system. We don't see that to the same extent, for instance, for low back pain or neck pain, but sports has done that. But maybe there has also kept people within the realms of sort of orthopedic approaches trying to understand what goes on. It's



tissues, and why did they hurt, and then when you couldn't find out why they hurt, we've just looked deeper into the tissues, which is, of course, a good idea from a scientistic or scientists perspective, because there are definitely things in the tissues that we don't know today, which will, you know, make us become more aware of what goes on, you know, as, as late as in the beginning of October, wasn't it where the Nobel Prizes were given out, there was given a Nobel Prize out for the person, I might do violence to his name, but it's part of Putin, I think he's last name it.



I didn't, I suppose a Putin or something like that. I do apologize for not being able to pronounce it. But he got the Nobel Prize was shared the Nobel Prize for his work on a peer to two receptors, which is a quite new phenomenon and sort of the longer perspective, but it might learn us over time, why could movement hurt? Which is something we don't know today? So if there's no sensitization, why does it hurt to be moving? And that's really interesting. But again, coming out in the clinic, we don't know enough. So we will have patients in the clinic where we simply do not know why they hurt.



And you could say that doesn't matter. We can call it anything. But then if you take a clinical look at what goes on what happens again, if you look at the signs, what does it mean, when people are hurting, and they think they're injured? They This is what a percentage again, they seem to be thinking that they're being in pain is the same as being weak. If you're weak, you're not, you know, you're not allowed to be in on the team, you might lose your position. So it has a lot of negative connotations. And I mean, that in itself is wrong. But what if it's based on a misconception that just because you're hurting, you are also injured? And couldn't we help people who are hurting with their pain,



just as well as we could if they are injured with a tissue injury. So what we are saying is that the two are different. They're both real, they should both be addressed. And they're not, they're not opposite ends of a dichotomy, you will have injury and pain in one end, but you will have pain without injury on the other end. So we need to pay attention to both of them separately. Yeah, it's because sometimes a person has a pain problem



may not be a specific tissue problem, but they have a pain problem. And so this pain problem may, like you said, cause certainly a an athlete to catastrophize. And to really play out to the point where maybe now they're fearful to get on the pitch or the court or the field. And so where does that leave us as physio therapists when it comes to their care? How do we help manage someone, or I should say, help someone manage their pain in order to play their sport, knowing that their every time they go out and play, they're not compounding, quote, unquote, tissue damage?



Yeah, and interesting, let's say someone has the perception that their tissues are injured, and every time they move, that's a sign of their tissue injury, or even when they hurt more, the injury is bigger, then that person, I mean, if that's a person like me, I would think that I should do something about that injury so that I don't hurt. But pain is always a symptom of something underlying it. Whereas we know from pain research in for instance, low back pain, that pain can in itself, be the disease, what the ICD 11 is now describing as chronic primary pain. So you can have that in your body, you can have it in your tendons, you can have it all way where your tendons are, you can have it where you know, where the bones are, where the where you feel the muscles are. And it's the pain itself is the problem. So rather than looking specifically at a tissue, which needs strengthening or some sort of treatment, then we can look at the person and say, What is it really that you need? A very, very simple example here, which is unlikely to be, you know, the case for everyone. But let's imagine we have someone with knee pain. And the thing that happens is that when they start running, their knee pain gets worse. But if they've been running for a kilometer, or two kilometer or miles, whatever, you know, whatever metric you use,



then the pain might be the same. So it sort of comes from nothing to let's say, five in the first mile, and then it stays at five, maybe six, and that person wants to run two miles perhaps. But what's the problem in that? I mean, the problem of course, is if pain in this case is a sign of an injury



that we should attend to. So we need to understand that it's not an injury.



Once we've done that, why not help this person, deal with the pain and maybe deal with it when they run, just like we would say to someone, if they have, again, back pain, for instance, and they have pain when they work, but their pain is not necessarily worse when they work, should they not be working? I mean, of course, if, if your pain can go away by two days of rest, and graded exposure, that's fine. But in some cases, and they're not as rare as I think most people believe they are, that we just need to work with that person and help them do what they need or want to do with that pain. And why is that, you know, of course, it's not the optimal it would be much nicer is if we would just kill the pain. Or if they could kill their own pain. But we're not there yet, we are still working to get it. And we're not giving up, there's a lot to do. But currently today, and tomorrow, we need to help people work with their pain, that's the best thing we can do now, and and, you know, giving people that agency to actually manage their pain. So in the case of the runner before, maybe the best thing we can help them do is share with them ideas and make them take agency over their pain by you know, using perhaps a cold pack or heat pack or a rest regime or watching you know, something that takes off their mind of their pain for a minute look at you know, watching dope sick on Disney, whatever they need to do to get their mind off, you know, the pain that they have, so that they can recharge, and they can be as you know, their normal again, before they go out for another run. So all of these things would make absolutely no sense if we didn't acknowledge that pain in itself is the problem, because it's not helping anyone's tissue injury, if there was a such to become better. So again, that's the infographic in its essence is that on one end, you use those inspiration to how to manage pain, what that means and how pain is influenced. And on the other side, you will have tissue injuries, and how to manage that, for instance, loading. In sports medicine loading is a big issue. It's probably the one thing that you know, everyone is doing when you're rehabilitating some someone after an injury or pain. But pain doesn't necessarily necessarily sorry, pain doesn't necessarily respond to loading. So you can have the same pain, whether or not you're loading. But there could be tons of other things such as the way you think about your pain, the way you respond to your pain experiences you've had before the context your work in. So you can run in one context without too many pains or problems. But in a completely different context. For instance, when you do a competition, or if you know, if you need to do something, because that's the bar to get onto the competition you want to do, then pain can be a much, much bigger problem. So we need to understand that context of beliefs and experience really influences pain, whereas loading may not. But it could have caused, but it doesn't have to. So pain is a much larger, much more complex topic of which we still don't know too much. We do know quite a lot. And as long as there's an injury, we understand the pain that goes with it. But when it comes to these pains that are there by themselves, the ICD 11 type chronic primary pain, then that's the type of pain that we you know, we've really, we don't have the sort of blueprints on that. So we can't help everyone. And we can't say this is right for you or wrong for you. We need to do individualized care for all of these people and help them find the best tools to support themselves. Yeah, and I think that was something that people who weren't at the conference and kind of reading through tweets,



that certainly brought up some questions, one of which was the pay mechanism, no sub plastic pain, where we can't fully explain it. And so then there was a question of, we can't fully explain it, why even bring it up? So I'll throw it over? Yeah. It's, again, it's a good question. And especially if you're a clinician, why would you use it, though, they're basically what they are. They're ways that scientists understand the pain. So again, imagine you're standing at one end of the road and you're looking at the other end by the end of that road, a very long road, you have pain. And then the way the place you're standing at is how you explain how to get to that end point. And if you're standing at a place and you know there's a tissue injury, there's inflammation. We understand that as



Part of the normal normal nociceptive system. So we would call it nociceptive pain.



Underneath that there is a range of different changes and modulator modulators of the system that leads to, for instance, peripheral and central sensitization. So they're not unique to anything that is there also in nociceptive pain, but it's induced by, for instance, a tissue injury.



If you have a different tissue injury, the one that hits your nervous system, we call it a neuropathic pain, so you have a nerve damage, along with pain, we call that a neuropathic pain. So again, you're standing on this long road, but in this case, the road itself is sort of gone wrong. But we still know what's going on. Again, if you want to use the study metaphor, you can, you can design a study, you can just take an animal, and you can compress or do something to the neurons, and you can create this similar pain experience, or at least the behavior that it assimilates this pain experience in animals, other than humans. And then finally, we have this new, we call it a mechanistic descriptor knows a plastic pain, which is much much blurrier. And perhaps it's more like a waste bin. As it is now it's, it's where you would say we acknowledge that people have pain.



And a lot of things goes into it. So just like in nociceptive, and neuropathic pain, sensitization is definitely part of it. It could also be part of the note of plastic pain. But unlike the other two, you don't have the inflammatory response that could explain it. And you don't have the neuron damage that could explain it. But the person experiencing the pain could have a similar experience. So what is it really? How do we a scientist tried to understand that pain, and that's what most plastic is at the moment. And there is a little bit of debate that whether or not you can actually use algorithms to diagnose or, you know,






justify at least that you yet the person in front of you are experiencing this type of pain mechanism or pain related to this mechanism, we definitely have a very, very, you know, widely embraced algorithm used for neuropathic pain. And some very, you know, high profile researchers has just recently come up with a paper suggesting that the same can be done for noisy plastic, sorry, for noisy plastic pain. But personally, I don't think we should, because unlike so nociceptive and neuropathic pain, they're both well understood by signs and we can separate them, they are different. So you can have both, but you would have different qualities to it, there'll be a nerve damage in one and there wouldn't in the other, for instance.



But we don't know about most plastic pain. So it could be changes in your nervous system, it could actually be, you know, increased responsiveness of your immune system in interaction with your nervous system. It could all be all of that. So it could be sensitization, but it could be tons of other things as well. So how can we start when we don't know what the mechanism is? How can we start to clinically differentiate? So I don't personally think we're quite there yet. Although I like the idea that maybe we can at some point, what I'm afraid of, if we start to use these clinical descriptors, sorry, these mechanistic descriptors, as clinical guidelines, is that what happens to the people who are now embraced and validated in their pain experience by scientists saying, Well, we know what you have, it's mostly plastic pain. But what if we made up an algorithm? And we used it for people? What about the people who fall out? Do they need, you know, a fourth descriptor? Are they just weird? Do they have unknown pain? Are they back to the psychogenic pain? So we've come quite a lot of way, embracing the clinical aspects of pain into the pain research world. And I think using you know, these three mechanistic describers, as you know, trying to really differentiate them and create perhaps treatments that is directed at either one. At this point, or especially anatomy is specifically directed at most aplastic point pain. Just because we know something doesn't mean we know everything.



So yeah, that's that's the issue. There was a bit of off topic. I'm sorry. But it's such an interesting topic. And I think that the most important thing about no plastic pain is that it is a construct that researchers use. It's embraced by the IRS, the world pain Association, the pay Research Association, and it validates that all pain is real. And there's, you know, it's still real even though we can



not understand it from a science perspective. I think that's important. And I would hate to see that we misuse it. To say that some really has it. And some don't. Because that's just, you know, that'll be I'll be sad. Yeah. And and can't one's pain experience?



Everybody's pain experiences individualized. But one person's nociceptive pain experience may be exactly like someone's neuropathic pain experience or someone's no support plastic pain experience, because it's in so then to categorize the persons Oh, well, my pain is like this. So it means this, so I can't have this. And I think it can get people a little confused. And when you have more long term or chronic pain, it's like, the the pain is there. Pain is pain. Some people need the the label or categorization, but like you said, Is it is it really helpful? And it kind of leads me to the one of the last slides in your presentation, and it was like pain prevention is well intentioned, yay, thumbs up, sometimes unrealistic, and possibly unhelpful? Yeah. So do you want to expand on that a little bit? And what you meant by that slide?



Yeah, that's slide was. That was actually the whole idea when, when I started to talk with Dr. Kieran Sullivan about workshop is that we see a lot of people, athletes. So both of us are still clinicians. And we see and we hear stories of a lot of athletes who have been treated and treated and treated again, or assessed and assessed and assessed again. And again, because they have a pain that we cannot objective eyes. So we can't find anything on scans or blood samples or clinical tests. So rather than acknowledging that pain can be there, so let's say nosey plastic pain, those are, there's something going on in your nervous system that gives you this pain, and we don't know what it is, we can't see it, that will be the, I would say the proper thing to do. So rather than doing that, we tend to keep sending people off. And it ends up with too many scans and too many assessments and too much worry. And in that process, we know the athlete is unlikely to be performing optimal during that period of time. Partly, of course, due to the pain, but also due to the insecurity to you know, if nothing is found on the first scan and a second scan that at some point, they probably start to wonder whether or not they're completely broken, or if it's a really rare disease or even if it's gonna kill them. And these are things that we might feed into by overtreating. So, of course, we should try and prevent pain. Statistics suggest that that's quite tricky. And we, you know, it would be great if we could or even perhaps what we can do is give people tools so they can take agency over their pain when it flares up. But having this idea that when you are in pain, you are damaged is very unhelpful. We think. So we really wanted to highlight the fact that sometimes pain is is that it is pain is still disabling. It's that feeling of pain, and nobody can feel whether or not their pain is due to an injury or not, it feels just like pain. But we identify all pain as if there was an injury, when in fact, it's it's quite unlikely that the majority of cases would have an injury attached to it. And just coming back to one thing you said before that it was quite subtle, but I think it's a really important point you made there, which is that all pain is real, it's always experienced as pain, whether that be of any of the descriptors or for any reason, it always feels like pain, and the quality that we attached to it, it's a muscle pain, or it's whatever is something we do it's our perception is our belief about what the pain is. And maybe that's what we need to also address in sports medicine is that disbelief about what your pain is caused by is a potential target for treatment, we call it psychotherapy or psychoeducation. Or, you know, and that doesn't have to be paying neurobiology education that's unlikely to be better than any other good education and listening and embracing. So there's a range of different interventions that are combining or embracing the fact that you need to talk to your athlete or your patient and help them make sense of their pain in a way that gives them empowerment will give them agency over their pain.



And something that came to my mind as you were saying, oh the pain it's it's in the muscles, the tendons, the bone, it's the joint and can't that all



So be a coping mechanism of the athlete. So they may say, oh, it's, you know, this is just a muscle strain. It's so it's their way of coping of saying it's nothing I can continue to to move forward. Do you know what I mean?



Yeah, absolutely and, and I think as long as it empowers them, if you know if you have the pain that you again, think about Dom's, or delete onset onset muscle soreness. That's an empowering pain, isn't it? I mean, I have Dom's, I was doing exercise yesterday. And if you really want to, you know, be good at something, then perhaps Dom's is your sort of reward even, even though it's painful, it should be awful, it might actually feel like a reward. So in that case, you interpret the pain that you are experiencing, as a reward or something you want it to happen. And I definitely think that some would say that this is just a minor thing, again, think about general health and male, you know, older men, like myself, tend to not go into, you know, the GP for what we consider to be minor things, but in fact, that might be killing us. Because we say, no, no, that's nothing, no, that little spot, that's not cancer. And I would say I don't, I don't think it's a lump, it's probably just something that's here this week. So we should be much better at listening to it, and giving it you know, you know, the quality or the, you know, the meaning that it should have. So it's on both ends of the spectrum, sometimes we neglect that pain is there for a reason, and we should listen to it. And sometimes we should understand that the pain is there without anyone really knowing what it is. But it doesn't mean just because we don't have a universal tool that can treat all pain, which is what we say when we say there's no treatment for chronic pain. In fact, there's quite a, you know, a variety of well established evidence based treatments, that can reduce pain, but they need to be targeted, and individualized so that each one find their, you know, their way through their pain. And of course, one way to do it is to go to everyone you know, who has a, you know, any background in health and ask them what to do, probably the best thing to do is to talk to someone who knows about pain, and then get advice about what seems to be working for you. Embracing that the one in this case, the athlete with pain, they have perhaps one or two years experience with their pain, they know much more about their pain than I do. But I can act as a consultant, I can listen to them, I can help them structure, I know what you know, patterns out there. So I can listen for that. And then together, we can try a few things. But over a period of maybe weeks, they should know as much as I do about pain generally, but with their focus on it. And and that should give them you know, with a bit of practice the ability to find out what works and what doesn't. And rather than thinking of pain management, in the case of a sports related pain, as an on off thing, so either it works and the pain is not there, or it doesn't work, it only reduces the pain a bit, we probably should be realistic and say that most people can have reductions in their pain, perhaps 2030, perhaps more percent. But the majority of people will experience from some sort of management of pain reduction. But it doesn't mean that the pain is going to go away. And it doesn't mean that thought is going to be absolutely pain free. But we need to find a balance between the two so that we understand when pain is actually a sign of either injury or possible injury. But also understand when pain is something that might just be part of life. And the best way we can do the most evidence based approach to that would be to find your way through it, you know, in perhaps, together with a



clinician of some sort? Yeah. And my gosh, I was just gonna say as we wrap things up, would you like to put a bow on it on your talk and at at the IOC conference and to this talk today, and I think you've just done it? I think you'd beat me to the punch. But is there anything else that you'd like to add?



That, that you want the listeners to take away?



I think the most the thing that I always want to stress is that people who meet or live their life with pain, they're experts. And we as clinicians, and researchers should embrace that much more. So the patient as an expert, is something I feel deeply about.



And I think we should be able to understand that as you know, as a scientist, you might know, you know a lot about groups.



As a clinician, you might know a lot about people who come to you with a similar symptoms, but as a person who have pain, you have two or three years



perhaps have experience with your own pain. And I think the best way to you know to get all of these together is by everyone being aware that we have different aspects and different competencies, and we should bring them together. And I think that's the best we can do right now. But still, don't give up hope we should definitely try and cure all pain from the planet, but maybe not by opioids. Yes, I would agree with that. And now more and where can people find you if they want to learn more about what you do? Read your research, where can they find you?



I think the easiest way would probably be to either find me on on Facebook, or go on Twitter. My handle is at MH underscore DK. And I'm also on Instagram. It's at MH DK underscore Dr. Moulton. Whoa.



Excellent. And one last question. It's a question I asked everyone is what advice would you give to your younger self, knowing where you are now in your life and in your career?



Remember, things take time to cope with sometimes you have a good idea. And you can't imagine, however, too, you know, you hear something and everyone else knows it. And you're like the only one who doesn't get it. But give it a bit of time. And, you know, I we have a saying that Rome wasn't built in one day. I think it goes in English as well. So give things time and and make sure you stick to good ideas if you think they're good, but also leave them if they're not.



Excellent advice. So Morton, thank you so much. This was a great conversation. And like I said, your talk at IOC was really wonderful. There's if people want to see his slides, there are tons of tons of tweets with all of his slides and great descriptors. You could go to IOC p r e v 2021. That was the hashtag for the conference. And as you look through, you'll see a lot of tweets from his from Morton's workshops. So thank you so much for coming on and expanding on that for us. I appreciate it.



Amazing. Thank you. It is a huge pleasure and privilege to be here. Thank you, Karen. Thanks so much. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.

Dec 14, 2021

In this episode, Bryan Guzski, Director of the Orthopaedic Residency Program at the University of Rochester Medical Center, and Tim Reynolds, Clinical Assistant Professor of Anatomy & Physiology at Ithaca College, talk about their work on Movers & Mentors.

Today, Bryan and Tim talk about their book, Movers & Mentors, and they get the opportunity to be the interviewers for a portion of the episode. Why is it important to have mentors?

Hear about the motivation behind the book, some surprising interviews they’ve done, the value of having a team, finding your ‘why’, and choosing when you say ‘yes’, all on today’s episode of The Healthy, Wealthy & Smart Podcast.


Key Takeaways

  • “From an entrepreneurial standpoint, from a business standpoint, your partner is everything.”
  • “Invest in [yourself] and take care of [yourself], physically and mentally, so that you can take care of your patients better.”
  • “Challenge yourself to step beyond your comfort zone, because the benefits of that can be significant if you’re willing to try.”
  • “Find a mentor and don’t fear or stray away from the imposter syndrome. Use that as fuel.”
  • “If you never ask the question, the answer is always no.”
  • “Trying to do it all will keep you small.”
  • “You have to really only say yes to things that align to your values.”
  • “Take a step back, know who you are, know your values, know what your individual mission statement is.”
  • “He who knows others is wise. He who knows himself is enlightened.” - Lao Tzu
  • “If you don’t have the capacity for it, then don’t do it.”
  • “Stay curious.”
  • “Continue to search for the ‘why’. It’s okay not to know.”


More about Bryan Guzski

Bryan GuzskiBryan Guzski PT, DPT, OCS, MBA, CSCS, is an outpatient orthopaedic physical therapist practicing in Rochester, NY working primarily with patients with spine related issues and persistent pain.

Bryan earned his Doctor of Physical Therapy degree from Ithaca College in 2014, completed an orthopaedic residency program through Cayuga Medical Center and received his Orthopaedic Clinical Specialist certification in 2015, and earned a Master of Business Administration degree from Simon Business School at the University of Rochester in 2021.


More about Tim Reynolds

Tim ReynoldsTim Reynolds PT, DPT, OCS, CSCS, is a Clinical Assistant Professor of Anatomy & Physiology at Ithaca College and a part-time physical therapist practicing at Cayuga Medical Center in Ithaca, NY, where he predominately treats patients with spine or lower extremity impairments.

Tim earned his Doctor of Physical Therapy degree from Ithaca College in 2014 and completed both his orthopaedic residency and spine fellowship through Cayuga Medical Center, and currently helps mentor and teach in both of these programs as well. 


Suggested Keywords

Healthy, Wealthy, Smart, Physiotherapy, Academia, Movers, Shakers, Mentors, Prioritizing, Self-care, Self-improvement, Values, Motivation,


To learn more, follow Bryan & Tim at:


Twitter:            @moversmentors


Facebook:       Movers and Mentors

Instagram:       @moversandmentors



LinkedIn:         Bryan Guzski

                        Tim Reynolds


Subscribe to Healthy, Wealthy & Smart:


Apple Podcasts:




iHeart Radio:     


Read the Full Transcript Here: 


Hey, Brian and Tim, welcome to the podcast. I'm happy to have you guys on to talk about movers and mentors. So welcome.



Thank you, Karen, thank you for having us today. We're sharing this sit down chat with you.



This is great, Karen, thank you so much.



Well, thank you guys for including me in your book with over 70 Other pretty illustrious folks in the Movement Science physical therapy world. So let's start with the basic question that I'm sure a lot of listeners want to know. What is the why behind the book?



Yeah. So Karen, Tim and I were going through residency orthopedic residency together. Back in 2015. We both graduated from Ithaca College in 2014. And we both entered into a residency program at ethika are in Ethica, in 2015. And as we were going through the coursework there, and kind of taking different classes and really kind of immersed in the PT literature and physical therapy, space and various different content. We started noticing a lot of reoccurring names and reoccurring themes. And so, you know, different names like Tim Flynn, Josh Cleveland, surely sermon, Stuart McGill, you know, all these all these names that, you know, names in our rehab space that I've done a lot of really cool things and have put out a lot of different research that that, you know, we follow to this day. So we started noticing those names. And Tim and I were also reading a book by Timothy Ferriss called Tools of Titans at the time. And we really liked that book. And we enjoyed it. We got a lot out of it. He interviews people like, you know, Arnold Schwarzenegger, and Oprah Winfrey. So various different industries and various different spaces. But we like the model that book and we started to ask ourselves, well, I wonder how, you know, individuals and movers and shakers within our industry would answer questions that we have. So fast forward two years. That was 2017 2018 at that point, and Tim and I started putting together a list of questions and a list of names. And at that point, you know, we kind of we kind of took it from there. And Tim has a little bit more info on how we how we came up with the names.



Yeah, so it's one of those things that we could have written a 5000 page book in regards to the movers and shakers within the physical therapy industry. And I think one of the most important things that Brian I have tried to stress is that this is a living project. This is not a one and done situation where there are movers and shakers that are currently developing and changing the practice. And so I think that's one of those things that, yes, there are people within the pages that I'm that are, we're happy to have there. But at the same time, there's so many other people would want to reach out to, and we look forward to have the opportunity to potentially talk to those individuals in the future, and are excited to see how does the profession change in the next five to 10 years and who are going to come up and literally shake the industry that we have the opportunity to be part of. And so as we started to go about this, like Brian said, we're diving into this literature, I had the opportunity to do spine fellowship after doing my orthopedic residency. And so the amount of Tim Flynn articles that I've read over the past three years was obnoxious. And so we started to make this almost like PT Dream Team, if you would, where we said okay, from, from a literature standpoint, who do we do we invest ourselves into a lot of, and like Brian mentioned, John John Childs, and we have Josh Cleveland. And then we have Tim Flynn, and the surely SARM and Gwendolyn Joel, there's these names that we have read multiple articles from and so kind of selfishly, we put together this list of people that we would really appreciate reaching out to, because we've been so invested in their in their literature over the past several years. And then from there, we kind of spread our net a little wider, because we had to see who's moving the industry from a clinical practice standpoint, right. So not necessarily from an academic or research standpoint, but from clinical practice. And who's moving it in regards to social media influencers? Because as someone who works in academia and works with the up and coming physical therapy generation, those are the people that they're following on Instagram and on Twitter, and so they're moving and shaking the industry in that format. And we looked at who's been guest speakers at recent conferences and who's putting out podcasts and how He was really trying to have the opportunity to get our profession to move in a positive direction. And so from there, we created this sort of master list, we reached out to all of them, and some have the opportunity to participate, which we're super thankful for. Some respectfully declined based on the fact that they had other stuff going on. But I think one of the things to remember, Brian is sort of given us timeframe, this was right pre pandemic, that we started to reach out to all these individuals. And what's been such a blessing is that we've been able to cast a wide net across multiple different countries across multiple different professions. But at the same time, we reach out to people in Australia, and there's Australian wildfires. And so we're trying to really respect individual's personal physical well being while navigating global pandemic while trying to also conduct interviews. And so it took us a little over two and a half years to be able to accumulate everything and be able to put everything out into a book format. But I'm super thankful to have those people within the pages. And like I said, I'm excited to have the opportunity to reach out to more in the future.



And so it takes, you know, a couple of years to get all this together. How did the two of you kind of keep the momentum going? Number one, because that's hard. And then number two, how did you kind of kind of temper your excitement and your expectations? Because I know, I'm the kind of person who's like, let's just get it done. Let's go, go go. But here, you know, you've really taken your time, over two plus years. So can you talk a little bit about that?



Yeah, I think from the outset, Tim and I both thought, I will send out some emails, you know, we'll get a handful of responses. It'll be a cool book, maybe we'll sell to maybe, you know, five, including our siblings, and parents, that sort of thing. And it really from the first batch of emails that we sent out, you know, Tim and I were really, every time we got a response, we would text each other, shoot each other an email immediately, Hey, Peter O'Sullivan responded, or David Butler responded, or Karen Litzy responded, you know, this is awesome. Like, we're actually doing this thing. So I think it you know, you spoke to momentum, Karen. And that's one thing that Tim and I, you know, we've never really hit a point where we were at a lack of that, or hit a dull moment, if you will. Because every time we got we did another interview, or we got another email, or we set up a, you know, maybe a podcast, it was definitely adding fuel to the fire. And, you know, they kept us pretty engaged and pretty excited throughout the whole thing. So, yeah, I mean, to I think if you asked us when we first sent out our emails in 2018, hey, you know, this is you're going to publish this in 2021, we'd say, No, it's going to be next year. And then life happens and pandemics happen and several other things. And, you know, it turned into a two and a half year project. But you know, it's been a lot of fun the whole time. And Tim and I still are still excited about it and excited about about the future, too.



And I think that's one of the things. There's kind of like Christmas every single time we had a response because it was super cool. You send out these, these emails, or you give a phone call to people that you've literally have had as your mentor from afar for years. And it's like, oh, my gosh, I cannot wait to have the opportunity to sit down. Like Peter, I saw that I've watched a lot of Peter softened videos from pain science standpoint, from spine fellowship work. And having the opportunity to sit down with Peter resolve them for an hour and 15 minutes was like, amazing. I was super stoked. And so so all those opportunities to talk to these people definitely continue to keep flame burning. And at the same time you talk about how do we sort of balance that, that excitement and try not to do too much too quickly. Brian and I have known each other for years, this has been such an amazing project to be able to find a partner that you want appreciate and to after two and a half years don't hate. So I think that's like a really good thing. And I think we balance each other out very well, where we're both skilled in a variety different formats. And then at the same time, after reading your draft manuscript, probably like five times through and through, you really do not want to read one more time. And there's points where we're like, I think it's good. I think we just just push it out, call it a day. And then Brian could probably agree that I'd say well, let's just read through it one more time, and then you catch one or two small mistakes. And so I think it's one of those things that just finding the right person that's willing to invest and stay motivated to push you and challenge you From an entrepreneurial standpoint, from a business standpoint, your partner is is everything. And so I think that's been one of the blessings that we've had this for this project.



Yeah, I love it, I think that's great advice is to have that person who complements you. Right and because you don't want to have just like a yes person, but instead you want something that's going to complement you and push you in, in a positive direction. And, and I will second the Peter O'Sullivan, he is just what a nice person and giving and charitable and gosh, I had an interview with him at CSM a number of years ago. And I had to ticket it. Because it was live at CSM. And we actually had to ticket it so that only 25 people could go and I it was only for students. And by the end of the interview, he was laying on the ground, you know, students and stuff. It was just so it was such a great experience, because he's just one of those very kind of electric personalities.



Definitely. very warm, very electric.



Yeah. Were there any interviews that you did that surprised you?



Um, in



a, in any way that doesn't have to be good or bad. Just surprise you because perhaps the persona that this person has, whether it be their research, social media clinical that you thought they had, and then when you interviewed them? It it surprised you?



Yeah, I would say. Obviously, when you when you interview over 75 individuals, you get a variety of different responses, you talk to a variety of different personas, devided different characteristics. And I think going into it, knowing the background of someone's, I use the metaphor of like the front cover of a book, we all have like front cover worthy attributes or accomplishments. And then it's like, well, what's on the inside of those pages. And so we see everybody's bio, and I've been on X, Y, and Z shows or published this many papers and, and so we see all that stuff. But we never really hear some of those people talk or talk personally about some of their successes and some of their failures. And so I think everybody had the opportunity to have some elements of surprise. But I think what was also cool as Brian, I made up this master list, and it was basically just based off of accomplishments and achievements, or their influence on the profession. And so, for instance, I was looking through and like talking to Michael Radcliffe, who is who is a researcher that I've read your research, but I, I never really pictured what you would look like. And I never really perceived that you would have such amazing responses within this book. So I think it was those individuals that I might not have been so invested from like falling on social media, or have watched your YouTube videos, and really getting a chance to know them in an hour, hour and a half. Those were the interviewers that really caught me by surprise, but at the same time, I think I walked away with so much more, because there is so much unknown that they're willing to offer me. Um, and so I think I think that was the most exciting part or the most surprising part for me.



Yeah, I think kind of, because of the types of questions that we asked, we really intimidate joke about this, if we want to know, you know, surely Simon's recommendations for motor control. We can find that online. We can we can Google that. Right? If we want to know, you know how David Butler opens his pain talks, we can probably find that somewhere and explain pain or explain pain Supercharged. But you know, how Heidi genetica who's the CEO of versio Excuse me? Why pte how she structures her day. And what her favourite failure is it those are things that you can't find you can't find that in textbook you can't find that online. So the types of questions that we asked really opened, opened it up to knowing these people from a different perspective, which we thought was pretty cool. I'd say that one of the individuals that really stands out in my mind, Tim actually did this interview, but I transcribe it so I got to listen to everything, literally word for word was Stanley Paris, who's one of the founding fathers of orthopaedic manual physical therapy and then the United States and North America for that matter. And I mean, this guy is is just incredible from sailing around the world to swimming the English Channel to founding St. Augustine to being, you know, a founder and president of various organizations like the guy has done it all to owning a winery or several wineries. I believe he's just, you know, a jack of all trades. And I think listening to that interview, I was like, you know, he's, I think 83 Now, and my jaw was dropped to some of the some of his answers and some of his experiences. So that was, that was really cool. But, I mean, we had so many so many great interviews, Jeff Moore was a terrific interviewer. Peter O'Sullivan, like we talked about Kelly star it gave, you know, exceptional answers. So we were really, really lucky. And, you know, positively surprised, I should say, surprise, in a positive way with with all of our guests.



Yeah. And it it, it does kind of, like an education for you. Right,



definitely. Yeah. 110% Yeah, I mean, it was one of those things. I had the opportunity to speak with Michael shacklock. Um, and such a well spoken. Such a thoughtful, mindful person. And back in residency, Brian Knight did some research with neurodynamics and your mobilizations. As I was like, Oh, my gosh, like, you're the Dude, that was like, given us all this information. And now we have the opportunity to actually speak to the source. So I think back to being like eight or nine years old, and have all these posters of Major League Baseball players up on the walls, and just like, thinking about how cool it was to have their pictures, and to think about what it would be like to play baseball with them. And now to be able to communicate with some of these movers and shakers within the industry, and have them be peers, and be able to carry out a conversation with them learn from us as much as we're learning from them in that conversation is just such a rewarding opportunity.



And do you feel like it has changed your clinical practice at all? How you are with patients? Did any of the answers or just even the interactions with some of these folks change the change the way you practice? Um,



I think yes. I would say I've slowed down, and I'm more intentional. Just based on a few, I guess, specific responses, but one that comes to mind is oh, shoot, pause. This might be a Karen, you might have to take this this out. And then wait,



wait, wait a mess up. Or 25? I



know. We were crushing it. Dude. Millet mark. I don't know. I want to say more. Mark Milligan. So we'll jump back in. Yes, I would say more mindful and intentional. And I've slowed down in my practice, one response, or several responses from Mark Milligan definitely kind of changed the way I think and operate within the clinic. And I've definitely tried to be more intentional and kind of think about my thinking a little bit more in the clinic from a specific, you know, tactical exercise prescription perspective, not so much. Because that wasn't really the focus of our book. But just, you know, Mark's mindset, and kind of his, his recommendation to all young professionals to really kind of invest in themselves and to take care of themselves mentally and physically so that you can take care of your patients better, I thought was really powerful. So yeah, I'd say, a little bit more intentional, focused, and I've slowed down.



Yeah. And I think sort of piggybacking off of what Brian was saying, less so about the actual clinical approach to what sort of treatments are you providing? And I think that was one of the the most exciting things about the book was we were not talking about what's your favorite three exercises for X y&z Because there's so much saturation, I'd say from a social media standpoint, which is great. I think that's one of the things that's challenging the profession, that anybody has the opportunity to put out content, and it's one of the curses of the profession that anybody has the opportunity to put out content. And so I think the opportunity for young graduates and PT students, and individuals interested in the Movement Science field that is sift through a lot of information to be able to find out what is truly valuable for them. And like Brian was saying, These are the answers questions that aren't necessarily within a textbook, but also probably not necessarily on people's social media channels also, right? No one really steps up to the plate and says, you know that one time when it took me three tries again to PT, school, Dad was really a good important point in time, my life, or, yeah, I remember when I failed the boards. Those are things that I think can really influence and the sort of career life changing for these individuals, who, as a current college professor, writing final exams, getting ready to watch by an influx of tears in my office in the next bout 48 hours, who perceive a failure as such a detriment to their potential growth, and well being as a person, I got a B plus on this test, all my friends got A's, I cannot necessarily navigate that situation. That's like conversation that I hear all the time. And so talking about how has things changed in my practice, I'm currently part time in the clinic, more time from an academia standpoint. So I think it's changed my communication opportunities, with the next generation, being able to literally use this book as an encyclopedia. And knowing the responses that people have given flipping to their name, and saying, I need you to read this chapter from Mike Reinhold, where he talks about becoming an expert, because you're not there yet. Because you shouldn't be there yet. Because you haven't gained clinical judgment and clinical experience. And it's going to be okay. But go read this come back in five minutes. And so I think that's how I've been able to sort of benefit from this, from this experience and how I've taken it influenced my own practice.



Excellent. And, and as a side note, Tim, the, my podcast episode coming out tomorrow, my podcast is with Silvia Zubaan. And she's a clinician 50% clinician 50% academia at St. Louis University in Washington, Washington University in St. Louis. Sure. And surely, sermons. Yeah. And it was a really nice conversation on how to navigate. She's been doing it for 15 years now. clinician and academia and academia. So it was a really nice, really wonderful conversation on how to navigate that those two worlds successfully and how to be vulnerable when you need to be and with whom, and because it can't always be great and perfect, like you just said. So if you have a chance, I would come out tomorrow, I would listen, I'm excited. Currently to edit this part out. I don't need to plug my own podcast within a podcast. He was a little self indulgent. But because you, you're kind of in a similar position. She's just been doing it for a lot longer.



That's awesome. I appreciate that. So



check it out tomorrow. It was really, like, such a good conversation. She's super cool. She should be in your next book. There. Yeah, like it. She's super cool. Yes, Silvia it's CZ you PP o n. Yeah. And she does some research and and she's written some papers and things like that, but she's super cool. Okay. So, um, is there anything? Before we sort of flipped this a little bit? Because I know you guys were like, Hey, would you like to expand on some of your answers, which, you know, is fine. So we'll flip this in, in a bit. And I'll have you guys host and I'll be your guest. But before we do that, is there anything else kind of about the process of of compiling and publishing the book, that you would love people to know, because it made such a big difference in your lives?



I think one of the blessings of our profession is the lat orality component to your growth as an entrepreneur, but also as a professional. We graduate with a clinical doctorate, or and this can be transcribed across multiple professions, but you go to school to be able to learn how to learn right and in our profession where you sit for a board certification, which gives us the opportunity to practice as a clinician within that. You can wear multiple different hats and I think what was nice with this is That title allowed for us to speak to a variety of different people and have this mutual commonality, which was physical therapy, or Movement Science or the treatment of individuals with certain pathologies. And I think this would never have happened if we didn't make ourselves vulnerable and uncomfortable. Because who are Brian and I? And why should we have the opportunity to talk to Karen Litzy? Or why should we have the opportunity to talk to David Butler? Or why should in so we had this idea, and it all stemmed from the courage to be able to reach out and ask because you never know, unless you try. And so I think sharing one of these thoughts with your listeners is, I think we all have dreams and aspirations that are slightly beyond our scope of practice. And sometimes we can limit that opportunity for us to navigate those ideas, because we are either potentially afraid of failure, or just don't know what the outcome is going to be. And so since that's an unfamiliar territory, we just assume, and therefore we never attempt. And so I think the one of the best things that I've learned from this is accepting failure for what it is, what's the worst that they're going to say? No, I do not want to be part of this, thank you for the opportunity. And the best thing that we could do is create a relationship, create a mentorship opportunity, and have sort of this professional friendship that stemmed from a cold call email. And so I would, I would recommend, at least my thoughts would be challenged, challenge yourself to step beyond your comfort zone, because the benefits of that can be significant if you're if you're willing to try.



Yeah, Brian, right. Yeah.



Yeah, I think there's some level of kind of normalization of failure and imposter syndrome within this book. And I think when you dive into it, and you dive into the responses, everyone has been there, everyone, I'm speaking to, you know, students, new graduates, young professionals here, but guess the message kind of spans anyone in any part of the PT space or industry with however many years of experience, you know, everyone's felt that level of imposter syndrome, or, or fear of failure, and the kind of ability to, to kind of push through that, overcome that and almost use that and leverage it to, to push further or overcome obstacles is really powerful. So I think of it like if you're ever kind of at the top of a mountain, in terms of, you know, imposter syndrome, if we look at it, like, like a curve or like a mountain, if you're at the top of it, then you know, what's really driving you and what's what's pushing you forward, if you're kind of somewhere along along the line on the slope, then you have some level of uncertainty, some level of fear, or some level level of imposter syndrome, and that's actually going to feel fuel you to learn more and be better be more effective. And again, one of the main themes of this book was finding a mentor and the importance of that and how valuable that can be in any, any track or any, you know, facet of our profession. So kind of find that person that's doing something similar or doing exactly what you want to be doing. And, you know, don't hesitate to reach out to them. Because we're in the, we're in the business of helping people and thankfully, we have a lot of professionals around us that that want to help other people but also want to help you know, students, young professionals, so don't hesitate to reach out. I think you'll be surprised with with, you know, the the feedback or the the return on that. So, definitely, definitely find a mentor and, you know, don't don't fear stray, stray away from the imposter syndrome use that as fuel.



Yes. And I will say I got a piece of advice several years ago from a fellow physical therapist, son. So her name's Cecily de Stefano. She's a physical therapist outside of DC. And we were in Chicago for a one night q&a With Lorimer Moseley. And the next day, we were walking around, she had her five year old six year old somewhere around there, young son with her, and she was sort of walking up ahead and he was walking Next to me, and he said this, Karen, would you like to have a play date? And I said, Well, I don't. I don't have any children. And he was like, no, just you. And I said, Oh, um, okay, well, I think we should probably ask your mom first. And then he gave me a great piece of advice. He said, Yeah, because if you never asked the question, the answer is always no. And I was like, and I said, that's the best piece of advice I've gotten in years, and you're like, five. So just to begin with what you guys said, If you never ask the question, the answer is always no. And I've never forgotten that, since he said that. And so now I just always add, ask the question, because the worst that can happen is it's no and so okay, you move on. But you never know. Unless you try. Okay, so true. So let's, uh, we'll start wrapping things up here. But now I, again, thank you for including me in this book. It's a real honor. So if you want if you guys have any questions to I guess I can expand upon or, you know, anything else that that may be? I don't know, you go ahead. Talk about being out of your comfort zone. Go ahead. And you asked me, I'll hand the mic over to you guys. And I'll see, we'll see what we can do here.



Sure. Karen, thank you, again, for being a part of this. I really liked your response. We were speaking about failure a little bit before. And I really liked your response on failure in the last comment, here you have, I'll read it right from the book, it says, failure has taught me to be more introspective to have an open mind to trust in others more. And to know that in the end, it will all work out the way it is supposed to. I was wondering if you could expand on the to trust in others more? Do you have a specific example that you're thinking of, or examples, or just, you know, have other people come in at really important times to help you out when you're, you know, in a in a, you know, event of a failure?



Well, I can't think of one person or one incident in particular, but what I will say is, I am personality type a driver. So someone who likes to get things done, who likes to be in the driver's seat who I don't need help, I don't need help, I can do it on my own, I can do it on my own. And as a result, I think that yeah, I've had failures, because I tried to do it all by myself. And it just doesn't work. You know. And so there's a great team building exercise called lost at sea. Google it, I won't go into detail as to what exactly it is. But you have to you fill out. They give you a list of things that maybe you need when you're lost at sea, and you fill them out what you think you would need from one to 15 or 16 or something like that. So you do it on your own. And then you you do it as a group? And then you find out, like, did you do better on your own? Or did you do better when you had someone helping you? And better meaning like, did you survive? lost at sea? Or were you eaten by sharks? Right? And time and time again, and the group that I did it with? Everybody did better with the group. Right? And so for me, and I learned that I took the Goldman Sachs 10,000 small business program, and it was part of that program. And the big part of that program is learning how to be part of a team and learning how to have people around you that make you better. And so I think my biggest failures came because I didn't ask for help. Because I always thought no, no, I can do this on my own, or I can handle this and quite frankly, I couldn't. And so it resulted in a failure resulted in a less than optimal outcome. It resulted in stress on me and and perhaps some mental and emotional anguish, when in fact, I could have just had a team around me ask for help. And that task probably would have been done better than if it's just me and so yeah, I always so when I said that line, I didn't have one particular person or event in mind, but rather that like sometimes you have to like suck it up, you know, and admit that you can't do things and it's okay. It's just part of life. Like I had interviewed a woman Her name's Stephanie Nikolaj and she said you know trying to do it all will keep you small and she's right. You know, you can it's hard to grow as a person as an entrepreneur as a clinician, my God if you just did everything I Your Own I mean, you'd be like, I don't know you'd stop growing from the day you graduated from college right from your PT program. So you you need the these people around you need people around you, who can lift you up and and make you a better person, a better clinician, a better entrepreneur, whatever it is. But you'll never be that evolved person if you're on your own, it's just impossible.



Yeah, I think, Karen, like the number of hats that you wear as a business owner, a podcast as a volunteer and advocate, right? You, you kind of need people like that in your ecosystem, and it for so many projects, and especially the bigger the project, it really does take a village, and you need people that specialize in certain aspects to come together as a team. You know, Tim and I have talked about this kind of checking, checking your ego at the door sometimes and just kind of leaving that, as you said, Karen, you know, kind of admit that you can't, you can't accomplish it all by yourself. So I that was a that was a really great answer. And, you know, I think you spoke to some of the points about being more introspective and having having an open mind as well.



Yeah, and being able to trust people, clearly, I have trust issues. But you know, I think finding like, like you guys said, like you found each other, you knew each other for many years, you have this really nice trust and bond. And I don't know, maybe it's like 20 years in New York has made me a cynical New Yorker or something. You know, but really finding those people that you can connect and trust that they have your back and you'll have theirs. I think it's really important.



I think, another question that I would have just to sort of elaborate on, obviously, we have a variety of individuals that are listening, right now clinicians, non clinicians, entrepreneurs, and one of the questions that we asked within the book is, what advice would you give to a smart driven college student or a young professional entering the quote unquote, real world? And I think one of the things that you mentioned, that was really valuable was that it is easy to say yes to everything, when you believe it will further your career, I would advise you to only say yes, the opportunities that align with your values and goals, as the saying goes, saying yes to one thing is saying no to something that might be a better fit. I think that's really powerful. Because I think we're in a society of more is better, or the perception that doing more is better. So knowing knowing who is listening to this and having the microphone if you would, for for a minute baseline question. Can you elaborate on that? Or if you had to give that sort of monumentous speech regarding that topic? I think that can be really valuable for a variety different people this?



Yeah. And I think that saying that saying yes to everything, or only saying yes to things that align with your values? I mean, yes, you have to really only say yes to things that align to your values. But I think that speaks to speak to that 30,000 foot view of society in general, and of social media and what we're seeing everyone else do, right, so you may scroll through your Instagram or Twitter, Facebook, Tik Tok, whatever it is, you're on. And you may say, Well, gosh, this person just, they wrote another article, or Gosh, this person speaking here, and they're doing this and they're starting an app, and they're, they've got a podcast, and how come I'm not doing all that? Should I be doing all of that, so I should be set? Why, you know, I need to be doing XY and Z and, and, you know, you've got that, that FOMO disease, you know, your fear of missing out, and then you bombard yourself with things that you think you should be doing because other people are doing them. But it's not even something you believe in, but you think you should believe in it? Because Because other people in the profession are doing it and look at how many followers they have, or, or look at all the success and I use that in quotation marks because we don't really know someone's true success out on social media, right? Because we only put the good stuff on social media, you're not going to put the shitty stuff on social media, right? And so I think this saying yes to everything. I think a lot of it is based on societal pressures, what you're seeing on social media, maybe what a colleague or someone that graduated with you like, oh my gosh, they already started their own practice. And I didn't do that yet. So I guess I have to do that. And I have to say yes to this, that the other thing and it's, I think you really have to especially now like take a step back. Know who you are, know your values know, know your what your individual mission statement is, right? I know you guys said you have a mission statement for your book, but I would challenge everyone like you have your own mission statement as whether it's a clinician or you're in academia. But really you have to know deep down what your values are, what you're willing to take and what you're not willing to take, and, and really know yourself in a very deep, meaningful way. And I'm not saying I know myself in a deep meaningful way yet, but I'm trying, right? It doesn't mean and again, it doesn't mean you have to know that. So again, that's another thing people think, Oh, I have to do this now. But you know, in researching a talk for CSM that I'm actually doing with how do you Janemba my, the part of my talk is increasing your self awareness as an entrepreneur, and how do you do that, and I came across a really great quote, he who knows others, as wise, He who knows himself as enlightened by louts Lao Tzu, la Otz, you I hope I'm pronouncing that correctly. And I saw that quote, and I thought, Oh, that's so perfect, right. Because as, as clinicians, and as physical therapists, our job is to get to know the patient in front of us or the student in front of us or whoever it is in front of you that oftentimes, I think we give away big parts of ourselves without taking it back and looking inward.



And so you kind of get this like, drain on your empathy, and your energy goes on as the day goes on. And I think that happens a lot. And in these kind of giving professions that we are in, whether you're a professor or a clinician, or even a researcher, right, you're going to give all of your energy to that. And then you see you're always looking outwardly all day. And do you take the time to come back at the end of the day and look at yourself inward? And say, Well, what, what am I doing? Like, why am I doing this? Am I doing it for the likes? Or to get more followers? Or like, what is your goal? Right? And so I think that's kind of where that saying no to things comes in, if you know, your why behind what why you're doing things. It will make it easier for you to say yes, and to say no, because it's going to align with with who you are. But that takes time, you know, so as a new as a student, or a new professional, maybe you do have that all figured out. And if you do awesome, come on the podcast, let's talk about it. How did you do it, but you know, if it takes time, and you have to kind of find your groove and, and really know, where you want your career to be headed. And some people do know that right off the bat, I didn't. But it doesn't mean that other people don't have a very clear path of where they want their career in life to go. You know. And, and there's obviously that changes here and there. But I think that's what I meant by that, quote is looking for those opportunities is to really know yourself, and what your How much are you willing to take? How much capacity do you have for XYZ? And if you don't have the capacity for it, then don't do it? Because it's going to be done like half assed, you know, and nobody wants



nothing. That's great. Yeah, great advice. Yeah, finding, finding your why and staying true to your why and finding things that that sort of line up with that to allow for you to not have that emotional, physiological draining. If you would find things that fill your cup not not dump your cup out.



Yeah, exactly. Exactly. Yeah. It's a nice way to put it.



Um, yeah. So Karen, thank you so much for, you know, kind of expanding and elaborating on some of those. You know, as Tim and I mentioned in the, in the beginning, I think when we were chatting probably before we were recording, Tim, and I want to probably get a podcast started at some point in the future. And, you know, we'd love for you to come on and be one of our guests, so we can talk more about this stuff.



Yeah, I'd be happy to. And now before we wrap things up here, where can people find you guys? Where can they get the book? Let's go. Go ahead. The floor is yours.



So we have a website. The website is movers and mentors calm on there is all of our social media information and links directly to Amazon where you can find both our Kindle version and paperback version. If you have questions, comments, please tag us send us stuff on social media. Tim and I love that we you know, we've been very fortunate we've had really engaged you know, an engaged audience up until this point and so you know, we're looking or looking for more of that and shoot us an email if you want and with with comments or feedback. We love to hear that as well.



Great. And how about where can people find you on social media? Oh, yeah. Yeah,



it's in those that thing tendons got our handles there.



Yeah. So my, you can message me on Instagram. But Tim Reynolds DPP would be my thing. That's my Twitter routes, and would be my Instagram. And we'll send you that Karen. So you can sort of tag along for the podcast. But I like Brian was saying, I think the opportunity to interact with our, with our audience is one of the most exciting things, getting somebody that reading the book from South America and is so excited to receive the book is one of the highlights of our day. And I think having the opportunity to have our our audience also send us Who do they think should be the movers and shakers in our potential upcoming volumes of this would be something that we'd really appreciate. There's so many people within the profession that we do not know of yet. And so obviously, appreciate having their insight and input in that as well.



So I'm at at Bryan, Bryan, Gaskey, and Instagram and then we're at movers and mentors, both on Instagram and Twitter.



Perfect. And all of that will be in the show notes at podcasts at healthy, wealthy, smart, calm. So before we wrap up, what is question I asked everyone, what advice would you give to your younger self? So let's say fresh out of PT school at Ithaca? What advice would you give yourself?



I would tell myself, stay curious. Because I find that when I'm curious and asking questions, that means I'm engaged. And I think engagement. If it aligns with your your purpose and your passion, then you have kind of all three things in alignment. And that, you know, lends itself to a happy, fruitful and hopefully, you know, effective career.



Excellent. Tim, go ahead.



And I would say sort of piggybacking off what we were talking about earlier, Aaron would be continue to search for the why. And it's okay not to know. And I think that's one of those things where finding your why and staying true to the values is one of those things I'll add to life journey, continue to search for that throughout the lifespan. But I think actively checking back to is this lining up with my Why would be one of the things that I would want to do, either from a journal reflecting standpoint, or just from like a quarterly check in. But then also, the acceptance of it's okay, not to know not necessarily not to know what your y is, but not to know certain things in part of your life. Um, and I think being 20 to 2324 and try to navigate your 20s. And I'm thinking that everybody in that sort of FOMO aspect is having the solutions and answers. And it is okay that you do not know yet you are enough, you will be enough, challenge yourself and have the opportunity to allow for that growth and expansion.



You guys, that is great advice. Thank you so much for coming on the podcast and sharing your book. Again. It's movers and mentors, and it's available on Go to their website, go to the social media. Everything again is that podcast out healthy, wealthy, smart, calm. One click, we'll take you to any thing you need for both Brian and Tim. So thank you so much, guys, for coming on.



Thanks for having us, Karen. Yeah, thank you, Karen.



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

Dec 7, 2021

In this episode, Dr. Sylvia Czuppon, Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine, talks about balancing her role as an academic with her role as a clinician.


More about Sylvia Czuppon: 

Dr. Sylvia Czuppon received her Bachelor of Arts in Psychology in 2000, Master of Science in Physical Therapy in 2002, and her clinical Doctorate in Physical Therapy in 2011, all from Washington University. She received her Certification as an Orthopaedic Clinical Specialist from the American Board of Physical Therapy Specialties in 2010. Her work has been published in British Journal of Sports Medicine, PM&R, Physical Therapy, and Journal of Orthopaedic & Sports Physical Therapy. Dr. Czuppon is currently an Associate Professor of Physical Therapy and Orthopaedic Surgery at Washington University School of Medicine in St. Louis, Missouri. She divides time between outpatient clinical practice treating musculoskeletal pain patients and teaching orthopaedic content in the professional DPT curriculum at Washington University. She has given local, state, and national presentations on lower extremity injury rehabilitation and return to sport. She volunteers her time educating coaches, parents, athletes, and the community about youth injury prevention strategies.


To learn more, follow Sylvia at:

Twitter: @czuppons


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Read the Full Transcript Here: 


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



Thanks for having me, Karen.



Of course, of course. And, you know, we were talking before we went on the air about, you know, not seeing people in person and going to conferences. And the last time we saw each other was in Vancouver, at the third annual World Congress of sports, physical therapy.



Yes, right. That's right. Yeah,



I think that's correct. Yeah.



I can't believe it's been that long.



I know. I know. 2019. Right. Beginning of 2019.



I think it was. Yeah, it was COVID. Year, but it was before all that stuff. Yeah, yeah,



exactly. And, you know, shameless plug, the fourth annual World Congress on sports. PT is going to be outside of Copenhagen in August of 2022. Absolutely. So I encourage people to try and and your fingers crossed, it'll work. I keep saying 2022. It's gonna be the year. So shameless plug for that. Now, let's move into you. So today, we're going to be talking about life as a clinician and academia. And I love this topic, because I think there's a lot of clinicians out there who are wondering, well, how do I get into academia? How do I how do I do that? So why don't you give the listeners a little bit more about your background and how you did it? Sure. Yeah. So



I've been fortunate to be on faculty at Washington University in St. Louis for 15 years now. I think, approximately, it's been a while. And yeah, I sometimes I'm like pinching myself. I'm like, How is time flown that way? How 15 years? Yeah. 15 years? I graduated in 2002. So yeah, yeah, it is, oh, my gosh, I



can't believe it, I can't believe it.



So. So when I, when I joined the faculty, honestly, it was it was a nice, it was a nice mix of events. When I came out of PT school, I knew I wanted to do a little bit of teaching, but the Washington University at least, recommends that you have about a year of clinical practice under your belt before you join an academic institution. Like lab assisting. So that's how I got my start, I started lab assisting in classes that had orthopedic content. And when a position on the faculty opened up, I, I basically jumped at the opportunity got lucky enough to be hired. And away I went. So when I first started, my split, I think was 90% of my time was in clinical practice. And about 10% of my time was in, it was in teaching and it was all a lab assisting. And over the years, that is at has morphed considerably. I'm about 5050 right now. So I spent 20 hours a week in the clinic and 20 hours a week, teaching or doing teaching related things. And it's been a I don't think I'll ever go below that. But who knows what will happen. But I like that balance that I've struck right now, I can't ever see myself coming completely out of the clinic into teaching, like some of my colleagues have done, you know, you go to PT school to become a clinician, you don't go to become an educator, otherwise I go to, you know, to get my teaching degree. And I think that's probably been one of the biggest challenges is I am a PT, learning how to provide high quality education without an education degree. So there's been a bit of a learning curve associated with that as well.



And what do you feel are the advantages of being a clinician and, and working in academia? So what does your clinician hat bring to your students?



Yeah, you know, I think it's interesting. So, um, as a clinician, what is nice is I can give them I don't want to call it real world application, but it really is. So they students, we teach them in the ideal scenario, like, Okay, your your patient comes in, they have this positive test this positive test this positive test, what must be their diagnosis? Is any patient ever that cookie cutter clean No, 99% of the time, they're not right. So we teach our students in the best case scenario, the easiest ways to understand and so being a clinician, I can still give them a little bit of perspective, but like, here's where the gray areas come in. And this is why we teach you that ideal scenario so that you recognize the ideal, but here's how you can kind of think more with the clinical hat on it's a little bit similar to being like a clinical instructor. I think that's the greatest part about being a clinical instructor and shameless plug for those of you that are out there that are not clinical instructors. We need a lot more of them there. You know, our students are. It's such a rewarding experience. It really is. It's time consuming, don't get me wrong, but it is very, very rewarding, but I'm so be so being a clinician and being able to, to give the clinical the true clinical perspective on some of the things that students is learning, I think can be, can be invaluable. Like I have students all the time. They're like, Sylvia, this this sounds like a load of hooey like this doesn't even make sense, like help me understand when I would ever do this, and to be able to tell them look, you know, this is exactly why you need to know this level of detail, or this is why as a, even though, you are determined to go into sports, physical therapy, or you're determined to go into orthopedics. This is why you need to understand neuro for example, like, this is why they teach you neuro related things. I think I posted on Twitter, you know, like a couple of weeks ago, I've been to patients this year, that I think I'm, you know, not to toot my own horn or anything, but it's unfortunate, these people fell through the cracks, I think, in referring them out, both of them have gotten a diagnosis of ALS that nobody caught before this point. And it was based on what history they had given me, as well as some of the signs and symptoms that I saw with it within them. They referred to me like one had scoliosis, and horrible back pain, and another one that was a total knee replacement. And those are not diagnoses, you would expect to have ALS diagnoses associated with them. But some of the other things they were describing, it was terrifying. And just, again, like these are things to help students understand that they all do go together, you're treating a person that doesn't come in with a strict diagnosis, you're treating a whole person. And they don't always get that in the education setting when we're giving them fabricated cases.



Yeah, I couldn't agree more. And that's, that's amazing, by the way, from a clinical standpoint, that you were able to refer them to the right people to get the right diagnosis. Yeah. And that's, you know, and again, that's where physical therapists come in. And I'm sure that this is part of your teaching to your students that, you know, we can be that kind of primary care provider, you know, and even the second opinion,



sure, sure, yeah. And it is, it is one of those, you know, Missouri is not a direct access state. And so it's interesting, like teaching in a non direct access state, because we do typically get the patients they have the referral, it's generally pretty accurate, but you get some of these that fall through the cracks. And it's why we get the training that we get as physical therapists, you know, for those scenarios. But even again, in a non direct access state, these patients had been screened by other physicians, and it possibly just the complexities of their care, it just things got missed. So



amazing. Well, now, let's talk about what your responsibilities are, as a clinician, educator, so if you want to break it apart clinician educator, separately, or just let because I think it's important if people are interested in in, going in this direction, they need to know what it entails and what their responsibilities. Sure.



So I think it's a little bit different if you're so so my position is a faculty member means that I split my my time, assume a 40 hour work week, you know, nobody who actually works that when they're a faculty member on any any academic program, but, um, so I split my time for many people that come from a physician, whether lab assistant, in addition to holding a full time job, that's usually hours, in addition to whatever your hours are in a week. So when I was working as a lab assistant, before I joined faculty, I was working 40 hours a week plus lab assisting X number of hours a week, so there was a little bit of that, because very few employers will give you that time off and say, Oh, you want to live six, eight hours, we sure only work 32 hours here, like, it's very difficult to get that. And then depending on when the classes are during the day. So we have labs from like one to three, some people couldn't do that it's smack in the middle of prime, you know, treating hours. So that is definitely a consideration that people want to make. If you're working part time, it becomes a whole lot easier. Your schedules are a lot more flexible, as a faculty member, so I have 20 hours a week, again, dedicated to patient care, 20 hours for teaching. So in my patient care responsibilities, I basically have a set schedule that is has to be designed around the times that I'm supposed to be in class. So that has to probably be the worst for the person for my for my clinic boss who has to come up with the clinic schedule. He's working around everybody's class schedules and the times that we can actually physically be in the clinic. And so I treat in our clinic, we have a one on one model, so we don't overlap patients, you know, and so that's, that's really nice. We do have physical therapy assistants that we work with as well. And so I balance my caseload, I feel like any like I would anywhere else, I have autonomy to decide when I want to delegate when the patient needs, needs to come back to CV, frequency, duration, all of those kind of standard, standard types of things. Um, I am fortunate because I've been there long enough that I do get a little bit of flexibility and asking for the patient. Two types that I want to see. So I love the postoperative knees and any knee, really. So I do get a little bit more of those than maybe some others do seniority, it's great. And then my academic hat is complicated. So I'm depending on what semester in the year that we're in. And we're also going through a curriculum renewal right now, which is a whole nother whole nother topic of discussion. But in some semesters, I am a course master for for a class. And so that entails doing everything you would expect from a course to making sure the syllabus is up to date, to organizing exams, practicals, lab assistants, supplies, outside lectures, patient labs, etc. to an other the other semester I am, quote, unquote, just a course assistant, so facilitating the course master with all of those duties. So those hours are kind of wrapped up in our actual academic time. So if I have 20 hours a week, and I'm only in lab for 12 hours, my other eight hours are supposed to be spent doing all these other behind the scenes things which are, which easily kind of add up. So it is a little bit of a mix, and the curriculum renewal that I was talking about. So Wash U is going towards more of competency based education, which I think is the movement in education as a whole. And so we're we're in the beginning stages of that our first year classes going through the start of our new revised curriculum, and I am helping to craft the second year curriculum. So that's a huge task, taking what we currently have reorganizing it, restructuring it into an even better product than what we currently have. So there's a lot going on, that is certainly more than 20 hours a week. So yeah.



And can you explain competency based education versus what's currently happening? I don't know if that's like opening a huge can of worms. But let's go for



Yeah, yeah. It's also challenging my my full understanding of this, because it's all it's all this is like a complete foreign language. It's like going through, as I as I kind of alluded to earlier, I'm going through, I'm becoming like, I feel like I'm going through to get my education degree in the process of learning how to teach the this material better. So with the competencies, it's essentially like saying, Okay, you're competent in gosh, there's domains, there's, there's all sorts of terminology, but basically saying that, like, okay, that you have this one domain of patient and client care, within that you have different competencies, like, I'm able to take a, I'm making stuff up, because I don't know them off the top my head, but like, able to take a complete history for like, able to do communicate with respect and dignity for the patient and care provider, like things like that. So there's different things that this student is now having to pass and show competence in these competencies, a pass individual competencies, versus getting a grade in a class to say, you're good enough for that grade, it could be really strong in one area, but really not great and another, but their overall grade is enough to move them forward. We want to kind of raise the bar a little bit and say, You know what, that was good. But we can do better. And taking it to like each one of these competencies you need to pass in order to continue on curriculum. Got it?



Got it? Well, that makes actually makes a lot of sense.



Does now trying to make every lesson plan, every lecture that you give mapped to every competency that you have is a whole nother topic of discussion. Yeah,



good luck. Yes. Yeah. Good luck with that. And now something that you kind of alluded to before, which I want to dive into is, so your 20 hours practice care, 20 hours teaching, and I put 20 hours in quotation marks, right? So we know as clinicians, it's always more than 20 hours, right? And in teaching Gosh, it's definitely more than maybe what you signed up for. So how do you and here comes the question, how do you balance all of that with the rest of your life? Because you've got kids?



I've got two teenagers. Yes, got a dog.



I've got two dogs, actually two dogs, you've got a home, you have got a life outside of all of this. So what do you do to balance it all?



Yeah, so that was probably the most challenging thing that if I could have gone back in time and talk to my younger self, I would have been like, don't say yes to everything. That was probably the first thing that nobody really ever told me. Because I thought that if I said, No, nobody would ever asked me to do anything again, you know, you feel like this. Oh, this is a fantastic opportunity. I don't know where the time is gonna come out of but I really want to do it. And so I just started I would say at the time yes to pretty much anything that sounded interesting. And even yes to some things that I was like, I'm not sure if this is what I want to do, but I feel like if I don't say yes, I'm going to lose this. They're going to think I'm not interested in it. Think so, naively when I was when I was a younger faculty, um, that's what I did, I said yes to literally everything and almost put myself in a horrible spiral of I had so many issues in terms of that work life balance, I didn't have any it was work, work work. And then life was like a tiny fraction of that. And that was when my kids were little, I've got teenagers that are 17 and 14 now. Um, but what I discovered over the years was that those opportunities are at least and I still believe this, if those opportunities were meant to be, they're going to come around again, if people really want you, they value your expertise and your knowledge and your skill set, they will come asking around again. And you know, just saying no, one time, and just even saying like, No, you know, what, now is not the right time, I'd love to help you out. Can you come back again, like, you know, if you have another project, just ask me. I mean, hopefully I'll have time at that point, you know, there's no, there's good ways to not just firmly shut the door right to leave that still open. Um, so I've found a better balance for myself now, because I've figured out what is super important for me, and what is not, like really important. So I started saying no to different class commitments that I had previously done, because it was it was stuff that was okay. But it was not my passion in teaching. And so I started whittling down to the things that that made me honestly, the maybe the most happy to think about teaching or be involved in. And when I started doing that, I did become happier with with how that balance was shaping up, because some of that work really wasn't work anymore. You were enjoying doing it, versus looking at it and saying, Man, I got three more hours of this that I've got to prepare for, and I'm just not feeling it. You know, there's a reason nobody's ever asked me to be an anatomy lab assistant. And it's, I mean, enjoy anatomy. Don't get me wrong, but the level of detail I just, that would that was not my forte. No, that was not my forte. And it's like, I want to know the applications and things that I'm interested in. But some of the things that they have to learn for PT school, it just wasn't wasn't in my wheelhouse. You know? Yeah. So it's like, things like that, where, where I just prioritize a little bit better.



Yeah. And I was gonna follow up question I was going to ask is, How did you? Like, what methods did you use to decide what was best for you? And what methods did you use to break down? Like, no, like, this is a No, maybe not forever? But uh, no, for now, this might be a no forever. This isn't a solid? Yes. Do you know what I?



Yeah, yeah, it wasn't in certainly not easy. Um, it came again, across several, several years to try to figure that out. So part of it came down to okay, I was lab assisting in multiple classes. And did I really want to stay lab assisting in that context? If the context, if there was a, there was an immediate hesitation in my answer, then I thought, okay, that can't be the number one priority that I really want to stay in that class. So then I started adding up hours, and how many hours a week? Or really, am I spending in that class? What could I replace it with? Um, is there another opportunity right now that I want to replace it with? So it was sort of like, figuring out the timing of things would be one thing? And then some of it was just just deciding, okay, well, I know it's gonna throw me over the, the 20 hours or whatever that I have right now. Am I okay with that for a little while. And for a period I was and then now that I'm older, I'm not, you know, I've got I've got a, I've got a teenager that's going to be leaving the house in two years. And I've decided, you know, what this would, this is the time I actually I want to spend with her, you know, not that I didn't want to spend it with her as a little kid. But now I'm like, feeling that like, empty nest feeling starting to grow. And I'm like, I don't want to miss, you know, all the things that she's doing. And, and so I've just prioritize, you know, what, no, I'm gonna say no to that. Or I'm gonna say, you know, I can't do this this year, or I can only do this for part of the time, like, admissions committee, you know, figuring out who we accepted to our program. Like, well, I can't do it the whole year, but I can do it for part of the year Will that be okay, you know, and try to work out compromises with the people that are there looking for my time.



I love it. And, you know, so often women have such a hard time with this. Yes, you know, yes. Because we think if we say no, like you said, That's it, we're done, or we're gonna be labeled difficult, or, you know, someone that you know, she doesn't, she's not interested. We'll never get back to that. Right. So I think it's, as a woman, we really have to kind of get over that kind of thinking and and realize like, Hey, if you say it's a no for now, but not a no forever and the people are like, Oh, God, she was setting it up, well, then they're probably not your people. Right? And that's okay to let that go as well. Right.



I think what also complicates it a little bit is this whole Superman thing, right, like women that believe they can literally do everything. So you've got to be the best parent, you've got to be the volunteer at all the PTO, whatever school stuff, the sporting team, the in then at school, and then it works the same thing, I got to be able to handle this whole load and show nobody a crack in my facade, you know, so that they can see that I can do it, you know, and if I do you crack, then they're gonna think that I'm weaker, you know, just stereotypes that way. I think that's obviously it's really unfortunate that that still exists. Um, but, uh, I, we're not super human, like we have, you know, we have breaking points too. And we need to know what those are for ourselves for our own sanity, you know, for the sanity of our family members, our friends, all the people around us, you know, the pets, yo, all of that. So,



yeah, and your students as well, like Have, have you ever kind of displayed that vulnerability, whether it be to your employer, obviously, your family, and that's a different story, but maybe to your employer or to the university, to say like, I'm reaching a breaking point. And so how did you do that?



Yeah, definitely. to the employer. Um, yeah. So So there have been times where and unfortunate our program director, gammon Earhart is amazing. And her predecessor, the CCD singer, was was great, too. And they've always been wonderful with this sort of open door policy. So when you hit that point, or you feel like you're coming up to that point, I felt 100% comfortable going to them and saying, Hey, guys, look, I am, I'm over my head right now. And I don't know what to do. Like, I really need some help. And they kind of talk you down a little bit and say, Okay, well, how can we make this better, I have been very fortunate to be supported in that role. Same thing with even my immediate supervisors within the clinic. Same kind of idea. I had some personal struggles earlier this year, unrelated to COVID. And having and knowing that I had that support system, by being in a good place, I think this is true of any job. But being in a in a in a supportive environment, where they were like, take the time that you need to get your your self. Right. You know, it was it was very nice to know that I had that kind of support.



Yeah. And so I think the moral here is, it's okay. Absolutely, to let people know that you're not okay. And it's okay to be vulnerable. And if you're the people you're working with or for don't accept that, then I think it's a clear sign to say, Well, wait, wait a second, what am I doing here?



Right, right. Yeah. And I would love to say like that, I have been fantastic. And always being vulnerable. That is definitely a lie. Nobody, nobody, nobody, nobody is and I, I, you know, grew up in a, in a, in a household where perfection was like, required, it wasn't even, you know, it was it was an expectation, just as you know, my hair is black. And it will say, well, it's gray now, but that it'll say one color like it was the expectation you will be perfect you will be you will not show or have any flaws. So bringing that into a scenario like I am in right now and telling somebody I'm not like I'm vulnerable, I'm hurting, I need help, like even asking for help was was a huge, huge deal for me. But again, I had I had a good support structure, even within my workplace environment to allow me to do that.



Yeah. And it is, it's hard to ask for help, you know, because because you don't want people to think you can't handle it. All. Right. Right. Right. So asking for help is I know, I have a really hard time asking for help. But I'm getting better at it. Yeah. But it is, it's hard to reach out, it's hard to ask for help. Because you're afraid that someone will maybe think of you as less than or incapable or whatever, you know, all those bad things that spin around in your head, right?



Or just that if they're thinking about asking you to help out with something that you really want to do, they're not going to ask you anymore, right? Like, you know, and kind of where I'm at as a as an associate professor trying to rise to the professor level in a couple of years, trying to take a larger leadership role in our curriculum, there was definitely a fear of well, wow, if I tell them that I can't handle what I've got right now. There's no way they're going to ask me to do X, Y, or Z. So do I risk doing that? Or do I just drown? And I wasn't willing to drown? No, no, no job is worth that. My personal happiness was not worth that. And again, fortunately, everybody was very understanding the the fear that I had built up in my head was no near nowhere near what I experienced at all. Like it wasn't there. They were like, You know what, we get it. Take the time that you need, it's fine. We'll figure it out. And we'll help you figure it out. We'll give you whatever resources you need, whatever support you need. So it was wonderful. It's really wonderful.



Yeah. And it's so important to kind of voice that because like you said, you're trying to kind of climb up this academic ladder. So if you never voiced that maybe you would never, you would never reach that Professor level. because you would have burned out left. Absolutely. Yeah. Right. So why not put those fears out there and and find the things that like not to use Marie Kondo here. I don't know if you know Marie Kondo she's so Marie Kondo is like this organizational guru. And her thing is if it doesn't bring you joy, get rid of it. Yeah. And so I wrote that down when you were talking about how, you know, anatomy lab, not for me doesn't bring me joy. This does. So I'm sticking with this. And and what you find is when you do the things that bring you joy, this sort of Marie Kondo method, I mean, she doesn't like, you know, does this shirt bring you joy? And if it doesn't know, this book, this, you know, tchotchke, whatever it is, but you can you can apply those principles, I think, in this scenario, when deciding what to say yes, and what to say no to? And even if you have nothing else on your plate at the moment, you can still say



no, sure. Absolutely. Absolutely. Right.



You can still say no, and that's okay. Absolutely, well, this oh my god, I'm so glad that we talked about this is so good. So let's, let's talk about now, I would love to get from you, maybe two or three pieces of advice that you would give to a clinician who's trying to break into the world of academia. Yeah,



so, um, I think with with clinicians, the first thing is that you've, you've got to know what your, what kind of teaching you want to do, right. So like, if you're, if you're an orthopedic just being happy with, I'll take any orthopedic class, that could take you from going geometry and manual muscle testing, to examination and treatment kind of thing. So knowing sort of what level you want to be involved in helps. Because when you're then approaching the education division director of a program, that's usually who you send your resume or your CV to, when you're interested, they can have a better idea of whether there's a need honestly, in the in the curriculum, for another lab assistant for another lecture, if there are certain topics that you know very well, that you are passionate about, that he would love to lecture on. I'm even offering that up, like, hey, you know, I have a special interest in blood flow restriction training, but I'd love to be able to share that with your students. You know, this is my experience and background with that, let me know if there's there's any any availability for that, I think that's that's another part of it. I do think that it is, um, it is nice if you have a connection to the school, I mean, obviously, like, I got fortunate, I graduated from Washington at school, I'm now in faculty here. So I already had a connection to the program, it made it easier for me to get my foot in the door, because they already knew me as a student. And then as a clinician, because I was in the area. I do believe it is harder when you don't have those connections. But that's where I think networking in general is huge, right? So like you and I, we met through the Twitter verse, and then of course in Vancouver, but like making connections because people that you connect with have connections elsewhere, right. And they might know, just in talking to you. They might say, Oh, wait, I remember Sylvia said that they were looking for X, Y or Z at their at Wash U, maybe you should reach out and talk to her and see if there's anything going on. You know, I think connections are the other part that that people value, but you don't necessarily value maybe as much as you should. As a clinician, I think I take for granted that. And I don't know, if you feel the same way, we travel a lot, we get to go to a lot of conferences, we get to get a lot of all these pre COVID, we went to a lot of conferences. And that's where a lot of the networking happened, right. Clinicians do have to take continuing education in order to keep their their licenses active. But I feel like clinicians are probably taking the cheap local easy place near them to take on it because they don't probably have the benefit, always a funding behind it like I do at an academic institution. And I think that's, you know, you do what you have to do, but finding other ways to network, whether it's through your state organization, like the Missouri Physical Therapy Association here, through the national organization through some of the sections like sports section, ortho section, you know, getting involved that way to make connections, you don't have to attend conferences to do this, but you can get involved. I mean, everything's through zoom right now, you know, and so being involved that way to make connections can get you in the door in other ways. And I think that's probably an underappreciated part of the whole, how do I get my foot in the door?



Yeah, I would agree with that. And I love all the options that you just gave for clinicians and even students who are thinking, hey, one day I want to do both. Sure, right. So let's know what kind of teaching you want to do. Reach out to people in the school if you have a connection if you don't have a connection start making those connections. Absolutely right. And as a student, I think connecting through whether it's a PTA in general, or the components or your state is a great way to do that. And I would also say, stay in touch with the with your professors.



100% 100%. Yeah, I mean, and your clinical instructors as well, I mean, for me, my first job coming out of PT school, was because I went back to talk to one of my clinical instructors, and she's like, Hey, by the way, we have a job opening, would you be interested in applying? And I said, Oh, I'm not sure. And she goes, Well, I already submitted your name. And literally, that's how I landed, my first job was like, Okay, well, I guess I have to like, contact them now. So it was great. Yeah.



Yeah. I love it. I love it. Okay, so now, as we start to kind of wrap things up, is there anything that maybe we didn't hit in the conversation that you came in? Like, ooh, I definitely want to talk about this. Did we miss anything?



The one thing I will say is, is being on faculty, what did help me was naturally meshing and getting myself a mentor on the faculty. So not all academic institutions, like I know why she didn't have it at the time. They didn't really have like sort of a mentoring program for new faculty joining. And I don't know if this is true for all academic institutions. But for anybody that's interested in doing that, or joining an academic institution, as a clinician, academic, or as a researcher academic, is understanding if there is some kind of mentoring program because without the guidance of my mentor, Marcy Harris, Hayes, there is no way I'd be where I was at today, Marcy was like, kind of like my voice of reason, she was the one that was just like, Okay, you your interests are like humongous Sylvia, you need to narrow it down a little bit, you cannot keep saying yes to everything. She was the one that pushed me in certain directions, because she knew that a gentle nudge would help me get to where I wanted to be, even if I didn't want to take that leap for myself. If I was doubting myself, she would be the one that would say, you can you can do this. She was the first person that put me in front of a crowd of 300 people at CSM. So I have a lot to say, and I never would have, I genuinely never would have done that without for encouragement. And her understanding that I was ready for it. As well as it was something that was going to help me in the future. And that I'd appreciate it later on down the line versus my fear, again, of doing it on my own, would have prevented me from getting that far. So so definitely identifying a mentor. And again, this is for clinicians, even to in the clinic, like don't go into a clinic, and just expect to just learn it all just on your own or through Con Ed guy, I would hope that whatever clinic somebody joins into, has some kind of mentoring program as well. So that you can learn you can shadow you can get experience from other people. And it's different than just being able to say to your your pod mate, hey, I had this patient that was a little complicated. What do you think like truly having a mentor, I think is a big, big thing. To help enhance the level of clinician you are as well as again, if you're an academia, how to get up that level ladder and how to navigate it to I think that was the other thing Marcy gave me was some advice on how to how to get a little bit further because she was ranked ahead of me, and she had some great personal experience. Pros and cons, I guess you could say, to navigate that.



I love it. I think that's great advice. And I love how you said not only get up the ladder, but navigate it as well. Right? Because there's a lot of things that are gonna push and pull you along each rung of that ladder. Absolutely. So I think that's amazing advice. Okay, where can people find you if they need a mentor? Or they have questions?



Yeah, so Twitter's the easiest place. So I think you've got my contact information, but I am on Twitter, and an email is perfectly fine as well. So they can find my email address just to the washi website. Or really, if you just Google my name, it's pretty impossible to miss. There's not that many Soviet coupons out in the world. There's none, in fact, so it's pretty easy to find me I come up readily on a Google search.



Excellent. And we will have all the all of those links in the show notes. And now I have a question that I asked everyone at the end, but you already answered it, but I'm gonna ask it again. And that's what advice would you give to your younger self?



Yeah, totally. My younger self would be learn how to say no, and how to prioritize what you really want to do. prioritize what's going to make you happy. What's going to make you the clinician, the person that you wanted to be when you grew up, you know, because if you sacrifice what you want for what everybody else wants, you're not going to be happy. Perfect, I



love it. Thank you so much. I appreciate this conversation so much. I appreciate you for coming on. This was wonderful. So thank you so much.



Yeah, thank you so much for giving me the opportunity to be on I appreciate it



too, of course, and hopefully we will see each other in person soon. That



would be fantastic. Indeed, indeed. All right, and everyone,



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